bluuebunny/crossref_metadata_2025 huggingface dataset:
Activity Budget and Positional Behavior of the Mysore Slender Loris (Loris tardigradus lydekkerianus) : Implications for Slow Climbing Locomotion
Authors: Nekaris K.A.I.
Published: April 2003

Both predator defense and feeding ecology models have been proposed to explain the relatively slow climbing locomotion of the Lorisinae. During a study of the socioecology of the Mysore slender loris (Loris tardigradus lydekkerianus) in Tamil Nadu, India, six categories of behavior and eleven different postures were recorded to estimate a general activity budget for the slender loris, and are examined here particularly in relation to slow climbing locomotor strategies. Reactions to potential predators are also described. The main study population was composed of 15 animals. Activity budgets were compiled in three ways: all instantaneous point samples collected over 1,173 h pooled (n = 13,717), the means of individual lorises (n = 15) and behavior at the moment of first contact (n = 357). No significant difference was found between these three data sets. Approximately 45% of the activity budget was spent in inactive behaviors including sitting vigilant, resting and sleeping. Foraging and traveling comprised nearly half the activity budget, with the rest of the time spent grooming. The most common postures assumed by lorises were sitting and quadrupedal walking. Individual lorises were relatively gregarious and spent up to half their activity budget with other animals. Unlike pottos and angwantibos, lorises did not freeze, head butt or drop from branches in reaction to potential predators, but either ignored them, fled or made loud calls. Cryptic and slow climbing locomotion were used before traveling on open ground between discontinuous substrates, thereby supporting hypotheses relating to predator pressure, and also before capturing fast moving insect prey, supporting hypotheses relating to diet. It is proposed that a divergence in foraging strategies between bushbabies and lorisines may be the best adaptive explanation for their behavioral and morphological differences, including predator defense mechanisms.
Behavioural Responses of Lion-Tailed Macaques (Macaca silenus) to a Changing Habitat in a Tropical Rain Forest Fragment in the Western Ghats, India
Authors: Singh Mewa , Kumara H.N. , Ananda Kumar M. , Sharma A.K.
Published: April 2003

This study reports critical changes in the behaviour patterns of lion-tailed macaques (Macaca silenus) inhabiting a continuously changing and deteriorating rain forest fragment in the Western Ghats, India. The study area, a privately owned rain forest patch in a tea/coffee garden called Puthuthotam, has suffered two massive selective logging episodes. Over the years, the native rain forest trees have been largely replaced by non-native/pioneer species resulting in loss of canopy contiguity and significant changes in other vegetation parameters. The almost wholly arboreal lion-tailed macaque now spends a considerable amount of time on the ground in this area. The species has also experienced a major shift in its diet, ranging patterns and other activities.
Hepatitis B Virus Genotype Distribution among Chronic Hepatitis B Virus Carriers in Shanghai, China
Authors: Ding Xin , Mizokami Masashi , Yao Guangbi , Xu Bei , Orito Etsuro , Ueda Ryuzo , Nakanishi Makoto
Published: April 2003

Objective: Hepatitis B virus (HBV) genotype distribution is still unclear in China, where a high prevalence of HBV infection exists, although it is well known that HBV can be classified into six genotypes based on intergroup divergence. The aim of this study was to investigate the epidemiological distribution of HBV genotypes and to clarify further the genotype-related differences in the pathogenicity of HBV. Methods: Seminested PCR and restriction fragment length polymorphism analysis were conducted in 97 asymptomatic HBV carriers (ASC) and 46 chronic hepatitis (CH), 37 liver cirrhosis (LC) and 44 hepatocellular carcinoma (HCC) patients in Shanghai, China. Results: Two hundred and twenty samples (98.2%) were positive for HBV DNA, and of these, 3 (1.4%), 38 (17.2%) and 179 (81.4%) were classified as genotype A, B and C, respectively. There was a statistically significant difference in the distribution of genotypes B and C among various categories of liver diseases (p < 0.01). The distribution of genotype C showed an increasing trend from ASC, CH and LC to the HCC group; in contrast, the distribution of genotype B showed a decreasing trend in the same order. HBeAg positivity was higher in genotype C than in genotype B in all the subjects or in the ASC group alone (p < 0.05, p < 0.01, respectively). More severe liver damage and a higher mean age were observed in genotype C than in genotype B (p < 0.01, p < 0.05, respectively). Conclusions: These results indicate the following: (1) genotypes A, B and C of HBV exist in Shanghai, China; (2) genotype C is the major genotype in this area; (3) genotype C is associated with the development of severe liver diseases, and (4) genotype B has a relatively good prognosis.
The Lateral Island Trapezius Myocutaneous Flap for Circumferential Reconstruction of Hypopharynx and Cervical Esophagus
Authors: Castillo Manuel H. , Peoples James B. , Machicao Carlos N. , Singhal Pankaj K.
Published: April 2003

The lateral island trapezius was utilized for reconstruction of hypopharyngeal and cervical esophagus defects in high-risk patients, avoiding entry into the celomic cavities as an approach to decrease morbidity and mortality. Seven male patients were treated at the State University of New York between 1988 and 1991 and underwent reconstruction with the lateral island trapezius flap. There was no mortality, 2 patients developed pharyngocutaneous fistulas; 1 patient operated after radiation treatment failure remained with positive margins at resection but his fistula never healed, and another patient underwent a minor revision with successful closure of the fistula. All patients regained swallowing and none required dilatations. The preferred methods of reconstruction for the reasonable risk patient are gastric pull-up and free jejunal transfer; both of which require entry into cavities. The lateral island is a reliable alternate method of reconstruction for high-risk patients in whom intracavitary surgery may lead to unacceptably high morbidity and mortality. When the vascular anatomy is not favorable, rerouting of the vessels may be required utilizing microvascular reconstruction. The donor site defect is closed primarily or skin grafted, and subsequent functional limitations are minimal and well tolerated.
Achieving Eugastrinaemia in Zollinger-Ellison Syndrome: Resection or Enucleation?
Authors: Thodiyil P.A. , El-Masry N.S. , Williamson R.C.N.
Published: April 2003

Background: Eugastrinaemia in Zollinger-Ellison syndrome can be an elusive goal, nearly one third of laparotomies failing to detect the tumour. Methods: A personal series of 13 patients with a mean age of 52 years operated between 1980 and 1996 was reviewed retrospectively. All patients had fasting hypergastrinaemia and recalcitrant ulcer disease with or without diarrhoea. Results: Computed tomography or selective visceral angiography localised the tumour to the pancreas in 6 of 12 elective patients; the thirteenth presented with a perforated duodenal ulcer. All underwent laparotomy with gastrinoma tissue being completely excised in every case, including the 6 patients with failed pre-operative localisation whose tumours arose from the duodenum (4), pancreas (1) and lymph node (1). Eugastrinaemia was achieved in all but 1 patient and was sustained during a mean follow-up of 5.2 years (SD = 4.2 years). These 12 patients remained clinically free of disease during a mean clinical follow-up of 7.5 years (SD = 5.0 years; range 2–19 years). There were no postoperative deaths, but 3 died from recurrent tumour at 3–7 years. Conclusion: Since normalisation of serum gastrin was achieved in 12 of 13 patients, laparotomy may well be worthwhile even if the gastrinoma cannot be localised pre-opera- tively.
Safety and Timing of Nonobstetric Abdominal Surgery in Pregnancy
Authors: Visser Brendan C. , Glasgow Robert E. , Mulvihill Kimberley K. , Mulvihill Sean J.
Published: April 2003

Background/Aims: Abdominal disorders occurring during pregnancy pose special difficulties in diagnosis and management to the obstetrician and surgeon. The advisability of nonobstetric abdominal surgery during pregnancy is uncertain. Our objective was to evaluate the safety and timing of abdominal surgery during pregnancy. Methods: We retrospectively reviewed 77 consecutive gravid patients undergoing nonobstetric abdominal surgery from 1989 to 1996 at an urban academic medical center and a large affiliated community teaching hospital. Medical records were evaluated for clinical presentation, perioperative management, preterm labor, and maternal and fetal morbidity and mortality. Results: The rate of nonobstetric abdominal surgery during pregnancy was 1 in every 527 births. Among the 77 patients, the indications for surgery were adnexal mass (42%), acute appendicitis (21%), gallstone disease (17%) and other (21%). There was no maternal or fetal loss or identifiable neonatal birth defect. Preterm labor occurred in 26% of the second-trimester patients and 82% of the third-trimester patients. Preterm labor was most common in patients with appendicitis and after adnexal surgery. Preterm delivery occurred in 16% of the patients, but appeared to be directly related to the abdominal surgery in only 5%. Conclusion: Surgery during the first or second trimester is not associated with significant preterm labor, fetal loss or risk of teratogenicity. Surgery during the third trimester is associated with preterm labor, but not fetal loss.
Pseudotumor of the Pancreatic Head Associated with Idiopathic Retroperitoneal Fibrosis
Authors: Wiesner Walter , Kocher Thomas , Beglinger Christoph , Harder Felix , Steinbrich Wolfgang
Published: April 2003

A 68-year-old male presented with abdominal pain and obstructive jaundice. CT revealed a large mass in the pancreatic head that was initially interpreted as pancreatic carcinoma. Needle biopsy revealed only fibrous tissue with signs of chronic inflammation. Together with typical findings of an idiopathic retroperitoneal fibrosis, the final diagnosis of multifocal idiopathic fibrosclerosis with focal pseudotumorous pancreatic head fibrosis could be made.
Treatment of Metastatic Bone Pain with Rhenium-188 Hydroxyethylidene Diphosphonate
Authors: Chen Shaoliang , Xu Kaipin , Liu Wenguan , Yao Zhifeng , Chen Kejing , Yin Duanzi , Wang Yongxian
Published: April 2003

Objective: This study was designed to evaluate the safety and effectiveness of rhenium-188 hydroxyethylidene diphosphonate (188Re-HEDP) in patients with skeletal metastases. Methods: Thirty-two patient volunteers with cancer metastasized to bone were included in this study. All patients underwent bone scanning with technetium-99m methylene diphosphonate 2 days before the administration of 188Re-HEDP. A dose of 1,110 MBq (30 mCi) of 188Re-HEDP was injected intravenously and whole body dynamic scans were obtained 1, 2, 3, and 5 days later. Blood and urine samples were collected daily for 5 days and then weekly for 4 weeks. The biokinetic data were obtained and the radiation doses were calculated. The reactions, toxicity and pain relief were corrected. Results: No acute reaction or toxicity was evident. Leukopenia was found only in 1 patient with skeletal metastases from prostate cancer. The baseline white blood cell count of 4.3 × 109/l (normal range 4.0–10.0) declined to a value of 3.0 × 109/l 1 week after receiving 1,110 MBq (30 mCi) of 188Re-HEDP. The white blood cell count had returned to the baseline category by 4 weeks after injection. No patient was found to be thrombocytopenic. The hemoglobin concentration remained at the baseline level for 6 weeks. The excretion rate of 188Re-HEDP in the urine was 62% of the administered activity during the first 2 days. Twenty-eight of the 32 patients (87.5%) were able to reduce their analgesic intake. Twenty of the 32 patients (62.5%) had a significant improvement in the quality of life while 8 patients (25%) had a minor improvement. Conclusion: Most of the patients experienced an improvement in the quality of life without induction of serious bone marrow reduction with this treatment regime. It is therefore concluded that the use of 188Re-HEDP for treatment of skeletal metastasis appears to be feasible.
Oxidant/Antioxidant Status of Erythrocytes from Patients with Chronic Renal Failure: Effects of Hemodialysis
Authors: Durak İlker , Kavutcu Mustafa , Çimen M.Y. Burak , Avcı Aslıhan , Elgün Serenay , Öztürk H. Serdar
Published: April 2003

Objective: It has been suggested that oxidative processes may be increased in patients with chronic renal failure (CRF), and that this is a possible factor contributing to the development of anemia and atherosclerosis, characteristic complications of CRF. The aim of this study was to investigate erythrocyte oxidant/antioxidant status in patients with CRF and to elucidate possible effects of hemodialysis on erythrocyte antioxidant system. Methods: Fasting blood samples were obtained from 33 patients with CRF and from 12 healthy controls. Of the patients, 17 subjects were under regular hemodialysis. Values of the activities of antioxidant enzymes, namely superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT) and antioxidant potential, nonenzymatic superoxide radical scavenger activity (NSSA) and levels of thiobarbituric acid reagent substances (TBARS) were measured in the erythrocytes from both patients and controls. Results: Antioxidant potential and NSSA values were found to be significantly decreased, while TBARS levels were increased in the erythrocytes of patients. SOD activity was found to be unchanged, but GSH-Px and CAT activities were significantly lower in the patient group. Moreover, the erythrocyte TBARS level in the hemodialysis group was higher than in the controls and nonhemodialysis patients. Conclusion: The results suggest that antioxidant potential is reduced due to impaired antioxidant system in erythrocytes from patients with CRF and that oxidant stress causes significant peroxidation. Hemodialysis is determined to further increase oxidative reactions. These changes seem to contribute to the occurrence of some complications of CRF. Therefore, it has been suggested that antioxidant supplementation may give beneficial results for these patients.
Vertex Epidural Hematoma with Communicating Bifrontal Subgaleal Hematomas Treated by Percutaneous Needle Aspiration
Authors: Strowitzki Martin , Eymann Regina , Schleifer Jochen , Steudel Wolf-Ingo
Published: April 2003

The case of an 11-year-old boy is presented who suffered a bicycle accident with a parasagittal skull fracture, a small vertex epidural hematoma, frontal contusions and a frontal subgaleal hematoma. Enlargement of the vertex epidural hematoma was diagnosed after development of a slight paraparesis on day 11 with the aid of MRI. Three percutaneous needle aspirations of the subgaleal hematoma with a total of 59 ml being evacuated led to quick recovery and disappearance of the subgaleal as well as the vertex epidural hematoma. It is speculated that both hematomas communicated via the skull fracture thus making the evacuation of the epidural hematoma by subgaleal punctures possible.
Ruptured Intracranial Mycotic Aneurysm: An Unusual Infectious Complication following Craniofacial Surgery
Authors: Uchiyama Christopher M. , Brockmeyer Douglas L. , Cherny W. Bruce , Jacobs John J. , Walker Marion L.
Published: April 2003

The case of a child with Apert syndrome is presented in which the development and rupture of an intracranial mycotic aneurysm occurred secondary to multiple infectious complications following craniofacial surgery. An endovascular procedure was utilized in an attempt to embolize the aneurysm and parent vessel. The patient recovered from her infections, but retained a residual right hemiparesis and left cranial nerve III palsy at the time of discharge. To our knowledge, this is the first report of a mycotic aneurysm developing after a craniofacial procedure. Risk factors leading to aneurysm formation in this case are presented, as well as a literature review of neurological complications following craniofacial surgery.
The Application of Controlled Intracranial Hypertension in Slit Ventricle Syndrome Patients with Obstructive Hydrocephalus and Shunt Malfunction
Authors: Butler William E. , Khan Saad A.
Published: April 2003

When a shunted patient with slit-ventricle syndrome (SVS) presents with a shunt malfunction or infection, the third ventricle may not be of sufficient caliber, despite the shunt malfunction, to allow atraumatic passage of an endoscope to the floor of the third ventricle. We describe four slit ventricle syndrome patients with respectively 24, 12, 18 and 2 prior shunt revisions who presented with shunt infection. In each patient the shunt was externalized and controlled intracranial hypertension (CIH) was applied over an average of 5.8 days by raising the height of the external ventricular drain (EVD) bag to a mean height of 18.8 cm above EAM. This increased the mean transverse third ventricular diameter from an average of 0.28 cm on admission to 1.13 cm after application of CIH. Endoscopic third ventriculocisternostomy (ETV) was satisfactorily performed in three of the four patients who remain shunt free after a mean follow-up of 21.3 months. CIH followed by ETV is an option in selected SVS patients who present with shunt malfunction or infection.
Usefulness of Various Diagnostic Techniques during Fiberoptic Bronchoscopy for Endoscopically Visible Lung Cancer: Should Cytologic Examinations Be Performed Routinely?
Authors: Karahalli Ergün , Yilmaz Adnan , Türker Hatice , Özvaran Kürşat
Published: April 2003

Background: The question of which combination of procedures gives the best diagnostic yield following fiberoptic bronchoscopy is controversial. Objectives: To evaluate the value of various diagnostic techniques following fiberoptic bronchoscopy in the diagnosis of endoscopically visible lung cancer. Methods: The study included 98 patients found to have endobronchially visible tumor during routine daily bronchoscopy. Endobronchial lesions were classified as mass, submucosal lesion and infiltration. Washings, brushings and forceps biopsies were obtained in all subjects. Transbronchial needle aspirations were performed in 67 of 76 cases with mass or submucosal lesions. Results: Bronchoscopy was diagnostic for cancer in 88 (89.8%) of the 98 patients. Forceps biopsy specimens gave positive result in 82.7% of cases, transbronchial needle aspirates in 68.6%, brushings in 68.4%, and washings in 31.6%. Combination of forceps biopsy and brushing cytology yielded a positive result for lung cancer in 87 patients. The addition of brushings increased the diagnostic yield of bronchoscopy from 82.7% to 88.8% (p < 0.05). Collection of washing specimens in addition to forceps biopsy did not increase the yield of forceps biopsy. Transbronchial needle aspiration gave an additional yield of 1%. Conclusions: Routine cytological examination of bronchial washings does not increase the yield of forceps biopsy specimens. Transbronchial needle aspiration may give an additional positive yield to forceps biopsy. We conclude that a combination of forceps biopsy and brushing is the best strategy in the diagnosis of bronchoscopically visible lung cancer.
Prevention of Pancreatic Cancer and Strategies for Management of Familial Pancreatic Cancer
Authors: Hruban Ralph H. , Canto Marcia I. , Yeo Charles J.
Published: April 2003

At the current time, pancreatic cancer remains a difficult and typically fatal disease. A number of case reports and case-control epidemiologic studies have suggested that familial aggregation plays a role in as many as 10% of all pancreatic cancers. During the last several years, genetic alterations responsible for syndromes linked with pancreatic cancer have been identified. These genes include BRCA2, p16, PRSS1, STK11, and various mismatch repair genes. Unfortunately, most kindreds with a familial aggregation cannot be explained by one of these known genetic syndromes. Recent data from the National Familial Pancreas Tumor Registry at Johns Hopkins have estimated the prospective risk of pancreatic cancer among first-degree relatives of pancreatic cancer patients. The risk was estimated by comparing observed new cases of pancreatic cancer to expected numbers. In families where three first-degree relatives had been diagnosed with pancreatic cancer, the risk of another individual developing pancreatic cancer rose to a 57-fold increase over the basal risk. This article reviews the data concerning familial pancreatic cancer. Additionally, this article reviews the data concerning the histological precursors of invasive ductal adenocarcinoma of the pancreas: pancreatic intraepithelial neoplasias. Further, the current Johns Hopkins methodology used to screen for early pancreatic neoplasia in familial pancreatic cancer patients and in patients with familial Peutz-Jeghers syndrome is discussed. In summary, the notable advances in the field of molecular genetics have allowed for a better definition of the genetics of pancreatic cancer. With this knowledge has evolved a better understanding of several high-risk clinical syndromes associated with pancreatic cancer, familial pancreatic cancer, and the evolution of strategies to screen high-risk families for early pancreatic neoplasia.
A Randomized Trial of Lansoprazole, Amoxycillin, and Clarithromycin versus Lansoprazole, Bismuth, Metronidazole and Tetracycline in the Retreatment of Patients Failing Initial Helicobacter pylori Therapy
Authors: Magaret Nathan , Burm Michael , Faigel Douglas , Kelly Carolyn , Peterson Walter , Fennerty M. Brian
Published: April 2003

Background/Aim: 10–30% of the patients treated for Helicobacter pylori fail to clear the infection after initial therapy. Little is known as to the efficacy of retreatment regimens in these patients. Proton pump inhibitor (PPI) -based triple and quadruple therapies demonstrate efficacies of 80–90% as initial therapy for H. pylori infection, but whether these regimens are as effective when used for retreatment is unknown. The efficacy of a metronidazole-containing regimen in this situation is also unknown. Our aim was to compare the efficacy of a nonmetronidazole-containing PPI-based triple versus a PPI-based quadruple therapy containing metronidazole in patients failing previous H. pylori therapy. Methods: 48 patients were enrolled in this study at two sites after failure of previous H. pylori therapy as determined by a positive 14C-urea breath test. Patients were stratified by prior treatment with a metronidazole-containing regimen and were then randomized to either lansoprazole (L) 30 mg twice daily, amoxycillin (A) 1,000 mg twice daily, and clarithromycin (C) 500 mg twice daily for 14 days (LAC) or L 30 mg four times daily, bismuth subsalicylate (B) 2 tablets four times daily, metronidazole (M) 250 mg four times daily and tetracycline (T) 250 mg four times daily for 14 days (LBMT). Side effects and compliance (pill count) were assessed at the completion of therapy. A repeat 14C-urea breath test was performed 4 or more weeks after completion of therapy, and cure was defined as a negative test result. Results: 48 patients (16 males and 32 females) were enrolled in this study. 20 patients received LAC (18 prior M), and 28 received LBMT (23 prior M). Per protocol and intention-to-treat efficacies were 82% (95% CI 64–100%) and 75% (95% CI 56–94%) for LAC and 80% (96% CI 64–96%) and 71% (95% CI 54–88%) for LBMT (p = 0.85 per protocol and p = 0.78 intention to treat between LAC and LBMT), respectively. The compliance (≧80% of pills taken) was found to be 89% in both treatment groups. Side effects were noted in 84% for LAC and in 82% for LBMT, but were mild and did not cause discontinuation of therapy. Conclusions: PPI-based triple and quadruple therapy with both LAC and LBMT are effective in retreating patients failing initial metronidazole-based H. pylori therapies. LAC was not statistically superior to LBMT as a ‘retreatment’ regimen in this clinical situation, but the small sample size and wide confidence limits do not preclude the possibility of a smaller but significant difference in efficacy between the regimens. To determine whether LAC or LBMT is as effective for retreating patients failing non-metronidazole-containing regimens requires further study.
Management of Dyspepsia across the Primary-Secondary Healthcare Interface
Authors: Hungin A. Pali S. , Rubin Greg P.
Published: April 2003

Primary care remains at the frontline of care for most patients and the need to contain healthcare costs has led to a re-evaluation of the divide between primary and secondary care. Dyspepsia has a community prevalence of 25–50%, and forms 5% of the primary care physician’s workload, 10% of whom are referred to a specialist. Problems presenting in primary care tend to be undifferentiated; those who do not have alarm symptoms and are under the age of 55 years are unlikely to have serious pathology. Management is largely symptom driven, on an empirical basis rather than on a diagnostic model as in secondary care where investigation rates are higher. The predictive value of symptoms for a specific diagnosis is small; primary care physicians include gastro-oesophageal reflux disease as part of the dyspepsia complex and the overall expenditure on acid suppression therapy is relatively large. The availability of open-access investigations such as endoscopy has influenced specialist referral rates and the ability to diagnose and treat patients with Helicobacter pylori-related problems has opened further opportunities. However, variations in the availability of the recommended diagnostic tests and the implications to primary care clinical practice of some of the new management recommendations (Maastricht II) in some national settings illustrate the divide with secondary care. The gap between primary and secondary care is narrowing in gastroenterology and the two groups need to continue collaboration to attain effective and cost-effective management for their patients.
Radiofrequency Thermal Ablation of Hepatocellular Carcinoma
Authors: Allgaier Hans-Peter , Galandi Daniel , Zuber Ina , Blum Hubert Erich
Published: April 2003

Hepatocellular carcinoma (HCC) is one of the major malignancies worldwide. Due to advanced or decompensated liver cirrhosis, comorbidity and multicentricity of the tumor lesions, 70–80% of HCC patients are inoperable at the time of diagnosis. Radiofrequency thermal ablation (RFTA) is a new minimally invasive and sage technique for the nonsurgical treatment of HCCs. Similar to other ablation techniques, the treatment strategy depends on several factors, including the patient’s clinical status, the stage of liver cirrhosis and of the HCC. RFTA can be performed percutaneously, laparoscopically or after laparotomy. Advanced RFTA equipment, refined techniques of modifying tumor tissue response to RFTA, and combined treatment strategies should lead to better response rates even in larger HCCs.
Methodological Approaches to Conducting Pooled Cross-Sectional Time Series Analysis: The Example of the Association between All-Cause Mortality and per capita Alcohol Consumption for Men in 15 European States
Authors: Gmel Gerhard , Rehm Jürgen , Frick Ulrich
Published: April 2003

Aim: To compare different statistical models in order to estimate the association of alcohol consumption and total mortality when time series data stem from different regions. Data and Methods: Data on per capita consumption in 15 European countries were combined with standardized mortality rates covering different periods between 1950 and 1995. An indicator of region-specific drinking patterns was measured without reference to a concrete time point, thus generating a hierarchical data structure. Two groups of models were compared: pooled cross-sectional time series models with different error structures and hierarchical linear models (random coefficient models). Results: If historical time is not controlled for in cross-sectional models, this might result in estimating a negative association between alcohol consumption and total mortality. Hierarchical linear models or cross-sectional models controlling for historical time, however, resulted in the expected positive association. Only hierarchical linear models were able to adequately estimate the moderating effect of drinking patterns on the association between alcohol consumption and total mortality. Conclusion: For pooled cross-sectional time series data, control for the potential impact of historical time is of utmost importance. Hierarchical linear models constitute a superior alternative to analyze such complex data sets, especially as time-independent characteristics of regions can be implemented in the model.
The Cerebrospinal Fluid Level of Glial Fibrillary Acidic Protein Is Increased in Cerebrospinal Fluid from Alzheimer’s Disease Patients and Correlates with Severity of Dementia
Authors: Fukuyama Ryuichi , Izumoto Taneno , Fushiki Shinji
Published: April 2003

To gain insight of the underlying mechanisms of astroglial response to Alzheimer’s disease (AD), the level of glial fibrillary acidic protein (GFAP) in cerebrospinal fluid (CSF) from controls and AD subjects were immunochemically determined, and the correlation between that level and dementia severity of AD patients was evaluated. Means and SD of CSF levels of GFAP for the young control group (from 1 to 25 years, mean ± SD 14.2 ± 5.0, n = 13) adult control (from 26 to 55 years, 41.6 ± 10.1, n = 9) and senescent control (older than 56 years, 65.4 ± 8.0, n = 8) were 2.96 ± 1.04, 2.80 ± 1.46 and 3.99 ± 1.55 ng/ml, respectively, and the CSF level of GFAP was not dependent on age (ANOVA, p = 0.17). While that of the AD patient group (n = 27, 70.8 ± 8.0 years) was 8.96 ± 7.80 ng/ml, significantly higher than that of both the all-control (3.19 ± 1.39 ng/ml, t test, p < 0.001) and age-matched senescent (3.99 ± 1.55 ng/ml, t test, p < 0.005) control groups. The receiver-operator characteristic (ROC) curve revealed that the GFAP concentration at 5 ng/ml in CSF could serve as a cutoff value. The CSF level of GFAP in the moderately to severely demented patients (MMSE ≤ 17, 13.2 ± 9.10 ng/ml, n = 9) was approximately by two-fold higher than that of the mildly to moderately demented patients (MMSE ≧ 18, 6.85 ± 5.76 ng/ml, n = 18; ANOVA, p < 0.05). These findings together with our previous report on an increase in the CSF level of apolipoprotein E suggest that degeneration and stimulation of astrocytes takes place concurrently in the AD brain.
Executive Dysfunction in Spinocerebellar Ataxia Type 1
Authors: Bürk K. , Bösch S. , Globas C. , Zühlke C. , Daum I. , Klockgether T. , Dichgans J.
Published: April 2003

Fourteen patients with spinocerebellar ataxia 1 (SCA1) and 11 controls with similar mean age and IQ estimates were submitted to a neuropsychological test battery comprising tests for IQ, attention, verbal and visuospatial memory as well as executive functions. Neuropsychological assessment yielded verbal memory and executive dysfunction while tests of visuospatial memory and attention were not significantly impaired in SCA1 as compared to controls. Test performance was neither related to the repeat length, the age of onset nor the disease duration. The profile of cognitive impairment in SCA1 with prominent executive dysfunction corresponds to the concept of ‘frontal-subcortical’ dementia that is likely to be contingent upon disruption of a cerebrocerebellar circuitry that consists of afferent and efferent connections between the prefrontal cortex and the cerebellum.
Guillain-Barré Syndrome in Spain, 1985–1997: Epidemiological and Public Health Views
Authors: Cuadrado José Ignacio , de Pedro-Cuesta Jesús , Ara José Ramón , Cemillán Carlos Alberto , Díaz Manuel , Duarte Jacinto , Fernández María Dolores , Fernández Oscar , García-López Fernando , García-Merino Antonio , García-Montero Rosa , Martínez-Matos Juan Antonio , Palomo Fernando , Pardo Julio , Tobías Aurelio
Published: April 2003

Retrospective demographic information and hospital record data were collected for 337 patients resident in Spain who had validated Guillain-Barré syndrome (GBS) diagnoses and clinical onset during the period 1985–1997 and had been admitted to 11 centres, covering a population of 3.9 million. The European age-adjusted GBS incidence per 100,000 for 1985–1997 among the population aged 20 and over was 0.85, with a breakdown of 1.14 in men and 0.58 in women. Incidence increased with age and time, with occasional rises that mimicked outbreaks and occurred at irregular 2- to 4-year intervals, mainly in winter. Spatial variation was modest. Respiratory and gastrointestinal infections respectively constituted 49.3 and 19.3% of recorded preceding events. The 97.5% intercentile limit, obtained from the 1985–1997 monthly incidences using predictions from a Poisson model, was proposed as the threshold value for pilot epidemiological surveillance of GBS in 1998–1999.
Dilated Virchow-Robin Spaces in Myotonic Dystrophy: Frequency, Extent and Significance
Authors: Di Costanzo Alfonso , Di Salle Francesco , Santoro Lucio , Bonavita Vincenzo , Tedeschi Gioacchino
Published: April 2003

To study the frequency, extent and significance of dilated Virchow-Robin spaces (VRSs) in dystrophia myotonica (DM), we evaluated the cranial magnetic resonance imaging (MRI) of 41 patients with the adult form of DM and 41 healthy controls. Dilated VRSs and white matter lesions (WMLs) were rated according to semiquantitative methods. Convexity VRSs were more frequent (68 vs. 34%; p < 0.01) and severer (median scores: 4 vs. 0; p < 0.01) in DM patients than in controls, while lenticulostriate VRSs did not show significant differences in frequency (83 vs. 70%; p > 0.05) and severity (median scores: 4 vs. 3; p > 0.05). WMLs were more frequent (66 vs. 22%; p < 0.01) and severer (median scores: 5 vs. 0; p < 0.01) in patients. Disease duration was negatively correlated with convexity VRSs and positively with lobar (centrum semiovale) WML scores. Dilated convexity VRSs might be one of the initial findings in cranial MRI of DM, preceding the appearance of lobar WMLs.
Prognostic Factors of Thymectomy in Patients with Myasthenia gravis: A Cohort of 132 Patients
Authors: Téllez-Zenteno José Francisco , Remes-Troche Jose María , García-Ramos Guillermo , Estañol Bruno , Garduño-Espinoza Juan
Published: April 2003

Objective: To identify the response to thymectomy and the factors associated with a poor response, a nested case-control study was performed on 132 patients with an established diagnosis of myasthenia gravis who had had a thymectomy between 1987 and 1997 and had been followed up for at least 3 years. Methods: In order to assess the response to thymectomy, the following two points were taken into account: (a) the dose of pyridostigmine and other drugs (steroids, azathioprine) that the patient took before and after thymectomy, and (b) the Osserman classification before and after thymectomy. The patients were divided into 4 groups: (1) patients in remission; (2) patients with improvement; (3) patients with no change, and (4) patients who were worse. Results: 91 patients had a good response (69%) and 41 patients had a poor response (31%). The response by groups was as follows: 50 patients were found to be in remission; 41 patients had improved; 34 patients had no changes, and 7 got worse. Being more than 60 years old was associated with a poor prognosis (odds ratio 4.6, CI 1.11–20.32, p 0.01). The patients who had the disease for more than 3 years (odds ratio 2.97, CI 0.79–5.39, p 0.09) had a tendency towards a bad prognosis even though there was no statistical significance, and for those who had it for more than 4 years (odds ratio 2.58, CI 0.89–0.96, p 0.02) the bad prognosis was statistically significant. The patients who had the disease for more than 3 years between diagnosis and thymectomy (odds ratio 2.02, CI 0.69–5.90, p 0.15) and those with it for more than 4 years (odds ratio 2.53, CI 0.83–7.7, p 0.06) had a tendency towards a poor prognosis even though there was no statistical significance. In addition, having Osserman I was associated with a bad prognosis. Referring to the pathological findings, patients with thymoma (odds ratio 3.51, CI 0.43–31.5, p 0.15) and those with thymic atrophy (odds ratio 2.19, CI 0.93–5.16, p 0.04) had a poor prognosis. Finally, the use of steroids before thymectomy (odds ratio 2.26, CI 0.99–5.18, p 0.03) was associated with a worse prognosis. Conclusions: The response to thymectomy was high (69%). The variables that had the most prognostic importance were age and the Osserman stage. Other variables of poor prognosis were: high doses of pyridostigmine and use of steroids before surgery; the total duration of the disease and the duration of the disease between diagnosis and the surgical procedure; history of previous thymectomy; use of plasmapheresis after surgery, and the discovery of thymic atrophy and thymoma in the histopathological result.
Association between Coeliac Disease, Epilepsy and Brain Atrophy
Authors: Luostarinen L. , Dastidar P. , Collin P. , Peräaho M. , Mäki M. , Erilä T. , Pirttilä T.
Published: April 2003

Patients with epilepsy and posterior cerebral calcifications have an increased risk of coeliac disease (CD). The occurrence of this syndrome and the overall risk of CD and epilepsy remain still poorly understood. This study presents the prevalence of CD, brain atrophy, and cerebral calcifications in patients with epilepsy of unknown aetiology. The medical records of 900 consecutive adult patients with epilepsy diagnosis were reviewed. The occurrence of CD in living patients with epilepsy of unknown aetiology (n = 199) was investigated; all patients without previously known CD were asked for serological screening for the disease and the diagnosis was verified with small bowel biopsy. The presence of occipital calcifications and brain atrophy in all available CT scans (n = 130) was evaluated. Five of 199 cases had prior history of CD. The prevalence of definite CD in the patients was 2.5% (5/199), which is significantly higher that the current prevalence of CD in our area (0.27%). Antibody testing and small bowel biopsy in positive cases failed to increase prevalence of CD. Eleven (8.5%) patients had intracerebral calcifications and 3 of them posterior calcifications; all 11 had negative screening results for CD. Four (80%) patients with definite CD had supratentorial brain atrophy compared with 33 (26%) of 125 patients without CD. Prevalence of CD was increased among patients with epilepsy of unknown aetiology, but the combination of CD, epilepsy and intracranial posterior calcifications was rare in Finnish adult epilepsy population.
Does Coenzyme Q10 Play a Role in Opposing Oxidative Stress in Patients with Age-Related Macular Degeneration?
Authors: Blasi Maria Antonietta , Bovina Carla , Carella Giuseppe , Genova Maria Luisa , Jansen Anna M.A. , Lenaz Giorgio , Brancato Rosario
Published: April 2003

To seek some specific biochemical markers of age-related macular degeneration (AMD), coenzyme Q10 (CoQ10) levels were determined in plasma and platelets from 19 exudative AMD patients and 19 age-matched controls. Lipid peroxidation was followed in plasma in vitro after the addition of a free radical initiator. Most patients had lower plasma CoQ10 content than most controls. Plasma from controls showed greater capacity to oppose the oxidative damage. These results support the concept that free radicals play a pathogenic role in AMD and that CoQ10 may have a protective effect.
Recurrent Vitreous Hemorrhages due to Combined Pigment Epithelial and Retinal Hamartoma: Natural Course and Indocyanine Green Angiographic Findings
Authors: Moschos Michael , Ladas Ioannis D. , Zafirakis Panayotis K. , Kokolakis Stefanos N. , Theodossiadis George P.
Published: April 2003

We report the clinical and angiographic features as well as the natural course of an optic disk and juxtapapillary combined pigment epithelial and retinal hamartoma in a 23-year-old white girl. The patient presented 3 episodes of recurrent vitreous hemorrhages in the first 4 years of follow-up, which were spontaneously and totally absorbed. During the last 6 years, she was absolutely free of any ocular symptom. The tumor did not show any growth during the 10 years of follow-up. The digital indocyanine green angiography, which was normal in the early frames, revealed a mild, patchy hyperfluorescence corresponding to the tumor location in the late phase.
Elevated Nitric Oxide Level in Aqueous Humor of Patients with Acute Angle-Closure Glaucoma
Authors: Chiou Shih-Hwa , Chang Charn-Jung , Hsu Wen-Ming , Kao Chung-Lan , Liu Jorn-Hon , Chen Wen-Lu , Tsai Der-Chong , Wu Chi-Chiao , Chou Ching-Kuang
Published: April 2003

Nitric oxide, a noxious and free-radical gas, plays a key role in vasodilatation, inflammation, immunity, and neurotoxicity. Studies have shown that a recently detected NO synthase inducible isoform, found in astrocytes in the optic nerve heads of glaucoma patients, could stimulate excessive production of NO. The purpose of our study was to elucidate the role of NO production in the pathogenesis of glaucoma. We measured the concentrations of NO in aqueous humor from 11 patients with acute angle-closure glaucoma (AACG) and 14 patients with cataract. All samples were collected from patients who were free of any other systemic disease. Utilizing a chemiluminescence assay, we found that in AACG patients the NO levels in aqueous humor samples (83.2 ± 6.7 µM) were significantly higher than in cataract patients (27.1 ± 3.6 µM; p < 0.001). We therefore concluded that excessive NO in AACG patients reflects the degree of ocular impairment demonstrated by concomitant retinal cell and optic nerve cell damage.
Type A Syndrome of Insulin Resistance: Anterior Chamber Anomalies of the Eye and Effects of Insulin-Like Growth Factor-I on the Retina
Authors: Martin Xavier D. , Zenobi Peter D.
Published: April 2003

Background: The purpose of this work was to describe the anterior chamber and iris anomalies as well as to evaluate the effects of recombinant human insulin-like growth factor-I (rhIGF-I) on the retinal vessels in 2 diabetic patients with type A syndrome of insulin resistance, a rare condition associated with acanthosis nigricans. Methods: Ophthalmologic examinations, including photographs and fluorescein angiograms, were performed before, and 2 and 4 weeks after starting subcutaneous rhIGF-I treatment, and 3 months after withdrawal of rhIGF-I treatment. Results: Both patients had goniodysgenesis with mild elevation of the intraocular pressure. Before and after 2 weeks of treatment with rhIGF-I, the fundus and the fluorescein angiograms were mainly normal. After 4 weeks of rhIGF-I treatment both patients’ retinas revealed leakage of fluorescein. Three (case 1) and 4 months (case 2) after withdrawal of rhIGF-I, the fundus of all four eyes were again without leakage. Conclusions: The anterior chamber anomalies found in these patients may be part of the type A syndrome of insulin resistance and could alert clinicians that these patients might not have the usual type of diabetes. Moreover, the data show that exogenous rhIGF-I administration in patients with type A syndrome of insulin resistance alters the permeability of the superficial layer of retinal capillaries which is comparable to the earliest angiographic changes in childhood diabetic retinopathy. Whether this is a direct effect of rhIGF-I, as suggested by experiments in an animal model, or an indirect effect due to the near-normalization of the glucose levels by rhIGF-I warrants further investigations. Finally, this work points to an important caveat regarding the therapeutic use of rhIGF-I in this patient population.
Central Retinal Vein Occlusion and Nonarteritic Ischemic Optic Neuropathy in 2 Patients with Mild Iron Deficiency Anemia
Authors: Kacer Boris , Hattenbach Lars-Olof , Hörle Steffen , Scharrer Inge , Kroll Peter , Koch Frank
Published: April 2003

We report on 2 patients with ophthalmologic complications associated with mild iron deficiency anemia. Case 1, a 37-year-old female patient, presented after 4 days of blurred vision in her left eye. Ophthalmoscopic and angiographic findings were consistent with the diagnosis of central retinal vein occlusion (CRVO). Further hematologic investigation into possible causes disclosed mild iron deficiency anemia (Hb 9.4 g/dl, hematocrit 30.5%). After the patient’s visual acuity had worsened progressively to 20/50, an initial thrombolytic treatment and continuous intravenous heparinization was started on day 8, followed by oral substitution therapy with ferrous sulfate. On day 14, her visual acuity recovered to 20/20 OS and remained stable during follow-up. Case 2, a 50-year-old female patient, presented with a 1-week-history of blurred vision and metamorphopsia. Her visual acuity was 20/200. Further examination revealed a nonarteritic ischemic optic neuropathy and an iron deficiency anemia as the underlying disease (Hb 7.3 g/dl, hematocrit 25%). Despite intravenous heparinization and systemic treatment with steroids, there was no improvement in visual acuity. Clinicians involved in the management of chronic iron deficiency anemia should be aware of possible ophthalmic manifestations in this disease.
Involutional Entropion Surgery: A Modified Technique
Authors: Marabotti Andrea , Bedei Andrea , Lanza Gustavo , Cariello Anna , Giannecchini Iacopo
Published: April 2003

Purpose: A study to evaluate the effectiveness of a modified procedure to correct involutional entropion. Methods: Seventeen cases of involutional entropion underwent surgery and had a postoperative follow-up of 18 months. The authors describe a technique of vertically shortening the anterior lamella (skin and orbicularis muscle), using a blepharoplasty incision and reflection of a skin muscle flap. Results: In 16 of 17 eyelids affected by involutional entropion, this operative procedure showed good functional outcome (good correction of the relation between lower eyelid edge and eyeball) and aesthetic outcome (no hypertrophic scar, dyschromia or unnatural folding of the skin). Conclusions: A correct approach to entropion surgery needs an accurate preoperative evaluation of the individual physiopathogenic factors. This procedure gives lasting functional and pleasing cosmetic results when preseptal orbicularis muscle override has been identified as the cause of senile entropion.
Les amétropies statiques du noir camerounais
Authors: Ebana Mvogo C. , Bella-Hiag A.L. , Ellong A. , Metogo Mbarga B. , Litumbe Njoh C.
Published: April 2003

Purpose: We undertook this study with the aim to determine static ametropias of black Cameroonians as well as their clinical manifestations. It is a prospective study carried out in the Department of Ophthalmology of Douala General Hospital from January 1996 to December 1998. Patients and Method: During this period, all patients who fulfilled our criteria had a skiascopy done under cycloplegia. We thus examined 2,484 patients (4,968 eyes). 66.2% of them were female and 33.8% were male. Results: In our series, hyperopia was found in 51% of the cases, hyperopic astigmatism in 27.5% of the cases, myopic astigmatism in 9.3% of cases, mixed astigmatism in 7.7% of cases and myopia in 4.5% of cases. Distribution of ametropias is influenced by age, not by sex or laterality. Discussion and Conclusion: Functional signs just have an indicative value; only objective refraction under cycloplegia can determine exactly the ametropia.