bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutrition and Growth in Cystic Fibrosis
Authors: Hankard Régis , Munck Anne , Navarro Jean
Published: April 2003

Malnutrition is a common complication of chronic diseases in children and may lead to growth impairment (stunting). Malnutrition in cystic fibrosis (CF) results from increased energy expenditure, decreased energy intakes, malabsorption of ingested nutrients because of pancreatic insufficiency and chronic inflammation. Malnutrition and high levels of inflammatory cytokines affect IGF-1 production through interrelated mechanisms. Nutritional support was shown to improve both nutritional status and outcome in CF. However, some nutrients have a direct effect on the disease. n-3 fatty acids supplementation is able to correct lipid abnormalities resulting from a primary mechanism. Moreover, n-3 fatty acids have a direct effect on the inflammatory response, decreasing eicosanoid synthesis and modulating nuclear transcriptional factors nuclear factor ĸB and peroxisome proliferator-activated receptors γ. Nutritional support may be considered part of the care of the CF patient together with antibiotics, pancreatic enzymes and physiotherapy, influencing significantly the evolution of the disease.
Mechanisms of Steroid Impairment of Growth
Authors: Hochberg Ze’ev
Published: April 2003

With child growth being multifactorial and the glucocorticoids (GC) having many target physiological and biochemical mechanisms, growth and the GC collide in several meeting points. Indirectly, GC have a general anti-anabolic and catabolic influences that include bone, cartilage and muscle proteins. The GC interfere with the GH–IGF-1 axis at the hypothalamic, pituitary and target organ levels, affecting hormone release, receptor abundance, signal transduction, gene transcription, pre-mRNA splicing and mRNA translation. GC disturb normal calcium balance at the intestine and kidney. Direct effects at the growth plate include the suppression of multiple gene expression, chondrocyte proliferation and matrix proteoglycan synthesis, sulfation, release and mineralization as well as the augmentation of hypertrophic cell apoptosis. At the tissues adjacent to the growth plate, GC enhance osteoclast and suppress osteoblast recruitment and function, they reduce muscle strength and disrupt the normal control of vascular invasion at the cartilage–bone interface. Growth damage from GC is maximal during the initial months of treatment and prevention is more effective than post-factual therapy. To reduce these growth-retarding effects, the following measures, which are partly experimental, may be effective in a decreasing order: minimize GC dose and use an alternate-day treatment; utilize the oxazoline analog of prednisolone deflazacort, normalize calcium balance; employ hGH or IGF-1.
Influence of Growth Hormone on Accretion of Bone Mass
Authors: Monson J.P. , Drake W.M. , Carroll P.V. , Weaver J.U. , Rodriguez-Arnao J. , Savage M.O.
Published: April 2003

Growth hormone (GH) exerts important influences on bone metabolism during lifespan. During childhood, GH is a major determinant of acquisition of bone mass and in adult life, GH partly determines the rate of bone remodelling and therefore influences maintenance of bone mineral density (BMD). Insights into the importance of GH in these respects may be obtained by studies of BMD and indices of bone remodelling in GH deficiency (GHD) of adult-onset and childhood-onset. Adult-onset GHD, usually accompanied by other features of hypopituitarism, may be associated with osteopenia and an increased fracture risk. Postulated mechanisms include GHD and gonadal steroid deficiency of unknown duration; glucocorticoid and thyroxine replacement do not appear to exert a major role. GH replacement in adult-onset GHD results in an early increment in indices of bone remodelling which persists for up to 5 years; BMD increases by 0.5–1.0 SD in males and stabilizes in females over this time period. In adolescents with GHD who traditionally discontinue GH at completion of linear growth, BMD is substantially lower than peak bone mass for a young adult population. Studies addressing the effects of continuation of GH after achievement of final height are currently underway and will provide insights into the possible need to continue GH into adult life. Such studies may confirm a role for GH in promoting continued accrual of bone mass and thereby demonstrate that cessation of GH at achievement of final height, by limiting peak bone mass, may predispose to clinically significant osteoporosis in later life. In addition to the potential importance of GH for achievement of peak bone mass, there may be a superimposed accelerated loss of BMD with advancing age similar to the situation observed in adult-onset GHD. To date, this has been difficult to assess in adult GHD of childhood-onset because the relative contributions of low peak bone mass and increased loss of bone in later life could not be distinguished.
Growth and Growth Hormone Status after a Bone Marrow Transplant
Authors: Shalet S.M. , Brennan B.M.D.
Published: April 2003

The three most common clinical situations which have given rise to diagnostic and therapeutic issues involve the child treated for: (1) a brain tumour or extracranial tumour with radiotherapy (XRT) which includes an XRT dose of ≧30 Gy to the hypothalamic-pituitary axis; (2) acute lymphoblastic leukaemia with a cranial XRT dose of 18–24 Gy, and (3) haematological malignancy or solid tumour requiring total body irradiation (dose 10– 14 Gy) and BMT. The decision about the intent to treat and the timing of GH replacement needs to be taken in collaboration with the paediatric oncologist who will provide guidance about overall prognosis and the risk of relapse. After a dose of ≧30 Gy to the hypothalamic pituitary axis the risk of GH deficiency (GHD) 2 years later is very high (>50%) and therefore there is ‘solid’ epidemiological evidence, which predicts outcome. Therapeutically the choice is whether or not to offer GH replacement at 2 years in the presence of biochemical evidence of GHD but independent of auxology, or wait until the growth rate declines. Diagnostically the IGF-1 SDS is more useful than previously thought, particularly if XRT-induced GHD is severe; there may, however, be systematic discordancy between the GH responses to different pharmacological stimuli (ITT vs. arginine). For irradiated children in categories 2 and 3, greater emphasis is placed on auxology in determining the need for assessment of GH status. Early rather than very precocious puberty is a real issue and needs to be actively treated with a GnRH analogue if final height appears to be significantly compromised.
Effects of Chemotherapy on Bone Metabolism and Skeletal Growth
Authors: Siebler T. , Shalet S.M. , Robson H.
Published: April 2003

In recent years there has been a significant increase in both acute and chronic toxicity associated with the more successful but now highly intensive chemotherapy (CT) regimens used to treat childhood cancers. The incidence of childhood cancers coincides with periods of rapid skeletal development. Consequently, short stature and osteoporosis are important long-term effects in adult survivors. Clinical data indicate that the effects of CT, including glucocorticoids, on final height are due to direct effects of these drugs on the skeleton. The multiple modes of action of CT drugs suggest a complex and diverse influence on chondrocytes, extracellular matrix and bone cells. However, only limited data demonstrate these direct effects on the proliferative capacity of growth plate chondrocytes and on key steps of endochondral ossification, the multistep process that determines rate and extent of long bone growth. Endochondral ossification requires coordinated maturation, proliferation and differentiation of growth plate chondrocytes leading to hypertrophic cells which eventually undergo apoptosis to leave a cartilaginous scaffold that is mineralized prior to the laying down of new bone. Disruption of the physiological cellular activity of growth plate chondrocytes and/or bone cells result in skeletal growth disturbances. Thus, CT drugs which disrupt normal cell division may manifest their effects on the growth plate as either a reduction in cell number and/or the loss of functional integrity of extracellular matrix. Histological and cell kinetic studies, using in vivo and in vitro models of long bone growth, are essential to increase our understanding of the cellular mechanisms involved and to finally determine how the individual growth potential might be maintained during treatment for childhood cancers.
Treatment of Growth Failure in Juvenile Chronic Arthritis
Authors: Simon Dominique , Lucidarme Nadine , Prieur Anne-Marie , Ruiz Jean-Charles , Czernichow Paul
Published: April 2003

We retrospectively assessed linear growth and final height in a group of 24 patients suffering from juvenile idiopathic arthritis (JIA) during childhood, receiving steroid therapy. In these patients, a significant loss of height (–2.7 ± 1.5 SDS) occurred in the first years of the disease which was positively correlated with prednisone therapy duration. After remission of the disease and prednisone discontinuation, most of the patients (70%) had catch-up growth but 30% had a persistent loss of height. Their mean final height was strongly correlated with their mean height at the end of steroid therapy and was significantly different between the group of patients with catch-up growth (–1.5 ± 1.6 SDS) and the group without catch-up growth (–3.6 ± 1.2 SDS). This pattern of growth observed in JIA patients should help us to define strategies of GH treatment in these patients in order to improve their final height. We have previously reported the beneficial effects on growth and body composition of a 1-year GH treatment in a group of 14 growth-retarded patients suffering from juvenile idiopathic arthritis, receiving glucocorticoid therapy. These patients (n = 13) were treated again with GH at the same dosage (0.46 mg/kg/week) for another 3-year period. GH treatment markedly increased growth velocity in these patients, but had a minor effect on SDS height suggesting that these children will remain short at adult age. Using GH earlier in these patients during the course of their disease may prevent growth deterioration and metabolic complications induced by chronic inflammation and long-term steroid therapy.
Catch-Up Growth and Endocrine Changes in Childhood Celiac Disease
Authors: Boersma B. , Houwen R.H.J. , Blum W.F. , van Doorn J. , Wit J.M.
Published: April 2003

Childhood celiac disease may lead to a failure of statural growth. After institution of a gluten-free diet most patients exhibit catch-up growth. Catch-up growth is a remarkable phenomenon characterized by a supranormal height velocity. One of the hypothetical mechanisms of catch-up growth is that an increased activity of the somatotrophic axis is involved. In order to provide further insight in the physiology of catch-up growth, auxological and endocrine changes were prospectively studied in 28 children with newly diagnosed celiac disease. The results demonstrate a malnutrition-like state of the somatotrophic axis at the time of diagnosis and a rapid recovery of this axis towards normal functioning after institution of the gluten-free diet. Although several correlations between these endocrine alterations and auxological parameters were detected, it is questionable whether the endocrine changes are the driving force behind catch-up growth.
Ranging Behavior, Group Size and Behavioral Flexibility in Ethiopian Hamadryas Baboons (Papio hamadryas hamadryas)
Authors: Swedell Larissa
Published: April 2003

This study reports group size, home range size, daily path lengths, seasonal effects on ranging behavior and qualitative information on diet for a population of hamadryas baboons inhabiting the lowlands of the northern Rift Valley in central Ethiopia. The minimum home range size and daily path length for this population are similar to those reported for other populations of hamadryas baboons in Ethiopia and Saudi Arabia. Group sizes, however, are much larger than those in most other hamadryas populations for which published data are available. The large group sizes in this area may be related to the abundance of one food resource in particular, doum palm nuts. Overall, this study suggests that hamadryas baboons may be more flexible in some aspects of their behavioral ecology (e.g. group size) than in others (e.g. ranging behavior).
Hormonal Sensitivity following Endocrine Withdrawal in Hormone-Refractory Prostate Cancer
Authors: Nishiyama Tsutomu , Terunuma Masahiro
Published: April 2003

Background: Prostate cancer is proposed to be classified according to hormonal sensitivity. The purpose of this study is to examine hormonal sensitivity of the patient with refractory prostate cancer subsequent to primary hormonal therapy. Methods: Sixteen patients with refractory prostate cancer subsequent to primary combination hormonal therapy were enrolled in this study. All 16 patients with progressive disease after elimination of oral hormonal agents or after response following hormonal withdrawal received dexamethasone (DXM) (initially 1.5 or 1.0 mg, then tapered to 0.5 mg) orally not only for the purpose of second-line hormonal therapy but also as an indicator of hormonal sensitivity. Results: Overall, 4 patients showed a prostate-specific antigen (PSA) decrease of >50% from baseline on discontinuation of hormonal agents, while another 7 patients showed a PSA decrease of <50%. Five patients showed PSA level was progressed after the withdrawal. In all patients with PSA values that decline not only >50% but also <50% following oral endocrine withdrawal, the fall in PSA values had been >50% following DXM administration. However, the PSA value in the patients with PSA progression following the oral endocrine withdrawal kept rising after DXM administration. Conclusions: The findings in this study would just suggest a possible relationship between DXM sensitivity and the response to endocrine withdrawal. The patients whose PSA values decline following oral endocrine withdrawal may maintain hormonal sensitivity.
Bladder Dysfunction due to Behçet’s Disease
Authors: Saito Motoaki , Miyagawa Ikuo
Published: April 2003

Behçet’s disease is a multiple disorder in which urogenital involvement mainly consists of genital aphthous ulcers, epididymitis, urethritis and recurrent cystitis. We report 2 cases of neurogenic bladder due to Behçet’s disease. Both cases showed detrusor hyperreflexia and detrusor-sphincter dyssynergia. One case has been managed by twice-daily intravesical oxybutynin treatment (5 mg/10 ml) and clean intermittent catheterization (CIC) 7 times/day, and the other case has been managed by CIC 6 times/day.
Solitary Fibrous Tumour of the Kidney
Authors: Leroy X. , Copin M.C. , Coindre J.M. , Meria P. , Wacrenier A. , Gosset P. , Gosselin B.
Published: April 2003

Solitary fibrous tumours are relatively rare neoplasms initially described in the pleura. Such lesions are now reported in many extrathoracic sites. To our knowledge, only 8 cases have been reported in the kidney. All these cases were benign. We report a patient with a solitary fibrous tumour of the kidney with infiltration of the wall of the renal vein. Microscopic examination showed proliferation of spindle cells with a prominent vascular haemangiopericytoma-like pattern. Hypercellular areas were admixed with hyalinized collagenous zones. The neoplastic cells stained for vimentin and CD34. CD31 was negative. Biologically, we did not find any arguments for malignancy: the flow cytometric study showed diploid histograms, and immunostaining for p53 was negative.
Solitary Fibrous Tumor of the Peritoneum Found in the Prevesical Space
Authors: Kubota Yasue , Kawai Noriyasu , Tozawa Keiichi , Hayashi Yutaro , Sasaki Shoichi , Kohri Kenjiro
Published: April 2003

Solitary fibrous tumors (SFT) are well recognized in the pleura, but their rare occurrence at other sites has become appreciated only in recent years. We experienced a 68-year-old male patient who presented with frequency of urination and difficulty in voiding. Computed tomographic scan revealed a solid and cystic mass which measured 12 × 10 cm in the prevesical space. This tumor showed typical histopathologic features of SFT, and was immunostained positive for vimentin, CD34 and CD99. This is an extremely rare case of SFT arising from the parietal peritoneum found in the prevesical space.
BTA Quantitative Assay and NMP22 Testing Compared with Urine Cytology in the Detection of Transitional Cell Carcinoma of the Bladder
Authors: Casetta G. , Gontero P. , Zitella A. , Pelucelli G. , Formiconi A. , Priolo G. , Martinasso G. , Mengozzi G. , Aimo G. , Viberti L. , Tizzani A.
Published: April 2003

Purpose: Both BTA TRAK and NMP22 urine concentrations have shown a sensitivity superior to urine cytology in the detection of bladder cancer. We compared these tumor markers with urine cytology performed on 3 consecutive samples and evaluated by an expert cytopathologist. Patients and Methods: The investigations were conducted on 94 patients undergoing a diagnostic cystoscopy for a high suspicion of bladder cancer (group 1) and on 102 patients with previous history of transitional cell carcinoma awaiting a follow-up cystoscopy (group 2). Biopsy specimens were obtained also from tumor negative patients. Immunoassays for BTA TRAK and NMP22 were carried out according to standard methods. The choice of the cut-off was based on the ground of sensitivity and specificity curves intersection. Urine cytology results were expressed as positive, negative and ‘dubious’. Results: Overall sensitivity was 56% for NMP22 (cut-off 11 U/ml) and 57% for BTA TRAK (cut-off 60 U/ml). When dubious results were considered as positive cases, urine cytology achieved a sensitivity of 73.3%. Assuming dubious cases as negative results, urine cytology sensitivity resulted 59.3%. When the 2 groups of patients were evaluated separately with different cut-off, there was no significant gain in sensitivity for BTA TRAK and NMP22 over urine cytology. Conclusions: Urine cytology performed on 3 samples showed the highest sensitivity and specificity. The diagnostic advantage of urine cytology over BTA TRAK and NMP22 was maintained when patients were stratified by tumor grade.
Cystic Leiomyosarcoma of the Kidney: An Unusual Clinical Presentation
Authors: Dominici A. , Mondaini N. , Nesi G. , Travaglini F. , Di Cello V. , Rizzo M.
Published: April 2003

Primary sarcomas of the kidney are rare, accounting for 1–3% of all renal malignancies. We describe an unusual case of renal leiomyosarcoma in a 41-year-old white woman who presented with a large smooth mass, which was mobile to the overlying structures and which occupied the right hypochondria and flank. Radical nephrectomy was carried out and the patient is well, without symptoms of relapse, 1 year after surgery. Leiomyosarcomas of the kidney have an aggressive and rapidly progressive natural history, with 5-year survival rates of 29–36%. Size <5 cm, low histological grade, absence of lymph node metastases and radical surgical treatment are all associated with a better prognosis. Irradiation and chemotherapy do not appear to alter the clinical course.
What Is the Nature of Multisensory Interaction between Octavolateralis Sub-Systems?
Authors: Braun Christopher B. , Coombs Sheryl , Fay Richard R.
Published: April 2003

The octavolateralis system consists of several submodalities, including the inertial-sensitive inner ear, the pressure-sensitive ear/air cavity complex (when present), and acceleration- and velocity-sensitive components of the lateral line system (canal and superficial neuromasts, respectively). All four of these channels are responsive to many of the same stimulus sources, particularly moving or vibrating objects within a short distance from the receiver. We therefore argue that the octavolateralis system is an excellent model for the study of multisensory interactions. We focus on the possible ways in which these channels may contribute to source localization mechanisms and to the multisensory guidance of behaviors with strong directional components (e.g., predator avoidance, prey capture and mate attraction). Finally, we define four ways in which information from multiple senses might interact. These include fractionation, synergy, accessory stimulation, and complementation. Although evidence for all types of octavolateralis interactions can be found, the primary modes of interaction appear to be complementation and fractionation. For example, the inertial and pressure-sensitive submodalities of the auditory system provide complementary pieces of information about the direction (e.g., left/right) and polarity (advancing or receding) of a moving source. In contrast, the lateral line canal system subserves short-range localization tasks, whereas the auditory system may subserve longer-range detection and localization tasks.
Molecular Chaperones and Their Roles in Neural Cell Differentiation
Authors: Calabrese V. , Scapagnini G. , Ravagna A. , Giuffrida Stella A.M. , Butterfield D.A.
Published: April 2003

During the development of the nervous system, a large number of neurons are eliminated through naturally occurring neuronal death. Many morphological and biochemical properties of such dying neurons are reminiscent not only of apoptosis, a type of death involving the action of genetically programmed events, but also of epigenetic phenomena such as oxidative stress. Increasing evidence demonstrates that oxidative stress alters the expression of antioxidant enzymes and enhances expression and/or DNA binding of numerous transcription factors, including heat shock factor. The latter is a transcription factor for specific promoter elements located upstream of the heat shock genes. Heat shock proteins (Hsps) are essential, highly conserved proteins that are needed for normal cell growth and maintenance, and expression of Hsps has been detected during embryogenesis in various organisms. Developmental profiles of Hsps indicate that they are differentially regulated during neural maturation, suggesting a role for Hsps in neural cell differentiation. Their putative function in cell remodeling during migration and differentiation, as well as during postnatal development, a time of extensive cell differentiation, is considered in the present review. Moreover, the function of Hsps in cell signaling, protein transport and the effect of heat shock on neural plate induction and brain development are discussed.
Left Ventricular Hypertrophy in Hypertension
Authors: Liebson Philip R.
Published: April 2003

Left ventricular hypertrophy (LVH) is a strong risk factor for cardiovascular events. It is present in a substantial percentage of persons with hypertension and accounts for an increased risk for sudden cardiac death, coronary heart disease and heart failure. LVH remodeling patterns are associated with characteristic hemodynamic effects and variable prognosis. Although early studies of LVH relied on electrocardiography, echocardiography is now the clinical and research standard in virtually all studies of left ventricular (LV) structure and function in hypertension and effects of therapeutic intervention. LV mass itself is indexed by some measure of body size to standardize measurement results. Clinical trials evaluating regression of LV mass following treatment of hypertension depend upon accurate test-retest reliability of sonography and reader interpretation. The design of such studies should take into account the diversity of participant demographics, have treatment groups of an adequate size, encompass a study period of at least 1 year to interpret results adequately and have a randomized double-blind design of comparison groups. Regression of LV mass as a surrogate end point for an adverse outcome event in prognostic studies requires evidence of a strong incremental association between LVH and the outcome.
Decreased CD4 Lymphocyte Count as a Marker Predicting High Mortality Rate in Managing ANCA Related Rapidly Progressive Glomerulonephritis
Authors: Furuta Takashi , Hotta Osamu , Horigome Ikuo , Chiba Shigemi , Noshiro Hiroo , Miyazaki Mariko , Satoh Mitsuhiro , Honda Satoko , Taguma Yoshio
Published: April 2003

As antineutrophil cytoplasmic antibody positive rapidly progressive glomerulonephritis (ANCA-RPGN) has a high risk of end stage renal failure and is a potentially life threatening disease, early aggressive therapy is recommended. However, aggressive immunosuppressive therapy may lead to immunodeficiency and subsequent mortality in the patients with this disease. Therefore, we need the index of immunodeficiency to cure the disease. To evaluate any risk factors, including therapies, on mortality in ANCA-RPGN, we conducted a retrospective investigation on patient survival in 32 patients with ANCA-RPGN by Kaplan-Meier analysis and the Cox regression model. Fourteen patients were treated with leucocytapheresis (LAP group) and the 18 patients were treated by steroid pulse therapy (steroid pulse group) as initial treatment. The patients were chosen for the different therapies at random. Two patients in the LAP group, and eight patients in the steroid pulse group had died within 6 months. The lymphocyte counts and CD4 cell counts after complete course of therapy were lower in the patients who died than in those who survived in the steroid pulse group. Patient survival was higher in the LAP group than in the steroid pulse group, but did not reach statistical significance. Multivariate Cox regression analysis showed that the factors influencing patient survival were initial serum creatinine, LAP therapy, CD4 cell counts, and lymphocytes at the end of treatment. Age, titer of MPO-ANCA, and percent of glomerular crescents were not found to have an effect on the patient survival. We recommend: that early diagnosis should be established, and immunosuppressive therapy may be done with monitoring of the lymphocyte and CD4 cell count.
Acute Renal Failure due to a Calculus Obstructing a Transplanted Kidney
Authors: Fabbian Fabio , Catalano Carlo , Rizzioli Emanuela , Normanno Marcella , Conz Piero Antonio
Published: April 2003

Nephrolithiasis is a rare finding in kidney transplantation and anuria could be the only clinical sign. We report the case of a 52-year-old Caucasian male renal transplant recipient admitted due to acute renal failure (ARF) and anuria. He reported no symptoms and a palpable bulge in the right iliac fossa corresponding to the graft was present. Ultrasonography showed hydronephrosis of the graft. A double-J ureteral stent was inserted with resolution of ARF. ARF with anuria and the presence of a palpable non-tender, elastic mass over the graft could be the clinical picture of obstructive ARF in a transplanted kidney.
Association of Interleukin-1 Receptor Antagonist Gene Polymorphism with IgA Nephropathy
Authors: Watanabe Makoto , Iwano Masayuki , Akai Yasuhiro , Kurioka Hideyuki , Nishitani Yoshiharu , Harada Koji , Hamano Kazumasa , Shiiki Hideo
Published: April 2003

It is evident that cytokines play an important role in the pathogenesis as well as disease progression of IgA nephropathy (IgAN). Several gene polymorphisms of the pertinent cytokines have an influence on the level of cytokine production. Interleukin-1 receptor antagonist (IL-1ra) gene polymorphism has been found to affect disease susceptibility and activity in several inflammatory diseases. In the present study, we analyzed polymorphism of the variable number tandem repeat (VNTR) of IL-1ra in patients diagnosed as having IgAN (n = 106) and normal controls (n = 74). The allele frequency of IL-1ra polymorphism in IgAN patients was not statistically different from that of the control group. There was no significant difference in the carriage rate of the two-repeat allele (IL1RN*2) between IgAN patients and the control group (8.5 vs. 6.8%). The carriage rate of IL1RN*2 was significantly higher in IgAN patients with severe proteinuria (≧1.6 g/day) or increased serum creatinine level (≧2.0 mg/dl; p < 0.05). Furthermore, the carriage rate of IL1RN*2 was significantly higher in patients with severe mesangial cell proliferation (p < 0.01). Our results suggest that IL-1ra polymorphisms are not associated with the development of IgAN in Japanese patients but the presence of IL1RN*2 may be associated with increased disease activity.
Effects of a Long-Term Pharmacological Interruption of the Renin-Angiotensin System on the Fibrinolytic System in Essential Hypertension
Authors: Sakata Kazuyuki , Pawlak Roberts , Urano Tetumei , Takada Akikazu
Published: April 2003

To assess the effects of pharmacological interruption of the renin-angiotensin system on the fibrinolysis, tissue plasminogen activator antigen (t-PA), plasminogen activator inhibitor-1 antigens (PAI-1) and neurohormones, such as plasma renin activity, norepinephrine, angiotensin II (AII) and IV (AIV) concentrations, were measured in 60 hypertensives. Among them, 48 patients were divided into two groups (25 with 10–20 mg quinapril and 23 with 50–100 mg losartan) who received the drug for 6 months. AII had a weak positive correlation with free PAI-I (n = 60, r = 0.26, p < 0.05) whereas AIV had a strong positive correlation with free PAI-I (n = 60, r = 0.57, p < 0.0001). In both treatment groups, blood pressures were significantly reduced to similar levels after drug treatment. While plasma renin activity increased significantly in both groups after drug treatment, only the losartan group showed significant increases in AII and AIV concentrations. In the quinapril group, there was a significant change in t-PA (p < 0.001) without changes in PAI-1. In the losartan group, free PAI-I and total PAI-I (p < 0.05 for free PAI-I and p < 0.04 for total PAI-I) were significantly increased without a change in t-PA. Thus, quinapril enhanced fibrinolysis but losartan attenuated it. These unique effects of each drug on the fibrinolytic system appear to be associated with changes in AII and AIV concentrations.
Experience with ICD-10/DSM-IV Substance Use Disorders
Authors: Rounsaville Bruce J.
Published: April 2003

‘Substance Use Disorders’ represents a diagnostic subgroup in which ICD-10 and DSM-IV agree in most generalities and many particulars. Both systems’ use disorders are based on the ‘dependence syndrome’ construct by Edwards and Gross and include a large and overlapping set of substance-induced syndromes. Differences at the category level are limited to DSM-IV ‘abuse’ vs. ICD-10 ‘harmful use’, elimination of ‘pathological alcohol intoxication’ from DSM-IV and inclusion of substance-induced ‘sexual dysfunctions and sleep disorders’ in DSM-IV, but not in ICD-10. Cross-system reconciliation would entail few conceptual compromises but many criterion changes. Before embarking on a reconciliation process, the benefits of a common, world-wide nomenclature must be weighed against the many costs of changing either system. Even small changes can yield large differences in rates, reduce comparability across data gathered with different systems and incur considerable costs related to clinician retraining, changes in record keeping and changes in diagnostic interview schedules. Moreover, empirical data can have limited impact on the choices between the two systems because findings are either absent or equivocal, particularly for differences at the criterion level. Nevertheless, more research is needed particularly to examine the comparative reliability and validity of abuse and harmful use diagnoses.
Medikamentöser Schwangerschafts-abbruch mit Mifepriston und Misoprostol
Authors: Schwendke A. , Zarkadas M. , Alder J. , Horner E. , Bitzer J. , Holzgreve W.
Published: April 2003

Fragestellung: Diese prospektive Studie erfasst die Wirksamkeit und somatische Verträglichkeit der medikamentösen Abruptio mit Mifepriston und Misoprostol sowie das Erleben der verschiedenen Phasen des Abbruchs. Des weiteren wurde der subjektive Einfluss der Beratung und Begleitung auf das Erleben und die psychischen Auswirkungen des Abbruchs geprüft. Methode: Alle somatischen Daten der Patientinnen, die vom 1. Dezember 1999 bis 31. Oktober 2000 eine medikamentöse Abruptio erhielten, wurden durch Krankenakten erfasst. Das Erleben der Abruptio wurde mittels eines Fragebogens unmittelbar danach und eines strukturierten telefonischen Interviews 6 Monate später erfragt. Ergebnisse: Die medikamentöse Abruptio mit Mifepriston und Misoprostol was bei 95,2% der Patientinnen erfolgreich. Die Beratung bewerteten 90,4% als sehr gut bzw. gut, die Begleitung 73,7% der betroffenen Frauen als gut. Psychisches Wohlbefinden wurde von 95,5% der Frauen 6 Monate danach angegeben. Schlussfolgerungen: Eine medikamentöse Abruptio mit Mifepriston und Misoprostol war bei 95,2% der Patientinnen erfolgreich. Das von uns entwickelte Betreuungskonzept wurde von den betroffenen Frauen insgesamt sehr positiv bewertet.
Differentialdiagnose benigner und maligner Mammaläsionen in der Mammographie unter besonderer Berücksichtigung der BI-RADS®-Klassifikation
Authors: Boehm Thomas , Garzoli Elisabeth , Marincek Borut
Published: April 2003

Die Mammographie ist die Methode der Wahl sowohl für das Screening auf Mammatumoren als auch für die Diagnostik symptomatischer Patienten. Für einen erfolgreichen Einsatz der Methode in beiden Gebieten bedarf es einer konsequenten Qualitätssicherung. Physikalisch-technisch ist diese Qualitätssicherung durch entsprechende Normen und Protokolle relativ einfach zu erreichen. Auf dem Gebiet der mammographischen Befundung ist eine Standardisierung Voraussetzung für einen Erfolg. Die vorliegende Übersichtsarbeit stellt das vom American College of Radiology entwickelte und vermarktete BI-RADS®-System zur standardisierten mammographischen Befundung vor, enthält ausgewählte Bildbeispiele für Verkalkungen und Herdbefunde und diskutiert die Existenzberechtigung dieses Ansatzes.
Thalassaemia Carrier Testing in Pakistani Adults: Behaviour, Knowledge and Attitudes
Authors: Ahmed Shenaz , Bekker Hilary , Hewison Jenny , Kinsey Sally
Published: April 2003

Objectives: To describe β-thalassaemia (thalassaemia) carrier testing behaviour (whether tested or intentions of testing) amongst a sample of UK Pakistani adults; their level of knowledge about thalassaemia, and their attitudes toward thalassaemia carrier testing. Method: In a cross-sectional design semi-structured interviews, data were obtained from 59 Pakistani adults including 19 parents of children with thalassaemia; 20 of their relatives, and 20 ‘lay’ adults. The outcome measures include: knowledge of thalassaemia and genetic inheritance, carrier testing behaviour, attitudes toward carrier testing and source of information about thalassaemia. Results: Knowledge about carriers and inheritance of thalassaemia was low. Intention to have carrier testing was low in those participants who had not been tested. Participants generally had positive attitudes toward carrier testing. Relatives and lay adults most frequently identified a thalassaemia family member as their source of information about thalassaemia, and only seven parents identified ‘a health service source’ as their source of information. Conclusion: Pakistani adults have insufficient knowledge to be aware of their risk of carrying a gene that may result in the birth of a child with thalassaemia. This finding may explain in part why intention to have carrier testing was low. Although thalassaemia is discussed in families where the disease is present, it is unlikely that information about its inheritance is discussed. Further empirical evidence is needed to improve the quality of information disseminated by both professionals and non-professionals to ensure Pakistani adults are able to make informed decisions about carrier testing, prenatal diagnosis and termination of pregnancy.
Host Genetic Factors in the Clinical Course of HIV-1 Infection: Chemokines and Chemokine Receptors
Authors: van Rij Ronald P. , Schuitemaker Hanneke
Published: April 2003

The outcome of HIV-1 infection is highly variable: not all individuals exposed to HIV-1 will become infected, and among individuals who do become infected, the time from seroconversion to AIDS diagnosis is highly variable. Some patients may develop AIDS within 3 years, whereas others may remain asymptomatic for over 15 years. The reasons for these differences are not fully understood, but are thought to reflect the complex interactions between virus and host. In recent years, an important role for host genetic factors in the pathogenesis of HIV-1 infection has increasingly been appreciated. Many novel genetic polymorphisms have been identified and analyzed for their role in HIV-1 transmission and disease progression. In this review, we will give an update of the current knowledge on the role of such polymorphisms in HIV-1 disease. As recent research in this field has focussed on polymorphisms in chemokine and chemokine receptor genes, this will be the main theme of our review.
Pepsin-Resistant 16-kD Buckwheat Protein Is Associated with Immediate Hypersensitivity Reaction in Patients with Buckwheat Allergy
Authors: Tanaka Kazuko , Matsumoto Kenji , Akasawa Akira , Nakajima Toshiharu , Nagasu Takeshi , Iikura Yoji , Saito Hirohisa
Published: April 2003

Background: Buckwheat is becoming popular in many countries as a health food and the incidence of buckwheat allergy is increasing in Asia. The ingestion of small amounts sometimes provokes an anaphylactic reaction. However, it remains controversial which is the major allergen responsible for such reactions. Methods: The patients whose sera are positive for buckwheat-specific IgE antibody measured by the CAP system fluorescein-enzyme immunoassay (CAP-FEIA) were classified into two subgroups depending on the history of immediate hypersensitivity reactions (IHR). Major buckwheat allergens were identified with immunoblotting, ELISA and N-terminal amino acid sequencing. Various treatments such as pepsin digestion were added to characterize the proteins. Results: We found that the 24-kD protein that had previously been reported to be a major allergen reacted to IgE antibodies present in sera from almost all subjects (19/20) regardless of symptoms. On the other hand, 16- and 19-kD proteins were bound with IgE antibodies present in sera from 9 of the 10 patients with IHR including 8 patients with anaphylaxis but not in sera from buckwheat-specific IgE-positive subjects without IHR. After pepsin treatment, the 16-kD protein but not the 19- and 24-kD proteins remained undigested and preserved the capacity of IgE binding. This pepsin-resistant 16-kD protein had no homology with the 24-kD protein by the N-terminal amino acid sequencing. Conclusions: The 16-kD buckwheat protein was resistant to pepsin digestion and appeared to be responsible for IHR including anaphylaxis, while the pepsin-sensitive 24-kD protein was responsible for CAP-FEIA but not IHR.
Characterization and Immunobiology of House Dust Mite Allergens
Authors: Thomas Wayne R. , Smith Wendy-Anne , Hales Belinda J. , Mills Kristina L. , O’Brien Richard M.
Published: April 2003

The examination of house dust mite extracts has indicated that over 30 different proteins can induce IgE antibody in patients allergic to the house dust mite. There are however dominant specificities especially the group 1 and 2 allergens which can account for much of the allergenicity of extracts. Of the 19 denominated allergens, the major IgE binding has been reported for the group 1, 2, 3, 9, 11, 14 and 15 allergens. The high-molecular-weight group 11, 14 and 15 allergens have only recently been described and although high IgE binding has been anticipated from immunoblotting, there is a need for considerable corroboration. Similarly, the study of the group 3 and 9 serine protease allergens has been incomplete. The group 4, 5, 7 and 8 allergens have shown intermediate IgE binding and the group 10 tropomyosins are of interest because of their potential cross-reactivity with allergen from disparate species. Although the progress with the production of recombinant group 1 allergens has been recent, many of the allergens can be produced as high IgE-binding polypeptides. The tertiary structure of the group 2 allergens has been determined from recombinant proteins and they are an excellent model for the investigation of modified allergens. An unexpected property of the group 1, 2 and 3 allergens has been the high degree of polymorphism found by cDNA analysis. It has however been possible to identify sequences to represent the variation in the natural allergens. The group 7 and 14 allergens show secondary modifications which vary in different extracts creating batch variation. While some estimate of the importance of allergens can be obtained from IgE binding, few analyses of T-cell responses have been made and these regulate both the development of, and the protection from sensitization.
Comparative Anatomy of the Paratympanic Organ (Vitali Organ) in the Middle Ear of Birds and Non-Avian Vertebrates: Focus on Alligators, Parakeets and Armadillos
Authors: Neeser Jason A. , von Bartheld Christopher S.
Published: April 2003

The paratympanic organ (PTO) in the middle ear has been described in numerous bird species, but little is known about the distribution of this presumed lateral line remnant in other vertebrate classes. Here we provide evidence for a PTO in juvenile alligators, and make the first detailed description of its location and relation to ligaments in the reptilian middle ear. The alligator PTO measures about 450 µm in diameter. The alligator PTO contains hair cells whose cilia extend into a mucous substance within the lumen. The PTO connects though a ligament to the ear drum, suggesting that pressure onto the tympanic membrane might induce fluid movement in the PTO. Labeling of innervating nerve fibers with the fluorescent dye, DiI, indicates that the alligator PTO is connected with the vestibular brainstem. Because all bird species examined possess a PTO except for owls and possibly parakeets, we verified the absence of a PTO in parakeets by examination of serial sections combined with GABA immunolabeling for potential hair cells. Bird species with significant upper beak movement lack a PTO, suggesting that PTO function is incompatible with upper beak movement. We also examined the middle ear of an armadillo, a mammal that has a very basal position within the eutherian phylogenetic tree. A small vesicle with ciliated cells was found, but did not label with a hair-cell specific marker, antibodies to myosin VIIa, and thus is not likely to represent a true PTO. Our evidence for a PTO in a non-avian species, the alligator, together with previous reports suggesting the presence of a PTO in some mammals, indicates that ancestral stem amniotes possessed a PTO, and that the PTO was not a de novo invention of birds.
Self-Management of Oral Anticoagulants with a Whole Blood Prothrombin-Time Monitor in Elderly Patients with Atrial Fibrillation
Authors: Eldor Amiram , Schwartz Joseph
Published: April 2003

The efficacy of oral anticoagulants (OAC) in reducing the incidence of stroke in elderly patients with atrial fibrillation (AF) has been well documented. The intensity of OAC therapy and deviations in the prothrombin time (PT) are the strongest risk factor for bleeding complications in elderly patients. The aim of this study was to evaluate a more rigorous regulation of OAC by the use of a portable whole blood PT-monitor (CoaguChek) in elderly patients with AF (age 65–80 years). The study group consisted of 20 patients, of whom 17 were evaluable , which were trained to use to CoaguChek monitor and adjust their anticoagulant dose for 12 months. The control group, 20 patients matched for age, gender and the duration of OAC treatment, were tested in an anticoagulant clinic and their OAC dose was adjusted by a physician. To validate the PT-monitor results, the patients performed a total of 129 simultaneous venous blood PT tests at various time points. The correlation coefficient R2 was 0.707 indicating the accuracy of the CoaguChek results. The self-managed patients perform more frequent measurements 46 ± 8.9 vs. 15.7 ± 3.1 PT tests per patient. They demonstrated a within the therapeutic range INR in 80.5% of the tests (95% confidence interval, 76.5–84.1%) as compared to 72.4% (95% confidence interval, 68.5–76.5%) in the control group (p = 0.057). The median value for all CoaguChek International Normalized Ratio (INR) recordings was within therapeutic range in the self-management group as well as in the control group. There were fewer INR results below or above the therapeutic range in the study group. None of the patients had hemorrhagic or thrombotic events during the study. Overall, the study group expressed high satisfaction from using the home monitor. We conclude that home PT monitoring and self-management of OAC are feasible in a motivated population of elderly patients with atrial fibrillation and are probably cost effective.
Relation between Interdialytic Weight Gain, Body Weight and Nutrition in Hemodialysis Patients
Authors: Ifudu Onyekachi , Uribarri Jaime , Rajwani Imran , Vlacich Vera , Reydel Kathy , Delosreyes Georgina , Friedman Eli A.
Published: April 2003

Background: Though interdialytic weight gain (IDWG) is used as an index of fluid and dietary compliance among hemodialysis patients, neither its clinical correlates nor an actual ‘normal range’ is established. Consequently, clinicians impose uniform dietary and fluid restrictions to limit IDWG, hoping to avoid symptomatic intravascular volume overload. Methods: We studied 309 stable hemodialysis patients over a 3-month period to determine the spectrum of their IDWG and the relation between IDWG, dry weight, nutritional and demographic parameters. Results: Mean IDWG was 2.8 ± 1.2 kg (range –0.8 to 8.2 kg). Dry weight had a direct correlation with actual IDWG (r = 0.31; p = 0.001) but an inverse correlation with percent IDWG (r = –0.25; p = 0.001). IDWG was less in older patients (r = –0.34; p = 0.001) even after adjustment for dry weight. Actual IDWG was greater in men than women (3.1 ± 1.2 vs. 2.5 ± 1.2 kg, p = 0.001), but was equivalent after adjustment for dry weight (men 4.2 ± 1.8%; women 3.9 ± 1.9%, p = 0.1). Hematocrit (r = 0.14; p = 0.02) and serum creatinine concentration (r = 0.18; p = 0.02) had direct correlations with IDWG. Conclusions: We conclude that IDWG in hemodialysis patients is proportional to body weight. Differences in body weight explain excess IDWG in men but not in younger hemodialysis patients. Fluid and dietary restrictions in hemodialysis patients should be individually prescribed as opposed to a fixed amount irrespective of body weight.
Spontaneous Improvement of the Renal Function in a Patient with HIV-Associated Focal Glomerulosclerosis
Authors: Morales Enrique , Martinez Alfonso , Sánchez-Ayuso Javier , Gutierrez Eduardo , Mateo Salvador , Martínez Miguel Angel , Herrero Juan Carlos , Praga Manuel
Published: April 2003

Collapsing glomerulopathy is a pattern of renal injury that is seen in association with human immunodeficiency virus (HIV) infection. Patients with this HIV-associated nephropathy (HIVAN) present nephrotic syndrome and rapid deterioration of the renal function. There is no proven effective therapy for HIVAN, and the majority of the patients become dialysis dependent. We report a case of biopsy-proven HIVAN that showed spontaneous improvement of the renal function.