bluuebunny/crossref_metadata_2025 huggingface dataset:
Age-Related Changes of Postural Control: Effect of Cognitive Tasks
Authors: Melzer I. , Benjuya N. , Kaplanski J.
Published: April 2003

Background: Postural control and falls in the elderly constitute a major health problem. The interest in balance deficits is growing, as concern about the rising costs of health care increases. This issue is particularly relevant to the elderly population in which falls occur most frequently. Postural control in the elderly was studied using a cognitive approach. Objective: The purpose of this study was to study the characteristics of central processing of postural control while performing cognitive tasks. Methods: A dual-task procedure was developed to estimate the level of automaticity of a quiet upright standing task. The effect of a concurrent attention-demanding task (modified Stroop test) on the efficiency of balance control in the elderly was determined using force platform and electromyography measurements. Results: It was found that there is an increase in postural sway in old subjects compared with young subjects when performing single tasks and dual-task tests. The results of the study demonstrate that postural adjustments require cognitive processing; young and old subjects showed similar interference effects on postural steadiness (postural sway) caused by the concurrent attention-demanding task. The results are corroborated by the hypothesis that a dual task gives information on the restoration of automaticity of postural control in old age by a central reorganization process. When performing a dual task tested on a narrow base of support, the old subjects decreased their body sway, while the younger did not. According to electromyography measurements, the older subjects increased their muscle activity in the tibialis anterior and soleus muscles, using slow-twitch motor units compared with the younger subjects. Conclusions: Both alterations (cognitive and base of support) have a substantially greater effect on the elderly than on the young. The older subjects decreased their body sway by activating a cocontraction strategy of postural control around the ankle joint, probably because of the danger to their postural stability.
Antiviral Activity of Amantadine in Elderly Patients with Chronic Hepatitis C
Authors: Torre F. , Campo N. , Giusto R. , Ansaldi F. , Icardi G.C. , Picciotto A.
Published: April 2003

Background: Hepatitis C virus (HCV) infection is a worldwide problem of public health. Epidemiological studies have shown a significant higher prevalence of infection in the elderly. Amantadine is an antiviral agent active against the influenza A virus that has been used in cases of chronic hepatitis C. Objectives: To evaluate the antiviral activity and the safety of amantadine (200 mg daily for 6 months) in elderly patients with chronic hepatitis C. Methods: The study group consisted of 23 consecutive patients over 65 years suffering from chronic hepatitis C. Aminotransferase (ALT) levels were tested at baseline, at 15 days and then monthly until the end of therapy. HCV genotype was determined at baseline. A quantitative HCV-RNA measurement was performed at baseline, at 15 days and at the 1st, 3rd and 6th month of treatment. Results: 13 males and 10 females were enrolled (mean age 70.1 ± 3.4 years; range: 65–75). The mean ALT levels did not change significantly during therapy except in 1 patient subsequently returned normal. The HCV-RNA remained detectable in all patients, but a significant difference in response was observed in patients infected by genotype 1b. Conclusions: Our results confirm the antiviral activity of amantadine against HCV, mainly for genotype 1b with initial high viral load. No consistent effects on aminotransferases were observed.
A Comparative Study of Two Psychometric Approaches to Detect Risk Status for Dementia
Authors: Raykov Tenko , Baltes Margret M. , Neher Karl M. , Sowarka Doris
Published: April 2003

This study results from an effort to examine the relationship between the diagnostic potentials for detecting risk status for dementia of a cognitive plasticity approach and a traditional status-oriented procedure (test battery) by Storandt et al. [Arch Neurol 1984;41:497–499]. The aim is to compare prediction accuracy for risk for developing dementia with these two approaches. A sample of 106 community-dwelling elderly adults were tested with both procedures, and their scores on the Structured Interview for the Diagnosis of Dementia used as external criterion for predicting risk status. The findings show that figural relations pretest and training gains account for a considerable amount of individual differences in mental status similar to that explained by the traditional test battery. In addition, the accuracy of discrimination between healthy and at-risk participants appears slightly higher when using the figural pretest and training gains. These results suggest the conclusion that use of figural relations tests and the cognitive plasticity approach represents a viable alternative to the traditional, status-oriented test battery as a means of early diagnosis of dementia in nonclinical populations.
How Should We Approach the Management of Pelvic Pain?
Authors: Walker James J. , Irvine Gillian
Published: April 2003

Pelvic pain is a common debilitating condition. Most investigations are invasive, expensive and usually negative. Although a positive diagnosis of endometriosis justifies a recognized treatment programme, the majority of women with negative investigations are left without a diagnosis and often accused of psychological abnormalities. The reasons for the negative investigations are just as likely to be due to the inadequate techniques of the operator as the lack of pathological signs. The early use of menstrual suppression with GnRH analogue allows pain relief sooner in the majority of sufferers and separates those with pain related to the menstrual cycle, from whatever cause, from those whose pain is not related to pelvic physiology and who would not benefit from further medication or operative therapy. The majority, who have obtained relief from the analogue therapy, then have time to discuss alternative long-term treatments without the feeling of desperation that chronic monthly pelvic pain can produce.
Distribution of Study Designs in Four Major US Journals of Obstetrics and Gynecology
Authors: Funai Edmund F. , Rosenbush Emily J. , Lee Men-Jean , Del Priore Giuseppe
Published: April 2003

Objective: To classify and compare articles, based on the study design, in four leading US obstetrics and gynecology journals. Methods: One year of each journal, American Journal of Obstetrics and Gynecology (AJOG), Obstetrics and Gynecology (O&G), Gynecologic Oncology (GO), and Fertility and Sterility (F&S), beginning May 1997, was reviewed. Supplementary issues were excluded from review. The percentage of articles devoted to observational versus experimental study design was determined, and the quality of evidence was assessed including how heavily randomized controlled trials were represented versus other study designs. Results: 1,517 articles were reviewed. The average percentage of clinical research articles was 90.4. The percentage of animal studies were 10.7 (AJOG), 1.1 (O&G), 1.1 (GO) and 4.2 (F&S) (χ2 p < 0.001). There were 5.3, 1.9, 6.5, and 7.5% basic science articles, respectively (χ2 p = 0.007). The average percentage of observational articles was 68.2 and that of experimental articles was 14.1. The percentages of total articles classified as controlled experimental were 10.9 (AJOG), 14.6 (O&G), 5.1 (GO), and 15.2 (F&S) (χ2 p = 0.01). There were 8.7, 11.1, 3.3 and 9.5% randomized controlled trials, respectively (χ2 p = 0.008). Conclusions: The majority of research reviewed was clinical, and more than half of the articles were observational. Under the US Preventative Services Task Force rating system, the randomized control trial is given the highest rating – class I evidence. The drive toward evidence-based clinical practice may not be fully supported by researchers in obstetrics and gynecology, as reflected by submissions to and publications in the major obstetrics and gynecology journals.
Maternal Plasma Leptin Levels and Their Relationship to Insulin and Glucose in Gestational-Onset Diabetes
Authors: Vitoratos N. , Salamalekis E. , Kassanos D. , Loghis C. , Panayotopoulos N. , Kouskouni E. , Creatsas G.
Published: April 2003

To investigate the changes in leptin levels and the relationship between this substance and insulin and glucose in pregnant women with gestational-onset diabetes, we measured plasma leptin levels in the maternal peripheral vein of 17 healthy and 17 diabetic women at 29 and 33 weeks of gestation. We also correlated maternal plasma leptin levels in diabetic women with fasting plasma insulin levels and plasma glucose levels obtained 1 h after oral administration of 50 g of glucose. Maternal serum leptin levels in women with gestational diabetes (mean ± SD 16.52 ± 5.07 ng/ml, range 10.84–27.4 ng/ml) were significantly higher (p < 0.001) than those found in uncomplicated pregnancies (10.61 ± 1.47 ng/ml, range 7.28–13.4 ng/ml). A positive correlation was found between maternal serum leptin levels and glycosylated haemoglobin values in diabetic pregnant women (r = 0.94, p < 0.001). A positive correlation was also found between maternal leptin concentrations and fasting serum insulin levels, as well as between leptin concentrations and plasma glucose levels obtained 1 h after the administration of 50 g of glucose in women with gestational diabetes (r = 0.84, p < 0.001, and r = 0.92, p < 0.001, respectively). We conclude that leptin levels are elevated in pregnant women with gestational diabetes, and its metabolism depends on insulin levels and the severity of diabetes.
Doppler Flow Velocity Waveforms and Vasoactive Effects of Serotonin in Human Umbilical Arteries
Authors: Haugen Guttorm , Rognerud Halvor
Published: April 2003

The vasoactive effect of serotonin was investigated by in vitro perfusion in human umbilical arteries in which antenatal Doppler ultrasound examination revealed abnormal velocity waveforms. The results were compared to those obtained in preparations from normotensive uncomplicated term pregnancies as well as from preterm deliveries in which antenatal Doppler ultrasound examination showed normal velocity waveforms related to gestational age. Serotonin induced a monophasic vasoconstriction or a biphasic pressure response with a transient pressure decrease succeeded by a constrictory response. In all groups serotonin induced a significant (p < 0.001) constrictory response, whereas no significant differences were observed between the groups. At a serotonin dose of 10–7 mol/l, the frequency of preparations with a biphasic pressure response was significantly smaller in the preparations with abnormal diastolic flow as compared to the term control group (5/18 vs. 13/19, p = 0.02), but not significantly different from that of the preterm control group (3/9). The umbilical arterial responsiveness to serotonin does not seem to be dependent on antenatal Doppler velocity waveforms.
Prognostic Importance of the Nucleolar Organizer Region Score in Ovarian Epithelial Tumors
Authors: Zergeroglu Sema , Aksakal Orhan , Demirtürk Fazli , Gökmen Oya
Published: April 2003

Objective: The score of the silver-stained nucleolar organizer region (AgNOR) is frequently found to be high in malignant tumors. We studied AgNOR in ovarian epithelial tumors diagnosed in our hospital between 1993 and 1998. Materials and Method: In our study 67 ovarian epithelial tumors (18 cystadenoma, 16 borderline type, 34 cystadenocarcinoma) were stained using the method previously described by Crocker. One-way ANOVA and logistic regression tests were used to find the statistical relationship between grade, recurrence, mortality rates and AgNOR scores in tumors (p values of <0.05 were considered statistically significant). Results: The mean AgNOR scores of 28 mucinous and 39 serous ovary tumors were calculated. The lowest AgNOR score of 1.33 was found in cystadenomas and the highest AgNOR score of 4.92 was found in serous and mucinous cystadenocarcinomas. In addition the relationship between mortality rate, recurrence and AgNOR score in carcinomas were studied. Conclusion: AgNOR scores in carcinomas were found to be higher than adenomas, and the highest AgNOR score was found in grade-III carcinomas. This shows that the AgNOR score can be used as a prognostic index in malignancies.
Eclampsia Despite Strict Dietary Sodium Restriction
Authors: Delemarre F.M.C. , Steegers E.A.P. , Berendes J.N. , de Jong P.A.
Published: April 2003

The classic indication for prescribing dietary sodium restriction in pregnancy has been the prevention of eclampsia. We describe a case of intrapartum eclampsia in a 24-year-old nulliparous woman. A strongly sodium restricted diet was prescibed because of pre-eclampsia. Compliance to the diet was checked with 24-hour urinary sodium excretion. This report, describing the first case of eclampsia despite neglectable urinary sodium excretion, adds to the view that sodium restriction in pregnancy is obsolete.
Observed versus Expected Rates of Unbalanced Fetal Karyotype at Second Trimester Amniocentesis when One Parent Carries a Balanced Translocation
Authors: Yaegashi Nobuo , Uehara Shigeki , Maeda Tohru , Fujimori Keiya , Okamura Kunihiro , Yajima Akira
Published: April 2003

Our purpose is to evaluate a model proposed by Stene et al. for estimating the risk of unbalanced progeny at the time of second trimester amniocentesis for 114 pregnancies of 71 couples, who are carriers of a reciprocal translocation. The overall estimated risk was 18%, 1.26 times higher than the observed risk (14%). There were no unbalanced fetuses in the 19 pregnancies of the no-risk group. In the low-risk group, the observed risk was highly correlated with the estimated risk. However, the estimated risks in the medium- and high-risk groups were much higher than the observed risks (2- and 1.5-fold). In the group ascertained through spontaneous abortions, the average estimated risk was 1.9 times higher than the observed risk. Although the model is useful in estimating individual empirical risks, it may be necessary to consider the type of ascertainments and add some modifications to calculate the risks in the second trimester.
Clinical Evaluation of the Q-Tip Test in Normal Pregnant Women
Authors: Nakamura Tetsuo , Ishiko Osamu , Hirai Kouzo , Sumi Toshiyuki , Nakagawa Eri , Nakai Yuichiro , Tomoda Shoji , Ogita Sachio
Published: April 2003

The crisis frequency of stress incontinence (SI) is known to be high among pregnant women. This preliminary study was performed to determine whether the diagnostic standard of the Q-tip test used in the diagnosis of SI in nonpregnant women is applicable to pregnant women. The Q-tip tests were performed regularly during pregnancy and after parturition on primipara (n = 71) and multipara (n = 55) who were not in SI crisis at any time during the pregnancy. The values measured in multipara were significantly higher than in primipara (p = 0.0001), and the tendency to be higher was more prominent at 2–5 months and 10 months of pregnancy. These findings show that different normal values of the Q-tip test are necessary for primipara and multipara.
Association between Polycystic Ovary and Fibrocystic Breast Disease
Authors: D’Amelio R. , Farris M. , Grande S. , Feraudo E. , Iuliano A. , Zichella L.
Published: April 2003

Objective: The aim of this study was to assess whether or not there was an association between a polycystic ovary (PCO) and fibrocystic breast disease based on ultrasound findings, both pelvic and mammographic. Design: Prospective case-control study. Population: Women aged between 18 and 30 years not using oral contraceptives attending the outpatient ultrasound clinic from January 1996 to December 1998. Main Outcome: Confirm the association between PCO and fibrocystic breast disease. Results: According to the ultrasound findings, women were allocated to three groups: 351 out of 456 showed normal-appearing ovaries (group A), 93 had polycystic-appearing ovaries/PCO (group B) and 12 had PCO syndrome (group C). In group A, 24 (6.83%) women showed breast pathology. In group B, there was an association between PCO and breast pathology in 53 (56.98%) women, while in group C it was noted in 11 out of 12 (91%). Conclusion: This study showed a significant association between PCO and benign pathology. This should encourage the performance of a screening breast sonography on women with PCO.
Lipid Peroxidation and Antioxidant Status in Maternal and Cord Blood
Authors: Arikan Serap , Konukoğlu Dildar , Arıkan Çağan , Akçay Tülay , Davas Inci
Published: April 2003

The present study was undertaken to determine the change of blood lipid peroxide and antioxidant status in healthy nonpregnant women (n = 20), pregnant women in the third trimester (n = 20), pregnant women during delivery (n = 26) and fetal cord blood. Plasma and erythrocyte malondialdehyde (MDA) levels were found to be significantly higher and erythrocyte glutathione (GSH) levels were significantly lower in pregnant women in the third trimester than in nonpregnant women (p < 0.02, p < 0.03 and p < 0.001, respectively). The highest plasma and erythrocyte MDA levels and the lowest GSH levels were obtained from the pregnant women during delivery (6.99 ± 2.35 nmol/ml, 283.20 ± 43.81 nmol/g Hb, 6.73 ± 2.34 µmol/g Hb, respectively). Erythrocyte glutathione peroxidase (GSH-P) and glutathione reductase (GSH-R) activities were not different between the groups. Maternal plasma and erythrocyte MDA levels were significantly correlated with cord blood plasma and erythrocyte MDA levels (r = 0.63, p < 0.001, and r = 0.41, p < 0.001, respectively). There was a significant positive correlation in GSH-R and in GSH-P activities between maternal and cord blood erythrocytes (r = 0.81, p < 0.001, and r = 0.79, p < 0.001, respectively). A significant correlation was found between maternal erythrocyte GSH-P and both cord blood erythrocyte GSH-R activities (r = 0.74, p < 0.001) and cord erythrocyte GSH levels (r = 0.73, p < 0.001). There was also a significant negative correlation between maternal erythrocyte MDA and cord erythrocyte GSH-R levels (r = –0.9, p < 0.001). Our results suggest that lipid peroxidation and antioxidant status may be changed during delivery, and these changes may affect the fetus by creating oxidative stress.
Erythropoietin in the Treatment of Iron Deficiency Anemia during Pregnancy
Authors: Sifakis S. , Angelakis E. , Vardaki E. , Koumantaki Y. , Matalliotakis I. , Koumantakis E.
Published: April 2003

The aim of this study was to investigate the efficacy of recombinant human erythropoietin (rHuEPO) combined with parenteral iron, in the treatment of moderate and severe iron deficiency anemia during pregnancy. Twenty-six pregnant women, who had been ineffectively treated with iron supplementation alone for at least 8 weeks, were enrolled. They met the following criteria for inclusion in the study: hemoglobin (Hb) concentration <8.5 g/dl, evidence of iron deficiency anemia, and absence of other pregnancy complications, or severe systemic diseases. The treatment protocol comprised of a combination therapy with 150 IU/kg rHuEPO subcutaneously three times per week and 100 mg parenteral iron daily, for a total period of 4 weeks. Nineteen out of 26 women (73%) showed a quick response, with Hb reaching normal levels within the first 2 weeks of treatment. They displayed an average of 3.17 g/dl increase in Hb concentration during the total period of therapy, with 3.0 g/dl increase within the first 2 weeks. In 5 women (19.2%) there was no significant increase in Hb levels, while in 2 women (7.6%) a further decline in Hb concentration was observed, that necessitated a blood transfusion. In conclusion, rHuEPO combined with parenteral iron is an effective treatment for moderate and severe iron deficiency anemia during pregnancy, with minimal adverse or side effects. It may serve as an alternative to blood transfusion, or in cases of resistant anemia that are not effectively treated by iron supplementation alone. However, further studies are needed to investigate the poor response observed in about 25% of treated patients.
Maternal and Paternal Family History of Diabetes in Women with Gestational Diabetes or Insulin-Dependent Diabetes mellitus Type I
Authors: Harder Thomas , Franke Kerstin , Kohlhoff Rainer , Plagemann Andreas
Published: April 2003

Animal studies have shown that prenatal exposure to a diabetic intrauterine milieu leads to an increased risk in the female offspring of developing gestational diabetes (GD). In the present study, the family history of non-insulin-dependent diabetes mellitus type II (NIDDM) and insulin-dependent diabetes mellitus type I (IDDM) was evaluated in 106 women with GD, as compared to 189 women with IDDM. In GD patients, the prevalence of diabetes was significantly greater in mothers than in fathers (p = 0.03). This was mainly due to a greater prevalence of NIDDM in the mothers (p = 0.05). Furthermore, a significant aggregation of NIDDM was also observed in the maternal-grandmaternal line of GD women, as compared to the paternal-grandpaternal side (p = 0.02). In patients with IDDM no significant difference concerning the prevalence of any type of diabetes between mothers and fathers was observed. In conclusion, an aggregation of NIDDM in mothers and grandmothers of women with GD is reported here. A history of NIDDM on the maternal side of pregnant women should be considered as a particular risk factor for GD and, hence, for intergenerative transmission of NIDDM, which therefore might be prevented, at least in part, by strict avoidance of GD.
Pudendal Nerve Terminal Motor Latency in Women with Genuine Stress Incontinence and Prolapse
Authors: Bakas P. , Liapis A. , Karandreas A. , Creatsas G.
Published: April 2003

The aim of this study was to investigate changes in pudendal nerve terminal motor latency (PNTML) time in women with genuine stress incontinence (GSI) and with or without prolapse, in conjunction with measurement of maximal urethral closure pressure (MUCP). Eighty-five patients participated in the study and they were allocated to one of four groups, including the control group. A statistically significant difference was found in the PNTML time between patients with GSI and patients of the control group. The conduction time in patients with prolapse but no GSI did not show a statistically significant difference compared to the patients of the control group. The MUCP was reduced in patients with GSI, but no cutoff value of MUCP, which is pathognomonic of GSI, could be identified. We conclude that GSI is associated with a prolongation of PNTML time and a reduction in MUCP.
Clinical and Prognostic Significance of Human Papillomavirus in a Chinese Population of Cervical Cancers
Authors: Lo Keith W.K. , Cheung T.H. , Chung Tony K.H. , Wang V.W. , Poon J.S. , Li J.C.B. , Lam Peggo , Wong Y.F.
Published: April 2003

Objective: To investigate the clinical and prognostic significance of human papillomavirus (HPV) in a Chinese population of cervical cancers. Methods: We studied 121 cervical cancer tissue samples from patients treated at our hospital. Identification and typing of HPV were done by polymerase chain reaction (PCR) using consensus primers MY11 and MY09 followed by direct DNA sequencing. The results were correlated with various clinical and prognostic parameters. Results: We found HPV DNA in 95 (78.5%) cases, including HPV-16 in 59 (48.8%) and HPV-18 in 14 (11.6%) cases. χ2 analysis revealed no significant correlation between the presence of HPV DNA and age at diagnosis, clinical stage, histologic type, tumor grading, 2-year and 5-year survival rate. Of the factors evaluated, age at diagnosis and histologic type were found to have a statistically significant relationship with HPV type. The mean age of the HPV-18 group was 48.6 years compared to 57.1 years for the HPV-16 group (p = 0.045) and 58.2 years for the HPV-negative group (p = 0.04). HPV-18 was detected more often in adenocarcinomas (AC) than in squamous cell carcinomas (SCC). Conversely HPV-16 was detected significantly more often in SCC (p < 0.0001). The HPV-negative group also had a higher incidence of SCC (p = 0.007). HPV-18-positive patients seemed to have more nodal involvement than both HPV-16-positive patients (45.5 vs. 20.8%) and HPV-negative patients (45.5 vs. 18.2%); however, it did not reach statistical significance. Conclusions: These observations suggest that the presence of HPV DNA does not bear any clinical or prognostic significance in a Chinese population of cervical cancers. HPV-18 is found more often in younger patients and is associated with AC.
Localization of α2-Macroglobulin Receptor/Low-Density Lipoprotein Receptor in Third-Trimester Human Placentas: A Preliminary Immunohistochemical Study
Authors: Fischer Uta , Birkenmeier Gerd , Horn Lars-Christian
Published: April 2003

The α2-macroglobulin receptor/low-densitiy lipoprotein receptor-related protein (α2-M-R/LRP) is involved in a variety of transcellular transportations, e.g. of apolipoprotein E, and represents an inhibitor of proteinases. After creation of monoclonal antibodies of the α- and β-subunits of the α2-M-R/LRP and its receptor-associated protein, we have tested their distribution in five 3rd-trimester placentas, using cryosections, immunohistochemically and by immunofluorescence. All three monoclonal antibodies showed positive staining in villous and extravillous cytotrophoblasts and intravillous vessels, but not in syncytiotrophoblasts. Thus, α2-M-R/LRP plays a possible role in the transplacental nutritional transportation process. It is necessary to search the distribution of α2-M-R/LRP under pathological conditions, like fetal growth retardation and preeclampsia.
Microsatellite Instability, Expression of hMSH2 and hMLH1 and HPV Infection in Cervical Cancer and Their Clinico-Pathological Association
Authors: Chung T.K.H. , Cheung T.H. , Wang V.W. , Yu M.Y. , Wong Y.F.
Published: April 2003

Infection with specific genotypes of human papillomavirus (HPV) has been strongly implicated in cervical carcinogenesis. However, HPV infection alone is insufficient for malignant transformation of the cervical epithelium. An alteration of microsatellite repeats is the result of slippage owing to strand misalignment during DNA replication and is referred to as microsatellite instability (MSI). These defects in DNA repair pathways have been related to human carcinogenesis; however, the role of MSI in the tumorigenesis of cervical cancer remains unclear. The clinical and pathological features of cervical cancers which are MSI-positive have also not been fully characterized. This study investigated the prevalence of MSI in cervical cancer and its relationship to clinico-pathological characteristics and HPV infection. Polymerase chain reaction-based microsatellite assay combined with tissue microdissection was used to examine for MSI in 50 cervical squamous cell carcinomas in Hong Kong women. In addition, the immunohistochemical staining was performed to determine the expression of major DNA mismatch repair genes, hMSH2 and hMLH1. Six cases (12%) displayed a low frequency of MSI (MSL-L) showing MSI at one locus only in 5 loci examined. Seven cases (14%) showed a high frequency of MSI (MSI-H) having MSI at 2 or more loci. Grouping MSI-L and MSI-H cases together as MSI-positive, statistical analysis of HPV infection, tumor grade, clinical stage and clinical status failed to disclose differences between MSI-positive and MSI-negative cases (p > 0.05). However, MSI-H correlated with advanced stage of disease (p < 0.05). Individuals with MSI-H tumors appeared to have reduced overall survival compared to individuals with MSI-L and MSI-negative tumors, but the difference was not statistically significant (p = 0.059). An absence of either MSH2 or MLH1 expression was observed in 2 MSI-L and 4 MSI-H cases, respectively. The results suggest that MSI is present in a subgroup of cervical squamous cell carcinomas, and defects resulting in MSI may be related to tumor progression and possibly poor prognosis in cervical cancer.
Maternal Arrhythmias of Normal Labor and Delivery
Authors: Berlinerblau Rubin , Yessian Annie , Lichstein Edgar , Haberman Shoshana , Oruci Edward , Jewelewicz Raymond
Published: April 2003

Labor and delivery are associated with significant hemodynamic changes, as well as pain and anxiety, all of which could be fertile ground for arrhythmias. In order to establish whether cardiac arrhythmias occur more frequently during labor and delivery in healthy parturients and whether it clinically affects the mother or the newborn, 100 pregnant women admitted for delivery had Holter monitoring before, during, and up to 1 h postpartum. Our results show that, excluding sinus rhythm variations, only a slight majority of the study subjects had arrhythmia at all, while only 2% had more complex arrhythmias, none of which required any therapeutic intervention. We conclude that cardiac arrhythmias occurring during labor, delivery, and postpartum in the healthy parturient are no more frequent than in the general female population of the same age and are without clinical consequences for the mother and the newborn.
Resistance to Multiple Agent Chemotherapy Including Cisplatin after Chronic Low-Dose Oral Etoposide Administration in Gestational Choriocarcinoma
Authors: Okamoto Tomomitsu , Goto Setsuko
Published: April 2003

Most patients with gestational trophoblastic disease in whom single-agent or even combination chemotherapy has failed can be cured with salvage chemotherapy including etoposide or platinum-based regimens. Here we report a rare case of uterine choriocarcinoma following a molar evacuation that seemed to develop during chronic low-dose oral administration of etoposide for approximately 16 months. Although the patient was expected to have a good chance of cure using combination chemotherapy, the lesion was resistant to multiple-agent chemotherapy including cisplatin.
Placenta and Myometrium – The Two Main Sources of Fibrinolytic Components during Pregnancy
Authors: Uszyński Mieczysław , Maciejewski Krzysztof , Uszyński Waldemar , Kuczyński Jarosław
Published: April 2003

Objectives: Placenta is a known source of some fibrinolytic components in pregnancy. The aim of the present study is to find out whether myometrium can be a parallel source. Study Design: The study group consisted of 34 women (16 primaparas and 18 multiparas, 39.0 ± 0.2 years) in the 36–40th week of gestation with some obstetric complications: preeclampsia – 11, fetal distress – 9, breech presentation – 3, placenta previa – 1, repeat caesarean birth – 10 cases (20 women were the control group). The strips of myometrium as well as samples of venous blood and placenta were collected at the time of caesarean section. The tissue extracts were prepared. The components of the plasminogen activator system were measured, i.e. tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), plasminogen activator inhibitor 1 (PAI-1) and plasminogen activator inhibitor 2 (PAI-2). An immunoenzymatic method (ELISA) was used. Spearman and Pearson’s correlation coefficients were the main tools of the statistical analysis. Results: The concentration of the fibrinolytic components in blood plasma, placenta and myometrium were as follows (ng/mg of total protein): tPA: 0.15 ± 0.07 (blood plasma), 0.12 ± 0.05 (placenta), and 1.42 ± 1.02 (myometrium); uPA: 0.01 ± 0.005 (blood plasma), 1.09 ± 0.25 (placenta), and 0.52 ± 0.13 (myometrium); PAI-1: 2.86 ± 0.90 (blood plasma), 30.67 ± 9.31 (placenta), and 22.29 ± 11.29 (myometrium); PAI-2: 2.86 ± 0.90 (blood plasma), 750.89 ± 170.29 (placenta), and 24.84 ± 8.03 (myometrium). Conclusion: Besides placenta, myometrium is another important source of fibrinolytic components in pregnancy.
Cirsoid Aneurysm after Hysterectomy
Authors: Kanaoka Yasushi , Hirai Kouzo , Ishiko Osamu , Ogita Sachio
Published: April 2003

Cirsoid aneurysm, an uncommon abnormal either congenital or acquired arteriovenous communication, is described. As massive life-threatening bleeding can be a consequence, diagnosis is very important. Earlier, angiography was the only imaging method available for visualizing vascular lesions and recent developments in imaging techniques have made diagnostic imaging of cirsoid aneurysms possible using ultrasonography, color flow mapping, magnetic resonance imaging and magnetic resonance angiography. In this report, a patient with intrapelvic cirsoid aneurysm posthysterectomy who died 8 h after she had been kicked in the abdomen is described and the results obtained by various imaging techniques are discussed.
Recurrent Molar Pregnancy: Report of a Case with Seven Consecutive Hydatidiform Moles
Authors: Ozalp S. , Yalcin O.T. , Tanir H.M. , Etiz E.
Published: April 2003

A case of seven consecutive hydatidiform moles is presented. All of her pregnancies revealed a molar pregnancy, 4 of which were demonstrated histopathologically. In the context of this study, the potential risk for malignant transformation and the obstetric outcome are highlighted. The literature regarding recurrent molar pregnancies is reviewed.
Efficacy of Every-Other-Day Administration of Conjugated Equine Estrogen and Medroxyprogesterone Acetate on Gonadotropin-Releasing Hormone Agonists Treatment in Women with Endometriosis
Authors: Irahara Minoru , Uemura Hirokazu , Yasui Toshiyuki , Kinoshita Hiromi , Yamada Masayo , Tezuka Michiko , Kiyokawa Machiko , Kamada Masaharu , Aono Toshihiro
Published: April 2003

We performed a randomized controlled study to determine the efficacy of add-backed therapy by every-other-day administration of 0.625 mg conjugated equine estrogen (CEE) and 2.5 mg medroxyprogesterone acetate (MPA) on GnRH agonists (GnRH-a) treatment in Japanese women with symptomatic endometriosis. At the end of treatment, serum estrone and estradiol levels in the add-back group (n = 11) were significantly higher than those in the control group (n = 10). The assessment of Beecham classification by bimanual examination, serum CA-125 levels, and the frequency of genital bleeding revealed no significant differences between the two groups. The add-back group showed reduced Kupperman indices relative to those of the control group, and could prevent the loss of bone density. These findings led to a conclusion that GnRH-a therapy added back by every-other-day administration of 0.625 mg CEE and 2.5 mg MPA was a safe and effective treatment for Japanese women with endometriosis.
Clinical Features Affecting the Results of Estrogen Replacement Therapy on Bone Density in Japanese Postmenopausal Women
Authors: Morishige Ken-ichirou , Matsumoto Keiko , Ohmichi Masahide , Nishio Yukihiro , Adachi Kazushige , Hayakawa Jun , Nukui Kazuhiko , Tasaka Keiichi , Kurachi Hirohisa , Murata Yuji
Published: April 2003

Although estrogen replacement therapy (ERT) has been established as an effective treatment for postmenopausal bone loss, the clinical features which predict the effects of ERT have not been well investigated in Japanese postmenopausal women. We analyzed the role of physical factors influencing the effect of ERT on vertebral bone mineral density (BMD) in 94 Japanese postmenopausal women treated for 2 years or longer. The increase in BMD with ERT is 17.6 ± 27.6 mg/cm2/year (mean ± SD) during the first 2 years. Rates of BMD change were negatively correlated with the estimated initial BMD, and positively correlated with age and years since menopause, while no correlation was noted with the body mass index by a simple correlation analysis. The relationships between BMD change and estimated initial BMD or age also held in a multiple regression analysis. The estimated initial BMD and age together accounted for 34.4% of the BMD change during ERT. Furthermore, there were very few (2.4%) nonresponders with a negative linear regression slope of BMD in the osteoporosis and osteopenia group, although 32.7% of the normal initial BMD group were nonresponders. These results suggest that the initial BMD and age are potent predictive factors of the ERT effect on BMD change in Japanese postmenopausal women.
Effect of the Supine Position on Uterine and Umbilical Blood Flow during the Third Trimester of Uncomplicated Pregnancies in Multiparous Patients
Authors: Jaffa Ariel J. , Gull I. , Amster Reuben , Lessing Joseph B. , Wolman Igal
Published: April 2003

We established the effects of the supine position on umbilical blood flow when measured during the third trimester in 30 multiparous, normotensive patients. Blood flow in the umbilical and uterine arteries and blood pressure in the brachial and popliteal arteries were blindly taken by two different observers: first in the lateral and 5 min later in the supine position. There was a significant difference in mean blood pressure between the two postures. However, there was no statistical difference in the pulse pressure or in systolic/diastolic ratio in the umbilical and uterine arteries between the two positions. Postural changes in normotensive multiparous patients do not affect uterine and umbilical blood flow during the third trimester of uncomplicated pregnancies.
Hormone-Related Factors Associated with Hormone Receptor Levels in Breast Cancer
Authors: Calzada Leobardo , Martinez José Manuel , Sandoval Teresita
Published: April 2003

Estrogen receptor (ER) and progesterone receptor (PgR) levels were determined in patients with a ductal infiltrating breast carcinoma. In premenopausal patients, the distribution of the PgR was higher than that of the ER. With increasing age of the patients, the concentration of the ER increased, whereas the PgR values showed an inverse relationship. According to the menstrual status, ER and PgR values were found to be higher in postmenopausal patients than in premenopausal ones. In relation to body fat distribution, in premenopausal patients the ER or PgR values were not found to be statistically significantly different (data no shown). In postmenopausal patients, the concentration of ER was diminished by 20% in patients with obesity of the upper body segment and by 40% in patients with obesity of the lower body segment as compared with the ER values of nonobese patients. While the PgR values diminished by 20% in patients with obesity of the lower body segment, in relation to PgR values of patients with obesity of the upper body segment, we found no statistically significant differences when compared with the PgR values of nonobese patients. With regard to the body mass index, this has remained constant in both types of body fat distribution. When body mass index values were compared with serum ER and PgR levels, no statistically significant differences were found.
A Perforated Sigmoid Diverticulum Abscess Difficult to Differentiate from an Ovarian Tumor
Authors: Ishiko Osamu , Tokuyama Osamu , Sumi Toshiyuki , Kawamura Naoki , Ueda Kayoko , Takada Nobuyasu , Osugi Harushi , Kinoshita Hiroaki , Ogita Sachio
Published: April 2003

We report a case of a perforated sigmoid diverticulum abscess that was difficult to differentiate from an ovarian tumor. A 53-year-old woman was diagnosed with an ovarian tumor, but laparotomy revealed a perforated sigmoid diverticulum abscess and appendicitis, with normal ovaries.
Blood Flow after Intraarterial Infusion Chemotherapy in a Patient with Advanced Cervical Cancer
Authors: Minagawa Yukihisa , Onohara Yoshimasa , Takahashi Hiroyuki , Tsudo Toshiyuki
Published: April 2003

We presented a case of locally advanced cervical cancer treated by intraarterial infusion chemotherapy, and evaluated the blood flow of uterine arteries before and after chemotherapy by using a transvaginal ultrasonic color Doppler device. Pulsatility index (PI) of each uterine artery increased after first course of chemotherapy compared to that of before chemotherapy. But PI did not change after second course in spite of a significant reduction in tumor size. Blood flow change assessed by Doppler ultrasound may be a limited but useful parameter for the efficacy of neoadjuvant chemotherapy in patients with cervical cancer.
Regulation of Plasma Adenosine Levels in Normal Pregnancy
Authors: Yoneyama Yoshio , Sawa Rintaro , Suzuki Shunji , Ishino Hiroshi , Miura Atsushi , Kuwabara Yoshimitsu , Kuwajima Toyohiko , Ito Naoko , Kiyokawa Yasuko , Otsubo Yasuo , Araki Tsutomu
Published: April 2003

The aim of this study was to investigate the possible mechanism of the regulation of plasma adenosine concentration [ADO] in normal pregnancy. We measured the activities of circulating enzymes that are involved in the production and metabolism of adenosine, and plasma [ADO] in nonpregnant (n = 14) and normal pregnant women (n = 14) in the third trimester. In pregnant women, the activity of plasma 5′-nucleotidase and plasma [ADO] were significantly elevated and plasma adenosine deaminase activity was significantly reduced. Enzymatic activities of both plasma enzymes appear to be changed in a way that would favor increased adenosine concentrations.
Obstetrics and Perinatal Outcome of Adolescent Nulliparous Pregnant Women
Authors: Abu-Heija Adel , Ali Abdulhai Mohammed , Al-Dakheil Sanna
Published: April 2003

Objective: To study obstetrics and perinatal outcome in nulliparous teenage singleton pregnancies at a referral teaching hospital in the eastern province of Saudi Arabia. Method: All singleton births during 1996–2000 of nulliparous mothers aged ≤17 years at King Fahd University Hospital were reviewed (n = 102) and compared with births of a control group of nulliparous mothers aged 20–24 years who delivered during the same period (n = 102). Results: The incidence of nulliparous teenage pregnancies was 0.8%. As compared with women aged 20–24 years, women of 17 years or less were at higher risk of very preterm birth (p < 0.05). The 5-min Apgar scores were not different between the two groups. Babies born to younger mothers had a significantly lower birth weight than those born to older mothers (p < 0.001); the incidence of a low birth weight (<2,500 g) was significantly lower in the control group (p < 0.04). There were no significant differences in distribution of mode of delivery, admission to the special care baby unit, antenatal complications, cesarean section indications, perinatal mortality rate, and early neonatal complications between the two groups. Conclusion: The increase in the very preterm births and the subsequently lower birth weight observed in nulliparous teenage women suggest that the maternal age may be a risk factor for very preterm births and associated long-term hazards.
Effects of Ondansetron, Granisetron, Ramosetron, and Azasetron on Human Neutrophil Functions
Authors: Mikawa Katsuya , Akamatsu Hirohiko , Nishina Kahoru , Shiga Makoto , Niwa Yukie
Published: April 2003

Neutrophil functions play an important role in the antibacterial or antitumor host defense system. Ondansetron, granisetron, ramosetron, and azasetron are often used in gynecological patients as a prophylaxis against postoperative emesis or chemotherapy-induced emesis. In this study, using an ex vivo system, we have shown that these antiemetics at clinically relevant concentrations had no effect on superoxide (O–2) and hydrogen peroxide (H2O2) production of neutrophils, although high doses of these drugs significantly inhibited it to a similar degree. The drugs failed to impair chemotaxis or phagocytosis and to scavenge O–2 or H2O2 generated by an acellular system. Inhibition of the reactive oxygen species production may be due to attenuation of calcium elevation in neutrophils with these antiemetics. Our findings suggest that we are able to use these antiemetics in gynecological patients with cancer or those undergoing surgery without great caution.
Pure Red Cell Aplasia and Acute Hepatitis during Pregnancy
Authors: Ohno Yasumasa , Itakura Atsuo , Sano Michiyo , Mizutani Shigehiko
Published: April 2003

Pure red cell aplasia during pregnancy is rare. We present a case in a 26-year-old pregnant woman, referred to our hospital at 31 weeks’ gestation because of severe anemia caused by acute hepatitis. She was treated with repeated blood transfusions and the pure red cell aplasia gradually remitted during the pregnancy. A live infant was delivered by cesarean section at 34 weeks’ gestation. Postpartum, the pure red cell aplasia and hemolytic anemia remitted completely. Our case illustrates that pure red cell aplasia may occur late in pregnancy associated with acute viral hepatitis and is reversible during pregnancy without any necessity for steroid therapy.
Local Erythematous Dermatitis after Intravenous Docetaxel
Authors: Hirai Kouzo , Ishiko Osamu , Nakajima Satoko , Kanaoka Yasushi , Nakamura Yoshihiro , Oiso Naoki , Ishii Masamitsu , Ogita Sachio
Published: April 2003

We report the case of a patient who developed a local skin eruption over the vein following intravenous infusion of docetaxel at 4-week intervals. The skin lesions were limited to an area of the forearm proximal to the site of infusion. They appeared 1 week after the infusion and were diagnosed as erythema multiforme (mixed-type) based on the histological findings.
Growth Hormone Therapy Update in Thailand
Authors: Angsusingha Kitti , Watcharasindhu Suttipong , Likitmaskul Supawadee , Tuchinda Chanika
Published: April 2003

There were 841 children in Thailand with growth hormone deficiency (GHD) from January 1992 to 1996. Idiopathic isolated GHD was the major diagnosis. Only 40.19% received recombinant DNA human growth hormone (rhGH) treatment. Also reported here is a 1–2 year study of rhGH therapy in 30 GH-deficient children (21 males, 9 females), aged (mean ± SD) 10.41 ± 3.16 years, and bone age 7.37 ± 3.34 years. The height velocity 1 and 2 years posttreatment were 8.17 ± 1.9 and 7.36 ± 2.8 cm/year respectively, which were statistically significant compared to pretreatment values of 3.91 ± 1.09 cm/year. Improved height SDS was observed at the end of each treatment period. Thyroid function and glycosylated hemoglobin tests were normal during the treatment period. There were no reports of side effects.
Short Stature Caused by a Natural Growth Hormone Antagonist
Authors: Chihara Kazuo , Takahashi Yutaka , Kaji Hidesuke , Goji Katsumi , Okimura Yasuhiko , Abe Hiromi
Published: April 2003

Severe short stature in a male child due to a single mutation in the GH-1 gene was first reported in 1996 by Takahashi et al. [N Engl J Med 1996;334:432–436]. This missense mutation was predicted to convert codon 77 from arginine (R) to cysteine (C). The child’s chronological age was 4 years and 11 months, and his bone age 2 years and 6 months, i.e., equal to only 51% of his chronological age. Body proportions were normal except for the prominent forehead and saddle nose. Pituitary size was normal on magnetic resonance imaging examinations. Serum IGF-1, IGFBP-3 and GHBP were all decreased or at the lower limit of the normal range. Nocturnal urinary growth hormone (GH) excretion was high. Isoelectric focusing analysis revealed the presence of an abnormal GH peak in addition to the normal one. The R77C mutant GH possessed a 6 times greater affinity to GHBP than the wild-type GH, and inhibited tyrosine phosphorylation in IM-9 cells 10 times more potently than the wild-type GH, showing an antagonistic or a dominant negative action. In agreement with the antagonistic property of the mutant GH exhibited, the child did not show any increase in serum IGF-1 levels after exogenous hGH administration. It should be noted that the child in this study is not a typical case of Kowarski syndrome in which endogenous GH is found to be simply bioinactive, as in the patient we recently described elsewhere. Therefore, this patient’s condition should be categorized as a new syndrome of short stature caused by a natural GH antagonist.