bluuebunny/crossref_metadata_2025 huggingface dataset:
Could We Treat More Unruptured Ectopic Pregnancies with Intramuscular Methotrexate?
Authors: Kucera E. , Schindl M. , Klem I. , Sam C. , Hanzal E. , Kölbl H. , Leodolter S. , Sliutz G.
Published: April 2003

The main reason for the restricted use of methotrexate in the treatment of ectopic pregnancy (EP) obviously is the fear of tubal rupture in patients with lower abdominal pain after the administration of methotrexate. Therefore, we wanted to find out if patient characteristics at first presentation, such as age, pretreatment β-hCG level, adnexal mass as visualized by transvaginal ultrasonography, or history of prior EP, would identify patients at risk for tubal rupture if they were hemodynamically stable and showed no signs of peritoneal irritation. We examined whether more patients could have been treated medically with methotrexate, because tubal rupture was unforeseeable at first presentation and inclusion criteria for methotrexate treatment were fulfilled. From January 1996 to August 1998, 122 patients diagnosed as having EP were treated at the Gynecologic Department of the University Hospital of Vienna. Inclusion criteria for medical treatment with intramuscular methotrexate (50 mg/ m2 body surface area) were (1) hemodynamic stability, (2) an unruptured ectopic mass ≤5 cm at the greatest dimension demonstrated at transvaginal ultrasonography; (3) β-hCG level ≤5,000 mIU/ml; (4) no cardiac activity of the extrauterine embryo; (5) wish of future fertility, and (6) informed consent. Patients with hemodynamic instability, severe abdominal pain, an ectopic mass ≥5 cm at the greatest dimension, β-hCG levels ≥5,000 mIU/ml, cardiac activity of the extrauterine embryo, and no wish of future fertility, or disagreement with methotrexate treatment, primarily underwent surgery. Despite the fact that none of the above patient characteristics at first presentation identified patients at risk for tubal rupture, only 60/122 patients (49%) actually underwent medical treatment whereas our inclusion criteria would have granted medical treatment in 101/122 patients (83%). We determined the actual and maximal possible percentages of patients with unruptured EP eligible for medical treatment of EP with intramuscular single-dose methotrexate 50 mg/m2 body surface area. Our data show that tubal rupture in hemodynamically stable patients is not foreseeable and should not lead to a restricted use of medical treatment in patients preferring methotrexate.
Clinical Trial of Induction of Labor versus Expectant Management in Twin Pregnancy
Authors: Suzuki Shunji , Otsubo Yasuo , Sawa Rintaro , Yoneyama Yoshio , Araki Tsutomu
Published: April 2003

Objective: The appropriate date of delivery in twin pregnancies is supposed to be earlier than that in singleton pregnancy. The aim of this study was to compare two strategies for managing twin pregnancies (i.e., immediate induction and expectant management). Methods: Seventeen patients underwent immediately induced labor by administration of oral prostaglandin E2 at 37 weeks, while 19 patients underwent expectant management. Results: The average gestational age at delivery in the induction group was 37.5 ± 0.4 weeks, significantly earlier than that in the expectant management group (39.0 ± 1.1 weeks). However, there were no significant differences in the average birth weight between the two groups (2,700 ± 330 g in the induction group vs. 2,672 ± 392 g in the expectant management group). The cesarean delivery rate in the induction group was 18%, not significantly different from that in the expectant management group (32%). The most common indication for cesarean section in the expectant management group was maternal infection, while there was no maternal infection in the induction group (p = 0.08). Conclusion: It may be acceptable do intervene in twin pregnancies earlier than in singleton pregnancies during term.
Superoxide Anion Formation and Glutathione Levels in Patients with Preeclampsia
Authors: Kharb Simmi , Gulati Nirmal , Singh Veena , Singh G.P.
Published: April 2003

Increased free radical activity has been implicated in the pathogenesis of preeclampsia. This article investigates the glutathione status in preeclampsia and whether superoxide generation is enhanced in preeclampsia. Venous blood samples were obtained from 30 preeclamptic women and 30 normotensive pregnant women (controls). Superoxide generation and glutathione content were measured. There was a significant increase in superoxide generation and a marked reduction in glutathione content in preeclamptic women as compared to controls (p < 0.001). These results indicate that enhanced superoxide generation and impaired glutathione metabolism may be involved in the pathogenesis of preeclampsia.
Effects of Gonadotropin-Releasing Hormone Agonist on the Incidence of Apoptosis in Porcine and Human Granulosa Cells
Authors: Zhao Shumei , Saito Hidekazu , Wang Xia , Saito Takakazu , Kaneko Tomoko , Hiroi Masahiko
Published: April 2003

Gonadotropin-releasing hormone (GnRH) has been found to be expressed in ovaries of various species and to modulate cell differentiation in ovarian cells. GnRH agonists (GnRHa) are widely used in the stimulation protocols of assisted reproduction. In the present study, the direct effects of a GnRHa on the incidence of apoptosis and sterodogenesis in porcine in human granulosa cells were investigated. Cells were obtained from 6-month-old swine and in vitro fertilization patients, and cultured in minimum essential medium (MEM) supplemented with 5% fetal bovine serum for 24 h. The GnRHa (burserelin acetate) was added to the MEM at various concentrations (0, 5, 50, 500 pg/ml, and 5 ng/ml). The nuclei of granulosa cells were examined by fluorescence microscopy after Hoechst 33258 staining, and the incidence of apoptotic cells was tabulated. The GnRHa directly increased the incidence of apoptosis in both types of granulosa cells. The concentration of GnRHa in clinical use is much higher than the concentration which produced apoptosis in granulosa cells here. The clinical dosage of GnRHa should be reconsidered with regard to its apoptosis-inducing effect.
Hormonal Parameters in Gestational Diabetes mellitus during the Third Trimester: High Glucagon Levels
Authors: Grigorakis S.I. , Alevizaki M. , Beis C. , Anastasiou E. , Alevizaki C.C. , Souvatzoglou A.
Published: April 2003

Hormonal parameters during the last trimester of pregnancy contribute to a natural increase of insulin resistance. It is not known whether any of these are further involved in the manifestation of gestational diabetes mellitus (GDM) in affected individuals. Basal levels of adrenocorticotropic hormone, cortisol, growth hormone, insulin-like growth factor-I, prolactin, glucagon, estradiol, progesterone, human placental lactogen and human chorionic gonadotropin were investigated in 15 nonobese women with GDM and 26 matched normal pregnant women (N). A linear discriminant analysis was performed to further compare the predictive value of the basal hormone levels. Plasma glucagon levels were significantly higher in the GDM group (p = 0.014); this difference was even higher (p = 0.007) when the number of women was increased (GDM = 33, N = 62). No significant differences were found in the levels of any of the other hormones. It is not clear whether elevated glucagon levels have any involvement in the pathogenesis of GDM or simply reflect the relative insulin deficiency of these women.
Follow-Up of Patients with Unexplained Infertility Who Previously Underwent Natural Cycle in vitro Fertilization
Authors: Zayed F.
Published: April 2003

One hundred and seventeen couples with unexplained infertility who underwent natural cycle in vitro fertilization (NIVF) in the years 1991–1993 at the Sheffield Fertility Centre (SFC) formed the basis of this analysis, where they were followed in the following years. Seventy-six of the 117 patients who did not conceive came back for further treatment and they were offered either stimulated intrauterine insemination (SIUI) or stimulated in vitro fertilization (SIVF). If fertilization was confirmed at NIVF they then received SIUI for three treatment cycles and a change to SIVF treatment. If fertilization was not confirmed at NIVF they were then subjected to SIVF. Only 41 patients out of 117 (35%) did not come back for further treatment. The remaining 76 patients (65%) had 130 cycles of treatment, 58 cycles of SIUI and 72 cycles of SIVF. An implantation rate of 23.4% per cycle completed was achieved in the SIUI group. The rate of implantation for the SIVF group was 19.4% per cycle completed. We conclude that patients with unexplained infertility who failed fertilization at NIVF showed fertilization and implantation at SIVF and SIUI, and the implantation rate was similar in both groups.
Endothelial Nitric Oxide Synthase Expression in Leiomyoma and Parental Myometrium
Authors: Gokdeniz Remzi , Mizrak Bulent , Ozen Suleyman , Bazoglu Nursel
Published: April 2003

The aim of this study was to determine the expression of endothelial nitric oxide synthase (eNOS) in leiomyomatous tissue as a possible mediator of the growth process. Nine patients had myoma enucleation during the follicular phase. The myomata and adjacent myometrial tissues were fixed in formol until study. Immunohistochemical localization of leiomyomatous and myometrial tissue eNOS expression was performed using specific monoclonal antibodies to eNOS. Statistical comparisons were made using the Mann-Whitney Wilcoxon rank-sum test for the expression of eNOS. The test was considered significant when p values were <0.05. Immunostaining for eNOS was seen in the cytoplasm of myometrial endothelial and smooth muscle cells in both tissue sections. eNOS expression was significantly higher in the smooth muscle cells of leiomyomata, compared to parental myometrium (p < 0.0005). The expression of eNOS in vascular endothelial cells was not different in the leiomyoma and myometrium (p > 0.05). To our knowledge, this is the first study to document marked expression of eNOS in leiomyomatous tissue, compared to parental myometrium. We also conclude that the mechanism(s) of the growth-promoting effect of estrogen on leiomyomata is mediated by more synthesis of NO.
Alteration of Telomerase Activity in Ovarian Cancer after Chemotherapy
Authors: Takahashi Masakuni , Kigawa Junzo , Oishi Tetsuro , Itamochi Hiroaki , Shimada Muneaki , Sato Shinya , Kamazawa Shunji , Akeshima Ryouji , Terakawa Naoki
Published: April 2003

To elucidate the relationship between telomerase activity and chemosensitivity in epithelial ovarian cancer, telomerase activity and telomere length (TRF) were examined before and after chemotherapy. Of 21 patients, 9 patients responded to chemotherapy and 12 did not. The positivity of telomerase activity did not significantly differ between responders and nonresponders. There were no differences in the mean length and the distribution of TRF between the two groups. Those distributions became narrow after chemotherapy in both groups. Seven nonresponders (58.3%) exhibited an increase in telomerase activity after chemotherapy but none of the responders showed an increase in activity. Telomerase activity may relate to chemosensitivity in epithelial ovarian cancer.
Significance of Serum and Peritoneal Fluid Lactate Dehydrogenase Levels in Ovarian Cancer
Authors: Boran N. , Kayikcioglu F. , Yalvaç S. , Tulunay G. , Ekinci U. , Köse M.F.
Published: April 2003

We investigated prospectively whether the detection of serum lactate dehydrogenase (LDH) and/or peritoneal fluid LDH levels may serve as a reliable biochemical marker in discriminating ovarian carcinoma from benign ovarian tumors. In this series, postoperatively 20 of 50 patients had a diagnosis of ovarian cancer while the remaining 30 patients had benign ovarian tumor. No significant difference in peritoneal fluid LDH levels was observed between patients with ovarian cancer and benign ovarian tumor (p > 0.05). Serum LDH levels in ovarian cancer patients were significantly higher than those in patients with benign ovarian tumor (p < 0.05). Statistically significant differences were not observed in LDH levels of different histological types of ovarian cancer and different stages of the disease. Serum LDH levels presented diagnostic accuracy with high specificity and may have a potential use as a biochemical marker.
Accurate Multiplex Polymerase Chain Reaction Assay for Gender Determination from a Single Cell
Authors: Hashiba T. , Sueoka K. , Kuroshima M. , Asada H. , Kuji N. , Yoshimura Y.
Published: April 2003

For gender determination of preimplantation embryos or circulating fetal cells in maternal blood, we developed a multiplex polymerase chain reaction assay from a single cell. This assay which co-amplifies X (DXZ1)- and Y (DYZ1)-specific repeat sequences, yields a 308-bp band in females and two bands of 154 and 308 bp in males. In a randomized, blinded assay of 100 isolated single amniocytes, 99 (99%) were amplified successfully. All 50 of the XY cells were correctly diagnosed as male (100%), whereas 49 of the 50 XX cells were diagnosed as female (98%). This accurate and efficient assay may be applicable in these clinical settings.
Production of Interleukins 1β, 6 and 8 and Tumor Necrosis Factor Alpha in Separated and Cultured Endometrial and Endometriotic Stromal and Epithelial Cells
Authors: Bergqvist Agneta , Nejaty Hedieh , Fröysa Berit , Bruse Christine , Carlberg Magdalena , Sjöblom Peter , Söder Olle
Published: April 2003

The production of IL-1β, IL-6, IL-8 and TNF-α was studied in short-time culture of separated stromal and epithelial cells. The cytokine secretion into culture medium was analyzed using immunoassay to evaluate the cytokine protein levels and bioassay to assess the bioactivity of the cytokines. Tissue samples of endometrium and ovarian endometriomas were obtained from 4 patients operated on for clinical reasons. Only IL-8 was found in all samples. IL-1β and TNF-α were detected in the culture medium from most stromal cell samples, but in fewer media from epithelial cell samples. IL-6 was measurable in a few medium samples. Few of the samples displayed a bioactivity. There was no obvious difference between endometrium and endometriotic cell samples besides the production of IL-8 that seems to be lower in endometriotic tissue.
Transforming Growth Factor-β1, -β2, -β3and Their Type I and II Receptors in HumanTerm Placenta
Authors: Schilling Birte , Yeh John
Published: April 2003

Expression of transforming growth factor (TGF)-β3 as well as cellular localization of TGF-β receptors has not been demonstrated in placenta. TGF-β receptor type I (RI) and type II (RII) are required to transmit TGF-β signals, therefore the determination of cells expressing both receptors in concert is necessary to identify target cells for TGF-β. We investigated presence and localization of TGF-βs and their receptors (RI, RII) in human term placenta using reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. RT-PCR showed that messenger RNA for TGF-β1, -β2, -β3, and RI and RII is present in human term placenta. We found intense staining for all TGF-β isoform and receptor proteins in the syncytiotrophoblastic layer, chorionic plate, and in cells of the extravillous trophoblasts using immunohistochemistry. The simultaneous expression of ligands and their receptors support the hypothesis that TGF-β may play an important role in regulating growth, differentiation, and function of the human placenta.
p53 Polymorphism and Human Papillomavirus Infection in Hong Kong Women with Cervical Cancer
Authors: Wong Y.F. , Chung T.K.H. , Cheung T.H. , Nobori T. , Hampton G.M. , Wang V.W. , Li Y.F. , Chang A.M.Z.
Published: April 2003

In this study we investigated the involvement of p53 polymorphism at codon 72, the infection and typing of human papillomavirus (HPV) and the correlation of p53 polymorphism with HPV type and other clinicopathologic characteristics in 72 Hong Kong women with cervical cancer. We developed a simple and nonradioactive method for determining polymorphism at codon 72 of the p53 gene. The homozygous p53 arginine allele (Arg/Arg) was detected in 22 (31%), the homozygous p53 proline allele (Pro/Pro) in 14 (19%) and the heterozygous allele (Arg/Pro) in 36 (50%) cases, respectively. Using the consensus primers MY11 and MY09, HPV infection was detected in 55 of 72 (76%) cases. The prevalent types were HPV-16 (55%), HPV-18 (16%) and HPV-58 (9%). The number of HPV-positive cases with Arg/Arg, Pro/Pro and Arg/Pro were 17 (31%), 12 (22%) and 26 (47%), respectively. The p53 polymorphism at codon 72 was not significantly correlated with any of the HPV types (p > 0.05). No striking overrepresentation of homozygous arginine-72 p53 was observed in HPV-associated cervical cancer. The results in this study did not show that any p53 polymorphic form has a prognostic significance for cervical cancer.
Hematometra in Postmenarchal Adolescent Girls: A Report of Two Cases
Authors: Dadhwal Vatsla , Mittal Suneeta , Kumar Sunesh , Barua Abhijeet
Published: April 2003

We report two cases of unicornuate uterus with functioning rudimentary horn to highlight that Mullerian duct anomalies should be considered in the differential diagnosis of severe dysmenorrhoea even in normally menstruating girls.
Tubal Ligation, Hysterectomy and D&C: Evidence from the Melbourne Women’s Midlife Health Project
Authors: Taffe John , Green Adèle , Dudley Emma , Dennerstein Lorraine
Published: April 2003

The question of whether tubal ligation (TL) is associated with increased risk of hysterectomy or dilatation and curettage (D&C) is examined using data from a population-based study. Retrospective information on TL, D&C and hysterectomy was gathered from 1,810 Australian-born women aged 45–55 who were randomly selected from the population of Melbourne, Australia. Odds ratios for the outcomes were adjusted via logistic regression for age, years of education, smoking status, alcohol consumption, history of premenopausal complaints, number of lost pregnancies, and whether women have discussed menstruation or menopause with their doctor. With these variables taken into account, TL does not emerge as a risk factor for hysterectomy. Though there was a significant association between TL and the probability of ever experiencing a D&C, related extraneous variables which appear to link these events are identified.
Adjuvant Chemotherapy Including Cisplatin in Endometrial Carcinoma
Authors: Fujimura Hidehiko , Kikkawa Fumitaka , Oguchi Hidenori , Nakashima Nobuo , Mizutani Shigehiko
Published: April 2003

To determine the outcome of patients with endometrial endometrioid adenocarcinoma following adjuvant chemotherapy, CAP (cyclophosphamide, pirarubicin and cisplatin) and EP (etoposide and cisplatin) were assigned at random to patients with Ic or more advanced stage carcinoma, and their efficacy was compared. These patients were treated by the Tokai Endometrial Cancer Study Group (Nagoya University and related institutions) between January 1992 and June 1996. The 5-year survival rate was 88.4% in the CAP group and 95.1% in the EP group; the difference between the two groups was not significant (p = 0.3496). The disease-free survival rate was 80.3% in the CAP group and 84.8% in the EP group (nonsignificant: p = 0.4533). However, the 5-year disease-free survival rates were 95.1 and 71.0% in patients with preoperative CA125 levels <35 and ≧35 IU/ml, and there was a significant difference in disease-free survival curves (p < 0.05). A significant difference was also observed in disease-free survival curves between patients with and without pelvic lymph node metastasis (5- year disease-free survival rate: 68.8 and 88.2% in patients with and without pelvic lymph node metastasis, respectively, p < 0.05). Multivariate analysis of disease- free survival showed that the preoperative CA125 level, and pelvic lymph node metastasis were significant risk factors for recurrence. In conclusion, the EP chemotherapy had no significant advantage in terms of survival and disease-free survival compared to CAP, although these rates were superior in the EP group compared to the CAP group.
Endometrial Metastasis from Breast Cancer in a Patient Receiving Tamoxifen Therapy
Authors: Horn Lars-Christian , Einenkel Jens , Baier Dieter
Published: April 2003

Tamoxifen (TAM) is known to be associated with several types of endometrial pathologies, e.g. hyperplasias, polyps and endometrial carcinomas, sometimes of special histologic type. Here we report a rare case of endometrial metastasis from a breast carcinoma (ductal carcinoma) discovered during TAM therapy. This occurrence does not suggest that TAM treatment causes endometrial metastases of breast cancer. However, clinicians should be aware of this possibility and provide patients receiving TAM therapy with close gynecologic follow-up using liberal indications for endometrial biopsies.
Association of Intrauterine Growth Retardation with Monosomy of the Terminal Segment of the Short Arm of the X Chromosome in Patients with Turner’s Syndrome
Authors: Yaegashi Nobuo , Uehara Shigeki , Ogawa Hidenobu , Hanew Kunihiko , Igarashi Akira , Okamura Kunihiro , Yajima Akira
Published: April 2003

Short stature, which may be a result of intrauterine growth retardation (IUGR), is a characteristic of Turner’s syndrome. However, the loci responsible for IUGR have not been well studied. We reviewed the birth records of 74 patients with Turner’s syndrome: 20 with pure X monosomy, 44 with X-mosaicisms, and 10 with X-structural abnormalities. The overall incidence of IUGR was 39.2% (29 of 74 patients). The SHOX gene is encoded in a terminal segment of the short arm of the X chromosome. In 39 patients where two copies of the SHOX gene were absent, the incidence of IUGR was 46.2% (18 of 39 patients). In 14 patients with two copies of the SHOX gene, the incidence of IUGR was significantly lower at 7.1% (1 of 14 patients). Our results suggest that SHOX influences in utero growth in Turner’s syndrome.
Changes in Plasma Soluble CD26 and CD30 during Pregnancy: Markers of Th1/Th2 Balance?
Authors: Hoshimoto Kazunori , Ohta Noriko , Ohkura Takeyoshi , Inaba Noriyuki
Published: April 2003

The theory that the Th1 and Th2 cell ratio shifts towards Th2 dominance during pregnancy may improve fetal survival has gained support from recent studies. Also, the variation in the Th1/Th2 cell ratio is reportedly associated with intrauterine growth retardation and preeclampsia. On the basis of these findings, the analysis of the Th1/Th2 balance may be useful in predicting severe complications during pregnancy. However, simple methods for the analysis of Th1/Th2 balance are presently not available. Recently, it has been reported that regulation of CD26 cell surface expression correlates with the production of Th1-like cytokines. On the other hand, previous studies proposed that the sCD30 molecule is an activation marker useful for evaluation of a Th2 immune response. It is, therefore, possible that the analysis of the Th1/Th2 balance during pregnancy by measuring plasma sCD26 and sCD30 simultaneously is a simple and useful method. We herein demonstrate that combined analysis of sCD26 and sCD30 is a potent surrogate tool to evaluate the Th1/Th2 balance during pregnancy.
Randomized Trial of Cisplatin and Carboplatin versus Cisplatin, Vinblastine and Bleomycin in Ovarian Cancer
Authors: Kikkawa Fumitaka , Matsuzawa Katsuji , Arii Yoshitaro , Kawai Michiyasu , Kobayashi Iwao , Nakashima Nobuo , Mizutani Shigehiko
Published: April 2003

Between January 1992 and July 1997, 202 cases of epithelial ovarian cancer were registered and assigned randomly to a combination of cisplatin and carboplatin (PP group), or cisplatin, vinblastine and bleomycin (PVB group). We analyzed 189 patients whose clinical records were available. The PP chemotherapeutic regimen was advantageous in terms of overall survival compared to the PVB regimen until 4 years after the initial operation. However, the 5-year survival rates were almost the same in both groups. However, in stage III patients, the mean survival time in the PP group was 51.4 months and that in the PVB group was 23.3 months, and there was a statistically significant difference in the survival curves between the two groups (p = 0.0158). The 5-year survival rates were 31.1 and 20.4% in the PP and PVB groups, respectively, in stage III patients. The PP regimen was also significantly superior in patients with macroscopic residual tumor after the initial operation, and the 5-year survival rates were 25.7 and 10.1% in the PP and PVB groups, respectively (p = 0.0128). However, there was no significant difference between the two regimens in patients without macroscopic residual tumor. Cox’s proportional hazards regression analysis showed that tumor stage, presence of macroscopic residual tumor, and the chemotherapeutic regimen used were significant prognostic factors. In conclusion, the PP chemotherapeutic regimen is superior to the PVB regimen especially in the treatment of advanced ovarian cancer.
Serial Transplants of DMBA-Induced Mammary Tumors in Fischer Rats as a Model System for Human Breast Cancer
Authors: Bartsch Christian , Bartsch Hella , Buchberger Anita , Stieglitz Ariane , Effenberger-Klein Anja , Kruse-Jarres Jürgen D. , Besenthal Ingo , Rokos Hartmut , Mecke Dieter
Published: April 2003

Previous studies on human breast cancer patients showed a decline in circulating melatonin levels corresponding to primary tumor growth and an increase when relapse occurred. The aim of the current investigation was to study in an experimental model possible mechanisms involved. Inbred female F344 Fischer rats were used for serial passages derived from a chemically induced mammary adenocarcinoma. Animals with slow-growing carcinosarcomas at passage 2 showed a significant elevation of nocturnal urinary melatonin (23.00–07.00 h; +50%, p < 0.05) and a nominal increase in plasma melatonin (+41%; 02.00–03.00 h). By contrast, these parameters were significantly depressed in animals with fast-growing sarcomas (urinary melatonin: –22%, p < 0.025; plasma melatonin: –56%, p < 0.01). At passage 2 nocturnal pineal N-acetylserotonin (02.00–03.00 h) was significantly enhanced (+62%, p < 0.05) probably due to an increased activity of serotonin-N-acetyltransferase (SNAT, +45%), the rate-limiting step of pineal melatonin biosynthesis converting serotonin to N-acetylserotonin. The activation of SNAT may be due to a stimulation of the sympathetic nervous system (urinary noradrenaline; NA: +243%, p < 0.005) when the cellular immune system responded towards tumor growth (urinary biopterin, +214%, p < 0.005). At passage 12 SNAT and N-acetylserotonin were unaffected but a depletion of plasma tryptophan (–34%, p < 0.0001), the precursor amino acid of melatonin, was found. The marginal decline in pineal serotonin (–18%, p < 0.05) disputes that the drastic depletion in circulating melatonin (–56%, p < 0.01) can be exclusively explained by a reduced availability of tryptophan. Therefore, the involvement of an additional mechanism has to be postulated, such as a degradation of melatonin via indoleamine 2,3-dioxygenase, an extrahepatic enzyme which has been detected in tumor tissue and is related to tryptophan 2,3-dioxygenase (TDO). TDO occurs only in the liver, is highly specific for L-tryptophan and is induced by glucocorticoids which would account for the observed depletion of plasma tryptophan resulting from a tumor-associated activation of the hypothalamo-pituitary-adrenal axis (urinary corticosterone +208%, p < 0.01). These findings present first explanations for the previously observed modulation of melatonin levels in cancer patients but also illustrate the high degree of complexity of mechanisms involved in the interactions between tumor growth and the immunoneuroendocrine system.
Treatment-Resistant Depression
Authors: Ananth Jambur
Published: April 2003

Our ability to treat depression has improved with the availability of receptor-specific and chemically diverse groups of antidepressants. Even now, most of the short-term studies indicate that about 20% of depressed patients remain resistant to treatment. Therefore, it is important to properly assess the treatment-resistant depressed (TRD) patients and to separate the truly refractory patients from those inadequately treated. Undiagnosed medical conditions should be eliminated. TRD is neither a clinically nor a biologically identifiable entity. As there are no established methods for the treatment of TRD, all options should be considered. The clinician can be enriched by the knowledge of the treatment modalities available, and yet, in treating an individual patient, clinical skills, intuitive judgment, family history of response to drugs and side effects, all play a vital role. Several of the approaches described in the paper indicate available methods and their merits in general but there is no way of ascertaining by which particular method a patient should be treated. The three common methods of treatment are substitution of one antidepressant drug for another, combination therapies and augmentation techniques. These are based on clinical experiences and not research findings. Therefore the treatment of TRD patients is more an art than a science. The physician should assess all the psychopathological, phenomenological and psychosocial variables to appropriately treat an individual patient.
Relationships between Alexithymia, Emotional Control, and Quality of Life in Patients with Inflammatory Bowel Disease
Authors: Verissimo Ramiro , Mota-Cardoso Rui , Taylor Graeme
Published: April 2003

Background: Although the constructs of alexithymia and emotional control have been associated with physical health, the relationship between these constructs is unclear and their influence on health-related quality of life has not been investigated previously. This study examined the relationships between alexithymia, emotional control, and quality of life in 74 patients with inflammatory bowel disease (IBD). Methods: The subjects completed the 20-item Toronto Alexithymia Scale (TAS-20), the Emotional Expression and Control Scale (EEC), and the Inflammatory Bowel Disease Questionnaire (IBDQ) for assessing quality of life. Results: The TAS-20 correlated negatively and significantly with the IBDQ global score and with subscales assessing bowel symptoms, systemic symptoms, and emotional functioning; the emotional control subscale of the EEC correlated positively and significantly with these measures. Although the TAS-20 correlated significantly and negatively with the emotional control subscale, alexithymia and quality of life scores were unrelated to subscales of the EEC assessing tendencies to either hold back or express emotions. A hierarchical stepwise multiple regression analysis revealed that alexithymia and, to a lesser extent, emotional control play a role in predicting quality of life in patients with IBD. Conclusions: Alexithymia and emotional control are negatively related constructs and each construct has an independent influence on the subjective health status of patients with IBD.
Neurobehavioral Functioning of Adults with Pituitary Disease
Authors: Meyers Christina
Published: April 2003

Neurobehavioral disorders are not infrequent in adults with pituitary disease. The disorders can be due to compression of brain structures important for cognitive and emotional function, effects of hormonal imbalance on sensitive structures, post-surgical disruption of connecting pathways, adverse reactions to medical therapy, and adverse delayed effects of radiation therapy. A multidisciplinary team approach to the treatment of pituitary tumors will allow for the early diagnosis of neurobehavioral disorders and the institution of pharmacologic and behavioral interventions.
The Impact of Pituitary Disease on the Family Caregiver and Overall Family Functioning
Authors: Weitzner Michael , Knutzen Robert
Published: April 2003

Chronic medical illness not only affects the patient but the entire family. The family system undergoes a tremendous change in focus during the acute illness, with members marshaling their resources to help the ill member. This inward focus is costly, producing profound stress. Often, family communication styles change to protect the family system and prior functioning. When the stress of caring for an ill member becomes chronic, as is seen in pituitary disease, the initially adaptive changes in family functioning may become problematic even in those families with previously healthy coping. Those families with previously less healthy functioning become even more dysfunctional. Each family identifies a caregiver for their ill member. This caregiver also experiences significant stress related to caregiving demands. Caregiver adaptation to the stress depends on how the stress is perceived, as well as the caregiver’s coping patterns and availability of and satisfaction with social support. These elements comprise a stress process model of caregiving, which has been well-validated in dementia caregiving research. Although the majority of research has focused on dementia and cancer caregiving, identified issues have applicability to caregiving and family issues related to pituitary disease. This report will review: (1) the field of caregiving research, focusing on a stress process model; (2) those issues identified in prior caregiving research which have applicability in caregiving for patients with pituitary disease; (3) stresses on the family system; (4) assessment of family functioning, and (5) interventions for caregivers and areas for future research.
Alexithymia and the Interpretation of Hostile-Provoking Situations
Authors: Berenbaum Howard , Davis Rachel , McGrew John
Published: April 2003

Background: To examine the relationship between alexithymia and the interpretation of hostility-provoking situations. Methods: Sixty-two college students completed the TAS-20 and the Test for the Interpretation of Provoking Situations (TIPS). The TIPS measures how accurately participants can select the most likely explanation for the occurrence of a hypothetical, potentially provoking situation; it also measures how accurately participants judge whether explanations for events are innocent or noninnocent. Results: Higher levels of alexithymia were associated with greater degrees of accuracy in interpreting the innocence of interpersonal information. The facets of alexithymia that were most strongly associated with interpretation accuracy varied by gender. Conclusions: Alexithymia is not associated with a general affect recognition deficit. The results are consistent with social factors playing a central role in alexithymia.
Psychoendocrine Concomitants in Patients following a New Design of a Geriatric Day-Care Unit
Authors: Lökk Johan
Published: April 2003

Background: Seventeen nondemented geriatric day-care attendees were subjected to a reorganized rehabilitation programme. It is suggested that increased control of and participation in the rehabilitation process might decrease psychoendocrine stress from uncertainty and passivity. Method: The new programme was a change from a traditional one-shift day-care into a two-shift design with two different patient sets a day. The programme was more individualized and time-efficient with written short- and long-term goals. Regular multidisciplinary case conferences were held with the patients to follow and feedback the progress of each individual patient. The patients were prospectively followed with stress markers such as prolactin, cortisol, dehydroepiandrosterone (DHA – a testosterone metabolite), estradiol, serum lipids and serum glucose. Results: There was significant increase in anabolic hormones (DHA, estradiol), which contrasted with a significant decrease in catabolic hormones (prolactin, cortisol) during the actual day-care period. This pattern was restored at the 24-week follow-up for estradiol and prolactin, but with a continuous increase for DHA. Serum lipids and glucose were unaffected. Conclusions: This study found psychoendocrine changes that might have been elicited by a reorganization of the delivery of health care in elderly and handicapped patients. Further research is needed in order to understand these changes as well as the ideal structure and content of geriatric day-care programmes from a psychophysiological point of view.
Suicide Risk and Coping Styles in Posttraumatic Stress Disorder Patients
Authors: Amir M. , Kaplan Z. , Efroni R. , Kotler M.
Published: April 2003

Background: Suicide and suicidal behavior have been found to be increased among posttraumatic stress disorder (PTSD) patients. The present study examined suicide risk and Plutchik’s coping styles in PTSD patients. Method: 47 PTSD patients were compared with 42 patients with mixed non-PTSD anxiety disorders and 50 healthy control subjects, matched for age and gender, on a measure of suicide risk. Results: The PTSD patients scored significantly higher than the two control groups on the suicide risk measure. Furthermore, in the PTSD group, suicide risk was significantly negatively correlated with the coping mechanisms of mapping, minimization and replacement and positively correlated with the coping style of suppression. Furthermore, the coping styles significantly explained the variance of the suicide risk measure for all three groups. Conclusions: The cognitive map of PTSD patients highly resembles other populations with high suicide risk. Clinicians treating victims of traumatic events should focus on problem-solving therapies in order to help these patients deal less rigidly with everyday stresses and by this decrease the suicide risk.
Psychophysiological Correlates of Relaxation Induced by Standard Autogenic Training
Authors: Mishima Norio , Kubota Shinya , Nagata Shoji
Published: April 2003

Background: The present study aimed to determine the psychophysiological changes induced in subjects by standard autogenic training (AT). Physiological measurements were taken under strict experimental conditions. Methods: Thirty-one healthy students were divided randomly into two groups: the AT group and the control group. In the first session, the physiological variables were measured for all students before and after all were asked to relax in their own way. The AT group were then taught AT for 3 months, after which time the measurements were repeated. In the second session, the AT group practised the standard AT exercise, while the control group repeated their own form of simple relaxation. Electrocardiogram, plethysmogram (PTG) and blood pressure (BP) were measured while the students carried out a breathing rate of 15 cycles/min. The R-R intervals and BP were analysed by an autoregressive model for spectral analysis, and the data were compared by repeated-measures ANOVA. Results: The AT group had a significant increase in the mean R-R interval and a significant decrease in the baseline deflection of the PTG in the second session. There were no significant changes in sympathetic activity except for the change in the PTG, although low frequency amplitude of systolic BP decreased slightly. Conclusions: AT was found to induce significant changes that were independent of respiration in healthy students, although paced breathing might have operated as a mental stress. The increase in mean R-R interval and the decrease in baseline deflection of the PTG were the most robust correlates of AT.
Alexithymia and Functional Gastrointestinal Disorders
Authors: Porcelli Piero , Taylor Graeme J. , Bagby R. Michael , De Carne Massimo
Published: April 2003

Background: Although the alexithymia construct was derived from observations of patients with classical psychosomatic diseases, empirical studies have found only a moderate association between alexithymia and inflammatory bowel disease (IBD). Indeed, there is some evidence that alexithymia may be associated more strongly with functional somatic symptoms than with the psychosomatic diseases. The present study examined the relationship between alexithymia and functional gastrointestinal disorders (FGIDs) in a group of 121 FGID patients, and compared the results with findings from a group of 116 IBD patients and a group of 112 healthy subjects. Method: The subjects completed the 20-item Toronto Alexithymia Scale and the Hospital Anxiety and Depression Scale. Results: The FGID group was significantly more alexithymic than the IBD group, and the two gastrointestinal groups were more alexithymic than the normal healthy group. These differences remained even after controlling for the influence of education, gender, anxiety, depression and gastrointestinal symptoms. Conclusions: The finding of a high rate of alexithymia (66%) in the group of FGID patients is consistent with the propensity of these patients to somatization and to high levels of poorly differentiated psychological distress.
Alexithymia, Affect Intensity and Emotional Range in Suicidal Patients
Authors: Iancu Iulian , Horesh Netta , Offer Dorit , Dannon Pinhas N. , Lepkifker Elie , Kotler Moshe
Published: April 2003

Background: Although negative affect in general has been widely associated with suicide, the role of specific emotions and affect features in depression and suicidality is unclear. This study examined the potential of three major components of the affect structure as predictors of suicidal behavior. Methods: Twenty suicidal depressed (SD) inpatients were compared with 20 nonsuicidal depressed (NSD) inpatients and 20 healthy controls for alexithymia, emotional range (ER; i.e. variety of emotions experienced by the subjects) and affect intensity (AI; i.e. the intensity of their emotional responsiveness). Results: Both the SD and the NSD patients had a narrower range of emotions, a stronger AI and a higher degree of alexithymia than did the healthy controls. No differences were found between the scores of the two inpatients groups. Conclusions: The three affect components examined (alexithymia, AI and ER) did not prove to represent sensitive predictors of suicidal behavior. Hopelessness and depression severity were found to be more reliable in the prediction of suicidal risk. We discuss the implications of this study, particularly the possibility of early detection and intervention in patients at risk.
A Comprehensive Model of Stress
Authors: de Jong G. Majella , van Sonderen Eric , Emmelkamp Paul M.G.
Published: April 2003

Background: In this study, a complex theoretical model regarding the stress-distress relationship was evaluated. The various components in the model included experienced stress (daily hassles), psychological distress, neuroticism, problem-focused coping, avoidant coping, satisfaction with received social support and unassertiveness. On the basis of various previous findings, experienced stress was assumed to have a direct effect on psychological distress. In addition, neuroticism was assumed to have a direct effect on psychological distress as well as an indirect effect through its association with experienced stress, problem-focused coping, avoidant coping, satisfaction with social support and unassertiveness. Further, both problem-focused and avoidant coping were assumed to affect the level of psychological distress directly as well as indirectly through their influence on experienced stress. Similarly, satisfaction with social support was assumed to have a direct beneficial effect on psychological distress in addition to an indirect effect through its association with coping and experienced stress. Finally, unassertiveness was assumed to have a direct effect on psychological distress as well as an indirect effect through its influence on experienced stress and coping. Methods: A covariance path analysis technique (LISREL) was used. Results: A considerable predictive power of the model could be demonstrated. Experienced stress and neuroticism turned out to be most predictive of psychological distress. The effects of social support, coping and unassertiveness on psychological distress were seriously attenuated by their common association with neuroticism. Conclusion: Above all, the present findings underscore the need to investigate all variables that are expected to play a role simultaneously so as to be able to take their interdependency into account. It is argued that although such comprehensive models may be more difficult to interpret as of yet, they are likely to more closely resemble reality.
Psychiatric and Medical Effects of Anabolic-Androgenic Steroid Use in Women
Authors: Gruber Amanda J. , Pope Jr. Harrison G.
Published: April 2003

Background: Although numerous studies have documented the psychiatric and physiological effects of anabolic-androgenic steroids (AAS) in males, virtually no studies have investigated the effects of illicit AAS use in women. Methods: We performed psychiatric and medical evaluations of 75 dedicated women athletes, recruited by advertisement primarily from gymnasiums in the Boston, Mass., area. Results: Twenty-five (33%) of the women reported current or past AAS use. Users were more muscular than nonusers and reported use of many other ‘ergogenic’ (performance-enhancing) drugs in addition to AAS. Some described a frank syndrome of ergogenic polysubstance dependence, often with significant morbidity. Fourteen (56%) of the users reported hypomanic symptoms during AAS use and 10 (40%) reported depressive symptoms during AAS withdrawal, but none met full DSM-IV criteria for a hypomanic or major depressive episode. Nineteen (76%) users reported at least one adverse medical effect associated with AAS use. Perhaps the most interesting findings were several unusual psychiatric syndromes reported by both the AAS users and nonusers. These included rigid dietary practices (which we have termed ‘eating disorder, bodybuilder type’), nontraditional gender roles and chronic dissatisfaction and preoccupation with their physiques (a syndrome which we have termed ‘muscle dysmorphia’). Conclusions: Dedicated women athletes exhibit not only AAS abuse, but use of many other ergogenic drugs, sometimes associated with significant morbidity. In addition, these athletes frequently display several psychiatric syndromes which have not previously been well described.
Development of a Brief Screening Instrument: The HANDS
Authors: Baer Lee , Jacobs Douglas G. , Meszler-Reizes Joelle , Blais Mark , Fava Maurizio , Kessler Ronald , Magruder Kathryn , Murphy Jane , Kopans Barbara , Cukor Peter , Leahy Linda , O’Laughlen John
Published: April 2003

Background: The present study was designed to develop a briefer screening scale of approximately 10 items which maintained the validity of the Zung Self-Rating Depression Scale in a sample similar to that attending National Depression Screening Day (NDSD), as well as a more general audience. Methods: We first administered 70 items from a variety of existing rating scales to 40 subjects who answered an ad for depressed subjects and 55 who answered an ad for non-depressed subjects, all of whose diagnoses were confirmed by the Structured Clinical Interview for DSM-IV (SCID). Based on the correlation between each item and the diagnostic criterion, we reduced the number of items to 17 which we then administered to another 45 subjects who answered an ad similar to that used for NDSD and also underwent a SCID interview. Based on these results, we arrived at the final 10-item Harvard Department of Psychiatry/NDSD scale (HANDS) with the assistance of the item-response theory. The items are scored for frequency of occurrence of each symptom over the past 2 weeks. Total scores range from 0 to 30. Results: The 10-item scale (HANDS) has good internal consistency and validity: a cutpoint score of 9 or greater gave sensitivity of at least 95% in both studies. Although specificity was lower for all scales in the self-selected population, the HANDS performed at least as well as the 20-item Zung Scale, the 21-item Beck Depression Inventory-II and the 15-item Hopkins Symptom Depression Checklist. Conclusion: The 10-item HANDS performs as well as other widely used longer self-report scales and has the advantage of briefer administration time.