bluuebunny/crossref_metadata_2025 huggingface dataset:
Terazosin and Doxazosin in the Treatment of BPH: Results of a Randomized Study with Crossover in Non-Responders
Authors: Samli M. Murat , Dincel Cetin
Published: August 2004

Objective: To compare the effects of the doxazosin and terazosin on total International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax) in treating patients with lower urinary tract symptoms (LUTS) and compare this effectivity by switching the drugs in the patients who did not benefit from either the first or the second drug. Methods: This is a prospective randomized study of the patients with LUTS suggestive of benign prostatic hyperplasia (BPH). Fifty male patients (mean age 59.4 ± 7.6 years) received either doxazosin (n = 25) or terazosin (n = 25) once daily every night. The patients were evaluated in the 1st, 2nd and 3rd months of treatment. Minimum 20% improvement in IPSS and Qmax in the 3rd month was considered as improvement. The patients with no improvement in any of the parameters switched the drugs, and they were followed up in the next 3 months. The patients whose only one parameter improved were excluded from the study. Results: Eleven (44%) out of 25 patients using doxazosin and 10 (40%) out of 25 patients using terazosin showed improvement in both IPSS and Qmax at the end of the 3rd month and continued using the drug. After 3 months of treatment, increase in Qmax (p < 0.001) and decrease in IPSS (p < 0.01) was significant for both doxazosin and terazosin. Nineteen patients, who did not show improvement in any of the parameters, switched the drug. Of the patients who switched the drug, 2 (4%) showed improvement both in IPSS and in Qmax, while 2 (4%) showed improvement only in IPSS but not in Qmax. The remaining 15 (30%) patients did not show improvement in any of the parameters. Conclusion: The results of the study suggest that α-blockade with either doxazosin or terazosin is effective in males with LUTS. The two α-blocking drugs showed equal effectiveness in the treatment of LUTS. If one of the drugs is ineffective in the treatment of LUTS, then the other drug will probably be ineffective.
30-MINUTES-TUMT
Authors: Dicuio Mauro , Knutson Tomas , Vesely Stepan , Damber Jan-Erik , Dahlstrand Christer
Published: August 2004

Introduction: Primary objective: to investigate if 30-MINUTES-TUMT can be performed under topical anesthesia and analgesics. Secondary objectives: to evaluate retrospectively analgesics and to study parameters connected with pain. Materials and Methods: Eighty-nine patients underwent TUMT. Patients were divided into four groups with different medications. Paracetamol and tolterodin-L-tartrate were administered in all groups. The first group was also given hydromorphone hydrochloride and atropine sulphate, the second group dextropropoxyphene, the third group morphine and diclofenac, and the fourth group morphine and dextropropoxyphene. Pain during TUMT was registered using the VAS scale. Results: Pain during TUMT was (VAS in mm), respectively, total-first-second-third-fourth group: at 5 min –30, 31, 12, 28, 35; at 15 min –30, 23, 16, 25, 34; at 25 min –30, 28, 18, 25, 35. All patients accepted the treatment. No significant difference between the different drug schedules was noticed. Conclusions: It is possible to treat patients with 30-MINUTES-TUMT with local anesthesia and analgesics. The pain can be accepted by all patients.
Sexual Function of LUTS Patients before and after Neodymium Laser Prostatectomy and Transurethral Resection of Prostate
Authors: Tuhkanen Kari , Heino Antero , Aaltoma Sirpa , Ala-Opas Martti
Published: August 2004

Objective: To assess and compare the sexual function of patients undergoing transurethral resection of the prostate (TURP) or Nd:YAG laser treatment for lower urinary tract symptoms (LUTS) caused by obstructing benign prostatic hyperplasia (BPH). Patients and Methods: 98 LUTS patients with urodynamically confirmed bladder outlet obstruction were recruited. Patients were randomised to TURP and laser treatment, which was further divided to contact and hybrid treatments according to prostate size. The sexual function at baseline and at 1 year postoperatively was assessed from the Danish Prostate Symptom Score Sexual Function Questionnaire (DanPSS Sex) items concerned with erectile stiffness, ejaculatory volume and pain or discomfort on ejaculation. Results: The sexual function data at 1 year was available for 83 patients. At baseline, a high prevalence of erectile dysfunction (86%), ejaculatory volume change (83%) and pain or discomfort on ejaculation (26%) was observed and considered problematic by 79%, 63% and 100% of men, respectively. An increase of total impotence in the TURP group was observed (p = 0.046). TURP decreased or totally eradicated the amount of ejaculate, which was the only difference found between the study groups (p < 0.001). Both laser and TURP treatments improved pain or discomfort on ejaculation. Conclusions: The prevalence of sexual dysfunction in patients with symptomatic infravesical obstruction caused by BPH is high and perceived mostly as bothersome. TURP, Nd:YAG contact or hybrid laser treatments did not increase erectile dysfunction but improved pain or discomfort on ejaculation. The only significant difference between these treatments in respect to sexual function was a higher incidence of decreased or absent ejaculate after TURP.
Enuresis Prevalence and Accompanying Factors in Schoolchildren: A Questionnaire Study from Southeast Anatolia
Authors: Özkan K.U. , Garipardic M. , Toktamis A. , Karabiber H. , Sahinkanat T.
Published: August 2004

Introduction: The aims of this study were to establish the prevalence of enuresis, to determine accompanying factors, and to identify common methods in the management of enuresis in Turkish children aged between 6 and 11 years living in eastern Anatolia. Methods: The parents of 3,527 schoolchildren aged between 6 and 11 years completed a self-administered questionnaire. The questionnaire asked about sociodemographic data, enuresis data, physical or psychological disorders, and family stressors. Descriptive statistics and χ2 test were used for data analysis. Results: The response rate was 88%. The overall prevalence of reported enuresis was 12.96%, and the prevalence of marked enuresis (at least weekly) was 9.8%. Enuresis was notably more common in boys (male:female ratio 1.6), and the prevalence rates decreased by age without gender bias. Of all enuretic children, 21% had also daytime bed-wetting. The rate of a positive family history was 42% for siblings only and 66% for the other family members. Significantly more of the dry children woke up spontaneously at night to void as compared with the enuretic children (p < 0.001). The parental concern level was not high, and only 15% of the children visited a physician for the management of enuresis. Low socioeconomic status, unfavorable perinatal or postnatal history, and unsatisfactory familial characteristics were significantly more frequent in the enuretic group (p < 0.05). The enuretic children had also higher rates of poor school performance and poor social adaptation as compared with nonenuretic children (p < 0.001). Conclusions: These results suggest that the prevalence of enuresis in eastern Anatolia is similar to that reported from western Anatolia and from most other countries. Turkish families did not report a high-level concern about enuresis, and the problem was managed primarily within the family.
Botulinum A Toxin Treatment of Urethral Sphincter Pseudodyssynergia in Patients with Cerebrovascular Accidents or Intracranial Lesions
Authors: Chen Yue Hwa , Kuo Hann-Chorng
Published: August 2004

Purpose: Detrusor overactivity and urethral sphincter pseudodyssynergia may develop during recovery from cerebrovascular accidents or intracranial lesions, resulting in difficulty in urination, a large amount of residual urine, and recurrent urinary tract infection. This study evaluated the effectiveness of urethral injection of botulinum A toxin in treating these patients. Methods: Twenty-one patients with chronic cerebrovascular accidents or intracranial lesions and difficult urination were enrolled. Patients participating in the study elected to receive either 100 units of botulinum A toxin (n = 11) or served as medically treated controls (n = 10). The urodynamic parameters and voiding efficiency after treatment were compared between the 2 groups. Results: An excellent result was obtained in 6 patients and an improved result in 4 patients, resulting in an overall success rate of 91% in the study group. Four patients with frank urinary retention before treatment resumed spontaneous voiding. The maximal effects of botulinum A toxin appeared about 2 weeks after treatment. The voiding pressure decreased (57.8 ± 35.2 vs. 33.8 ± 16.9 cm H2O, p = 0.005) and the maximal flow rate increased (7.2 ± 5.9 vs. 10.3 ± 5.2 ml/s, p = 0.005) significantly. In the control group, 4 patients (40%) had spontaneous voiding 6 months after medical treatment, whereas 6 patients remained unchanged requiring an indwelling Foley catheter (n = 2) or clean intermittent catheterization (n = 4). The symptom score and the quality of life index showed significantly greater improvement in the study group than in the control group. Conclusion: This study demonstrates that urethral injection of botulinum A toxin is effective and without adverse effects in the treatment of patients with urethral sphincter pseudodyssynergia after cerebrovascular accidents or the development of intracranial lesions.
Venous Abnormalities Incidentally Accompanied by Renal Tumors
Authors: Matsuura Takeshi , Morimoto Yasuhiro , Nose Kazuhiro , Hara Yasushi , Akiyama Takahiro , Kurita Takashi
Published: August 2004

We retrospectively examined the cases of renal tumors experienced between 1993 and 2002 to evaluate the rates of incidence and preoperative identification by imaging techniques, mainly CT, of retroperitoneal venous abnormalities. Among a total of 178 renal cell carcinomas and 13 renal benign tumors, the incidence of multiplicity of renal veins was 5.3%, restricted to operatively confirmed cases (9 out of 170 cases). None of these multiplicities could be detected by preoperative radiological examinations. Other major venous abnormalities included duplications of inferior vena cava and retroaortic left renal vein and spontaneous splenorenal shunt which were all correctly diagnosed preoperatively. The incidence of these abnormalities was 0.52% (1 out of 191 cases for each). A retroperitoneal venous anomaly is common, but urologists must have sufficient knowledge about acquired retroperitoneal venous abnormalities, which seem rather uncommon, to be prepared for the potential hazards which may occur during urological operations.
Percutaneous Drainage of Simple Cysts of the Kidney: A New Method
Authors: Touloupidis S. , Fatles G. , Rombis V. , Papathanasiou A. , Balaxis E.
Published: August 2004

Objective: The experience of our department on the treatment of solitary simple kidney cysts with continuous percutaneous drainage for 24 h and instillation of pure alcohol as a sclerotic agent is reported. The results are compared with those of previous years when the treatment consisted of percutaneous drainage and injection of pure alcohol. Patients and Methods: During the period 1992–2001, 252 patients (136 male, 116 female; aged 22–74 years) were treated at our department, and all had a solitary kidney cyst. They were treated by percutaneous drainage and then injection of pure alcohol for 20 min via a nephrostomy tube (which remained in position for 24 h). The mean follow-up period was 5 years. This cohort of patients was compared to another one of 238 patients who were treated with a previous method (126 male, 124 female; aged 28–79 years, mean 59 years). Results: In 71% of the patients the symptoms and the cyst both disappeared, in 22% there was no significant recurrence (i.e. cyst diameter <5 cm), and the remaining 7% presented significant recurrence (i.e. cyst diameter >5 cm). Most of the latter cases were treated again using the same method. Of the 73 patients with impaired kidney function, in 61 (83%) this appeared to have improved as a result of our treatment. Of the 61 patients with hypertension, in 29 (47%) this appeared to have improved. There was only 1 case with complications, which presented purulence of the cyst that required open surgery. In previous case series, which were treated with percutaneous drainage and injection of pure alcohol just after the puncture of the cyst – without continuous drainage of the cyst for 24 h – only 10% of the patients had no recurrence, 30% had no significant recurrence (volume of the cyst <20% of the pre-operative volume), and 60% of the patients had significant recurrence (volume of the cyst >20% of the pre-operative volume). Conclusions: Percutaneous drainage of solitary kidney cysts for 24 h followed by injection of pure alcohol, as a sclerotic agent, is an effective therapeutic method with only a few complications. It was therefore considered being the proffered method for the treatment of solitary kidney cysts.
Dramatic Remission of Hormone Refractory Prostate Cancer Achieved with Extract of the Mushroom, Phellinus linteus
Authors: Shibata Yasuhiro , Kurita Susumu , Okugi Hironobu , Yamanaka Hidetoshi
Published: August 2004

At present, there is no distinctly effective treatment for hormone refractory prostate cancer. We describe a hormone refractory prostate cancer patient with rapidly progressive bone metastasis who showed dramatic response to intake of an extract from the mushroom, Phellinus linteus.
Ectopic Adrenal Cortex Tissue in the Spermatic Cord in Association with Testicular Cancer
Authors: Mari Mauro , Cagnazzi Eugenio , Bollito Enrico , Bellina Maurizio
Published: August 2004

Ectopic adrenal cortex tissue is not an uncommon clinical finding, but the simultaneous occurrence with testicular cancer has not been reported. We describe a patient who had both pathologies.
Comparative Antimicrobial Susceptibility of Respiratory Tract Pathogens
Authors: Felmingham David
Published: August 2004

Bacterial respiratory tract infections (RTIs), whether primary or subsequent to viral infection, are a frequent cause of morbidity and mortality worldwide. Treatment of these infections is most often empirical. Therefore, an antimicrobial’s antibacterial spectrum must include the most likely pathogens: Streptococcus pneumoniae, the most frequent cause of community-acquired pneumonia (CAP), Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus, as well as atypicals such as Mycoplasma pneumoniae, Legionella pneumophila and Chlamydophila (Chlamydia) pneumoniae. In addition, knowledge of antimicrobial resistance among these key pathogens is imperative for physicians to choose the most appropriate therapeutic agent. The latest data from global surveillance studies indicates that high-level resistance to penicillin (MIC ≧2 mg/l) among isolates of S. pneumoniae varies widely by geographic location. Rates exceed 20% in the USA, Mexico, Japan, Saudi Arabia, Israel, Spain, France, Greece, Hungary, and the Slovak Republic. In South Africa, Hong Kong, Taiwan, and South Korea rates exceed 50%. Penicillin non-susceptibility – including isolates exhibiting high-level resistance and intermediate susceptibility (MIC 0.12–1 mg/l) – is frequently found in association with macrolide resistance, which is found at a prevalence of 70–80% in some Asian countries. Trimethoprim-sulfamethoxazole (TMP-SMX) and tetracycline resistance, either individually or combined with macrolide resistance as multiple resistance, is also associated with reduced susceptibility to penicillin. Another concern about antimicrobial resistance in respiratory tract pathogens is β-lactamase production among isolates of H. influenzae and M. catarrhalis. However, respiratory fluoroquinolones, of which levofloxacin has been available for the longest time, currently remain active against the great majority of common bacterial respiratory pathogens, including atypicals.
Experience with Levofloxacin in a Critical Pathway for the Treatment of Community-Acquired Pneumonia
Authors: Marrie Thomas J.
Published: August 2004

Community-acquired pneumonia (CAP) is associated with considerable morbidity and mortality in both developed and developing countries. Despite research into the optimal management of this condition, there remains great variation in how patients with CAP are treated. A study was performed to assess the results of CAP treatment using a clinical pathway that incorporated admission guidelines, standard treatment orders with oral levofloxacin or cefuroxime axetil plus azithromycin, and an algorithm for oxygen therapy and discharge. The study involved seven centers enrolling 7,734 patients, 55% of whom were treated as outpatients and the remainder were admitted. Overall mortality was 8%, and increasing severity of illness, as assessed by pneumonia severity risk score, was associated with early mortality (within five days of admission) and late mortality (five or more days following admission). The use of the clinical pathway was associated with a reduction in early mortality. The use of levofloxacin alone or with cefuroxime axetil plus azithromycin was associated with decreased mortality compared with the use of other antibiotics.
Seasonal Variations in Exacerbations and MRI Parameters in Relapsing- Remitting Multiple Sclerosis
Authors: Koziol James A. , Feng Anne C.
Published: August 2004

Environmental factors may be involved in the etiology of multiple sclerosis (MS). We investigate prevalence of exacerbations and MRI findings in a cohort of relapsing-remitting multiple sclerosis patients, for evidence of seasonal variation or cyclic trends. We find only weak evidence of seasonality in our data. Differences in reports of seasonal variation in multiple sclerosis disease activity may be due to regional climatic differences or other geographic variables that change with latitude as well as genetic predisposition.
Cancer Incidence in Multiple Sclerosis: A 35-Year Follow-Up
Authors: Sumelahti Marja-Liisa , Pukkala Eero , Hakama Matti
Published: August 2004

The risk of cancer among multiple sclerosis (MS) patients was evaluated emphasising cancers with a potentially infectious aetiology. Cancer incidence was estimated among incident MS patients in 1964–1993 (n = 1,597) in Finland. The cohort was followed up for cancer incidence through the Finnish Cancer Registry until 1999. A total of 85 cancer cases were diagnosed showing a standardised incidence ratio (SIR) of 1.0 (95% CI 0.8–1.2) for all cancers. The risk (SIR) of haematological tumours was 1.1 and that of central nervous system (CNS) tumours 1.3. The small excess risk of haematological malignancies is consistent with infectious aetiology, whereas the association between MS and CNS tumours may be due to misclassification.
Relationship between Supra-Annual Trends in Influenza Rates and Stroke Occurrence
Authors: Field Thalia S. , Zhu Hongmei , Tarrant Michael , Mitchell J. Ross , Hill Michael D.
Published: August 2004

Background: Stroke occurrence appears to be a random event, yet annual and supra-annual periodicity is observed. Recent attention in atherosclerotic disease etiology has focused on infectious and inflammatory mechanisms. Influenza is one such infection that may influence stroke occurrence. Methods: We explored population-based time series data on stroke occurrence and influenza activity. Using Fourier transformation to isolate low-frequency signals in the data, the inverse transformed time series were regressed using Prais-Winsten regression to correct for serially auto-correlated residuals, to assess the relationship between influenza rates and stroke occurrence rates. Results: Changes in the low-frequency components of influenza activity predicted the changes in low-frequency components of the stroke occurrence data with a delay of about 20 weeks. The delay between changes in influenza activity and subsequent stroke activity was different for different stroke types. Overall, the effect size was small with a tripling of the influenza rate associated with about a 6% change in stroke occurrence rate. Conclusions: A small proportion of the patterns of stroke occurrence may be explained by variation in influenza activity. Further evaluation of influenza as a triggering agent in stroke is needed.
How Do American Stroke Risk Functions Perform in a Western European Population?
Authors: Vokó Zoltán , Hollander Monika , Koudstaal Peter J. , Hofman Albert , Breteler Monique M.B.
Published: August 2004

Objectives: We evaluated the predictive performance of the stroke risk functions from the Framingham and the Cardiovascular Health Study in a population-based study in The Netherlands. Methods: We assessed how well the functions could estimate the number of strokes in the Rotterdam Study, and how well they could discriminate between high- and low-risk persons. Results: Both functions predicted the number of stroke cases reasonably well, except in persons with a predicted 5-year risk higher than 5%, where they overestimated the risk. The area under the receiver operator characteristic curve was 0.75 (95% confidence interval, 0.71–0.78) for both functions. Conclusions: Stroke risk functions developed in US populations predict the number of strokes reasonably well in elderly Western European persons at low or modest risk for stroke. The functions can be a useful tool to discriminate between persons at high or low risk for stroke.
Subacute Sclerosing Panencephalitis in Bulgaria (1978–2002)
Authors: Bojinova Veneta , Dimova Petia , Belopitova Liliana , Mihailov Asen , Gatcheva Nina , Mihneva Zaphira , Todorova Maria
Published: August 2004

The epidemiology of subacute sclerosing panencephalitis (SSPE) has changed substantially since the introduction of measles vaccine. We studied the incidence of SSPE in Bulgaria based on cases admitted to the Child Neurology Clinic, University Hospital of Neurology and Psychiatry, Sofia, for a 25-year period (1978–2002). The SSPE incidence prior to and during the period of routine measles immunization was analyzed. SSPE was diagnosed in 40 children (29 males and 11 females, mean age 8.5 years), 28 from 1978 to 1984 (average 4 patients/year), and 12 from 1995 to 2002 (average 1.7 patients/year). Thirty-eight cases (95%) were non-immunized and had early measles infection. Age at onset of SSPE ranged from 8 to 11 years (52.5%) with a mean latent period of 7 years following measles infection. The increase in SSPE incidence (1995–2002) following a 10-year disease-free period (1985–1994) appears to be related to early measles infection (mean age 11 months) during the measles epidemic of 1991–1992. During the period 1995–2002, children had earlier measles infection (average 11 months) and earlier onset of SSPE (mean age 8.4 years) than in the period 1978–1984 (mean age at measles infection 18 months, and of SSPE onset 11.2 years). The SSPE incidence in Bulgaria during the 25-year period from 1978 to 2002 confirms the importance of early measles infection as a risk factor for SSPE, and the role of routine measles immunization in SSPE prevention.
Suicide in Hungarian Huntington’s Disease Patients
Authors: Baliko Laszlo , Csala Bela , Czopf Jozsef
Published: August 2004

We studied 96 families with Huntington’s disease (HD). There were 396 deaths reported in 195 males and 201 females. Family history and clinical information about the deceased were collected and 40 suicides were found. Suicide occurred most frequently in the early or late stages of the disease; age at onset was slightly lower among those who committed suicide. Of the 40 subjects who committed suicide, 34 were male and 6 were female; this was not significantly different to the expected ratio based on suicide in the general population. Those who committed suicide had a smaller number of children than other HD patients. No significant relationship was shown between the sex of the affected parent and suicide. Four suicides occurred in hospital. Suicide among patients with HD is more common than in the general population. Knowledge about the high suicide risk in this disease is important for genetic counseling.
Evidence of Bacterial Biofilms in Human Chronic Sinusitis
Authors: Cryer Jonathan , Schipor Ioana , Perloff Joel R. , Palmer James N.
Published: August 2004

The purpose of this study was to evaluate whether bacterial biofilms exist on the sinus mucosa surfaces of human subjects with recalcitrant chronic sinusitis. Scanning electron microscopy was used to evaluate patients with continued symptoms of chronic sinusitis despite prior appropriate medical and surgical management. Morphologic structures that confirm the presence of bacterial biofilms were identified on the sinus mucosa of patients infected with Pseudomonas aeruginosa, a known biofilm former. The presence of bacterial biofilms may explain the recalcitrant nature of some forms of chronic sinusitis.
The Shortest Expanded Allele of the MJD1 Gene in a Chinese MJD Kindred with Autonomic Dysfunction
Authors: Gu Weihong , Ma Huizi , Wang Kang , Jin Miao , Zhou Yongxing , Liu Xingzhou , Wang Guoxiang , Shen Yan
Published: August 2004

Machado-Joseph disease (MJD) is the most common type of autosomal dominant spinocerebellar ataxia caused by an expanded CAG repeat in the MJD1 gene. Intermediate CAG alleles have been previously described, and they tend to be associated with unusual manifestations of the nervous system. Here we describe a Chinese kindred with hereditary spinocerebellar ataxia, in which the proband presented with autonomic dysfunction besides the typical features of MJD. DNA analysis confirmed the clinical diagnosis and revealed that the expanded CAG repeat number of the proband is 51, which is the shortest known causative expanded allele. These findings indicate that the clinical entity of MJD can occur with 51 trinucleotide repeats, and that the clinical features of MJD might cover a wider spectrum than previously believed. The high clinical pleomorphism and the phenomenon with the 51-CAG-repeat units caused the disease phenotype in our patient, but the normal phenotype in the individuals from another MJD family strongly supports that the MJD phenotype is modulated by modifier factors.
Association of Single Nucleotide Polymorphisms in the Eosinophil Peroxidase Gene with Japanese Cedar Pollinosis
Authors: Nakamura Hiroyuki , Higashikawa Fumiko , Miyagawa Kiyoshi , Nobukuni Yoshitaka , Endo Tomohiko , Imai Toru , Ozasa Kotaro , Motohashi Yutaka , Matsuzaki Ichiyo , Sasahara Shinichiro , Hatta Kotaro , Ogino Keiki , Eboshida Akira
Published: August 2004

Background: Japanese cedar pollinosis is the most common form of hay fever in spring in Japan. We have previously demonstrated that single nucleotide polymorphism Pro358Leu of exon 7 in the eosinophil peroxidase (EPO) gene is associated with cedar pollinosis, although the association has not been confirmed by analysis of the whole gene in a different population. Methods: We sequenced all exons of the EPO gene in 60 children with pollinosis and their parents using the PCR-restriction fragment length polymorphism method. Results: We found 8 polymorphisms, Ile40Met, Gln122His, Arg202Arg (A660G), Asn303Asn (C909T), Arg326Pro, Arg326His, Pro358Leu, and Asn572Ty, in the EPO gene. As a result of the transmission disequilibrium test, we recognized significant transmissions of 202Arg (660G) in exon 6 in addition to 358Leu of exon 7 in the EPO gene of affected children. Conclusions: Our results might indicate that polymorphisms of the EPO gene are associated with Japanese cedar pollinosis.
Bone-Anchored Hearing Aid in Unilateral Inner Ear Deafness: A Study of 20 Patients
Authors: Hol Myrthe K.S. , Bosman Arjan J. , Snik Ad F.M. , Mylanus Emmanuel A.M. , Cremers Cor W.R.J.
Published: August 2004

Objective: To evaluate the benefit of a bone-anchored hearing aid (BAHA) contralateral routing of sound (CROS) in 20 patients with unilateral inner ear deafness. Subjects: 21 patients were recruited; 15 had undergone acoustic neuroma surgery and 6 patients had unilateral profound hearing loss due to other causes; 1 patient was excluded. Only patients with thresholds of better than 25 dB HL (500–2000 Hz) and an air-bone gap of less than 10 dB in the best ear were included. Methods: Evaluation involved audiometric measurements before intervention, when fitted with a conventional CROS and after implementation and quantification of the patients’ subjective benefit with a hearing aid-specific instrument: the Abbreviated Profile of Hearing Aid Benefit (APHAB). Results: Lateralization scores were not significantly different from chance (50%) in any of the three conditions. Measurements of speech perception in noise showed an increase in the signal to noise ratio (S/N ratio) with the conventional CROS (p = 0.001) and with the BAHA CROS compared to the unaided condition when speech was presented at the front with noise on the poor hearing side. On the other hand, a lower S/N ratio was seen with the BAHA CROS (p = 0.003) compared to the unaided situation when noise was presented at the front with speech on the poor hearing side. The patient outcome measure (APHAB) showed improvement, particularly with the BAHA CROS. Conclusions: The poor sound localization results illustrate the inability of patients with unilateral inner ear deafness to localize sounds. The speech-in-noise measurements reflect the benefit of a BAHA CROS in lifting the head shadow while avoiding some of the disadvantages of a conventional CROS. The benefit of the BAHA CROS was most clearly reflected in the patients’ opinion measured with the APHAB.
Cortical Activation Shortly after Cochlear Implantation
Authors: Ito Ken , Momose Toshimitsu , Oku Shinya , Ishimoto Shin-ichi , Yamasoba Tatsuya , Sugasawa Masashi , Kaga Kimitaka
Published: August 2004

We evaluated the cortical activations in postlingually deaf cochlear implant (CI) users in the early period (0–2 months) of CI usage. The subjects were 8 early CI users and 8 normal subjects. With tone burst stimuli (1 kHz) delivered to the right side, strong and broad activation of the ipsilateral (right) primary auditory cortex with 2 peaks and weaker activation of the contralateral (left) temporal lobe were observed in early CI users, in a clear contrast with the normal subjects in whom activation was observed in a small area of the contralateral (left) primary cortex. With word stimuli, activation of the superior frontomedian cortex presumably including the supplementary motor area and the neighboring cingulate gyri was observed in early CI users, which was absent in normal subjects. The activation in the immediate association cortices near the primary area was lower in early CI users, while the periphery of the association cortex seemed to be more mobilized.
Subtle Memory Decline over 12 Months in Mild Cognitive Impairment
Authors: Maruff P. , Collie A. , Darby D. , Weaver-Cargin J. , Masters C. , Currie Jon
Published: August 2004

Objective: Screening of normal older persons for progressive memory decline is a worthwhile strategy in the pursuit of the earliest possible stages of pre-clinical Alzheimer’s disease (AD) or mild cognitive impairment (MCI). Reliable tests are needed to both detect MCI and measure the natural history of decline over months rather than years. We aimed to detect memory decline over 1 year in a group of older individuals with well-characterised amnestic MCI. Methods: The continuous learning task (CLT) from the CogState test battery was administered 8 times in 12 months to 15 individuals with MCI and 35 controls matched for age, education, IQ and gender. All subjects were recruited from an ongoing aging study. The rate of change in CLT performance over the year was compared between groups and also compared to that detected with a word list learning task and a computerised paired associate learning task. Results: At baseline, memory performance in the amnestic MCI group was significantly worse than controls on all memory tests. However, at 12 months the magnitude of the difference between the groups had increased significantly on the CLT due to decline in memory accuracy in the MCI group. No decline over 12 months was detectable on the routine memory tests. Conclusions: Subtle memory decline is detectable in amnestic MCI using reliable and sensitive tests of memory. Such measures may assist in the early identification of AD and also in trials of putative disease-modifying therapies to be conducted over as little as 12 months.
Characterization of the DialGuardTM Device for Endotoxin Removal in Hemodialysis
Authors: Szathmary Susan , Hegyi Edit , Amoureux Marie-Claude , Rajapakse Nandani , Chicorka Lisa , Szalai Gyorgy , Reszegi Katalin , Derbyshire Zachary , Paluh Janet , Dodson Bryce , Grandics Peter
Published: August 2004

Bacterial pyrogens, capable of penetrating dialyzer membranes, are responsible for a systemic inflammatory reaction in hemodialysis patients. Dialyzer reuse, involving rinsing of the dialyzer with pyrogen-containing water, may exacerbate this situation. Studies of the mechanism of action of endotoxin suggest that it irreversibly damages the vascular endothelium. The novel endotoxin removal method described here, is based on affinity-binding of endotoxin by the adsorbent ClarEtoxTM, a USP Class VI-certified resin that is the active component of the medical device DialGuardTM. Under standard hemodialysis operating conditions, challenge of DialGuard with Pseudomonas maltophilia supernatant-spiked dialysate, containing 35–193 EU/ml endotoxin, resulted in endotoxin levels below 0.05 EU/ml in the treated dialysate. DialGuard was able to decrease endotoxin concentrations in the dialysate from a range of 2.39–8.49 to <0.005 EU/ml. DialGuard supports high fluid velocities at low back pressures and can be sanitized using the heat sanitization cycle of hemodialysis machines. DialGuard offers a simple, user-friendly way to reduce the concentration of endotoxin in dialysate and water for dialysis at a low cost.
Catheter-Related Infections in Continuous Hemodiafiltration in Intensive Care Patients
Authors: Nakada Taka-aki , Hirasawa Hiroyuki , Oda Shigeto , Shiga Hidetoshi , Nakanishi Kazuya , Matsuda Ken-Ichi , Nakamura Masataka , Shima Masayuki , Watanabe Masaharu
Published: August 2004

Background/Aims: Infection control is of key importance especially in the application of long-term continuous hemodiafiltration (CHDF) involving invasive vascular catheterization to critically ill patients. We investigated hemodialysis catheter-related infections in long-term CHDF. Methods: We examined catheter infections in 54 patients who were admitted to the intensive care unit and underwent CHDF for 2 weeks or longer. Results: With a total of 155 catheters (1,071 catheter days) studied, catheter colonization and catheter-related bloodstream infection were noted with an incidence rate of 4.8 and 2.7 per 1,000 catheter days, respectively. No difference in catheter colonization rate was observed depending on the catheterization sites or duration of catheterization. Infections were identified in 39 patients (72%) and blood culture positivity was noted in 25 patients (46%). Conclusions: Since the majority of cases requiring long-term CHDF are complicated with a variety of infections, it is difficult to control infections associated with hemodialysis catheters separately from infections of other types. Systemic infection control should serve as a strategy finally leading to successful control of catheter-related infection.
Cytokine Removal with a Novel Adsorbent Polymer
Authors: Song Mingchen , Winchester James , Albright Robert L. , Capponi Vincent J. , Choquette Michael D. , Kellum John A.
Published: August 2004

Background/Aims: We sought to characterize a novel adsorbent polymer in terms of cytokine removal. Methods: We challenged 50 rats with lipopolysaccharide to obtain cytokine-rich blood and circulated this through cartridges containing polymer. In separate experiments, cell-free supernatants were passed through cartridges containing polymer. We measured tumor necrosis factor alpha, interleukin 10 and interleukin 6 concentrations under a variety of conditions to evaluate adsorption kinetics. Results: All three cytokines were rapidly removed from the blood with less than 50% of the initial concentrations present after 1 h of circulation through the cartridge. There was no significant difference in the effect across a range of blood flows and Ca2+ concentrations. Adsorption was decreased somewhat by extremely low temperature (4°C). Conclusion: The adsorbent polymer removes cytokines with high efficiency, and binding is relatively unaffected by a variety of physical conditions.
Randomized Controlled Trial on the Efficacy and Safety of Atorvastatin in Patients with Type 2 Diabetes on Hemodialysis (4D Study): Demographic and Baseline Characteristics
Authors: Wanner Christoph , Krane Vera , März Winfried , Olschewski Manfred , Asmus Hans-Gernot , Krämer Walter , Kühn Karl-Wilhelm , Kütemeyer Heinrich , Mann Johannes F.E. , Ruf Günther , Ritz Eberhard
Published: August 2004

Patients with type 2 diabetes on dialysis are at a substantially increased risk of cardiovascular and cerebrovascular diseases. Dyslipidemia characterized by moderately elevated low-density lipoprotein cholesterol and high triglycerides and low high-density lipoprotein cholesterol levels is common in this population. We hypothesized that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors would reduce vascular morbidity and mortality in this patient group. The ‘Deutsche Diabetes Dialyse Studie’ (4D study) is a prospective, randomized, double-blind study involving 178 dialysis centers throughout Germany. Between March 1998 and October 2002, 1,255 patients were randomized to either atorvastatin 20 mg or placebo; 677 men and 578 women, aged 30–83 years, have been enrolled. The study will be terminated as soon as the predefined number of 424 patients with primary combined end points (i.e., cardiovascular death, nonfatal myocardial infarction, or fatal/nonfatal stroke) will have occurred. The total cohort had the following characteristics at baseline: the mean age was 65.7 years, 54% were men, 89% had a history of hypertension, 21% had coronary artery disease, 17.8% had a history of stroke or a transient ischemic attack, and 45% suffered from peripheral arterial disease. The mean time interval between the diagnosis of diabetes and the onset of dialysis was 17.4 years. On average, the patients were on hemodialysis for 8.3 months. Mean lipid and lipoprotein levels were: total cholesterol 219 ± 43 mg/dl, low-density lipoprotein cholesterol 126 ± 30 mg/dl, high-density lipoprotein cholesterol 36 ± 13 mg/dl, and triglycerides 264 ± 167 mg/dl. The results of the study will provide important information on the efficacy and safety of atorvastatin to support its use in patients with an impaired renal function who are at a high risk of vascular morbidity and mortality.
Pathways Controlling Trigeminal and Auditory Nerve-Evoked Abducens Eyeblink Reflexes in Pond Turtles
Authors: Zhu Dantong , Keifer Joyce
Published: August 2004

An in vitro brain stem preparation from turtles exhibits a neural correlate of eyeblink classical conditioning during pairing of auditory (CS) and trigeminal (US) nerve stimulation while recording from the abducens nerve. The premotor neuronal circuits controlling abducens nerve-mediated eyeblinks in turtles have not been previously described, which is a necessary step for understanding cellular mechanisms of conditioning in this preparation. The purpose of the present study was to neuroanatomically define the premotor pathways that underlie the trigeminal and auditory nerve-evoked abducens eyeblink responses. The results show that the principal sensory trigeminal nucleus forms a disynaptic pathway from both the trigeminal and auditory nerves to the principal and accessory abducens motor nuclei. Additionally, the principal abducens nucleus receives vestibular inputs, whereas the accessory nucleus receives input from the cochlear nucleus. The late R2-like component of abducens nerve responses is mediated by the spinal trigeminal nucleus in the medulla. Both the principal sensory trigeminal nucleus and the abducens motor nuclei receive CS-US convergence and therefore both, or either, might be considered potential sites of synapse modification during in vitro abducens conditioning. Further data are required to determine the role of the principal sensory trigeminal nucleus in in vitro conditioning.
Afferent Connections of the Corpus cerebelli in Holocentrid Teleosts
Authors: Xue Hao-Gang , Yamamoto Naoyuki , Yang Chun-Ying , Imura Kosuke , Ito Hironobu
Published: August 2004

The holocentrid corpus cerebelli (CC) is composed of the dorsal (CCd) and ventral (CCv) lobes. In the present study, afferent connections of the CCd and CCv in holocentrid teleosts (Sargocentron rubrum and S. diadema) were examined by means of tract-tracing methods. Tracer injections into either lobe of the CC labeled neurons in the ipsilateral area pretectalis pars anterior et posterior, nucleus paracommissuralis (NPC), nucleus accessorius opticus and nucleus tegmentocerebellaris. Labeled neurons were also present in the bilateral nucleus lateralis valvulae (NLV), nucleus raphes, nucleus reticularis lateralis and inferior reticular formation, and in the contralateral inferior olive. Injections into the CCd labeled only a few neurons in the area pretectalis pars anterior et posterior, nucleus accessorius opticus and nucleus tegmentocerebellaris, whereas many labeled cells were seen in these nuclei after CCv injections. Injections into the CCv also revealed afferent connections that were not observed after CCd injections. The CCv injections labeled additional neurons in the ipsilateral torus longitudinalis and nucleus subeminentialis and in the bilateral nucleus subvalvularis and nucleus of the commissure of Wallenberg. These differences in afferent connections suggest functional differences between the CCd and CCv. After injections into the CCd, labeled neurons in the NPC were restricted to a medial portion of the nucleus. On the other hand, after injections into the CCv, labeled neurons were found throughout the NPC. Labeled neurons in the NLV were mainly located in its rostral portion following CCd injections, whereas labeled neurons were mainly distributed in the medial portion following CCv injections. These observations suggest topographical organizations of the NPC-CC and NLV-CC projections.
Long-Term Outcome after Spontaneous Cerebellar Haemorrhage
Authors: Dolderer Simone , Kallenberg Kai , Aschoff Alfred , Schwab Stefan , Schwarz Stefan
Published: August 2004

We analysed the clinical and radiological findings and the long-term outcome after 49 ± 34 months in 75 patients (42 men, aged 67 ± 11 years) with spontaneous cerebellar haemorrhage (SCH). At the follow-up examination, 36 patients had died. Outcome was excellent [Rankin Scale (RS) score 0 + 1] in 22 survivors, 4 patients were moderately (RS score 2 + 3) and 13 patients were severely disabled (RS score 4 + 5). Prognostic factors are haematoma volume, intubation, hydrocephalus and clinical signs of brainstem involvement. Of the 28 surgically treated patients, outcome was favourable (RS score 0–2) in 4 patients only, 6 were severely disabled (RS score 3–6) and 18 patients had died. We conclude that the long-term outcome after SCH is frequently favourable. Because patients who were surgically treated had less favourable clinical and radiological findings, a good long-term outcome was rarely present in this group.
Nitroaspirins and Morpholinosydnonimine but Not Aspirin Inhibit the Formation of Superoxide and the Expression of gp91
phox
Induced by Endotoxin and Cytokines in Pig Pulmonary Artery Vascular Smooth Muscle Cells and Endothelial Cells
Authors: Muzaffar Saima , Shukla Nilima , Angelini Gianni , Jeremy Jamie Y.
Published: August 2004

Background—

Although nonsteroidal antiinflammatory drugs (NSAIDs) are ineffective in treating acute respiratory distress syndrome (ARDS), inhalational NO has proved to be useful. NO-donating NSAIDs may therefore be more effective in treating ARDS than NSAIDs alone. Because oxidant stress is central to the pathophysiology of ARDS, the effect of nitroaspirins (NCX 4016, NCX 4040, and NCX 4050) compared with morpholinosydnonimine (SIN-1; an NO donor) and aspirin (ASA) on superoxide (O
2
·−
) formation and gp91
phox
(an active catalytic subunit of NADPH oxidase) expression in pig pulmonary artery vascular smooth muscle cells (PAVSMCs) and endothelial cells (PAECs) was investigated.

Methods and Results—

Cultured PAVSMCs and PAECs were incubated with lipopolysaccharide (LPS), tumor necrosis factor (TNF)-α, and interleukin (IL)-1α (with or without NO-ASA, SIN-1, or ASA) for 16 hours, and O
2
·−
release was measured by use of the reduction of ferricytochrome
c
. The expression of gp91
phox
was assessed by use of Western blotting. LPS, TNF-α, and IL-1α all stimulated the formation of O
2
·−
and expression of gp91
phox
in both PAVSMCs and PAECs, an effect inhibited by NADPH oxidase inhibitors, diphenyleneiodonium, and apocynin. SIN-1, NCX 4016, and NCX 4050 but not ASA alone inhibited the formation of O
2
·−
and expression of gp91
phox
.

Conclusions—

LPS and cytokines promote the formation of O
2
·−
in PAVSMCs and PAECs through an augmentation of NADPH oxidase activity, which in turn is prevented by NO. Thus, NO may play a protective role in preventing excess O
2
·−
formation, but its negation by O
2
·−
may augment the progress of ARDS. The inhibitory effect of nitroaspirins suggests that they may be therapeutically useful in treating ARDS through the suppression of NADPH oxidase upregulation and O
2
·−
formation.
Serum Myeloperoxidase Levels Independently Predict Endothelial Dysfunction in Humans
Authors: Vita Joseph A. , Brennan Marie-Luise , Gokce Noyan , Mann Shirley A. , Goormastic Marlene , Shishehbor Mehdi H. , Penn Marc S. , Keaney John F. , Hazen Stanley L.
Published: August 2004

Background—

In vitro and animal studies demonstrate that myeloperoxidase catalytically consumes nitric oxide as a substrate, limiting its bioavailability and function. We therefore hypothesized that circulating levels of myeloperoxidase would predict risk of endothelial dysfunction in human subjects.

Methods and Results—

Serum myeloperoxidase was measured by enzyme-linked immunoassay, and brachial artery flow-mediated dilation and nitroglycerin-mediated dilation were determined by ultrasound in a hospital-based population of 298 subjects participating in an ongoing study of the clinical correlates of endothelial dysfunction (age, 51±16; 61% men, 51% with cardiovascular disease). A strong inverse relation between brachial artery flow-mediated dilation and increasing quartile of serum myeloperoxidase level was observed (11.0±6.0%, 9.4±5.3%, 8.6±5.8%, and 6.4±4.5% for quartiles 1 through 4, respectively;
P
<0.001 for trend). Using the median as a cut point to define endothelial dysfunction, increasing quartile of myeloperoxidase predicted endothelial dysfunction after adjustment for classic cardiovascular disease risk factors, C-reactive protein levels, prevalence of cardiovascular disease, and ongoing treatment with cardiovascular medications (OR, 6.4; 95% CI, 2.6 to 16;
P
=0.001 for highest versus lowest quartile).

Conclusions—

Serum myeloperoxidase levels serve as a strong and independent predictor of endothelial dysfunction in human subjects. Myeloperoxidase-mediated endothelial dysfunction may be an important mechanistic link between oxidation, inflammation, and cardiovascular disease.