bluuebunny/crossref_metadata_2025 huggingface dataset:
How useful is uterine artery Doppler flow velocimetry in the prediction of pre‐eclampsia, intrauterine growth retardation and perinatal death? An overview
Authors: Chien Patrick F. W. , Arnott Neil , Gordon Adam , Owen Philip , Khan Khalid S.
Published: August 2005

Objective
To evaluate the clinical usefulness of Doppler analysis of the uterine artery velocity waveform in the prediction of pre‐eclampsia and its associated complications of intrauterine growth retardation and perinatal death.

Design
Quantitative systematic review of observational diagnostic studies using online searching of the MEDLINE database coupled with scanning of the bibliographies of primary and review articles including known unpublished studies.

Material
Twenty‐seven studies involving 12,994 subjects stratified into population subgroups at low and high risk of developing pre‐eclampsia and its complications.

Outcome measures
The outcome measures studied were: 1. the development of pre‐eclampsia; 2. intrauterine growth retardation; and 3. perinatal death. The main meta‐analyses were the flow velocity waveform ratio ± diastolic notch derived by transabdominal Doppler ultrasound as the measurement parameter. The analyses were conducted using likelihood ratio as a measure of diagnostic accuracy. A likelihood ratio of 1 indicates that the test has no predictive value for the outcome. Prediction for the outcome event is considered conclusive with likelihood ratios of > 10 or < 0.1 for a positive and negative test result, respectively. Moderate prediction can be achieved with likelihood ratios of 5–10 and 0.1–0.2 whereas likelihood ratios values of 1–5 and 0.2–1 would generate only minimal prediction.

Results
In the low risk population a positive test result, predicted pre‐eclampsia with a pooled likelihood ratio of 6.4 (95% CI 5.7–7.1), while a negative test result had a pooled likelihood ratio of 0.7 (95% CI 0.6–0.8). For intrauterine growth retardation the pooled likelihood ratio was 3.6 (95% CI 3.2–4.0) for a positive test result and 0.8 (95% CI 0.8–0.9) for a negative test result. Using perinatal death as outcome measure, the pooled likelihood ratio was 1.8 (95% CI 1.2–2.9) for a positive test result and 0.9 (95% CI 0.8–1.1) for a negative test result. In the high risk population a positive test result predicted pre‐eclampsia with a pooled likelihood ratio of 2.8 (95% CI 2.3–3.4), while a negative test had a likelihood ratio of 0.8 (95% CI 0.7–0.9). For intrauterine growth retardation the pooled likelihood ratio was 2.7 (95% CI 2.1–3.4) for a positive test result and 0.7 (95% CI 0.6–0.9) for a negative result. For perinatal death the pooled likelihood ratio was 4.0 (95% CI 2.4–6.6) for a positive test result and 0.6 (95% CI 0.4–0.9) for a negative result.

Conclusion
Uterine artery Doppler flow velocity has limited diagnostic accuracy in predicting preeclampsia, intrauterine growth retardation and perinatal death.
Labour characteristics and uterine activity: misoprostol compared with oxytocin in women at term with prelabour rupture of the membranes
Authors: Ngai Suk Wai , Chan Yik Ming , Lam Sze Wing , Lao Terence T.
Published: August 2005

Objective
To compare the labour pattern and uterine activity of oral misoprostol with oxytocin for labour induction in women presenting with prelabour rupture of membranes at term.

Design
Prospective randomised study.

Setting
Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong.

Participants
Eighty women presenting with prelabour rupture of membranes at term.

Methods
The women were randomised to receive either 100 μg misoprostol orally every 4 hours to a maximum of three doses, or intravenous oxytocin infusion according to the hospital protocol. Intrauterine pressure transducers were inserted one hour before induction of labour in both groups of women. We compared the pattern of uterine activity, the induction‐to‐delivery interval, duration of labour, mode of delivery and neonatal outcome between the two groups.

Results
Both oxytocin and oral misoprostol caused an increase in uterine activity within one hour of labour induction. Peak uterine activity was reached 6–8 h after oral misoprostol, with persistent effects, and 8–10 h after oxytocin, requiring continuous titration of medication. The duration of labour was significantly reduced in nulliparous women, but not in those who were multiparous in the misoprostol group. The induction‐to‐delivery interval, the mode of delivery and the perinatal outcome were similar for the two groups.

Conclusion
Oral misoprostol caused earlier peak uterine activity, compared with oxytocin (6–8 h vs 8–10 h). Oral misoprostol was not only as effective as oxytocin in inducing labour in women at term with prelabour rupture of the membranes, but it reduced significantly the duration of labour in nulliparous women.
Pregnancy outcomes and cardiac complications in women with mechanical, bioprosthetic and homograft valves
Authors: Sadler Lynn , McCowan Lesley , White Harvey , Stewart Alistair , Bracken Michael , North Robyn
Published: August 2005

Objectives
Firstly, to compare pregnancy outcomes and cardiac complications in women with: 1. either mechanical or bioprosthetic valves at the mitral site; 2. mechanical valves treated with warfarin or subcutaneous heparin. Secondly, to determine pregnancy and cardiac outcomes in women with aortic homograft valves.

Design
Historical cohort study.

Setting
Greenlane Hospital, Auckland, New Zealand.

Population
Young women (n= 255) who had valve replacements between 1972 and 1992. Seventy‐nine women underwent 147 pregnancies.

Main outcome measures
Pregnancy loss, cardiac complications.

Results
Pregnancy loss occurred in 59% of pregnancies with mitral mechanical valves (n= 50) and 7% with mitral bioprosthetic valves (n= 33) (RR 8.20,95% CI2.10–31.93). Pregnancy loss rate was 70% in pregnancies treated with warfarin, compared with 25% for those switched from warfarin to heparin (RR 2.81, 95% CI 1.03–7.73). All heparin‐associated losses occurred in the first trimester, whereas there were four stillbirths with warfarin. Cardiac complications occurred in 10 pregnancies (20%) in the women with mitral mechanical valves and four (13%) with mitral bioprosthetic valves (RR 1.55, 95% CI 0.53–4.52). All four thromboembolic complications with mechanical valves occurred in the 14 women treated with heparin throughout pregnancy. Structural valve deterioration occurred in four pregnancies (10%) with mitral bioprosthetic valves. No cardiac complications or known pregnancy losses occurred with aortic homograft valves (n= 41).

Conclusion
The high pregnancy loss rate in women with mitral mechanical valves was associated with warfarin throughout pregnancy, whereas the thromboembolic cardiac complications were associated with heparin. Pregnancy outcome was very good in women with bioprosthetic and homograft valves.
Prostaglandin endoperoxide H synthase mRNA expression in the fetal membranes correlates with fetal fibronectin concentration in the cervico‐vaginal fluids at term: evidence of enzyme induction before the onset of labour
Authors: Mijovic Jane E. , Demianczuk Nestor , Olson David M. , Zakar Tamas
Published: August 2005

Objective
To determine the relationship of prostaglandin endoperoxide H synthase (PGHS) expression in the gestational tissues and fetal fibronectin in cervico‐vaginal fluids before the onset of labour at term.

Design
Cross‐sectional, observational study.

Samples
Amnion, chorion laeve and decidua were collected from 24 term pregnant women following elective caesarean section. Samples of cervico‐vaginal secretions were obtained from the same women immediately before caesarean section.

Methods
PGHS‐1 and PGHS‐2 mRNA levels in tissues were determined by specific ribonuclease protection assays. Fetal fibronectin concentrations in the cervico‐vaginal fluids were measured by enzyme‐linked immunosorbent assay. The abundance of PGHS mRNA was compared between groups of patients with the same mean gestational age but different cervico‐vaginal fetal fibronectin levels. Linear regression analysis was used to determine the association between PGHS levels and fetal fibronectin.

Results
Two groups of women were identified who had significantly different fetal fibronectin values but the same gestational ages. The group with the higher fetal fibronectin concentrations had significantly higher PGHS‐1 and PGHS‐2 mRNA levels in the chorion laeve and higher PGHS‐2 mRNA levels in the amnion, than the group with lower fetal fibronectin concentrations. PGHS‐1 and PGHS‐2 mRNA levels in the chorion laeve and PGHS‐2 mRNA in the amnion showed an overall significant association with fetal fibronectin levels.

Conclusions
High concentrations of fetal fibronectin in cervico‐vaginal secretions before the onset of spontaneous labour at term are associated with high levels of PGHS‐2 mRNA in the chorion laeve and the amnion and of PGHS‐1 mRNA in the chorion laeve. Increased expression of PGHS in these tissues may therefore be involved in the events leading to term birth.
Assessment of menstrual blood loss using a pictorial chart: a validation study
Authors: Reid Peter C. , Coker Adeyemi , Coltart Rosemary
Published: August 2005

Objective
To assess the accuracy of a pictorial blood loss assessment chart (PBAC) as a method for estimating menstrual blood loss in women complaining of heavy periods.

Design
A prospective analysis of 103 consecutive women complaining of excessive menstrual blood loss.

Population
Women recruited into an on‐going study of menstrual blood loss in a large district general hospital.

Main outcome measures
Correlation between pictorial assessment of blood loss and actual measured menstrual blood loss.

Results
There was poor correlation between observed PBAC score and menstrual blood loss.

Conclusion
We have not been able to validate previously published work. The pictorial assessment chart offers no significant improvement in the quality of objective diagnosis in women complaining of menorrhagia.
Hyperechogenic fetal bowel: a prospective analysis of sixty consecutive cases
Authors: Ghose Ishika , Mason Gerald C. , Martinez Delia , Harrison Karen L. , Evans J. Anthony , Ferriman Emma L. , Stringer Mark D.
Published: August 2005

A two year prospective analysis of all second trimester fetuses (16–22 weeks of gestation) with hyperechogenic bowel was undertaken. Hyperechogenic fetal bowel (sonographic echogenicity similar to or greater than that of surrounding fetal bone) was diagnosed using strict criteria. Outcome of affected fetuses was ascertained from hospital records, health care workers and autopsy reports, up to six months of age. Sixty consecutive fetuses were identified, of which 48 (80%) were liveborn. Six pregnancies were terminated, four ended with an intrauterine fetal death and two died at birth. The incidence of cystic fibrosis and aneuploidy were each 5%, and there were no cases of congenital infection. Intrauterine growth retardation was recorded in six fetuses (10%), four of whom died perinatally. Eighty‐two percent of fetuses (28/34) with isolated hyperechogenic bowel had a normal outcome.
Correlation between placental bed biopsy findings, vascular cell adhesion molecule and fibronectin levels in pre‐eclampsia
Authors: Madazli Riza , Budak Erdal , Calay Zerrin , Aksu M. Feridun
Published: August 2005

Objective
To determine the correlation between placental bed biopsy findings, and blood levels of the vascular cell adhesion molecule (VCAM‐1) and fibronectin in pre‐eclampsia/eclampsia, and to evaluate the relationship between these variables and severity of the disease.

Design
A prospective case‐control study.

Setting
Department of Obstetrics and Gynaecology, Cerrahpasa Medical Faculty, Istanbul.

Sample
Thirty‐five women with pre‐eclampsia/eclampsia were compared with 25 healthy women with uncomplicated pregnancies. Twenty‐one placental bed biopsies from pre‐eclamptic pregnancies were compared with 17 from normal pregnancies.

Main outcome measures
Peripheral venous blood levels of VCAM‐1 and fibronectin, measured by enzyme‐linked immunoassay and radial immune diffusion technique.

Results
In pre‐eclampsia/eclampsia, blood VCAM‐1 and fibronectin levels were higher than in normal pregnancy. Levels of both fibronectin and VCAM‐1 correlated significantly with the diastolic blood pressure (r= 0.49 and r= 0.65, P < 0.001). There was also a significant direct linear correlation between plasma fibronectin and VCAM‐1 levels (r= 0.57, P < 0.001). Normotensive women all had normal placental bed biopsy findings and the incidence of pathological placental bed biopsy findings increased with the severity of the pre‐eclampsia.

Conclusion
Inadequate trophoblastic invasion of spiral arteries, and elevated levels VCAM‐1 and fibronectin were found in women with pre‐eclampsia. The magnitude of defective trophoblastic invasion, and blood levels of VCAM‐1 and fibronectin correlate with the clinical severity of pre‐eclampsia.
Epidemiological assessment of misoprostol teratogenicity
Authors: Orioli Iêda M. , Castilla Eduardo E.
Published: August 2005

Objective
To verify if any of the 15 congenital defects already reported in association with misoprostol can be found within an epidemiological registry of congenital defects.

Design
Case‐control study including case‐sick and case‐health controls.

Methods
Comparison of misoprostol exposure for each specific defect, using the exposure for the rest of defects as a reference group.

Population
Four thousand six hundred seventy‐three consecutive newborn infants with malformations of unknown aetiology, in the Latin American Collaborative Study of Congenital Malformation.

Results
There was no difference in exposure rate between the malformed (34/4673) and nonmalformed (23/4980) newborns. Four of the five more frequently cited defects in the literature were found to be in excess: constriction ring, terminal transverse‐limb defects, hydrocephalus, and arthrogryposis. Equinovarus feet had a normal frequency in our study. Thirteen different defects not described in the literature were seen in our misoprostol exposed cases, but only holoprosencephaly and bladder exstrophy significantly exceeded the expected number.

Conclusions
The confirmation from an epidemiological registry of an association for four of the five more commonly observed congenital defects among misoprostol exposed children described in the literature seems indicative of a real teratogenic effect. The defects are of vascular disruption type. However, additional attempts to achieve abortion could not be excluded as a concurrent contribution.
Fertility outcome following combined methotrexate treatment of unruptured extrauterine pregnancy
Authors: Debby Abraham , Golan Abraham , Sadan Oscar , Zakut Haim , Glezerman Marek
Published: August 2005

Objective
To assess the effectiveness of systemic treatment with methotrexate in combination with local injection for unruptured tubal pregnancy, and to evaluate reproductive function following treatment.

Design
Prospective, open clinical study.

Setting
University clinic.

Population
Sixty‐seven women with unruptured tubal pregnancy.

Methods
Systemic methotrexate (intramuscular methotrexate 0.5 mg/kg for up to five days) in combination with local application of 12.5 mg methotrexate via laparoscopy.

Main outcome measures
The subsequent surgical intervention required and future fertility.

Results
In 89.6% of women no further surgical intervention was required and 47 women (81%) experienced subsequently an intrauterine pregnancy. In 39 of 40 women who underwent hysterosalpingo‐graphy following treatment, patency of the affected tube was observed.

Conclusions
Combined local and systemic methotrexate treatment for unruptured tubal pregnancy seems to be more effective than each therapeutic modality alone.
Fertility following radical, conservative‐surgical or medical treatment for tubal pregnancy: a population‐based study
Authors: Bouyer J. , Job‐Spira N. , Pouly J. L. , Coste J. , Germain E. , Fernandez H.
Published: August 2005

Objective
To investigate the factors influencing the choice of treatment for ectopic pregnancy and to compare the subsequent fertility rates of radical, conservative‐surgical or medical treatments.

Design
Population‐based study of 835 ectopic pregnancies registered between 1992 and 1996.

Setting
Auvergne Ectopic Pregnancy Register (France).

Sample
Four hundred and seventy‐six women with tubal ectopic pregnancy who were not using contraception at the time of conception. Subsequent fertility was studied for the 291 women who attempted to conceive again.

Methods
Comparison of reproductive outcomes according to ectopic pregnancy treatment. Cumulative fertility curves were calculated by the Kaplan‐Meier estimator and compared by log rank test for univariate analysis and by Cox regression to take into account confounding variables.

Main outcome measure
Recurrence and fertility rates after ectopic pregnancy.

Results
The first treatment given was ‘radical’ for 178 women (37%), ‘conservative‐surgical’ for 262 (55%), and ‘medical’ for 35 (8%). The treatment failed in 1% for radical treatment, 5% for conservative‐surgical treatment, and 36% for medical treatment. The two‐year cumulative rate of recurrence was 27% with no significant difference between treatments. For women with previous infertility factors (in particular diseased contralateral tube), the treatments differed significantly, with the rate of intrauterine pregnancy lower for radical treatment and higher for medical treatment than for conservative‐surgical treatment. For women with no infertility factor, there was no significant difference between treatments.

Conclusions
These results should be confirmed in a controlled trial. The results of this study provide the elements necessary to plan such a trial.
The effect of smoking on pre‐eclampsia in twin pregnancy
Authors: Martin Christine L. , Hall Marion H. , Campbell Doris M.
Published: August 2005

ObjectiveTo assess the effect of smoking on the incidence of pre‐eclampsia and on perinatal outcome in twin pregnancy.

DesignRetrospective study using Aberdeen Maternity and Neonatal Databank.

SettingGrampian, Orkney and Shetland.

PopulationAll 1575 twin pregnancies delivered in the years 1969–1971 and 1976–1997 (when smoking data were available).

MethodsIn all twin pregnancies the effects of smoking on pre‐eclampsia were analysed by parity and gestation at delivery. The effect of smoking upon late miscarriage and perinatal outcome was analysed without subdivision.

Main outcome measuresPre‐eclampsia and perinatal outcome.

ResultsPrimiparae had significantly higher rates of pre‐eclampsia than multiparae and were'delivered significantly earlier. The incidence of pre‐eclampsia in smokers was significantly lower only in multiparae. Length of gestation was significantly shorter in multiparous smokers. The effect of smoking on pre‐eclampsia appeared to be direct in multiparae but possibly indirect in primiparae (by causing earlier delivery). Smokers had a higher late miscarriage rate than nonsmokers.

ConclusionsIn twin pregnancy the apparent protective effect of smoking against pre‐eclampsia is significant only in multiparae, suggesting that in primiparae the smoking effect is overwhelmed by the other reasons for the development of pre‐eclampsia. Smoking in twin pregnancy is not recommended due to the worse fetal outcome rates.
Nifedipine administered in pregnancy: effect on the development of children at 18 months
Authors: Bortolus Renata , Ricci Elena , Chatenoud Liliane , Parazzini Fabio
Published: August 2005

The safety of use of the calcium channel blocker nifedipine in pregnancy as it affects child development has not been well evaluated. We report the results, with regard to the safety for children of use of nifedipine in pregnancy, on children followed up at 18 months of age born from women recruited in a study comparing routine treatment with nifedipine compared with no treatment1.
Clinical Relevance of a Dipole Field in Rolandic Spikes
Authors: Gregory D. L. , Wong P. K. H.
Published: August 2005

Summary: The clinical presentation of 366 children with rolandic spikes was examined to determine whether the presence of a temporal‐frontal dipole field is associated with a lower incidence of clinical abnormality. Comparisons were made between the clinical presentation of 99 children with temporal‐frontal dipole discharges versus 267 children with nondipole rolandic discharges. Criteria examined were birth history, developmental milestones, school history, total number of seizures, neurological examination, and computed tomography (CT) findings. For all clinical parameters, except birth history and CT finding, there was a lower incidence of clinical abnormality in the group with dipole discharges (p < 0.001). The clinical profile seen with temporal‐frontal dipole discharges was very different than with nondipole rolandic spikes. Children with dipole discharges less often presented with frequent seizures (10%), developmental delay (18%), school difficulties (34%), or abnormal neurological exam (22%). In contrast, children with nondipole rolandic discharges often presented with a history of frequent seizures (55%), developmental delay (55%), school difficulties (60%), and an abnormal neurological exam (63%). The incidence of clinical abnormalities in the nondipole group exceeded that found in our control population in all areas. Temporal‐frontal dipole discharges are associated with a lower incidence of clinical abnormality than are nondipole rolandic spikes. These discharges may represent a benign functional focus.
Aphasia as the Sole Manifestation of Simple Partial Status Epilepticus
Authors: Wells Christine R. , Labar Douglas R. , Solomon Gail E.
Published: August 2005

Summary: Aphasia due to simple partial status epilepticus is rare, particularly in the absence of a seizure history. No previous report describes acute aphasia as the sole clinical manifestation of EEG‐monitored status epilepticus, with prompt resolution with treatment. We report a 45‐year‐old man with a left temporal glioblastoma who acutely developed a global aphasia, during which an EEG revealed continual repetitive sharp waves emanating from the left hemisphere. After injection of i.v. diazepam, the EEG seizure activity ceased, and the patient's language output returned to preseizure levels.
Effect of Vigabatrin on the Electroencephalogram in Rats
Authors: Halonen Toivo , Pitkanen Asla , Koivisto Esa , Partanen Juhani , Riekkinen Paavo J.
Published: August 2005

Summary: Vigabatrin (γ‐vinyl GABA; GVG) is a new antiepileptic drug (AED) that increases the level of the inhibitory transmitter, γ‐aminobutyric acid (GABA) in the brain. We evaluated the effect of GVG on the EEG of normal rats. GVG was administered intraperitoneally (i.p.) at a dose of 100 mg/kg once a day for 12 days. EEG was recorded at baseline, on the fourth day, at the end of the 12‐day GVG period and 10 days after discontinuation of GVG. GVG increased the amplitude of delta (1–4 Hz) and theta (4–8 Hz) frequency bands and resulted in slowing of the peak frequency (F) and mean frequency (Fp) in both the frontal and occipital cortex, especially during waking‐immobility. EEG changes normalized within 10 days after the last GVG injections. The results suggest that a relationship may exist between the EEG changes and increase in GABA levels with GVG.
Effects of Vigabatrin on Cognitive Function and Mood When Used as Add‐on Therapy in Patients with Intractable Epilepsy
Authors: McGuire Anna M. , Duncan John S. , Trimble Michael R.
Published: August 2005

Summary: Cognitive function and mood of patients with epilepsy who received 2 g/day vigabatrin (GVG) in addition to their usual antiepileptic drugs (AEDs) was assessed on two occasions: before start of treatment (base‐line) and 4 weeks after start of treatment. A battery of selected psychological tasks measuring attention, mental speed, motor speed, central cognitive processing, and perceptuomotor performance was used, along with standardized, objective mood assessments. A comparison group (n = 15) of patients receiving stable medication was also tested to evaluate practice effects of the psychometric tests. Administration of 2 g/day GVG significantly decreased response time on a test of central cognitive processing ability (arithmetic). No adverse effect was noted on any other test of cognitive function or mood.
Cerebrospinal Fluid and Serum Levels of DOPA, Catechols, and Monoamine Metabolites in Patients with Epilepsy
Authors: Devinsky Orrin , Emoto Sherrie , Goldstein David S. , Stull Robin , Porter Roger J. , Theodore William H. , Nadi N. Suzan
Published: August 2005

Summary: We measured CSF and serum concentrations of monoamines and monoamine metabolites in normal control subjects and in patients with partial epilepsy between and less than 2 h after complex partial seizures (CPS) or secondarily generalized tonic‐clonic seizures (SGTCs). After SGTCs, concentrations of norepinephrine in CSF were significantly higher (p < 0.05) than interictal concentrations, concentrations after PSs, and concentrations in control subjects. Serum epinephrine levels also were significantly higher after SGTCs than interictal and control subjects’levels. CSF HVA levels were significantly higher after PSs than interictal or control subjects’levels. CSF concentrations of norepinephrine and its intraneuronal metabolite, dihydroxyphenylglycol, were highly correlated, both interictally and following SGTCs, whereas correlations between serum and CSF levels of these catechols generally were not statistically significant. The results indicate that seizures are associated with release of catecholamines in the central nervous system.
Calcium Antagonist Nimodipine in Intractable Epilepsy
Authors: de Falco F. A. , Bartiromo U. , Majello L. , Di Geronimo G. , Mundo P.
Published: August 2005

Summary: The influx of Ca2+ into the neuron seems to play an important role in the genesis of epileptic seizures, and current research suggests that calcium entry blockers may have anticonvulsant activity. We used nimodipine, a calcium antagonist with high central nervous system affinity at a fixed dosage of 30 mg, t.i.d., in 21 patients with intractable epilepsy caused by organic brain lesions in addition to basal antiepileptic drug (AED) therapy. After a 12‐week treatment period 14 patients (67%) showed a decrease in seizure frequency, four patients had no change, and three had an increase. In eight patients (38%) seizure frequency decreased by >40%. The p value with one‐tailed t‐test was 0.0491. No significant modifications in AED or electrolyte serum levels were found. One patient had a lowering of blood pressure at this dosage.
Nifedipine for Epilepsy? A Double‐Blind, Placebo‐Controlled Trial
Authors: Larkin John G. , Besag Frank M. C. , Cox Angela , Williams John , Brodie Martin J.
Published: August 2005

Summary: The movement of calcium into neurons may be the common denominator for the triggering and propagation of seizure activity. We report results of the first double‐blind, placebo‐controlled, crossover trial with the dihidropyridine calcium antagonist nifedipine (NFD) as adjuvant therapy in refractory epilepsy. Twenty‐two students (12 male, 10 female, age 17–22 years) attending Lingfield Hospital School received NFD retard and matched placebo for 8 weeks in 2 doses (20 and 40 mg b.i.d. each for 4 weeks) with a washout period of 8 weeks between treatment phases. In the 20 students who completed the trial, fewer partial seizures (p < 0.05) were documented during the first 2 weeks of NFD administration. Similarly, fewer seizure days (p < 0.05) were reported in the first month of active treatment. This response was not sustained into the second month of the trial. Blind scoring of EEGs suggested a small improvement with NFD (p < 0.05). More patients reported headache when receiving NFD (p < 0.02) than placebo, but heart rate and erect and supine blood pressure remained unaffected. Mean maximum NFD concentrations were 13.1 ± 10.4 ng/ml. A weak correlation was noted between total (p < 0.05) and partial (p = 0.025) seizure numbers and NFD concentrations following 8 weeks of treatment. This study does not support important anticonvulsant efficacy for NFD as adjuvant therapy for refractory epilepsy at doses appropriate for the treatment of angina or hypertension. Further trials are recommended using higher doses of NFD in less severely affected patients.
Neuroimaging in Temporal Lobe Epilepsy: Test Sensitivity and Relationships to Pathology and Postoperative Outcome
Authors: Swartz B. E. , Tomiyasu U. , Delgado‐Escueta A. V. , Mandelkern M. , Khonsari A.
Published: August 2005

Summary: We studied patients with documented temporal lobe seizures to evaluate the predictive value of computed tomography (CT), magnetic resonance imaging (MRI), and F‐18 fluorodeoxyglucose positron emission tomography (FDG‐PET) for surgical therapy and the relationships between these tests and the pathologic diagnoses. CT detected abnormalities in 32.5%, with an accuracy of 19% when accuracy was defined as congruence with electrophysiologic studies. MRI detected abnormalities in 81%, with an accuracy of 67%. FDG‐PET detected abnormalities in 85%, with an accuracy of 82%. Pathologic change was detected in 79% of the excised temporal neocortex, 65% of amygdalae, and 93% of hippocampi. After follow‐up periods of 20–71 months (mean 41 months), 67% of patients were free of seizures and 94% had at least a 90% reduction in seizure frequency. There was no relationship between the type of abnormality on MRI or the type of pathology and postoperative outcome. Better outcomes were associated with focal or regional ictal onsets as recorded by surface EEG. Worse out‐comes were associated with hypometabolism that extended outside the temporal lobe. Pathologic change in the temporal neocortex was associated with extension of hypometabolism outside the temporal lobe.
Comparison of the Intracarotid Amobarbital Procedure and Interictal Cerebral 18‐Fluorodeoxyglucose Positron Emission Tomography Scans in Refractory Temporal Lobe Epilepsy
Authors: Salanova V. , Morris H. H. , Rehm P. , Wyllie E. , Dinner D. S. , Lüders H. , Gilmore‐Pollak W.
Published: August 2005

Summary: The relationship between interictal focal hypometabolism determined by 18‐fluorodeoxyglucose positron emission tomography (FDG‐PET) scans and memory function with the intracarotid amobarbital procedure (IAP) was evaluated in 23 patients with temporal lobe epilepsy. All patients underwent prolonged EEG/video monitoring. The epileptogenic focus was defined by interictal epileptiform discharges and ictal onsets. All 23 patients had recorded seizures arising exclusively from one temporal lobe. PET showed temporal lobe hypometabolism ipsilateral to the epileptogenic focus in 86% (20 of 23) of patients; IAP showed impaired memory of the hemisphere of seizure onset in 65% (15 of 23). Sixty‐five percent (13 of 20) of patients with focal hypometabolism had ipsilateral memory impairment. Memory impairment contralateral to the hypometabolic zone was not observed. Ninety‐five percent (22 of 23) of patients demonstrated functional impairment by either PET or IAP (or both) on the epileptogenic side.
Epileptic Seizures in Elderly Patients with Dementia
Authors: McAreavey Martin J. , Ballinger Brian R. , Fenton George W.
Published: August 2005

Summary: All inpatients aged <55 years with dementia in the Dundee Psychiatric Service were surveyed for seizure occurrence by interviewing staff and reviewing records. Of 208 patients, 19 (9.1%) were recorded as having seizures. The seizures were major in 92% and occurred at a rate of ∼2.3 seizures per patient per year. Patients with epilepsy were significantly younger than a control group of dementia inpatients and were significantly more cognitively impaired on the survey Clifton Assessment Procedure for the Elderly (CAPE), but not on the Mini Mental State Examination. Of 111 reported accidents, only 5 appeared to be associated with epilepsy. Although epileptic seizures are relatively common in patients with severe dementia, they rarely caused severe problems.
Clinical Manifestations in Children with Occipital Spike‐Wave Paroxysms
Authors: Talwar Dinesh , Rask Cynthia A. , Torres Fernando
Published: August 2005

Summary: The pattern of occipital‐posterotemporal spike‐wave paroxysms (O‐PT SWPs), is a distinctive EEG abnormality observed primarily with occipital epilepsy of childhood and basilar artery migraine. We studied EEG and clinical features in 30 children and young adults with this EEG pattern. Prolonged and brief O‐PT SWPs were observed. Prolonged discharges (>6 s) were observed only in children with seizures (p < 0.001), and brief discharges (1–6 s) were observed immediately after eye closure. Generalized SWPs (11 patients, 37%) and background abnormalities (17 patients, 57%) were common. Photic activation of O‐PT SWPs was not observed. Twenty‐four patients (80%) manifested paroxysmal phenomena‐seizures (20 patients, 67%) and migraine (12 patients, 40%, 4 alone and 8 with seizures). Fifteen patients (75%) had partial seizures, and 5 (25%) had absence seizures. In 7 patients with partial seizures, an etiology was evident. Neurologic examination was more often abnormal in patients with secondary partial seizures than in those with idiopathic partial seizures (p < 0.05) and absence seizures. Conversely, migraine was more often associated with idiopathic partial seizures than with secondary partial seizures (p < 0.05) and absence seizures. Six children (20%) had no paroxysmal events. Generalized SWPs were uncommon in patients with idiopathic partial seizures. We conclude that 0‐PT SWPs is a nonspecific epileptiform abnormality that may occur in children with (a) idiopathic partial, (b) symptomatic partial, and (c) absence epilepsies, but it may also occur in patients with no evidence of seizures.
Discontinuing Medication in Epileptic Children: A Study of Risk Factors Related to Recurrence
Authors: Gherpelli José Luiz D. , Kok Fernando , Forno Silvana dal , Elkis Livia C. , Lefevre Beatriz H. W. , Diament Aron J.
Published: August 2005

Summary: We studied 70 children who had experienced at least two seizures before age 12 years, excluding febrile seizures, neonatal seizures, or seizures occurring during a metabolic, or infectious insult to the central nervous system (CNS) and who had been seizure free for at least 2 years. Twenty children (28.5%) experienced a recurrence, 75% during antiepileptic (AED) drug discontinuation or <6 months after discontinuation. Risk factors statistically related to seizure recurrence were >10 seizures before seizure control, an abnormal EEG in the year before AED discontinuation, presence of focal neurologic signs and/or mental retardation, and presence of a mixed seizure pattern. Fourteen children (70%) with recurrence had two or more risk factors, whereas 36 (72%) without recurrence had no risk factor or only one. We conclude that a selected group of epileptic children who remain seizure‐free for a period of at least 2 years can have AEDs discontinued based on presence or absence of risk factors.
Effect of Antiepileptic Drugs on Growth of Murine Lymphoid Tumor Cells in Single‐Cell Culture
Authors: Tittle Thomas V. , Schaumann Blanka A.
Published: August 2005

Summary: The effect of three commonly used antiepileptic drugs (AEDs), phenytoin (PHT), carbamazepine (CBZ), and valproate (VPA), on the growth of lymphoid tumor cells was assessed in vitro. A single‐cell culture method was used to determine growth rates by direct visualization. The amount of free drug was determined by ultrafiltration to ascertain its correlation to therapeutic drug levels. VPA slowed the growth of B‐myeloma (FO) and T‐lymphoma (AKR‐1) cells significantly within the range of therapeutic drug levels. CBZ and PHT likewise inhibited cell growth in both lineages but at two to four times the therapeutic level of free drug. CBZ was shown to have long‐term effects on FO and AKR‐1 cells, demonstrated by the reduced growth rates of cloned lines for 2–3 months after drug removal. Cloned sublines of myeloma cells secreting A light chain (J558L) treated with CBZ or PHT had a higher frequency of A light chain secretion loss mutations than the nontreated parent line.
Effect of Valproate Dose on Formation of Hepatotoxic Metabolites
Authors: Anderson Gail D. , Acheampong Andrew A. , Wilensky Alan J. , Levy René H.
Published: August 2005

Summary: Valproate (VPA) therapy has been associated with a rare but fatal hepatotoxicity. 4‐ene‐VPA and 2(E), 4‐diene‐VPA, unsaturated metabolites of VPA, are hepatotoxins several times more potent than VPA. In a previous study, a dose‐dependent excretion of hepatotoxic metabolites was noted in patients receiving VPA. Our study was designed to evaluate the effect of dose on VPA metabolism under controlled conditions. Nineteen healthy volunteers sequentially received three different daily doses of VPA (250, 500, and 1,000 mg). Each dose was given twice daily for 4 days. Urine was collected for one dosage interval (12 h) at steady state for each dose and assayed for 15 VPA metabolites by gas chromatography/mass spectrometry (GCMS). Blood samples were also obtained from eight of the subjects, and VPA was assayed by GCMS. No effect of dose was noted on total plasma clearance. There was a significant dose‐dependent decrease in intrinsic hepatic clearance. The intrinsic formation clearance (Clf) of the 4‐ene‐VPA path‐way showed a statistically significant dose‐dependent increase (0.22, 0.33, 0.40 ml/h/kg). The corresponding percentage of dose recovered as 4‐ene‐VPA and its sequential metabolites showed significant dose‐dependent increases (0.15, 0.27, 0.62%). The role of VPA dose in the pathogenesis of hepatotoxicity may be more important than was previously believed. Key Words: Valproate–4‐ene‐VPA formation clearance—Hepatotoxicity—Dose—Drug‐induced abnormalities.
Adolescent Generativity: A Longitudinal Study of Two Possible Contexts for Learning Concern for Future Generations
Authors: Lawford Heather , Pratt Michael W. , Hunsberger Bruce , Mark Pancer S.
Published: August 2005

The purpose of the present study was to investigate developmental pathways to Erikson's (1959) construct of generativity, defined as care and concern for the next generation and traditionally viewed as important for midlife adults, in a late adolescent sample. A sample of 198 adolescents was followed three times over a 6‐year period, from ages 17 to 23. Questionnaire measures of generative concern, parenting style, community involvement, and personal adjustment were collected. Adolescents' generative concern was positively related to good adjustment, as has been observed previously among adults. Generative concern at age 23 was predicted by earlier reports of family authoritative parenting, and especially by higher levels of earlier prosocial community involvement among these adolescents. Overall, results suggest that generativity may be a developing element in the domain of prosocial moral concern in later adolescence, and that family and community roots may be important in its establishment.
Developmental Shifts in Parent and Peer Influences on Boys' Beliefs About Delinquent Behavior
Authors: Pardini Dustin A. , Loeber Rolf , Stouthamer‐Loeber Magda
Published: August 2005

This paper examines the relative shifts in parent and peer influences on the development of boys' beliefs regarding delinquency from early to middle adolescence. The paper also explores the influence that beliefs about delinquency have on subsequent changes in these social relationships. Structural equation modeling is used to analyze six annual waves of data for 481 boys from the youngest sample of the Pittsburgh Youth Study. Increased parent–adolescent conflict only predicted changes in beliefs about delinquency in early adolescence, while increases in peer delinquency was associated with adopting more tolerant beliefs about delinquent acts from early to middle adolescence. Changes in boys' delinquent peer group association were initially influenced by increased family conflict. However, in middle adolescence increasingly tolerant beliefs about delinquency were related to subsequent increases in delinquent peers. The potential implications for preventing the formation of beliefs favoring delinquency during adolescence are discussed.
Getting There is Only Half the Battle: Stigma Consciousness and Maintaining Diversity in Higher Education
Authors: Pinel Elizabeth C. , Warner Leah R. , Chua Poh‐Pheng
Published: August 2005

Increases in stigma consciousness since arriving at a primarily White college could predict the college performance and self‐esteem of the academically stigmatized. After reviewing relevant research, the authors report on a study in which 44 stigmatized (African Americans and Latinos/Latinas) and 79 nonstigmatized (Whites and Asian Americans) students completed measures of stigma consciousness, GPA, disengagement from academics, and self‐esteem. Among stigmatized males, increases in stigma consciousness predicted lower GPAs and greater disengagement. Although stigmatized females had low GPAs regardless of their increases in stigma consciousness, with increases in stigma consciousness came less disengagement from school and lower self‐esteem. The discussion offers suggestions for how to minimize these negative effects of heightened stigma consciousness levels.
Private Equity Performance: Returns, Persistence, and Capital Flows
Authors: KAPLAN STEVEN N. , SCHOAR ANTOINETTE
Published: August 2005

This paper investigates the performance and capital inflows of private equity partnerships. Average fund returns (net of fees) approximately equal the S&P 500 although substantial heterogeneity across funds exists. Returns persist strongly across subsequent funds of a partnership. Better performing partnerships are more likely to raise follow‐on funds and larger funds. This relationship is concave, so top performing partnerships grow proportionally less than average performers. At the industry level, market entry and fund performance are procyclical; however, established funds are less sensitive to cycles than new entrants. Several of these results differ markedly from those for mutual funds.
On the Industry Concentration of Actively Managed Equity Mutual Funds
Authors: KACPERCZYK MARCIN , SIALM CLEMENS , ZHENG LU
Published: August 2005

Mutual fund managers may decide to deviate from a well‐diversified portfolio and concentrate their holdings in industries where they have informational advantages. In this paper, we study the relation between the industry concentration and the performance of actively managed U.S. mutual funds from 1984 to 1999. Our results indicate that, on average, more concentrated funds perform better after controlling for risk and style differences using various performance measures. This finding suggests that investment ability is more evident among managers who hold portfolios concentrated in a few industries.
Effects of Intravenous Magnesium in a Prolonged QT Interval Model of Polymorphic Ventricular Tachycardia Focus on Transmural Ventricular Repolarization
Authors: CHINUSHI MASAOMI , SUGIURA HIROTAKA , KOMURA SATORU , HIRONO TAKASHI , IZUMI DAISUKE , TAGAWA MINORU , FURUSHIMA HIROSHI , AIZAWA YOSHIFUSA
Published: August 2005

Background: This study was performed to clarify the antiarrhythmic effects of magnesium sulfate (Mg++) in a prolonged QT interval canine model of polymorphic ventricular tachyarrhythmia (VTA).

Methods: In six experiments in a canine model of prolonged QT by anthopleurin‐A, Mg++ was administered in boluses of 0.2 mL/kg during repetitive episodes of self‐terminating polymorphic VTA or frequent premature ventricular complexes (PVCs). The distribution of ventricular repolarization across the left ventricular(LV) wall and dispersion of transmural repolarization were analyzed before, and 30 and 120 seconds after Mg++ administration, during ventricular pacing at 100 bpm. Transmural unipolar electrograms were recorded from multipolar needle electrodes, and local activation‐recovery intervals (ARI) were measured.

Results: Mg++ rapidly eliminated self‐terminating polymorphic VTA and all isolated PVCs. During ventricular pacing at 100 bpm, Mg++ caused modest shortening of ARI at all recording sites. Since the magnitude of ARI shortening was greater at mid‐myocardial sites than at other ventricular sites, mean transmural ARI dispersion decreased from 80 ± 22 to 45 ± 18 ms within 30 seconds after Mg++ injection. However, this effect was transient, and, at 120 seconds after Mg++ administration, ARI had increased all sites and transmural ARI dispersion lengthened to 65 ± 18 ms. Besides suppression of triggered premature activity, homogenization of transmural ventricular repolarization was associated with the antiarrhythmic effects of intravenous Mg++ in this model.

Conclusion: Since these effects were transient, a continuous intravenous infusion of Mg++ is preferred to prevent recurrences of VTA.
Reentry Within the Cavotricuspid Isthmus: An Isthmus Dependent Circuit
Authors: YANG YANFEI , VARMA NIRAJ , KEUNG EDMUND C. , SCHEINMAN MELVIN M.
Published: August 2005

Background: We describe a new cavotricuspid isthmus (CTI) circuit.

Methods: This study includes 8 patients referred for atrial flutter (AFL) ablation whose tachycardia circuit was confined to the septal CTI and the os of the coronary sinus (CSOS) region. Entrainment mapping was performed within the CTI, CSOS, and other right atrial annular sites (tricuspid annulus (TA)). Electroanatomic mapping was available in 2 patients.

Results: Sustained AFL occurred in all patients with mean tachycardia cycle length (TCL) of 318 ± 54 (276 − 420) ms. During tachycardia, fractionated or double potentials were recorded at either the septal CTI and/or the region of CSOS in all, and concealed entrainment with post‐pacing interval (PPI) − TCL ≤ 25 ms occurred in this area; but manifest entrainment with PPI > TCL was demonstrated from the anteroinferior CTI and other annular sites in 7/8 patients. In one, tachycardia continued with conduction block at the anteroinferior CTI during ablation. Up to three different right atrial activation patterns (identical TCL) were observed. The tachycardia showed a counterclockwise (CCW) pattern in 6, a clockwise pattern in 2, and simultaneous activation of both low lateral right atrium and septum in 5. Electroanatomic mapping was available in 2, showing an early area arising from the septal CTI in 1, and a CCW activation sequence along the TA in another. Radiofrequency application to the septal CTI terminated tachycardia in 4, and tachycardia no longer inducible in all.

Conclusions: We describe a tachycardia circuit confined to the septal CTI/CSOS region, and hypothesize that this circuit involves slow conduction within the CTI and around the CSOS, which acts as a central obstacle.