bluuebunny/crossref_metadata_2025 huggingface dataset:
Antibacterial Activity of Peritoneal Exudate in Patients Treated with2 g Cefotiam for Surgical Anti-Microbial Prophylaxis
Authors: Miglioli P.A. , Schoeffel U. , Gabroska E. , Allerberger F.
Published: April 2003

The objective of this study was to investigate the presence of antibacterial activity in peritoneal exudate (PE) of patients treated with cefotiam (CFT). CFT (2 g) was administered as a ‘single-shot’ antimicrobial prophylaxis to 6 patients at the beginning of colorectal resection. Samples of PE were collected from each patient on days 1, 2 and 3 after surgery. CFT was detectable in the samples of day 1 for 5 of the 6 patients. The influence of PE on antibacterial activity of the antimicrobial drug was evaluated carrying out the MICs of CFT against Escherichia coli K-12, E. coli (ATCC 10798), Klebsiella pneumoniae (ATCC 1003), Proteus rettgeri (Sanelli) and Staphylococcus aureus (ATCC 29213) with and without the addition of PE. The presence of PE enhanced the antimicrobial activity of CFT against gram-negative strains, but not against S. aureus (ATCC 29213). These results suggest the presence of substances in PE that possess endogenous antibacterial activity. Thus, antimicrobial activity in PE cannot be predicted by evaluating pathogen sensitivity in vitro only.
Antibiotic Susceptibility Testing (Agar Disk Diffusion and Agar Dilution) of Clinical Isolates of Corynebacterium jeikeium
Authors: Traub Walter H. , Geipel Udo , Leonhard Birgit , Bauer Dierk
Published: April 2003

Thirty-three clinical isolates of Corynebacterium jeikeium were examined for susceptibility to 27 antimicrobial drugs with the agar dilution test. Sheep-blood-supplemented Mueller-Hinton agar performed better than Wilkins-Chalgren agar. Disk susceptibility (Bauer-Kirby) tests were carried out in parallel with 24 of the chemotherapeutic agents. All isolates were susceptible to teicoplanin and vancomycin. All isolates resisted fosfomycin, mupirocin, and trimethoprim-sulfamethoxazole. The isolates varied in susceptibility to ciprofloxacin, doxycycline, fusidic acid, ofloxacin, and tetracycline; most were susceptible to rifampin. Surprisingly few discrepancies between agar dilution and disk diffusion tests were encountered when utilizing NCCLS interpretive criteria currently valid for enterococcal isolates.
In vitro Activity of Piperacillin/Tazobactam against 615 Pseudomonas aeruginosa Strains Isolated in Intensive Care Units
Authors: Bonfiglio Giovanni , Laksai Younes , Franceschini Nicola , Perilli Mariagrazia , Segatore Bernadetta , Bianchi Ciro , Stefani Stefania , Amicosante Gianfranco , Nicoletti Giuseppe
Published: April 2003

From May 1996 to September 1997, 615 Pseudomonas aeruginosa strains isolated from patients in intensive care units collected from different Italian laboratories were studied. The susceptibility of piperacillin/tazobactam, in comparison with other antipseudomonal antibiotics, to their NCCLS breakpoints was evaluated: amikacin 79.6%, carbenicillin 67.0%, ceftazidime 73.4%, ciprofloxacin 55.8%, imipenem 64.1%, piperacillin 88.1%, piperacillin/tazobactam 92.4% and ticarcillin/clavulanic acid 69.0%. Seventy-three strains were selected because of their resistance to piperacillin and the mechanisms underlying such a resistance were investigated. Isoelectric focusing and hydrolysis assays revealed the presence of 15 plasmid-mediated β-lactamases. Chromosomal β-lactamase derepression was demonstrated in 34 isolates. The remaining 24 piperacillin-resistant strains did not produce β-lactamases and an ‘intrinsic mechanism’ of resistance was inferred. The piperacillin/tazobactam combination restored resistance in 25 piperacillin strains. Nine of these were derepressed for chromosomal β-lactamase, 8 showed impermeability and 8 showed plasmid enzymes.
Ceftriaxone Monotherapy in the Treatment of Low-Risk Febrile Neutropenia
Authors: Karthaus M. , Wolf H.H. , Kämpfe D. , Egerer G. , Ritter J. , Peters G. , Südhoff T. , Franke A. , Heil G. , Kullmann K.H. , Jürgens H.
Published: April 2003

Febrile neutropenia in patients who have undergone chemotherapy is usually treated with a combination of broad-spectrum antibiotics. There are no exactly defined protocols for single-agent treatment because a clear definition of low risk febrile neutropenia is lacking. This paper examines the safety and efficacy of once-daily ceftriaxone in 376 cases. Material and Methods: In a prospective observational study carried out between February 1992 and January 1996, 959 febrile episodes at 48 hospitals were recorded. Inclusion criteria were neutropenia (absolute neutrophil count, ANC <1,000/µl) with fever (≥38.5°C) or a C-reactive protein concentration >1 mg/dl and suspected infection. Nine hundred and one episodes (acute leukemia n = 396, lymphoma n = 220, solid tumors n = 272 and other disorders n = 13) in 828 patients aged between 1 and 97 years were analyzed, of which 876 episodes were evaluable for response. All patients initially underwent empirical treatment with ceftriaxone (adults: 2 g/day; children: 80 mg/kg/day), either alone (376) or in combination with other agents (525). Results: The mean ANC was 423/µl (SD ± 316) and the median duration of neutropenia 10 days. Of the 363 episodes treated initially with ceftriaxone alone, 70.8% responded versus 56.9% in the combination therapy group. The favorable response to the initial monotherapy treatment was explained by a low-risk population in the monotherapy group. A KI >6 (p < 0.0001), ANC ≥500/µl (p = 0.0001) and a duration of ANC <5 days (p < 0.05) were significantly more frequent in the monotherapy arm and were predictive of lower risk at the commencement of treatment. Conclusion: Ceftriaxone is effective in febrile neutropenia. Treatment with ceftriaxone alone was safe and highly effective in low-risk patients. Single-agent regimens appear to be a suitable treatment option in low-risk febrile neutropenia.
Single-Dose Pharmacokinetic Study of Ciprofloxacin and Fleroxacin in Healthy Adult Nigerian Volunteers
Authors: Chukwuani C.M. , Coker H.A.B. , Oduola A.M.J. , Ifudu N.D. , Sowunmi A.
Published: April 2003

The kinetics of absorption, distribution and elimination of ciprofloxacin and fleroxacin (following an intravenous dose of 200 mg), were evaluated in 24 adult healthy male Nigerian volunteers. Appropriate mathematical models were applied with the aid of a microcomputer software program for the estimation of the basic pharmacokinetic parameters. Appropriate statistical tests and profiles formed the basis for accepting or rejecting a proposed model. For parametric comparisons between the profile of the two drugs, the null hypothesis of no difference in their pharmacokinetic profile was proposed. All statistical tests were performed at a significance level of 95% (α = 0.05) and the 95% confidence level was determined where appropriate. Additionally, the model-independent or stochastic method of analysis was also employed in the pharmacokinetic evaluation of the blood level data. The parametric estimates obtained from both methods were compared. The plasma elimination half-life (t1/2) was estimated as 13.8 ± 5.5 h for fleroxacin and 7.5 ± 4.0 h for ciprofloxacin; the maximal plasma concentration (Cmax) was 0.8 ± 0.3 and 2.3 ± 1.0 mg/l for fleroxacin and ciprofloxacin, respectively, whilst the volume of distribution (Vd) was 2.5 ± 1.6 and 0.4 ± 0.3 liters/kg for fleroxacin and ciprofloxacin, respectively. 71 and 70% of unchanged drug were excreted in urine for fleroxacin and ciprofloxacin, respectively. With respect to comparative values, the results confirmed trends already observed in the literature, particularly as regards the t1/2. However, for fleroxacin there was a significant deviation from the literature trends with respect to Vd, Cmax and AUC. The results also confirmed earlier findings, advocating a once-daily dosage schedule for fleroxacin also in the Negroid population.
Effect of Omeprazole on the Pharmacokinetics of Oral Gemifloxacin in Healthy Volunteers
Authors: Allen Ann , Vousden Marika , Lewis Anastasia
Published: April 2003

This randomized, double-blind, 2-way crossover study investigated the effect of omeprazole on the pharmacokinetics of gemifloxacin, a novel fluoroquinolone. Thirteen healthy male volunteers received a 320 mg oral dose of gemifloxacin after 4 days of dosing with either omeprazole (40 mg once daily) or matching placebo. Blood was sampled for 48 h after dosing for determination of pharmacokinetic parameters. The mean area under the plasma concentration-time curve extrapolated to infinity (AUC0–∞) and maximum plasma concentration (Cmax) for gemifloxacin were increased by, on average, 10% (90% confidence interval [CI], 0.89, 1.36) and 11% (90% CI, 0.87, 1.43), respectively, when gemifloxacin was given after omeprazole compared with after placebo. Neither the time to Cmax (Tmax) nor the half-life of gemifloxacin appeared to be affected by administration of omeprazole. There were no clinically relevant changes in adverse events, vital signs or the results of laboratory investigations after co-administration of omeprazole compared with placebo. In view of the modest increase in systemic exposure and the likely maximal increases indicated by the CIs, the effect of omeprazole on gemifloxacin pharmacokinetics is not considered to be clinically significant. Gemifloxacin and omeprazole can therefore be co-administered with no requirement for a dose adjustment.
In vitro Susceptibilities of Enterococcal Blood Culture Isolates from the Hamburg Area to Ten Antibiotics
Authors: Elsner Holger-Andreas , Sobottka Ingo , Feucht Heinz-Hubert , Claussen Matthias , Kaulfers Paul-Michael , Laufs Rainer , Mack Dietrich
Published: April 2003

Treatment of enterococcal infections is often difficult because of intrinsic and acquired resistance to a variety of antimicrobial agents. Between January 1993 and May 1997, enterococci were isolated from blood cultures of 117 patients at the Institute of Medical Microbiology and Immunology, University Hospital Eppendorf, Hamburg, Germany. Eightynine (76%) isolates were phenotypically identified as Enterococcus faecalis, and 24 (21%) as Enterococcus faecium. All E. faecalis isolates, but only 17% of the E. faecium isolates were susceptible to ampicillin. Two E. faecium isolates (8%) but no E. faecalis were vancomycin resistant (vanA genotype). Quinupristin/dalfopristin shows a high degree of susceptiblity of E. faecium (79%) and may be suitable for the therapy of infections caused by glycopeptide-resistant E. faecium strains.
Effect of Varidase (Streptokinase) on Biofilm Formed by Staphylococcus aureus
Authors: Nemoto Ken , Hirota Katsuhiko , Ono Tsuneko , Murakami Kinya , Murakami Keiji , Nagao Daisuke , Miyake Yoichiro
Published: April 2003

Staphylococcus aureus forms a fibrin-rich biofilm in the presence of plasma which is highly resistant to attack by the human immune system and to chemotherapy. Varidase, composed mainly of streptokinase, is used for hydrolyzing clots. In this study, we attempted to destroy the biofilm of S. aureus with Varidase and to apply this drug in the treatment of staphylococcal infections. Four clinical isolates were used in the experiments. These organisms formed a several-millimeter-thick biofilm on type IV collagen coated coverslips in trypticase soy broth containing 50% human plasma. The biofilm was composed of bacterial cell which adhered to fibrillar fibers and of sediment derived from plasma. 10,000 U/ml of Varidase, the dose which is used clinically, removed the sediment and reduced the number of live bacteria in biofilms to less than 20% of control. 200 U/ml of Varidase was also effective against biofilms of the organisms. An equal combination of Varidase and ofloxacin had an additive effect on the bacteria. The results of this study demonstrate that Varidase is highly effective in destroying biofilms of S. aureus in vitro and suggest that this drug would be useful for treating staphylococcal infections.
Susceptibility of Clinical Strains of Herpes simplex Virus to Three Nucleoside Analogues
Authors: Edert Danielle Y. , Finance Chantal M.-T. , Le Faou Alain E.
Published: April 2003

The susceptibility of clinical isolates of herpes simplex virus 1 (HSV1) (58 strains) and 2 (HSV2) (17 strains) from the Centre Hospitalier et Universitaire de Nancy to three nucleoside analogues was compared by the dye uptake method. As expected, all strains of HSV2 were resistant to brovavir or sorivudine. Aciclovir and penciclovir activities were comparable; 2 strains of HSV1 were resistant to these two compounds. Four strains isolated from immunocompromised patients gave different results with brovavir as compared to aciclovir; resistance to aciclovir (1 strain of HSV1) did not correlate with resistance to brovavir (3 strains of HSV1). Following up antiviral susceptibility is of interest for the detection of resistant strains in immunocompromised patients receiving prophylactic aciclovir.
Acute Dystonia with Thalamic and Brainstem Lesions after Initial Penicillamine Treatment in Wilson’s Disease
Authors: Huang Chin-Chang , Chu Nai-Shin
Published: April 2003

Dystonia is a common manifestation in Wilson’s disease (WD). The striatum, especially the putamen, has been considered to be responsible for dystonia. We reported 3 patients who developed acute generalized dystonia and akinetic rigid syndrome following an initial therapy with d-penicillamine 125–500 mg daily. Brain MRI revealed lesions in the thalamus and the brainstem, particularly the tegmentum, and the basis pontis in addition to the basal ganglion lesions. After the episode, 1 patient continued to receive d-penicillamine therapy and 2 changed to zinc sulfate treatment. The generalized dystonia improved in the following 3 months and 3 years respectively in 2 patients. Follow-up brain MRI of these 2 patients revealed that the lesions in the thalamus and brainstem disappeared or resolved almost completely. From these data, acute generalized dystonia with brainstem and thalamic lesions may occur in WD patients after an initial d-penicillamine therapy. Furthermore, the dystonia may resolve following the disappearance of the brainstem and thalamic lesions.
The Lateralizing Value of Ictal Clinical Symptoms in Uniregional Temporal Lobe Epilepsy
Authors: Steinhoff B.J. , Schindler M. , Herrendorf G. , Kurth C. , Bittermann H.-J. , Paulus W.
Published: April 2003

In order to assess the lateralizing value of several ictal and postictal clinical symptoms in temporal lobe epilepsy (TLE), we analyzed 89 seizures of 20 left dominant patients with intractable left (n = 9) versus right (n = 11) TLE who had undergone successful anterior temporal lobectomy. In left TLE, movement arrest at seizure onset, postictal dysphasia >120 s and postictal dyslexia >180 s were the most typical findings and associated with a sensitivity of 94, 94, and 100%, respectively. The highest specificity of 100% each was evident for contralateral versions of eyes and head and dystonic posturing. In right TLE, the highest sensitivity was seen for whole-body movements at seizure onset, postictal dysphasia <120 s and postictal dyslexia <180 s with figures of 82, 87, and 93%, respectively. As compared to left TLE, contralateral version and dystonic posturing, ictal speech, and postictal dyslexia <180 s each had a specificity of 100%. The careful combined analysis of certain ictal clinical signs combined with consistent findings of interictal EEG and neuroimaging studies may be often sufficient to proceed with epilepsy surgery without invasive recordings even if ictal scalp EEG is not unambiguous.
Slowly Progressive Pure Word Deafness
Authors: Otsuki Mika , Soma Yoshiaki , Sato Masahisa , Homma Atsushi , Tsuji Shoji
Published: April 2003

Among the reports of primary progressive aphasia, there are few about patients who exhibited progressive pure word deafness with detailed auditory and radiological examination as well as neuropsychological assessment. We describe a 67-year-old right-handed man who exhibited slowly progressive pure word deafness over a period of 9 years without exhibiting any other cognitive or mental deterioration. Magnetic resonance imaging of his brain revealed generalized cortical atrophy, particularly in the left superior temporal region. Auditory examination revealed severe disability in discriminating each syllable or mora of Japanese words despite adequate auditory acuity. He also showed impairment in temporal auditory discrimination assessed by the click fusion test and the click counting test. His ability to discriminate meaningful environmental sounds was mildly impaired. We discuss the pathophysiology of slowly progressive pure word deafness over a period of many years which was not complicated by other language or cognitive dysfunctions.
Muscle Pathology in the Early Stage of Guillain-Barré Syndrome
Authors: Ono S. , Inoue K. , Munakata S. , Nagao K. , Shimizu N.
Published: April 2003

Although many studies have been performed on nervous tissue pathology in Guillain-Barré syndrome (GBS), much less is known about pathological changes in skeletal muscle in this disorder. We have studied muscle biopsies from 5 patients with GBS, 5 patients with amyotrophic lateral sclerosis (control A), and 5 patients with polyarteritis nodosa (control B). We also examined muscle obtained after death from 7 patients without neurologic or muscular diseases (control C). By light microscopy, all specimens from patients with GBS exhibited necrosis and/or phagocytosis, none of which was observed in the other three controls. Neither small angulated fibers nor small group atrophy was found in patients with GBS and in control C, by contrast with controls A and B. Ultrastructurally, filamentous bodies, subsarcolemmal aggregates of mitochondria, accumulation of glycogen particles, and concentric laminated bodies were present much more frequently in patients with GBS than in all controls. Only GBS patients showed cytoplasmic bodies. These observation suggests that there is muscle involvement in the early stage of GBS and that these muscle changes may have an intimate and important relationship to the pathogenesis of GBS.
Analysis of Creatine Kinase Activity in 504 Patients with Proximal Spinal Muscular Atrophy Types I–III from the Point of View of Progression and Severity
Authors: Rudnik-Schöneborn Sabine , Lützenrath Susanne , Borkowska Janina , Karwanska Anna , Hausmanowa-Petrusewicz Irena , Zerres Klaus
Published: April 2003

Mild to moderately elevated creatine kinase (CK) activity is a frequent biochemical finding in proximal spinal muscular atrophy (SMA). In a collaborative study on all types of childhood and juvenile onset SMA, we analysed the CK activity of 504 SMA patients (138 type I, 127 type II, 144 type IIIa, and 95 type IIIb patients). Under the assumption of a lognormal distribution of CK activity as the most appropriate statistical model, CK levels were transformed into logarithms and compared by standard deviation scores = CK-SDS (log). CK activity was statistically different between early and later onset SMA: in SMA I and II, about one-third of patients showed CK-SDS (log) >2 SD, the analysis of the means did not show significant differences. In SMA III, CK-SDS (log) was significantly higher (p < 0.01) than in the two other groups, which was most pronounced in SMA IIIb. More than 90% of SMA IIIb patients showed CK-SDS (log) values >2 vs. 57% in SMA IIIa. As similar values were obtained for a subgroup of 100 patients in whom the diagnosis of autosomal recessive SMA was confirmed by a deletion of the telomeric copy of the survival motor neuron gene, our results can be considered representative for SMA I–III. There was no correlation between CK level and disease duration. The fact that patients were ambulatory or chair-bound had no influence on CK activity in type III SMA. There was no sex influence in SMA I, II and IIIa. The observed higher male values in the group SMA IIIb are most likely the result of a lack of female patients with onset after puberty.
Muscle Weakness in Parkinson’s Disease: Isokinetic Study of the Lower Limbs
Authors: Kakinuma Susumu , Nogaki Hiroshi , Pramanik Bimalendu , Morimatsu Mitsunori
Published: April 2003

Isokinetic strength of knee extension and flexion was measured at two speeds of movement in 23 patients with Parkinson’s disease, to clarify whether muscle weakness is inherent to the disease. To counteract normal variation among subjects, we selected patients with symptoms completely or largely confined to one side and compared sides for each patient. The affected side was weaker than the other in both slow and fast movements early in the disease. In more advanced disease, the difference between sides diminished at the slow speed but remained significant at the faster speed. These observations suggest that weakness is inherent to Parkinson’s disease and influenced by movement speed.
Reevaluating the Role of Vascular Changes in the Differential Diagnosis of Alzheimer’s Disease and Vascular Dementia
Authors: Gold Gabriel , Giannakopoulos Panteleimon , Bouras Constantin
Published: April 2003

Alzheimer’s disease (AD) and vascular dementia (VaD) are the two most common causes of dementia, and much effort has been devoted to their differential diagnosis. However, current epidemiological, clinical and neuropathological evidence points to a substantial overlap between AD and VaD and suggests that vascular pathology, the traditional cornerstone of the differential diagnosis between the two entities, may not represent as clear a line of demarcation as originally believed. It may be time to reevaluate the dichotomy between AD and VaD.
A Unique Autosomal Dominant Disorder with Indifference to Pain: Clinicopathologic Correlation of Indifference to Pain and Thalamic Gliosis
Authors: Davis Bradley J. , Reed Lee A. , Schelper Robert L.
Published: April 2003

We present updated information on a previously reported kindred with an autosomal dominant disorder variably expressed as indifference to pain, dementia, and ataxia. Additional clinical and radiological information is presented, as are autopsy results form the index case. In addition to evidence of Alzheimer’s disease, the autopsy revealed bilateral thalamic gliosis, which may be a neuroanatomic substrate for the indifference to pain seen in this patient. To our knowledge, this is the first reported association of thalamic gliosis and indifference to pain.
Detecting New Lesion Formation in Multiple Sclerosis: The Relative Contributions of Monthly Dual-Echo and T1-Weighted Scans after Triple-Dose Gadolinium
Authors: Filippi M. , Mastronardo G. , Rocca M.A. , Capra R. , Gasperini C. , Rovaris M. , Bastianello S. , Comi G.
Published: April 2003

In this study, we evaluated the frequency of formation of new lesions on brain magnetic resonance imaging (MRI) from patients with relapsing-remitting multiple sclerosis (MS) and defined the relative contributions of unenhanced and enhanced MRI. Every 4 weeks for 3 months, dual-echo and postcontrast T1-weighted (5 min after the injection of 0.3 mmol/kg gadolinium-DTPA) scans were obtained from 28 patients with relapsing-remitting MS. New lesions were defined as those present on dual-echo and/or postcontrast T1-weighted scans but with no corresponding MRI abnormalities on any of the preceding scans. A total of 111 newly formed lesions were detected during the follow-up on dual-echo and postcontrast T1-weighted scans (i.e., an average of 1.3 lesions per patient per month). Ninety-eight (88%) of such lesions were seen on both dual-echo and postcontrast T1-weighted scans, whilst 13 (12%) were seen only with one of the two techniques: 9 only on dual-echo and 4 only on postcontrast scans. Five of the 98 new lesions seen by both techniques were seen by postcontrast scans 1 month before their appearance on dual-echo scans. Our study suggests that both dual-echo and postcontrast T1-weighted scans are useful to detect newly formed lesions in patients with MS. This is of importance when using MRI to monitor the efficacy of treatments which may halt MS lesion formation.
Plasma Semicarbazide-Sensitive Amine Oxidase in Stroke
Authors: Garpenstrand Håkan , Ekblom Jonas , von Arbin Magnus , Oreland Lars , Murray Veronica
Published: April 2003

Semicarbazide-sensitive amine oxidase (SSAO) has been suggested to be involved in the development of vascular endothelial damage. The source of the soluble form of SSAO found in the blood serum is unknown. However, it has been speculated that it is secreted from cells within the vascular wall where high activity of the enzyme is found. Altered SSAO activity has been reported in atherosclerotic plaques of the human aorta. Stroke is a manifestation of long-term atherosclerotic disease, and in this study, plasma SSAO activities were estimated in 42 patients with cerebral thrombosis and 26 patients with cerebral embolism, and compared to two control groups of 45 individuals in total. No statistically significant differences were found between the patient groups and controls regarding plasma SSAO activity, suggesting that changes in the soluble form of SSAO found in the circulation do not play a major role in this type of acute cerebrovascular event. Furthermore, it does not seem likely that the involvement of vascular tissue occurring in stroke results in release of the enzyme into the circulation. Nevertheless, further studies on tissue-bound SSAO in cerebral vessels would be of great interest.
Combined Peripheral Facial and Abducens Nerve Palsy Caused by Caudal Tegmental Pontine Infarction
Authors: Roh Jae-Kyu , Kim Byung-Kun , Chung Jae-Myun
Published: April 2003

Isolated peripheral facial and abducens nerve palsy could theoretically be caused by a caudal pontine infarction, but as far as we know, there has been no published case history which has demonstrated this point. We describe the cases of two hypertensive patients who showed combined peripheral facial and abducens nerve palsy without other neurologic symptoms or signs. Other than hypertension, there was no identifiable etiology. Magnetic resonance imaging demonstrated compatible isolated ipsilateral ischemic infarction of the caudal tegmental pons. The present cases indicate that a well-placed small pontine infarction can cause isolated peripheral facial and abducens nerve palsy.
Correlation between MRI and Short-Term Clinical Activity in Multiple Sclerosis: Comparison between Standard- and Triple-Dose Gd-Enhanced MRI
Authors: Rovaris M. , Rodegher M. , Comi G. , Filippi M.
Published: April 2003

We assessed the relative sensitivities of standard (SD)- and triple-dose (TD) gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) for detecting enhancing lesions in different phases of multiple sclerosis (MS) disease activity. Ten MS patients were studied with monthly brain MRI scans for a 3-month follow-up (i.e., 4 scans were obtained for each patient with both SD and TD). A total of 11 relapses were recorded and treated with short-term high-dose steroid therapy. Enhancing lesion numbers and volumes were significantly higher for TD vs. SD scans (p < 0.0001). For both Gd doses, the numbers and volumes of lesions were higher during clinical relapses; the differences were statistically significant when comparing the results for scans obtained during and after a relapse. The gain in sensitivity of TD vs. SD scans for enhancing lesion detection was lower during relapses, whilst it was maximum after relapses, although these differences did not reach statistical significance. Our data confirm the potential role of TD MRI for monitoring MS activity, since, with its higher sensitivity, it may detect more subtle blood-brain barrier (BBB) damage. They also suggest that the degree of BBB damage in individual lesions changes during different phases of disease activity.
Neurological Complications after Cardiopulmonary Bypass: An Update
Authors: Carrascal Y. , Guerrero A.L. , Maroto L.C. , Cortina J.M. , Rodríguez J.E. , Renes E. , Rufilanchas J.J.
Published: April 2003

Introduction: Neurological complications are, at the present time, considered among the most important causes of morbidity and mortality after heart surgery. We evaluated their importance and risk factors. Patients and Methods: We retrospectively reviewed 2,528 consecutive patients who underwent cardiopulmonary bypass in a single center. In each one, we attended to previous vascular risk factors, such as surgical and postoperative events. We considered four categories of neurologic outcome: (1) persistent neurological focal deficits, (2) stupor or coma, (3) temporary neurological focal deficits, and (4) seizures. We carried out univariant and multivariant statistical analysis, looking for predictors of adverse neurologic events. Results: Neurological complications occurred in 76 patients (3%); 36 of them (47%) had persistent neurological focal deficits, 18 (24%) stupor or coma, 18 (24%) temporary neurological focal deficits, and 27 (36%) seizures. Twenty-two patients with cerebral adverse outcomes died (29%), the overall mortality among the 2,528 cases being 5%. Predictors of risk were aortic aneurysm and aortic valve surgery, advanced age, female sex, and the use of intra-aortic balloon pump. A longer hospitalization time was noticed among patients with neurological side effects. Discussion: Neurological complications are common and serious after heart surgery, as we have noticed with this series, the largest up to now, according to our review of the literature. They increase perioperative mortality and hospitalization time. Neurological morbidity and risk factors in our study are similar to those previously published.
The Barcelona Stroke Registry
Authors: Martí-Vilalta J.L. , Arboix A.
Published: April 2003

The Barcelona Stroke Registry was established to collect clinical data of hospitalized patients with stroke, in order to study their clinical characteristics and outcome. Data were collected over a 17-year period in 3,577 consecutive patients with first-ever stroke admitted to a stroke unit in two university hospitals in the city of Barcelona (Catalonia, Spain). Patients were generally admitted within 48 h from stroke onset, were evaluated by a neurologist, and clinical data were collected using a standardized protocol. All subjects underwent computerized tomography (CT) examination. Data on the 3,577 patients revealed the following stroke subtypes: cerebral infarction (81%), corresponding to the varieties of atherothrombotic (39.5%), cardioembolic (17.5%), lacunar (11%), unusual (5%), or unknown (8%); and cerebral hemorrhage. We analyzed age distribution (mean age 66 years); risk factors (the most frequent being hypertension, present in 54% of cerebral infarctions and in 65% of hemorrhages); clinical manifestations (the most salient being abrupt onset in one half of the cases; high frequency of decreased consciousness in cardioembolic infarction; headache, seizures and nuclear palsy in ‘unusual’ cerebral infarctions; vomiting and coma in hemorrhage); localizations by vascular territories; mechanisms of the various stroke subtypes; complications (present in one third of patients, with a mortality of 14%), and outcome. Two out of 3 hospitalized stroke patients are first-ever stroke sufferers. Neuroimaging shows a cerebral infarct in 86.5% of cases. Clinical and laboratory investigations cannot determine the mechanism of 8% of infarcts and of 23% of hemorrhages. The high frequency of medical complications, mortality, and disability highlights the need to establish stroke units and stroke registries in order to perform further research into the diagnosis and management of patients with cerebrovascular disease.
Assessment of Colour Vision in Epileptic Patients Exposed to Single-Drug Therapy
Authors: López Lidia , Thomson Alfredo , Rabinowicz Adrian L.
Published: April 2003

Diplopia, blurred vision and colour disturbances are well-known side effects associated with anti-epileptic drugs (AEDs). Farnsworth-Munsell 100-hue colour test (F-100) is an accepted and sensitive tool to detect changes in colour perception. To determine the impact of AEDs upon colour vision, we evaluated 37 consecutive patients with complex partial seizures exposed to monotherapy with phenytoin (PHT, carbamazepine (CBZ) or valproic acid (VPA). All had normal IQ and no congenital disturbances in colour vision or ocular diseases. Twenty normal controls were used for statistical analysis. Thirteen patients were exposed to PHT, 12 to CBZ and 12 to VPA. Visual colour perception was impaired in 30/37 (82%) of the study group. The most significant abnormality was detected in the blue-yellow axis in 10/13 patients exposed to PHT (p < 0.02) and in 8/12 treated with CBZ (p < 0.009). In 8/12 patients taking VPA, no significant abnormality was observed (p < 0.06). None of the studied patients complained of colour vision disturbances. Our findings strongly support the negative effect of AEDs upon colour vision discrimination, most likely due to changes at the retinal processing level. F-100 proved to be very useful to assess early toxicity due to AEDs.
Adrenoleukodystrophy Associated with Vitiligo and Ulcerative Colitis
Authors: Sawaya Raja A. , Mourad Fadi H. , Najjar Samir , Mikati Muhammad , Raymond Gerald V.
Published: April 2003

Adrenoleukodystrophy (ALD) is an X-linked inherited disorder of lipid metabolism usually presenting in childhood or early adolescence. It is a progressive disease with symptoms of adrenal insufficiency and central nervous system demyelination. The pathology results from the accumulation of very long-chain fatty acids and an inflammatory reaction in the brain white matter. We report a case of ALD associated with adrenal insufficiency and two autoimmune diseases: vitiligo and ulcerative colitis.
Unusual Clinical Expression of Dystrophinopathy in a Female, Mimicking a Congenital Myopathy
Authors: Palmucci L. , Doriguzzi C. , Mongini T. , Chiadò-Piat L. , Ugo I.
Published: April 2003

A 25-year-old woman with negative family history and delayed motor development presented hypotrophy of the right lower limb and calf hypertrophy since age 7 and she complained of muscle weakness since 23. Neurological examination showed a thin elongated face, high-arched palate, high-pitched voice, proximal wasting and weakness, impairment of distal muscles in the lower limbs. CK was 3,034 U/l, EMG showed a myopathic pattern. Muscle biopsy displayed dystrophic features with diffuse dystrophin deficiency; immunoblotting demonstrated quantitative reduction of the protein and normal molecular weight. Lyonization study showed skewed X-inactivation with the maternal X active. Seven years’ follow-up did not show progression of the disease.
An Epidemiological Study to Assess Migraine Prevalence in a Sample of Italian Population Presenting to Their GPs
Authors: Roncolato M. , Fabbri L. , Recchia G. , Cavazzuti L. , Visona G. , Brignoli O. , Medea G.
Published: April 2003

This multicentre, observational, cross-sectional study was conducted to determine migraine prevalence in a sample of population presenting to their GPs. The study covered all the patients who visited the GPs practice, for any reason, on 5 consecutive days of 2 different weeks. A total of 71,588 patients were interviewed by 902 GPs. The prevalence of migraine in this sample was 11.6%.
The Development of Synkinesis after Facial Nerve Paralysis
Authors: Çelik Münevver , Forta Hulki , Vural Çetin
Published: April 2003

In this study, the development of clinical synkinesis after facial nerve paralysis (FP) and its relationship to electrophysiological findings were investigated. Thirty-four patients who were examined within the first 5 days after onset of FP and who could also be followed up for at least 4 months were included in the study. Electrophysiological investigations consisted of: (1) recording of the direct responses by facial nerve stimulation at the stylomastoid fossa; (2) recording of the ‘synkinetic spread’ of the supraorbital nerve reflex to the lower facial muscles; (3) recording of the ‘lateral spread responses’ by stimulating the mandible and zygomatic branches of the facial nerve. Clinical synkinesis developed in 14 of 18 patients (78%) with a direct response ratio (DRr) of less than 40%. Among the 16 patients with a DRr of 40% or more, synkinesis was observed in 3 cases (18.7%) only. The DRr provided reliable information concerning the development of synkinesis. Forty percent seemed to be a reasonable limit to distinguish the high-risk group for the development of clinical synkinesis.
New Hypointense Lesions on MRI in Relapsing-Remitting Multiple Sclerosis Patients
Authors: Wagner S. , Adams H.-P. , Sobel D.F. , Slivka L.S. , Sipe J.C. , Romine J.S. , Koziol J.A.
Published: April 2003

Background: Preliminary observational studies with multiple sclerosis (MS) patients have reported strong correlations between an increase in hypointense lesion load (black holes) on T1-weighted spin echo images, and an increase in disability. Objective: We assessed the relationship of hypointense lesions to the clinical course of disease among 50 relapsing-remitting MS patients in the controlled setting of a randomized clinical trial. Methods: Fifty patients with relapsing-remitting disease were enrolled in a randomized double-blind two-arm (cladribine vs. placebo) clinical trial of 1-year duration. All patients had monthly clinical evaluations and MRIs over the course of the trial. Multivariate techniques were used to identify predictors of clinical severity from information on exacerbations, MRIs, baseline clinical parameters, and demographics. Results: At baseline, clinical severity is weakly related to counts of black holes, with rank correlations between counts and clinical scores (EDSS and SNRS) of absolute magnitude 0.3. Rates of appearance of new black holes over the course of the trial are higher for patients with more severe disease at baseline (EDSS ≥ 4) than for the less severe patients. Changes in clinical severity over the course of the trial are best predicted by baseline neurologic scores and numbers of exacerbations, with black holes adding no further improvement in prediction. Conclusions: Numbers of exacerbations seem more critical to short-term clinical outcomes in relapsing-remitting MS, as reflected by patients’ clinical scores, rather than black holes. Various imaging methods and MRI indices capture complementary information relating to MS disease processes. The determination of which processes are affected by different drugs should lead to more effective treatment of MS patients.
Increased Cerebrospinal Fluid Tau Protein in Multiple Sclerosis
Authors: Kapaki Elisabeth , Paraskevas George P. , Michalopoulou Maria , Kilidireas Konstantinos
Published: April 2003

Axonal damage is now being recognized as a common finding in multiple sclerosis (MS) lesions and a cause of irreversible neurological damage. Attempts to identify markers of early axonal damage are of great significance. This prompted us to examine the microtubule-associated protein tau in the cerebrospinal fluid (CSF) of patients with MS vs. controls. Tau was measured by double antibody sandwich ELISA. Increased CSF tau levels were found in MS as compared to controls (medians 249.6 and 135 pg/ml respectively, p < 0.001). Half of the MS patients presented with levels above the upper limit of the controls. A significant increase vs. controls was found in both relapsing-remitting and progressive subtypes. These data may indicate axonal impairment in a subpopulation of MS patients and may provide a tool for the estimation of axonal damage during life.
Developmental Dyslexia: Re-Evaluation of the Corpus callosum in Male Adults
Authors: Robichon Fabrice , Bouchard Pascal , Démonet Jean-François , Habib Michel
Published: April 2003

Using a new method based upon the measurement of four angles, we analyzed the corpus callosum of 23 adult male dyslexics and 25 age-matched controls on MRI sagittal scans. Two out of the four angles measured showed significant differences between the groups that are consistent with previous findings concerning the size of the corpus callosum in dyslexics. In particular, posterior regions are concerned, displaying a lowered corpus callosum in dyslexics. These findings are discussed in relation to cortical parietal asymmetries and possible hormonal events, referring to the testosterone hypothesis, that could occur in utero or in the perinatal period in the dyslexic population.
‘Iatrogenic’ Wernicke’s Encephalopathy in Japan
Authors: Shikata Elisa , Mizutani Tomohiko , Kokubun Yuji , Takasu Toshiaki
Published: April 2003

‘Iatrogenic’ Wernicke’s encephalopathy has appeared to occur more frequently in Japan, probably induced by the change of our Japanese national health insurance policy in 1992. We report 4 nonalcoholic patients with such Wernicke’s encephalopathy, which occurred during the early postoperative oral food intake period following intravenous nutrition without vitamin supplements. We analyzed the medical records of 4 patients, 3 men and 1 woman, aged between 55 and 71 years, who were admitted to our hospital between 1992 and 1995. Three patients underwent gastrointestinal surgery and 1 suffered chronic pyothorax. We diagnosed our patients as having Wernicke’s encephalopathy based on typical neurological abnormalities, in addition to typical cranial magnetic resonance image findings, low serum vitamin B1 levels, or both. Although all of the patients were treated with vitamin B1 and showed some improvement, 1 patient developed Korsakoff syndrome, 2 made incomplete neurological recovery, and 1 died. We speculated that the body vitamin B1 stores had been decreasing in our patients who did not receive any vitamin supplements during intravenous hyperalimentation or hydration. Subsequent administration of high calorie and high carbohydrate oral diets increased the demand for vitamin B1, further depleting the vitamin stores, thereby causing ‘iatrogenic’ Wernicke’s encephalopathy. The change of our national health insurance policy in 1992 discouraged the routine administration of vitamins, probably causing Wernicke’s encephalopathy in our patients.
Spinocerebellar Ataxia in Singapore: Predictive Features of a Positive DNA Test?
Authors: Tan E.K. , Law H.Y. , Zhao Y. , Lim E. , Chan L.L. , Chang H.M. , Ng I. , Wong M.C.
Published: April 2003

Significant differences in frequency of the different spinocerebellar ataxia (SCA) subtypes have been described to occur in different populations. A ‘blunderbuss’ diagnostic DNA testing approach would entail unnecessary healthcare cost. In this study, we determine the prevalence of SCA subtypes and predictive features of a positive DNA test in consecutive clinically diagnosed SCA cases in Singapore. Twenty-one consecutive patients from 14 families were evaluated over a 3-year period. Thirteen patients (61.9%) from 6 families had a positive DNA test. Eleven of these (all ethnic Chinese) had SCA 3 (abnormal CAG size ranged from 61 to 71), and 2 ethnic Malays had SCA 2 (abnormal CAG size of 39). Clinical features which were highly predictive of a positive DNA SCA test in our population included presence of a positive family history, chorea and dystonia, muscle and tongue fasciculations, gaze-evoked nystagmus, and hypertonia. Our study draws attention to the observation that knowledge of relatively specific features of the most common SCA subtype in a local population can greatly enhance the practical accuracy of the choice of which SCA DNA test to order.
Electrophysiological, Neuropsychological and Clinical Findings in Multiple Sclerosis Patients Receiving Interferon β-1b: A 1-Year Follow-Up
Authors: Gerschlager W. , Beisteiner R. , Deecke L. , Dirnberger G. , Endl W. , Kollegger H. , Lindinger G. , Vass K. , Lang W.
Published: April 2003

We assessed serial event-related potentials (ERPs) as well as neuropsychological and clinical test findings in a group of multiple sclerosis (MS) patients (n = 14) treated with interferon β-1b (INF-β-1b) compared to normal controls (n = 14). All investigations were done within 1 week before INF-β-1b therapy was started and 12 months later. An auditory oddball paradigm was employed. No significant differences in the N100, P200, N200 or P300 latencies between patients and control group were found, but 3 out of 14 MS patients developed abnormal P300 latencies (more than 2 standard errors from the mean) after 1 year of INF-β-1b therapy. This was not reflected by the respective neurological impairment as assessed by the Expanded Disability Status Scale score. ERPs might be a useful tool in clinical studies in order to evaluate drug effects on cognition, but for a final statement, the analysis of ERPs in a larger group of patients is required.
Eye Deviation in Patients with One-and-a-Half Syndrome
Authors: Johkura Ken , Komiyama Atsushi , Kuroiwa Yoshiyuki
Published: April 2003

To understand malalignments of the visual axes in one-and-a-half syndrome, we measured eye positions in 4 patients with this syndrome under two conditions: with Frenzel goggles to prevent eye fixation and without Frenzel goggles. When fixation was prevented with the Frenzel goggles, all patients showed mild outward deviation in both eyes. Removal of the Frenzel goggles elicited adduction of the eye ipsilateral to the side of the lesion for fixation, with greater outward deviation of the contralateral eye (acute stage), or adduction of both eyes to midposition for biocular fixation (convalescent stage). In 3 patients whose outward eye deviation with Frenzel goggles was greater on the ipsilateral side, a transition from one-and-a-half syndrome to ipsilateral internuclear ophthalmoplegia was noted, whereas a transition to ipsilateral gaze palsy was seen in the one patient whose deviation was greater on the contralateral side. These findings suggest that in one-and-a-half syndrome patients, the eyes tend to be in divergent positions when fixation is prevented; ipsilateral eye deviation may result from medial longitudinal fasciculus involvement, and contralateral eye deviation may result from paramedian pontine reticular formation involvement. Viewing a target may lead to a secondary deviation or adaptation of eye positions for fixation.
Total Recovery after Bilateral Paramedian Thalamic Infarct
Authors: Krolak-Salmon Pierre , Croisile Bernard , Houzard Claire , Setiey Alice , Girard-Madoux Philippe , Vighetto Alain
Published: April 2003

Bilateral paramedian thalamic infarcts are characterised initially by the association of acute vigilance disorders and vertical gaze palsy, followed by persisting dementia with severe mnemic disturbance, global aspontaneity and apathy. We describe a patient with a dramatic neuropsychological recovery, confirmed by testing examination and completed by a cerebral metabolism study. The pathophysiology of this type of cognitive deficit is discussed.
Cytoprotective Effect of Trimetazidine on 75 min Warm Renal Ischemia-Reperfusion Injury in Rats
Authors: Özden A. , Aybek Z. , Saydam N. , Çalli N. , Saydam O. , Düzcan E. , Güner G.
Published: April 2003

In this experimental study, we evaluated the effect of trimetazidine (TMZ) on renal ischemia-reperfusion (IR) injury in Sprague-Dawley rats. Renal IR was achieved by a 75-min clamping of the left renal pedicle and subsequent 24 h reperfusion, after right nephrectomy was performed. The rats were randomly divided into three groups: group 1 (sham operated: no IR injury), group 2 (ischemic control: saline treatment), and group 3 (3 mg/kg TMZ before ischemia). After 24 h of reperfusion, blood samples and renal tissue samples were taken to measure the levels of creatinine, tissue malondialdehyde (MDA), and glutathione peroxidase (GSH-Px) activity. Histopathological changes were evaluated. In addition, the 7-day survival rates in each group were evaluated. We found significant increases in the levels of creatinine and tissue MDA, severe acute tubular necrosis, and a significant decrease in the activity of the GSH-Px in group 2. There were significant decreases in the levels of creatinine and tissue MDA, mild acute tubular necrosis, and a significant increase in activity of the GSH-Px in group 3 when compared with the control group (p <0.05). Statistically significant differences (p <0.05) in survival were noted between the ischemic control and sham-operated and TMZ groups. We have concluded that TMZ is able to protect the kidney from warm IR injury.