bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression in Intractable Partial Epilepsy Varies by Laterality of Focus and Surgery
Authors: Quigg Mark , Broshek Donna K. , Heidal‐Schiltz Susan , Maedgen Jennifer W. , Bertram Edward H.
Published: March 2003

Summary:  Purpose: Depression sometimes occurs after surgical treatment for medically intractable partial epilepsy. The risk of pre‐ and postsurgical depression may vary by laterality of seizure focus. We reviewed the pre‐ and postsurgical psychological assessments and clinical courses of patients to identify those at highest risk for postsurgical mood disorders.

Methods: Depression status was assessed in a consecutive series of epilepsy patients before and 1 year after epilepsy surgery with the use of Scale 2 of the MMPI‐2 and a clinical depression index (CDI) scoring the occurrence of depressive symptoms, psychiatric referral, or attempted/completed suicide. Outcome at 1 year was modeled by regression techniques as functions of preoperative mood measurements, side of epilepsy surgery, and preoperative verbal intelligence.

Results: The CDI and Scale 2 MMPI‐2 correlated significantly (r = 0.341; p ≤ 0.01). Left (n = 54 subjects) and right (n = 53) surgery groups did not differ by sex, seizure outcome, age, education, age at first seizure, duration of epilepsy, or intellect. Higher presurgical depressive morbidity (p = 0.0037) and right‐sided surgery (p = 0.0003) predicted higher postoperative CDI. Higher preoperative Scale 2 scores, indicating worse depressive traits, predicted worse postoperative Scale 2 scores (p < 0.0001). Although side of surgery did not predict Scale 2 scores, Scale 2 scores of patients with preoperative right‐sided foci tended to have worse postsurgical Scale 2 scores (p = 0.08). Findings for the temporal lobectomy subgroup (n = 90) were similar to those of the overall sample.

Conclusions: Patients undergoing right hemispheric epilepsy surgery, especially those with high presurgical depression–related morbidity, may be particularly susceptible to clinical depression. Our findings support other studies that show an interhemispheric modulation of depressive traits and symptoms.
A Multicenter Study on the Prevalence of Psychiatric Disorders among New Referrals for Epilepsy in Japan
Authors: Matsuura Masato , Oana Yasunori , Kato Masaaki , Kawana Akinori , Kan Rumiko , Kubota Humio , Nakano Takashi , Hara Tsunekatsu , Horikawa Naoshi
Published: March 2003

Summary:  Purpose: To investigate the prevalence rate and risk factors of psychiatric disorders among new referrals for epilepsy, a multicenter study was conducted by using the International League Against Epilepsy (ILAE) criteria for epilepsy and the ICD‐10 criteria for psychiatric disorders.

Methods: From April 2000 to March 2001, 398 patients with epilepsy, who were referred to nine neuropsychiatric outpatient clinics specialized for epilepsy in the Tokyo metropolitan area, were evaluated by using a newly developed five‐axis classification scheme.

Results: Forty‐two percent of the subjects showed a psychiatric disorder. Twenty‐four percent of the total showed psychiatric disorders, including neurotic disorders in 8%, psychotic disorders in 7%, and affective disorders in 1%. In addition, 23% of the total showed mental retardation, and 18% showed personality disorders. A logistic regression analysis revealed that the three risk factors for a psychiatric disorder were mental retardation, temporal lobe epilepsy (as opposed to other subtypes), and a high seizure frequency.

Conclusions: The presence of mental retardation was the primary risk factor for developing a psychiatric disorder, especially a schizophrenia‐spectrum disorder. The type of epilepsy alone is not a strong predictor of psychiatric illness, and intractable temporal lobe epilepsy with a high seizure frequency is accountable for the link between the epilepsy and the psychiatric illness.
Interictal Epileptic Spiking during Sleep and Wakefulness in Mesial Temporal Lobe Epilepsy: A Comparative Study of Scalp and Foramen Ovale Electrodes
Authors: Clemens Zsófia , Janszky József , Szűcs Anna , Békésy Mariann , Clemens Béla , Halász Péter
Published: March 2003

Summary:  Purpose: To assess distribution of temporal lobe spikes across different states of sleep and wakefulness in simultaneous scalp and foramen ovale (Fo) recordings.

Methods: The study included 12 patients with mesial temporal lobe epilepsy (MTLE). As part of their presurgical evaluation, patients underwent long‐term video‐EEG monitoring with combined scalp and foramen ovale electrodes (FoEs). In addition to traditional sleep scoring, waking was subdivided into eyes‐opened and eyes‐closed states, and rapid‐eye‐movement (REM) sleep was divided into phasic and tonic states. Spike counts were carried out visually for scalp and FoEs, and spiking rates were determined for each state. A ratio between FoE and scalp spiking rates also was calculated for each state.

Results: Scalp spiking showed a significant increase during NREM3,4, whereas FoE spiking increased during NREM2. The scalp/FoE ratio significantly increased during NREM3,4. A significant difference in spiking rate also was found between phasic and tonic REM states as well as between waking with eyes opened and closed in FoE recordings.

Conclusions: Our data provide evidence of a discrepancy in spike distribution across different states of sleep and waking monitored by scalp and FoE recordings. We suggest that these discrepancies may reflect differences in archicortical and neocortical spike synchronization.
Treatment of Phenytoin Toxicity by the Molecular Adsorbents Recirculating System (MARS)
Authors: Sen Sambit , Ratnaraj Neville , Davies Nathan A. , Mookerjee Rajeshwar P. , Cooper Christopher E. , Patsalos Philip N. , Williams Roger , Jalan Rajiv
Published: March 2003

Summary:  Purpose: Toxicity is common in patients of epilepsy treated with phenytoin (PHT), requiring careful drug level monitoring and supportive care. Specific treatment options are limited, although charcoal haemofiltration has been used previously. We attempted to demonstrate that severe PHT toxicity can be treated successfully with the Molecular Adsorbents Recirculating System (MARS). The mechanism of drug removal by the system also was studied.

Methods: A 45‐year‐old patient of status epilepticus with acute renal failure and severe PHT toxicity, associated with cardiac arrhythmias, hepatotoxicity, and altered sensorium, was treated with the MARS, a blood‐purification system based on albumin dialysis, and including a charcoal filter, for 11.5 h. Serum PHT levels and blood levels of oxygen‐based free radicals (by electron paramagnetic resonance spectroscopy) were measured before and after treatment.

Results: Serum total and free PHT levels declined sharply (32 to 11 μM and 9.8 to 2.0 μM, respectively), with clinical improvement and a 65% reduction in measured oxidative stress. The mechanism of drug removal, deduced by measuring PHT in the dialysate collected from different segments of the MARS circuit, was by clearance from blood into the albumin dialysate, and ultimately removal by the charcoal filter.

Conclusions: The observed removal of PHT by MARS, along with the clinical improvement of the patient and reduction of the associated oxidative stress after treatment, indicates that MARS offers a promising option in PHT toxicity.
Anterior Thalamic Mediation of Experimental Seizures: Selective EEG Spectral Coherence
Authors: Mirski Marek A. , Tsai Yien Che , Rossell Lisa Ann , Thakor Nitish V. , Sherman David L.
Published: March 2003

Summary:  Purpose: Physiological evidence has shown that the anterior thalamus (AN) and its associated efferents/afferents constitute an important propagation pathway for pentylenetetrazol (PTZ)‐mediated generalized seizures in rodents. Previous work demonstrated metabolic, physical, chemical, and electrical stimulation data supporting a role for AN in the expression of PTZ seizures. We now extend these observations through examination of neuroelectric signal indicators during seizure epochs. We show that the EEG recorded from AN is highly coherent with surface cortical (CTX) EEG during the immediate preconvulsant period and during the ictal stateough.

Methods: Awake rats were continuously infused with PTZ until clonic seizures were recorded by using both subcortical AN, posterior thalamus (PT), or hippocampal (HPC) bipolar electrodes and cortical EEG. Through the signal‐analysis techniques of ordinary and partial coherence, it was possible to focus selectively on signal correlations between AN and CTX (AN/CTX) by removing the effects of unaffiliated regions such as PT and HPC.

Results: Coherence of PT/CTX was observed to be modest, and partial coherence of PT/CTX with the effects of AN/CTX removed did not improve the signal coherence of PT/CTX (PT/CTX‐AN). In contrast, AN/CTX coherence was observed to be high, with undiminished correlation when PT/CTX influence was removed (AN/CTX‐PT). The most robust band of AN/CTX coherence was centered around the spike–wave clonic frequency of 1–3 Hz. Partial multiple coherence‐analysis techniques were used to remove the possible signal contributions from hippocampus in addition to PT. The AN/CTX coherence remained fully preserved in the low‐frequency bands.

Conclusions: These data provide electrophysiologic evidence supporting the special role of the anterior thalamus in the propagation of seizure activity between subcortex and cortex.
Successful Neurosurgical Treatment of Childhood Complex Partial Status Epilepticus with Focal Resection
Authors: Ng Yu‐tze , Kim Howard L. , Wheless James W.
Published: March 2003

Summary:The treatment of complex partial status epilepticus continues to be controversial, especially with regard to the intensity of the treatment. Medical therapy and drug‐induced coma are sometimes required. Rarely this may not be effective. A healthy 4‐year old girl was first seen in complex partial status epilepticus. She had a 1‐year history of cryptogenic partial‐onset seizures. Detailed magnetic resonance imaging (MRI) studies were normal. Her course was refractory to multiple medical therapies and multiple subpial transection (MST). An urgent epilepsy surgery evaluation resulted in a focal cortical resection being performed over the right mesial parietal region with resultant seizure freedom and no significant neurologic deficit 2 years later. This patient illustrates the need to consider occult focal cortical dysplasia as a cause of nonconvulsive status epilepticus (NCSE) in children, and if it is not responsive to medical management, the utility of performing an urgent epilepsy surgery evaluation.
EEG in Children with Early‐onset Benign Occipital Seizure Susceptibility Syndrome: Panayiotopoulos Syndrome
Authors: Ohtsu Mayu , Oguni Hirokazu , Hayashi Kitami , Funatsuka Makoto , Imai Kaoru , Osawa Makiko
Published: March 2003

Summary: Purpose:We analyzed sequential changes in the localization of EEG foci along with age to identify a specific EEG pattern, and the relation between the clinical manifestations and the EEG pattern in patients with Panayiotopoulos syndrome (PS).

Methods:The subjects were 76 children, who had been followed up >2 years with repeated EEG examinations at 6‐month intervals. Analysis of EEG findings included the determination of localization of spike foci, as a function of age, by using cross‐sectional data, and the identification of subgroups with homogeneous EEG patterns. Then we compared certain clinical features among these subgroups.

Results:In the cross‐sectional EEG study, the occipital EEG spike focus was most frequently seen between ages 2 and 5 years. Independent and synchronous frontopolar and occipital spikes (Fp‐O spikes) and centroparietotemporal (CPT) EEG spike foci had increased incidences between ages 4 and 7 years, and between ages 6 and 10 years, respectively. We subclassified the 76 patients into the following five subgroups based on the evolutional changes in epileptic EEG foci, which frequently showed shifting, multiplications, and generalization: (a) persistent occipital focus group (O group), (b) Fp‐O spikes group (Fp‐O pattern group), (c) generalized EEG pattern group, (d) CPT foci group (CPT group), and (e) no epileptic EEG focus group. The Fp‐O group showed the latest age at onset of epilepsy. The generalized EEG pattern group had the highest frequency of seizures as well as recurrences of status epilepticus (SE), as well as the longest active seizure period among the five groups.

Conclusions:These results indicated that the EEG foci in most of patients with PS are frequently shifting location, multiplying, and propagating diffusely with age, rather than persistently localizing in the occipital region. In addition, the EEG patterns showed a certain trend and roughly corresponded to certain clinical characteristics. However, the prognosis of the seizures appeared to be favorable regardless of the EEG pattern.
The Influence of Sulthiame on EEG in Children with Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS)
Authors: Bast Thomas , Völp Andreas , Wolf Christian , For The Sulthiame Study Group Dietz Rating
Published: March 2003

Summary:  Purpose: To evaluate the effects of sulthiame (Ospolot; STM) monotherapy compared with placebo on the EEG in children with benign childhood epilepsy with centrotemporal spikes (BECTS).

Methods: Sixty‐six patients (aged 3–11 years) entered a 6‐month double‐blind trial and were randomized to either STM (n = 31) or placebo (n = 35). Clinical data and general results have been reported elsewhere (1). One‐hundred seventy‐nine sleep EEGs were recorded at screening and after 4 weeks, 3 months, and 6 months. EEGs were analyzed by a blind reviewer using a standard protocol for each EEG. This standard protocol collected data on general changes, specific epileptiform, and nonspecific focal and generalized changes. A classification system was defined depending on rating of pathologic EEG changes. Because of the higher number of treatment‐failure events (i.e., seizures) in the placebo group, there was an increasing imbalance between the two groups regarding the number of recorded sleep EEGs over time (STM, 104; placebo, 74). A Wilcoxon–Mann–Whitney U test was used to describe differences in the grade of pathology during individual follow‐up between the two groups.

Results: The sleep‐EEG was found to be normalized in 21 patients treated with STM (12/21 transient) and in five patients treated with placebo (4/5 transient). In the STM group, the EEG showed a marked improvement during intraindividual course when comparing the classification of follow‐up EEGs at each time point with the screening EEG. Comparable improvements were not observed in the placebo group (exact two‐tailed p value at 4 weeks, p < 0.0001; at 3 months, p = 0.0010; and at 6 months, p < 0.0001).

Conclusions: STM had marked effects on the EEG in BECTS, which led to normalization in the majority of the patients. Most of those whose EEGs were not normalized showed improvement in the grade of EEG pathology. Normalization persisted in >50% of patients during the investigation. Spontaneous normalization in the placebo group reflects the wide spectrum of individual courses, which must be considered when analyzing drug effects on EEG in BECTS.
Neonatal Seizures and Syndromes
Authors: Tharp Barry R.
Published: March 2003

Summary:Neonatal seizures frequently accompany neonatal encephalopathies. Seizures occur in ∼1.8–5/1,000 live births in this country and are caused by virtually any condition that affects neonatal brain function. This review provides a simple classification of seizures and emphasizes that many abnormal intermittent behaviors in this age group are not accompanied by ictal EEG patterns. Additionally, ≤50% of neonatal seizures are not associated with abnormal clinical behavior. This is a common phenomenon, particularly after anticonvulsant treatment in which the clinical seizures are suppressed but electrographic seizures continue unabated. Seizures also may be caused by genetic disorders, several of which are benign, familial, and caused by channelopathies involving potassium channels. The review also discusses the epileptic syndromes seen in neonates, including early myoclonic encephalopathy, Ohtahara syndrome, pyridoxine dependency, and glucose transporter type 1 syndrome.
Changes in Flip/Flop Splicing of Astroglial AMPA Receptors in Human Temporal Lobe Epilepsy
Authors: Seifert Gerald , Schröder Wolfgang , Hinterkeuser Stefan , Schumacher Thekla , Schramm Johannes , Steinhäuser Christian
Published: March 2003

Summary:  Purpose: Recent data suggested a role for glial cells in epilepsy. This study sought to identify and functionally characterize AMPA receptors expressed by astrocytes in human hippocampal tissue resected from patients with intractable temporal lobe epilepsy.

Methods: Patch‐clamp and fast application methods were combined to investigate astrocytes in situ and after fresh isolation from the stratum radiatum of the hippocampal CA1 subfield. Relying on presurgical and histopathologic analysis, we divided human specimens into two groups, Ammon's horn sclerosis (AHS) and lesion‐associated epilepsy.

Results: Fast application of glutamate and kainate evoked receptor currents in all cells studied. Reversal‐potential analysis revealed an intermediate Ca2+ permeability of the receptor channels that did not vary between the two groups of patients. However, preapplication of the AMPA receptor–specific modulator, cyclothiazide, disclosed differences in flip‐flop splicing. This treatment considerably enhanced the receptor conductance, with potentiation being significantly stronger in cells from AHS specimens compared with lesion‐associated cells, suggesting upregulation of AMPA receptor flip splice variants in astrocytes of the sclerotic tissue.

Conclusions: Compelling evidence has been accumulated showing direct and rapid signaling between neurons and glial cells. Our data suggest that in AHS patients, neuronally released glutamate will lead to an enhanced and prolonged depolarization of astrocytes, which might be involved in seizure generation and spread in this particular condition of human temporal lobe epilepsy.
How Mutations in the nAChRs Can Cause ADNFLE Epilepsy
Authors: Bertrand D. , Picard F. , Le Hellard S. , Weiland S. , Favre I. , Phillips H. , Bertrand S. , Berkovic S. F. , Malafosse A. , Mulley J.
Published: March 2003

Summary:  Purpose: The linkage between autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) and neuronal nicotinic acetylcholine receptor has been strongly reinforced by the report of five distinct mutations in the two genes coding for the major brain α4β2 nicotinic acetylcholine (ACh) receptors. As a first step toward understanding the basic mechanisms underlying this genetically transmissible neurologic disorder, we examined the similarities and differences of the functional properties displayed by naturally occurring mutant forms of this ligand‐gated channel.

Methods: Functional studies of neuronal nicotinic ACh receptors reconstituted in Xenopus oocytes were designed to analyze the common traits displayed by the different mutations associated with ADNFLE.

Results: Coexpression of the control and mutated alleles harboring the α4S248F mutation obtained from patient DNAs yielded ACh‐evoked currents of amplitude comparable to the control responses but with a higher sensitivity and desensitization to the natural agonist. Alternatively, the other mutants (α4L776ins3, α4S252L, and β2V287M) displayed an increased ACh sensitivity without pronounced desensitization. In addition, whereas a reduction of calcium permeability was observed for the mutants (α4S248F and α4L776ins3), no significant modification of ionic selectivity could be detected in the α4S252L mutation. Hence increase in ACh sensitivity is the only common characteristic so far observed between the four naturally occurring mutant receptors investigated.

Conclusions: Analyses of functional properties of four nAChR mutants associated with ADNFLE indicate that a gain of function of these mutant receptors may be at the origin of the neuronal network dysfunction that causes the epileptic seizures. These data are discussed in the context of our latest knowledge of the pyramidal cell function.
Rate of Interictal Events and Spontaneous Seizures in Epileptic Rats After Electrical Stimulation of Hippocampus and Its Afferents
Authors: Bragin Anatol , Wilson Charles L. , Engel Jerome
Published: March 2003

Summary:  Purpose: Deep brain stimulation has been used by several investigators to prevent the occurrence of spontaneous seizures in patients with intractable epilepsy. With the kainic acid rat model of spontaneous recurrent seizures, we examined the consequences of subthreshold electrical stimulation of commissural pathways and perforant path on the synaptic plasticity, rate of interictal epileptiform events (IIEs), and spontaneous seizures in kainic acid (KA)‐treated rats epileptic rats.

Methods: Recording microelectrodes were implanted bilaterally in the dentate gyrus and entorhinal cortex. Stimulating electrodes were implanted into the rostral part of the right hippocampus and right perforant path. Stimulation was performed daily with 200 Hz/0.5‐s duration trains, 10‐min duration 1‐Hz train, or 2‐h, 1‐Hz train and 2‐h duration, 50‐Hz trains. Integrated amplitude of evoked potentials, rate of IIE, and spontaneous seizures was analyzed before and after stimulation.

Results: High‐frequency tetani evoked long‐term potentiation in 50% of epileptic rats compared with 100% of control rats. No long‐term depression was observed after 1‐Hz train. Decrease rate of IIE was found during 1‐Hz and 50‐Hz stimulation and returned to the basal level within 30–60 min. No significant change of the spontaneous seizure rate was found.

Conclusions: Epileptic brain is less prone to plastic changes compared with the normal brain. Daily 2‐h electrical stimulation with either low or high frequency does not have a long‐term effect on the rate of interictal events and spontaneous seizures.
Loss and Sprouting of Nitric Oxide Synthase Neurons in the Human Epileptic Hippocampus
Authors: Leite J. P. , Chimelli L. , Terra‐Bustamante V. C. , Costa E. T. , Assirati J. A. , De Nucci G. , Martins A. R.
Published: March 2003

Summary:  Purpose: Nitric oxide (NO) has been implicated in a variety of functions, including the control of synaptic plasticity and sensory signaling. Current evidence suggests that this unconventional neurotransmitter mediates N‐methyl‐d‐aspartate (NMDA) receptor–linked excitotoxicity. This study describes the expression of neuronal NO synthase (nNOS) immunoreactivity (IR) in hippocampi from patients with temporal lobe epilepsy (TLE).

Methods: Hippocampi from patients with clinical symptoms, neuroimaging, and EEG typical of hippocampal sclerosis (HS; n = 22) were compared with those from patients with neocortical temporal lesions (NONHS; n = 4) and autopsy (AUT; n = 18) patients for total cells, and nNOS‐IR neuron and puncta densities.

Results: Compared with AUT, HS hippocampi had significantly less nNOS‐IR neuron densities in the fascia dentata (FD); hilus, and CA4, CA3, CA2, and CA1 subfields. HS hippocampi had significantly greater nNOS‐IR puncta densities in the FD, as compared with AUT and NONHS.

Conclusions: Our results show that hippocampi from TLE patients exhibit a loss of nNOS‐IR neurons and an abnormal FD innervation. The release of NO can influence the dynamics of ionic channels and neurotransmitter release, thus affecting neuronal membrane potential. Because the NOergic transmission does not obey the topographic constraints imposed on conventional transmitters, target cells can be stimulated even in regions with severe deafferentation. The plastic changes described here may contribute to abnormal hippocampal excitability.
Helicobacter pylori und gastroösophageale Refluxkrankheit
Authors: Schütze K.
Published: March 2003

Die derzeit verfügbaren Daten weisen darauf hin, daß die Helicobacter pylori (H. p.)‐Infektion, vor allem mit cagA‐positiven Stämmen, vor gastrooesophagealer Refluxkrankheit und ihren Komplikationen schützen kann. Zahlreiche epidemiologische, pathophysiologische und klinische Studien zeigen diesen protektiven Effekt, der vom Ausmaß der infektiösen Korpusgastritis und der dadurch verminderten Säuresekretion abhängt.  Bei der Behandlungsstrategie der Refluxösophagitis mit PPI (Protonenpumpen‐Inhibitoren) nützt dieser biologische antisekretorische Effekt von H. p. jedoch, sowohl bei Akut‐ als auch bei Langzeittherapie, nur einer Minorität der Patienten. Nach wie vor umstritten ist die Entstehung einer atrophischen Gastritis bei Refluxpatienten unter PPI‐Langzeittherapie.  Nach dem derzeitigen Stand des Wissens ist es anzuraten, die H. p.‐Eradikation auf die gut etablierten Indikationen zu beschränken.
Therapie der endokrinen Orbitopathie mit Somatostatin‐Analoga bei Patienten mit positivem Octreo‐Scan
Authors: Pichler R. , Maschek W. , Holzinger C.
Published: March 2003

Zusammenfassung: Wir untersuchten prospektiv 28 Personen mit aktiver endokriner Orbitopathie und positivem Sonographiebefund (A‐mode) der extraokulären Augenmuskel. Zur Beurteilung des Somatostatin‐Rezeptor‐Status wurden SPECT‐Aufnahmen der Orbitae mit einer Doppelkopf‐Gammakamera nach der Applikation von 110 MBq 111‐In‐Pentreotide durch­geführt. 9 Patienten (beziehungsweise 12/56 Bulbi) zeigten einen deutlich erhöhten Uptake (Faktor > 2 in zirkulären ROIs bei semiquantitativer Auswertung) und wurden für eine Therapie mit Lanreotide (30 mg i. m. alle 14 Tage) selektiert. Aufgrund klinischer Progression wurde bei 5 Personen eine Kontrollszintigraphie durchgeführt, die bei zwei von ihnen ein positives Ergebnis zeigte. Mit Ausnahme eines Patienten wurden milde Nebenerscheinungen der Lanreotidetherapie (Diarrhoe) toleriert. Nach Erreichen der fibrotischen Phase an den bulbären Muskeln in 3 – 10 Monaten wurde die Medikation abgesetzt. Diese Untergruppe (außer zwei Frauen, denen in Folge zusätzlich Kortikosteroide verabreicht wurden) präsentierte einen stabilen Krankheitsverlauf. Eine der beiden musste jedoch wegen drohender Atrophie des N. opticus akut einer operativen Sanierung zugeführt werden. Klinische augenfachärztliche Kontrollen zeigten bei den Patienten, die frühzeitig Somatostatin‐Analoga erhielten – so ein positiver Octreo‐Scan‐Befund vorlag – viel versprechende Ergebnisse.
Indikation und Technik der Orbitavergrößerung bei endokriner Orbitopathie
Authors: Obwegeser J. A. , Gattinger B.
Published: March 2003

Zusammenfassung:Die typischen Symptome der endokrinen Orbitopathie sind Folge der interstitiellen Verdickung der Augenmuskeln sowie der Volumenzunahme des retrobulbären Fett‐ und Bindegewebes. Das klinische Spektrum reicht von Lid‐ und Bindehautinfiltrationen, Exophthalmus, Muskelverdickungen und Doppelbildern, Hornhautschädigungen bis hin zur Seh­nervbeteiligung mit Visusabfall. Bei einer Funktionsstörung des Sehnerven stellt die chirurgische Orbitavergrößerung eine Ultima Ratio dar. Das chirurgische Prinzip beruht auf Dekompression im Bereich einer oder meist mehrerer Orbitawände, gelegentlich in Kombination mit einer sagittalen Vergrößerung der Orbita durch Osteotomie und Vorverlagerung der ventralen Orbitaabschnitte. Als Faustregel gilt: Die Reduktion des Exophthalmus ist proportional zur Anzahl der dekomprimierten Wände und beträgt 2 – 3 mm pro dekomprimierter Orbitawand. Durch Vorverlagerung des ventralen Orbitaringes kann eine darüber hinaus gehende Exopthalmusreduktion erzielt werden.
The Anti‐Inflammatory Actions of Antithrombin – A Review
Authors: Wiedermann Ch. J. , Römisch J.
Published: March 2003

Summary: Leukocyte–endothelial cell interaction and microvascular perfusion failure are characteristic deteriorations of the microcirculation in endotoxaemia and are known to play a crucial role in the development of septic multiple organ dysfunction. Recent studies have indicated that antithrombin III treatment is capable of significantly ameliorating these microcirculatory disorders. Endothelial cells have important anticoagulant systems, including the heparan sulfate‐antithrombin system. Antithrombin III stimulates prostacyclin generation in endothelial cells by interacting with heparan sulfate of endothelial cells and inhibits cytokine and tissue factor production in endothelial cells and monocytes. Similar mechanisms may be involved in cellular actions of antithrombin III causing desensitization of chemoattractant receptors of leukocytes by activating the heparan sulfate proteoglycan, syndecan‐4. Thus, antithrombin III might be among the useful agents for treating coagulation abnormalities associated with sepsis or other inflammation because it inhibits not only coagulation but also downregulation of anticoagulant activities of endothelial cells and affects leukocyte activation.(Acta Med.
Inhibition of Plasma‐Dependent Monocyte Chemokinesis and Cytokine‐Triggered Endothelial Activation for Neutrophil Transmigration by Administration of Clopidogrel in Man
Authors: Dunzendorfer St. , M. Reinisch Christina , Kaneider Nicole C. , Pechlaner Ch. , Wiedermann Ch. J.
Published: March 2003

Summary: Mediators released by spontaneously activated platelets may contribute to alterations in endothelial and leukocyte dysfunctions. We investigated the roles of clopidogrel and aspirin in ex vivo endothelial activation for interactions with leukocytes. Eight healthy volunteers received clopidogrel or aspirin for 8 days. Blood samples were taken before, during, and after treatment. Levels of adhesion molecules and platelet‐derived mediators in these samples were measured using commercially available test kits, and effects of plasma on endothelial cells and leukocytes were investigated in neutrophil transendothelial migration, monocyte‐endothelial adhesion and leukocyte migration assays. Plasma samples from clopidogrel‐treated persons induced diminished chemokinesis of monocytes. Tumour necrosis factor‐induced priming of endothelial cells for enhanced neutrophil transmigration was also diminished by pretreatment of endothelial cells, but not of neutrophils, with plasma derived from subjects during clopidogrel treatment. Plasma from the aspirin group had no such effects. Administration of clopidogrel but not aspirin significantly decreased serum levels of soluble intercellular adhesion molecule‐1, whereas no changes in levels of soluble vascular cell adhesion molecule‐1, P‐selectin, L‐selectin, von Willebrand factor, platelet‐derived growth factor, vascular‐endothelial growth factor, and transforming growth factor‐beta were observed. Inhibition of plasma‐promoted endothelial activation by clopidogrel may indicate a novel role in the prevention of atherosclerosis.
Comparison of Colonoscopies Performed under Sedation with Propofol or with Midazolam or without Sedation
Authors: Gašparović Stojanka , Rustemović N. , Opačić M. , Bates M. , Petrovečki M.
Published: March 2003

Summary: Background
: Previous studies have shown that some patients are not able to tolerate colonoscopy without sedation because of low pain threshold, anxiety, colonic sensitivity and anatomical variations. Benzodiazepines are most commonly used, often in combination with pethidine. Our study compares sedation with propofol to midazolam and colonoscopy without sedation.
Methods
: In this study 147 patients were examined. The patients were divided into three groups: The first group included patients in whom propofol was used for sedation, the second group included patients sedated with midazolam, and the third group was comprised of patients who received no sedation. Oxygen saturation and heart rate were recorded continuously by pulse oxymetry. Arterial blood pressure (BP) was monitored at 3‐min intervals.
Results
: A decrease in blood pressure and heart rate was documented in the first two groups (
P
< 0.001), whereas in group 3 we found an increase in both BP and heart rate (
P
< 0.001). Oxygen saturation dropped below 90 % in 11/102 patients sedated with propofol and in 9/23 sedated with midazolam. Two of 22 patients in whom no sedation was used were found to have oxygen saturation below 90 %. The recovery time was shorter (7 min) in group 1 (propofol) than in group 2 (midazolam), in which it was found to be 20 min.
Conclusions : Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant haemodynamic side effects.
Expression profiling identifies strain‐specific changes associated with ethanol withdrawal in mice
Authors: Daniels G. M. , Buck K. J.
Published: March 2003

Mice that exhibit characteristics of physical dependence following ethanol exposure serve as useful models of alcoholism in humans. The DBA/2 J and C57BL/6 J inbred strains differ in their behavioral response to ethanol withdrawal. Alterations in gene expression are believed to underlie neuroadaptation to ethanol dependence and tolerance. Therefore, the differences in ethanol withdrawal severity observed between the DBA/2 J and C57BL/6 J strains may be related to differential regulation of gene expression. We have used cDNA microarrays to determine the gene expression profile in the hippocampus of DBA/2 J and C57BL/6 J mice during withdrawal after chronic and acute ethanol exposure. Of the 7634 genes surveyed, approximately 2% were consistently differentially expressed by at least 1.4‐fold in DBA/2 J mice during chronic ethanol withdrawal. Less than 1% of the genes showed altered expression in C57BL/6 J mice under the same conditions, or in DBA/2 J mice during acute ethanol withdrawal. Strain‐ and treatment‐specific patterns of altered expression were observed for multiple genes associated with the Janus kinase/signal transducers and activators of transcription and the mitogen activated protein kinase pathways. Genes associated with both pathways are regulated in DBA/2 J mice during chronic ethanol withdrawal, and to a lesser extent during acute ethanol withdrawal. Only those genes associated with the mitogen‐activated protein kinase (MAPK) pathway exhibited changes in expression in C57BL/6 J mice during ethanol withdrawal. Furthermore, genes associated with retinoic acid‐mediated signaling show differential expression exclusively in C57BL/6 J mice. These findings represent significant differences in cellular adaptation to ethanol between the DBA/2 J and C57BL/6 J strains.
Polarized Distribution of IQGAP Proteins in Gastric Parietal Cells and Their Roles in Regulated Epithelial Cell Secretion
Authors: Zhou Rihong , Guo Zhen , Watson Charles , Chen Emily , Kong Rong , Wang Wenxian , Yao Xuebiao
Published: March 2003

Actin cytoskeleton plays an important role in the establishment of epithelial cell polarity. Cdc42, a member of Rho GTPase family, modulates actin dynamics via its regulators, such as IQGAP proteins. Gastric parietal cells are polarized epithelial cells in which regulated acid secretion occurs in the apical membrane upon stimulation. We have previously shown that actin isoforms are polarized to different membrane domains and that the integrity of the actin cytoskeleton is essential for acid secretion. Herein, we show that Cdc42 is preferentially distributed to the apical membrane of gastric parietal cells. In addition, we revealed that two Cdc42 regulators, IQGAP1 and IQGAP2, are present in gastric parietal cells. Interestingly, IQGAP2 is polarized to the apical membrane of the parietal cells, whereas IQGAP1 is mainly distributed to the basolateral membrane. An IQGAP peptide that competes with full-length IQGAP proteins for Cdc42-binding in vitro also inhibits acid secretion in streptolysin-O-permeabilized gastric glands. Furthermore, this peptide disrupts the association of IQGAP and Cdc42 with the apical actin cytoskeleton and prevents the apical membrane remodeling upon stimulation. We propose that IQGAP2 forms a link that associates Cdc42 with the apical cytoskeleton and thus allows for activation of polarized secretion in gastric parietal cells.
UDP/IP based distributed control for a hydraulic valve
Authors: Heffernan Donal , Murphy Don
Published: March 2003

The hardware and software development of a remotely controlled hydraulic valve assembly is described. The valve becomes a dedicated server in a distributed control environment. The communication system is an Ethernet network supporting the UDP/IP communications protocol. A client/server application model is developed that allows a client to specify a desired control position for a valve spool. The solution is being proposed as an alternative to a formal fieldbus solution, where precision real‐time operation is not required. The performance of the valve is measured under different configurations considering both open loop and closed loop models. The justification for selecting the UDP/IP protocol is stated. The resulting hydraulic valve control system is efficient, accurate and flexible.
Internet training in trade unions: a comparison of four European confederations
Authors: Walker Steve
Published: March 2003

The paper draws on the evaluation activities of a European transnational Internet training programme involving trade union confederations and other worker education organisations. Three complementary views of the role of ICT in worker education are identified and discussed: the Internet as a topic of training; the Internet as a tool for delivering training; and the Internet in the mediation of changing relationships between union education and organisation. There is no inevitable progression through these views of the Internet: the outcomes of Internet use are dependent on a range of interacting influences that are likely to result in a diversity of patterns of Internet use.
Tariff strategies and small open economies
Authors: Raimondos‐Møller Pascalis , Woodland Alan D.
Published: March 2003

In this paper we examine the issue of optimal tariffs for a small economy that trades with a large economy. We define ‘small’ and ‘large’ in the sense that the world prices are determined solely by the large country, and, therefore, the small country faces exogenously given world prices. Within this framework it is shown that there exist situations in which the small country has an incentive to behave as a Stackelberg leader by committing itself to a non‐zero optimal tariff. Although the small country is unable to directly affect world prices, by pre‐committing to a non‐zero trade tax it may induce a reduction of the large country's optimal trade tax, thereby indirectly improving its terms of trade and welfare. JEL Classification: F13, F35

Stratégies de droits de douane et petites économies ouvertes. Ce mémoire examine le problème des droits de douane optimaux pour une petite économie qui commerce avec une grande. On définit ‘petit’ et ‘grand’ en un sens économique: les prix mondiaux sont déterminés seulement par le grand pays et le petit pays fait face à des prix mondiaux exogènes. A l'intérieur de ce cadre d'analyse, les auteurs montrent qu'il existe des situations dans lesquelles le petit pays est incitéà se conduire en leader à la Stackelberg en s'engageant fermement dans une politique de droit de douane optimal différent de zéro. Même si le petit pays ne peut pas influencer directement les prix mondiaux, en adoptant une politique ferme de droits de douane positifs, il peut amener le grand pays à réduire son niveau de droit de douane optimal, et, ce faisant, améliorer ses propres termes d'échange et son propre niveau de bien‐être.
Optimality of workfare with heterogeneous preferences
Authors: Cuff Katherine
Published: March 2003

With the standard non‐linear income taxation framework with heterogeneity of preferences, in this paper the optimality of workfare as a screening tool is examined. It is assumed that workfare does not serve as a human capital investment, participation is mandatory, and administrative costs are negligible. Imposing alternative cardinalizations on individuals utilities allows for the possibility that the government optimally redistributes income to or from high disutility of labour individuals. Under either case, it is never optimal to impose workfare on these individuals. It is also shown that non‐productive workfare can be an eﬃcient policy tool, in contrast to the results found in Besley and Coate (1995), Brett (1998), and Beaudry and Blackorby (1997). JEL Classification: H21, H23

Optimalité du workfare en présence de préférences hétérogènes. L'auteur examine l'timalité du workfare en tant qu'instrument de tamisage à l'aide du cadre conceptuel traditionnel d'imposition non‐linéaire des revenus en présence de préférences hétérogènes. On postule que le workfare n'est pas un processus d'investissement en capital humain, que la participatioun est obligatoire, et que les coûts d'administration sont négligeables. Quand on postule aussi des utilités cardinales différentes pour les individus, il devient possible pour le gouvernement de redistribuer optimalement les revenus en faveur ou au détriment des individus pour qui le travail a une très grande désutilité. Dans l'un et l'autre cas, on montre que le workfare n'est jamais une politique optimale. On montre aussi que le workfare dans des activités non‐productives peut être un instrument de politique publique eﬃcient, contrairement a ce qu'aﬃrment Besley et Coate (1995), Brett (1998) et Beaudry et Blackorby (1997).
Setting standards for credible compliance and law enforcement
Authors: Boyer Marcel , Lewis Tracy R. , Liu Wei Lin
Published: March 2003

In this paper we examine the setting of optimal legal standards to simultaneously induce parties to invest in care and to motivate law enforcers to detect violators of the law. The strategic interaction between care providers and law enforcers determines the degree of efficiency achieved by the standards. Our principal finding is that some divergence between the marginal benefits and marginal costs of providing care is required to control enforcement costs. Further, the setting of standards may effectively substitute for the setting of fines when penalties for violation are fixed. In particular, maximal fines may be welfare reducing when standards are set optimally.

Nous considérons dans cet article la détermination, en information incomplète, de normes légales optimales pour à la fois inciter les citoyens à faire preuve de diligence (prévention) et motiver les agents de la paix à veiller au respect des lois. L'interaction stratégique entre citoyens et agents de la paix détermine l'efficacité des normes choisies. Notre résultat principal est à l'effet qu'un écart entre bénéfices marginaux et coûts marginaux de la diligence est nécessaire afin de réduire les coûts d'application des lois. De plus, les normes peuvent être un substitut aux amendes lorsque les pénalités pour infraction sont fixes. Des amendes maximales peuvent en particulier être contre‐indiquées lorsque les normes sont optimalement déterminées.
Buyback programs in commercial fisheries: effciency versus transfers
Authors: Weninger Quinn , McConnell K. E.
Published: March 2003

A Cournot model of investment is used to characterize the pre‐ and post‐buyback investment equilibrium for vessels operating in a total‐allowable‐catch‐regulated fishery. Welfare effects – the net welfare gains or losses and the distributional eﬀects – that may be expected from vessel buyback programs are identifed. Net welfare effects depend on the ability of remaining vessels to replace buyback capital, the speed of capital replacement, and capital investment irreversibility. Net welfare effects are likely to be positive only under exceptional technological and capital‐market conditions. A brief review of the British Columbia Pacific Salmon Revitalization Plan is presented to anchor the theoretical model. JEL Classification: Q28, D24

Les auteurs utilisent un modèle d;qgainvestissement à la Cournot pour analyser la situation d;qga´equilibre d'investissement avant et après le rachat de vaisseaux opérant dans des pêches où le total des prises permises est réglementé. Les effets de bien‐être – les effets nets de gains ou de pertes et les effets de redistribution – qu;qgaon peut anticiper de programmes de rachats de vaisseaux sont identifiés Les effets nets de bien‐être dépendent de la capacité des vaisseaux qui restent en service à remplacer le capital racheté, de la vitesse avec laquelle le capital est remplacé, et de l'irréversibilité de la capitalisation. Les effets nets de bien‐être sont susceptibles d'être positifs seulement dans des conditions exceptionnelles sur le plan technologique et pour ce qui est du marché du capital. Les auteurs examinent le plan de revitalisation du saumon du Pacifique de la Colombie Britannique pour donner un point d;qgaancrage au modèle théorique.
The deductibility of provincial business taxes in a federation with vertical fiscal externalities
Authors: Dahlby Bev , Mintz Jack , Wilson Sam
Published: March 2003

Should provincial business taxes be deductible under a federal profit tax? We show that the ‘optimal deductible,’ which neutralizes the vertical fiscal externality between the federal and provincial government, is the change in the federal tax base per dollar of tax revenue collected by the provincial government. The optimal payroll tax deductibility rate depends on the extent to which it is shifted to workers and on the difference between the federal tax rates on profits and on labour income. Two apparently contradictory positions – full deductibility of a payroll tax and non‐deductibility – are special cases of our model.

La déductibilité des taxes provinciales imposées aux entreprises dans une fédération où il y a des externalités fiscales verticales. Est‐ce que les taxes provinciales imposées aux entreprises devraient être déductibles de l'impôt fédéral sur les profits? Les auteurs montrent que l'optimum de déductibilité qui neutralise les externalités fiscales verticales entre le fédéral et les provinces est le changement dans la base d'imposition fédérale par dollar de revenu fiscal collecté par le gouvernement provincial. Le taux de déductibilité optimal d'un impôt sur les salaires dépend de la portion du fardeau fiscal qui est déportée vers les travailleurs et de la différence entre les taux d'imposition du fédéral sur les profits et sur le revenu du travail. Deux positions apparemment contradictoires – pleine déductibilité d'un impôt sur les salaires et déductibilité nulle – sont des cas spéciaux du modèle général.
The determinants of municipal tax rates in British Columbia
Authors: Brett Craig , Pinkse Joris
Published: March 2003

In this paper we study the regional pattern of municipal business property tax rates in the province of British Columbia. Reduced‐form tax‐setting equations produce some evidence that municipal governments respond to tax changes in neighbouring jurisdictions. A joint investigation of the determinants of tax base and municipal taxation decisions, however, reveals that it is difficult to interpret this response as arising primarily out of competition over tax base. There is also some evidence that municipal tax rates are sensitive to taxes set on the same base by super‐municipal bodies. JEL Classification: C33, H71

Les déterminants des taux d'imposition municipale en Colombie Britannique. Dans ce mémoire, les auteurs étudient le pattern régional des taux d'imposition municipale sur la propriété foncière commerciale dans la province de la Colombie Britannique. On montre à l'aide d'un modèle en forme réduite d'équations de définition des taux d'imposition que les gouvernements municipaux réagissent aux changements dans les taux d'imposition dans leur voisinage. Cependant, un examen conjoint des déterminants de la base d'imposition et des décisions municipales montre qu'il est difficile d'interpréter cette réaction comme émanant d'une concurrence fiscale. On montre aussi que les taux d'imposition municipale sont sensibles aux niveaux de fiscalité imposés sur la même base par les autorités supra‐municipales.