bluuebunny/crossref_metadata_2025 huggingface dataset:
Short-Term Portal Hemodynamic Effects of Endoscopic Embolization for Esophageal Varices
Authors: Chikamori Fumio , Kuniyoshi Nobutoshi , Shibuya Susumu , Takase Yasuhiro
Published: April 2003

Background/Aim: Endoscopic embolization (EE) is a specialized treatment that obliterates esophageal varices along with their associated blood supply. The purpose of this study was to investigate the short-term effects of EE for esophageal varices on portal hemodynamics and liver function. Methods: Thirty patients with esophageal varices were included in this study. The portal blood flow was measured by an ultrasonic duplex Doppler system before and after EE. EE was performed by freehand intravariceal injection of 5% ethanolamine oleate with iopamidol with the aid of a balloon attached to the tip of an endoscope under fluoroscopy. Results: For the blood supply system, endoscopic varicography at the time of EE was able to show the vessels of the cardiac branch of the left gastric vein in 93% of the cases, the cardiac venous plexus in 90%, the trunk of the left gastric vein in 27%, the lesser curvature branch of the left gastric vein in 10%, the fundic branch of the short gastric vein in 13%, and the posterior gastric vein in 13%. For the blood drainage system, endoscopic varicography was able to show the paraesophageal vein in 39% of the cases, the inferior phrenic vein in 17%, and the mediastinal vein in 13%. No clotting was detected after EE in the intra- and extraportal veins in any of the cases. The flow velocities in the main portal vein before and after EE were 14.2 ± 3.2 and 15.5 ± 3.5 cm/s, respectively, showing no significant change. The cross-sectional area of the portal vein before and after EE was 0.96 ± 0.21 and 1.04 ± 0.23 cm2, and the flow volume of the portal vein was 817 ± 288 and 930 ± 189 ml/min, both also showing no significant change. The blood laboratory parameters showed no significant change after EE. Conclusions: We conclude that neither portal blood flow nor liver function were damaged by EE, although both the varices and their associated blood supply were obliterated.
Sweden: Integrated Compulsory Treatment
Authors: Palm Jessica , Stenius Kerstin
Published: April 2003

In the year 2000, 804 adults were in coercive care for a maximum of 6 months under the Swedish Act on Care of Addicts in Certain Cases, which has both paternalistic and utilitarian motives. The extensive rights of the state to intervene in the private lives of its citizens seem to have a solid support in society. The article describes the present system and offers some explanations for its acceptance by looking at history. The fact that compulsory decisions have been made within the social administration has meant that such measures grew with the welfare system and could benefit from its goodwill. The medical profession provided motivation for preventive compulsory measures for social or individual reasons and gave hope for a cure. The crucial involvement of laypersons and non-governmental organisations in decision-making and provision of compulsory treatment has given compulsory treatment a high political legitimacy. Compulsion became ‘internalised’ in the Swedish society. The economic and political liberalisation of today may pose a threat to the Swedish compulsory treatment of substance misusers.
Clinical Efficacy of Almitrine-Raubasine
Authors: Allain H. , Bentué-Ferrer D.
Published: April 2003

Different pharmacological properties of almitrine-raubasine show that this combination may be a good therapy for the treatment of age-related cerebral disorders and functional rehabilitation after stroke. Many clinical studies have been carried out in France and in the rest of Europe, confirming the value of this compound in such situations. Without discussing the complexity of clinical trials in both the areas of cognitive disorders and stroke, we shall present two studies demonstrating the beneficial effects of almitrine-raubasine against cognitive impairments. The first is a double-blind controlled study versus placebo with a 3-month follow-up period involving patients (aged between 60 and 85) with memory loss, lack of concentration, impaired mental altertness, and emotional instability. The second is a controlled multicenter study of 155 outpatients (age 70–85) presenting with cognitive decline (assessed by MMSE, SCAG). In both these studies, almitrine-raubasine significantly improved symptomatology and was superior to placebo, especially in the vascular cases. This confirms the validity of previous studies and justifies the indication of these compounds in the treatment of age-related cognitive disorders. Other studies also demonstrated the beneficial effect of this compound on neurosensory vascular disorders, with specific studies carried out on chorioretinal dysfunctions (visual symptomatology) and in vestibular disorders (vertigo associated with electronystagmographic modifications). The appropriate and usual dosage (2 tablets per day) and the good tolerance of the compound have been confirmed in a French multicentric study in 5,361 outpatients.
Neurotrophic Factors and Diabetic Peripheral Neuropathy
Authors: Apfel StuartC.
Published: April 2003

Recent evidence from animal models of diabetes and human diabetic subjects suggests that the reduced availability of neurotrophic factors may contribute to the pathogenesis of diabetic peripheral neuropathy (DPN). Of these proteins, nerve growth factor (NGF), brain-derived neurotrophic factor, neurotrophin (NT-3) and NT-4/5 appear to be important for the development and maintenance of peripheral neurons, but others, including insulin-like growth factors (IGFs), may also be involved. Studies with NGF, NT-3, IGF-I and IGF-II both in vitro and in animal models of neuropathies (including DPN) suggest that these factors ameliorate nerve degeneration. Recombinant human NGF is the first neurotrophic factor to enter clinical trials for DPN and is currently being tested in two phase III studies.
Patterns of Cognitive Impairment in Secondary Progressive Stable Phase of Multiple Sclerosis: Correlations with MRI Findings
Authors: Nocentini U. , Rossini P.M. , Carlesimo G.A. , Graceffa A. , Grasso M.G. , Lupoi D. , Oliveri M. , Orlacchio A. , Pozzilli C. , Rizzato B. , Caltagirone C.
Published: April 2003

Cognitive impairment is commonly described in multiple sclerosis (MS), but conflicting results have been reported about its pattern by previous studies focused on heterogeneous patient groups. The aim of this study was to investigate the cognitive skills of a homogeneous group of secondary progressive MS patients, and to examine the relationship of this impairment to MRI parameters. Forty-four MS patients underwent a series of neuropsychological tests devised to explore the main cognitive domains, and T1- and T2-weighted brain MRI. Results showed the presence of deficits of attention, memory, planning abilities, problem-solving and conceptual reasoning (frontal functions) in a subgroup of MS patients. Correlations between the performance in some ‘frontal’ tests and the extent of frontal lobe MRI lesional area were present, but rather unspecific, the same performance being also correlated with the nonfrontal lesional area. These findings suggest that in MS, overall macroscopic and microscopic brain damage is more important than the corresponding focal brain disease, even in determining deficits of selective cognitive domains.
Thiamine-Responsive Acute Neurological Disorders in Nonalcoholic Patients
Authors: Merkin-Zaborsky H. , Ifergane G. , Frisher S. , Valdman S. , Herishanu Y. , Wirguin I.
Published: April 2003

Wernicke’s encephalopathy (WE) is most commonly associated with alcoholism, although other causes have also been implicated. In the years 1994–1997, 9 patients with no history of alcohol abuse presented with acute signs of ophthalmoplegia or nystagmus and ataxia which resolved within 48 h after intravenous thiamine. There were 7 women and 2 men aged 17–57 (7 below the age of 30). Precipitating events included vomiting 2, drastic weight-reducing diet 2, renal colic in a postpartum woman 1, colonic surgery 2 and chronic hemodialysis 1. In 2 patients there was no obvious precipitating event but their history was suggestive of a genetic predisposition. Mental changes were slight or absent in all patients and all of them made good functional recovery. These cases suggest that the diagnosis of WE should be considered more often in nonalcoholics in various clinical settings.
Patients with Primary Brain Tumours Have Elevated Serum Titres of Antibodies to the Myelin Glycolipid Sulphatide
Authors: Nygren C. , v. Holst H. , Ericson K. , Fredman P.
Published: April 2003

Primary and metastatic brain tumours may result in an altered exposure of normal cellular components to the immune system inducing an immune response measurable in autoantibodies. One potential immunogenic molecule is sulphatide, the major acidic glycolipid in myelin. Thirty-eight sera from 31 patients with primary and metastatic brain tumours have, therefore, been analyzed for the presence of antisulphatide antibodies by an ELISA performed on thin layer chromatography plates. Twenty-eight of the thirty-eight sera (74%) showed a positive antibody titre to sulphatide. The antibody titres were significantly higher (p < 0.01) in sera from patients with primary brain tumours than in sera from those with metastases. The study lends support to the possibility that antisulphatide antibodies could contribute to tissue damage and this might facilitate the invasive growth in primary brain tumours by demyelination. However, the pathogenic significance of these autoantibodies remains to be further elucidated.
Efficacy and Tolerability of Entacapone as Adjunctive Therapy to Levodopa in Patients with Parkinson’s Disease and End-of-Dose Deterioration in Daily Medical Practice: An Open, Multicenter Study
Authors: Durif F. , Devaux I. , Pere J.-J. , Delumeau J.-C. , Bourdeix I.
Published: April 2003

Entacapone is a potent, reversible and orally active inhibitor of catechol-O-methyltransferase. This open multicenter study evaluated the efficacy, safety and tolerability of entacapone as adjunct therapy to levodopa/dopa decarboxylase inhibitor (≧3 daily doses) in patients with idiopathic Parkinson’s disease and end-of-dose motor fluctuations. The 8-week study included 489 patients under conditions of typical daily medical practice. Patients were treated with a 200-mg fixed dose of entacapone administered with each scheduled dose of levodopa to a maximum of 10 doses per day. Other antiparkinsonian medication should have been stable for at least 1 month. The primary efficacy criteria were: (1) Part II (activities of daily living, ADL) of the Unified Parkinson’s Disease Rating Scale (UPDRS), (2) the reduction of ‘off’ time during the daily waking period as assessed by the percentage of patients improving by at least one category at Item 39 of Part IV of the UPDRS. Secondary outcome measures included: (1) the investigator’s global assessment of change, (2) quality of life (QoL) was assessed using the Parkinson’s Disease Questionnaire (PDQ-39). Adverse events, vital signs and liver enzymes were monitored at weeks 2 and 8. The baseline mean score for ADL was 10.5 (±7.04), which decreased to 8.5 (±6.37) at the end of the study (p < 0.0001). Compared to baseline, 40.8% of patients experienced a reduction in ‘off’ time during the waking period; this improvement was highly significant (p < 0.0001). A reduction in the daily dose of levodopa was observed in 35.8% of patients (mean decrease 209 ± 149 mg). QoL was improved by a mean of 10% in all categories of the PDQ-39 (p < 0.001), except social support and cognition. This improvement was statistically significant (p < 0.001). The dyskinesia score (UPDRS Item 32) was decreased significantly from 2.3 to 2.1 from baseline to end of study (p < 0.001), although 52.7% of patients reported levodopa-induced dyskinesia as an adverse event. There was no case of increased liver enzymes. The study results confirm that the excellent risk/benefit ratio seen in phase III controlled studies can be seen in daily neurological practice. Moreover, the study suggests that the benefits of entacapone are associated with a significant improvement in QoL.
Towards a Pain Treatment Based on the Identification of the Pain-Generating Mechanisms?
Authors: Dallel Radhouane , Voisin Daniel
Published: April 2003

Despite continuous improvements in available pain treatments, many patients with chronic pain still remain insufficiently relieved. Although such therapeutic failures are often ascribed to pharmacological or psychological factors, difficulties in elucidating pain-generating mechanisms may be the main cause of insufficient pain management. These difficulties arise from several origins, including the unsuitability of the usual classification of pain, the exclusive use of etiology or symptom criteria as the main dimension of pain to guide the choice of therapeutic agents, the inadequate interpretation of sensory deficit, the lack of identification of the injured tissues, the absence of objective pain assessment by psychophysical methods. In this paper, we review briefly some fundamental knowledge to determine pain treatment based on the identification of the physiopathological mechanisms of pain. We advocate that once pain-generating mechanisms are known, it becomes possible to establish the appropriate treatment of pain.
Polymyography Combined with Time-Locked Video Recording (Video EMG) for Presurgical Assessment of Patients with Cervical Dystonia
Authors: Münchau A. , Bahlke G. , Allen P.J. , Quinn N.P. , Lees A.J. , Rothwell J.C. , Palmer J.D. , Bhatia K.P.
Published: April 2003

We assessed 26 patients with cervical dystonia, in whom botulinum toxin (BT) injections had failed, before selective peripheral denervation. We decided to base the decision which muscle should be denervated on both clinical information and EMG data and focussed on the following features: activity at onset or during ‘dystonic spasms’ (according to the concept of the ‘leading’ dystonic muscle), paradoxical activity during voluntary head movements causing restriction of head movements opposite the side of head turn or tilt and activity when symptoms deteriorated during walking. To identify these muscles we developed a new recording system that integrates simultaneous video-taping and polymyography (video EMG) by means of a digital counter, driven by the recording software (resolution 0.1 s), that was fixed in view of the video camera. This system time-locked clinical signs with relevant EMG activity thus allowing demonstration of the above features. These were found in 68% of dystonic muscles with each of them being present in approximately 40%. Video EMG allows an integrated approach to identify overactive neck muscles in patients with cervical dystonia taking into account both relevant clinical findings and EMG data.
Botulinum Toxin Antibody Testing: Comparison between the Immunoprecipitation Assay and the Mouse Diaphragm Assay
Authors: Dressler D. , Dirnberger G.
Published: April 2003

Antibodies against botulinum toxin (BT) are currently best detected by the mouse diaphragm assay (MDA). Nevertheless, the MDA still has disadvantages, so that an immunoprecipitation assay (IPA) was introduced recently. We sought to compare the results of both tests. 33 samples from patients with cervical dystonia and complete or partial BT therapy failure underwent blinded simultaneous IPA and MDA testing. 27 (82%) samples showed concordant results, 17 (52%) being positive and 10 (30%) negative for both IPA and MDA resulting in a significant association of the dichotomous test results (Fisher’s exact test, p < 0.01). The other six samples (18%) showed discordant results, all being IPA-negative and MDA-positive. This excess of MDA-positive results was also significant (Sign rank test, p = 0.03). IPA and MDA results showed a very strong and significant qualitative and quantitative association. The IPA seems to be less sensitive than the MDA for detection of low BT-AB titres, but the clinical relevance of this still needs to be established. Since the IPA is simpler, faster and cheaper than the MDA and avoids sacrifice of animals, it could become the preferred BT-AB test.
Speech Patterns in Children with Velo-Cardio-Facial Syndrome
Authors: van Lierde K.M. , van Borsel J. , van Cauwenberge P. , Callewaert S.
Published: April 2003

The purpose of this study was to document the articulation patterns in children with velo-cardio-facial syndrome. The subjects were 2 children with this syndrome, aged 6 years 6 months and 3 years 11 months. Phonetically transcribed speech samples collected by means of a picture naming test formed the basis for this study. The speech samples were subjected to two types of analyses: independent analyses describing the children’s sound productions regardless of their relation to the adult targets and relational analyses comparing the children’s productions with the adult standard form. It was found that the articulatory problems in velo-cardio-facial syndrome are not simply due to a delay in speech sound acquisition. Articulation errors found in this syndrome are uncharacteristic of normal speech development. Whether errors are syndrome-specific awaits further investigation.
Subcortical Brain Mechanisms in Speech and Language
Authors: Murdoch Bruce E.
Published: April 2003

This paper reviews current research and contemporary theories of subcortical participation in the motor control of speech production and language processing. As a necessary precursor to the discussion of the functional roles of the basal ganglia and thalamus, the neuroanatomy of the basal ganglial-thalamocortical circuitry is described. Contemporary models of hypokinetic and hyperkinetic movement disorders based on recent neuroanatomical descriptions of the multi-segmented circuits that characterise basal ganglion anatomy are described. Reported effects of surgically induced lesions in the globus pallidus and thalamus on speech production are reviewed. In addition, contemporary models proposed to explain the possible contribution of various subcortical structures to language processing are described and discussed in the context of evidence gained from observation of the effects of circumscribed surgically induced lesions in the basal ganglia and thalamus on language function. The potential of studies based on examination of the speech/language outcomes of patients undergoing pallidotomy and thalamotomy to further inform the debate relating to the role of subcortical structures in speech motor control and language processing is highlighted.
Pair-Bonding, Female Aggression and the Evolution of Lemur Societies
Authors: Jolly Alison
Published: April 2003

Lemur societies have been described as convergent with those of anthropoids, including Papio-like female-bonded multi-male groups. Recent research, however, shows at least 5 pair-bonded species among the Lemuridae and Indriidae. Three more, Eulemur mongoz, Eulemur fulvus and Varecia variegata, have societies combining aspects of pairing with aspects of troop life. The best-known female-bonded societies, those of Lemur catta, Propithecus diadema edwardsi and Propithecus verreauxi, may be assemblages of mother-daughter dyads, capable of high aggression towards other females, but derived from more solitary female ancestors, perhaps also living as pairs. The internal structure of such lemur groups differs from the more extensive kin groups of catarrhines. This in turn may relate to the lemurs’ level of social intelligence and to lemur female dominance over males.
Role of Vocalization in Species Differentiation of Sulawesi Tarsiers
Authors: Nietsch Alexandra , Kopp Marie-Luise
Published: April 2003

Recent work on the tarsiers of Sulawesi indicates that the degree of species differentiation is greater than has hitherto been thought. This is indicated by the acoustic differences between the vocal duets of mated pairs of Tarsius spectrum, Tarsius dianae and tarsiers from the Togian Islands (Tomini Bay, Sulawesi). This paper presents further evidence of taxonomic differentiation, based on the vocal behaviour shown during playback experiments. Six adult T. spectrum, kept in captivity, were stimulated by the playback of duets of their own species, those of T. dianae and those of Togian tarsiers. The results show that T. spectrum discriminates between the vocalizations of conspecifics and heterospecifics. The behavioural responses of the test subjects to playback of the various duets suggest that T. spectrum is unlikely to interbreed with either T. dianae or with the Togian tarsiers. This not only confirms the taxonomic differentiation between T. spectrum and T. dianae, but also supports the specific status of the Togian tarsiers.
Cytogenetic Arguments in Favour of a Taxonomic Revision of Lepilemur septentrionalis
Authors: Rumpler Yves , Ravaoarimanana Berthine , Hauwy Marcel , Warter Stæphanie
Published: April 2003

Cytogenetic investigations performed on 30 specimens of Lepilemur septentrionalis confirmed the existence of 4 karyotypes differing from each other by 1–2 chromosomal rearrangements. These data, pooled with those obtained in earlier studies, showed that out of 60 animals karyotyped only two kinds of hybrids were detected, allowing us to characterise two chromosomally polymorphic populations. No natural hybrids could be found between these two populations, which could thus be considered as two separate species. The possible role of the chromosomal rearrangements in the process of reproductive isolation between these two populations is discussed.
Frontotemporal Lobar Degeneration
Authors: Tolnay M. , Probst A.
Published: April 2003

Frontotemporal lobar degeneration is the second most common form of cortical dementia in the presenium after Alzheimer’s disease. Clinically, based on consensus guidelines, three distinct disease entities can be distinguished: frontotemporal dementia, semantic dementia and progressive nonfluent aphasia. Dementia of frontal type and motor neuron disease inclusion dementia are the most frequent neuropathological subtypes of frontotemporal lobar degeneration. By using immunohistochemistry, the latter is characterized by the presence of filamentous ubiquitin-reactive but tau-negative inclusions in nerve cell bodies and neurites. In contrast, Pick‘s disease and familial frontotemporal dementia with parkinsonism linked to chromosome 17 (FTDP-17) are both characterized by abundant filamentous nerve cell inclusions made up of the microtubule-associated protein tau. The recent discovery of more than 15 different mutations in the tau gene in FTDP-17 brought the tau protein to the centre stage. These findings had a major impact on our understanding of neurodegenerative disorders characterized by tau filamentous inclusions in neurones and/or glial cells which are grouped under the generic term of tauopathies. However, as exciting these new molecular insights are, it would be inappropriate to lump frontotemporal lobar degeneration as tauopathies. Recent neuropathological and genetic data strongly suggest that there is more than one genetic background for frontotemporal lobar degeneration.
Isolating the Cost of Osteoporosis-Related Fracture for Postmenopausal Women
Authors: Martin Bradley C. , Chisholm Marie A. , Kotzan Jeffrey A.
Published: April 2003

Background: Osteoporosis is a condition that will pose an increasing burden on health systems as populations age. Objective: The objective of this study was to estimate the net ‘per case’ direct medical cost of fracture of indigent women age 50 years or greater and describe the cost of fracture for Medicaid and Medicare payers by inpatient hospital, physician, long-term care, prescription and miscellaneous expenditures. Methods: This study utilized a quasi-experimental retrospective interrupted time series design to isolate the economic impact of fracture. Administrative claims data for a continuous period of 24 months (12 months prior to fracture and 12 months after fracture) describing the Medicaid and Medicare expenditures for a cohort of women suffering from femur or other fracture in 1993 was abstracted and analyzed. ICD-9CM and CPT-4 codes were used to identify incident cases of fracture. Interrupted time series regression models were estimated using monthly expenditures. Results: A total of 765 Medicaid eligible women 50 years of age or greater experienced a fracture in the base year and met inclusion criteria. Of these, 226 experienced a femur fracture. The time series models detected significant increases in expenditures the month of fracture, however, total Medicaid expenditures returned to baseline trend charge in 7 and 5 months for femur and nonfemur fracture, respectively. Increases in long-term care expenditures persisted throughout the time series, but were offset by reductions in other categories of service. Conclusion: The net per case costs of femur and nonfemur fracture are about USD 3,300 and USD 1,300, respectively. The impact of fracture on Medicaid expenditures is temporary as costs rise sharply and return to baseline trend charges within a 12-month period.
Scientific Breakthroughs: Cause or Cure of the Aging ‘Problem’
Authors: Bramstedt Katrina A.
Published: April 2003

Could it be that society’s construction of what it means to be elderly has created and now fuels the current immortality revolution? Have we defined aging in such a manner that we ‘need’ technological breakthroughs in order to fight the ‘problem’ of the soaring geriatric population? This fight may indeed improve quality of life and increase longevity, but while doing so, society must accept that this strategy will result in an ever increasing elderly population, a population that cannot be expected to let beneficient medical technology (comfort or cure oriented) pass them by. Society’s medical breakthroughs are creating a population that ethically we cannot turn our backs on.
Age-Dependent Changes of Serum Oxygen Radical Scavenger Capacity and Haemoglobin Glycosylation in Non-Insulin-Dependent Diabetic Patients
Authors: Pieri C. , Testa R. , Marra M. , Bonfigli A.R. , Manfrini S. , Testa I.
Published: April 2003

Background: Contradictory results have been reported in the literature concerning the correlation between glycosylated haemoglobin (HbA1c) and peroxidation level in serum of diabetic patients. Objective: To evaluate this correlation in type 2 diabetic patients by comparing the level of HbA1c with the oxygen radical absorbance capacity (ORACOH) of serum. Methods: One hundred and five type 2 diabetic patients were enroled for the study. After having obtained informed consent, venous blood samples were drawn after overnight fast at the time of routine diabetic check-ups. The blood was collected in plain and EDTA (1 mg/ml) tubes. Glycosylated haemoglobin (HbA1c) was determined by cation-exchange chromatography (HPLC), and spectrophotometric detection (Diamat Analyzer, BioRad). Serum was used for biochemical determinations performed by standard laboratory procedures and for ORACOH analysis. This last parameter was determined measuring the loss of β-phycoerytrin fluorescence due to oxidation by hydroxyl radicals generated by Cu2+ and H2O2, in the presence and absence of serum. Seventy-eight control age-matched subjects were obtained from the personnel staff of our Research Department and old healthy subjects, selected on the basis of Senieur Protocol, were relatives of the above mentioned personnel. Results: When the population of diabetic patients was taken as a whole, a decrease of ORACOH has been observed compared to the controls. Moreover, negative correlations were found comparing ORACOH either with HbA1c (r = –0.213; p = 0.029) and with the age of patients (r = –0.27; p = 0.005). To better understand the effect of age, the data were re-examined dividing the diabetics into two populations, i.e. under and over 65 years of age. An age-dependent decrease of ORACOH and an increase in HbA1c levels has been observed comparing these two populations; however, the correlation between the two parameters remained statistically significant only in the oldest group (r = –0.31; p = 0.026). Conclusions: Present data point to an involvement of oxidative stress in the glycation of haemoglobin especially in old diabetic patients, and provide support for the potential use of an antioxidant therapy in these patients, irrespective of their glycaemic control.
What Was the Disease of the Legs that Afflicted King Asa?
Authors: Ben-Noun Liubov (Louba)
Published: April 2003

Background/Objective: The elderly have suffered from pain in their legs, which may be associated with various diseases, for thousands of years. This report analyzes the disease that afflicted the biblical King Asa (the third king of the house of Judah who reigned between 867 and 906 BCE). Results: The sentence ‘Nevertheless in the time of his old age he was diseased in his legs’ indicates that King Asa suffered from disease in his legs. Among numerous diseases, peripheral vascular disease, gout, and degenerative osteoarthritis were most likely to affect the King’s legs. And among these diseases, the diagnosis of peripheral vascular disease is the most acceptable. Conclusion: This report shows that the roots of contemporary modern gerontology can be traced back to biblical times.
Slip Resistance of Casual Footwear: Implications for Falls in Older Adults
Authors: Menz Hylton B. , Lord Stephen R. , McIntosh Andrew S.
Published: April 2003

Background: A large proportion of falls in older people are caused by slipping. Previous occupational safety research suggests that inadequate footwear may contribute to slipping accidents; however, no studies have assessed the slip resistance of casual footwear. Objective: To evaluate the slip resistance of different types of casual footwear over a range of common household surfaces. Methods: The slip resistance of men’s Oxford shoes and women’s fashion shoes with different heel configurations was determined by measuring the dynamic coefficient of friction (DCoF) at heel contact (in both dry and wet conditions) on a bathroom tile, concrete, vinyl flooring and a terra cotta tile using a specially-designed piezoelectric force plate apparatus. Results:  Analysis of variance revealed significant shoe, surface, and shoe-surface interaction effects. Men’s Oxford shoes exhibited higher average DCoF values than the women’s fashion shoes, however, none of the shoes could be considered safe on wet surfaces. Application of a textured sole material did not improve slip resistance of any of the shoes on wet surfaces. Conclusion: Heel geometry influences the slip resistance of casual footwear on common household surfaces. The suboptimal performance of all of the test shoes on wet surfaces suggests that a safety standard for casual footwear is required to assist in the development of safe footwear for older people.
Vasculitis in the Very Elderly
Authors: Turcu Alin , Bielefeld Philip , Besancenot Jean-François , Lorcerie Bernard , Pfitzenmeyer Pierre
Published: April 2003

Background: Whatever may be their clinical presentation, vasculitis syndromes (VS) have a bad prognosis in the very elderly. Objective: The aim of this work was to study VS particularities in very old people. Most published studies on VS in elderly people concern patients older than 60 years; studies concerning very old patients are unusual. Methods: We studied retrospectively subjects older than 75 years with a diagnosis of VS from the Departments of Geriatrics and Internal Medicine at Dijon University Hospital. These subjects were hospitalized between January 1995 and December 1999. Data were obtained from the medical files of these patients. Several aspects were considered: type of VS, associated diseases, treatment, complications, and outcome. Results: Twelve patients, 5 men and 7 women aged 79–91 (mean age 82.3) years, were included. Primary VS was observed in half of the patients and secondary VS in the others. The initial clinical presentation was often polymorphous and unspecific; 8 of the patients died, 2 developed progressive severe functional impairment, 1 was stabilized under therapy, and 1 patient with VS secondary to infection recovered. Most patients either died quickly or progressively deteriorated from infections, malnutrition, or functional impairment. Conclusion: The health of the majority of patients (83%) deteriorated dramatically, leading to death or severe functional impairment.
Steroidal ‘Add-Back’ Therapy in Patients Treated with GnRH Agonists
Authors: Freundl G. , Gödtke K. , Gnoth Ch. , Godehardt E. , Kienle E.
Published: April 2003

GnRH analogues (GnRH-a) are well established in the treatment of endometriosis. However, due to hypooestrogenic effects, treatment is limited to 6 months. The aim of this randomized, double-blind, comparative study was to evaluate whether symptoms and signs of hypooestrogenism, e.g. hot flushes, sweating and sleeplessness, could be avoided by a steroidal add-back regimen, while the beneficial effect of a GnRH-a on endometriosis could be maintained. In group A, 14 patients were treated with 3.75 mg leuprorelin acetate depot per month i.m. in combination with 20 mg ethinyloestradiol plus 0.15 mg desogestrel orally for 3 weeks. In group P, 13 patients received leuprorelin acetate, following the same schedule as in group A, and placebo. Treatment duration was 6 months. At first-look laparoscopy (postoperatively) group A had an r-AFS score of 23.57 and group P of 24.23. After 6 months of treatment with leuprorelin acetate depot r-AFS scores had dropped to 16.14 in group A and to 6.25 in group P at second-look laparoscopy, achieving statistical significance in both groups (p < 0.001). Hypooestrogenic adverse drug reactions (e.g. hot flushes, sweating and sleeplessness) were more frequently reported in group P, whereas the occurrence of headache was comparable in both groups. Dysmenorrhoea was significantly reduced in both groups, whereas dyspareunia was only decreased in group P. Variations in laboratory values were within normal ranges and did not give any concern about drug safety. Loss of bone mineral density caused by the GnRH-a was reduced by the combined oestrogen/progestin add-back therapy. In conclusion, this therapy can lead to a reduction in hypooestrogenic adverse drug reactions and mostly preserves agonist efficacy with the chance of treatment prolongation.
Angiogenesis in Endometriosis and Angiogenic Factors
Authors: Fujimoto Jiro , Sakaguchi Hideki , Hirose Reiko , Wen Hongwu , Tamaya Teruhiko
Published: April 2003

Among angiogenic factors, VEGF secreted from activated macrophages under the influence of ovarian steroids, IL-8 expressed in endometrial stromal cells, and basic FGF expressed in endometriotic tissue and PD-ECGF expressed in lining epithelial cells independently of the sex steroidal milieu might contribute to the characteristic advancement of angiogenic lesions in endometriosis in individual manners.
Evidence that Endometriosis Behaves in a Malignant Manner
Authors: Thomas Eric J. , Campbell I.G.
Published: April 2003

It is well known that certain aspects of endometriosis are similar to those of malignant disease. For example, like cancer, endometriosis can be both locally and distantly metastatic; it attaches to other tissues, invades, and damages them. Endometriosis is a common disease that does not create a cachectic or catabolic state, and is rarely fatal. There are, however, numerous reported cases of malignancy arising from endometriotic deposits and substantial histologic evidence that endometriosis is associated with endometrioid carcinoma and clear cell carcinoma of the ovary. A large review article by Mostoufizadeh and Scully investigated the association between endometriosis and endometrioid carcinoma, noting that women who had both diseases tended to be younger [1]. They found no association between endometriosis and serous or mucinous carcinoma of the ovary, and reported that malignant transformation of endometriosis was rare and associated with the use of exogenous estrogens. An epidemiological study of Swedish women reported a higher incidence of breast and ovarian cancer and non-Hodgkin’s lymphoma in women with endometriosis compared with controls [2]. Vercellini and colleagues also reported a higher incidence of endometrioid and clear cell carcinoma in women with endometriosis compared with controls [3]. Mutations in genes associated with galactose metabolism have been identified as one possible mechanism for this association. These mutations are more common in ovarian cancer and have been reported to be more common in women with endometriosis. We compared 78 women with endometriosis with 248 controls and were unable to demonstrate an increased frequency of these mutations in any of these groups.
Celiac Disease: Fertility and Pregnancy
Authors: Eliakim Rami , Sherer David M.
Published: April 2003

Celiac disease (gluten-sensitive enteropathy) may manifest clinically with an array of nongastrointestinal symptoms among which are: dermatitis herpetiformis; dementia; depression; various neurological symptoms; osteoporosis; osteomalacia; dental enamel defects, and anemia of various types. Important data have accumulated in recent years regarding the association between celiac disease, fertility and pregnancy. Many primary care obstetricians and gynecologists and perinatologists are not aware of these important relationships. The aim of this review, utilizing a MEDLINE search from 1966 through March 2000 of the English language, is to describe the possible effects of celiac disease and its treatment upon the reproductive cycle, fertility, pregnancy, and menopause. Review of the literature reveals that patients with untreated celiac disease sustain a significantly delayed menarche, earlier menopause, and an increased prevalence of secondary amenorrhea. Patients with untreated celiac disease incur higher miscarriage rates, increased fetal growth restriction, and lower birth weights. It appears that improvement of celiac disease, as reflected by restoration of small bowel mucosa associated with implementation of a gluten-free diet, may decrease miscarriage rates, improve fetal nutritional support and overall perinatal outcome.
Late Second-Trimester Nonstress Test Characteristics in Preterm Delivery before 32 Weeks of Gestation
Authors: Yanagihara Toshihiro , Ueta Mari , Hanaoka Uiko , Tanaka Yasuko , Kuno Atsushi , Kanenishi Kenji , Yamashiro Chizu , Tanaka Hirokazu , Hata Toshiyuki
Published: April 2003

Objective: To clarify electronic fetal heart rate (FHR) monitoring characteristics in pregnancies with preterm delivery before 32 weeks of gestation, using the late second-trimester nonstress test. Methods: Among 953 children born from 1993 to 1996, we identified 100 singleton infants born before 32 weeks of gestation in whom second-trimester (24–27 weeks of gestation) electronic fetal monitoring (EFM) records were obtained. Individual components of the FHR patterns [baseline rate, baseline FHR variability, presence of acceleration (at least 10 beats/min for at least 10 s) and periodic or episodic deceleration (at least 25 beats/min for at least 15 s)] and birth characteristics were compared between pregnancy with or without second-trimester decelerations. Results: Among 100 infants, 65 had and 35 did not have second-trimester decelerations. There were no significant differences in gestational age at birth, birth weight, cord arterial blood pH, Apgar score and meconium staining between pregnancies with second-trimester decelerations and those without second-trimester decelerations. There were no significant differences in baseline rate and baseline variability between pregnancies with or without second-trimester decelerations. The number of accelerations in pregnancies with second-trimester decelerations was significantly more frequent than that in pregnancies without second-trimester decelerations (p < 0.001). There was a significant increase in the occurrence of premature rupture of the membranes (PROM; 60.0%) in pregnancies with second-trimester decelerations, when compared with events (37.1%) related to pregnancies without second-trimester decelerations (p < 0.05). There were no significant differences in the onset of breech presentation, cervical incompetency, preeclampsia and abnormal FHR pattern at birth between pregnancies with second-trimester decelerations and those without second-trimester decelerations. Pregnancies with PROM after second-trimester EFM were significantly more likely to have second-trimester decelerations than those without PROM (75.0 vs. 54.2%, p < 0.05). Conclusion: Periodic or episodic decelerations during late second-trimester EFM were associated with an increased risk of the occurrence of PROM in pregnancies with preterm delivery before 32 weeks of gestation.
Regulation of Platelet Aggregation in vitro by Plasma Adenosine in Preeclampsia
Authors: Takeuchi Tsutomu , Yoneyama Yoshio , Suzuki Shunji , Sawa Rintaro , Otsubo Yasuo , Araki Tsutomu
Published: April 2003

The aim of this study was to evaluate the possible role of plasma adenosine in platelet aggregation in preeclampsia. We measured the plasma adenosine concentration [ADO] and in vitro platelet aggregation in the third trimester of normal pregnant (n = 15) and preeclamptic women (n = 15). The mean plasma [ADO] in preeclampsia was 0.68 ± 0.08 µM (means ± SEM), significantly higher than in normal pregnancy (0.42 ± 0.09 µM) (p < 0.05). In preeclampsia, platelet aggregation in response to collagen was approximately 40% lower than that in normal pregnancy (p < 0.05). There was an inverse correlation between the plasma [ADO] and platelet aggregation in vitro (r = –0.27, p < 0.05). These results suggest reduced platelet aggregation in preeclampsia may be at least in part attributed to an elevation of the the plasma [ADO].
Prenatal Ultrasonographic Diagnosis of Congenital Umbilical Hernia and Associated Patent Omphalomesenteric Duct
Authors: Sherer David M. , Dar Peer
Published: April 2003

We present an unusual case in whom a small congenital hernia of the umbilical cord and associated patent omphalomesenteric duct were diagnosed at midtrimester ultrasonography. The diagnosis was confirmed following delivery, and neonatal corrective surgery was performed. We compare prenatal ultrasound findings of umbilical hernia and associated persistent omphalomesenteric duct with those of omphalocele.
Low Dose of Ethinyl Estradiol Can Reverse the Antiestrogenic Effects of Clomiphene Citrate on Endometrium
Authors: Unfer Vittorio , Costabile Loredana , Gerli Sandro , Papaleo Enrico , Marelli Guido , Di Renzo Gian Carlo
Published: April 2003

Fifty healthy, voluntary patients aged between 20 and 30 years with regular menstruation and plasmatic progesterone level >10 ng/ml at the midluteal phase have been enrolled in this study. They were randomly treated with clomiphene citrate (CC; group A) or CC + ethinyl estradiol (0.05 mg group B, or 0.02 mg group C). We estimated the difference in uterine artery pulsatily index, endometrial thickness and histological dating and morphometric analysis of endometrium. No significant differences in Pulsatility Index values and in the number of preovulatory follicles were noted. The difference between endometrial thickness, histological dating and morphometric analysis of the endometrium were statistically different between groups B and C vs. A. Our study shows that CC has a deleterious effect on endometrium maturity and that adding ethinyl-E2 produces a favorable endometrial response even with very low doses.
Elevated Interleukin-8 Concentrations in Cervical Secretions Are Associated with Preterm Labour
Authors: Dowd Jennifer , Laham Nihay , Rice Gregory , Brennecke Shaun , Permezel Michael
Published: April 2003

The aim of this study was to assess the potential clinical utility of interleukin-8 (IL-8) present in cervical secretions as a marker of preterm labour and delivery. Samples of cervical mucus from 91 pregnant women were assessed for the presence and concentration of IL-8. Two samples were collected (at 18 ± 2 and 28 ± 2.5 weeks of gestation) and correlated with cervicovaginal microbiology and cervical length, as measured by transvaginal ultrasound. The IL-8 concentration at 28/40 was significantly higher in women who went on to deliver preterm (p < 0.01), and there was a greater than five-fold increase from 18 to 28 weeks in 6/7 of these women.
Umbilical Artery Pulsatility Index in Pregnancies Complicated by Insulin-Dependent Diabetes mellitus without Hypertension
Authors: Fadda Giovanni Maria , Cherchi Pier Luigi , D’Antona Donato , Ambrosini Guido , Marchesoni Diego , Capobianco Giampiero , Dessole Salvatore
Published: April 2003

Objective: In a group of diabetic pregnant women, the umbilical artery pulsatility index (PI) was compared with both pregnancy complications and perinatal outcomes. Method: We evaluated 67 women with pregnancies complicated by insulin-dependent diabetes mellitus (IDDM), without hypertension. For the study we took the last umbilical PI value before delivery into consideration. Doppler results were not used for patient management. Umbilical artery PI was correlated with the route of delivery and the following perinatal complications: intrauterine growth retardation; cesarean sections for acute fetal distress; respiratory distress syndrome (RDS); neonatal hyperbilirubinemia; hypocalcemia; hypoglycemia; macrosomia, and neonatal intensive care unit (NICU). Results: Among the 67 diabetic patients enrolled in this study, 44 (66%) had umbilical PIs ranging from the 5th to the 95th percentile (PI mean ± SD = 1.2 ± 0.3), while 23 (34%) had PIs above the 95th percentile (PI mean ± SD = 1.6 ± 0.3). Among the group with pathologic umbilical PIs, analysis of the data revealed a significantly higher incidence of both cesarean sections for acute fetal distress and perinatal complications: RDS; hyperbilirubinemia; hypoglycemia, and the need for NICU, respectively. Conclusion: In 34% of the diabetic pregnant women without hypertension, we found increased vascular resistances. Among these patients the incidence of perinatal complications was higher, and both closer maternal metabolic control and stricter care of fetal conditions are needed.
Effect of Repeated Doses of Dexamethasone on the Incidence and Severity of Respiratory Distress Syndrome in Multifetal Gestation between 24 and 34 Weeks
Authors: Al-Yatama M.K. , Al Essa M. , Omu A.E. , Al-Shamali I. , Egbase P. , Rashwan N.
Published: April 2003

The objective of the study was to evaluate the effects of antenatal corticosteroid therapy in multiple pregnancy on the incidence and severity of respiratory distress syndrome (RDS). Twenty-two women with twin, 12 with triplet and 2 with quadruplet pregnancies and an emergency group of 20 mothers with twin pregnancies, who only had one course of dexamethasone, were compared with controls. Corticosteroid therapy was associated with a reduction in moderate to severe RDS in all groups (twins p < 0.01, triplets and quadruplets p < 0.008) and the emergency group with dexamethasone therapy (p < 0.036) when compared to their individual controls. Dexamethasone reduced the duration of stay in the neonatal intensive care unit of the emergency twin group (p < 0.01). Neonatal birth weights were significantly less in all groups treated with repeated doses in comparison to the controls.
Apoptotic Changes in Cervical Intraepithelial Neoplasia
Authors: Duttagupta Chandralekha , Basu Jayasri , Ray Monika , Romney Seymour L.
Published: April 2003

We examined apoptosis in paraffin-embedded archival cervical tissues from cervical intraepithelial neoplasia (CIN) cases to determine whether the apoptotic process is involved in the cellular changes of CIN. Apoptotic bodies, determined by the Tunel method, were largely found at the surface epithelium in a few tissue specimens with no significant abnormality and in most tissues with CIN. Apoptotic bodies were also found within the stratified epithelium of CIN lesions and were altogether absent in specimens with no significant abnormalities. The apoptotic index was significantly associated with the severity of CIN and not with either age or human papillomavirus infection. Based on the findings of increased numbers of apoptotic bodies and their presence within the stratified epithelium in CIN tissues, we hypothesize that dysregulation in the exfoliation of apoptotic cells and resistance towards apoptosis may be prerequisites for the pathogenesis of CIN.