bluuebunny/crossref_metadata_2025 huggingface dataset:
Bacteraemia in Patients with Hidradenitis Suppurativa Undergoing Carbon Dioxide Laser Surgery: Detection and Quantification of Bacteria by Lysis-Filtration
Authors: Sartorius Karin , Lapins Jan , Jalal Shah , Emtestam Lennart , Hedberg Maria
Published: November 2006

Background: Hidradenitis suppurativa (HS) is a cicatrising and persistent disease of apocrine gland-bearing areas in adults. The severity of this condition varies from a few suppurating lesions to widespread, disabling disease. The aetiology is obscure, but suggested contributory factors include a genetic predisposition, comedones occluding the pilosebaceous apparatus, bacterial infections, and hormonal factors. Treatment consists mainly of surgery, while medical therapies serve principally as adjunct therapy. Objectives: The aim of the study was to determine the number and type of bacteria circulating in the bloodstream in patients with HS undergoing surgical treatment with a carbon dioxide laser stripping-secondary intention technique. Methods: Twenty-one patients (20 females and 1 male, mean age 36, range 20–55 years) were included in the study. One blood sample (8.3 ml) was taken before surgery, one during the operation and the last one 10 min after surgery. Five healthy persons (all females, mean age 36, range 23–48 years) not undergoing any operation were used as the controls. The blood was cultured by a lysis-filtration technique which had been shown to be very sensitive. Since the filter catches the microorganisms and colonies are formed during culturing, the number of bacteria in the samples is easily determined. Results: In 6 patients, all samples were negative, which indicates that the method of surgery itself caused no spread of bacteria from the lesions. Bacterial growth in the first blood sample was found in 9 patients, from the second sample in 10 and from the third one in 6. In 1 patient, bacteria were detected in three samples. At least 12 bacterial species were identified. The dominating bacteria were coagulase-negative staphylococci of which most were subtyped as Staphylococcus warneri. Among the anaerobic microorganisms, Propionibacterium acnes and P.granulosum were the most frequently isolated bacteria. The bacterial findings in the blood samples accord well with the results from a previous study in which cultures were taken from the deep parts of the HS lesions. In the 5 controls, no microbial growth was detected. Conclusion: The carbon dioxide laser stripping technique caused no additional spread of bacteria into the bloodstream. The evaluation of cultures containing microorganisms from normal skin flora is controversial. Since the bacteria encountered in this study are in close agreement with the findings in cultures from the deeper parts of HS lesions they seem to be relevant. The growth of bacteria in the first blood sample taken before surgery may indicate that some of these patients have bacteria continuously circulating in their blood.
Benefits from the Use of a Pimecrolimus-Based Treatment in the Management of Atopic Dermatitis in Clinical Practice
Authors: Simon Dagmar , Lübbe Jann , Wüthrich Brunello , Wiesner Alice , Weber M. Monika , Laffitte Emmanuel , Anliker Mark D. , Schöni Martin H. , Braathen Lasse R. , Schmid-Grendelmeier Peter , Gilgen Bobalj Nicole , Schneider Dirk
Published: November 2006

Background: Controlled studies established the efficacy and good tolerability of pimecrolimus cream 1% for the treatment of atopic dermatitis but they may not reflect real-life use. Objective: To evaluate the efficacy, tolerability and cosmetic acceptance of a pimecrolimus-based regimen in daily practice in Switzerland. Methods: This was a 6-month, open-label, multicentre study in 109 patients (55% ≧18 years) with atopic dermatitis. Pimecrolimus cream 1% was incorporated into patients’ standard treatment protocols. Results: The pimecrolimus-based treatment was well tolerated and produced disease improvement in 65.7% of patients. It was particularly effective on the face (improvement rate: 75.0%). Mean pimecrolimus consumption decreased from 6.4 g/day (months 1–3) to 4.0 g/day (months 3–6) as disease improved. Most patients (74.1%) rated their disease control as ‘complete’ or ‘good’ and 90% were highly satisfied with the cream formulation. Conclusion: The use of a pimecrolimus-based regimen in everyday practice was effective, well tolerated and well accepted by patients.
Prurigo Pigmentosa Successfully Treated with Low-Dose Isotretinoin
Authors: Akoglu Gulsen , Boztepe Gonca , Karaduman Aysen
Published: November 2006

Background/Aims: Prurigo pigmentosa (PP) is an uncommon inflammatory disease with pruritic reddish papules, papulovesicules or vesicules that are symmetrically localized on the trunk and nape, accompanied by reticular hyperpigmentation. Currently available therapeutic options seem somewhat unsatisfying. Herein, we report an 18-year-old female with PP successfully treated with low-dose isotretinoin. Methods: The patient presented with a symmetrical pruritic eruption on the lateral sides of her trunk with erythematous papules on a hyperpigmented background. Based on the typical clinical and associated histological findings, the patient was diagnosed as PP and a treatment with low-dose isotretinoin 0.3 mg/kg/day (20 mg/day) was started. Results: After a total of 3 months of 20 mg/day isotretinoin therapy, all erythematous macules and papules resolved and the residual pigmentation had almost disappeared. Conclusion: Low-dose isotretinoin is not only adequate for the improvement of erythematous lesions, it also helps resolve the reticular hyperpigmentation of PP. Further studies are needed to observe the efficacy of isotretinoin in the treatment of PP.
Echinococcosis: A Possible Etiology in Psoriatic Disease
Authors: Apan Teoman Zafer , Kaygusuz Sedat
Published: November 2006

We aimed to investigate seroprevalence of Echinococcus granulosus in patients with psoriasis to determine a possible etiologic role, since both echinococcosis and psoriasis are defined as T cell-mediated diseases. Forty psoriatic patients and 50 age- and sex-matched control subjects were included in the study. IgG-specific ELISA was used to determine seropositivity. E. granulosus-specific IgG antibodies were found to be positive in 17/40 (42.5%) of the patients with psoriasis and in 11/50 (22%) of the control subjects (p = 0.008). Our results suggest thatechinococcosis might be one of the causative pathogens in the etiopathogenesis of psoriasis in highly endemic regions.
Drug-Induced Hypersensitivity Syndrome due to Mexiletine Hydrochloride Associated with Reactivation of Human Herpesvirus 7
Authors: Yagami Akiko , Yoshikawa Tetsushi , Asano Yoshizo , Koie Shin , Shiohara Tetsuo , Matsunaga Kayoko
Published: November 2006

It has been suggested that reactivation of human herpesvirus 6 (HHV-6) infection may be involved in the pathogenesis of drug-induced hypersensitivity syndrome. We report a 45-year-old Japanese man who developed a generalized papuloerythematous rash, fever, hepatitis, lymphadenopathy and lymphocytosis with an increased number of atypical lymphocytes. He was diagnosed with DIHS due to mexiletine hydrochloride based on laboratory data, results of a patch test and the clinical course of his complaint, and was treated with systemic steroids. In order to determine whether HHV-6 or -7 was associated with the patient’s disease, serological assays and PCR were carried out. Significant increases in antibody titers against HHV-6 and -7 were observed from day 12 to 24. From PCR analysis, none of the peripheral blood mononuclear cells or skin tissue samples contained HHV-6 DNA. All samples, however, were found to contain HHV-7 DNA. Reactivation of HHV-7 could be responsible for drug-induced hypersensitivity syndrome.
Pitfalls with MRI Evaluation of Prostate Cancer Detection
Authors: Okamura Takehiko , Umemoto Yukihiro , Yamashita Kazuaki , Suzuki Shugo , Shirai Tomoyuki , Hashimoto Yoshihiro , Kohri Kenjiro
Published: November 2006

Introduction: To assess differences between MRI findings and histopathologically defined prostate cancer localization, we compared clinical results with mapping of radical prostatectomy specimens, and conducted a retrospective MRI cancer localization re-assessment by a urologist-technician after surgery. Methods: We performed MRI for a total of 37 suspected prostate cancer patients. Subsequently, all underwent retropubic radical prostatectomy after prostate biopsy for confirmation of the diagnosis. All the specimens were studied histopathologically with serial sectioning using a whole organ approach. Results: Of the 37 patients, 26 had positive MRI findings. All the surgical specimens contained cancerous lesions, and 23 had multiple foci. Twenty-four of the MRI-positive cases (92.3%) demonstrated coincidence of both MRI and histopathologically defined lesions. In the single focus cases, 78.6% (11/14) demonstrated exact coincidence, but in the multifocal cases there were no cases with exact coincidence of MRI and histopathological findings (0/23). Conclusion: MRI evaluation cannot be considered an effective diagnostic tool in itself for detection of prostate cancers because sensitivity is far from satisfactory, especially in multi-focal cases.
Spontaneous Knotting of Urinary Catheters
Authors: Raveenthiran V.
Published: November 2006

Urinary catheters are known to spontaneously knot inside the bladder. Approximately 40 cases of this complication have been recorded in the world literature. Clinical observation in 4 children and simulation experiments done using a balloon model are described herein. Risk factors identified in this study includes catheter size less than 10 Fr, overdistended bladder and insertion of more than 10 cm length of catheter inside the bladder. Water-current generated by the flow of urine appears to play an important role in the pathogenesis of catheter knotting.
Voiding Pattern of Healthy Taiwanese Women
Authors: Huang Yi-Hsiu , Lin Alex T.L. , Chen Kuang-Kuo , Chang Luke S.
Published: November 2006

Aim: Few studies have examined the voiding pattern of healthy females, despite the importance of such research for diagnosing abnormal voiding behavior. This study investigates the voiding behavior of healthy women in Taiwan. Methods: 68 healthy women, aged 19–66 years and claiming to void normally were enrolled. Twenty-two of the subjects (32.4%) were postmenopausal. Each woman completed a 3-day voiding diary. The diary recorded urine volume, voiding frequency, urine volume per voiding for the whole day (24 h), and urine volume during both daytime and nighttime. Age and various other voiding parameters were correlated, and the voiding patterns were compared between premenopausal and postmenopausal women. Results: All women voided 7.34 ± 1.63 times daily. Higher age was associated with higher whole day and daytime voiding frequency. Nocturia was not common for the group as a whole, with a mean nocturnal voiding of 0.25 times per night. However, higher age was significantly associated with a higher nighttime voiding frequency. A significantly positive correlation was also observed between age and whole day urine volume. Compared with regularly menstruating women, postmenopausal women had a significantly higher whole day and nighttime voiding frequency. Menopause and age both independently affect voiding parameters after multivariate analysis. Conclusions: The results of this study provide invaluable baseline data on female voiding behavior. Additionally, this study found that for healthy women, age and menstruation status significantly affect voiding patterns. Analysis of female voiding behavior thus should consider these two factors.
Overactive Bladder Syndrome among Community-Dwelling Adults in Taiwan: Prevalence, Correlates, Perception, and Treatment Seeking
Authors: Yu Hong-Jeng , Liu Cheng-Ying , Lee Kuang-Lug , Lee Wei-Chia , Chen Tony Hsiu-Hsi
Published: November 2006

Purpose: We investigated the prevalence, correlates, perception of overactive bladder syndrome (OAB) and doctor-consultation behavior among community adults. Subjects and Methods: This urological survey was part of a government-supported health utilization project conducted in Matsu, Taiwan. Participants (n = 1,827) completed a questionnaire collecting information on OAB, which was defined as urgency with either frequency or nocturia. Results: The age-adjusted prevalence of OAB was 16.9%, including 4.5% with urge incontinence. Age (p = 0.002), diabetes (p = 0.03), and benign prostatic hyperplasia (p < 0.001) in men, whereas diabetes (p = 0.01), hyperlipidemia (p = 0.03), stress incontinence (p < 0.001), and recurrent lower urinary tract infections (p = 0.02) in women were factors independently associated with OAB. Most people with OAB (69.0%) perceived little bother; only 13.0% had consulted doctors for this problem. Conclusion: Symptoms related to OAB are common among community-dwelling adults, yet most perceive it as a minor problem. Our results identify several factors that are significantly associated with OAB.
Propiverine Hydrochloride Immediate and Extended Release: Comparison of Efficacy and Tolerability in Patients with Overactive Bladder
Authors: Jünemann K.-P. , Hessdörfer E. , Unamba-Oparah I. , Berse M. , Brünjes R. , Madersbacher H. , Gramatté T.
Published: November 2006

Introduction: This study aims to compare the efficacy of propiverine hydrochloride immediate release (IR), propiverine hydrochloride extended release (ER) and placebo for the treatment of overactive bladder syndrome. The primary outcome measure is incontinence episode frequency, with secondary outcome measures including mean volume per void and quality of life as assessed on King’s Health Questionnaire. Material and Methods: The double-blind, double-dummy, randomized study compared IR 15 mg twice daily, ER 30 mg once daily and placebo in 3 parallel groups. After a run-in period of 7 days, the patients were treated for 32 days. Nine hundred and eighty-eight patients were randomized, and 910 patients completed the protocol without major violations. Results: The number of incontinence episodes/24 h decreased by 2.26 in the IR group (p < 0.001 vs. placebo), by 2.46 in the ER group (p < 0.0001 vs. placebo) and by 1.75 in the placebo group. The most frequent adverse event was dry mouth with 22.8% of the patients in the IR group, 21.7% in the ER group and 6.4% in the placebo group. The overall tolerability was rated ‘very good’ or ‘good’ by more than 80% of the investigators and patients in all 3 groups. Conclusions: Propiverine ER 30 mg once daily and propiverine IR 15 mg twice daily significantly reduce the number of incontinence episodes/24h within a treatment period of 32 days. Both formulations are safe and well tolerated. The extended release formulation of propiverine is a suitable new option for the treatment of the overactive bladder.
A Comparative Study of Protein Profiling by Proteomic Analysis in Camptothecin-Resistant PC3 and Camptothecin-Sensitive LNCaP Human Prostate Cancer Cells
Authors: Hasegawa Nobuko , Mizutani Kosuke , Suzuki Tohru , Deguchi Takashi , Nozawa Yoshinori
Published: November 2006

Introduction: Drug resistance is a major obstacle for the therapy of prostate cancer, but its underlying mechanisms are not clarified. To detect some candidate marker proteins which may confer resistance to the anticancer drug camptothecin (CPT; DNA topoisomerase 1 inhibitor), the current study deals with the comparative proteomic profiling of CPT-resistant PC3 and CPT-sensitive LNCaP human prostate cancer cell lines which have been widely employed as a useful model to investigate prostate cancer cells. Materials and Methods: The global profiling of the protein expression was investigated in CPT-resistant PC3 and CPT-sensitive LNCaP prostate cancer cells using 2-dimensional polyacrylamide gel electrophoresis/matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Results: 144 proteins were identified and their expression levels were compared between the two cell lines. Four proteins – annexin A1, glutathione-S-transferase (GST) π, galectin (Gal) 3 and glucose-regulated protein 78/Bip – that are suggested to contribute to the development of drug resistance were found to be preferentially or highly expressed in PC3 cells, whereas LNCaP cells did not show detectable expression of annexin A1, GST-π and Gal-3. Conclusion: The expression level of these proteins and/or mRNAs could be a useful parameter to evaluate the chemotherapy resistance in clinical specimens of prostate cancer.
Additional Gene Therapy with rAAV-wt-p53 Enhanced the Efficacy of Cisplatin in Human Bladder Cancer Cells
Authors: Ruifa Han , Liwei Liu , Binxin Lu , Ximing Li
Published: November 2006

Objective:Gene therapy is defined as the treatment of an acquired or inherited disease by transfer of genetic material. The most common strategies in gene therapy of bladder cancer are corrective, inductive and cytotoxic gene therapy. Mutations in the p53 tumor suppressor gene are the most common molecular genetic abnormalities in bladder cancer and p53 gene transfer in the human bladder cancer cell line by adenoviral or other vectors was demonstrated to be cytotoxic. However, so far there has been no report of adeno-associated virus-2 vector-mediated p53 gene deliveries in bladder cancer. In this study, wild-type p53 cDNA was transfected into the bladder cancer cells, using the adeno-associated virus-2 vector, and the capability of rAAV-wt-p53 gene therapy in bladder cancer was evaluated in vitro. Method:Bladder cancer cell lines 5637 were transduced with adeno-associated virus-2 vectors containing wild-type human p53 gene (rAAV-wt-p53). Gene expression and transcriptional activation of p53 was determined by Western blot analysis. The cellular growth inhibition and apoptosis of rAAV-mediated p53 transfection were assessed by flow cytometry. The combination effect of rAAV-wt-p53 and cisplatin was measured by MTT assay. Results:The virus rAAV efficiently enters the cells and expresses its gene products. The gene product of rAAV-wt-p53 is cytotoxic to bladder cancer cells. The bladder cell line 5637 was found to experience a synergistic killing effect when rAAV-wt-p53 was used in combination with cisplatin. Conclusion: rAAV-mediated p53 gene transfer could offer a powerful novel therapeutic approach in bladder cancer.
Isolated Unilocular Renal Hydatid Cyst: A Rare Diagnostic Difficulty with Simple Cyst
Authors: Kilciler Mete , Bedir Selahattin , Erdemir Fikret , Coban Hidayet , Sahan Burak , Ozgok Yasar
Published: November 2006

Hydatid disease is endemic in many parts of the world. The location is mostly hepatic (75%) and pulmonary (15%), and only 10% of the cysts occur in the rest of the body. It may develop in almost any part of the body. Although hydatidosis can be present in all parts of the human body, urinary tract involvement develops in only 2–4% of all cases, and isolated renal cysts are extremely rare. There are no specific clinical symptoms or signs that will reliably confirm the diagnosis of renal echinococcosis. In addition, there is no laboratory finding that is pathognomonic for hydatid disease except for hydatiduria. Routine blood tests are generally normal except for eosinophilia which is found in only 50% of the cases. Radiological studies have a more important place in the preoperative diagnosis of renal hydatic disease. However, there is no specific sign on plain radiography or intravenous urography, and ultrasound or computed tomography cannot always show a hydatidosis as a specific lesion. From these reasons, sometimes it is difficult to differentiate between a unilocular hydatid cyst without mural calcification and a simple renal cyst. So, despite its rarity, hydatid disease should be included in the differential diagnosis of cystic lesions in solid organs or other anatomic sites, especially in endemic countries. We present herein a patient with isolated renal hydatid cyst mimicking a simple cyst treated successfully with complete excision.
Antibodies to Trophoblast Antigens HLA-G, Placenta Growth Factor, and NeuroD2 Do Not Improve Detection of Circulating Trophoblast Cells in Maternal Blood
Authors: Tjoa M.L. , Delli-Bovi L. , Johnson K.L. , Bianchi D.W.
Published: November 2006

Objectives: Non-invasive prenatal diagnosis using circulating fetal trophoblast cells has been challenging due to lack of a reproducible trophoblast-specific antibody. We investigated the use of three trophoblast cell-specific antibodies, HLA-G, placenta growth factor, and neuroD2, for the isolation of trophoblast cells from the maternal circulation. Methods: Trophoblast cells were isolated by density centrifugation from maternal blood samples (gestational age 10–20 weeks, n = 9). All women were carrying a male fetus. Following immunocytochemical staining with the trophoblast-specific antibodies, fluorescent in situ hybridization was performed, to verify whether any stained cells were indeed fetal. Results: The HLA-G antibody had a ubiquitous staining pattern, which was not specific for trophoblast cells. Neither the placenta growth factor nor the neuroD2 antibodies were able to identify any trophoblast cells. Following fluorescent in situ hybridization, no male cells were detected on any of the slides. Conclusion: The antibodies used in this study were unable to improve detection of trophoblast cells in the maternal circulation.
Antibiotic Treatment of Intra-Amniotic Infection with Ureaplasma urealyticum
Authors: Smorgick Noam , Frenkel Eugenia , Zaidenstein Ronit , Lazarovitch Tsilia , Sherman Dan J.
Published: November 2006

Background:Ureaplasma urealyticum is the most common pathogen cultured from the amniotic cavity of women with preterm labor and intact membranes. However, experience with antibiotic eradication of the pathogen in this setting is limited. Case: We report a case of U. urealyticum isolation from the amniotic cavity of a woman with preterm labor at 27 weeks gestation. The patient was treated with erythromycin base for 1 week, followed by fluoroquinolones and clindamycin for 10 days. A healthy neonate was delivered after spontaneous labor began at 33 weeks. The cultures obtained from the placenta and membranes were sterile, but the histopathology of the placenta revealed acute chorioamnionitis with acute funisitis. Conclusion: We suggest that intra-amniotic colonization with Mycoplasma spp. remote from term may be managed expectantly, and that therapy with fluoroquinolones and/or clindamycin may be an appropriate choice.
Pharmacokinetics of Oral Cefatrizine in Pregnant and Non-Pregnant Women with Reference to Fetal Distribution
Authors: Papantoniou N. , Ismailos G. , Daskalakis G. , Karabinas C. , Mesogitis S. , Papapanagiotou A. , Antsaklis A.
Published: November 2006

Objective: To investigate the effect of gestation on the pharmacokinetics of orally administered β-lactams, choosing cefatrizine as the model antibiotic. Setting: A tertiary teaching hospital. Design: Prospective study. Methods: In 20 women with affected fetuses, 17 by β-thalassemia major and 3 with congenital malformations, termination of gestation between 19 and 24 weeks was induced by intra-amniotic administration of prostaglandin F2α. Pharmacokinetics of cefatrizine in maternal and fetal blood were studied after the administration of three 1 g doses of oral cefatrizine, every 12 h. Twenty female non-pregnant volunteers consisted the control group. Results: Gestation was found to decrease substantially both cefatrizine oral bioavailability and maximum serum plasma concentration (42.8 and 44.5%, respectively) but increased elimination half-life. This effect can be attributed to a substantial increase of the apparent volume of distribution of cefatrizine in relation to a moderate increase of clearance that occurs during pregnancy. Fetal serum cefatrizine levels were lower for the first few hours after administration and then exceeded the corresponding maternal ones. Conclusions: Our results indicate that gestation decreases the oral bioavailability of cefatrizine. A delay in the maternal drug elimination compared to non-pregnant controls was more pronounced in the fetus.
Evolving Indications for the EXIT Procedure: The Usefulness of Combining Ultrasound and Fetal MRI
Authors: Mota Raquel , Ramalho Carla , Monteiro Joaquim , Correia-Pinto Jorge , Rodrigues Manuela , Guimarães Hercília , Spratley Jorge , Macedo Filipe , Matias Alexandra , Montenegro Nuno
Published: November 2006

The EXIT procedure (EX utero Intrapartum Treatment) encompasses a multidisciplinary approach to situations in which airway obstruction is anticipated. Uteroplacental circulation is maintained to avoid neonatal hypoxemia while intubation is attempted. Not only is it useful in congenital diaphragmatic hernia with intrauterine tracheal occlusion, but new indications have been proposed. We present two cases in which EXIT procedure was adopted (huge cervical mass with tracheal compression and a highly vascularized cephalocervical mass) for the same purpose on different grounds. Our two cases stress once more the importance of combining fetal ultrasound and magnetic resonance imaging in the characterization of cervical masses and its usefulness in programming the procedure with a multidisciplinary team.
Prenatal Diagnosis of Fetal Exencephaly Associated with Amniotic Band Sequence at 17 Weeks of Gestation by Fetal Magnetic Resonance Imaging
Authors: Rohrbach M. , Chitayat D. , Drake J. , Velsher L. , Sirkin W.L. , Blaser S.
Published: November 2006

We report a fetus with exencephaly diagnosed by fetal magnetic resonance imaging (MRI) at 17 weeks of gestation. Fetal ultrasound performed at 13 and 17 weeks of gestation suggested occipital encephalocele. However, the fetal MRI done at 17 weeks of gestation showed exencephaly and suggested amniotic bands as the cause. By providing early and precise information regarding the abnormality and the possible etiology, the fetal MRI enabled us to provide the couple and their families with accurate information regarding the low recurrence risk of this condition.
Alpha-1-Antitrypsin and IgA in Serial Meconium and Faeces of Healthy Breast-Fed Newborns
Authors: Lisowska-Myjak Barbara , Pachecka Jan
Published: November 2006

Background: Meconium is a series of layers formed in the foetal intestine from the 12th week of gestation. High content of meconial alpha-1-antitrypsin (AAT), decreasing within the first several days of extrauterine life appears to reflect the meconium clearance of the gut. At birth, IgA is not present in the meconium and breast-fed infants receive this antibody postnatally with human milk. The aim of the study was to determine changes in AAT concentrations, functional activity of that inhibitor expressed as trypsin inhibitory capacity (TIC) and IgA concentration in serial meconium and faeces, as endogenous biochemical markers discriminating between faeces portions formed in intrauterine and extrauterine life periods of healthy breast-fed newborns. Methods: A group of 24 healthy breast-fed newborns delivered by spontaneous labour were studied prospectively during the first 4 days of postnatal life. AAT and IgA concentrations in the newborn‘s meconial and faecal samples and IgA concentration in mother’s milk samples taken on the third day after delivery, were determined by radial immunodiffusion. TIC was assessed using BAPNA (N-benzoyl-DL-arginine-p-nitroanilide). Results: The medians (range) of AAT concentrations in milligrams per gram of dry meconium or faeces were: 68.8(29.2–138.4) (day 1), 56.9 (30.8–112.8) (day 2), 26.2 (6.8–80.7) (day 3), and 6.6 (1.4–27.1) (day 4). The medians (range) of TIC in milligrams of trypsin/g dry mass of meconium or faeces were: 0.76 (0.33–1.79) (day 1), 0.44 (0.17–1.08) (day 2), 0.16 (0.03–0.56) (day 3), and 0.03 (0–0.11) (day 4). The median (range) of IgA concentration in mothers’ milk was 715 mg/dl (420–890). IgA was absent in meconium portions from the first day of life while on the successive days the medians (range) of IgA concentration in mg/g dry mass of meconium and faeces were as follows: 0 (0–2.90) (day 2), 2.50 (1.10–9.60) (day 3), 7.05 (4.10–30.60) (day 4). On day 4 of extrauterine life a negative correlation was found between AAT and IgA concentrations in faeces of the newborns (r = –0.46) and a positive correlation was seen between IgA concentrations in faeces and milk (r = 0.93). Conclusions: Analyses of the systematic decrease in AAT and increase of IgA concentration in serial portions of meconium and faeces over the first days of extrauterine life of breast-fed newborns can date newborn’s faeces portions formed during intrauterine and extrauterine maturation. AAT deposited in foetal intestine is an active antiprotease.
Are Placental Chorionic Capillary Nucleated Red Blood Cell Counts Useful Compared to Umbilical Cord Blood Tests?
Authors: McCarthy Joan M. , Gilbert-Barness Enid , Tsibris John C.M. , Spellacy William N.
Published: November 2006

Objective: To compare measurement of fetal nucleated red blood cell (NRBC) counts in paired histologic samples of the placenta and umbilical cord bloods. Method: Forty-five randomly selected pregnancies had two determinations of the NRBC count. A sample of umbilical venous blood had a NRBC count measured and sections of the placenta were examined for their villous capillary NRBC counts. Results: Umbilical venous blood had NRBC/100 white blood cell counts ranging from 0 to 67. Paired evaluation of placental tissue had NRBC counts of 0–5 with 60% being zero compared to 8% zero counts in cord blood. There was no correlation between the paired counts (R2 = 0.04). Conclusion: Umbilical cord blood provides different information on fetal NRBC count than does histologic study of the placenta.
Emergent Fetal Intracardiac Transfusion for Thrombocytopenia and Acute Hypovolemia due to Cordocentesis-Associated Hemorrhage in Parvovirus-Induced Hydrops
Authors: Sarno Jr. Albert P. , Feinstein Steven J. , Bell Joseph G. , Parikh Reshma , Papazian Karen
Published: November 2006

Objectives: To demonstrate the utility of fetal intracardiac transfusion to correct acute fetal hypovolemia and thrombocytopenia in fetal Parvovirus infection. Methods: Intracardiac transfusion in a 19-week gestation was indicated due to cordocentesis-associated hemorrhage. Results: Intracardiac transfusion resulted in correction of acute bradycardia, anemia and thrombocytopenia and persistent umbilical cord hemorrhage following attempted intravascular transfusion. Conclusions: This case illustrates the importance of anticipating both thrombocytopenia and anemia in fetal Parvovirus infection and how an intracardiac approach can be employed in the setting of acute, life-threatening hemorrhage.
Advanced Combined Abdominal and Intrauterine Pregnancy: A Case Report
Authors: Shojai R. , Chaumoitre K. , Chau C. , Panuel M. , Boubli L. , d’Ercole C.
Published: November 2006

We present a case of simultaneous abdominal and intrauterine pregnancy following in vitro fertilization and embryo transfer diagnosed during the second trimester. The patient had a recent history of hysteroscopic metroplasty due to in utero exposition to diethylstilboestrol. The pregnancy was managed conservatively with a favorable outcome for the mother and both fetuses.
A Study to Determine if Human Umbilical Cord Hematopoietic Stem Cells Can Survive in Baboon Extra-Embryonic Celomic Fluid: A Prerequisite for Determining the Feasibility of in-utero Stem Cell Xeno-Transplantation via Celocentesis
Authors: Santolaya-Forgas Joaquin , Galan Isabel , DeLeon-Luis Juan , Wolf Roman
Published: November 2006

Objectives: To determine if: (1) human umbilical cord stem cells could survive for 20 h in extra-embryonic celomic fluid obtained at 40 days of development from baboon pregnancies by ultrasound-guided celocentesis and, (2) human hematopoietic stem cell survival could be enhanced by adding increasing concentrations of hematopoietic stem cell culture medium to the celomic fluid. Methods: CD34+ cells were isolated from umbilical cord blood using a magnetic activated cell sorter and flow cytometry. Cells were then cultured in five platforms containing different combinations of baboon extra-embryonic celomic fluid and hematopoietic stem cell culture medium to determine cell survival kinetics over a 20-hour period in each of the conditions. Results: Human umbilical cord stem cells can survive for at least 20 h in baboon’s celomic fluid. Chi-square for linear trends demonstrated that the number of viable cells was significantly enhanced by adding the increasing concentrations of culture medium to the celomic fluid (29% cell survival in pure celomic fluid, 48% at 1:8, 50% at 1:2, 54.5% at 1:1, 61% in pure culture medium; p < 0.001). Conclusions: Human umbilical cord stem cells survive in baboon celomic fluid and cell survival improves when the celomic fluid is mixed with greater concentrations of hematopoietic stem cell culture medium. Based on these findings, future in-vivo experiments in the pregnant baboon animal model can be directed at determining whether in-utero injection of human hematopoietic stem cells prior to 10 weeks of pregnancy can lead to permanent chimeras.
Unusual Manifestation of Acute Hepatic Porphyria in Pregnancy
Authors: Weinzierl A. , Brezinka C. , Engelhardt K.
Published: November 2006

A 22-year-old para I/gravida II developed psychiatric symptoms at 8 weeks of gestation. Subsequently neurological symptoms with seizures developed leading to a status epilepticus with continuing seizures at week 14. Anticonvulsive therapy had little effect in alleviating the seizures and the condition of the patient rapidly deteriorated. A sudden reddening of her urine lead to the diagnosis of acute hepatic porphyria confirmed by laboratory tests. After extensive discussion with the patient’s family it was decided to terminate the pregnancy at week 16. Within hours after pregnancy termination the seizures stopped and the patient recovered without any neurological deficits. Acute hepatic porphyria can be triggered by pregnancy and usually presents with gastrointestinal symptoms and personality changes. In its rare neurological manifestation it can lead to untreatable convulsions which leave no option but to terminate the pregnancy.
Emergency Peripartum Hysterectomy in a Tertiary Obstetric Center: 8-Year Evaluation
Authors: Habek Dubravko , Bečareviç Renata
Published: November 2006

Objective: The aim of the study was to present the incidence, indications, and operative morbidity and mortality in pregnant women undergoing emergency peripartum hysterectomy (EPH) at a tertiary obstetric institution. Methods: In this retrospective clinical study, performed during the period 1995–2003, 17 EPH procedures were recorded in a total of 21,659 deliveries carried out at Department of Gynecology and Obstetrics, Osijek Clinical Hospital in Osijek, Croatia. Data on the incidence of EPH in total number of deliveries, rate of EPH in vaginal delivery and cesarean section, indications for EPH, and maternal and fetal/early neonatal morbidity and mortality were derived from operative protocols and medical records of hospitalized patients. Results: During the 8-year study period, the incidence of EPH in total number of deliveries was 0.078%. Out of 17 EPH procedures, 5 (29.41%) were performed after vaginal delivery and 12 (70.59%) during cesarean section, elective in five and urgent in seven cases. The indications for EPH included severe peripartum hemorrhage with placenta previa in four, placenta previa percreta in four, various forms of invasive malplacentation (placenta accreta, increta, percreta) in five, uterine rupture in two cases, and atony along with massive retroperitoneal hematoma due to rupture of periuterine vascular bundle during cesarean section in one multipara. EPH was carried out in 12 multipara and five primipara. Lesions of urinary bladder occurred in three cases and were managed by suture. Twelve patients received blood transfusion, whereas development of hemorrhagic shock necessitated transfer to Intensive Care Unit in three patients. No late complications or maternal mortality were recorded. Sixteen total hysterectomies and one supracervical hysterectomy were performed. One case of intrauterine fetal death was caused by total abruptio placenta and uterine rupture during the patient’s transport from a primary obstetric institution. Conclusion: Invasive malplacentation is a major isolated risk factor for EPH, as shown in the present study. Other risk factors for EPH are massive hemorrhagy because placenta previa, uterine atony and uterine rupture associated with multiparity, and previous cesarean section. A great proportion of EPH procedures can be prevented by the introduction of compressive operative methods such as B-Lynch suture in the obstetric algorithms, which will certainly favorably reflect in future fertility and genital health of the female population.
Ultrasound Assessment prior to Laser Photocoagulation for Twin-Twin Transfusion Syndrome for Predicting Intrauterine Fetal Demise after Surgery in Japanese Patients
Authors: Ishii Keisuke , Hayashi Satoshi , Nakata Masahiko , Murakoshi Takeshi , Sago Haruhiko , Tanaka Kenichi
Published: November 2006

Objective: To evaluate the use of ultrasound before selective laser photocoagulation of communicating vessels (SLPCV) for twin–twin transfusion syndrome in predicting intrauterine fetal demise (IUFD). Methods: Fifty-five patients underwent SLPCV in Japan. Fetal biometry and Doppler studies of the umbilical artery, ductus venosus, and umbilical vein were performed prior to SLPCV. The visualization of the bladder and hydrops was recorded. Association between the parameters and IUFD was analyzed using multiple logistic regression analysis. The study was approved by the Institutional Review Board and patients gave their informed consent. Results: The IUFD incidence was 25.5% (14/55) in the donors and 12.7% (7/55) in the recipients. Twelve donors and 4 recipients of them ended in unexplainable IUFD. In the analysis of 53 donors, absent or reversed end-diastolic flow of umbilical artery (UAAREDF) was only associated with IUFD (p = 0.016). No parameters could predict IUFD in 52 recipients. Conclusions: UAAREDF may be useful for predicting IUFD of the donor after SLPCV.
Prenatal Diagnosis and Genetic Counseling in a Case of Spina Bifida in a Family with Waardenburg Syndrome Type I
Authors: Kujat Annegret , Veith Veit-Peter , Faber Renaldo , Froster Ursula G.
Published: November 2006

Objective: Waardenburg syndrome type I (WS I) is an autosomal dominant inherited disorder with an incidence of 1:45,000 in Europe. Mutations within the PAX3 gene are responsible for the clinical phenotype ranging from mild facial features to severe malformations detectable in prenatal diagnosis. Methods: Here, we report a four-generation family with several affected members showing various symptoms of WS I. We diagnosed the syndrome first in a pregnant young woman; she was referred because of a spina bifida in prenatal diagnosis. We performed clinical genetic investigations and molecular genetic analysis in all available family members. Results: The phenotype displays a wide intra-familial clinical variability of pigmentary disturbances, facial anomalies and developmental defects. Molecular studies identified a novel splice site mutation within the PAX3 gene in intron 5 in all affected family members, but in none of the unaffected relatives. Conclusions: This case demonstrates the prenatal diagnosis of spina bifida in a fetus which leads to the initial diagnosis of WS I. Further studies could identify a private splice site mutation within the PAX3 gene responsible for the phenotype in this family.
Sex and Age Specificity of Susceptibility Genes Modulating Survival at Old Age
Authors: Passarino Giuseppe , Montesanto Alberto , Dato Serena , Giordano Sabrina , Domma Filippo , Mari Vincenzo , Feraco Emidio , De Benedictis Giovanna
Published: November 2006

Objective: We aimed to investigate the influence of the genetic variability of candidate genes on survival at old age in good health. Methods: First, on the basis of a synthetic survival curve constructed using historic mortality data taken from the Italian population from 1890 onward, we defined three age classes ranging from 18 to 106 years. Second, we assembled a multinomial logistic regression model to evaluate the effect of dichotomous variables (genotypes) on the probability to be assigned to a specific category (age class). Third, we applied the regression model to a cross-sectional dataset (10 genes; 972 subjects selected for healthy status) categorized according to age and sex. Results: We found that genetic factors influence survival at advanced age in good health in a sex- and age-specific way. Furthermore, we found that genetic variability plays a stronger role in males than in females and that, in both genders, its impact is especially important at very old ages. Conclusions: The analyses presented here underline the age-specific effect of the gene network in modulating survival at advanced age in good health.
Differential CSF Biomarker Levels in APOE-ε4-Positive and -Negative Patients with Memory Impairment
Authors: Andersson Christin , Blennow Kaj , Johansson Sven-Erik , Almkvist Ove , Engfeldt Peter , Lindau Maria , Eriksdotter-Jönhagen Maria
Published: November 2006

Objectives: To investigate the relationships between episodic memory, APOE genotype, CSF markers (total tau, T-tau; phospho-tau, P-tau; β-amyloid, Aβ42) and longitudinal cognitive decline. Methods: 124 memory clinic patients were retrospectively divided into 6 groups based on (i) episodic memory function (Rey Auditory Verbal Learning Test, RAVLT): severe, moderate or no impairment (SIM, MIM or NIM), and (ii) APOE genotype (Ε4+ or Ε4–). CSF marker levels and cognitive decline were compared across groups. Results: Episodic memory function, according to RAVLT scores, was significantly correlated with CSF marker levels only among Ε4+ subjects and not among Ε4– subjects. When comparing the 6 subgroups, SIM Ε4+ and MIM Ε4+ groups showed significantly lower Aβ42 levels than the other groups. T-tau and P-tau levels were significantly increased in SIM Ε4+ when compared to all the other groups, including the SIM Ε4– group. However, both SIM Ε4+ and SIM Ε4– declined cognitively during the follow-up. Conclusion: It remains to be determined whether APOE genotype affects the expression of biomarkers in CSF, or whether the different biomarker patterns reflect different types of disease processes in patients with progressive cognitive dysfunction.
Effects of Pravastatin Treatment on Blood Pressure Regulation after Renal Transplantation
Authors: Lopau Kai , Spindler Katrin , Wanner Christoph
Published: November 2006

Background/Aim: Hypertension is one of the main cardiovascular risk factors and has an impact also on long-term kidney graft survival. In addition to their lipid-lowering properties, it was shown that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors also have a blood pressure lowering effect. We examined whether treatment with a statin interferes with blood pressure regulation and antihypertensive treatment after renal transplantation. Methods: 74 patients were treated with initially 20 mg of pravastatin daily immediately after kidney transplantation. This group was compared to a matched cohort of 76 patients without statin treatment. All patients received standard immunosuppressive triple therapy with ciclosporin A microemulsion together with an antiproliferative agent and prednisolone. Primary objective of this analysis was systolic and diastolic blood pressure regulation with and without pravastatin. Furthermore, graft function expressed as creatinine clearance and proteinuria, immunosuppressive regimen, and incidence of cardiovascular events and graft loss were recorded for 48 months. Results: The blood pressure regulation was comparable in both groups; however, to achieve this, significantly more antihypertensive drugs had to be used in the statin-treated patients as compared with the controls (2.9 vs. 2.2 agents at 48 months). A slightly higher ciclosporin A exposure of the statin-treated patients could have contributed to this observation. The graft function after 4 years was comparable between the groups (creatinine clearance 56.9 vs. 57.0 ml/min), and a trend of reduced proteinuria could be demonstrated after 4 years of statin treatment (0.4 vs. 0.9 g/day). The low-density lipoprotein cholesterol levels decreased as expected during treatment (3.1 vs. 3.7 mmol/l at 48 months), but the recommended target levels for patients with a high cardiovascular risk have not been reached. A trend towards lower incidences of acute rejection, chronic allograft nephropathy, and graft loss was noted in the statin-treated group. Adverse effects of statin treatment have not been observed. Conclusion: Treatment with pravastatin at low to average dosages does not result in improved blood pressure regulation after kidney transplantation.
Role of Cytokines in Allergic Airway Inflammation
Authors: Nakajima Hiroshi , Takatsu Kiyoshi
Published: November 2006

Asthma is characterized by intense infiltration of eosinophils and CD4+ T cells into the submucosal tissue of airways. Accumulating evidence indicates that T helper type 2 cell-derived cytokines such as interleukin (IL)-4, IL-5 and IL-13 play critical roles in orchestrating and amplifying allergic inflammation in asthma. In addition, it has been suggested that newly identified cytokines including thymic stromal lymphopoietin, IL-25 and IL-33 are involved in the induction of allergic inflammation in asthma. In this review, we discuss the role of individual cytokines in the pathogenesis of asthma.
A Hybrid Expressing Genetically Engineered Major Allergens of the Parietaria Pollen as a Tool for Specific Allergy Vaccination
Authors: Bonura A. , Corinti S. , Artale A. , Di Felice G. , Amoroso S. , Melis M. , Geraci D. , Colombo P.
Published: November 2006

Background: Allergy is an immunological disorder affecting about 25% of the population living in the industrialized countries. Specific immunotherapy is the only treatment with a long-lasting relief of allergic symptoms and able to reduce the risk of developing new allergic sensitizations and inhibiting the development of clinical asthma in children treated for allergic rhinitis. Methods: By means of DNA recombinant technology, we were able to design a head to tail dimer expressing disulphide bond variants of the major allergen of the Parietaria pollen. IgE binding activity was studied by Western blot, ELISA inhibition assays and the skin prick test. T cell recognition was studied by peripheral blood mononuclear cell proliferation. The immunogenicity of the hybrid was studied in a mouse model of sensitization. Results: In vitro and in vivo analysis showed that the disruption of specific cysteine residues in both allergens caused a strong reduction in IgE binding activity of the PjEDcys hybrid. In addition,we were able to show that a reduction in the IgE epitope content profoundly reduced the anaphylactic activity of the hybrid (from 100 to 1,000 times less than wild-type allergens) without interfering with the T cell recognition. Sera from BALB/c mice immunized with the hybrid were able to bind the natural Parietaria allergens and to inhibit the binding of human IgE to wild-type Par j 1 and Par j 2 allergens up to 90%. Conclusion: Our results demonstrate that hybrid-expressing disulphide bond variants of the major allergens of the Parietaria pollen displayed reduced allergenicity and maintained T cell reactivity for induction of protective antibodies.