bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology and Natural History of Human Papillomavirus Infections in the Female Genital Tract
Authors: Ault Kevin A.
Published: June 2006

Human papillomavirus (HPV) is the most common newly diagnosed
sexually transmitted infection in the United States. Although the
majority of sexually active adults will be infected with HPV at
least once in their lives, it is sexually active women less than
25 years of age who consistently have the highest rates of
infection. Besides youth and gender, common risk factors for HPV
infection and clinical sequelae of infection include high number
of sexual partners and coinfection with Chlamydia
trachomatis or herpes simplex virus. Most HPV infections are
cleared by the immune system and do not result in clinical
complications. Clinical sequelae in cases of low‐risk HPV
infection consist of genital warts, and clinical manifestations of
high‐risk HPV infection include abnormal Pap test results,
low‐grade squamous intraepithelial lesions (LSIL), high‐grade
squamous intraepithelial lesions (HSIL), and cervical cancer.
LSIL, HSIL, and cervical cancer carry significant morbidity and/or
mortality; genital warts and abnormal Pap test results are often
significant sources of psychosocial distress. Currently, there are
neither effective means of preventing HPV transmission nor cures
for clinical manifestations: infection can only be prevented via
complete sexual abstinence, while treatment for clinical sequelae
such as genital warts and cytologic abnormalities consists of
removing the problematic cells and watching for recurrence; this
method consumes significant health care resources and is costly.
New prophylactic HPV vaccines promise to dramatically reduce the
incidence of HPV infection, genital warts, and cytologic
abnormalities.
Preterm Premature Rupture of Membranes in Human Immunodeficiency Virus‐Infected Women: A Novel Case Series
Authors: Aagaard-Tillery Kjersti M. , Lin Monique G. , Lupo Virginia , Buchbinder Alan , Ramsey Patrick S.
Published: June 2006

Objective. To evaluate the management and outcomes of a
series of human immunodeficiency virus‐(HIV‐) infected women whose
pregnancies were complicated by preterm premature rupture of
membranes (PPROM). Study design. We conducted a
retrospective chart review of all women with confirmed HIV
infection who had a pregnancy complicated by PPROM remote from
term. PPROM remote from term was defined as rupture of membranes
prior to 32‐week gestation. Collective cases from two centers
(Hennepin County Medical Center and The University of Alabama at
Birmingham) were reviewed and data on management and outcomes were
abstracted. Results. Of the HIV‐positive women, we
identified 291 pregnancies having occurred in the study interval
from two institutions. Of these pregnancies, 7 (2.4%)
developed PPROM remote from term with subsequent delivery from
25‐ to 32‐week gestation. Vertical HIV transmission was noted
in 2 of 6 children whose long‐term followup status was confirmed
(33%) of these cases. However, both of these cases occurred
in women with either no antepartum/intrapartum antiviral therapy
or where only zidovudine monotherapy was used. Importantly, in
spite of expectant management, no cases of vertical HIV
transmission occurred in women who were receiving either multidrug
or highly active antiviral therapy (HAART) at the time of PPROM
and who had a cesarean delivery in cases where the predelivery
viral load > 1000 copies/mL. Conclusion. Our limited
observations raise the question as to whether in the current era
of multidrug therapy immediate delivery should be undertaken in
HIV+ pregnancies complicated by PPROM at an early gestational age.
This case series further suggests that in those pregnancies that
lend themselves to expectant management, such a strategy may be
considered appropriate.
Patterns of Antibiotic Resistance Among Group BStreptococcus Isolates: 2001–2004
Authors: Chohan Lubna , Hollier Lisa M. , Bishop Karen , Kilpatrick Charles C.
Published: June 2006

The objectives were to determine the prevalence of group B
streptococcus (GBS) and to characterize antibiotic resistance
patterns. All pregnant women presenting to the triage units at
two urban hospitals during three intervals from 2001 to 2004 were
included. Each interval lasted approximately four weeks. Swabs
were inoculated into selective broth and cultured on tryptic soy
agar with 5% sheep blood. GBS was identified using the StrepTex
latex agglutination system. GBS positive cultures were tested
for their resistance to ampicillin, erythromycin, clindamycin,
and cefazolin. GBS was isolated from 154 (12.2%) of 1264 swabs
collected during the study period. African‐American women were
more likely to be colonized with GBS than Caucasians and
Hispanics. Resistance to routinely administered antibiotics was
common, but there were no statistically significant increases in
resistance to antibiotics over the study period. Ongoing
surveillance of antibiotic resistance patterns is important in
determining optimal prophylaxis and therapy.
Spontaneous Uterine Perforation due to Pyometra Presenting as Acute Abdomen
Authors: Geranpayeh Loabat , Fadaei-Araghi Mohsen , Shakiba Behnam
Published: June 2006

Spontaneous perforation of the uterus is rare, its incidence being about 0.01%–0.05%. We report a rare case of diffuse peritonitis caused by spontaneously perforated pyometra. A 63‐year‐old woman with severe abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy, about 900 mL of pus was found in the peritoneal cavity. There were no abnormal findings in the alimentary tract, liver, or gallbladder. A total abdominal hysterectomy with bilateral salpingo‐oophorectomy was performed. Pathological investigation of the surgical specimen revealed endometritis and myometritis of the uterus; but there was no evidence of malignancy, and the cervical canal was patent. Although spontaneously perforated pyometra is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.
Efficacy of an Immune Modulator in Experimental Chlamydia trachomatis Infection of the Female Genital Tract
Authors: Lyons Joseph M. , Ito James I. , Morré Servaas A.
Published: June 2006

Objective. The aim of this study was to determine if
vaginal application of the immune response modifier
imiquimod (Aldara cream, 3M Pharmaceuticals, St Paul, Minn) would
alter the course and/or outcome of female genital tract infection
with a human isolate of Chlamydia trachomatis in a murine
model. Methods. Groups of CF‐1 mice were treated with
Aldara on three different schedules: (1) ongoing beginning 5 days
prior to and continuing through day 5 of infection; (2) a single
prophylactic dose 2 hours prior to infection; and (3) therapeutic
from day 4 to day 14 of infection. Mice were infected
vaginally with a serovar D strain of C trachomatis, and
monitored by culture to determine the level of shedding and
duration of infection. Results. We observed a significant
reduction in both duration of infection and the level of shedding
during the acute phase in mice treated on an ongoing basis
commencing 5 days prior to infection. There was no effect
with respect to the other regimens. Conclusion.
These results demonstrate that ongoing Aldara treatment has
efficacy and may enhance local innate immunity which reduces the
duration of subsequent infection with human isolates of C
trachomatis in a murine model of female genital tract infection.
Acquisition and Elimination of Bacterial Vaginosis During Pregnancy: A Danish Population‐Based Study
Authors: Vogel Ida , Thorsen Poul , Jeune Bernard , Jacobsson Bo , Ebbesen Niels , Arpi Magnus , Bremmelgaard Annie , Møller Birger R.
Published: June 2006

Objectives: the aim was to examine factors associated with acquisition and elimination of bacterial vaginosis in pregnancy. Methods: a group of 229 pregnant women were randomly selected from a population‐based prospective cohort study of 2927. They were examined at enrollment (mean gestational weeks 16w + 0d) and again in mid‐third trimester (mean gestational age 32w + 3d). Measures: BV (Amsel′s clinical criteria), microbiological cultures of the genital tract and questionnaire data. Results: BV prevalence decreased from 17% in early second trimester to 14% in mid‐third trimester due to a tenfold higher elimination rate (39%) than incidence rate (4%). Heavy smokers (>10/d) in early pregnancy were at increased risk (5.3 [1.1 − 25]) for the acquisition of BV during pregnancy, as were women receiving public benefits (4.8 [1.0 − 22]), having a vaginal pH above 4.5 (6.3 [1.4 − 29]) or vaginal anaerobe bacteria (18 [2.7 − 122]) at enrollment. A previous use of combined oral contraceptives was preventive for the acquisition of BV (0.2 [0.03 − 0.96]). Elimination of BV in pregnancy tended to be associated with a heavy growth of Lactobacillus 
(3.2 [0.8 − 13]) at enrollment. Conclusions: acquisition of BV during pregnancy is rare and is associated with smoking, while the presence of anaerobe bacteria and a vaginal pH > 4.5 are interpreted as steps on a gradual change towards BV. In the same way heavy growth of Lactobacillus spp in early pregnancy may be an indicator of women on the way to eliminate BV.
The Intellectual Crisis of Psychiatric Research
Authors: Fava Giovanni A.
Published: June 2006

The aim of this paper was to examine the intellectual crisis and the potential sources of reveille in clinical research in psychiatry. Current prevailing conceptual models in psychiatry are critically examined, with particular reference to neurobiology, clinical psychopharmacology, assessment, and the therapeutic process. Biological reductionism, neglect of individual responses to treatment, massive propaganda from the pharmaceutical industry, misleading effects of psychometric theory on clinical assessment, and lack of consideration of multiple therapeutic ingredients and of the role of psychological well-being are identified as major sources of an intellectual crisis in psychiatric research. The conceptual crisis of psychiatry is shared by other areas of clinical medicine and stems from a narrow concept of science that neglects clinical observation, the basic method of medicine. A unified concept of health and disease may yield new clinical insights in psychiatric disorders, and may result in therapeutic efforts of more enduring quality than current strategies.
Interpersonal Psychotherapy for Somatizing Patients
Authors: Stuart Scott , Noyes Jr. Russell
Published: June 2006

The interpersonal model is important for understanding somatizing behavior. According to this model, somatizing behavior is a form of interpersonal communication driven by insecure attachment. Interpersonal psychotherapy (IPT) is a time-limited, manual-based treatment designed to relieve symptoms and improve interpersonal functioning. Based on our experience using IPT with somatizing patients, we recommend a series of strategies for its successful implementation. These strategies include an emphasis on the therapeutic alliance within a bilaterally negotiated treatment contract, and aiming for improvement in interpersonal functioning rather than for alleviation of physical symptoms. Specific techniques include the use of bridging metaphors, communication analysis, and genuine positive reinforcement. With a focus on communication in a time-limited frame, fostered by a strong collaborative relationship, IPT appears to be a promising method of reducing somatizing behavior. We urge further research on the efficacy of this form of therapy.
Pregnant Women with Bronchial Asthma Benefit from Progressive Muscle Relaxation: A Randomized, Prospective, Controlled Trial
Authors: Nickel Cerstin , Lahmann Claas , Muehlbacher Moritz , Pedrosa Gil Francisco , Kaplan Patrick , Buschmann Wiebke , Tritt Karin , Kettler Christian , Bachler Egon , Egger Christian , Anvar Javaid , Fartacek Rainhold , Loew Thomas , Rother Wolfhardt , Nickel Marius
Published: June 2006

Background: Asthma is a serious medical problem in pregnancy and is often associated with stress, anger and poor quality of life.The aim of this study was to determine the efficacy of progressive muscle relaxation (PMR) on change in blood pressure, lung parameters, heart rate, anger and health-related quality of life in pregnant women with bronchial asthma. Methods: We treated a sample of 64 pregnant women with bronchial asthma from the local population in an 8-week randomized, prospective, controlled trial. Thirty-two were selected for PMR, and 32 received a placebo intervention. The systolic blood pressure, forced expiratory volume in the first second, peak expiratory flow and heart rate were tested, and the State-Trait Anger Expression Inventory and Health Survey (SF-36) were employed. Results: According to the intend-to-treat principle, a significant reduction in systolic blood pressure and a significant increase in both forced expiratory volume in the first second and peak expiratory flow were observed after PMR. The heart rate showed a significant increase in the coefficient of variation, root mean square of successive differences and high frequency ranges, in addition to a significant reduction in low and middle frequency ranges. A significant reduction on three of five State-Trait Anger Expression Inventory scales, and a significant increase on seven of eight SF-36 scales were observed. Conclusions: PMR appears to be an effective method to improve blood pressure, lung parameters and heart rate, and to decrease anger levels, thus enhancing health-related quality of life in pregnant women with bronchial asthma.
Performance of the Pictorial Representation of Illness and Self Measure in Individuals with Alcohol Dependence, Alcohol Abuse or At-Risk Drinking
Authors: Reinhardt Susa , Bischof Gallus , Grothues Janina , John Ulrich , Rumpf Hans-Jürgen
Published: June 2006

Background: The impact of chronic illnesses is not only influenced by one’s physical functioning but also by its subjective importance to the individual’s life. However, it is often difficult to asses such an impact in an appropriate way. PRISM (pictorial representation of illness and self measure) measures the perception of illness and first data on its validity have been published. The aim of the present study was to prove the applicability of PRISM regarding alcohol-dependent patients. Therefore, a comparison was made between alcohol-dependent patients, alcohol abusers and at-risk drinkers. Method: The sample consisted of 763 general practice patients, who scored above the cutoff in alcohol-related screening questionnaires. Of this sample, 330 were diagnosed as alcohol dependent, alcohol abusers (both according to DSM-IV) or at-risk drinkers. To prove the applicability, PRISM was put in context with the severity of alcohol dependence and the core constructs of the transtheoretical model of behavior change. Results: PRISM was related to the severity of the drinking problem: the severer the drinking problem, the shorter the distance between self and illness. High correlations with aspects of alcohol consumption – such as adverse consequences from drinking, temptation to drink, and self-efficacy to abstain – were found. Concerning stages of change according to the transtheoretical model of behavior change, data show a significant difference in the self-illness separation between patients in the stage of contemplation compared to those in the precontemplation or action stage. Conclusions: The PRISM task is applicable to patients with alcohol use disorders. Within this group and in contrast to other chronic diseases, PRISM reveals a significant relationship not only to the severity of drinking, but also to the readiness to change one’s drinking behavior.
Metacognitive Therapy versus Exposure and Response Prevention for Pediatric Obsessive-Compulsive Disorder
Authors: Simons Michael , Schneider Silvia , Herpertz-Dahlmann Beate
Published: June 2006

Background: Exposure with ritual prevention (ERP) is the psychotherapeutic treatment of choice for pediatric obsessive-compulsive disorder (OCD). In the present study, a new treatment rationale – metacognitive therapy (MCT) for children – was developed and evaluated. Methods: Ten children and adolescents with OCD were randomly assigned to either MCT or ERP therapy condition. Patients were assessed before and after treatment and at the 3-month and 2-year follow-up by means of symptom severity interviews. Depressive symptoms were also assessed. Manualized treatment involved up to 20 sessions on a weekly basis. Results: We found clinically and statistically significant improvements in symptom severity after treatment. At the 3-month and 2-year follow-up, the attained improvements during treatment were retained. Conclusions:Despite some methodological limitations, results showed that MCT proved to be a promising psychotherapeutic alternative to the well-established ERP in the treatment of pediatric OCD. Further investigations into the efficacy of MCT are necessary to answer questions as to the working mechanisms underlying therapy for OCD.
Experimental Model for Proliferative Vitreoretinopathy by Intravitreal Dispase: Limited by Zonulolysis and Cataract
Authors: Kralinger Martina T. , Kieselbach Gerhard F. , Voigt Monika , Hayden Brandy , Hernandez Eleut , Fernandez Viviana , Parel Jean-Marie
Published: June 2006

Background: The intravitreal injection of dispase has been shown to be a valuable method for induction of experimental PVR. The goal of the present study was to gain additional information about potential side effects associated with this method. Methods: Twenty-one pigmented rabbits received a single injection of dispase under topical anesthesia to one eye only, contralateral eyes served as untreated control. The animals were injected with doses from 0.045 to 0.065 units of dispase: 8 animals received 0.045 units, 9 animals 0.055 units and 4 animals 0.065 units. Results: Proliferative vitreoretinopathy occurred in 81% of the treated eyes. In 90% cataract formation was observed. Lens luxation was present in 47.3% of the cataract eyes. Conclusion: Intravitreal injection of dispase resulted in the reproducible induction of PVR in addition to cataract formation and lens luxation. Whether these effects may all be associated with a toxic reaction or whether the proliferative changes are solely triggered by endogenous reactions similar to the pathomechanism of human PVR and whether the cataract formation and the lens luxation may be avoided by changing the method of injection require further investigation.
Problems Associated with the 25-Gauge Transconjunctival Sutureless Vitrectomy System during and after Surgery
Authors: Byeon Suk Ho , Chu Young Kwang , Lee Sung Chul , Koh Hyoung Jun , Kim Sung Soo , Kwon Oh Woong
Published: June 2006

Objective: To report the initial experiences with the 25-gauge transconjunctival sutureless vitrectomy (TSV) system, including intraoperative and postoperative problems. Methods: We retrospectively reviewed the medical records and surgical videotapes of 50 consecutive patients who underwent vitrectomy performed by one surgeon using the TSV system. Results: Intraoperatively, we encountered such problems as difficulty in inserting the microcannula, which led to deformity, instability of the microcannula, self-disconnection of the infusion tip and resultant lens damage, and conversion to 20-gauge conventional vitrectomy. Postoperatively, there were 8 cases with hypotony (IOP < 6 mm Hg) on day 1, 6 cases with elevated IOP, and 3 cases with retinal detachment during follow-up. Conclusion: Though certain problems exist during and after surgeries using TSV, this system is both convenient and safe for various vitreoretinal procedures.
Mycobacterium abscessus Keratitis after LASIK with IntraLase® Femtosecond Laser
Authors: Chung So-Hyang , Roh Mi In , Park Min Soo , Kong Young Tae , Lee Hyung Keun , Kim Eung Kweon
Published: June 2006

A healthy 38-year-old woman developed 2 white spots in her left eye 2 weeks after bilateral laser in situ keratomileusis (LASIK) using the IntraLase® femtosecond laser. Initial treatment included levofloxacin 0.5% but was unsuccessful. The surgeon irrigated the interface and repositioned the flap due to a worsened lesion. She was referred to us after the keratitis had not improved. The flap was lifted for collection of the specimen and irrigation of the interface. The keratitis was treated with intensive topical clarithromycin 1%, amikacin 1.25% and oral clarithromycin, which improved her clinical condition. She developed a toxic reaction to amikacin 1.25%, which was replaced by moxifloxacin 0.5%. Mycobacterium abscessus was identified. The keratitis resolved over 2 months. Five months after treatment, the patient had a visual acuity of 20/20 with correction. Nontuberculous mycobacteria should be considered as an etiologic agent, even in cases of infectious keratitis after LASIK using the femtosecond laser.
Improvements in the Analysis Strategy Make Single Nucleotide Polymorphism Analysis a Powerful Tool in the Detection and Characterization of Amplified Chromosomal Regions in Human Tumors
Authors: Korsching Eberhard , Agelopolous Konstantin , Schmidt Hartmut , Buchroth Inka , Gosheger Georg , Wülfing Pia , Boecker Werner , Brandt Burkhard , Buerger Horst
Published: June 2006

Objective: Single nucleotide polymorphism analysis (SNP) has recently been proposed as an alternative technique to comparative genomic hybridization (CGH) for defining loss of heterozygosity and gene copy number changes in a single experimental setup. In order to assess the potential of SNP analysis to complement or, ultimately, substitute CGH results, we applied both techniques to five primary tumor samples and two tumor cell lines. This was complemented by dilution experiments based on normal lymphocyte DNA to decipher the lower detection limit for genetic alterations. Methods/Results: Using an in-house software tool, we demonstrated that SNP analysis permits the generation of chromosomal alteration patterns that largely resemble conventional CGH ratio profiles of a given tumor/cell line. Moreover, compared to CGH, our SNP software tool allows a much more detailed definition of amplicon sizes and involved candidate genes. This advantage even persisted when the technique was applied to DNA with more than 60% of nontumor content. However, the detection of chromosomal losses is severely hampered by the presence of nontumor DNA so that the use of the SNP technique should be limited to tumor samples with more than 80% tumor DNA. Conclusion: SNP analysis is a very valuable tool for the detection and characterization of high-level chromosomal amplifications in the vast majority of primary tumor samples. Our software tool improves the analysis of SNP data and the presentation of the results, bridging the gap to existing CGH knowledge (http://bioinformatics.uni-muenster.de, ‘Publications and Supplements’).
Immunosuppressive Treatment of Idiopathic Focal Segmental Glomerulosclerosis: A Five-Year Follow-Up Study
Authors: Goumenos Dimitrios S. , Tsagalis George , El Nahas A. Meguid , Shortland John R. , Davlouros Periklis , Vlachojannis John G. , Brown Colin B.
Published: June 2006

Background/Aims: Focal segmental glomerulosclerosis (FSGS) is a common type of glomerular disease that can lead to chronic renal failure. Various therapeutic regimens have been used in nephrotic FSGS patients. The effect of treatment with prednisolone alone or its combination with azathioprine and cyclosporin and parameters related to a poor outcome are studied. Methods: Fifty-one patients with idiopathic FSGS and a follow-up period of 5 years were included. Twenty-five were treated with prednisolone alone (1 mg/kg BW/day) or combination of prednisolone (0.5 mg/kg BW/day) with azathioprine (2 mg/kg BW/day) or cyclosporine (3 mg/kg BW/day) in gradually reduced doses whereas 26 patients received no immunosuppressive drugs. Lower prednisolone dose regimens were used as initial treatment in obese, borderline diabetics or patients with bone disease. The clinical course was estimated using the end-points of 50% or doubling of baseline serum creatinine and/or end-stage renal failure. The contribution of clinical and histological parameters in the clinical outcome was estimated by univariate and multivariate analyses. Results: Increase of baseline serum creatinine by 50% during the follow-up period was observed in 2 treated and 9 untreated patients (8% vs. 35%, p = 0.03) whereas doubling of serum creatinine in 2 and 5 patients respectively (8% vs. 19%, p = NS). End-stage renal failure developed in 4 of 51 patients (8%), 2 treated and 2 untreated (p = NS). Parameters related to a poor outcome were baseline serum creatinine and severity of glomerulosclerosis (multivariate analysis OR = 1.08, p = 0.01). Most of patients (68%) who reached end-points had persistent nephrotic syndrome during the follow-up. Remission of nephrotic syndrome was observed more frequently among treated (75 vs. 30.7%, p = 0.05). Prednisolone alone was followed by remission of nephrotic syndrome in 62.5% whereas combination of lower prednisolone dose with azathioprine and cyclosporin in 80 and 85.7% of patients. No serious side-effects were observed. Conclusion: This and previous studies suggest that steroid and/or immunosuppressive therapy have a role in amelioration of the clinical course and remission of nephrotic syndrome in patients with FSGS A combination of low predisolone dose with cyclosporine could be used as initial treatment in patients with higher risk for side-effects from the usual prednisolone dose.
Leucine-Rich Repeat-Containing G Protein-Coupled Receptor-4 (LGR4, Gpr48) Is Essential for Renal Development in Mice
Authors: Kato Shigeki , Matsubara Mitsunobu , Matsuo Tsuyoshi , Mohri Yasuaki , Kazama Itsuro , Hatano Ryo , Umezawa Akihiro , Nishimori Katsuhiko
Published: June 2006

Leucine-rich repeat-containing G protein-coupled receptor (LGR)-4 is a G protein-coupled receptor (GPCR) with a seven-transmembrane domain structure. LGRs are evolutionally and structurally phylogenetic, classified into three subgroups and are members of the so-called orphan receptors whose ligands have yet to be identified. We generated knockout mice lacking Lgr4(Gpr48) by targeted deletion of part of exon 18, which codes for the transmembrane and signal-transducing domains of the receptor. Lgr4 null mice were born at much less than the 25% expected frequency from crosses of Lgr4 heterozygous mice (Lgr4+/–). Lgr4 null mice that survived in utero died shortly after birth in almost all cases. We observed striking renal hypoplasia in the null mice, accompanied by elevated concentration of plasma creatinine. Histological analysis of the P0 null mouse kidney showed a notable decrease in the total number and density of the glomerulus. Thus, the function of Lgr4 is essential to regulate renal development in the mouse. This study suggests that the Lgr4 gene is a new and important member of LGRs involved in a group of genes responsible for hereditary disease in the kidney.
Increased TGF-α and EGF Receptor mRNA Expression in Response to Neonatal Unilateral Partial Ureter Obstruction in Rats
Authors: Bor Mustafa Vakur , Shi Ymin , Sorensen Boe S. , Wen Jan Guo , Frokiaer Jorgen , Djurhuus Jens Christian , Nexo Ebba
Published: June 2006

Aim: To evaluate the potential role of members of the epidermal growth factor (EGF) family in altered renal growth caused by partial ureteral obstruction in the developing obstructed and non-obstructed kidneys. Methods: During anesthesia either the upper fourth (n = 6–7) or the upper two-thirds of the left ureter (n = 6–7) were embedded into the psoas muscle in newborn rats resulting in mild or severe partial unilateral obstruction, respectively, which was maintained during the following 24 weeks. Sham-operated control rats were prepared in parallel (n = 6–7). Real time PCR assays were used to quantify mRNA encoding EGF, TGF-α, HB-EGF and EGF receptor. The expression of ribosomal RNA was determined to relate the specific mRNA expression of members of the EGF system. Results: Relative expression of TGF-α and EGF receptor mRNA levels were elevated significantly both in the severe and mild obstructed kidney compared with the contralateral or sham-operated kidneys after 24 weeks of obstruction. However, the expression of neither EGF nor HB-EGF was changed after obstruction. Conclusion: The increased expression of TGF-α and its receptor in the obstructed kidney might be related to a cell-survival function in the affected cells possibly by protecting them from entering apoptosis.
Central Thyrotropin-Releasing Hormone Infusion Opposes Cardiovascular and Metabolic Suppression during Caloric Restriction
Authors: Knight W. David , Swoap Steven J. , Parsons Almetra D. , Overton J. Michael
Published: June 2006

Inhibition of hypothalamic thyrotropin-releasing hormone (TRH) neuronal activity is a well-established adaptation to caloric restriction (CR) that suppresses pituitary secretion of thyroid-stimulating hormone, but may also participate in modulation of autonomic function. Thus, we hypothesized that decreased hypothalamic TRH activity contributes to CR-induced bradycardia and decreased metabolic rate. To test this hypothesis, male Sprague-Dawley rats were instrumented with telemetry devices for measurement of heart rate (HR) and blood pressure (BP) and a lateral intracerebroventricular (i.c.v.) guide cannula for central infusions. After recovery, rats were housed in metabolic chambers and given either ad libitum(ad-lib) or CR treatments for 7 days; half of each diet group was then given continuous i.c.v. infusions of TRH (25 nmol/h) or saline (0.25 µl/h) for 7 days via osmotic pump. This dose of TRH did not significantly alter peripheral free T4 levels. In ad-lib rats, TRH infusion produced small reductions in food intake and small increases in HR and BP over saline-infused controls. In CR rats, TRH infusion resulted in an increase in HR and also energy expenditure over saline-infused controls. These results support the hypothesis that suppression of central TRH activity contributes to the homeostatic suppression of energy expenditure and HR observed during CR.
Metastatic Mantle Cell Lymphoma Presenting as a Vaginal Mass
Authors: Bujor Alexandra , Chen Bertha
Published: June 2006

Background: Vaginal masses are an uncommon finding in well-woman gynecologic examinations. The differential diagnosis includes cysts, leiomyomata, ectopic ureteroceles, infected granuloma, and malignancy. Case: A 74-year-old woman with a history of mantle cell lymphoma was referred for vaginal prolapse. Examination revealed a vaginal mass, with MRI confirming 3 masses. Fine needle aspiration confirmed metastatic mantle cell lymphoma which later regressed with radiation therapy. Conclusion: Although vaginal masses are often rare and incidental findings during routine gynecologic examinations, a comprehensive differential diagnosis is required to avoid delays in treatment. Fine needle aspiration should be included as part of the arsenal of diagnostic tools because of its low cost and the ease with which it can be performed in a clinical setting.
High Titer of Anticardiolipin Antibody Is Associated with First-Ever Ischemic Stroke in Taiwan
Authors: Lien Li-Ming , Chen Wei-Hung , Chiu Hou-Chang , Pan Wen-Harn , Chen Jiunn-Rong , Bai Chyi-Huey
Published: June 2006

Background and Purpose: The association between anticardiolipin antibody (aCL) and ischemic stroke is controversial, and there are few case-control studies of Asian populations. The aim of this study, therefore, was to determine whether aCL is an independent risk factor for ischemic stroke in Taiwanese patients over the age of 40 years. Methods: Both the IgG and IgM isotypes of aCL were measured in 273 patients (>40 years of age) hospitalized for first-ever ischemic stroke and in 181 non-stroke controls. Results were defined as: negative (<10 IgG phospholipid units [GPL] or <7.5 IgM phospholipid units [MPL]); low positive (10–20 GPL or 7.5–15 MPL); or, high positive (>20 GPL or >15 MPL). Odds ratios (OR) were estimated by logistic regression with adjustment for potential confounders. Results: A high positive IgG aCL was present in 4.4% of the stroke patients and 1.2% of the controls. Age- and sex-adjusted analysis showed a borderline association between a high positive level for aCL IgG titer and stroke, with an OR of 4.01 (95% CI 0.87–18.37; p = 0.0739). Final analysis, with adjustments for age, sex, hypertension, diabetes, tobacco smoking, atrial fibrillation, left ventricular hypertrophy and hyperlipidemia, revealed an OR of 5.25 (95% CI 1.06–25.89; p = 0.0419). Conclusions: The results of this study suggest that elevated titer of aCL IgG (>20 GPL) is associated with first-ever ischemic stroke in Taiwanese patients aged over 40 years. High positive aCL titer is related to ischemic stroke after adjustment for conventional cerebrovascular risk factors, indicating that it is probably an independent risk factor for ischemic stroke.
Activity Index – A Complementary ADL Scale to the Barthel Index in the Acute Stage in Patients with Severe Stroke
Authors: Martinsson Louise , Eksborg Staffan
Published: June 2006

Objective: It was the aim of this study to compare the Barthel Index (BI) and the activities of daily living (ADL) component of the Activity Index [AI(ADL)] regarding floor and ceiling effects, responsiveness and the predictive value for survival during the first week until 3 months after stroke onset. Patients and Methods: Basic ADL were assessed in 75 patients with ischaemic stroke. Results: There was a strong concordance between BI and AI(ADL) scores at all time points (Kendall’s τb = 0.7878, p < 0.0001 at baseline; Kendall’s τb = 0.8901, p < 0.0001 at 1 week; Kendall’s τb = 0.9027, p < 0.0001 at 3 months). BI had a significantly more pronounced floor effect at baseline and at 1 week compared with AI(ADL) in patients with severe stroke. Both scales had a substantial ceiling effect at 3 months. At 1 week, the baseline BI score was significantly higher in patients being alive as compared with those who had died, while their AI(ADL) score did not differ significantly. At 3 months, baseline BI and AI(ADL) scores were significantly higher in patients being alive as compared with those who had died. The predictive value of being alive at 1 week and 3 months did not differ between BI and AI(ADL). Conclusion: AI(ADL) is recommended to be used in addition as a complement to BI in patients with severe stroke since the floor effect with BI in the acute stage is significantly more pronounced than with AI(ADL), thus hampering the responsiveness.
Predictive Implications of Recurrent Transient Ischemic Attacks in Large-Artery Atherosclerosis
Authors: Kim Seo Hyun , Han Sang Won , Heo Ji Hoe
Published: June 2006

Background: It is uncertain whether recurrent transient ischemic attacks (R-TIAs), when comparing with single TIAs (S-TIAs), have any distinct mechanisms. Methods: All consecutive patients with TIAs, who had been admitted for a 2-year period, were divided into two groups: those who had R-TIAs and those who had S-TIAs. Registry data, medical records, and imaging findings were reviewed and compared between the two groups. Results: There were 85 patients who had TIAs: 42 patients had R-TIAs, and 43 patients had S-TIAs. On univariate analysis, R-TIA patients had less cardiac embolic TIA sources, less weakness, less speech disturbances, shorter symptom duration, a longer time interval from onset to treatment, less abnormalities on diffusion-weighted magnetic resonance imaging, and more significant relevant arterial stenoses. After logistic regression analysis, independent factors associated with R-TIAs were symptom duration <10 min (odds ratio OR 3.62; 95% confidence interval CI 1.37–9.57), ≧50% stenosis of the clinically relevant artery (OR 7.08; 95% CI 1.29–38.71), and absence of cardiac embolic sources (OR 0.04; 95% CI 0.002–0.71). Conclusions: R-TIAs may have pathophysiological mechanisms distinct from those of S-TIAs and so may provide a clue for the etiologic diagnosis, in that patients with R-TIAs are more likely to have large-artery atherosclerosis.
Effect of Social Deprivation on Mortality and the Duration of Hospital Stay after a Stroke
Authors: Wong K.Y.K. , Wong S.Y.S. , Fraser H.W. , Ersoy Y. , Ogston S. , Wolfson D. , Malek† M. , Struthers A.D. , Tunstall-Pedoe H. , MacWalter R.S.
Published: June 2006

Background: We aim to assess whether social deprivation independently predicts case fatality after a stroke patient has been admitted to hospital, and to assess whether social deprivation affected duration of hospital stay. Methods: Cohort study in a tertiary teaching hospital included consecutive patients admitted to hospital within 48 h of their stroke between 1988 and 1994. Outcome measures were case fatality at 1 year and length of hospital stay. The socioeconomiccategory was derived from the postcode sectorof residence for the patients (Carstairs index). Cause of death was determined by data linkage to the Registrar General data for Scotland. Results: 2,042 stroke patients were included. A significant age difference existed between the deprivation categories (76.0 ± 10.9 years in the affluent cohort vs. 71.4 ± 10.7 years in the deprived cohort). Smoking was more common in the deprived group. ECG findings and neurological score on admission were similar between the groups. No difference existed between groups for length of hospital stay (p = 0.793), and in the proportions remaining alive at 1 year (p = 0.416). When entered into a multivariate Cox regression analysis, the deprivation categories did not predict mortality. Age, sex, Philadelphia Geriatric Center Instrumental Activities of Daily Living (IADL) Scale Score, Orgogozo neurological score on admission, and ECG abnormalities were the significant predictors. Conclusions: Stroke patients living in more socially deprived areas had their strokes at an earlier age but were not at a greater risk of dying or longer hospital stay once they had been admitted to hospital.
Dose Titration to Reduce Dipyridamole-Related Headache
Authors: Chang Yeu-Jhy , Ryu Shan-Jin , Lee Tsong-Hai
Published: June 2006

Background: Combination of low-dose aspirin and modified-release dipyridamole (ASA+MR-DP) provides a significantly increased benefit in stroke prevention over aspirin alone. However, headaches were reported in more patients receiving dipyridamole-containing agents than in those receiving placebo. We undertook a randomized, double-blind, placebo-controlled trial to evaluate which dosing regimens of ASA+MR-DP have better tolerance. Methods: This trial randomized 146 patients with a history of ischemic cerebrovascular disease into three groups: placebo (days 1–28), reduced dose (placebo on days 1–4, ASA+MR-DP once daily before bed during days 5–14, and b.i.d. on days 15–28), and regular dose (placebo on days 1–4, and ASA+MR-DP b.i.d. on days 5–28). Using Chinese diary card, headache was assessed as mean cumulated headache (Σ frequency × intensity/occurrence days × study days) over the study period, and was graded 0–4 according to Cancer Therapy Evaluation Program, Common Toxicity Criteria, Version 2.0. Results: Intent-to-treat patients after randomization was 46 in placebo group, 45, reduced dose, and 49, regular dose. Among commonly reported adverse effects, headache of any grade occurred significantly more in the regular dose group (38.8%), as compared to the other two groups (p < 0.05). Mean cumulated headache was higher (p < 0.05) in the regular dose group than in the reduced group during days 5–14. Of 27 patients who dropped out, 15 (55.6%) were due to headache, which was substantially more in regular dose (8, 53.3%), though the difference was statistically insignificant. Conclusions: Initial reduced dose treatment with ASA+MR-DP may cause fewer headaches than regular dosing, and seems better tolerated by those susceptible to phosphodiesterase inhibitor-induced headache.
Stroke Risk of Asymptomatic Intra- and Extracranial Large-Artery Disease in Apparently Healthy Adults
Authors: Takahashi Wakoh , Ohnuki Tomohide , Ide Michiru , Takagi Shigeharu , Shinohara Yukito
Published: June 2006

Background: The predictive value of asymptomatic intracranial artery stenosis for future stroke remains uncertain. The aim of this study is to assess the stroke risk of asymptomatic intracranial artery stenosis and to compare it with that of extracranial artery disease. Methods: The study subjects were 2,924 participants (mean age 55 years) without any history of stroke. We examined the relation between intra- or extracranial large-artery disease and subsequent cerebrovascular events (mean follow-up 63 months). Results: The incidence rate of total cerebrovascular events in persons with intracranial artery stenosis was 1.3% per year. In the group without plaque in the extracranial carotid arteries, the annual rate of total cerebrovascular events was only 0.6%, but in the group with plaque, the rate was 3.6%. Kaplan-Meier analysis of total events showed a significant difference between the 2 groups (p = 0.002). Conclusions: The stroke risk in subjects with asymptomatic extracranial artery disease is markedly increased if intracranial artery stenosis is also present.
Primary Stroke Unit Treatment Followed by Very Early Carotid Endarterectomy for Carotid Artery Stenosis after Acute Stroke
Authors: Aleksic M. , Rueger M.A. , Lehnhardt F.G. , Sobesky J. , Matoussevitch V. , Neveling M. , Heiss W.D. , Brunkwall J. , Jacobs A.H.
Published: June 2006

Background: Although it is recognized that carotid endarterectomy (CEA) is the treatment of choice in symptomatic internal carotid artery (ICA) stenosis, in the past, very early CEA has been shown to carry substantial risks. We assessed an interdisciplinary concept of very early CEA in patients with high-grade (>70%) symptomatic ICA stenosis at a single center. Patients and Methods: The course of treatment and outcomes of patients who underwent CEA as early as possible after being referred to the stroke unit for symptoms of transient ischemic attack and stroke were prospectively evaluated, including the following parameters: age, severity of ischemia-related symptoms according to the modified Rankin scale, duration of symptoms until admission, multimodal imaging findings (color-coded duplex, cranial computed tomography, magnetic resonance imaging, positron emission tomography), duration until CEA, perioperative course and complications, as well as duration of in-hospital care. Results: Fifty consecutive patients (median age 68 years, range 44–90) with clinical and imaging signs of transient ischemic attack (n = 19) or stroke (n = 31) were included from January 2000 until December 2004. All except 1 patient showed a preoperative Rankin <4. There was a median time period of 6 h between the onset of symptoms and admission (range 1 h to 15 days) and a median duration of 4 days after admission until operation (range 1–21 days). Seven patients underwent CEA of the contralateral, severely stenosed ICA after symptomatic ipsilateral ICA occlusion. Four out of 5 patients who primarily underwent systemic thrombolysis recovered almost completely. Three patients (6%) experienced a clinical deterioration before surgery. In the majority of patients (43/50), CEA was performed under local anesthesia with selective shunt use which became necessary in 26%. Three patients (6%) had postoperative worsening due to new infarcts. In 2 cases, an intracerebral hemorrhage occurred, of which 1 remained asymptomatic. In 1 case, surgical revision was necessary because of an ICA thrombosis without permanent neurological decline. Patients were discharged after a median time of 14.5 days (range 4–44). Conclusions: After careful selection and preparation in a stroke unit, patients with acute stroke due to carotid stenosis can undergo very early CEA under local anesthesia with a perioperative risk comparable with the risk of later endarterectomy, therefore preventing very early stroke recurrences.
Effects of ω–3 Fatty Acids on Acute Necrotizing Pancreatitis in Rats
Authors: Alhan E. , Türkyilmaz S. , Erçin C. , Kaklikkaya N. , Kural B.V.
Published: June 2006

The aim of this study was to investigate the influence ofω–3 fatty acids (ω3FA) on acute necrotizing pancreatitis (ANP) induced by glycodeoxycholic acid in rats. The induction of ANP resulted in significant increases in mortality rate, intestinal permeability, bacterial infection in pancreas and extrapancreatic organs, and serum activity of urea and amylase, alanine transferase (ALT), interleukin (IL)-6, tumor necrotizing factor-α (TNF-α), lactate dehydrogenase (LDH) in bronchoalveolar lavage (BAL) fluid, tissue activity of myeloperoxidase (MPO) and malondialdehyde (MDA) in the pancreas and lung, and a considerable decrease of concentrations of calcium, protein and albumin. The use of ω3FA reduced mortality, phenol sulfophthalein excretion in urine, bacterial infection in pancreas, liver, spleen, MPO and MDA levels in pancreatic and lung tissue, LDH level in BAL fluid and serum IL-6 and TNF-α values. Serum triglyceride increased only in the ω3FA groups. Serum amylase, ALT, calcium, urea, protein, IL-1, and degree of pancreatic damage indicated no difference between the pancreatitis groups. Increased intestinal permeability and cytokine levels, and free radical damage play an important role during the course of acute pancreatitis. The treatment with ω3FA improves these effects. ω3FA may be useful in the treatment during ANP in rats. Therefore, it can be beneficial in patients with pancreatitis.
Effect of Proton Pump Inhibitors on Hepatic Regeneration
Authors: Kucuk Hasan Fehmi , Akyol Huseyin , Kaptanoglu Levent , Kurt Necmi , Barisik Nagehan Ozdemir , Bingul Sadık , Torlak Oguzhan Aziz , Colak Elif
Published: June 2006

Introduction: The liver is critical in multiple processes, including the clearance of endogenous compounds, the synthesis of macromolecules, and organ-specific biotransformation processes. Therefore, the liver’s regenerating capacity is of vital importance. Multiple pathways are activated in the complex process that leads to hepatic regeneration. In the present study, we aimed to evaluate the effect of proton pump inhibitors omeprozole, lansoprazole, and pantoprazole on hepatic regeneration following partial hepatectomy. Materials and Methods: Four groups were formed with 32 rats in each. Partial liver resections were performed for all animals. Omeprazole (71.4 µg/day), lansoprazole (107 µg/day), pantoprazole (143 µg/day) and placebo (0.5 cm3) were administered to the groups respectively. A quarter of the rats in each group were sacrificed on the 1st postoperative day. The rest were sacrificed on the 3rd, 5th and 7th postoperative days. The remnant regenerating liver mass was removed and weighed, and Ki-67 monoclonal antibody levels were measured. Results: There was no statistical difference between the four groups on the first day in evaluating the weight of the liver mass (p = 0.09) and Ki-67 (p = 0.268) levels. Only the omeprazole group showed a difference; the Ki-67 level was lower in the omeprazole group on the 3rd (p = 0.003, p = 0.0001, p = 0.003), 5th (p = 0.017, p = 0.001, p = 0.0001) and 7th (p = 0.0001) days compared to the other groups. Also the weight of the remnant liver mass was lower in the omeprazole group on the 3rd, 5th and 7th (p = 0.0001) days. Conclusion: We figured out that lansoprazole and pantoprazole have no effects on liver regeneration, whereas omeprazole showed a negative effect on hepatic regeneration.
Intestinal Duplications – Experience in 6 Cases
Authors: Cavar Stanko , Bogovic Marko , Luetic Tomislav , Antabak Anko , Batinica Stipe
Published: June 2006

Intestinal duplications are rare congenital anomalies, and most of them are detected in the first 2 years of life or antenatally. The clinical presentation depends on location, size, and the presence of ectopic gastric mucosa. Ultrasound scans during pregnancy result in a higher rate of antenatally detected duplications which allows early treatment and avoidance of possible complications. Resection of the duplication without adjacent bowel should be the treatment of choice. En bloc resection or partial excision with mucosectomy is advised in some cases. We present our experience with 6 patients treated in our institution from February 2002 to October 2005.