bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategies for introducing evidence‐based practice and changing clinician behaviour: A manager’s toolbox
Authors: McCluskey Annie , Cusick Anne
Published: March 2003

Significant behaviour change is required if occupational therapy practice in Australia is to become more evidence‐based. Occupational therapy managers, both clinical and academic, are well positioned to be key players in this process. Indeed, it is suggested that managers need to drive the change process. The aim of this paper is to help occupational therapy managers better understand and prepare for the change process, and the shift to evidence‐based practice. Two models of change are presented and applied to evidence‐based practice: (i) the stages of readiness for change; and (ii) individual responses to change, according to how quickly a person alters their behaviour and practice when confronted with change. Practical strategies are suggested for managers to use during the change process, including a review of the attitudes and values of staff, identifying barriers to implementation, strategic planning, and the use of SWOT analysis (strengths, weaknesses, opportunities and threats). Recommendations for further research are also discussed. Unfortunately, there are no quick‐fix strategies or ‘magic bullets’. Evidence‐based practice requires a change in attitudes and values, a major change in work behaviours, and a commitment to lifelong, self‐directed learning.
Occupational therapy and people with intellectual disability from culturally diverse backgrounds
Authors: Francisco Irene , Carlson Glenys
Published: March 2003

The multicultural nature of Australian society creates a need for occupational therapists to become aware of the issues facing people from culturally diverse backgrounds. People with intellectual disability from culturally diverse backgrounds may experience a ‘double disadvantage’ due to issues of their culture and their disability. This research aimed to identify the experiences, issues and strategies used by occupational therapists working with people with intellectual disability from culturally diverse backgrounds. A semistructured group interview and three individual interviews were conducted with occupational therapists from both metropolitan and rural locations in Queensland. It was found that communication and residential services present some unique issues for people with intellectual disability from culturally diverse backgrounds. Strategies suggested by therapists to address a range of issues are listed. Implications for occupational therapy are discussed, and suggestions for future research are provided.
Australian occupational therapists working in adult physical dysfunction settings: What treatment media do they use?
Authors: McEneany Janine , McKenna Kryss , Summerville Patti
Published: March 2003

The use of exercise‐based treatment media, which target the underlying basis of physical dysfunction but can overlook the psychological, social, and cognitive aspects of human function, has been criticised as being incongruent with occupational therapy philosophy. This study aimed to explore the treatment choices of Australian occupational therapists in adult physical dysfunction settings, to identify the influences on those choices, and to determine whether the use of client priority assessments impacts on treatment choice. Responses to a mail‐out questionnaire were obtained from 147 occupational therapists working in eight specialty areas of physical dysfunction practice. Following descriptive analysis, the five most frequently used treatment media were education and counselling, home visits/modifications, functional mobility, self‐care and pure upper extremity exercise. Regardless of the treatment medium chosen, participants identified client‐related factors, such as clients’ skill level or special interest in the activity, as the greatest influence on their selection of that medium. Results suggest a trend toward the use of treatments that are functional, client‐focused and that address occupational dysfunction. Further exploration of the clinical reasoning associated with decisions about treatment choices is needed.
Corrosion of lead shielding in a radiology department
Authors: Schick DK , Casey RN , Sim LH , Siddle KJ
Published: March 2003

Corrosion of lead sheet used for structural radiation protection in the Princess Alexandra Hospital radiology department has been identified. The corrosion is thought to have been caused by organic acid vapours released from oregon timber wall panelling. Non‐destructive testing (NDT) and X‐ray transmission measurements were used to define the extent and severity of damage, and subsequently to provide the data necessary for estimation of staff and public radiation doses. Although radiation dose limits have not been exceeded, corrective actions including structural modifications and staff information sessions have been undertaken.
Cerebellopontine angle Hodgkin’s disease
Authors: Antonio Gregory , Dahlstrom Jane , Chandran K Nadana , O’Neil Ross
Published: March 2003

Intracranial Hodgkin’s disease is a rare site of involvement, and even more rare is its presentation as a cerebellopontine angle mass. The imaging findings are non‐specific but the rapid response to therapy may provide a clue to diagnosis.
Meningeal infiltration in recurrent nasopharyngeal carcinoma
Authors: Chong Vincent Fh , Fan Yoke‐Fun
Published: March 2003

Permeative infiltration of the meninges appears to be a distinct form of recurrent nasopharyngeal carcinoma (NPC). The present report of eight patients with recurrent NPC illustrates meningeal infiltration following basal foramina extension. Seven of the eight patients (88%) showed jugular foramen involvement. Three patients had concomitant infiltration of the foramen magnum. There was one patient showing spread through the foramen lacerum. Only four (50%) of these patients had clinically detectable tumour in the nasopharynx, while the other half showed deep submucosal recurrence with endoscopically unremarkable findings. Permeative meningeal infiltration appears to be a distinct form of NPC recurrence. It is important to recognize this phenomenon so as to optimize the treatment options.
Early glottic carcinoma: Results of treatment by radiotherapy
Authors: Smee R , Bridger Gp , Williams J , Fisher R
Published: March 2003

The purpose of the present paper was to review the results of treating early (stages T1–2N0) glottic, squamous cell carcinoma by radiotherapy in the Department of Radiation Oncology, Prince of Wales Hospital, Sydney. A retrospective review was carried out of all patients seen in the department from 1967 to 1994, inclusive. To be eligible, patients had to have newly diagnosed cancer and to have been treated with curative intent by radiotherapy alone. Three hundred and sixty‐nine patients satisfied the eligibility requirements. The mean follow‐up time was 12.2 years (maximum: 28 years). At 5 years the actuarial local control rate was 80% (84% for stage T1 and 72% for T2). The ultimate local control rate was 96%. The overall survival rates at 5 and 10 years were 73% and 52%, respectively. The risk of nodal recurrence was much higher after persisting disease or local recurrence. Our results confirm the high cure rates achieved with this modality of treatment and are comparable with those reported in the literature.
A study of concurrent radiochemotherapy with paclitaxel in glioblastoma multiforme
Authors: Julka Pk , Awasthy Bs , Rath Gk , Agarwal S , Varna T , Mahapatra Ak , Singh R
Published: March 2003

Despite advances in neurosurgery and radiotherapy, the prognosis of patients with glioblastoma multiforme remains poor. Reports in the literature about the radiosensitizing properties of paclitaxel stimulated the authors to conduct a study using paclitaxel concurrently with radiation in a group of 18 patients who had residual disease postoperatively. Paclitaxel was delivered weekly as an intravenous infusion in a dose of 60 mg/m 2 along with radiation to the primary lesion. A total of 108 cycles of paclitaxel was given. All the patients tolerated the treatment well. The main side effects were haematological, and neuropathy which was self‐limiting. The overall 1‐year survival rate was 70%, with 12 patients alive at 13 months. The median survival has not yet been reached although it is more than 13 months. Thus, paclitaxel can be safely delivered concomitantly with radiation in patients with glioblastoma multiforme. Larger, randomized trials are required to establish the comparative efficacy of paclitaxel as a radiosensitizer in glioblastoma multiforme.
Synovial, chondropathic, depositional: The radiological categories of arthritis. A review
Authors: Alexander Colin
Published: March 2003

The accepted optimum logic frame for complex diagnostic problems is sequential hypothesis testing. The X‐ray diagnosis of arthritis has now become sufficiently complex to make this the procedure of choice, but standard classifications of arthritis lack the discriminatory power needed for its effective deployment. This obstacle can be overcome if these standard classifications are replaced by a more discriminant classification based on radiologically identifiable discriminators. This classification divides arthritis into three groups: synovial, chondropathic and depositional. The initial categorization is usually made fairly simply from two or three markers, of which the most important is the site of any erosions present. Once categorized, the subsequent analysis can proceed in an approximately binary manner using the discriminators appropriate for that category. The use of this radiological classification simplifies the diagnostic approach, reduces the workload, and provides the algorithm needed for sequential hypothesis testing.
Two‐tone pancreas on T1‐weighted images: Correlation with abnormalities on magnetic resonance pancreatography
Authors: Matar Luke D , Frazer Christopher
Published: March 2003

Two patients are presented in whom geographical alteration in signal between areas of normal and abnormal pancreatic tissue on T1‐weighted magnetic resonance images of the pancreas was observed. This alteration in signal intensity produced a ‘two‐tone’ pattern; magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in both patients revealed altered pancreatic duct drainage. It is believed that the ‘two‐tone’ pancreas effect on T1‐weighted images of the abdomen, may indicate aberrant duct drainage and that MRCP is an ideal means of further evaluation.
Hypertrophic osteoarthropathy: An unusual manifestation in nasopharyngeal cancer
Authors: Biswal BM , Kareem A , Ahmed NM
Published: March 2003

A patient with nasopharyngeal carcinoma developed clubbing and hypertrophic osteoarthropathy 6 months before radiological detection of secondary deposits in the lung. Another patient with nasopharyngeal carcinoma developed digital clubbing and hypertrophic osteoarthropathy 6 months after the discovery of lung metastases. Development of a paraneoplastic syndrome in the form of hypertrophic osteoarthropathy and digital clubbing is very rare. This manifestation of nasopharyngeal cancers is presented, with a short review of its biology and pathogenesis.
Computed tomography versus intravenous urography in diagnosis of acute flank pain from urolithiasis: A randomized study comparing imaging costs and radiation dose
Authors: Thomson Jacqueline MZ , Glocer Jeffrey , Abbott Christopher , Maling Thomas MJ
Published: March 2003

The equivalent sensitivity of non‐contrast computed tomography (NCCT) and intravenous urography (IVU) in the diagnosis of suspected ureteric colic has been established. Approximately 50% of patients with suspected ureteric colic do not have a nephro‐urological cause for pain. Because many such patients require further imaging studies, NCCT may obviate the need for these studies and, in so doing, be more cost effective and involve less overall radiation exposure. The present study compares the total imaging cost and radiation dose of NCCT versus IVU in the diagnosis of acute flank pain. Two hundred and twenty‐four patients (157 men; mean age 45 years; age range 19–79 years) with suspected renal colic were randomized either to NCCT or IVU. The number of additional diagnostic imaging studies, cost (IVU A$136; CTU A$173), radiation exposure and imaging times were compared. Of 119 (53%) patients with renal obstruction, 105 had no nephro‐urological causes of pain. For 21 (20%) of these patients an alternative diagnosis was made at the initial imaging, 10 of which were significant. Of 118 IVU patients, 28 (24%) required 32 additional imaging tests to reach a diagnosis, whereas seven of 106 (6%) NCCT patients required seven additional imaging studies. The average total diagnostic imaging cost for the NCCT group was A$181.94 and A$175.46 for the IVU group (P < 0.43). Mean radiation dose to diagnosis was 5.00 mSv (NCCT) versus 3.50 mSv (IVU) (P < 0.001). Mean imaging time was 30 min (NCCT) versus 75 min (IVU) (P < 0.001). Diagnostic imaging costs were remarkably similar. Although NCCT involves a higher radiation dose than IVU, its advantages of faster diagnosis, the avoidance of additional diagnostic imaging tests and its ability to diagnose other causes makes it the study of choice for acute flank pain at Christchurch Hospital.
Methanol intoxication with bilateral basal ganglia infarct
Authors: Çomoğlu Selçuk , Özen Banu , Özbakır Şenay
Published: March 2003

Methanol is a toxic agent that affects the central nervous system, especially the optic nerves and basal ganglia. Symmetrical hypodense lesions in the basal ganglia, which can be demonstrated by CT or MRI, is accepted as the most characteristic radiological feature of the disease. A case of a patient with bilateral putaminal hypodense infarcts due to methanol intoxication is presented.
Chordoma: Review of clinicoradiological features and factors affecting survival
Authors: Soo Mark YS
Published: March 2003

This study reviews the clinicoradiological features of cranial and sacrospinal chordomas and identifies factors affecting survival. Nineteen patients seen between January 1980 and December 2000 with histopathological diagnosis of chordomas were retrospectively reviewed with reference to clinical presentation, imaging features, treatment modalities and post‐therapy status. Eight had tumours in the skull base while 11 patients had spinal and sacrococcygeal lesions. Surgical resection was performed in 16 patients whose subsequent natural history was used to identify clinical indicators that may influence survival. Completeness of resection, age, gender and postoperative irradiation were subjected to analysis using the Cox proportional hazard models. Kaplan–Meir survival curves illustrate the survival distributions. Diplopia and facial pain are prime clinical presentations in cranial lesions, while extremity weakness and a sacrogluteal mass are common complaints in the sacrospinal group. Lesional calcifications are present in 40% while an osteolytic soft tissue mass is detectable by CT in all cases. Heterogeneous signals and internal septations on T2‐weighted MRI are predominant features. In sacrospinal tumours, complete excision with adjuvant radiotherapy achieves the best results with a disease‐free survival of more than 5 years. The clinical and imaging findings in this study are in accordance with those of other series. Except for complete surgical excision followed by radiotherapy in the subset of patients with sacrospinal tumours, none of the other clinical indicators show a statistical significant influence on survival.
Disappearing liver sign
Authors: Loh Y Han , Dunn Graham D
Published: March 2003

The development of a pneumothorax is a recognized complication of ultrasound‐guided percutaneous liver biopsy. A way of detecting such a complication using real‐time ultrasound is described, whereby the well‐visualized liver disappears from the monitor screen. We also discuss the reasons for this occurrence.
Primary leiomyosarcoma of inferior vena cava, a rare entity: Imaging features
Authors: Hemant Deshmukh , Krantikumar Rathod , Amita Joshi , Chawla Ashish , Ranjeet Narlawar
Published: March 2003

Leiomyosarcoma of the inferior vena cava (IVC) is an uncommon neoplasm, most frequently seen in the sixth decade with a female predominance. Imaging modalities allow an early and accurate preoperative diagnosis resulting in a higher rate of surgical resection and improved survival. Imaging findings in a 65‐year‐old woman with leiomyosarcoma of IVC are described. Computed tomography and MRI typically showed a non‐fatty, necrotic intraluminal IVC mass with extension to retroperitoneal compartments. Cavography was useful to evaluate the collateral circulation associated with the extensive intraluminal mass. The lesion was biopsied under ultrasound guidance.
Investigations of fatal causes of chest pain: Case report and literature review
Authors: Kalouche H
Published: March 2003

A case of fatal ascending aortic dissection (AAD) misdiagnosed as pulmonary embolism (PE) despite strong radiological evidence is described. The occurrence of this serious pathology is uncommon. Its prompt diagnosis and treatment are crucial. Anticoagulant therapy for pulmonary embolism should be withheld until acute aortic dissection is excluded definitively. A management approach to optimise the outcome of patients with chest pain in which ascending aortic dissection and/or pulmonary embolism are suspected is presented.
Idiopathic hypereosinophilic syndrome: Magnetic resonance imaging findings in endomyocardial fibrosis
Authors: Puvaneswary Murugasu , Joshua Fred , Ratnarajah Siva
Published: March 2003

Significant eosinophilia and even eosinophilic tissue infiltration has been associated with a variety of clinical disorders including allergic and immunodeficiency states, drug reaction, infection, parasitic infestation and malignancy. Eosinophilia without an underlying aetiology and with multi‐organ dysfunction has been designated idiopathic hypereosinophilic syndrome. We report a case of endomyocardial fibrosis with MRI findings.
Prosthetic devices within radiotherapy fields: Planning implications and results
Authors: Christie David RH , Hulbert Peter , Christiansen Peter
Published: March 2003

Prosthetic devices made of plastic or silicon are occasionally present in patients requiring radiotherapy (RT). The effect of RT on these devices and the potential implications of their presence on RT planning are relatively unknown. Three examples are presented in which various devices were included in RT fields. In two of the examples in vitro testing of the devices with high single doses of radiation was undertaken. Radiotherapy was given to all patients with high doses received by the devices. Minor adjustments were made to the planning techniques to reduce the doses to the devices. Neither significant complications nor any malfunctions of the devices were noted subsequently.
Comprehensive evaluation of patients with haematuria on multi‐slice computed tomography scanner: Protocol design and preliminary observations
Authors: Chai Richard Y , Jhaveri Kartik , Saini Sanjay , Hahn Peter F , Nichols Steven , Mueller Peter R
Published: March 2003

An imaging protocol with a multi‐slice CT scanner that allows comprehensive assessment of patients with haematuria is described. This protocol allows evaluation of the kidneys, ureters and bladder in a single examination using CT. This approach should streamline the diagnostic work‐up of patients with haematuria.
Spontaneous regression of pulmonary bullae
Authors: Satoh Hiroaki , Ishikawa Hiroichi , Ohtsuka Morio , Sekizawa Kiyohisa
Published: March 2003

The natural history of pulmonary bullae is often characterized by gradual, progressive enlargement. Spontaneous regression of bullae is, however, very rare. We report a case in which complete resolution of pulmonary bullae in the left upper lung occurred spontaneously.
Epidural extramedullary haemopoiesis in thalassaemia
Authors: Boyacigil Süreyya , Ali Afşin , Ardiç Selim , Yüksel Enis
Published: March 2003

Intrathoracic extramedullary haematopoiesis is a rare condition. Involvement of the spinal epidural space with haematopoietic tissue is rather unusual. A 31‐year‐old‐man with a known diagnosis of β‐thalassaemia was referred with focal back pain. Magnetic resonance imaging revealed diffuse bone‐marrow changes, thoracic paraspinal masses and lobulated epidural masses, suggesting extramedullary haemopoiesis. The patient was treated with radiotherapy and blood transfusions. Follow‐up MRI was performed for evaluation efficacy of the treatment.
Extramammary Paget’s disease: Role of radiation therapy
Authors: Guerrieri Mario , Back Michael F
Published: March 2003

Extramammary Paget’s disease (EMPD) is an uncommon premalignant skin condition that has been traditionally managed with surgery. A report of long‐standing Paget’s disease with transformation to invasive adenocarcinoma definitively managed with radiation therapy is presented. A review of cases of extramammary Paget’s disease treated with radiation therapy is discussed. The use of radiation therapy should be considered in selected cases, as these studies demonstrate acceptable rates of local control when used as an adjunct to surgery, or as a definitive treatment modality.
Solitary pulmonary metastasis from intracranial meningiothelial meningioma
Authors: Kovoor Jerry ME , Jayakumar PN , Srikanth SG , Indira B , Devi M Gayatri
Published: March 2003

Although known, histologically proven pulmonary metastasis from a benign intracranial meningioma is exceedingly rare. We report a case of meningiothelial meningioma producing a solitary pulmonary deposit.
Segmental hyperattenuation in the liver as a result of right hepatic vein thrombosis: An unusual complication of central venous catheterization
Authors: Fitoz Suat , Atasoy Çetin , Yagmurlu Aydin , Akyar Serdar
Published: March 2003

Liver perfusion disorder secondary to hepatic vein occlusion is not often reported. This abnormality might be caused by invasion of the hepatic veins by tumour or compression by a large right adrenal mass. We present an unusual cause of hepatic perfusion disturbance due to right hepatic vein thrombosis resulting from inadvertent hepatic venous catheterization. On contrast‐enhanced CT, the tip of a central venous catheter extended into the right hepatic vein, which was thrombosed. A sharply marginated wedge‐shaped hyperdense region was demonstrated in the right lobe of the liver, thought to represent a compensatory increase in arterial flow to the affected territory.
Eosinophilic granuloma of the bone: Ultrasonographic imaging
Authors: Bodner Gerd , Kreczy Alfons , Rachbauer Franz , Baechter Oliver , Peer Siegfied
Published: March 2003

Eosinophilic granuloma is a rare disease of unknown aetiology that affects the bones. Two cases of eosinophilic granuloma are presented. Ultrasonographic, CT and histopathological findings are described. Ultrasonographic‐guided core‐needle biopsy was performed. Treatment was initiated by installing steroid suspension into the lesions, which resulted in complete healing of the bone in both cases.
Stenosis of the hepatic vein anastomosis after liver transplantation: Treatment with a heparin‐coated metal stent
Authors: Frazer CK , Gupta A
Published: March 2003

Delayed‐onset fibrotic stenosis of the hepatic‐vein anastomosis following liver transplantation resulted in ascites and abnormal liver‐function tests. The stenosis was treated with balloon dilatation resulting in a clinical improvement; however, this had to be repeated four times in the 9 months after transplantation due to recurrent stenosis. The stenosis was eventually successfully treated with percutaneous insertion of a metal stent. Aspirin 50 mg daily was prescribed for 1 month. The patient was not anticoagulated. The patient remains clinically well at follow up after 18 months.
Cultural attitudes to cancer management in traditional South‐East Asian patients
Authors: Ong K Jane , Back Michael F , Lu Jiade J , Shakespeare Thomas S , Wynne Christopher J
Published: March 2003

Cultural differences might influence patients’ attitudes to decision‐making for cancer management. In a Western medical system promoting shared decision‐making and patient autonomy, the effects of traditional South‐East Asian cultural and religious attitudes might provoke confusion for both the patient and health‐care provider. Especially in oncology, these beliefs might influence patients’ perceptions of diagnosis, symptoms, interventions and approaches to death. For the clinician, the potential conflicts in patient disclosure and discussion of diagnosis are evident, as well as patient avoidance of certain interventions. This review article explores the background and interpretation of cultural aspects experienced by Australasian‐trained oncologists working in Singapore. Explanations of traditional health beliefs of South‐East Asian patients are outlined, and provide a perspective for oncologists managing similar patients within Australasia's multicultural community.
Solitary hemispheric demyelination in acute disseminated encephalomyelitis: Clinicoradiological correlation
Authors: Singh Surendra , Alexander Mathew , Sase Nathaniel , Korah Ipeson Parackal
Published: March 2003

We retrospectively studied 13 patients with solitary hemispheric demyelination in acute disseminated encephalo­‐myelitis (solitary‐ADEM) to look for specific MRI features. Thirteen patients were subjected to routine MRI with varying initial clinical diagnosis, including demyelination, neoplasm, encephalitis and infarct. The provisional MRI diagnosis was based on lesion morphology, size, location, mass effect, effect on adjacent sulci, cisterns and gyral shape. On long repetition time (TR)/long echo time (TE) spin echo sequences, the lesions were heterogeneously hyperintense, and on short TR/short TE spin echo sequences, heterogeneously hypointense. Later, the provisional MRI diagnosis was corroborated with clinical parameters such as multimode‐evoked potentials, electro­‐physiological studies and analysis of cerebrospinal fluid (CSF) in order to establish a definitive diagnosis. The diagnosis was established in all except one patient with tumour‐like clinical and MRI features. The combination of MRI features and clinical parameters can establish a definitive diagnosis in the majority of cases, and this avoids a biopsy.
PUTATIVE MEDIATOR ROLE OF ENDOTHELIN‐1 IN ASTHMA AND OTHER LUNG DISEASES
Authors: Hay DWP
Published: March 2003

1. There is an increasing amount of research to implicate endothelin (ET)‐1, a member of a family of 21 amino acid peptides, as a potentially important mediator in pulmonary diseases, in particular asthma and pulmonary hypertension. Thus, ET‐1 fits several of the standard criteria that need to be fulfilled for a pathophysiologically relevant substance.

2. Endothelin‐1 is present in abundance in human lung: the major loci for ET‐1 are the epithelium, endothelium, endocrine cells and inflammatory cells. Furthermore, the receptors that mediate the biological effects of ET‐1, the ETA and ETB receptor subtypes, are found in human lung, predominantly in airway smooth muscle, and vascular smooth muscle and, to a lesser extent, nerves. There is no change in the relative proportions of ETA and ETB receptors in asthmatic versus non‐asthmatic bronchial smooth muscle and peripheral lung.

3. Several studies have shown that ET‐1 mimics several of the features of asthma (including bronchospasm, airway remodelling, inflammatory cell recruitment and activation, oedema, mucus secretion, airway hyperreactivity and dysfunction in neuronal inputs); however, some other reports are at odds with these findings.

4. Endothelin‐1 mimics the two classical features of pulmonary hypertension (pulmonary vascular constriction and remodelling), which is often a serious complication of chronic obstructive pulmonary disease.

5. Intranasal ET‐1 produces several of the symptoms of allergic rhinitis.

6. There are several reports of increased levels and/or expression of ET in patients with many pulmonary disorders, in particular asthma or pulmonary hypertension, with some evidence of a correlation between ET amounts and disease severity; however, other studies do not confirm these observations.

7. Despite these intriguing data in support of a pathophysiological role of ET‐1 in lung diseases, the definitive test and most difficult criteria to fulfil, the clinical evaluation of ET receptor antagonists or ET synthesis inhibitors, has still to be conducted. Only after these pivotal data are available will we be able to determine definitively whether ET‐1 is a pathophysiologically important mediator in lung diseases or merely an interesting peptide with several effects in the pulmonary system.
THE A1166C MUTATION IN THE ANGIOTENSIN II TYPE I RECEPTOR AND HYPERTENSION IN THE ELDERLY
Authors: Liyou Nancy , Davis Darren , James Kristy , Simons Leon , Friedlander Yechiel , Simons Judith , McCallum John , Johnson Anthony
Published: March 2003

1. Using a nested case‐control study of 661 non‐institutionalized elderly (≥ 60 years) residents of Dubbo, New South Wales, Australia, the aim of this study is to determine whether the A1166C polymorphism of the angiotensin II type I (AT1) receptor gene is associated with hypertension in the elderly.

2. Individuals were classified as isolated systolic hypertension (ISH, n = 146), systolic diastolic hypertension (SDH, n = 188), or normotensive, age‐ and sex‐matched controls (n = 327). AA, CC and AC genotypes were determined using restriction fragment length polymorphism analysis of DNA generated by nested polymerase chain reaction.

3. A univariate analysis (χ2) was complemented by a logistic regression analysis, facilitating adjustment for potential confounders. The unadjusted genotype and allele frequencies in ISH or SDH subjects did not differ significantly from the control subjects (χ2 = 3.0, P = 0.55, 4 d.f.; χ2 = 3.0, P = 0.23, 2 d.f., respectively). After adjustment for potential confounders neither genotype nor allele predicted ISH or SDH in this cohort.

4. From this study we conclude that the A1166C polymorphism of the AT1 receptor gene is not a marker for ISH nor for SDH in this large, elderly community sample.
SYSTEMIC ADENOSINE INCREASE DURING COLD PRESSOR TEST IS DEPENDENT ON SYMPATHETIC ACTIVATION
Authors: Pasini FRANCO LAGHI , Capecchi PIER LEOPOLDO , Colafati MARCELLA , Randisi PAOLA , Puccetti LUCA
Published: March 2003

1. Following local vasoconstriction‐inducing stimuli, such as the cold pressor test (CPT), significant changes occur in haemodynamics, with a rise in arterial blood pressure and heart rate (HR) due to the activation of the sympathetic nervous system. Among the compensatory mechanisms to local ischaemia, the endogenous nucleoside adenosine (ADO) has been suggested to play a relevant role by contributing to sympathetic stimulation. The possibility was investigated that CPT‐induced increases in plasma ADO levels were not only an expression of the increased production of ADO in the ischaemic area, but also a consequence of systemic sympathoexcitatory mechanisms, thus showing a bidirectional involvement of the mechanisms of ADO formation.

2. The CPT was performed in 15 volunteers and mean arterial blood pressure (MABP) and HR were evaluated, together with plasma levels of noradrenaline (NA) and ADO in the tested and contralateral arm. The 15 subjects were then divided into three groups of five that were treated with either 5 mg transdermal clonidine weekly, 100 mg atenolol daily or 600 mg aminophylline twice daily. After 1 week treatment, the same test was repeated in the respective groups.

3. The CPT induced a rise in MABP and HR and an increase in plasma levels of NA and ADO. Increases in ADO were more pronounced in the tested arm. Clonidine blunted the haemodynamic response and NA release, while increases in ADO increase were reduced to a greater extent in the contralateral arm rather than the tested arm. Atenolol only affected MABP and HR without any effect on NA and ADO levels. Theophylline did not show any effect on CPT‐induced changes.

4. In conclusion, local vasoconstriction and ischaemia induced in one arm following CPT are associated with haemodynamic changes dependent on the activation of the sympathetic system. The observed increase in plasma levels of ADO seems to be, in part, a direct expression of local responses to ischaemia (predominant in the tested arm), but also appears as the consequence of systemic sympathoexcitatory mechanisms. Such increases in ADO are not dependent on a β1‐adrenoceptor‐mediated mechanism. Finally, theophylline, at a therapeutic dose, has no effect on the response to CPT.
PATHOGENESIS OF AN EXPERIMENTAL HEATSTROKE MODEL
Authors: Lin MT
Published: March 2003

1. Heatstroke was induced by exposure under general anaesthesia to a high ambient temperature. The moment in which the mean arterial pressure (MAP) began to decrease from its peak level was taken as the onset of heatstroke.

2. Compared with normothermic controls, rats with heatstroke had higher values for colon temperature, neuronal damage score and heart rate, but lower MAP and cerebral blood flow.

3. Induction of heat shock protein, antagonism of interleukin‐1 or N‐methyl‐
D‐aspartate receptors or depletion of brain monoamines protects against the heatstroke‐induced arterial hypotension and cerebral ischaemic injury.

4. Thus, it appears that arterial hypotension and cerebral ischaemic damage is the main reason for development of heatstroke syndromes.
INHIBITION OF INTIMAL LIPID DEPOSITION IN HUMAN APOLIPOPROTEIN A1 TRANSGENIC MICE
Authors: She MINGPENG , Li HUIHUA , Yu LIQING , Gu SUMIN , Wang ZONGLI
Published: March 2003

1. Southern blot confirmed the emergence of the human apolipoprotein A1 (h‐apoAl) gene (four to 15 copies) in newborn transgenic mice. The inheritance pattern of h‐apoAl transgene in three generations of progeny was compatible with a single autosomal integration site.

2. Northern blot showed h‐apoA1 mRNA expressed mainly in liver, kidney and aorta. The total plasma apoA1 (murine plus human) level was significantly increased to 58 and 118 in transgenic mice without or under zinc induction, respectively. The majority was h‐apoA1. Plasma lecithin:cholesterol acyltransferase activity was positively correlated with h‐apoA1 levels in transgenic mice (r = 0.43; P < 0.01).

3. After a high cholesterol intake for 14 weeks, the incidence of fatty streak at the aortic sinus was 40% in transgenic mice and 80% in controls. Expression of platelet‐derived growth factor‐B, c‐myc and c‐fos proteins was much weaker in smooth muscle cells at the aortic sinus in transgenic mice.
DISTRIBUTION OF GABAA AND GLYCINE RECEPTORS IN THE MAMMALIAN RETINA
Authors: Grünert Ulrike
Published: March 2003

1. GABA and glycine mediate synaptic inhibition via specific neurotransmitter receptors. Molecular cloning studies have shown that there is a great diversity of receptors for these two neurotransmitters. In the present paper, the distribution of GABAA and glycine receptors in the mammalian retina is reviewed.

2. In situ hybridization, immunocytochemistry with subunit‐specific antibodies and single cell injection were used to analyse the localization of receptor subunits. Specific subunits are expressed in characteristic strata of the inner plexiform layer, suggesting that different functional circuits involve specific subtypes of neurotransmitter receptors.

3. Different cell types express different combinations of receptor subunits and an individual neuron can express several receptor isoforms at distinct post‐synaptic sites.
EFFECTS OF INTRACRANIAL HYPERTENSION ON STEADY AND PULSATILE HAEMODYNAMICS IN DOGS
Authors: Su Chain‐Fa , Hu Cheng‐Tao , Chen Hsing I
Published: March 2003

1. Intracranial hypertension (ICH) tends to elicit various cardiovascular changes. Previous studies on the haemodynamic responses to ICH have been confined mainly to measurements of arterial pressure (AP), cardiac output (CO) and total peripheral resistance (TPR). In the present study, we used the technique of arterial impedance analysis for a complete assessment of steady and pulsatile haemodynamics in ICH.

2. In anaesthetized dogs, aortic pressure and flow waves were obtained with high‐fidelity Millar sensors. The pressure and flow waves were subjected to Fourier transformation (frequency analysis) for an analysis of impedance spectra. Intracranial pressure (ICP) was elevated by inflation of an epidural balloon. At an ICP of 50 mmHg, the changes in steady and pulsatile haemodynamics were slight.

3. Haemodynamic changes became evident at an ICP of 100 mmHg. The mean AP was elevated by 31 mmHg (+32%) and heart rate (HR) was reduced by 25 b.p.m. (–18%). There was also a significant decrease in CO by 27% and large increase in TPR by 82%. With respect to pulsatile haemodynamics, an elevation of ICP to 100 mmHg caused significant increases in characteristic impedance by 45% and wave reflection by 53%. Arterial compliance was reduced by 50%. The ventricular oscillatory work was increased without a significant change in steady work.

4. The results indicate that ICH causes constriction of resistance vessels to affect AP and TPR. Because the pulsatile haemodynamics reflect mainly the Windkessel functions, ICH also induces stiffness of the large vessels to affect arterial impedance, pulse wave reflection and ventricular oscillatory work.
Treatment Of Joint Pain In Crohn’s Patients With Budesonide Controlled Ileal Release§
Authors: Florin Timothy Hj , Graffner Hans , Nilsson Lars‐Göran , Persson Tore
Published: March 2003

1. Joint pain is a frequent manifestation of Crohn’s disease. Budesonide controlled ileal release (CIR) is a predominantly topically acting glucocorticosteroid, which is effective in treating active ileal or ileocaecal Crohn’s disease.

2. Therefore, it was of interest to study the effect of this predominantly topically acting therapy on the treatment of an extra‐intestinal symptom of Crohn’s disease by analysing data collected from budesonide CIR (Entocort®; Astra Draco AB, Lund, Sweden) trials.

3. Three large studies of budesonide CIR treatment in active Crohn’s disease provided a reliable source of clinical data. Of the 611 patients treated in the prospective double‐blind controlled trials, 291 had joint pain (arthritis/arthralgia) at entry, which was recorded as part of the Crohn’s Disease Activity Index. Statistical analysis was based on all patients treated, provided that the patient had joint pain at the start of treatment.

4. Daily oral budesonide CIR (9 mg) resulted in clinical remission of joint pain in 74% (95% confidence intervals (CI) 67–82%) of patients. This outcome was nearly twice as good as placebo (41%; 95% CI 34–57%) and as good as the outcome effected by daily oral prednisolone (40 mg; 72%; 95% CI 60–84%). The favourable response to budesonide CIR (9 mg) did not correlate with glucocorticosteroid‐associated side effects or with adrenal suppression, which were half those in the prednisolone (40 mg/day) group.

5. The favourable outcome may relate to restitution of normal intestinal immune function.
Angiotensin And Osmoreceptor Inputs To The Area Postrema: Role In Long‐Term Control Of Fluid Homeostasis And Arterial Pressure
Authors: Osborn John W , Collister John P , Carlson Scott H
Published: March 2003

1. The role of the area postrema (AP) in the long‐term control of body fluid homeostasis and arterial pressure under conditions of increased dietary salt intake is reviewed. A model is proposed in which sympathetic nerve activity is suppressed when dietary salt is increased. It is hypothesized that the AP acts as an essential integrative site in the hind‐brain for this response.

2. An essential component of the hypothesis is that basal levels of circulating angiotensin II support arterial pressure in animals consuming a normal salt diet by acting on the AP to drive sympathetic nerve activity. This hypothesis is supported by the observation that the long‐term hypotensive response to losartan, the AT1receptor antagonist, is attenuated in AP‐lesioned (APx) rats.

3. The role of hepatoportal sodium receptors in signalling the AP about changes in dietary salt intake is discussed. Intragastric hypertonic saline infusion increases portal venous, but not systemic plasma, osmolality and increases Fos‐like immunoreactivity in the AP, nucleus tractus solitarius and the supraoptic, paraventricular and lateral parabrachial nuclei. Other studies have shown that stimulation of these receptors decreases renal sympathetic nerve activity.

4. The hypothesis that the AP is critical in long‐term control of arterial pressure and body fluid homeostasis under conditions of altered dietary salt intake was studied. The responses of arterial pressure and sodium and water balance to changes in dietary salt intake were measured in intact and APx rats. Contrary to the hypothesis, APx rats did not exhibit impaired regulation of arterial pressure or water balance. However, APx rats did demonstrate an impaired ability to excrete sodium when salt intake was elevated.

5. Based on these observations, it is concluded that the AP is important in the control of sodium balance, but not arterial pressure, when dietary salt intake is altered.
Nicotine Administration In Rabbits Using Habitrol® Nicotine Patches And Nicotine Nasal Spray
Authors: Sipe Richard V Sipe , Buck David C , Hollinger Jeffrey O
Published: March 2003

1. Several methods are used to provide predictable and effective nicotine to experimental animals in scientific studies. Due to the expense and technical challenges of these methods, we sought suitable alternatives. Consequently, the purpose of the present study was to develop a reliable experimental nicotine protocol in rabbits that included either Habitrol® nicotine patches (Novartis Consumer Health Inc., Summit, NJ, USA) or nicotine nasal spray.

2. Administration of one of three doses of nicotine (2.5, 5, or 10 mg) was accomplished daily on 13 rabbits divided between either the patch or spray groups. Systemic nicotine and cotinine levels at 0 h, 15 min and 8 and 24 h were assayed. Data were analysed by a Fisher’s protected least significant difference test at P = 0.05.

3. Rabbits treated with Habitrol® patches exhibited consistent and predictable systemic nicotine levels. The nicotine nasal spray produced an immediate dose‐dependent response with no measurable nicotine serum levels at 8 h.

4. For nicotine administration in rabbits, nicotine patches are easy to administer and provide a nicotine serum level between 5 and 25 ng/mL, which is consistent with the average daily level found in a patient who smokes cigarettes.
Effects Of Chronic Inhibition Of Nitric Oxide Synthase In The Genetically Hypertensive Rat
Authors: Tucker Elizabeth J , Ledingham Janet M , Zheng Yiwen , Laverty R
Published: March 2003

1. The effects of graded inhibition of nitric oxide synthase (NOS) on blood pressure in the genetically hypertensive (GH) rat strain and NOS activity in regions of the brain (cerebellum, striatum, hippocampus, frontal cortex and medulla oblongata) as a measure of body NOS inhibition were studied.

2. Male GH and normotensive (N) rats (n= 7–10 per group) were given NG‐nitro‐
L‐arginine methyl ester (
L‐NAME; 2, 5, 10 or 20 mg/kg per day in drinking water) from age 7 weeks. Age‐ and weight‐matched controls received water only. Systolic blood pressure (SBP) was measured weekly by the tail‐cuff method from age 6 weeks. By age 10 weeks, rats were killed and NOS activity was measured.

3. Some GH rats that received over 5 mg/kg per day L‐NAME developed stroke‐like symptoms and were killed before the end of the treatment period.

4. No difference in NOS activity was found between untreated N and GH strains but, in those that received treatment, a graded inhibition was observed with increasing L‐NAME dose levels. The frontal cortex in the GH strain given 20 mg/kg per day
L‐NAME had NOS inhibition of 90% where the N strain had 73% inhibition. Similar results were seen in the other areas of the brain.

5. Left ventricular mass, weight related, was significantly greater in the GH compared with N and was further elevated by treatment with L‐NAME.

6. The SBP at 10 weeks was significantly elevated in GH rats by NOS inhibition with L‐NAME in a dose‐dependent manner; 25% for 2 mg/kg per day, 31% for 20 mg/kg per day (P < 0.001). There was a non‐significant increase in BP in the N‐treated groups (average change of 7.5%).

7. Nitric oxide synthase inhibition causing increased SBP in GH rats suggests an abnormality in the nitric oxide–L‐arginine pathway in this strain.
Garlic Elicits A Nitric Oxide‐Dependent Relaxation And Inhibits Hypoxic Pulmonary Vasoconstriction In Rats
Authors: Kim‐Park SangAe , Ku David D
Published: March 2003

1. The aims of the present study were to determine the characteristics of garlic extract‐induced relaxation in rat isolated pulmonary arteries, its susceptibility to changes in oxygen tension and its protective effect against hypoxic pulmonary vasoconstriction.

2. In normoxia, garlic extract (3–500 μg/mL) produced a dose‐ and nitric oxide (NO)‐dependent relaxation. Following 60 min hypoxia, maximum garlic relaxation was reduced compared with control (mean (±SEM) –86±3 vs–69±2% of phenylephrine (PE) precontraction, respectively), but recovered after 60 min reoxygenation (–85±3% PE precontraction).

3. Acetylcholine (0.1 μmol/L)‐induced NO‐dependent relaxation was reduced from a control value of –76±1% to –46±4% during hypoxia and was further reduced to –35±2% after reoxygenation.

4. In endothelium‐intact arteries, hypoxic exposure resulted in a triphasic response: early transient contraction (+24±4%), followed by transient relaxation (–37±7%) and then sustained contraction (+62±5%).

5. Pretreatment with NG‐nitro‐
L‐arginine methyl ester abolished the early transient contraction, moderately attenuated the sustained contraction and had no effect on the transient relaxation. Mechanical endothelial disruption inhibited all hypoxia‐induced vascular changes.

6. Garlic pretreatment had no effect on the early transient contraction (+25±4%), but inhibited the transient relaxation (–5±3%; P < 0.05) and the sustained contraction (+26±5%; P < 0.05).

7. Garlic also significantly inhibited endothelin‐1‐induced contractions in a dose‐dependent manner.

8. These findings show that garlic extract modulates the production and function of both endothelium‐derived relaxing and constricting factors and this may contribute to its protective effect against hypoxic pulmonary vasoconstriction.