bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of Herpes simplex Virus (HSV) in Aborted Material Using the Polymerase Chain Reaction Technique
Authors: Sifakis S. , Koumantakis E. , Koffa M. , Ergazaki M. , Spandidos D.A.
Published: April 2003

Objective: To investigate the contribution of HSV to the aetiopathogenesis of spontaneous abortion. Design: A hospital-based, case-control study. Setting: Department of Obstetrics and Gynecology, University Hospital and Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion, Crete, Greece. Population and Methods: Abortion material from 102 cases of women with spontaneous abortion was analysed for the presence of HSV DNA applying the PCR technique. Serological assays were used for the detection of specific IgM and IgG antibodies in the maternal sera of 90 pregnant women with successful outcome of their pregnancy while 70 non-pregnant women at reproductive age were also examined as control. Results: The HSV genome was detected by PCR amplification in 3 cases of spontaneous abortion, 2 of them exhibited serological markers of virus reactivation while the 3rd showed a past infection. There were no obvious clinical manifestations indicating a current herpes infection. Both groups of pregnant women, either with spontaneous abortion or with a successful outcome of pregnancy, displayed serological markers of HSV reactivation at higher rates compared with non-pregnant women (χ2, p < 0.05). Conclusions: Using the PCR technique we were able to detect the HSV genome in gestational tissues of spontaneous abortions, even in cases without any clinical symptoms or seropositivity for a primary infection. Serological assays were not very useful for the elucidation of the role of HSV in inducing spontaneous abortions, although they indicate that the state of pregnancy predisposes to HSV reactivation. However, the detection of HSV in 3 out of a total number of 102 cases does not support HSV infection as a major abortion-related factor.
Power Doppler Findings of Adenoma malignum of Uterine Cervix
Authors: Umesaki Naohiko , Nakai Yuichiro , Honda Ken-ichi , Kawamura Naoki , Kanaoka Yasushi , Nishimura Sadako , Ishiko Osamu , Ogita Sachio
Published: April 2003

Adenoma malignum (minimum deviation adenocarcinoma) is a rare neoplasma of the uterine cervix, the diagnosis of wich cannot be determined by cervical smear. Recently, magnetic resonance imaging (MRI) was reported as useful for its diagnosis, but differentiation of adenoma malignum from deep-seated nabothian cysts remains problematic. We report here a case of adenoma malignum of the uterine cervix, for which MRI findings could not neglect deep-seated nabothian cysts. However, transvaginal power Doppler ultrasonography clearly showed richness of small vessels, whose arterial flow had higher velocity in the diastolic phase, around the cystic lesion of the uterine cervix. These findings indicate that, at least in the case reported here, transvaginal power and pulsed Doppler ultrasonography is a useful tool for the diagnosis of adenoma malignum of the uterine cervix.
Localization of Matrix Metalloproteinase-2 in Uterine Endometrium and Ectopic Implants
Authors: Wenzl René J. , Heinzl Harald
Published: April 2003

We performed an immunohistochemical study on paraffin-embedded tissues to evaluate the invasion pattern of endometriotic implants by determination of matrix metalloproteinase (gelatinase A) expression. Endometriotic tissues (n = 32) and uterine endometria (n = 18) of patients with endometriosis and uterine endometria of normal-menstruating women without endometriosis (n = 11) were examined. Endometriotic tissues showed statistically significantly stronger staining compared with uterine endometria. However, we did not find differences in staining between uterine endometrium of women with endometriosis and normal controls. Compared to uterine endometrium, ectopic endometrium has a significantly higher capacity to produce the latent forms (72 kD) of gelatinase A. This leads to the conclusion that endometriotic implants express the protease enabling the invasion of surrounding tissue.
Evaluation of Ovarian Cysts following GnRH-a Treatment in Patients with Polycystic Ovarian Syndrome
Authors: Gregoriou O. , Vitoratos N. , Konidaris S. , Papadias C. , Chryssikopoulos A.
Published: April 2003

The aim of this study was to evaluate the ovarian cysts appearing during GnRH-a/hMG treatment in patients with polycystic ovarian syndrome (PCOS). A total of 35 women with PCOS were included in the study. All women received 3.75 mg IM of long-acting leuprolide acetate on the first day of the menstrual cycle. On the 15th day of the menstrual cycle, transvaginal ultrasound examination (US) and determination of serum E2 were done. A total of 90 cycles were studied in this way and during these cycles, 14 (15.5%) ovarian cysts with a diameter of ≥ 20 mm developed. According to the serum E2 levels, 11 cases (group A) had E2 concentrations > 35 pg/ml and 3 (group B) had serum E2 levels < 35 pg/ml. Group A patients attained a significantly larger mean size of ovarian cyst than group B patients (42 ± 7.3 vs. 24.2 ± 3.2 mm, p < 0.001). When the serum E2 concentrations were < 35 pg/ml, the ovarian cysts were disregarded and ovarian stimulation with gonadotropins was initiated. In case that serum E2 levels were > 35 pg/ml, the initiation of the ovarian stimulation with hMG was postponed until serum E2 levels indicated down-regulation, which was achieved after 5.8 ± 2.9 days. In both groups the ovarian stimulation resulted in ovulatory cycles, while four pregnancies in group A and one in group B were achieved. In conclusion, our results indicate that in patients with PCOS the GnRH-a administration may cause follicular cysts at an incidence of 15.5%. These cysts do not constitute a contraindication for ovarian stimulation provided that serum E2 levels are low.
Psychometric Characteristics of the Somatoform Dissociation Questionnaire: A Replication Study1
Authors: Nijenhuis Ellert R.S. , Spinhoven Philip , van Dyck Richard , van der Hart Onno , Vanderlinden Johan
Published: April 2003

Background: The present study aimed to replicate the results of previous studies concerning the development of two versions of the Somatoform Dissociation Questionnaire. The SDQ-20 evaluates the severity of somatoform dissociative phenomena, and the SDQ-5 is a dissociative disorders screening instrument. Methods: Thirty-one patients with dissociative disorders and 45 consecutive psychiatric outpatients with other DSM-IV diagnoses completed the SDQ-20 and SDQ-5 as well as the Dissociation Questionnaire which measures psychological dissociation. Results: Mokken scale analysis showed that the items of the SDQ-20 are strongly scalable on a latent unidimensional scale. Internal consistency was high. The SDQ-20 convergent validity was supported by high intercorrelations with the DIS-Q. Dissociative patients obtained significantly higher scores than comparison patients. Patients with dissociative identity disorder scored significantly higher compared to patients with dissociative disorder nos. Sensitivity (94%) and specificity (98%) of the SDQ-5 were very satisfactory, as were, at an estimated prevalence rate of dissociative disorders of 10% among psychiatric patients, positive predictive value (84%) and negative predictive value (99%). Conclusions: All results replicated the first findings, and therefore corroborate the conclusion that the SDQ-20 and SDQ-5 are instruments of sound psychometric quality, and that somatoform dissociative phenomena are core symptoms of complex dissociative disorders.
Graphic Representation of Illness: A Novel Method of Measuring Patients’ Perceptions of the Impact of Illness
Authors: Büchi Stefan , Sensky Tom , Sharpe Louis , Timberlake Natalie
Published: April 2003

Background: Health outcome is multi-faceted, and for both research and clinical practice, greater knowledge of its facets is required. The Pictorial Representation of Illness and Self Measure (PRISM) was developed as a simple, rapid measure of the current impact of illness and symptoms on the individual. Methods: The PRISM task was completed by 26 outpatients with rheumatoid arthritis participating in a larger study of psychosocial correlates of arthritis, which included assessment of disease variables, functional impairment, pain, depression and patients’ appraisals of their illness. In the PRISM task, the patient was asked to imagine that a small board represents his/her life and a fixed disk on the board represents his/her ‘self’. The task was to place another (Illness) disk on the board to represent the current importance of illness in the patients’ life. The main outcome measure was the distance between the Self and Illness disks. Findings: Only 2 patients had difficulty understanding the task. PRISM distance did not correlate with any disease variables. It correlated inversely with pain, functional impairment and depression, and positively with coping resources. PRISM distance correlated with perceived control over illness and negatively with awareness of illness. Interpretation: PRISM is an innovative measure, simple and well accepted by patients. It appears to measure what in German is termed leidensdruck, the burden of suffering due to illness. It offers a promising measure of an intangible but important health outcome, hitherto neglected, applicable to research interventions and clinical practice.
Well-Being Therapy: Conceptual and Technical Issues
Authors: Fava Giovanni A.
Published: April 2003

Well-being therapy is a short-term, well-being-enhancing psychotherapeutic strategy. It is based on Carol D. Ryff’s multidimensional model of psychological well-being, encompassing environmental mastery, personal growth, purpose in life, autonomy, self-acceptance and positive relations with others. Its conceptual and technical issues are described. It may be applied as a relapse-preventive strategy in the residual phase of affective (mood and anxiety) disorders, as an additional ingredient of cognitive behavioral packages, in patients with affective disorders who failed to respond to standard pharmacological and psychotherapeutic treatments, in body image disorders and in psychosomatic medicine. The first validation studies appeared to be promising. The technique is in its preliminary stage of development and may undergo major changes in the next years. It is hoped it may herald a new trend of psychotherapy research and practice in the current symptom-oriented settings.
Dietary n–3 Polyunsaturated Fatty Acid and Status of Immunocompetent Cells Involved in Innate Immunity in Female Rats
Authors: Sasaki Taku , Kanke Yusuke , Kudoh Keita , Nagahashi Masahito , Toyokawa Maki , Matsuda Michiyo , Shimizu Jun , Takita Toshichika
Published: April 2003

The aim of this study was to estimate the contributions of dietary n–3 polyunsaturated fatty acid (PUFA), a representative dietary immunosuppressant, to the activity of both alveolar macrophages (AM) and natural killer (NK) cells, and compare them to those of n–6 PUFA. Twelve 5-week-old female Sprague-Dawley rats were divided into two dietary groups, one fed a 10% fat diet for 9 weeks enriched with n–3 PUFA (n–3 diet) and the other an n–6 PUFA (n–6 diet). AM reduced the release of nitric oxide, monocyte chemoattractant protein 1 and tumor necrosis factor α in the rats fed the n–3 diet, compared with rats fed the n–6 diet. NK cell activity was reduced by consumption of the n–3 diet. This study suggests that consumption of n–3 PUFA can ameliorate pulmonary inflammatory disorders which are affected by the reduction of not only proinflammatory cytokines but also chemokine released from AM.
Daytime Alertness, Mood, Psychomotor Performances, and Oral Temperature during Ramadan Intermittent Fasting
Authors: Roky Rachida , Iraki Leila , HajKhlifa Rachida , Ghazal Nouria Lakhdar , Hakkou Farid
Published: April 2003

During the month of Ramadan, Moslems abstain from drinking and eating daily between sunrise and sunset. This change of meals schedule is accompanied with changes in sleep habit, which may affect diurnal alertness. This study examined the effect of Ramadan intermittent fasting on the diurnal alertness and oral temperature in 10 healthy young subjects. The cognitive task battery including movement reaction time (MRT), critical flicker fusion (CFF) and visual analogue scale, was administered at 6 different times of the day: 09.00, 11.00, 13.00, 16.00, 20.00 and 23.00 h on the 6th, 15th, and 28th days of Ramadan. The baseline day was scheduled one week before Ramadan, and the recovery day 18 days after this month. Oral temperature was measured prior to each test session and at 00.00 h. During Ramadan oral temperature decreased at 09.00, 11.00, 13.00, 16.00 and 20.00 h and increased at 23.00 and 00.00 h. Subjective alertness decreased at 09.00 and 16.00 h and increased at 23.00 h. Mood decreased at 16.00 h. MRT was increased at the beginning of Ramadan (R6) and CFF was not changed. These results showed that daytime oral temperature, subjective alertness and mood were decreased during Ramadan intermittent fasting.
Effect of Increasing Sucrose Concentrations on Oral Lactic Acid Production
Authors: Linke Harald A.B. , Birchmeier Ruth I.
Published: April 2003

Oral lactic acid production was studied on 11 healthy dental student volunteers (5 males and 6 females) during clearance of five solutions containing 5, 10, 15, 20 and 30% of sucrose. Oral fluid samples were collected at times zero, immediately before taking the sucrose solutions (‘baseline’), and 15 min following intake of the solutions. The samples were analyzed qualitatively and quantitatively for the presence of lactic acid and remaining sugars using high-performance liquid chromatography (HPLC). Results indicate that the amount of lactic acid in oral fluid significantly increased with increasing sucrose concentrations, up to 15% sucrose. With the higher sucrose concentrations (20 and 30%) equivalent or lower amounts of lactic acid were obtained. The threshold level for maximum lactic acid production was found to be between 10 and 15% sucrose. Statistical analysis of the data (Student’s t test) indicated a significant difference in lactic acid production between the 5 and 10% sucrose solutions versus the 15, 20 and 30% sucrose solutions tested (p < 0.05). Clinical Significance: Ingestion of solutions with higher sucrose concentrations (>15%) produced similar amounts or less of lactic acid during oral clearance than solutions containing lower sucrose concentrations (<15%).
Bioavailability of n–3 Polyunsaturated Fatty Acids (PUFA) in Foods Enriched with Microencapsulated Fish Oil
Authors: Wallace J.M.W. , McCabe A.J. , Robson P.J. , Keogh M.K. , Murray C.A. , Kelly P.M. , Márquez-Ruiz G. , McGlynn H. , Gilmore W.S. , Strain J.J.
Published: April 2003

Objective: Incorporation of fish oil into food products provides a means of increasing n–3 fatty acid intake, particularly in populations where fish consumption remains low. The aim of the present study was to evaluate the bioavailability of n–3 PUFA in microencapsulated fish-oil-enriched foods compared with an equal amount of n–3 PUFAs contained in fish oil capsules. Methods: Twenty-five healthy female volunteers were randomly assigned to one of two groups for the 4-week intervention: one group received 0.9 g of n–3 PUFA/day as fish oil capsule (capsule group), while the second group (food group) received an equal amount of n–3 PUFA/day from enriched foods. Baseline and post-intervention samples were analysed for platelet fatty acid composition. Results: There was no significant difference in the change in platelet arachidonic acid (AA), eicosapentaenoic acid (EPA), or docosahexaenoic acid (DHA) between the two groups following the intervention. Conclusions: The results indicate that n–3 PUFA from microencapsulated fish-oil-enriched foods are as bioavailable as n–3 PUFA in a capsule. Fortification of foods with microencapsulated fish oil, therefore, offers an effective way of increasing n–3 PUFA intakes and status in line with current dietary recommendations.
Bioavailability of Folate from Processed Spinach in Humans
Authors: Castenmiller Jacqueline J.M. , van de Poll Charlotte J. , West Clive E. , Brouwer Ingeborg A. , Thomas Chris M.G. , van Dusseldorp Marijke
Published: April 2003

The effect of the food matrix and dietary fibre on the bioavailability of folate is not known. In a controlled, 3-week dietary intervention study, 28 men and 42 women were divided into six groups to receive either a control diet (n = 10), or the control diet plus 20 g/MJ per day (n = 12 per group) of whole-leaf spinach, minced spinach, liquefied spinach, or liquefied spinach to which dietary fibre (10 g/kg wet weight) was added. The sixth group received the control diet plus a synthetic carotenoid supplement with similar amounts of β-carotene and lutein as found in spinach. A significantly higher plasma folate response was found for the pooled spinach groups than for the control group. Among the spinach groups no significant differences were detected. However, the plasma folate response of the pooled minced and liquefied spinach groups was greater than that of the whole-leaf spinach group (p = 0.03). Re-addition of dietary fibre to the liquefied spinach to compensate for the fibre broken down during liquefaction did not reduce the plasma folate response. The consumption of the carotenoid supplement did not have an effect on plasma folate concentrations compared with the control group. The food matrix in which the folate is entrapped plays a role in folate bioavailability.
End-Stage Renal Interstitial Fibrosis in an Adult Ten Years after Ifosfamide Therapy
Authors: Friedlaender Michael M. , Haviv Yosef S. , Rosenmann Eliezer , Peylan-Ramu Nili
Published: April 2003

A 33-year-old male presented with end-stage renal failure. Renal biopsy showed severe interstitial fibrosis without glomerulopathy or vasculopathy. More than 10 years previously the patient had been successfully treated for recurrent rhabdomyosarcoma. The treatment included ifosfamide, a drug known to cause acute tubular dysfunction. Though a possible synergistic effect of previous radiation which was well within accepted tolerance limits cannot be excluded, it would appear that ifosfamide was almost certainly the major cause of the late onset chronic renal disease.
Appearance of Nephrotic Syndrome following Interferon-α Therapy in a Patient with Hepatitis B Virus and Hepatitis C Virus Coinfection
Authors: Endo Morito , Ohi Hiroyuki , Fujita Takayuki , Ohsawa Isao , Kanmatsuse Katsuo , Yamaguchi Yutaka
Published: April 2003

A 59-year-old woman with hepatitis B surface antigen (HBsAg) and hepatitis C viral (HCV) antibody presented with proteinuria and hematuria. The patient was treated with interferon-alpha (INF-α) because plasma aminotransferase levels had been elevated and a liver biopsy had showed chronic active hepatitis. Her urinary protein excretion decreased as liver function normalized and her serum HCV-RNA was negative during treatment. Eleven weeks after completion of INF-α treatment, she suddenly presented with nephrotic-range proteinuria, although an improvement in the hepatic function was maintained. Renal pathologic findings were consistent with membranous glomerulonephritis (MGN), and HBsAg was detected in the glomeruli but not HCV. After treatment with prednisolone, her 24-hour protein excretion was below 0.7 g/day. To our knowledge this is the first report on hepatitis B virus MGN with nephrotic syndrome following IFN-α therapy for HCV. This suggests that treatment with INF-α might affect the immune processes and may be associated with the pathogenic mechanism in this patient.
Use of Recombinant Erythropoietin in a Pregnant Renal Transplant Recipient
Authors: Thorp Micah , Pulliam Joseph
Published: April 2003

The use of recombinant human erythropoietin (rHuEPO) has been extensively studied among patients with anemia of chronic renal failure. Less well described is its safe use during pregnancy. We report a case of a 17-year-old gravid renal transplant patient with underlying renal insufficiency who became severely anemic and responded to rHuEPO. As the number of renal transplant recipients who become pregnant increases, the need for correction of anemia of chronic renal failure during pregnancy may rise as well. Our case illustrates the use of rHuEPO in this situation.
Effect of L-Carnitine and Palmitoyl-L-Carnitine on Erythroid Colony Formation in Fetal Mouse Liver Cell Culture
Authors: Matsumura Masami , Hatakeyama Syuichi , Koni Ichiro , Mabuchi Hiroshi
Published: April 2003

The administration of L-carnitine to patients undergoing hemodialysis increases hematocrit and improves the response to recombinant human erythropoietin (rhEPO). This suggests a contribution by carnitine to erythrocyte membrane function or erythropoiesis. We investigated the effect of L-carnitine and palmitoyl-L-carnitine on erythropoiesis by assessing erythroid colony formation in in vitro fetal mouse liver cell cultures. L-Carnitine or palmitoyl-L-carnitine was added with rhEPO to fetal mouse liver cell cultures. Doses of L-carnitine of up to 200 µmol/l to the culture had no effect on colony formation. In contrast, the addition of above 12.5 µmol/l palmitoyl-L-carnitine into the culture increased colony formation significantly. These results suggest that long-chain acyl carnitine may have an effect on erythropoiesis.
Glomerular Injuries – Excretion of Glomerular Epithelial Cells – Induced by Chemotherapy (Antineoplastic Drugs) Independent of Tubular Damage
Authors: Kakihara Toshio , Onozuka Junya , Hayakawa Hiroshi , Tanaka Atsushi , Uchiyama Makoto , Hara Masanori , Yanagihara Toshio
Published: April 2003

For the purpose of studying glomerular injuries induced by antineoplastic drugs, the excretion of glomerular epithelial cells (GEC) was evaluated. In 13 children who received antineoplastic drugs, the excretion of GEC in urine samples was examined with an immunofluorescent study using a monoclonal antibody directed against podocalyxin, which was expressed on glomerular epithelial cells. GEC were detected in 20 of 25 chemotherapy courses. The excretion of GEC persisted until the next chemotherapy course in some cases. After an initiation of chemotherapy an increased urinary albumin-creatinine ratio (more than 2-fold) was found in 6 patients. A significant increase of N-acetylglucosaminidase was observed in 2 patients. Proteinuria and hematuria were not observed in all patients. These results indicate that glomerular injuries are frequently induced by chemotherapy independent of the tubular damage. Repeated glomerular injuries may result in late renal dysfunction.
A Case of Mitochondrial Cytopathy with a Typical Point Mutation for MELAS, Presenting with Severe Focal-Segmental Glomerulosclerosis as MainClinical Manifesta tion
Authors: Kurogouchi Fumio , Oguchi Tomomasa , Mawatari Eiichirou , Yamaura Shuichi , Hora Kazuhiko , Takei Manabu , Sekijima Yoshiki , Ikeda Shu-ichi , Kiyosawa Kendo
Published: April 2003

A 27-year-old female with short stature and mild hearing loss was diagnosed as having focal-segmental glomerulosclerosis by renal biopsy at our hospital. One year later she developed progressive renal dysfunction and cardiac failure and was admitted again to our hospital for evaluation. Though her only neurological disorder was mild hearing loss, her short stature and elevated lactate and pyruvate values in cerebrospinal fluid suggested mitochondrial cytopathy. A muscle biopsy specimen of the left biceps brachii, using modified Gomori trichrome stain, showed a typical image of ragged-red fibers, and an increased number of giant mitochondria with paracrystalline inclusions were visible by electron microscopy. Mitochondrial DNA from the skeletal muscle showed an A-to-G transition at 3243 of transfer RNALeu(UUR), the common point mutation for mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes. These data confirmed the diagnosis of atypical mitochondrial cytopathy with renal and heart involvement. Mitochondrial cytopathies are often associated with hypertrophic cardiomyopathy but rarely with renal disease. Among the few reported cases with associated renal disease, most included renal tubular disorders; few cases with focal glomerular sclerosis are known. The present case of atypical mitochondrial cytopathy was characterized by a unique clinical course and rare complications with focal-segmental glomerulosclerosis.
Cerebral Tuberculoma 11 Years after Renal Transplantation
Authors: Mrowka Christian , Heintz Bernhard , Reul Jürgen , Sieberth Heinz-Günter
Published: April 2003

A case of cerebral tuberculoma in a 39-year-old patient who had received a renal graft from a living related donor 11 years previously is reported. The patient had a major seizure, progressive psychiatric signs and fever 5 days prior to admission. The clinical history suggested a neurological cause and rapid diagnosis of a cerebral tuberculoma was made by a computed tomography-guided stereotactic puncture of a space-occupying cerebral lesion. The aspirated pus contained Mycobacterium tuberculosis. Anti-tuberculous therapy with isoniacid, rifampicin, ethambutol and pyracinamide was administered. Transplant function deteriorated and the patient died due to intractable septicemia with multiorgan failure from pulmonary infection dissemination and additional urinary tract infection with atypical mycobacteria. The chance for a benign clinical course necessitates vigorous procedures for an early diagnosis of cerebral infections in renal transplant recipients with neurological/psychiatric signs.
Oxalate Kinetics and Reversal of the Complications after Orthotopic Liver Transplantation in a Patient with Primary Hyperoxalosis Type 1 Awaiting Renal Transplantation
Authors: Bastani Bahar , Mistry BhargavM. , Nahass GeorgeT. , Joh Jung , Dundoo Gayathri , Solomon Harvey
Published: April 2003

We present the case of a young woman with end-stage renal disease secondary to primary hyperoxaluria type 1, who after 3 years and 6 months of maintenance hemodialysis, and despite intensification of the dialytic treatment, developed severe livedo reticularis in her extremities leading to ischemic cutaneous ulcerations, necessitating continuous intravenous infusion of narcotics for pain control. She received a liver transplant after native hepatectomy. However, due to positive crossmatch, she could not receive a kidney from that donor. After transplantation, following serial serum oxalate levels, the hemodialysis regimen was safely reduced from 4 h daily to 3 h three times weekly. Over the course of 6 weeks after liver transplantation, her livedo reticularis resolved, the ischemic ulcers markedly improved, she was weaned off all pain medications, and her erythropoietin-resistant anemia resolved. Our results suggest that in patients with primary hyperoxaluria type 1, who have received a liver transplant and are on maintenance hemodialysis, after serial serum oxalate determinations, some may safely be changed to a thrice-weekly maintenance hemodialysis regimen. Moreover, with this regimen the complications of systemic oxalosis can reverse.
The Future of the Realm: Medicine and Divination in Ancient Syro-Mesopotamia
Authors: Mujais Salim
Published: April 2003

The contributions of Syro-Mesopotamian cultures to the understanding of illnesses and organ functions have been sought in examination of medical and therapeutic texts. These provide a wealth of knowledge on prevalent diseases and nascent empirical therapeutics. There are, however, other sources of information relevant to this topic that have not been as thoroughly explored. Examination of representative arts, for example, provides documentations of the breadth of anatomical knowledge in these cultures. Study of the omen literature is useful in illustrating beliefs in disease etiology as well as documentation of prevalent diseases and observations on anatomical variations. In the present article we explore the various sources for information relevant to the kidney and related diseases.
Gentile da Foligno, a Pioneer of Cardionephrology: Commentary on Carmina de urinarum iudiciis and De pulsibus
Authors: Timio Mario
Published: April 2003

Gentile da Foligno was an influential professor and teacher of medicine at the Universities of Bologna, Padua, Siena and Perugia in the first part of the 14th century. He was one of the first physicians to perform human dissection. He authored many important texts and commentaries, among which is the Consilla, a collection of therapeutic advices for many diseases. He made a commentary on Carmina de urinarum iudiciis (Songs of urinary judgements) and to De pulsibus (About pulses) composed by Egidius Corbaliensis. This work is more than a commentary: it is a text attempting to conceptualise the physiology of urine formation. According to his writing, urine associated to the blood passes ‘per poros euritides’ (through the porous tubules) of the kidney and is then delivered to the bladder. Commenting and explaining the writing on De pulsibus, he stressed the importance of heart disease on modulating the colour and output of urine and the relationship between fast pulse rate and urine output. For the originality of his thought and for the conceptualization of the relationship between pulse rate and urine characteristic, Gentile da Foligno could be indicated as the ‘first’ cardionephrologist in the history of medicine.
Bartolomeo Eustachio: A Pioneer in Morphological Studies of the Kidney
Authors: Mezzogiorno A. , Mezzogiorno V.
Published: April 2003

The morphological structure of the kidney only started being seriously investigated and truly understood in the 16th century, thanks mainly to Bartolomeo Eustachio. In his De Renibus, in fact, he painstakingly described the size, consistency, location and variations of the kidney, to which modern understanding can add very little. In describing the renal parenchyma he stated that it is made up of an external and an internal substance, and recognized the central role of the renal arteries in the excretory function of the kidneys. He made observations regarding the presence of extremely fine arteries that filter urine, the nature and function of the renal tubules and the columns of external substance that protrude between the papillae. There can be no doubt that Eustachio’s remarkable achievements made him a pioneer in morphological studies of the kidney.
Artificial Dialysis Membranes: From Concept to Large Scale Production
Authors: Vienken Jörg , Diamantoglou Michael , Henne Werner , Nederlof Bernd
Published: April 2003

The development of hemodialysis from an experimental concept to a routine medical therapy is closely related to research, manufacturing and availability of dialysis membranes. Collodion, a cellulose-trinitrate derivative, was the first polymer to be used as an artificial membrane and played a central role in further investigations and applications. Basic studies on the mechanism of solute transport through membranes, like diffusion, were done by A. Fick and T. Graham using collodion as a membrane material. In vivo dialysis in animals and humans was performed with collodion by J. Abel in the USA and G. Haas in Germany. Cellophane and Cuprophan membranes replaced collodion later, because of their better performance and mechanical stability. However, due to its alleged lack of hemocompatibility, membranes made from unmodified cellulose lost their market share. They have been replaced by modified cellulosic and synthetic dialysis membranes which show a better hemocompatibility than unmodified cellulose membranes. Most of the new membrane materials are also available in high-flux modifications and for this reason suitable as well for more effective therapy modes, such as hemodiafiltration and hemofiltration. The success of hemodialysis as a routine therapy is also the success of membrane development, because both, a reproducible membrane production and an unlimited availability of dialysis membranes have increased the number of dialyzed patients to about 1 million patients worldwide in 1999.
Effect of Usual Doses of Folate Supplementation on Elevated Plasma Homocyst(e)ine in Hemodialysis Patients: No Difference between 1 and 5 mg Daily
Authors: Spence J. David , Cordy Peter , Kortas Claude , Freeman David
Published: April 2003

Hyperhomocyst(e)inemia is a probable contributor to the excess atherosclerosis of patients with chronic renal failure on dialysis. Although treatment with folate 2 mg daily is usually effective in normalizing plasma homocyst(e)ine (H(e)) in patients with normal renal function, higher doses of folate or other approaches to treatment may be necessary in renal failure. There is no agreement among dialysis units regarding the ‘correct’ dose of folate supplementation; routine doses range from 1 to 5 mg daily. To determine whether one of these doses is more effective, we compared H(e) in 55 hemodialysis taking 1 mg folate versus 73 patients taking 5 mg folate daily at two dialysis units. In the group as a whole, mean H(e) was 28.23 ± 17.49, significantly higher than in a group of 290 volunteers with normal renal function 12.31 ± 6.17 (p = 0.0001). H(e) levels were 28.93 ± 16.79 μmol/l on 5 mg folate and 27.31 ± 18.49 on 1 mg; p = 0.61. There was no significant relationship between adequacy of dialysis (Kt/V) and H(e). In a small group of peritoneal dialysis patients, H(e) was significantly lower at 18.8 ± 7.89 (p = 0.026), but further study is required in a larger sample to confirm that observation. It appears that routine doses of folate in use in dialysis units are not sufficient to reduce H(e) to levels associated with average cardiovascular risk; new approaches to treatment of hyperhomocyst(e)inemia in dialysis patients are required.
Mesangial Cell Proliferation in Long-Term Streptozotocin-Induced Diabetes mellitus in the Rat and the Renoprotective Activity of Heparin
Authors: Gambaro Giovanni , D’Angelo Angela , Del Prete Dorella , Ceol Monica , Garbisa Spiridione , Bertaglia Giselda , Forino Monica , Baggio Bruno , Anglani Franca
Published: April 2003

At present, it is not clear whether mesangial proliferation underlies mesangial expansion in diabetic nephropathy. To address this issue and the relationship between heparin’s renoprotective and antimitogenic activities, we studied three streptozotocin-induced diabetic rat groups 5 and 12 months after diabetes induction: two groups were administered a modified heparin, each with a different protocol, and two healthy rat groups, one of which was treated with the same heparin, served as controls. Untreated diabetic animals developed clear evidence of nephropathy, namely expansion of the glomerular extracellular matrix, as expressed by glomerular basement membrane thickening, and increased mesangial deposition of type IV collagen. These alterations were prevented/cured by heparin treatment. Kidney sections were processed immunohistochemically for proliferating cell nuclear antigen and smooth muscle α-actin which is expressed only by proliferating mesangial cells. The number of proliferating cell nuclear antigen positive nuclei and α-actin-positive cells per glomerulus did not differ between groups at both 5 and 12 months. In conclusion, there is no evidence that mesangial proliferation is increased in late experimental diabetic nephropathy, and heparin seems to be renoprotective through mechanisms other than antiproliferation.
Intradialytic Dobutamine Therapy in Maintenance Hemodialysis Patients with Persistent Hypotension
Authors: Anand Urmila , Bastani Bahar , Dhanraj Padubidri , Ballal Sudarshan H.
Published: April 2003

Intradialysis hypotension is a common problem, especially in patients with poor left-ventricular function. We studied 6 patients who were on maintenance hemodialysis with left-ventricular ejection fraction of <40%, whose dialysis sessions were often complicated with severe hypotension (systolic blood presure <90 mm Hg). Dobutamine infusion during dialysis significantly reduced the number of hypotensive episodes, increased left-ventricular ejection fraction, and decreased the number of emergency admissions to the hospital.
Relapsing Membranous Nephropathy
Authors: Suki Wadi N. , Trimarchi Hernan , Frommer J. Pedro
Published: April 2003

Background: Although controversial, treatment of membranous nephropathy appears to yield a reduction in the degree of proteinuria and conservation of renal function. Methods: We report herein our experience with the treatment with steroids alone (group II, n = 13), or in combination with immunosuppressants (group III, n = 19) of patients with membranous nephropathy and the nephrotic syndrome, with a mean follow-up of 8.37 years. Results: All patients underwent a first remission, with 24-hour urine protein excretion falling to 0.63 ± 0.25 g in group II and 0.62 ± 0.26 g in group III (p = NS) after 12.69 ± 10.94 months of treatment in group II and 18.95 ± 13.17 months in group III (p = NS). Three patients from group II (23%) and seven patients from group III (36.8%) experienced four and eight relapses, respectively (proteinuria in 24 h 4.0 ± 0.80 g in group II relapsers and 4.4 ± 0.87 in group III relapsers; p = NS). On treatment, all relapses remitted (second remission) after 7 ± 6.93 months of therapy for group II and 8.6 ± 6.70 months of treatment for group III (p = NS). Thereafter, no patients from group II, but 3 patients from group III (33.3%) had a second relapse. After treatment, all relapses remitted (third remission) in 3.3 ± 1.53 months of therapy. Conclusions: These studies show that relapses, which occur in one-third of patients, respond favorably to treatment albeit remitting in approximately half the time, and that the duration of remission gets progressively longer in the later compared to the earlier remission.
Effect of Amlodipine Therapy on the Monoclonal Antibody 3G8-Induced Calcium Signal in Polymorphonuclear Leukocytes of Hemodialysis Patients
Authors: Ahmed Amina , Krol Ewa , Smogorzewski Miroslaw , Massry Shaul G.
Published: April 2003

Chronic renal failure is associated with impaired phagocytosis. This was attributed to the PTH-induced elevation of basal levels of [Ca2+]i of polymorphonuclear leukocytes (PMNLs) and to the small calcium transient induced by the ligation of the Fcγ RIII receptors of these cells with 3G8 monoclonal antibodies. The blocking of the action of PTH on the PMNLs of patients with chronic renal failure by their treatment with a calcium channel blocker normalized the basal levels of [Ca2+]i of the PMNLs and reversed the defect in their phagocytic property. It is not known whether such therapy would also restore the calcium transient in the PMNLs in response to 3G8 monoclonal antibody to normal. We examined this issue in 12 normal subjects and 18 hemodialysis patients; 9 of them were treated with the calcium channel blocker, amlodipine, and the other 9 did not receive such therapy. The treatment with amlodipine normalized [Ca2+]i of PMNLs as well as the calcium transient in response to 3G8 monoclonal antibody and reversed the defect in their phagocytosis. It is concluded that chronic renal failure is associated with deranged calcium homeostasis of PMNLs which causes abnormalities in the function of Fcγ RIII receptors and consequently results in impaired phagocytosis. Therapy with a calcium channel blocker can reverse all these derangements in metabolism and function of PMNLs.
Risk Factors for Hospitalization in Well-Dialyzed Chronic Hemodialysis Patients
Authors: Becker Bryan N. , Coomer Roger W. , Fotiadis Chris , Evanson James , Shyr Yu , Hakim Raymond M.
Published: April 2003

Background/Aims: Hemodialysis (HD) patients are hospitalized more frequently than patients with other chronic diseases, averaging 11.5 hospital days/patient/year. Hospital costs attributable to renal failure in the US exceed $2 billion per year. The present healthcare climate continues to force dialysis providers to focus on these issues in order to optimize patient care while limiting cost. Methods: We used a novel method for analyzing hospitalization risk, a multiple-event Cox proportional hazards model, to identify factors that influenced hospitalization in a HD unit population over a two-year period. This model allows individual patients to contribute multiple failure events to the model while controlling for the serial dependency of events. Results: 178 HD patients were retrospectively examined. There were 381 hospitalizations during the study period, averaging out to 1.9 hospitalizations and 10.5 hospital days/patient-year. Substance abuse and diabetes conveyed the largest risks for hospitalization (diabetes RR: 2.09; substance abuse RR: 2.24) in the study cohort, exposing the necessity for examining practice patterns and behavioral interventions as means for improving HD patient care. Conclusion: Despite the small numbers of patients in this single-center HD population, the model achieved adequate statistical power. Therefore, it has the potential to serve as a continuous quality improvement (CQI) tool in particular HD patient sub-groups, or in individual HD units.
Hyperfibrinogenemia Is an Independent Risk Factor for Atherosclerotic Renal Artery Stenosis
Authors: Park Jung Sik , Park Jee Hyun , Kang Jae Young , Yang Won Seok , Kim Soon Bae , Park Seong Wook , Park Seung Jung
Published: April 2003

It is important to identify patients at risk for atherosclerotic renal artery stenosis because renal artery stenosis is a progressive disease and a potentially correctable problem. To determine the risk factors for atherosclerotic renal artery stenosis, we performed renal arteriography at the time of cardiac catheterization in 270 patients (M:F, 193:77, mean age: 59 years) with clinical ischemic heart disease. Before the procedure, demographic data, medical history, physical findings and laboratory data were obtained. The degree of coronary artery stenosis and renal artery stenosis was quantified with automatic edge detection technique. Significant renal artery stenosis, defined as a narrowing of the diameter by more than 50%, was identified in 28 (10%) patients. Three patients (1%) had bilateral disease. Significant coronary artery disease, defined as a narrowing of the diameter by more than 50%, was present in 231 patients (85%). By univariate logistic regression analysis, older age (68 ± 8 vs. 58 ± 10 years), the presence of hypertension (61% vs. 38%), the extent of coronary artery disease, a high fibrinogen level (391 ± 93 mg/dl vs. 335 ± 109 mg/dl), a low albumin level (3.9 ± 0.4 g/dl vs. 4.1 ± 0.4 g/dl), and a low hemoglobin level (12.5 ± 1.6 g/dl vs. 13.5 ± 1.6 g/dl) were associated with the presence of renal artery stenosis (p < 0.05). Serum lipids, lipoprotein(a), creatinine, sex, smoking, or diabetes were not associated. By multivariate logistic regression analysis, older age (OR: 2.43 analyzed by 10 years increment, p = 0.0001), the presence of hypertension (OR: 2.68, p = 0.039) and a higher fibrinogen level (OR: 1.63 analyzed by 100 mg/dl increment, p = 0.038) were significant risk factors of renal artery stenosis. Fibrinogen level was negatively correlated with albumin level (r = –0.18, p = 0.004). These results suggest that hyperfibrinogenemia as well as old age and hypertension are independent risk factors for atherosclerotic renal artery stenosis.
Urea Kinetics with Dialyzer Reuse – A Prospective Study
Authors: Sridhar Nagaraja Rao , Ferrand Kathleen , Reger Deborah , Hayes Patrick , Pinnavaia Leah , Butts Dewey , Kohli Romesh , Papandenatos George
Published: April 2003

We performed a prospective study to examine the impact of dialyzer reuse on KT/V under rigidly standardized conditions on 3 membrane types. Heparin dosage was standardized with ACT during an eight week run-in period and remained unchanged through the study. Post dialysis BUN and weight were obtained at five minutes after exactly 80 ± 0.5 l of blood were processed through the dialyzer. Dialyzers were reused after automated glutaraldehyde processing and after ensuring >80% open fiber bundles. Each membrane type was utilized 3 times on a set of 3 patients; each individual dialyzer was reused 8 times. KT/V was done on the 1st, 2nd, 4th and 8th uses of each dialyzer (36 measurements) starting mid week; BUN measurements were grouped. The KT/V (mean ± SD) for the 1st, 2nd, 4th, and 8th uses of the cellulose acetate dialyzer were 1.3 ± 0.2, 1.3 ± 0.3, 1.3 ± 0.2, 1.3 ± 0.2 respectively; the corresponding values of the cuprophane dialyzer were 1.4 ± 0.3, 1.4 ± 0.3, 1.3 ± 0.4, 1.3 ± 0.3 respectively; and those of the polysulfone dialyzer 1.7 ± 0.3, 1.6 ± 0.2, 1.6 ± 0.2 respectively. By a 3 way ANOVA there were no significant differences between the 1st and subsequent uses of any of the dialyzers tested. Conclusions: Reuse of dialyzers up to 8 times does not result in a loss of urea clearance. We believe this model is useful for further studies on reuse and quality assurance.
Renal Myofibroblasts Contract Collagen I Matrix Lattices in vitro
Authors: Kelynack Kristen J. , Hewitson Tim D. , Pedagogos Eugenia , Nicholls Kathy M. , Becker Gavin J.
Published: April 2003

Myofibroblasts, cells with both fibroblastic and smooth muscle cell features, have been implicated in renal scarring. In addition to synthetic properties, contractile features and integrin expression may allow myofibroblasts to rearrange and contract interstitial collagenous proteins. Myofibroblasts from normal rat kidneys were grown in cell-populated collagen lattices to measure cell generated contraction. Following detachment of cell populated collagen lattices, myofibroblasts progressively contracted collagen lattices, reducing lattice diameter by 42% at 24 h. Alignment of myofibroblasts, rearrangement of fibrils and β1 integrin expression were observed within lattices. We postulate that interstitial myofibroblasts contribute to renal scarring through manipulation of collagenous proteins.
Early Posttransplant Lymphoproliferative Disorder Presenting with Ureteric Obstruction in En Bloc Kidneys
Authors: AlShaibani Khalid M. , AlMeshari Khalid A. , Raza Syed M. , AlFurayh Osman , Mourad Waleed A.
Published: April 2003

We describe a female patient who received double pediatric (en bloc) kidney transplants. She presented initially with fever of unknown origin 3 months after transplantation; 5 months after surgery, she presented with obstruction of one ureter followed by obstruction of the other. After 9 months she developed posttransplant lymphoproliferative disorder in both kidneys. To our knowledge, this is the first case report of this disorder occurring in en bloc kidneys and presenting with bilateral ureteric obstruction.
Low Doses of Liquorice Can Induce Hypertension Encephalopathy
Authors: Russo S. , Mastropasqua M. , Mosetti M.A. , Persegani C. , Paggi A.
Published: April 2003

Prolonged ingestion of liquorice is a well-known cause of hypertension due to hypermineralocorticoidism. We describe 2 cases of hypertension encephalopathy (in addition to the classical symptoms of hypertension, hypokalemia and suppression of the renin-aldosterone system) which resulted in pseudohyperaldosteronism syndrome due to the regular daily intake of low doses of liquorice. Glycyrrhizic acid, a component of liquorice, produces both hypermineralocorticism and the onset of encephalopathy through the inhibition of 11β-hydroxysteroid dehydrogenase. Hypertension encephalopathy due to the daily intake of low doses of liquorice, however, has not been previously documented. It is proposed that some people could be susceptible to low doses of glycyrrhizic acid because of a 11β-hydroxysteroid dehydrogenase deficiency.