bluuebunny/crossref_metadata_2025 huggingface dataset:
Allocare in a Nocturnal Primate: Data on the Spectral Tarsier, Tarsius spectrum
Authors: Gursky Sharon
Published: April 2003

Non-maternal infant care in many of the small-bodied New World primate species has been hypothesized by some researchers to be related to the high infant/adult weight ratio found in these species. The spectral tarsier, Tarsius spectrum, an Old World primate, has one of the highest infant/adult weight ratios of any primate, with infants weighing between 20–33% of adult weight at birth. On the basis of the hypothesized relationship between allocare and the infant/adult weight ratio, it is predicted that the spectral tarsier will also exhibit extensive allocaretaking behaviour. The results of this study indicate that although spectral tarsiers show care by male and female subadults as well as adult males, it is extremely limited compared to the extensive allocaretaking behavior observed in New World primate species such as Aotus and Callicebus. Spectral tarsier subadult females provide substantially more allocare to infants than do subadult males or adult males. Female subadults were observed sharing food, transporting, grooming, playing, alarm calling, baby-sitting and maintaining physical contact with infants more than other age/sex classes. Although the amount of allocare exhibited by adult males and subadult males was much less than that exhibited by female subadults, the data suggest that adult and subadult male spectral tarsiers do play a small part in the care and socialization of the infant. Adult males and subadult males were both observed occasionally engaging in allocaretaking behaviors such as grooming and playing, as well as frequently patrolling and defending the territory’s boundaries. The results from this study suggest that although a high infant/adult weight ratio may be a prerequisite for selection to favor extensive allocare, it is not a causal factor. Additional research is needed in order to understand better the selective pressures involved and the costs and benefits of providing allocare to subadults and adult male spectral tarsiers.
Age Differences in Decision Making: To Take a Risk or Not?
Authors: Dror Itiel E. , Katona Michelle , Mungur Krishna
Published: April 2003

A controlled laboratory experiment was used to assess the efficacy of the cognitive processes that underlie risk taking decision making in young and elderly people. Thirty-six participants took part in the study; half the subjects were elderly (mean age of 74) and the other half were young adults (mean age of 19). The elderly participants made equivalent decisions to those of the control young adults. Both age-groups of participants systematically and comparably changed their behavior as a function of risk levels. Furthermore, the elderly participants, relative to young adults, did not exhibit any slowing down in the speed of processing the information involved in making risk taking decisions, reflecting that healthy elderly people are cognitively apt to making risk taking decisions. Both age-groups took comparably less time on the easy trials (trials with either low or high levels of risk) and comparably more time on the difficult trials (trials with medium levels of risk).
Relationship between Hypertension and Renal Function and Its Therapeutic Implications in the Elderly
Authors: Fliser Danilo , Ritz Eberhard
Published: April 2003

The kidney is an important target of hypertension-induced organ damage. Recent long-term observation studies have documented that in individuals, without primary chronic renal disease, a very significant relationship exists between hypertension and impaired renal function, elderly hypertensives having a particularly worse prognosis. The hallmark of hypertensive renal injury is thought to be a progressive increase in intrarenal vascular resistance. The alterations in renal hemodynamics are accentuated in elderly patients with essential hypertension, pointing to a greater vulnerability of the senescent kidney to superimposed injury such as high blood pressure. Treatment of elevated blood pressure in the elderly therefore not only reduces cardiovascular morbidity and mortality, but also reduces the incidence of renal failure as a consequence of hypertension-induced damage.
Enlarging Effects of Estradiol on the Nuclear Volume of Neurons in the Hypothalamus during Aging
Authors: Hsu Chin , Yang Shaw-Lang , Hsieh Ya-Lun , Lue Seng-I , Hsu Hseng-Kuang , Peng Ming-Tsung
Published: April 2003

Neuronal nuclear volumes (NNVs) were measured in the medial preoptic nucleus (MPN), anterior hypothalamic area (AHA) and arcuate nucleus (ARN) of young adult, middle-aged, and old rats of both sexes. The NNVs in the darkly stained sexual-dimorphic nucleus of the preoptic area (SDN-POA) and the lighter staining surrounding area (non-SDN-POA) within the MPN were measured separately. Intact young and middle-aged female rats had larger NNVs than those of the males in SDN-POA, non-SDN-POA and AHA but not in ARN. During aging, only intact old female rats manifested significant NNV shrinkage in all the measured areas. Long-term treatment with estradiol benzoate (EB) caused a significant enlargement of the NNVs in non-SDN-POA and ARN of middle-aged and old male rats as well as the NNVs in SDN-POA, non-SDN-POA and ARN of old female rats. The enlarging effect of EB on NNVs in both SDN-POA and non-SDN-POA of female rats could be prevented by ovariectomy. Furthermore, NNVs in SDN-POA and non-SDN-POA of ovariectomized female rats were even smaller than those of the age-matched intact female rats. These results indicate that: (1) the NNVs of MPN and ARN in male and female rats were enlarged after long-term exposure of physiological dose of estradiol; (2) the enlarging effects of EB on NNV in MPN can explain why the NNV of intact female rats is larger than that of males, and (3) during aging, the sex-specific shrinkage of NNVs in MPN, AHA and ARN of female rats may be due to an intrinsic aging process rather than long-term effects of EB.
Psychoneuroimmunology and Aging
Authors: Guidi Luisa , Tricerri Augusto , Frasca Daniela , Vangeli Marcello , Errani Andrea R. , Bartoloni Carlo
Published: April 2003

Background: The senescence of the immune system is a complex phenomenon, characterized by impairment of several lymphocyte activities and generally considered a state of immune dysregulation. Aging is a condition associated with many social changes likely to induce psychological stress, which is often perceived as uncontrollable and can lead, in some cases, to clinically relevant depression. In the recent years a growing interest has been raised for the study of bidirectional interactions between the central nervous system and the immunological network (psychoneuroimmunology). Objective and Methods: We analyzed the possibility that chronic psychological distress and depression could worsen some immune functions in the aged. We postulate the neuroendocrine mechanisms of psychoimmune interaction, analyzing both the human and animal studies focused on aging. Results: The data from the literature reviewed suggest a significant impact of affective disorders on immune functions in the elderly subjects. This psychoimmune imbalance appears particularly important when the studies are carried out in otherwise healthy aged people. Conclusions: Here we reviewed the relationships between psychological stress and depression and immunological functions, with particular regard to those aspects pertinent to the aging process. The clinical relevance of these interactions remains to be elucidated, but the high frequency in the aged of autoimmune, infectious, and neoplastic diseases suggests to focus on the psychoneuroimmune interactions in the old age. We also propose some outlines for future studies concerning psychoneuroimmunology and aging.
Evolutionary Theories of Aging: Handle with Care
Authors: Le Bourg Eric
Published: April 2003

Background: Evolutionary theories are considered by a growing number of gerontologists as providing a basis to understand why aging occurs. Objective: In such conditions, a risk could exist to favor evolutionary explanations rather than nonevolutionary ones, even when both equally fit the data. Methods: A paper recently published on longevity in ants is analyzed, and a study of fertility and longevity in human beings is done to illustrate this risk. Results: In the two cases, evolutionary and concurrent hypotheses may apply to the same data. Conclusions: When both kinds of explanations may be applied, the way to solve the problem is not to favor one explanation by relying on a priori preferences, particularly if the favored hypothesis is still controversial.
A Neuropathological Study of Dementia in Nursing Homes over a 17-Year Period, in Shimane Prefecture, Japan
Authors: Seno H. , Ishino H. , Inagaki T. , Iijima M. , Kaku K. , Inata T.
Published: April 2003

Background: In Japan, vascular dementia (VD) has been responsible for the majority of all dementia cases in both epidemiological and neuropathological studies. Recently, however, several epidemiological investigations have shown that the rate of VD has decreased and senile dementia of the Alzheimer type (SDAT) is now the major cause of dementia, though few neuropathological investigations show that the majority of dementia is SDAT. Objective: The purpose of the study was to clarify the rates of dementia types in Japanese nursing home residents and to compare the ratio of SDAT to VD in the first and second halves of the study. Methods: One hundred and twenty-two demented nursing home residents (48 men and 74 women) were evaluated neuropathologically over a period of 17 years in Shimane prefecture, Japan. All subjects died between 1976 and 1992. The average age at death was 81.4 ± 9.4 years for men, 85.0 ± 7.2 for women and 83.6 ± 8.3 for total samples. Results: In classifying dementia type, SDAT accounted for 34% (41 cases); VD 35% (42); mixed dementia 11% (14); and ‘other’ dementia 20% (25) of all samples. Comparison of the first 9-year period with the second 8-year period revealed the ratio of SDAT to VD tended to increase (from 0.83 to 1.15). This increasing tendency was found both in men (from 0.53 to 0.7) and in women (from 1.13 to 1.44). These tendencies, however, were not statistically significant. Conclusion: There was no change statistically in the ratio of SDAT to VD between the first half of the study and the second half. However, there was an increasing tendency of the ratio in our study.
Age-Related Changes on Glucose Transport and Utilization of Human Erythrocytes: Effect of Oxidative Stress
Authors: Güven Mehmet , Özkılıç Alper , Kanıgür-Sultuybek Gönül , Ulutin Turgut
Published: April 2003

Background: Normal aging is associated with an impairment in glucose homeostasis. Methods: In order to investigate the effect of aging on glucose transport and utilization in erythrocytes, the transport and utilization of glucose were measured in erythrocytes from 10 young (mean age 26 ± 3 years) and 10 elderly (mean age 70 ± 7 years) healthy individuals. In addition, the glucose transport and utilization were also measured in the presence of cumene hydroperoxide (CumOOH), a toxic organic hydroperoxide that is known to induce oxidative stress. Results: The levels of glucose transport and utilization were significantly lower in the elderly group than the young group (p < 0.05). The glucose transport and utilization were not altered by CumOOH treatment in either young or elderly individuals. Conclusion: These results indicate an age-related decrease in the both glucose transport and utilization in erythrocytes.
Age-Related Change in Peripheral Nerve Conduction: Compound Muscle Action Potential Duration and Dispersion
Authors: Kurokawa Katsumi , Mimori Yasuyo , Tanaka Eiji , Kohriyama Tatsuo , Nakamura Shigenobu
Published: April 2003

Background: We investigated the effect of age on nerve conduction parameters with special reference to the compound muscle action potential (CMAP) duration and duration ratio. Method: We examined 295 subjects (aged 15–85 years old) with no previous history or present signs of peripheral neuropathy. The subjects were divided into 3 groups: young (15–34 years old); intermediate (35–64 years old), and old (65–85 years old). Results: CMAP amplitude was lower in the old group than in the young group; however, the CMAP ratio (proximal CMAP/distal CMAP) did not change with age. The CMAP duration and duration ratio did not differ among the 3 groups. The CMAP area was smaller in the old group, but the area ratio was almost constant among the 3 groups. Conclusion: We suggest that age-related changes in CMAP amplitude, duration or area may occur uniformly, at least in the forearm and the calf segment, in routine nerve conduction studies. The present findings also provide useful and reliable information, regardless of age, in diagnosing peripheral neuropathy.
Quality of Life Determinants and Hearing Function in an Elderly Population: Osservatorio Geriatrico Campano Study Group
Authors: Cacciatore Francesco , Napoli Claudio , Abete Pasquale , Marciano Elio , Triassi Maria , Rengo Franco
Published: April 2003

Background: Hearing impairment (HI) is a very common condition in elderly people and the epidemiology together with hearing-related problems is still poorly investigated. Moreover, the cognitive status may be impaired in relation to hearing function. Objective: The goal of the study was to evaluate: (a) the prevalence of HI in a random sample of elderly people aged 65 and over (n = 1,750) living in Campania, a region of southern Italy; (b) the cross-sectional relationship between hearing function and cognitive status and also depressive symptomatology and disability, and (c) to assess the role of hearing aids on depressive symptomatology. Methods: Cross-sectional study on a random sample of elderly population. Results: The overall participation rate in the study was 74.8% (n = 1,332, mean age was 74.2 ± 6.4 years). The prevalence rate of HI (evaluated by questionnaire) was 27.2%, cognitive impairment prevalence (evaluated by the Mini-Mental State Examination (MMSE)) was 27.9%, mean depressive symptomatology score (evaluated by Geriatric Depression Scale (GDS)) was 11.4 ± 6.6, while disability assessed by Activity of Daily Living (ADL) was present in 7.0% of the whole population. A strong relationship was found between both decreasing hearing function and MMSE decline, independently by the effect of age and education (r = 0.97; p < 0.01). A positive relationship (r = 0.85; p < 0.01) between GDS score and hearing function was also found. Moreover, at an increased level of hearing loss, a lower ADL score was recorded (r = 0.98; p < 0.01). Finally, the use of hearing aids reduced GDS score. In logistic regression analysis, gender, age and educational level indicate that hearing loss risk increased with age (odds ratio 1.60; 95% confidence interval 1.53–1.71), whereas education plays a protective role (odds ratio 0.75; 95% confidence interval 0.72–0.80). Conclusion: HI is very prevalent among elderly people and is associated with either cognitive impairment and/or depression and reduction of functional status. This study suggests that hearing aids may protect against cognitive impairment and disability, improving quality of life of aged people.
Senile Tremor
Authors: Louis Elan D. , Wendt Kristin J. , Ford Blair
Published: April 2003

Background/Setting: It is well recognized that mild tremor is common among older adults, but the prevalence and clinical characteristics of this tremor have not been studied in detail. Objectives: To examine a cohort of normal older adults to: (1) ascertain the prevalence of mild test-detectible tremor; (2) quantify the severity and functional impact of this tremor, and (3) determine whether age, gender and concomitant illness predict the severity of tremor. Participants: 76 normal older adults >55 years of age (mean age = 73.7 years). Design: Healthy older adults were identified in a community-based case-control study of essential tremor in Washington Heights-Inwood, New York. All subjects underwent a medical interview and a videotaped neurological examination. The examination included six tests: arm extension, pouring water, drinking water, using a spoon, finger-to-nose movements, and drawing spirals with each arm. Two neurologists rated the severity of tremor using a 0 to +3 clinical rating scale and a total tremor score (TTS) was calculated (range = 0–36). Forward stepwise linear regression was used to determine the association between TTS and other variables. Results: Virtually all (75 or 98.7%) showed signs of tremor (TTS > 0.5). The mean TTS = 6.3 (range = 0–14.5), corresponding to a tremor that was either mild or intermittent. Twenty-eight of 76 (36.8%) received tremor ratings of +2 (clearly oscillatory tremor of moderate amplitude and usually present) during at least one of the six tests; a tremor rating of +2 was 2.1 times more likely to occur in the nondominant than in the dominant hand. Those who were aged 57–74 years had a lower mean TTS (5.8) than those aged 75–93 (6.8), but this was not significant. Only 2 patients (2.6%) answered ‘yes’ to the question ‘do you have uncontrollable shaking in your hands?’ None was taking medication to treat tremor. Gender, ethnicity, concomitant illness (diabetes, arthritis, heart disease), and medications were not associated with a higher TTS. Conclusion: Mild but test-detectible tremor was present in almost all normal older adults, and in one-third this tremor attained a moderate amplitude during at least one activity. Characterization of this tremor would be of value to practitioners who care for older adults.
Pancreas and Aging: A Study Using Ultrasonography
Authors: Glaser J. , Stienecker K.
Published: April 2003

Background: The pancreas undergoes a continuous aging process leading to alterations such as atrophy, fatty infiltration and fibrosis. Objective: The aim of this study was to determine the normal ultrasonic aspect of the pancreas and any relationship to age with special regard to pancreatic echogenicity and pancreatic duct diameter. Methods: In the study on pancreatic echogenicity 131 patients (56 male, 75 female), aged 18–92 (median 52) years, with normal weight were examined prospectively. The echogenicity of the pancreas was compared with the normal liver and divided into four different categories. The prospective investigation into any age relationship of pancreatic duct diameter was performed on 101 patients (44 male, 57 female), ages 18–91 (median 53) years, with normal weight. In both studies, the patients were split into seven age groups. For statistical analysis the chi-square test for independence was used. Results: With advancing age, ultrasonography demonstrated an increasing echogenicity of the pancreas, beginning in the 4th decade of life. Most patients over 50 years, and all patients over 80 had a marked echogenicity, distinctly higher than that found in the liver. The mean pancreatic duct diameter of all patients in the second study was 1.9 mm. Younger subjects had a smaller diameter – average 1.5 mm in the group 18–29 years – but with advancing age a distinct duct enlargement was observed: mean 1.9 mm in the group 40–49 years, mean 2.3 mm in patients over 80 years, but not exceeding 3 mm. Conclusion: On ultrasonography, the aging process of the pancreas leads to an increase of echogenicity. In the aged, a very high echogenicity is a normal ultrasonic finding. The pancreatic duct diameter also increases with advancing age. Even in advanced age, a diameter of more than 3 mm, however, should be regarded as a pathological finding.
Initial Symptoms of Parkinson’s Disease with Elderly Onset
Authors: Nagayama Hiroshi , Hamamoto Makoto , Nito Chikako , Takagi Shin-ichi , Miyazaki Tokuzo , Katayama Yasuo
Published: April 2003

Background/Objective: As the incidence of Parkinson’s disease (PD) is related to aging, we consider it important to determine how the initial symptoms change with age in order to diagnose early elderly cases of PD accurately. Methods: 84 patients (age at onset 70.7 ± 9.0 years; mean ± 1 SD) were studied to see whether the initial symptoms change according to age. Results: The prevalence of resting tremor was significantly lower in patients of advanced age (p = 0.041). In contrast, the incidence of postural and gait disorders increased significantly with aging (p = 0.032). The prevalences of rigidity and kinetic disorders, which are important clinical features of PD, were not influenced by aging. Conclusion: These findings suggest that the cause of PD is not related to the aging process itself, since the prevalences of all symptoms were not influenced by aging. Knowledge of the prevalence of the inital symptoms of PD may contribute to the accurate diagnosis in early and elderly cases.
Falls on Integrated Medical Wards
Authors: Vassallo Michael , Amersey Rajiv A. , Sharma Jagdish C. , Allen Stephen C.
Published: April 2003

Background: An effective approach to fall prevention should involve an assessment of environmental as well as patient-related characteristics. Objective: To study the effect of age and ward design on fall characteristics among medical inpatients. Methods: In a prospective open observational study over 1 year, we studied falls on three medical wards. Wards A and B are nuclear designed, and C is longitudinal. Results: We recorded 199 falls involving 167 fallers. Fifty-four (27.1%) involved patients under 65 years. Most falls were intrinsic (60.8%) and involved elderly male patients (male/female ratio 97/48 vs. 24/30; p = 0.009). We identified no age differences in relation to location, activity, preceding fall, classification, time, consequences, and intervention required. On ward C, most falls occurred in the bed areas (bays and cubicles), but on wards A and B a higher proportion occurred in bathroom, corridor, and dayroom (C vs. A/B 87.9 vs. 73.7/62.0%; p = 0.04/p = 0.004). On ward C, activities of daily living around the bed significantly preceded falls (C vs. A/B 44.6 vs. 25.9/24.1%; p = 0.03/p = 0.01). Most falls were unwitnessed (C vs. A/B 10 vs. 21/20; p = 0.002/p = 0.0009). Conclusions: Intrinsic falls are the commonest; however, differences exist in fall demographics between wards, and this must be recognized to enhance the effectiveness of fall prevention programmes.
Audiometric and Epidemiological Analysis of Elderly in the Veneto Region
Authors: Megighian David , Savastano Marina , Salvador Lara , Frigo Anna , Bolzan Mario
Published: April 2003

Background: Presbyacusis, or age-related hearing loss, has become a problem of increasing social interest due to the rise in the mean age of the population. Investigations performed to date have generally been carried out with the aid of self-reporting questionnaires, without the support of objective findings. Objective: The purpose of this study was to analyze an extensive series of elderly people from different areas of the Veneto region to obtain an epidemiological descriptive analysis, as detailed as possible, of their presbyacusis, considering their hearing thresholds at various frequencies, distinguishing findings according to sex and age in classes and the geographical area where the survey was performed. Methods: The survey was carried out collecting information from the audiometric reports on 13,710 subjects of both sexes aged 60 years and over, with a proportion of males (M/F × 100) of 92.02%, referred spontaneously for hearing examination to the ENT departments of eight hospitals between 1986 and 1994. The catchment area includes three provincial capitals and five mainly rural municipalities. Results: The results show that the hearing threshold rises progressively with age in both sexes. The hearing loss is milder in women than in men, especially at the higher frequencies. No important differences emerged among findings recorded in their 80s and in their 90s or among findings in the different geographical areas considered. Conclusions: Statistical descriptive analysis confirms the typical trend of the audiometric curve in presbyacusis, tracing the typical audiometric curve of old age described in the literature. The mean values of the audiometric curve reveal no significant differences between people residing in the country and people living in the cities.
Role of Physical Activity Training in Attenuation of Height Loss through Aging
Authors: Sagiv Michael , Vogelaere Peter P. , Soudry Michael , Ehrsam Rolf
Published: April 2003

Background: Although the genetic contribution to variability in bone mass has been estimated to be as high as 80%, evidence continues to accumulate suggesting that factors such as physical activity can influence bone mass which may avoid compression of the vertebrae leading to slower stature decline with age. Objectives: This study examines whether regular exercise has the potential of positively affecting the aging process with regard to height loss. Methods: The height of 957 females and 1,088 males who were 35–55 years of age in 1965 were measured again in 1995. Based on a questionnaire, the subjects were divided into four groups. Group A (80 females, aged 73.2 ± 6 years, and 141 males, aged 72.1 ± 5.7 years) represented subjects who were engaged in moderate vigorous aerobic activity throughout their lives; group B (95 females, aged 73.6 ± 5.5 years, and 207 males, aged 71.7 ± 6.1 years) were subjects who started their moderate vigorous aerobic activity around the age of 40 and kept their activity until the present time; group C (362 females, aged 73.2 ± 5 years, and 390 males, aged 71.1 ± 6 years) were persons who were active as young adults, but did not continue to exercise, and group D (425 females, aged 72.8 ± 5.3 years, and 350 males, aged 70.9 ± 6.1 years) were subjects who had not exercised regularly throughout their lives. Results: All subjects lost height due to aging. However, significant (p < 0.05) differences in rate of height loss were found among the A, B, C, and D groups: for females 3.4 ± 0.7, 3.5 ± 0.8, 6.0 ± 0.5, and 6.5 ± 0.7 cm, respectively; for males 2.6 ± 0.5, 3.1 ± 0.4, 5.3 ± 0.4, and 5.5 ± 0.5 cm, respectively. In addition, the females’ height loss rate was significantly (p < 0.05) higher than that of the males in all four activity categories. Conclusions: These data suggest that lifelong moderate endurance training, especially after the age of 40 years, is associated with attenuation of height loss in both sexes. However, the magnitude of the attenuation is significantly higher in males.
Sleep Patterns and Mortality among Elderly Patients in a Geriatric Hospital
Authors: Manabe K. , Matsui T. , Yamaya M. , Sato-Nakagawa T. , Okamura N. , Arai H. , Sasaki H.
Published: April 2003

Background: Sleep disturbance is one of the major and unsolved problems in older people. Most of the previous sleep studies rely on self-reported documents, and memory disturbance in older people might bias sleep complaints and health status. Objective: Sleep disturbances were studied as a mortality risk. Methods: In 272 patients who were aged, infirmed and chronically institutionalized in a skilled-care geriatric hospital, the presence or absence of sleep disturbances were examined by hourly observations of patients over 2 weeks at baseline, and they were prospectively followed up for 2 years to assess mortality. Results: Mortality after 2 years was significantly higher in the nighttime insomnia, daytime sleepiness, and sleep-onset delay groups. Further, adjusted for age, gender and activities of daily living status, the presence of nighttime insomnia and sleep-onset delay remained associated with a higher risk of mortality. Conclusion: Sleep disturbance may be one of the symptoms indicating poor health or functional deficits, and be an independent risk factor for survival.
Aging and Carcinogenesis – Insufficient Metabolic Cell Repair as the Common Link
Authors: Baramiya M.G.
Published: April 2003

Background: The mechanisms of the development of cancer in old age and also the mechanisms of aging are not well understood. This paper tries to interpret consequences of malignant tissue transformation from the viewpoint of aging, or in other words, from an insufficient cell adaptation to the needs of repair and proliferation. Subject: A hypothesis is presented that a unified but quite opposite at different stages of ontogenesis mechanism is the basis of atypical growth and embryonic development. In the beginning of a malignant dedifferentiation is an insufficiency of an effective self-renovation and disturbed preservation of its adaptation capability. The suppression of regenerating cell proliferation is the primary event of the development of a dedifferentiated tissue growth. The transformation of normal cells into tumor cells is an adaptive reaction in reply to a shortage of self-regeneration capability and repair. Allowing for the process of rebirth, i.e. the complete restoration of tissues leading to the restrain of senescence proceeds by the type of embryonic growth of tissues, the possibility to use the potential of transformed cells for restraining senescence is proposed. The latter will permit to direct the process of transformation to an integrated growth channel, to prevent the clinical phenomenon of malignancy, and use the potential of transformed cells for realization of the self-renovation program and program of unlimited life duration of the whole organism. Conclusion: By a stimulation or compensation of the age-induced shortage of cell metabolism, two effects can be expected: prevention of cancer and retardation of aging.
Prädiktion der Präeklampsie: neue Hypothesen, neue Ansätze
Authors: Müller Hannes M. , Widschwendter Martin , Mörtl Manfred G. , Schröcksnadel Hans
Published: April 2003

Die Präeklampsie ist eine Multiorganerkrankung, die bei 5,8% aller Erstgebärenden auftritt. Die Krankheit zeigt einen progressiven Verlauf mit sehr unterschiedlichen Symptomen und einer variablen Progressionsrate. Hypertonie und schwangerschaftsinduzierte Proteinurie sind die klassischen Manifestationen. Die Krankheit verursacht schwere Komplikationen bei Mutter und Fetus. Es gibt weder Prädiktionsfaktoren noch Präventions- und Therapiestrategien. Die bisherigen Ergebnisse deuten entschieden darauf hin, dass ein gänzliches Ausbleiben oder eine nur unvollständige Invasion von Trophoblastzellen (Ende des 1., Beginn des 2. Trimenons) in die Spiralarterien, was deren Verengung und Schäden am Endothelium zur Folge hat, für das Auftreten dieser Krankheit (3. Trimenon) verantwortlich ist. Der Gund für diese gestörte trophoblastäre Invasion ist unbekannt. Die therapeutischen Möglichkeiten beschränken sich darauf, die aufgetretenen klinischen Symptome zu behandeln. In dieser Arbeit diskutieren wir die Möglichkeiten, um spezifische und sensitive prädiktive Parameter entsprechend dem heutigen Wissen über die Pathophysiologie dieser schwangerschaftsinduzierten schweren Erkrankung zu finden.
Prävalenz depressiver Störungen im frühen Wochenbett
Authors: Bergant A. , Nguyen T. , Moser R. , Ulmer H.
Published: April 2003

Fragestellung: Ziel dieser Untersuchung war es, die Prävalenz depressiver Störungen am fünften Tag postpartum mit der Edinburgh Postnatal Depression Scale (EPDS) zu untersuchen und Zusammenhänge mit geburtshilflichen und psychosozialen Variablen darzustellen. Methoden: Die Erfassung soziodemographischer Daten, somatischer und psychiatrischer Anamnesen sowie geburtshilflicher und psychologischer Variablen erfolgte mittels Interview bzw. der Krankengeschichte. An der Untersuchung nahmen 1250 Wöchnerinnen 5 Tage nach der Geburt teil. Ergebnisse: Gemäss den Resultaten der deutschen Validierung der EPDS zeigte sich für 254 (20,3%) Wöchnerinnen eine zumindest leichte depressive Störung. Der Vergleich zwischen nichtdepressiven Frauen (EPDS ≤9, n = 996) und depressiven Frauen (EPDS ≥10, n = 254) erbrachte folgende Risikofaktoren für eine depressive Störung: subjektiv erhöhte Geburtsbelastung, höhere Angstneigung, ungünstige Partnerbeziehung, niederer Sozialstatus und geringere Berufszufriedenheit. Hinsichtlich geburtshilflicher Variablen erwiesen sich vermehrte Schwangerschaftsrisiken, Fehlgeburten in der Anamnese, niederes Geburtsgewicht und Kaiserschnittentbindungen als Risikofaktoren. Schlussfolgerungen: Depressive Störungen im frühen Wochenbett treten bei 20% der Wöchnerinnen auf. Entsprechend der Literatur stellt diese Gruppe von Frauen das Risikokollektiv für eine spätere postpartale Depression dar. Unter Beachtung der psychosozialen und geburtshilflichen Risikovariablen sind präventive psychotherapeutische Interventionen bereits an der Wochenstation sinnvoll.
Stellenwert der Chemotherapie in der Behandlung des Endometriumkarzinoms
Authors: Fehr Mathias K. , Wight Edward , Haller Urs
Published: April 2003

Beim fortgeschrittenen oder rezidivierenden Endometriumkarzinom stellen Doxorubicin, Epirubicin, Cisplatin, Carboblatin, Paclitaxel, Ifosfamid, 5-Fluorouracil und Vincristin die aktivsten Einzelsubstanzen dar mit Ansprechraten zwischen 18 und 36%. Die vorliegenden Daten weisen darauf hin, dass bei gegebener Indikation einer Chemotherapie die Kombinationschemotherapie mit Doxorubicin und Cisplatin die Standardchemotherapie beim fortgeschrittenen oder rezidivierenden Endometriumkarzinom mit Ansprechraten von 47–60% darstellt. Eine erste Studie mit Paclitaxel in Kombination mit diesen Substanzen zeigte eine Erhöhung der Ansprechrate auf 73%, bezüglich Überlebensvorteil liegen jedoch noch keine Daten vor. Die Kombination der Chemotherapie mit einer Gestagentherapie scheint keinen additiven Effekt zu zeigen. In der adjuvanten Situation zeigte weder die Chemotherapie noch die Hormontherapie einen Vorteil beim frühen Endometriumkarzinom.
Ureaplasmapneumonien und Nachweis von Ureaplasma urealyticum im Tubussekret bei Früh- und Neugeborenen
Authors: Zotter H. , Urlesberger B. , Reiterer F. , Dornbusch H.J. , Sixl B. , Müller W.
Published: April 2003

Bei wie vielen Frühgeborenen ≤1250 g und bei wie vielen Neugeborenen >1250 g mit klinischer Symptomatik Ureaplasma urealyticum im Tubussekret nachweisbar war und bei wie vielen eine Pneumonie auftrat. Methodik: Die Patienten wurden in zwei Gruppen unterteilt (Gruppe 1: Geburtsgewicht ≤1250 g, n = 25; Gruppe 2: Geburtsgewicht >1250 g, n = 45) und diese wiederum in zwei Subgruppen (Subgruppe a: U. urealyticum im Tubussekret ohne Pneumonie; Subgruppe b: U. urealyticum im Tubussekret mit Pneumonie). Ergebnisse: Bei 9 Patienten der Gruppe 1 (36%) konnte U. urealyticum nachgewiesen werden, und 5 dieser Patienten (20%) hatten eine Pneumonie (Gruppe 1b). Frühgeborene mit einer Ureaplasmapneumonie hatten im Vergleich zu jenen mit einer blossen Ureaplasmabesiedelung signifikant höhere Beatmungsparameter, eine längere Beatmungsdauer und einen grösseren Sauerstoffbedarf. Bei 6 Patienten der Gruppe 2 (13%) konnte U. urealyticum nachgewiesen werden, und 2 von ihnen (4,4%) hatten eine Pneumonie. Schlussfolgerungen: Bei neonatalen Pneumonien bei sehr kleinen Frühgeborenen, aber auch bei reifen Neugeborenen, sollte stets U. urealyticum in die Differentialdiagnose miteinbezogen werden.
Lichen sclerosus – hormonelle Therapie heute
Authors: Küng Fides
Published: April 2003

Zahlreiche Behandlungsmöglichkeiten der Symptome des Lichen sclerosus, mit meist geringem Erfolg, wurden bisher beschrieben. Testosteron 2% lokal galt während Jahren als Therapie der Wahl, wobei Erfolgsraten zwischen 67 und 100% berichtet wurden. Neuere mit Plazebo kontrollierte Untersuchungen zeigten Remissionsraten von lediglich 20% (Testosteron) and 10% (Plazebo). Bei lokaler Applikation von Kortikosteroiden der Klasse 4 (z.B. Clobetasol 0,05%) hingegen wurden Remissionsraten bis zu 75% beobachtet, wobei die befürchteten kortikosteroidbedingten Nebenwirkungen, wie z.B. Hautatrophie, auch bei mehrwöchiger Applikation kein Problem darstellten.
Ultraschallgesteuerte Schneidbiopsien nicht palpabler Mammaläsionen: Korrelation mit den Ergebnissen der ultraschallgesteuerten Feinnadelpunktion
Authors: Hilfiker P.R. , Caduff R. , Pok-Lundquist J. , Garzoli E. , Marincek B. , Kubik-Huch R.A.
Published: April 2003

Ziel: Ziel der Studie war es, die Ergebnisse der ultraschallgesteuerten Schneidbiopsie im Vergleich zu der ultraschallgesteuerten Feinnadelpunktion (FNP) bei identischen nicht palpablen Mammaläsionen zu evaluieren und diese miteinander zu korrelieren. Material und Methode: Von August 1997 bis Juli 1998 wurden 73 ultraschallgesteuerte Punktionen an 66 Patientinnen mit nicht palpablen Läsionen der Brust vorgenommen. Bei 18 Patientinnen (33–77 Jahre) mit 20 nicht palpablen Läsionen waren eine FNP (20-G Nadel) und Schneidbiopsie (18-G-Biopsiekanüle) im gleichen Abklärungsgang durchgeführt worden; diese Patientinnen bildeten das Kollektiv unserer retrospektiven Analyse. Resultate: Unter den 20 punktierten Läsionen wurde 1 Malignom gefunden; die anderen 19 Läsionen waren benigner Natur. In 20% der Fälle war das Material der FNP für die zytologische Diagnostik nicht ausreichend, die Biopsie erlaubte mit einer Ausnahme in allen Fällen eine Diagnose. Komplikationen wurden nicht verzeichnet. Folgerungen: Die ultraschallgesteuerte Biopsie mit 18-G-Nadel ist eine Methode zur Abklärung von nicht palpablen, nur im Ultraschall sichtbaren Läsionen. Sie ist eine attraktive Alternative zur FNP überall dort, wo keine erfahrene Zytologie vorhanden ist.
Profiles of Plasma Serpins in Patients with Advanced Malignant Melanoma, Gastric Cancer and Breast Cancer
Authors: Wojtukiewicz M.Z. , Ruciñska M. , Kloczko J. , Dib A. , Galar M.
Published: April 2003

Blood coagulation and fibrinolysis are activated systemically in patients with malignancy. The precarious balance between coagulation and fibrinolysis is modulated by serine proteinase inhibitors (serpins). Levels of selected serpins (α1-antichymotrypsin, α1-antitrypsin, α2-macroglobulin, antithrombin III, C1 inhibitor, α2-antiplasmin), substrates (factor XIIIa, fibrinogen, fibronectin) and endproducts (fibrin/fibrinogen degradation products) of coagulation reactions were measured in the plasma of 61 patients with common malignancies associated with a tendency to thrombosis (i.e. malignant melanoma, gastric cancer and breast cancer). The data revealed a heterogeneity in plasma levels of serpins between tumor types. The most profound differences between cancer and healthy subject groups were found in breast cancer patients. Levels of α1-antitrypsin were significantly higher and levels of α2-antiplasmin were significantly lower in all cancer groups, whereas there were no differences in antithrombin III levels.
Effects of a Supersulfated Low Molecular Weight Heparin (IK-SSH) on Different Hemostatic Parameters
Authors: Glusa E. , Barthel W. , Schenk J. , Radziwon P. , Butti A. , Markwardt F. , Breddin K.H.
Published: April 2003

In a phase I trial effects of a new supersulfated low molecular weight heparin (IK-SSH) on different hemostatic parameters were investigated in healthy volunteers. Parameters studied were activated partial thromboplastin time (aPTT), thrombin time, Heptest, anti-activated factor II (anti-FIIa) and anti-activated factor X (anti-FXa) activity, platelet adhesion, platelet count, platelet-induced thrombin generation time (PITT), bleeding time, antithrombin III, fibrinogen and several safety parameters. After single intravenous (i.v.) injections of IK-SSH (0.14, 0.33 and 0.66 mg/kg) aPTT, Heptest and PITT were strongly and dose-dependently prolonged. After ascending subcutaneous (s.c.) doses of IK-SSH (0.33, 0.66 and 1 mg/kg) aPTT, Heptest and PITT were prolonged in a dose-dependent manner. Repeat s.c. injections of 1 mg/kg IK-SSH for 5 days markedly prolonged aPTT, Heptest and PITT. No cumulative effects were observed. Anti-FIIa and anti-FXa activity were not or only slightly increased. Bleeding time, thrombin time and platelet adhesion were not significantly changed after i.v. and s.c. injections of IK-SSH. However, tissue factor pathway inhibitor (TFPI) concentration was markedly increased after each injection of IK-SSH and returned to the preinjection value 24 h later. IK-SSH prolongs aPTT, Heptest and PITT in a similar manner as other low molecular weight heparins but without significantly affecting thrombin time, FIIa and FXa activity. The release of TFPI may well be responsible for the prolongation of aPTT, Heptest and PITT. IK-SSH may be further developed as an antithrombotic agent.
Long-Term Prophylaxis in Venous Thromboembolism: LMWH or Oral Anticoagulation?
Authors: Schulman Sam
Published: April 2003

Warfarin remains the standard drug for secondary prophylaxis following venous thromboembolism, however this treatment is not ideal. In patients for whom monitoring is problematic or who have a high risk of bleeding complications, other possible solutions have been explored. Unfractionated heparin has been used to a limited extent in these situations and requires dose adjustment in order to achieve an acceptable efficacy. Low-molecular-weight heparin (LMWH) is a valuable alternative to warfarin for these patients and for thromboprophylaxis during pregnancy. In several subgroups of patients with venous thromboembolism the use of a LMWH instead of warfarin could offer specific advantages. The combination of warfarin and LMWH is warranted in patients for whom it is predicted that warfarin treatment alone may fail. The optimal dose of LMWH in long-term prophylaxis has not been evaluated in a properly designed study and the optimal duration of prophylaxis with LMWH is thought to be similar to that for warfarin.
New Perspectives for Treatment of Pulmonary Embolism
Authors: Simonneau G.
Published: April 2003

Subcutaneous low-molecular-weight heparins (LMWHs) have been shown to be as safe and effective as intravenous unfractionated heparin (UFH) for the initial treatment of patients with deep vein thrombosis and acute symptomatic pulmonary embolism. In comparison with UFH, LMWHs have a longer half-life, greater bioavailability and more predictable antithrombotic effect when administered in fixed doses, thus obviating the need for laboratory monitoring. It is therefore feasible that LMWH preparations may replace UFH for the treatment of pulmonary embolism in the future. It is recommended that LMWH should be administered for 5–10 days and should overlap with oral anticoagulant therapy by at least 4 days. Surgical pulmonary embolectomy should only be considered in patients with life-threatening pulmonary embolism who have failed to respond during the first 3 h of thrombolytic therapy. The systematic use of vena cava filters is not recommended in patients presumed to be at high risk for pulmonary embolism.
Low-Dose Vitamin K1 versus Short-Term Withholding of Acenocoumarol in the Treatment of Excessive Anticoagulation Episodes Induced by Acenocoumarol
Authors: Ortín Miguel , Olalla Jose-Ignacio , Marco Fernando , Velasco Nieves
Published: April 2003

Background: No consensus exists about the management of iatrogenically induced excessive hypocoagulability episodes. Objective: To compare the two most common therapeutic approaches in such situations (discontinuation of the oral anticoagulant vs. low-dose subcutaneous vitamin K1) when acenocoumarol is the normally used anticoagulant. Patients and Methods: The study was retrospective and comparative. Patients received antithrombotic therapy using acenocoumarol. Anticoagulant plasmatic activity was assessed through the international normalized ratio (INR) recorded from December 1994 to December 1997 at two medical centers. Results: INR is brought faster to a safe range in patients treated with low-dose vitamin K1 (p = 0.01). Their long-term behavior is also more stable and predictable and no resistance to the oral anticoagulant was found. Conclusion: Low-dose vitamin K1 is a safer therapeutic option compared to simply withholding the oral anticoagulant. Its best scheme of administration, however, has yet to be defined.
Enoxaparin Reduces Cerebral Edemaafter Photothrombotic Injury in the Rat
Authors: Pratt J. , Boudeau P. , Uzan A. , Imperato A. , Stutzmann J.-M.
Published: April 2003

This study investigates the effect of enoxaparin (Lovenox, Klexane), a low-molecular-weight heparin, on edema following a photothrombotic lesion using rose bengal dye in the rat. An area of cerebral ischemia was provoked in the right hemisphere of rats. Edema developed over 24 h after the lesion, as seen comparing water content of a core sample from the right hemisphere to that of a similar sample from the left hemisphere of each rat. Enoxaparin at 0.5 mg/kg i.v. plus 2 mg/kg s.c. reduced edema 24 h after lesion induction by 32% (p < 0.01) when the treatment was started 2 h after photothrombotic insult, with maintenance doses of 2 mg/kg s.c. enoxaparin at 6 and 18 h. When the same initial treatment with enoxaparin was started 18 h after insult, there was still a significant reduction of 20% (p < 0.01) in cerebral edema. Administration of enoxaparin 18 h after insult reduced cerebral edema in a dose-dependent manner. There was no evidence of intracranial hemorrhages in any of the animal groups and when the hemoglobin content of the brain samples was assayed by the method of Drabkin, no increase in hemoglobin content was seen compared to sham-operated animals.
Adenosine 5’-Diphosphate-Induced Platelet Aggregation in Uremia Shows Resistance to Inhibition by the Novel Nitric Oxide Donor GEA 3175 but Not by S-Nitroso-N-Acetylpenicillamine
Authors: Whiss Per A. , Larsson Rutger
Published: April 2003

Both bleeding and thrombosis are complications of uremia in patients on regular hemodialysis. An excessive endogenous formation of the vasodilator and platelet inhibitor nitric oxide (NO) has been proposed to contribute to the bleeding defect. Since exposure to pharmacological donors of NO, nitrovasodilators, can cause tolerance to NO, we investigated whether platelets from uremic patients on regular hemodialysis are influenced differently by NO donors than platelets from healthy subjects. A frequently used S-nitrosothiol, S-nitroso-N-acetylpenicillamine (SNAP), was compared to a recently synthezised mesoionic oxatriazole derivate, GEA 3175, regarding its capacity to inhibit adenosine 5′-diphosphate (ADP)-induced platelet aggregation in vitro. The final products of NO production, nitrite + nitrate, were found to be significantly increased in uremic patients. The capacity to inhibit platelet aggregation by SNAP was only slightly different between the groups. However, GEA 3175 showed a significantly marked and reduced capacity to inhibit aggregation of uremic platelets compared to controls. Interactions of erythropoietin (EPO) with NO have earlier been reported. Addition of EPO to platelets from healthy donors in vitro did not significantly influence the NO donor capacity to inhibit platelet aggregation, but showed a tendency to enhance the effect of SNAP while the effect of GEA 3175 was inhibited. These results suggest compound-specific resistance to NO donors in uremic platelet activation.