bluuebunny/crossref_metadata_2025 huggingface dataset:
Manometric techniques for the evaluation of colonic motor activity: current status
Authors: Scott S. M.
Published: September 2003

Colonic motility disorders are common conditions. However, our understanding of normal, and, consequently, pathological motor function of the colon remains limited, mainly due to the relative inaccessibility of this organ for study. Investigation of colonic motility may encompass one or more of the four separate components (myoelectric activity, phasic and tonic contractile activity and movement of intraluminal content) using electrophysiological, manometric or transit studies. Although transit studies provide the best ‘functional’ appreciation of colonic motor activity, and are the only techniques used in contemporary clinical practice, manometric methods are becoming increasingly popular, as they allow a direct study of colonic contractile activity over prolonged periods. To date, the majority of studies have been limited to the pelvic colon by a retrograde (per rectal) approach; however, recent technological advances have facilitated ‘pan‐colonic’ investigation. This review concentrates on manometry of the human colon proximal to the sigmoid, and includes evaluation of both phasic and tonic motor activity, by utilization of perfused‐tube and solid‐state manometric catheters, and also the electronic barostat. Methodological techniques, experimental protocols and the analysis and interpretation of recorded data are critically explored, and a contemporary classification of colonic contractile activities is presented.
Colonic motor activity in slow‐transit idiopathic constipation as identified by 24‐h pancolonic ambulatory manometry
Authors: Hagger R. , Kumar D. , Benson M. , Grundy A.
Published: September 2003

Colorectal motor activity in slow‐transit idiopathic constipation has not been fully evaluated under physiological conditions. The aim of this study was to evaluate colorectal motor activity in chronic idiopathic constipation using 24‐h ambulant pancolonic manometry. Ten healthy volunteers (six females) 19–31 years of age, and eight females 25–46 years of age with slow‐transit idiopathic constipation were studied. Motor activity was measured using two custom‐made silicone‐coated catheters, each with five solid‐state pressure transducers. Bowel preparation or sedation was not used. Frequency of high‐amplitude propagated contractions was reduced in chronic idiopathic constipation, median 1.9/24 h vs 6/24 h (P = 0.01). Contractile frequency of low‐amplitude complexes was reduced throughout the colon in slow‐transit idiopathic constipation (P < 0.0001). The interval between contractile complexes was reduced in the transverse colon and splenic flexure (P < 0.0001). This study demonstrates that colonic motor activity is abnormal in slow‐transit idiopathic constipation; decreased motor activity leads to a reduction in propulsion of intraluminal contents.
Duodenal contractile activity in dystrophic (mdx) mice: reduction of nitric oxide influence
Authors: Zizzo M. G. , Mulè F. , Serio R
Published: September 2003

The present study was undertaken to analyse duodenal contractility in adult dystrophic (mdx) mice. The spontaneous changes of the isometric tension and the responses of longitudinal duodenal muscle to nonadrenergic, noncholinergic (NANC) nerve stimulation and to exogenous drugs were compared between normal and mdx mice. Duodenal segments from mdx mice displayed spontaneous contractions with higher frequency than normals. Nω‐nitro‐l‐arginine methyl ester (l‐NAME) increased the frequency of contractions in normals without affecting that in mdx mice. In normals, NANC nerve stimulation elicited a transient relaxation abolished by l‐NAME. In mdx mice a frank relaxation was not observed, the inhibitory response consisted just in the suppression of the phasic activity. This response was reduced by l‐NAME and abolished by the subsequent addition of α‐chymotrypsin. In normals, α‐chymotrypsin hardly affected NANC relaxation, whilst it significantly antagonised that in mdx mice. Mdx duodenal muscle also showed a reduced responsiveness to sodium nitroprusside, and to 8‐bromoguanosine 3′, 5′‐cyclic monophosphate in comparison with normal preparations. The results indicate that mdx mice experience duodenal contractile disturbances due to an impairment of NO function with defective responsiveness of the muscle to NO. The reduction in NO influence is functionally compensated by the peptidergic system.
Involvement of abscisic acid and cytokinins in the senescence and remobilization of carbon reserves in wheat subjected to water stress during grain filling
Authors: YANG J. C. , ZHANG J. H. , WANG Z. Q. , ZHU Q. S. , LIU L. J.
Published: September 2003

This study investigated the possibility that abscisic acid (ABA) and cytokinins may mediate the effect of water deficit that enhances plant senescence and remobilization of pre‐stored carbon reserves. Two high lodging‐resistant wheat (Triticum aestivum L.) cultivars were field grown and treated with either a normal or high amount of nitrogen at heading. Well‐watered (WW) and water‐stressed (WS) treatments were imposed from 9 d post‐anthesis until maturity. Chlorophyll (Chl) and photosynthetic rate (Pr) of the flag leaves declined faster in WS plants than in WW plants, indicating that the water deficit enhanced senescence. Water stress facilitated the reduction of non‐structural carbohydrate in the stems and promoted the re‐allocation of prefixed 14C from the stems to grains, shortened the grain filling period and increased the grain filling rate. Water stress substantially increased ABA but reduced zeatin (Z) + zeatin riboside (ZR) concentrations in the stems and leaves. ABA correlated significantly and negatively, whereas Z + ZR correlated positively, with Pr and Chl of the flag leaves. ABA but not Z + ZR, was positively and significantly correlated with remobilization of pre‐stored carbon and grain filling rate. Exogenous ABA reduced Chl in the flag leaves, enhanced the remobilization, and increased grain filling rate. Spraying with kinetin had the opposite effect. The results suggest that both ABA and cytokinins are involved in controlling plant senescence, and an enhanced carbon remobilization and accelerated grain filling rate are attributed to an elevated ABA level in wheat plants when subjected to water stress.
The Brassica napus extA extensin gene negative regulatory region controls expression in response to mechanical stresses
Authors: SHIRSAT A. H. , THOMSON H. E. C. , ELLIOTT K. A.
Published: September 2003

In the present study the hypothesis that the −433 to −664 bp negative regulatory region (NRR) of the Brassica napus extA extensin promoter controls extA activation in response to externally applied weight loads was tested. When weight loads were applied to the nodal regions of transgenic tobacco plants containing extA promoter deletions fused to GUS, repression controlled by the NRR was overcome and GUS expression was induced only in the transgenics carrying the NRR. This proves that extensin expression in nodal regions is not developmentally controlled, but is induced in response to mechanical stresses, and is controlled by the NRR. It was also shown that the activation of the extA promoter during the development of lateral roots is a stress‐related response that is also under the control of the NRR but that the constitutive expression of extensin mRNA in the phloem of roots is not due to the mechanical forces the root experiences as it forces it way through the soil. Electrophoretic mobility shift assays using a 25 bp oligonucleotide have been used to show that an 8 bp consensus sequence from the NRR binds nuclear proteins. Wound‐induced signals regulating extensin gene expression are shown to travel bi‐directionally through the plant, from root to leaf and vice versa.
Natural variation in cadmium tolerance and its relationship to metal hyperaccumulation for seven populations of Thlaspi caerulescens from western Europe
Authors: ROOSENS N. , VERBRUGGEN N. , MEERTS P. , XIMÉNEZ‐EMBÚN P. , SMITH J. A. C.
Published: September 2003

Thlaspi caerulescens J. & C. Presl is a distinctive metallophyte of central and western Europe that almost invariably hyperaccumulates Zn to> 1.0% of shoot dry biomass in its natural habitats, and can hyperaccumulate Ni to> 0.1% when growing on serpentine soils. Populations from the Ganges region of southern France also have a remarkable ability to accumulate Cd in their shoots to concentrations well in excess of 0.01% without apparent toxicity symptoms. Because hyperaccumulation of Cd appears to be highly variable in this species, the relationship between Cd tolerance and metal accumulation was investigated for seven contrasting populations of T. caerulescens grown under controlled conditions in solution culture. The populations varied considerably in average plant biomass (3.1‐fold), shoot : root ratio (2.2‐fold), Cd hyperaccumulation (3.5‐fold), shoot : root Cd‐concentration ratio (3.1‐fold), and shoot Cd : Zn ratio (2.6‐fold), but the degree of hyperaccumulation of Cd and Zn were strongly correlated. Two populations from the Ganges region were distinct in exhibiting high degrees of both Cd tolerance and hyperaccumulation (one requiring 3 µM Cd for optimal growth), whereas across the other five populations there was an inverse relationship between Cd tolerance and hyperaccumulation, as has been noted previously for Zn. Metal hyperaccumulation was negatively correlated with shoot : root ratio, which could account quantitatively for the differences between populations in shoot Zn (but not Cd) concentrations. On exposure to 30 µM Cd, the two Ganges populations showed marked reductions in shoot Zn and Fe concentrations, although Cd accumulation was not inhibited by elevated Zn; in the other five populations, 30 µM Cd had little or no effect on Zn or Fe accumulation but markedly reduced shoot Ca concentration. These results support a proposal that Cd is taken up predominantly via a high‐affinity uptake system for Fe in the Ganges populations, but via a lower‐affinity pathway for Ca in other populations. Total shoot Cd accumulated per plant was much more closely related to population Cd tolerance than Cd hyperaccumulation, indicating that metal tolerance may be the more important selection criterion in developing lines with greatest phytoremediation potential.
Phosphorus (P) uptake and growth of a root hairless barley mutant (bald root barley, brb) and wild type in low‐ and high‐P soils
Authors: GAHOONIA T. S. , NIELSEN N. E.
Published: September 2003

The recently isolated root‐hairless mutant of barley (Hordeum vulgare L), bald root barley, brb offers a unique possibility to quantify the importance of root hairs in phosphorus (P) uptake from soil. In the present study the ability of brb and the wild‐type, barley genotype Pallas producing normal root hairs to deplete P in the rhizosphere soil was investigated and the theory of diffusion and mass flow applied to compare the predicted and measured depletion profiles of diffusible P. Pallas depleted twice as much P from the rhizosphere soil as brb. The P depletion profile of Pallas uniformly extended to 0.8 mm from the root surface, which was equal to the root hair length (RHL). The model based on the theory of diffusion and mass flow explained the observed P‐depletion profile of brb, and the P depletion outside the root‐hair zone of Pallas, suggesting that the model is valid only for P movement in rhizosphere soil outside the root‐hair zone. In low‐P soil (P in soil solution 3 µm) brb did not survive after 30 d, whereas Pallas continued to grow, confirming the importance of root hairs in plant growth in a P‐limiting environment. In high‐P soil (P in soil solution 10 µm) both brb and Pallas maintained their growth, and they were able to produce seeds. At the high‐P concentration, RHL of the Pallas was reduced from 0.80 ± 0.2 to 0.68 ± 0.14 mm. In low‐P soil, P‐uptake rate into the roots of Pallas was 4.0 × 10−7 g mm−1 d−1 and that of brb was 1.9 × 10−7 g mm−1 d−1, which agreed well with the double amount of P depleted from the rhizosphere soil of Pallas in comparison with that of brb. In high‐P soil, the P uptake rates into the roots of brb and Pallas were 3.3 and 5.5 × 10−7 g mm−1 d−1, respectively. The results unequivocally confirmed that in a low‐P environment, root hairs are of immense importance in P acquisition and plants survival, but under high‐P conditions they may be dispensable. The characterization of phenotypes brb and Pallas and the ability to reproduce seeds offers a unique possibility of molecular mapping of QTLs and candidate genes conferring root‐hair formation and growth of barley.
A hydromechanical and biochemical model of stomatal conductance
Authors: BUCKLEY T. N. , MOTT K. A. , FARQUHAR G. D.
Published: September 2003

A mathematical model of stomatal conductance is presented. It is based on whole‐plant and epidermal hydromechanics, and on two hypotheses: (1) the osmotic gradient across guard cell membranes is proportional to the concentration of ATP in the guard cells; and (2) the osmotic gradient that can be sustained per unit of ATP is proportional to the turgor pressure of adjacent epidermal cells. In the present study, guard cell [ATP] is calculated using a previously published model that is based on a widely used biochemical model of C3 mesophyll photosynthesis. The conductance model for Vicia faba L. is parameterized and tested As with most other stomatal models, the present model correctly predicts the stomatal responses to variations in transpiration rate, irradiance and intercellular CO2. Unlike most other models, however, this model can predict the transient stomatal opening often observed before conductance declines in response to decreases in humidity, soil water potential, or xylem conductance. The model also explicitly accommodates the mechanical advantage of the epidermis and correctly predicts that stomata are relatively insensitive to the ambient partial pressure of oxygen, as a result of the assumed dependence on ATP concentration.
Rheological differences between Archaean and younger crust can determine rates of Quaternary vertical motions revealed by fluvial geomorphology
Authors: Westaway Rob , Bridgland David , Mishra Sheila
Published: September 2003

Surface uplift is widely observed in subaerial regions of continental crust that are distant from plate boundaries, often revealed by river terrace staircases with altitude ranges of several hundred metres, which typically span the Quaternary. This characteristic geomorphology has been explained by forcing of flow in the weak lower‐crustal layer by surface processes: non‐steady‐state erosion and cyclical loading by ice‐sheets and sea‐level fluctuations. This study tests this interpretation, by showing that analogous river‐terrace staircases are absent in Archaean crust, which lacks the weak lower‐crustal layer found elsewhere.
Post‐nappe brittle extension in the inner Western Alps (Schistes Lustrés) following late ductile exhumation: a record of synextension block rotation?
Authors: Agard P. , Fournier M. , Lacombe O.
Published: September 2003

Fault data collected from the Schistes Lustrés domain point to the existence of successive steps of deformation and indicate that extension is not multidirectional. This study underlines the continuity between the patterns of late brittle/ductile exhumation tectonics and brittle deformation, and strenghtens the view that extensional movements dominate in shallow levels of the inner Western Alps since at least 35–30 Ma. The progressive clockwise rotation of the earliest directions of extension with time is compatible with the amount of anticlockwise rotation from c. 35 Ma determined by recent palaeomagnetic studies, whereas the last documented N–S extension may reflect a short‐lived stage of orogen‐parallel extension.
Vertical movements in and around the south‐east Carpathian foredeep: lithospheric memory and stress field control
Authors: Bertotti G. , Ma⃛enco L. , Cloetingh S.
Published: September 2003

A > 10‐km‐thick basin formed in Tertiary to Quaternary times in front and overlapping with the south‐east Carpathians. The Focşani Depression is part of this system and overlies the Vrancea seismogenetic volume, thought to correspond to the remnants of the continental slab subducted beneath the Carpathians. Slab detachment and its lateral migration are considered to control vertical movements in the area. We present the first complete analysis of subsidence patterns in the Depression and derive a substantially different picture. The strongest subsidence is Sarmatian in age, coeval with the main nappe emplacement events. Subsequently, subsidence did not stop and persisted until present times despite cessation of thrusting. The main depocentre remained the Focşani Depression and no significant lateral migration is detected. Post‐Sarmatian subsidence is contemporaneous with major exhumation/erosion in the Carpathians. The evolution of the basin is associated with a combination of vertical and far‐field horizontal stresses, and its position is controlled by pre‐existing lithospheric heterogeneities.
High‐ to ultrahigh‐pressure (UHP) ductile shear zones in the Sulu UHP metamorphic belt, China: implications for continental subduction and exhumation
Authors: Zhao Z. Y. , Fang A. M. , Yu L. J.
Published: September 2003

High‐ to ultrahigh‐pressure (HP‐UHP) metamorphic rocks that resulted from deep continental subduction and subsequent exhumation in the Sulu orogenic belt, China, have experienced multiphase deformation and metamorphic overprint during its long journey to the mantle and return to the surface. HP‐UHP shear zones are strain‐localized weak zones on which the UHP slab is transported over long distances. HP‐UHP shear zones are well exposed along a 200‐km belt in the Sulu UHP metamorphic belt. The shear zones lie structurally below the UHP rocks and above the non‐UHP rocks, suggesting the early exhumation of the UHP rocks by thrusting. The large area distribution, HP‐UHP nature, high strain and structural association of the shear zones with the UHP rocks suggest that the shear zones are probably a regional detachment developed during the early stage of exhumation of the UHP rocks. Kinematic indicators suggest top‐to‐the N–NW motion of the UHP slab during the exhumation, which, combined with isotope signature in Mesozoic igneous rocks, leads us to the interpretation that the subduction polarity is the North China plate down to the south rather than the Yangtze plate down to the north in the Sulu region.
On the number and spacing of faults
Authors: Morellato Chiara , Redini Francesco , Doglioni Carlo
Published: September 2003

Orogens and rift zones have a finite number of regional faults. The accretionary prisms analysed here have a number of thrusts < 50, whereas extensional areas have a number of normal faults ranging between six and 44. The average spacing of thrusts is between 5 and 25 km; spacing of normal faults is more restricted into two peaks, at 25–29 km and 4–6 km, in which the latter is the most common. The number and spacing of faults appear to be mainly controlled by the depth of the decollement plane, which seems to be more variable in compressive settings with respect to rift zones. Basement‐involved orogens present fewer and more spaced thrusts; by contrast, a greater number of thrusts with shorter spacing characterize thin‐skinned thrust belts. The shallower the decollement is, the stronger it appears to control the palaeogeography, in the sense of rheological lateral variations in the sedimentary cover.
Offshore granulites from the Bay of Biscay margins: fission tracks constrain a Proterozoic to Tertiary thermal history
Authors: Fügenschuh Bernhard , Froitzheim Nikolaus , Capdevila Raymond , Boillot Gilbert
Published: September 2003

Zircon and apatite fission track ages were determined on granulites dredged along the Bay of Biscay margins. A sample from Ortegal Spur (Iberia margin) yielded 725 ± 67 Ma (zircon). A sample from Le Danois Bank (Iberia margin) yielded 284 ± 58 Ma (zircon), indicating post‐Variscan cooling. Apatite from this sample gave 52 ± 2 Ma, interpreted as final cooling after ‘Pyrenean’ thrust imbrication. Two other samples from Le Danois Bank have Early Cretaceous apatite ages (138 ± 7 and 120 ± 8 Ma), interpreted to result from exhumation during rifting. Finally, a granulite from Goban Spur (Armorican margin) gave 212 ± 10 Ma (apatite), coinciding with a precursory rifting phase. Together with published radiometric results, these data indicate a Precambrian high‐grade terrane at the site of the current margins. The distribution of the granulites on the seafloor reflects tectonic and erosional processes related to (a) Mesozoic rifting and (b) Early Tertiary incipient subduction of the Bay of Biscay beneath Iberia.
Urinary nitric oxide levels are increased and correlated with plasma concentrations in patients with Behçet's disease: Is it a new urinary activity marker?
Authors: EVEREKLIOGLU CEM , ÖZBEK EMIN , ÇEKMEN MUSTAFA , MEHMET NIHAYET , DUYGULU FUAT , OZKIRIS ABDULLAH , ÇALIP MUSTAFA , ER HAMDI , TÜRKÖZ YUSUF
Published: September 2003

SUMMARY:  Nitric oxide (NO) is a free radical and serves many functions within the kidney. Excess NO causes glomerular injury. Behçet's disease (BD) is a systemic immunoinflammatory vasculitis, affecting every organ in the body including the kidneys (subclinic glomerulonephritis). We investigated the role of urinary total nitrite levels (end product of NO) in BD and evaluated whether urinary concentrations were correlated with its plasma levels or disease activity. Thirty‐six consecutive Behçet's patients (19 men, 17 women; 35.9 years), and 20 age‐ and sex‐matched healthy control volunteers (12 men, eight women; 33.2 years) were divided into an active (n = 16) and inactive (n = 20) period. Urinary and serum NO levels (µmol/mg urinary creatinine) were higher in BD patients (4.1 ± 0.3) than control subjects (1.7 ± 0.2; P < 0.001). Serum NO levels in Behçet's patients and control subjects were 51.3 ± 9.8 and 21.7 ± 7.3 µmol/L, respectively (P < 0.001). Active patients had higher urinary NO excretion (4.9 ± 0.3) than inactive patients (3.3 ± 0.3; P < 0.01). Urinary NO levels were correlated with its serum levels (r2 = 0.69, P < 0.001). Higher urinary NO levels found in BD may be produced by the kidney as a result of an inflammatory stimulation. As excess NO is toxic to the tissues, increased NO levels may play a role in mediating subclinic glomerular injury of such patients. However, we could not determine the exact site(s) of NO synthesis by the kidney, such as the glomeruli, blood vessels and/or the tubular cells. Whatever the source, urinary NO levels may be used as a new activity marker in the diagnosis and follow up of BD by serial measurements.
Severe metabolic complications from theophylline intoxication
Authors: CHARYTAN DAVID , JANSEN KEVIN
Published: September 2003

SUMMARY:  Theophylline is commonly used in the treatment of bronchospastic lung disease. In addition to gastrointestinal and cardiac dysfunction, hypokalaemia, lactic and ketoacidosis can complicate theophylline overdose. Clinicians frequently fail to identify theophylline's role when complications develop. A case of an 80‐year‐old man who developed profound metabolic disturbances while hospitalized is presented. The typical causes of these abnormalities were absent, theophylline levels were elevated, and the patient recovered after theophylline was held. Based on our case and review of the literature, we discuss the reasons why theophylline toxicity is underecognized, and propose mechanisms for the rare metabolic abnormalities identified in this case. A high index of suspicion for theophylline toxicity should be maintained and it should be considered when unexplained acidosis or hypokalaemia occur.
Five‐year incidence of diabetic retinopathy in the Melbourne Visual Impairment Project
Authors: McCarty Daniel J , Fu Cara L , Harper C Alex , Taylor Hugh R , McCarty Catherine A
Published: September 2003

Background: The purpose of the present paper was to describe the 5‐year incidence and progression of diabetic retinopathy in the Melbourne Visual Impairment Project (VIP) cohort.

Methods: Baseline examinations were conducted from 1992 to 1994 and follow‐up data were collected 5 years later. Data collected during the baseline and follow‐up studies included medical history (including previous diag­nosis of diabetes mellitus) and dilated fundus examination. Two 30° stereoscopic fundus photographs were taken with a Topcon TRC fundus camera, one centred on the optic disc and the other centred on the fovea. Photographs from participants who reported having diabetes were graded for diabetic retinopathy based on an extension of the Modified Airlie House Classification. Grouping of participant data into retinopathy grades was based on the results of the worst eye.

Results: The follow‐up survey included 82% (n = 121) of those with diabetes at baseline. Prevalence of any retino­pathy was 35.7% and macular oedema was 13% at follow up. Diabetic retinopathy was newly detected in 8/73 (5‐year incidence = 11.0%, 95% confidence interval (CI) = 3.8−18.1). Disease progression was seen in 9/31 participants (29.0%, 95%CI = 14.9−47.8) who had diabetic retinopathy at baseline. The 5‐year incidence of proliferative diabetic retino­pathy in people without proliferative diabetic retinopathy at baseline was 2.9% (3/104, 95%CI = 0−6.4). The 5‐year incidence of macular oedema in people who did not have macular oedema at baseline was 8.0% (8/100, 95%CI = 2.7−13.3). All people with proliferative diabetic retinopathy at baseline had received laser treatment by the follow‐up survey. Twenty‐four per cent of people without diabetic retinopathy reported never having had a dilated fundus examination (excluding the VIP examinations).

Conclusion: The 5‐year incidence of diabetic retinopathy was 11% in the Melbourne Visual Impairment Project. Most people with proliferative diabetic retinopathy or macular oedema are receiving treatment. However, many people with diabetes are not having regular dilated fundus examinations.
Comparison of scleral buckling with combined scleral buckling and pars plana vitrectomy in the management of rhegmatogenous retinal detachment with unseen retinal breaks
Authors: Tewari Hem K , Kedar Sachin , Kumar Atul , Garg Sat P , Verma Lalit K
Published: September 2003

Background: The purpose of the present paper was to compare the techniques of conventional scleral buckling and combined pars plana vitrectomy and scleral buckling procedures in rhegmatogenous retinal detachments with unseen retinal breaks.

Methods: Forty‐four consecutive eyes with uncomplicated, primary rhegmatogenous retinal detachments with a clear media and unseen retinal breaks were randomized to two groups. The scleral buckling group underwent 360° scleral buckling, cryopexy and external subretinal fluid drainage. In the combined surgery group, 360° scleral buckling, pars plana vitrectomy, air−fluid exchange, endolaser and injection of 14% perfluoropropane gas was done.

Results: At 3 months follow up the primary reattachment rate was 80% (16/20 cases) in the combined surgery group, and 70% (14/20 cases) in the scleral buckling group (P = 0.716). The visual acuity improved significantly from a preoperative median of hand movement (HM; range: HM to 6/60; similar in both the groups), to a median of 6/60 (range: perception of light to 6/18) in the combined surgery group and a median of 6/36 (range: HM to 6/18) in the scleral buckling group, the difference between the two groups not being statistically significant (P = 0.4). The number of intraoperative and postoperative complications was more in the combined surgery group. (four cases were lost to follow up and were doing well when last examined.)

Conclusion: Conventional scleral buckling was found to be a safe and effective technique in the primary management of uncomplicated, rhegmatogenous retinal detachments with unseen retinal breaks when the media is clear.
Effect of whiplash injury on accommodation
Authors: Brown Shayne
Published: September 2003

Background: Accommodative disturbance has been cited as one of the causes of visual disturbance following whiplash injury but to date, with one exception, none of the studies have incorporated a group of control subjects; none of the results have been statistically analysed. The aim of the present study was to examine the amplitude of accommodation in a group of whiplash subjects, the majority of whom had specifically complained of visual/ocular symptoms.

Methods: The whiplash group consisted of 19 subjects and the control group consisted of 43 subjects. The amplitude of accommodation of the right and left eyes of the whiplash and control group subjects was measured and the results of the two groups compared.

Results: There was reduced amplitude of accommodation of the right (P = 0.02) and left (P = 0.02) eyes in the whiplash group subjects compared to the control group subjects.

Conclusion: These results indicate that whiplash was associated with defective accommodation in the present select group of whiplash subjects.
New paediatric contrast test: Hiding Heidi low‐contrast ‘face’ test
Authors: Chen Ai Hong , Mohamed Diana
Published: September 2003

ABSTRACT

Background: The Hiding Heidi low‐contrast ‘face’ test is a new paediatric contrast test to evaluate the ability to detect objects with low contrast. The purpose of the present study was to compare the Hiding Heidi low‐contrast ‘face’ test (HH) with the Pelli−Robson contrast sensitivity test (PR) and the functional acuity contrast test (FACT) in the low‐contrast assessment.

Methods: Thirty university students participated in the present study. The contrast ability was evaluated by using three different methods: HH, PR and FACT. The HH was repeated on two separate occasions to test the repeatability.

Results: There was a significant positive correlation between HH and PR (r = 0.65, P < 0.01); between HH and FACT at 6 cycles per degree (c.p.d.; r = 0.64, P < 0.01); between HH and FACT at 3 c.p.d. (r = 0.91, P < 0.01); and between HH and FACT at 1.5 c.p.d. (r = 0.56, P < 0.01). The paired t‐test showed a significant difference between HH and PR (t = −6.05, P < 0.01); between HH and FACT at 6 c.p.d. (t = −11.16, P < 0.01); between HH and FACT at 3 c.p.d. (t = −8.35, P < 0.01); and between HH and FACT at 1.5 c.p.d. (t = −5.64, P < 0.01). They had good agreement. The HH had a high repeatability.

Conclusions: The HH had a positive correlation but produced significantly different readings when compared with FACT and PR. The features and role of HH in clinical contrast sensitivity assessment are discussed.
Quantitative model demonstrating that recombinant adeno‐associated virus and green fluorescent protein are non‐toxic to the rat retina
Authors: Daniels Dru M , Shen Wei‐Yong , Constable Ian J , Rakoczy P Elizabeth
Published: September 2003

Background: Recombinant adeno‐associated virus (rAAV) is one of the most promising recombinant viral vectors for delivering therapeutic agents to the retina. The present study aims to quantify any effect that an rAAV construct may have on the retina. To be able to use rAAV for therapeutic purposes, the potentially toxic effect of the vector and an associated green fluorescent protein (gfp) marker has to be investigated.

Methods: By combining histological analysis with computer scanning techniques, the local toxicity of rAAV and gfp can be measured. This will have obvious implications for its role as a carrier in the rapidly developing world of gene therapy.

Results: It is shown that a construct consisting of rAAV and gfp, delivered subretinally to rat eyes, causes no more histological damage than injection with saline alone. Furthermore, via fluorescent fundus photography and computer scanning techniques it is seen that the area exposed to the rAAV−gfp construct is significantly greater than the area of histological change.

Conclusions: It is thus concluded that the rAAV−gfp construct has no significant toxic effect, at an anatomical level, on the retina 12 months after injection.
In vitro comparison studies of truncated rhodopsin promoter fragments from various species in human cell lines
Authors: May Leigh A , Lai Chooi‐May , Rakoczy P Elizabeth
Published: September 2003

Background: The aim of the present study was to define the rhodopsin promoter elements of various mammalian species by evaluating the effect of these promoters on transgene specificity and expression in human cell lines. Additional characterization of these promoters was performed in the presence or absence of a human inter­photoreceptor retinoid‐binding protein (IRBP) enhancer element.

Methods: Truncated murine, bovine and human rhodopsin promoter fragments containing 1.4 kb of the 5′ upstream regulatory sequence were subcloned into pEGFP‐N1 expression vector to drive the expression of the green fluorescence protein (GFP). Fluorescence‐activated cell sorter analysis was used to determine the strength and specificity of GFP expression in three human cell lines, in the presence or absence of an IRBP enhancer element at the 5′ end of the promoters.

Results: It was found that the truncated murine rhodopsin promoter was the strongest in Y‐79 retinoblastoma cells but it was less specific than the truncated human rhodopsin promoter. It is surmised that transcription factors located at the 5′ proximal region of the rhodopsin promoter fragments were responsible for the expression patterns seen in the present study.

Conclusions: These results indicate that the rhodopsin promoter of choice for in vivo work should be from the same species if specificity is to be maximal and the addition of the IRBP enhancer element could increase transgene expression in photoreceptor cells without deleterious effects on specificity.
Helicobacter pylori‐eradication therapy decreases the level of neutrophil‐derived oxidants in the ulcerous mucosa of the human stomach: Relationship between ulcer stage and mucosal oxidant level
Authors: Suzuki Masayuki , Suzuki Hidekazu , Kitahora Tetsuji , Nagahashi Shoichi , Masaoka Tatsuhiro , Tanaka Shin , Suzuki Kouichi , Ishii Hiromasa
Published: September 2003

Background:  The purpose of the present study was to determine the effect of Helicobacter pylori eradication on the intensity of inflammation in the ulcerous mucosa by measuring the level of neutrophil‐associated oxidants and to understand the role of mucosal inflammation in ulcer relapse from the viewpoints of the scarring stage and the H. pylori‐infection status. The level of inflammation in the gastric mucosa after the eradication of H. pylori was examined using biopsy samples obtained from patients with gastric ulcers.

Methods:  Gastric mucosal specimens were endoscopically obtained before and after H. pylori‐eradication therapy from 39 patients with gastric ulcers and a positive H. pylori‐infection status. The level of neutrophil‐derived oxidants was then measured in each sample using a luminol‐dependent chemiluminescence (ChL) assay.

Results:  Chemiluminescence activity in the ulcer portion and the background gastric mucosa (antrum and corpus) was significantly reduced 3 months after successful therapy (n = 32). The ChL activity was further decreased 9 months after successful therapy, but the activity in the ulcer portion remained unchanged. In patients who did not respond to the H. pylori‐eradication therapy (n = 7), the ChL activities were not altered in any mucosal portion after the therapy. Before the H. pylori‐eradication therapy, a higher ChL activity was observed in open ulcer tissue than in scarred tissue. The ChL activity in the scarred tissue was reduced 3 months after the successful eradication of H. pylori; however, the ChL activity in the red scars was significantly higher than that in the white scars. The ChL level in the white scars was almost equivalent to that in the background mucosa 9 months after the completion of the H. pylori‐eradication therapy.

Conclusion:  The eradication of H. pylori may reduce the level of oxidant production in gastric ulcers, promoting the prevention of ulcer recurrence. Furthermore, the presence of a red scar may indicate unstable healing, even after the successful eradication of H. pylori.
Use of non‐powder surgical glove for extraction of gallbladder in laparoscopic cholecystectomy
Authors: Yano Hiroshi , Okada Kazuyuki , Kinuta Masakatsu , Iwazawa Takashi , Kanoh Toshiyuki , Monden Takushi
Published: September 2003

Background:  The present study was conducted to evaluate the usefulness and safety of the non‐powder surgical glove for extraction of the gallbladder in laparoscopic cholecystectomy.

Methods:  A total of 830 patients who underwent laparoscopic cholecystectomy using the surgical glove for extraction of the gallbladder in our hospital were analyzed. The operative times, blood loss during the operation, intra‐ and postoperative complications, length of hospital stay and the rate of morbidity were evaluated.

Results:  The mean operative time, mean intraoperative blood loss and mean length of hospital stay were 98.9 min, 12.1 g, and 7.93 days, respectively. The most frequent complication in this study was postoperative bleeding from the liver bed or port sites. Postoperative wound infection was found in six (0.72%) of 830 cases. Umbilical port infection was found in five of six cases. Seven cases with gallbladder cancer were incidentally detected by intra‐ or postoperative pathology. Five cases underwent reoperation by open laparotomy to resect the regional lymph nodes. Two cases have been followed up, because the depth of cancer invasion was limited to the mucosa of the gallbladder. There was no intra‐abdominal abscess formation and no port site metastasis in this study.

Conclusion:  The use of the surgical glove for extraction of the gallbladder is safe, cheap, simple and potentially reduces significant morbidity. Its routine use at laparoscopic cholecystectomy is strongly advocated where bile leak occurs or tumor is suspected.
Carbohydrate antigen 19‐9‐producing early protruded gastric carcinoma prolapsing into the duodenal bulb
Authors: Ishikawa Koichi , Arita Tsuyoshi , Shimoda Katsuhiro , Hagino Yoshiaki , Kitano Seigo
Published: September 2003

The patient was an 81‐year‐old man who was admitted to the Arita Gastrointestinal Hospital for anemia. Upper gastrointestinal series and endoscopic examinations revealed transpyloric prolapse of a pedunculated polypoid gastric carcinoma with an abnormal mucosal fold from the posterior wall of the lesser curvature of the gastric antrum. Biopsy and histological examination led to a diagnosis of papillary adenocarcinoma. The incarcerated tumor could not be restored endoscopically into the stomach, the lesion head was ulcerated, and the serum carbohydrate antigen (CA) 19‐9 was elevated to 379.7 U/mL. Surgery was indicated. Intraoperatively, the tumor was found in the duodenal bulb; it was easily manipulated into the stomach, and distal gastrectomy was performed. The tumor, 5.0 × 4.2 × 2.5 cm, was diagnosed histologically as papillary adenocarcinoma of the stomach infiltrating into the submucosal layer. The carcinoma cells stained positively for CA19‐9 antibody. The postoperative course was uneventful, the anemia improved, and the serum CA19‐9 level decreased to within normal range. The patient remains alive 15 months after the surgery. This may be the first report of a patient with Type 0 I early gastric cancer characterized by both CA19‐9 production and transpyloric prolapse.
Endoscopic ultrasound‐guided drainage of pancreatic pseudocysts using a large‐channel echoendoscope and a conventional polypectomy snare
Authors: Enya Masamichi , Yasuda Ichiro , Tomita Eiichi , Shirakami Youhei , Otsuji Kentaro , Shinoda Tohru , Moriwaki Hisataka
Published: September 2003

Background:  Endoscopic drainage of pancreatic pseudocysts is becoming common. Recent techniques using endoscopic ultrasound (EUS) have made the procedure safer and easier. However, bleeding related to the procedure is sometimes still experienced and placement of the tube is also sometimes difficult in cases where the cystic wall is thick and hard. We describe a new technique of EUS‐guided drainage using a large‐channel echoendoscope, a conventional polypectomy snare and a high‐frequency current generator with automatic controls. We also evaluate this technique's utility.

Methods:  Between May 2001 and December 2002, EUS‐guided drainage was attempted in consecutive patients with symptomatic pancreatic pseudocysts that had resisted conservative treatments. The EUS device was a recently introduced large‐channel linear scanning echoendoscope. A puncture was made with a 19 G needle under EUS guidance and a 0.035 inch guidewire was passed through the puncture and into the pseudocyst. Then, a conventional polypectomy snare was used to enlarge the puncture tract with the new current generator, and a 7 Fr pigtail‐type nasocystic drain was placed.

Results:  The drainage was successful and insertion of the drain was easy in all 13 patients included in the study. No complications related to the procedure, such as bleeding and perforation, were observed. The clinical symptoms resolved after the procedure in all patients. In nine patients, the cyst completely disappeared and the discharge also stopped, allowing the tube to be removed after a mean of 15 days. The median follow‐up period for these nine patients was 4 months and no recurrence has been observed. In two other patients, the cysts shrank but did not disappear completely 4 weeks or more after the procedure. Since both of these patients had had previous cystic infections, they were given surgical operations. In the remaining two cases, the cystic lumen completely disappeared but the discharge continued for 4 weeks, so we replaced the 7 Fr nasobiliary tube with a 10 Fr internal drainage tube.

Conclusion:  This method is an easy and effective treatment for pancreatic pseudocysts. It may also reduce the risk of bleeding related to the procedure.
Modification of endoscopic mucosal resection to collect plural polypectomied specimens with clip connected with string using a one‐channel colonoscope
Authors: Hashimoto Yoshinari , Toyota Jyo , Fujii Toshihito , Kasahara Hiroshi , Yoshizumi Kazuo , Kim Yong‐Sik , Nakamura Yoichiro , Maekawa Syuji , Urakawa Tomoaki
Published: September 2003

Background:  Multiple colon polyps and early cancers are often detected at colonoscopy, but we could not collect all polypectomied specimens in one insertion of a colonoscope. Endoscopic mucosal resection (EMR) may often be very difficult for the collection of the size, type, form, or location of the polyps.

Methods:  We performed EMR to collect plural polypectomied specimens by a modified new technique using a clip connected with a string in 40 patients (25 male, 15 female) who visited Saiseikai Nakatsu Hospital and Mitsubishi Kobe Hospital  for  colonoscopic  treatment.  The  method  was  as  follows:  (i)  insert  a  colonoscope;  (ii)  check  polyps  by  indigocarmine pigmentation and endoscopic ultrasonography (EUS); (iii) check the lift‐up sign by submucosal injection of 2.5% hypersaline‐epinephrine containing indigocarmine; (iv) make a clip connected with string (Tegusu‐3 go) and insert the clip kit through the channel of the colonoscope; (v) clip the polyp; (vi) insert snare in the channel of an endoscope, passing the string through the center of the snare; (vii) snare the polyp with counter traction of string and cutting by bipolar electric power; (viii) check for bleeding. If there is bleeding from the polypectomied site, another clip is necessary; and (ix) collect polyp. If there are many polyps, flags connecting the string are required.

Results and Conclusion:  All polyps were treated and collected in all patients by one insertion of the colonoscope without complications. Our modified EMR method was useful in the collection of multiple polypectomied polyps.
Enhancing the fertility of poor responders by treatment with estrogen rebound combined with a short protocol
Authors: Yokota Yoshimasa , Yokota Mikako , Yokota Hidemi , Makita Masami , Sato Setsuko , Araki Yasuhisa
Published: September 2003

Aim:  To assess the efficacy of estrogen rebound (ER) plus flare‐up by gonadotropin releasing hormone agonist (GnRH‐a) in poor responders who failed to become pregnant prior to a long protocol treatment.

Methods:  The patients comprised of thirty‐one infertile patients with oocyte retrieval levels of less than five, who had undergone several long protocol treatment cycles. The efficacy of treatment with the ER plus flare‐up from GnRH‐a was compared with the prior long protocol treatment. The main outcome measures are: confirmation of ER, maximal serum E2 levels prior to human chorionic gonadotropin (hCG) administration, follicular development, dose, and duration of gonadotrophins in a clinical setting.

Results:  The ER was confirmed by estrogen levels; FSH increased with ER plus flare‐up from GnRH‐a. Although the 31 patients included in the study had undergone frequent prior treatment cycles, including the long protocol, the pregnancy rate per embryo transfer following ER plus flare‐up by GnRH‐a was 37.5% (nine of 24). The number of follicles, number of oocytes retrieved, and the E2 level was higher than those found in prior treatment cycles.

Conclusion:  Exogenous estrogen administration with PremarinR plus flare‐up by GnRH‐a may represent an alternative and effective protocol for poor responder patients who had previously undergone several prior long protocol treatments. (Reprod Med Biol 2003; 2: 127–131)
Cellular adhesion molecules and cardiovascular disease. Part II. Their association with conventional and emerging risk factors, acute coronary events and cardiovascular risk prediction
Authors: Hope S. A. , Meredith I. T.
Published: September 2003

Abstract

The role of cellular adhesion molecules in the patho­genesis of atherosclerosis has now been clearly demonstrated. Plasma levels of adhesion molecules, which have been shed from the cell surface, have also been associated with the presence of clinical atherosclerotic disease, cardiovascular risk factors and acute coronary syndromes. However, there is little consensus in the literature, including between the large well‐designed population studies. This may be explained either by unrecognized confounding factors or, alternatively, by the unpredictable relationship between cell surface expression and activity of cellular adhesion molecules and their shedding into the plasma under different circumstances. Probably for the latter reasons, there is at present little evidence that the measurement of circulating adhesion molecules is likely to offer any additional benefit for individual patients above the assessment of conventional cardiovascular risk factors in the assessment of either the extent of, or future risk from, cardiovascular disease. (Intern Med J 2003; 33: 450−462)
Pharmacokinetics Made Easy (2nd edn)
Authors: Begg E.
Published: September 2003

By Donald J Birkett, Sydney, McGraw‐Hill Australia, 2002. 132 pp. $A23.95 (paperback). ISBN 0‐07‐471072‐9
Recovery of pure red‐cell aplasia secondary to antierythropoietin antibodies after cessation of recombinant human erythropoietin
Authors: Panchapakesan U. , Austin S. K. , Shafransky A. , Lawrence J. A. , Savdie E.
Published: September 2003

Abstract

We describe a patient with end‐stage renal failure (ESRF) who developed anti‐erythropoietin (anti‐EPO) antibodies and pure red‐cell aplasia (PRCA) after using Eprex (Janssen‐Cilag, Sydney). Anti‐EPO antibodies were detected with an immunoprecipitation technique and were shown to inhibit erythropoiesis in vitro. Antibody levels waned upon ceasing Eprex. The patient required transfusions for 21 months then recovered after immunosuppression. (Intern Med J 2003; 33: 468−471)