bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Acute Ischemic Stroke: Selecting the Right Treatment for the Right Patient
Authors: Adams Jr. Harold P.
Published: April 2003

At present, thrombolytic therapy is the only therapy approved for the treatment of acute brain injury among patients with ischemic stroke. While recombinant tissue plasminogen activator (rt-PA) is efficacious, its usefulness is limited, largely because of the very limited time window for its administration. Other medications that have potential neuroprotective actions or that affect coagulation or flow have not been established as efficacious or have not been approved by regulatory authorities. Additional therapies are needed to reduce the neurological consequences of ischemic stroke. Although the number of options to treat the stroke itself is limited, physicians should remember that management is multifaceted. Even if a patient cannot be treated with rt-PA, there is much that can be done to improve outcomes. Therapies of proven value are available to prevent or control complications, to augment recovery and to forestall recurrent stroke. The choice of treatment will continue to be made on a case-by-case basis and will be influenced by a number of variables. The most important factors are the time interval from stroke, the severity of the neurological impairments, the results of the baseline brain imaging and the cause of stroke.
Usefulness of Primitive Reflexes in Demented and Non-Demented Cerebrovascular Patients in Daily Clinical Practice
Authors: Di Legge Silvia , Di Piero Vittorio , Altieri Marta , Vicenzini Edoardo , Tombari David , Di Stani Fabrizio , Lenzi Gian Luigi
Published: April 2003

The aim of this study was to investigate the usefulness of primitive reflexes (PRs) as additional alert signs in a routine clinical setting of cognitive decline in an elderly population of chronic ischemic cerebrovascular patients. We considered the occurrence of grasp, palmomental, glabellar and snout reflexes in 75 demented (VaD) and 75 non-demented (VaND) patients, and in 75 healthy elderly controls. We never elicited more than two PRs in controls. The occurrence of three or four PRs provided the strongest correlation with dementia (p < 0.0001), with 93% specificity irrespective of low sensitivity. In conclusion, the occurrence of more than two PRs might serve as an additional warning sign of possible mild cognitive impairment in chronic ischemic cerebrovascular patients.
A New Visual Rating Scale for White Matter Low Attenuation on CT
Authors: Mendes Ribeiro H.K. , Barnetson L.P.D. , Hogervorst E. , Molyneux A.J.
Published: April 2003

The pathological substrate and clinical significance of white matter low density change on computed tomography (CT) remains incompletely understood, hampered by suboptimal rating scales. We developed a new scale and applied it to 647 CTs in 382 patients. White matter change was categorised by region (anterior and posterior frontal, parietal, occipital), severity (mild, moderate, severe) and extent (periventricular, extending to deep white, full thickness). Multiplying extent by severity gave regional scores, which were summated to give an overall score. CTs were read separately by 2 radiologists. Intraobserver reliabilities were 0.69 and 0.55, interobserver 0.70 (ĸ values). Each assessment required only 1 min.
Transient Ischaemic Attack: A Common Initial Manifestation of Cardiac Myxomas
Authors: Álvarez-Sabín J. , Lozano M. , Sastre-Garriga J. , Montoyo J. , Murtra M. , Abilleira S. , Codina A.
Published: April 2003

Background and Aims: Cardiac myxomas may present clinically with many different features. Since highly effective treatments exist, it is important that they are diagnosed quickly in order to avoid further complications. Our aim was to determine the influence of neurological presentation in diagnosis and prognosis of cardiac myxomas. Methods: We have reviewed the clinical charts of 28 patients diagnosed with cardiac myxomas seen at our centre in the last 20 years. Results: Mean age at diagnosis in patients with neurological events was 49.22 years and 60.84 years in those without neurological manifestations (p = 0.0325). Most frequent presentations were: cardiac manifestations (92.8%), general manifestations (71.4%) and embolic events (39.3%). Nine patients (32.1%) presented with cerebral embolism; 7 of whom presented with transient ischaemic attacks (TIA), which was the first manifestation in 6 of them; 3 of them later suffered complete cerebral infarction with sequelae. Echocardiography confirmed diagnosis in 26 out of 27 patients in which it was performed. None of the patients presented neurological symptoms after surgery. Conclusion: The most frequent initial neurological manifestation in our series was TIA. Nevertheless, none of the patients were diagnosed after the first neurological symptom. Although the contribution of cardiac myxomas to the total amount of TIA is low, since surgery is highly effective and of low risk, and patients with neurological manifestations are younger, it is vital to consider the possibility of cardiac myxoma after a TIA of unknown origin.
Multiperspective Assessment of Peripheral Nerve Involvement in Diabetic Patients
Authors: Padua L. , Aprile I. , Saponara C. , Padua R. , Ghirlanda G. , Pauri F. , D’Amico P. , Tonali P.
Published: April 2003

To assess the relationship between peripheral nerve involvement and the patient’s perception of his own quality of life, we studied 36 consecutive out-patients affected by insulin-dependent diabetes mellitus without other diabetic complications other than neuropathy (20 men, 16 women; mean age 39.1 years). We used clinical (Semmes-Weinstein, vibration perception threshold, muscle strength, osteotendinous reflexes), neurophysiological (sural, peroneal and ulnar nerves), metabolic (glycosylated haemoglobin) and patient-oriented (SF-36 and NASS questionnaires) measurements. Patient-oriented physical scores were significantly related to: (1) neurophysiological findings of the inferior limbs; (2) conventional measurements of sensitivity; (3) metabolic assessment. Conversely, patient-oriented mental scores were significantly related only to metabolic assessment. The patient-oriented measure provided an important perspective of the severity of the disease often closely related with the biological parameters and suggested new ways of interpreting conventional biological measurements. In particular, the peripheral nerve picture appeared strictly related with the physical aspects of the patients’ quality of life, while the metabolic picture appeared related with both the mental and physical aspects of the quality of life.
Radiculopathy and Myelopathy in Patients with Primary Cervical Dystonia
Authors: Hagenah Johann M. , Vieregge Alexandra , Vieregge Peter
Published: April 2003

In a prospective series of 34 incident patients with primary cervical dystonia (CD), 6 showed clinical or radiological signs of cervical radiculopathy (RP) or myelopathy (MP) during the course of their movement disorder. Age at onset in these patients was in the range reported for pure spondylotic cervical RP without an accompanying movement disorder. Radiologically, spondylosis was mild in 1 case and absent in 2 cases. The intervals between onset of CD and RP were shorter than in literature reports of RP/MP in dystonic-athetotic patients of cerebral paresis. Clinically, RP/MP in patients with CD mostly appears at mid-cervical levels, whereas cases with cerebral paresis are more frequently affected at higher cervical segments. We propose that RP/MP does not occur more frequently in CD than in pure spondylotic cervical RP.
Ataxic Form of Chronic Inflammatory Demyelinating Polyradiculoneuropathy: Clinical Features and Pathological Study of the Sural Nerves
Authors: Ohkoshi Norio , Harada Katsutoshi , Nagata Hiroshi , Yato Mutsuko , Shoji Shin’ich
Published: April 2003

We investigated clinical and pathological features of the sural nerves of 5 patients with the ataxic form of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and compared these features with those of chronic ataxic neuropathies due to other causes. The CIDP patients presented with slowly progressive ataxia with deep sensory impairment. The durations of the symptoms from onset were relatively short in CIDP (4–8 months) and cancer (3 and 10 months), but long in chronic idiopathic ataxic neuropathy (24–260 months). Corticosteroid therapy elicited a good response in all the patients with CIDP, but a poor response in the patients with other ataxic neuropathies. Sural nerve biopsy of CIDP patients showed a slight or moderate loss of myelinated fiber. This report suggests that ataxic form of CIDP is a steroid-responsive ataxic neuropathy, and large myelinated fibers of the sural nerves in ataxic form of CIDP were better preserved than those in nerves with other chronic ataxic neuropathies.
Discrepancy between Dysmetric Centrifugal Movements and Normometric Centripetal Movements in Psychogenic Ataxia
Authors: Manto Mario-Ubaldo
Published: April 2003

A method to unravel an aberrant motor behaviour in psychogenic ataxia is reported. The kinematic features of fast reaching movements in the vertical plane are described in a patient presenting a psychogenic ataxia. The procedure compared centrifugal and centripetal movements. Path ratios were computed for each phase, as well as the ratios of the paths for centrifugal and centripetal directions. Trajectories of centrifugal phases were erratic but centripetal movements were very regular, whereas both centripetal and centrifugal movements were irregular in patients presenting an organic cerebellar syndrome. A similar incongruity between movements in opposite directions is also shown for a second patient exhibiting psychogenic ataxia. Discrepancies between the centrifugal phase and the centripetal phase of multi-joint reaching movements support the diagnosis of a psychogenic movement disorder.
Workshop: Population Genetics and Conservation Biology in Non-Human Primates
Authors: Scheffrahn Wolfgang , Tomiuk Jürgen , Bayes Michell
Published: April 2003

A workshop on conservation genetics was held as part of the International Conference on the Biology and Conservation of Prosimians, at Chester Zoo, on September 15, 1995. The contribution of population genetics to conservation biology was questioned by most of the speakers gathered for this animated round-table discussion. The main topics of discussion were: (1) the importance of ex situ conservation for the preservation of the genome of some species by way of genome banking and captive breeding; (2) the choice of genetic parameters for measuring the magnitude of genetic variation; (3) the need for preliminary screening of genetic variation in the founding populations of captive breeding programmes; (4) the need for more sophisticated computer software for breeding programmes, and (5) the importance of preserving natural habitats for the conservation of non-human primates.
Comparison of the Genetic Diversity of Wild and Captive Groups of Microcebus murinus Using the Random Amplified Polymorphic DNA Method
Authors: Neveu H. , Hafen T. , Zimmermann E. , Rumpler Y.
Published: April 2003

Continued survival of most animal species depends on population management and active protection. It is generally agreed that, in order to avoid extinction of endangered species, ex situ and in situ conservation must be developed in tandem. However, even though many recommendations have been put forward to promote the survival of captive populations, some rapidly become extinct due to loss of genetic diversity (drift effect). Genetic markers, such as random amplified polymorphic DNA (RAPD) markers, can be applied to rapid testing of many individuals. They also permit analysis of very small amounts of DNA, when small species such as mouse lemurs (Microcebus) are to be tested. Using RAPD markers, we compare genetic diversity in four captive groups of Microcebus murinus to that in a sample of 70 wild mouse lemurs. Following the principles of Mendelian inheritance, each amplified fragment of DNA may be considered as a ‘locus’ (or an amplifying site). The series of bands amplified by a particular primer in any individual is referred to as the individual’s ‘profile’. We tested 5 primers, or, in the above terms, we studied 98 different ‘loci’. Results showed that the captive groups had lost genetic information with respect to the wild sample. Among the four captive groups, the loss of genetic diversity varied according to their number of founders and/or the management of their captive reproduction. Our study of polymorphism permitted us to establish tools for the genetic management of captive breeding, and for the determination of paternity which frequently give better results than behavioural studies; and simulation of introductions or departures of individuals in one very monomorphic group permitted estimation of future increases in its genetic diversity.
The Prosimian Fauna of the Fayum Eocene/Oligocene Deposits of Egypt
Authors: Simons Elwyn L.
Published: April 2003

After decades when only higher primates had been found in the Oligocene deposits of the Fayum, Egypt, a few isolated teeth of prosimians and a partial mandible of a tarsier were discovered there in the 1980s. These, assigned to the families Lorisidae, Omomyidae and a new genus and species, Afrotarsius chatrathi, are discussed and reviewed. Since 1990, a late Eocene locality in the Fayum, L-41, has been intensively explored, and in this older site a new suite of archaic higher primates has been recovered. Together with these anthropoideans, material of at least three new prosimians has been found. A skull and mandibles of the most complete of these, Plesiopithecus teras, was described in 1994. This appears to be the oldest strepsirhine yet discovered worldwide, and it has been assigned a position as a sister-group to the Lorisidea. In 1995, a cercamoniine adapid, Aframonius dieides, was also described from L-41. The description of a third new genus and species of prosimian from L-41 is presently in preparation. The previously described prosimians are here reviewed and their implications for understanding the overall prosimian radiation discussed.
Speciation in the Lesser Galagos
Authors: Masters J.C.
Published: April 2003

Species and their origins remain one of the outstanding enigmas of evolutionary biology. Many different views of the problem exist, but few have concrete predictions that open the problem to investigation. This study formalises predictions arising from the Recognition Concept of species (RC) and the Organization Theory of Speciation (OTS), and applies them to the pattern demonstrated by the lesser galago radiation. The RC and OTS are in agreement that one of the primary adaptive responses during animal speciation events involves the system of sexual recognition and reproduction, and indeed the lesser galago taxa show significant divergences in their communication systems relating to specific-mate recognition. On the other hand, only the RC predicts a concomitant adaptive response to the ecological conditions prevailing during speciation, and there are strong indications of shifts in habitat preference among these taxa. The predictions of the RC are supported above those of the OTS.
Clinical Profile of Donepezil in the Treatment of Alzheimer’s Disease
Authors: Doody R.S.
Published: April 2003

Although the underlying pathogenesis of Alzheimer’s disease (AD) is not fully understood, one of its key features is the widespread loss of central cholinergic innervation, known to be fundamental for cognitive processes. This finding led to the hypothesis that pharmacological enhancement of acetylcholine (ACh) neurotransmission may alleviate the symptoms of AD. Currently, cholinergic therapy, particularly cholinesterase (ChE) inhibition, represents the most realistic approach to the symptomatic treatment of AD. Donepezil HCl, for example, is a piperidine-based, reversible acetylcholinesterase (AChE) inhibitor, chemically distinct from other ChE inhibitors and rationally designed for the symptomatic treatment of AD. It is highly selective for centrally acting AChE, with little or no affinity for butyrylcholinesterase, present predominantly in the periphery. Phase I and II clinical trials demonstrated donepezil’s favourable pharmacokinetic, pharmacodynamic and safety profile with no requirement for dose modification in the elderly or in patients with renal or hepatic impairment. Furthermore, its long half-life supports a simple and convenient once-daily dosing regimen. Subsequent to encouraging phase II clinical trial results, two pivotal, randomized, double-blind phase III trials (of 15 and 30 weeks’ duration) demonstrated highly significant improvements in cognition and global function in mild to moderately severe AD patients treated with either 5 or 10 mg/day donepezil compared with placebo. Adverse events in the phase II and III trials, primarily cholinergic in nature, were transient and generally mild in severity and resolved during continued donepezil administration. Thus, the donepezil clinical trials programme has shown that this drug is a clinically effective and well-tolerated, once-daily treatment for the symptoms of mild to moderately severe AD.
Prenatal Exposure to a Maternal Low Protein Diet Shortens Life Span in Rats
Authors: Aihie Sayer Avan , Dunn Rebecca , Langley-Evans Simon , Cooper Cyrus
Published: April 2003

Background: Postweaning diet restriction is associated with prolongation of life span, reduced age-related disease and slower ageing. The effects of diet restriction imposed prior to weaning have not been so well characterised, but studies suggest an opposite effect with increased age-related diseases occurring in offspring exposed to undernutrition in prenatal life. It remains unclear whether life span is similarly adversely affected by early diet restriction. Objective: The present study in rats aimed to evaluate the impact of a maternal low protein diet upon the life span of the resulting offspring. Methods: Rat dams were fed either a 180-gram casein/kg control diet or a 90-gram casein/kg low protein diet from conception until the end of pregnancy. The offspring were then maintained with minimal handling until death from natural causes or distress-necessitated euthanasia. Results: The average life span of female rats exposed to low protein diets in utero was reduced by 11% (p = 0.044, Kaplan-Meier analysis). There was a similar but non- significant trend in the male offspring (control 76 ± 3 weeks, low protein 73 ± 3 weeks). In addition the rats exposed to a prenatal low protein diet had significantly higher systolic blood pressure at 4 weeks of age and tended to be smaller than control animals in postnatal life. Conclusion: The results suggest that intrauterine diet restriction reduces life span in rats and contrasts with the well-recognised increase in life span produced by postweaning diet restriction. The timing of the nutritional intervention appears to be critical and recognition of this is relevant to understanding the mechanisms underlying the effects of diet restriction on ageing and life span.
Elevation of Serum Hyaluronan Level in Werner’s Syndrome
Authors: Tanabe Manabu , Goto Makoto
Published: April 2003

Background: There is a well-established association between Werner’s syndrome (WS) and hyperhyaluronic aciduria; however, to date hyaluronan (HA) in the serum has not been statistically linked with WS. Recently, the gene that causes WS has been defined as a DNA helicase on chromosome 8, and 19 different mutations in WS patients have been identified. It is not known whether the mutation type of the Werner helicase gene affects the levels of serum and urine HA in WS patients. Objective: To evaluate the association of serum HA with WS, and the relationship of the serum and urine HA levels to the mutation type. Methods: HA both in the serum and the urine was measured in 40 patients with WS and 114 normal controls. The serum and urine HA were quantified by sandwich binding protein assay and competitive ELISA-like method, respectively. The muation on WS helicase gene was analyzed by mutant-allele-specific amplification and oligomer ligation assay. Results: WS patients showed significantly higher levels of HA in the serum (mean ± SD: 115.7 ± 119.8 ng/ml, p < 0.001) and urine (1,040.8 ± 777.3 ng/mg creatinine, Cre, p < 0.001) than age-matched controls (serum HA: 15.8 ± 14.2 ng/ml, urine HA: 379.7 ± 124.2 ng/mg Cre). The serum and urine HA levels of WS patients are almost equal to those of normal controls over 80 years (serum HA: 118.5 ± 108.4 ng/ml, urine HA: 914.5 ± 712.1 ng/mg Cre). There was a significant correlation between serum and urine HA levels in WS patients (r = 0.42, p = 0.007). Analysis of the mutation on the helicase gene in 22 WS patients showed that among 44 chromosomes, 3 (6.8%) chromosomes had type 1 mutation, 22 (50.0%) had type 4 mutation, 14 (31.8%) had type 6 mutation, and the rest had other mutations. The serum and urine levels of HA did not show any significant association with the mutation type. Conclusion: The hyperhyaluronic aciduria in WS reflects the high level of serum HA. The serum and urine HA levels are useful biochemical markers for WS irrespective of the muation type of the Werner helicase gene.
Cerebral Haemorrhage
Authors: MacWalter Ronald S. , Ersoy Yuksel , Wolfson Deborah R.
Published: April 2003

While there have been substantial improvements in the management of patients with cerebral infarction and there are likely to be further improvements over the next decade, the same may not be true for cerebral haemorrhage. Diagnostic facilities and neurosurgical techniques have improved but not all patients are benefiting from these. The current literature is reviewed. Further controlled trials of the utility of modern neurosurgical techniques are urgently required as at present no therapeutic intervention holds out hope for these patients other than optimum medical management. The main focus must be on prevention.
Tuberculosis in the Elderly
Authors: Packham Stuart
Published: April 2003

Tuberculosis is still a major cause of morbidity and mortality worldwide. Recent studies have suggested that even in the developed world its incidence in the elderly is increasing. Symptoms of active tuberculosis are non-specific and less pronounced in the elderly. Radiological features are more likely to be ‘atypical’ in the older subject and skin tests more frequently negative. This results in delay in diagnosis and higher mortality from tuberculosis in the aged population. A high degree of clinical suspicion is therefore required to ensure the diagnosis is not missed and appropriate treatment instigated.
The Relationship between Apolipoprotein E4 and Lipid Metabolism Is Impaired in Alzheimer’s Disease
Authors: Dupuy A.M. , Mas E. , Ritchie K. , Descomps B. , Badiou S. , Cristol J.P. , Touchon J.
Published: April 2003

Background: Human apolipoprotein (Apo) E4 (ApoE4) is an important determinant of lipid metabolism and cell-to-cell cholesterol transport. It is also a major genetic risk factor for both vascular disease and familial and sporadic late-onset Alzheimer’s disease (AD). Since vascular pathology could dramatically reduce neuronal reserve capacity, a biological chain of events between ApoE4, hypercholesterolemia and AD has been postulated. The aim of the present study is to explore the relationship between lipid metabolism and ApoE isoforms in a large series of elderly subjects in relation to the presence or absence of AD. Methods: Of 332 referrals to a neurology clinic specializing in memory disorders, 146 were given a diagnosis of AD (age, mean ± SD 76 ± 13.1 years, 64.4% women) according to DSM-IIIR criteria. One hundred and seventy-six subjects were included as controls (age 80 ± 5.6 years, 58% women). The ApoE phenotype was determined by the isoelectrofocalization method, cholesterol, triglycerides, phospholipids, ApoA and ApoB were determined by routine chemistry. Findings: A significant association was observed between the E4 allele and AD (χ2 = 13, p < 0.001) only below age 80. In the control group, cholesterol levels were found to be significantly higher in men but not in women with an E4 allele (6.35 ± 1.3 mmol/l) as opposed to those without (5.8 ± 1.2 mmol/l). ApoB levels were also found to be higher in the presence of ApoE4, with no gender effect. Within the AD group no significant relationship was found between ApoE4 and cholesterol levels (mean 6.05 ± 0.9 mmol/l in E4-AD subjects versus 5.8 ± 1.21 mmol/l in non-E4-AD subjects). Similar observations were made in relation to triglycerides and phospholipids. Interpretation: Our results demonstrate the disappearance of the ApoE4-raising effect on serum cholesterol, triglyceride and phospholipid levels in AD suggesting a more complex relationship between AD and lipid metabolism than has previously been supposed. This lipid abnormality may further contribute to the progression of AD.
Plasma Folate, Vitamin B12, and Total Homocysteine and Homozygosity for the C677T Mutation of the 5,10-Methylene Tetrahydrofolate Reductase Gene in Patients with Alzheimer’s Dementia
Authors: Postiglione Alfredo , Milan Graziella , Ruocco Antonio , Gallotta Giovanni , Guiotto Giovanna , Di Minno Giovanni
Published: April 2003

Background: Elevated total plasma homocysteine (tHcy) levels are considered a risk factor for cerebrovascular disease and may also play an important role in the pathogenesis of Alzheimer’s disease (AD). High values of plasma tHcy and low levels of vitamin B12 and folate are frequently present in AD patients. Moreover, the homozygous mutation (C677T) of the methylene tetrahydrofolate reductase (MTHFR) gene, related to a thermolabile type of the encoded enzyme, causes hyperhomocysteinemia by reducing the 5-methyltetrahydrofolate availability. Objective: The aim of the study was to investigate plasma levels of folate, vitamin B12 and tHcy in patients with AD. These values were also related to the severity and the duration of the disease and to the possible role of the MTHFR genotype (C677T). Method: Plasma tHcy levels, homozygosity for the C677T mutation of the MTHFR gene, and folate and vitamin B12 plasma levels were evaluated in 74 patients with AD (45 men, 29 women, mean age 68 years) and in 74 healthy matched controls (42 men, 32 women, mean age 68 years). Results: AD patients had higher mean (± SD) plasma levels of tHcy (20.9 ± 15 µmol/l compared to 11.8 ± 5 µmol/l, p < 0.001) and lower mean plasma folate (5.7 ± 2.1 ng/ml compared to 8.5 ± 3.2 ng/ml, p < 0.001) and vitamin B12 (491 ± 144 pmol/l compared to 780 ± 211 pmol/l, p < 0.001) concentrations. Homozygosity for the C677T mutation of the MTHFR gene had a similar prevalence among controls (18%) and AD patients (20%). Homozygous AD patients (n = 15) had higher plasma tHcy values than nonhomozygotes, in spite of similar mean plasma folate and vitamin B12 levels. This difference in plasma tHcy levels was not observed in controls. Patients with levels of plasma tHcy above and of plasma folate below the normal limits were more frequent in the homozygous AD group. The duration of the disease correlated with plasma levels of tHcy (r = +0.832, p < 0.001), plasma folate (r = –0.580, p < 0.05), and vitamin B12 (r = –0.460, p < 0.05). However, when all the data were corrected for age, serum creatinine levels, and duration of the disease, mean plasma tHcy, folate, and vitamin B12 levels were not statistically different between controls and AD patients. Conclusions: Our data suggest that rather than a risk factor for AD, hyperhomocysteinemia is related to its progression and increasing severity. This might be particularly relevant in homozygotes for the C677T mutation of the MTHFR gene and supports the possible need for continuous supplements in this setting.
Thermal Balloon Ablation in Myoma-Induced Menorrhagia under Local Anesthesia
Authors: Soysal Mehmet Emin , Soysal Seyide Kara , Vicdan Kubilay
Published: April 2003

Objective: Our purposes were to compare the impact of surgery on menstrual blood flow reduction and on the increase in hemoglobin values as primary endpoints at 12 months, and operating time, complication rates, postoperative pain scores at 12 h and surgically induced amenorrhea rates at 12 months as secondary endpoints after roller ball endometrial ablation or thermal balloon ablation for myoma-induced menorrhagia. Materials and Methods: Menorrhagic women (documented by a validated pad scoring system) over 40 years of age, with a mobile myomatous uterus smaller than 12-week pregnancy, were enrolled in a prospective randomized trial to compare endometrial roller ball ablation and thermal balloon ablation after pharmacological endometrial thinning. One year after surgery, primary and secondary endpoints in both groups were compared. Results: Forty-five subjects underwent endometrial thermal balloon ablation under local anesthesia and 48 underwent endometrial roller ball ablation under general anesthesia. Statistically significant but similar decreases in mean pictorial blood assessment score and increases in mean hemoglobin values were noted for both groups at 12 months. Those who underwent endometrial roller ball ablation had experienced significantly more intraoperative complications. Conclusion: Thermal balloon ablation under local anesthesia for myoma-induced menor- rhagia provided both significant and statistically similar reductions in menstrual blood flow and increases in hemoglobin values with no intraoperative complication compared to roller ball endometrial ablation.
Neonatal Vaginal Prolapse
Authors: Vega-Rich Carlos , Sherer David M.
Published: April 2003

We present an unusual case of neonatal vaginal prolapse in a term newborn and review the literature pertaining to this rare condition.
Expression of Ovarian Prolactin Receptor in Relation to Hormonal Changes during Induction of Ovulation in the Rat
Authors: Kinoshita Hiromi , Yasui Toshiyuki , Ushigoe Kenjirou , Irahara Minoru , Tanaka Minoru , Nakashima Kunio , Aono Toshihiro
Published: April 2003

We examined the relationships between the expression of the short and long forms of the prolactin (PRL) receptor (PRLR) mRNA in the ovary and changes in the levels of serum hormones such as sex steroid hormones and PRL during induction of ovulation in the rat. The expression of both forms of PRLR mRNA in the ovary was examined by Northern blot analysis in immature female rats treated with pregnant mare serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG). Ovarian tissues and blood samples were obtained before treatment, 24 and 48 h after PMSG injection and 4, 6, 8, 12, 24 and 48 h after hCG treatment. Serum levels of 17β-estradiol, progesterone and PRL were determined by radioimmunoassay. Serum levels of 17β-estradiol rapidly increased to a maximal level 48 h after PMSG injection and then rapidly declined until 4 h after hCG injection. Serum levels of progesterone gradually increased after PMSG treatment, markedly increased to 114.2 nmol/l 8 h after hCG treatment and remained high until 48 h after hCG treatment. The serum level of PRL peaked at 66.2 µg/l (p < 0.01) 48 h after PMSG injection, and a temporary decrease after hCG treatment was followed by a continuously high level from 8 to 48 h. The expression of the long form of PRLR mRNA increased significantly (p < 0.01) to 688% of the control level after PMSG treatment, while that of the short form increased to only 184% of the control level. The expression of the long form of PRLR-mRNA rapidly declined until 6 h and then gradually increased until 48 h after hCG treatment. On the other hand, the expression of the short form of PRLR mRNA decreased to a nadir 12 h after hCG injection and then increased significantly (p < 0.01) to 142% of the control level. Our results showed that the changes in the short and long forms of PRLR mRNA differed in a time-specific manner and that these two forms are involved in different functions in the rat ovary during induction of ovulation. It is thought that the long form of PRLR mRNA is involved in folliculogenesis, while the short form of PRLR mRNA may play an important role in the formation and maintenance of the corpus luteum in the rat ovulatory cycle.
Obstetric Litigation: Effects on Clinical Practice1
Authors: Symon Andrew
Published: April 2003

Many claims concerning extent and consequences of litigation have been made, despite a lack of comprehensive and widely available data. It has been suggested that a rapidly increasing rate of litigation has caused problems in the recruitment and retention of obstetricians, and has also caused practitioners to practice ‘defensively’. This article discusses meaning and significance of defensiveness within obstetrics and midwifery and quantifies the incidence of certain examples of defensive practice. Based on large-scale postal surveys of obstetricians and midwives in Scotland and England, as well as follow-up interviews, it clarifies the significance of what has become known as defensive medicine in maternity care, notably in relation to caesarean sections. It then examines the role of clinical risk management, and the growth of protocols and guidelines in particular, in trying to limit litigation.
Langzeitkontrazeption
Authors: Bitzer J. , Hänggi W. , Husslein P. , Kunz J. , Ringler Marianne , Staudach A.
Published: April 2003

Leider besteht für diesen Artikel keine Zusammenfassung. Als Einstieg stellen wir den Textanfang zur Verfügung. Langzeitkontrazeption ist sowohl für Frauen mit abgeschlossener Familienplanung als auch für Frauen ohne Kinderwunsch in naher Zukunft ein wichtiges Thema. Der geänderte Lebensstil jüngerer Frauen lässt sie einen Kinderwunsch hinauszögern oder zurückstellen. Bei noch nicht abgeschlossener Familienplanung ist die vorhersehbare Widererlangung der Konzeptionsfähigkeit nach längerfristiger Anwendung von Verhütungsmethoden besonders relevant. In den vergangenen Jahren wurden einige Empfehlungen zur Langzeitkontrazeption von der WHO [1] und dem Royal College of Obstetrics and Gynaecology [2] sowie der Canadian Consensus Conference [3] veröffentlicht. Diese beruhen primär auf medizinischen Erkenntnissen, berücksichtigen aber keine psychosozialen Aspekte der Frauen, weshalb sie in der täglichen Praxis nur beschränkt umsetzbar sind.
Additional Glomangioma Families Link to Chromosome 1p: No Evidence for Genetic Heterogeneity
Authors: Calvert Jennifer T. , Burns Shannon , Riney Travis J. , Sahoo Trilochan , Orlow Seth J. , Nevin Norman C. , Haisley-Royster Camille , Prose Neil , Simpson Sheila A. , Speer Marcy C. , Marchuk Douglas A.
Published: April 2003

Venous malformations are a common abnormality of the vasculature that may occur sporadically or, more rarely, as an autosomal dominant trait. One familial form of venous malformations has previously been linked to chromosome 9p. Mutations in the gene encoding Tie2, an endothelial specific receptor tyrosine kinase, have been identified in four different families. Glomangiomas are a subtype of venous malformations with glomus cell involvement. These cutaneous lesions can be inherited as an autosomal dominant disease with reduced penetrance and variable expressivity. We present evidence of linkage to chromosome 1p21-1p22 using four new glomangioma families, with a combined maximum two-point lod score of 7.32 at marker D1S2804. Markers D1S2129 and D1S2881 define the 24-cM linkage interval determined by recombination within affected individuals. A recent report also showed linkage of the glomangioma locus to chromosome 1p. A total of 9 families now map to this region, suggesting a decreased likelihood of locus heterogenity in familial glomangiomas. Investigation of candidate genes within the interval should provide new insights into lesion formation in inherited venous malformations.
A Novel Nonsense Mutation of the GTP Cyclohydrolase I Gene in a Family with Dopa-Responsive Dystonia
Authors: Hong Kyeong-Man , Kim Yo-Sik , Paik Moon-Kee
Published: April 2003

We report a new nonsense mutation in the GTP cyclohydrolase I (GCH1) gene in a family with dopa-responsive dystonia. Two sisters and three children of the sisters are affected. The exons of the GCH1 gene were amplified by PCR and sequenced. The substitution of thymine for cytosine at nucleotide position 142 causing a nonsense mutation (Q48X) in exon 1 was identified in all of the five affected patients. There were three asymptomatic carriers of the mutation in the family.
Localization of a Recessive Juvenile Cataract Mutation to Proximal Chromosome 7 in Mice
Authors: Cargill E.J. , Happold T.R. , Bertani G. , Rocha J. , Lou M.F. , Pomp D. , Nielsen M.K.
Published: April 2003

Objective: To localize the chromosomal position of a novel cataract mutation (juvenile recessive cataract; jrc) in mice. Methods: A mapping population was developed by crossing cataract males (albino MH) to wild-type females (black C57BL/6J). F1 females were backcrossed to albino MH males with cataracts. Results: The results were consistent with a model of a single autosomal recessive gene [153 cataract, 169 wild-type; χ2 = 0.8, 1 degree of freedom (d.f.), p > 0.35]. Linkage with the albino (tyrosinase; Tyr) locus was evident (χ2 = 61.5, 1 d.f., p < 0.0001), implicating chromosome 7 as the location of jrc. Recombination percentages (± SE) between jrc and D7Mit340 (1.2 cM location), D7Mit227 (16.0 cM) and D7Mit270 (18.0 cM) were 17.1 ± 2.1, 3.7 ± 1.1 and 6.2 ± 1.3%, respectively. Multi-point mapping determined that the most likely order of these loci is D7Mit340 – jrc – D7Mit227 – D7Mit270 – Tyr. Although animals with the mutant phenotype appeared to have little or no sense of sight, their growth was not different (p >0.20) from that of normal mice. Conclusion: The jrc mutation model may be useful in the study of the genetics of cataracts in other animal species, including humans.
Multipoint Estimation of Identity-by-Descent Probabilities at Arbitrary Positions among Marker Loci on General Pedigrees
Authors: Sobel Eric , Sengul Haydar , Weeks Daniel E.
Published: April 2003

Objectives: To describe, implement, and test an efficient algorithm to obtain multipoint identity-by-descent (IBD) probabilities at arbitrary positions among marker loci for general pedigrees. Unlike existing programs, our algorithm can analyze data sets with large numbers of people and markers. The algorithm has been implemented in the SimWalk2 computer package. Methods: Using a rigorous testing regimen containing five pedigrees of various sizes with realistic marker data, we compared several widely used IBD computation programs: Allegro, Aspex, GeneHunter, MapMaker/Sibs, Mendel, Sage, SimWalk2, and Solar. Results: The testing revealed a few discrepancies, particularly on consanguineous pedigrees, but overall excellent results in the deterministic multipoint packages. SimWalk2 was also found to be in good agreement with the deterministic multipoint programs, usually matching to two decimal places the kinship coefficient that ranges from 0 to 1. However, the packages based on single-point IBD estimation, while consistent with each other, often showed poor results, disagreeing with the multipoint kinship results by as much as 0.5. Conclusions: Our testing has clearly shown that multipoint IBD estimation is much better than single-point estimation. In addition, our testing has validated our algorithm for estimating IBD probabilities at arbitrary positions on general pedigrees.
Modulation of Normal Human Eosinophil Chemotaxis in vitro by Herbimycin A, Erbstatin and Pervanadate
Authors: El-Shazly Amr , Masuyama Keisuke , Samejima Yasuhiro , Eura Masao , Ishikawa Takeru
Published: April 2003

Background: The mediators involved in eosinophil accumulation in diseases such as allergy continue to be an area of interest, even though little is known regarding the signaling involved in the human cell type recruitment. In the present study, we demonstrate a novel modulatory role of tyrosine kinase and tyrosine phosphatase activities on normal human eosinophil chemotaxis induced by different groups of chemoattractant. Methods: Purified eosinophils were obtained from normal healthy volunteers with the CD16-negative procedure. Chemotactic activities against platelet-activating factor (PAF), vasoactive intestinal peptide (VIP) and eotaxin were assessed using a 48-well microchemotaxis chamber assay. Purified eosinophils were pretreated with herbimycin A, erbastatin or pervanadate to examine the role of tyrosine kinase in chemoattractant signaling. Results: Pretreatment of eosinophils with the tyrosine kinase inhibitors herbimycin A and erbstatin significantly blocked chemotaxis induced by eotaxin whilst both inhibitors augmented chemotaxis induced by VIP; however, they had no effect on PAF-induced chemotaxis. On the other hand, pretreatment of eosinophils with the phosphotyrosine phosphatase inhibitor pervanadate resulted in augmentation of eotaxin-induced chemotaxis and inhibition of VIP-induced chemotaxis, but it had no effect on PAF-induced chemotaxis. Conclusions: These results suggest that protein kinase plays a modulatory role in eosinophil chemotaxis induced by various chemoattractants.
Effect of Immunotherapy on the Production of Eosinophil Adhesion-Inducing Activity from Mononuclear Cells in House-Dust-Mite-Sensitive Bronchial Asthma
Authors: Nagata Makoto , Tabe Kazuaki , Hong Choo Jae , Sakamoto Yoshio , Matsuo Hiroshi
Published: April 2003

An initial step of eosinophil (EOS) accumulation in the sites of allergic inflammation is the adhesion to endothelial cells. There is increasing evidence that immunotherapy (IT) modulates the production of cytokines from mononuclear cells and hence attenuates allergic inflammation. To examine whether IT modifies the production of factor(s) which induce EOS adhesion, peripheral blood mononuclear cells (PBMC) from house-dust-mite-sensitive asthmatics treated with or without IT were cultured for 96 h in the presence or absence of 1/µg/ml Dermatophagoides farinae antigen. EOS were isolated from the peripheral blood of healthy subjects. EOS adhesion-inducing activity (EAIA) in the PBMC culture supernatants was examined by the ability to modify EOS adhesion to paraformaldehyde-fixed human umbilical vein endothelial cells (HUVEC) which were stimulated with IL-4 plus TNF-α. In asthmatics without IT, the addition of D. farinae antigen significantly promoted the production of EAIA from PBMC (EOS adhesion: 22.4±13.1% by medium control vs. 30.5±18.9% by D. farinae, n=10, p=0.023). This enhancing effect was blocked by an anti-β2-integrin antibody. In contrast, the addition of D. farinae did not modulate EAIA production from PBMC in asthmatics treated with IT (23.1±10.3% vs. 21.5±12.3%, n=10, p=NS). These results suggest that IT induces the inhibition of antigen-dependent production of EAIA from PBMC. This may contribute to the inhibitory effect of IT on eosinophil recruitment in allergic inflammation.
Human Skin Mast Cells Produce TNF-α by Substance P
Authors: Okayama Yoshimichi , Ono Yoshihiro , Nakazawa Tsugio , Church Martin , Mori Masatomo
Published: April 2003

Using in situ hybridization and the reverse transcriptase polymerase chain reaction (RT-PCR) we show that messenger RNA for IL-4, IL-5 and tumor necrosis factor-α (TNF-α) is induced by cross-linkage of high-affinity FcΕ receptors (FcΕRI) on human skin mast cells, but that only TNF-α mRNA is selectively induced by substance P. Skin mast cells were purified using the Percoll density technique. T cells were removed by serial negative selection using a CD2 monoclonal antibody (mAb) to achieve a final mast cell purity >95%. Purified mast cells were precultured with recombinant human stem cell factor (rhSCF; 10 ng/ml) and myeloma IgE (3 µg/ml) for 16 h before challenge with sheep polyclonal antihuman IgE antibody (anti-IgE; 1 or 10 µg/ml) in the presence of rhSCF (50 ng/ml). Using in situ hybridization, we demonstrated that IgE-dependent stimulation induces the expression of IL-4, IL-5 and TNF-α mRNA in skin mast cells. We have investigated the expression of IL-4, IL-5 and TNF-α mRNA by substance P, with the result that substance P, 0.003–30 µM, selectively induced TNF-α mRNA. However, substance P did not induce IL-4 mRNA and did not enhance IL-5 mRNA. Furthermore, we confirmed the release of TNF-α by substance P from skin mast cells using an ELISA technique. These findings demonstrate the capacity of human skin mast cells to transcribe IL-4, IL-5 and TNF-α by immunological activation and to transcribe and release TNF-α by substance P.
Functional Expression of Transmembrane 4 Superfamily Molecules on Human Eosinophils
Authors: Matsumoto Kenji , Bochner Bruce S. , Wakiguchi Hiroshi , Kurashige Takanobu
Published: April 2003

Background: Transmembrane 4 superfamily (TM4SF) molecules are exclusively found on hematopoietic cells. Several members of the TM4SF are reported to be associated with other cell surface molecules, including integrins, and might participate in signal transduction, but little is known about their role on eosinophils. In the present study, we determined the expression and function of TM4SF molecules on human eosinophils. Methods: Surface expression of TM4SF molecules on purified peripheral blood eosinophils was examined using indirect immunofluorescence and flow cytometry. Purified eosinophils were incubated with anti-TM4SF monoclonal antibodies (mAbs) for up to 24 h. Eosinophil activation was evaluated by measuring eosinophil homotypic aggregation as well as changes in surface expression of CD11b or CD62L by flow cytometry. Results: Freshly isolated eosinophils expressed CD9, CD37, CD53, CD63 and CD81. Incubation with anti-CD9 mAb but not with anti-CD37, CD53, CD63 or CD81 mAb induced significant eosinophil homotypic aggregation. Incubation with any of the anti-TM4SF mAb for 30 min failed to alter the expression of either CD11b or CD62L on eosinophils. In contrast, the expression of CD11b was significantly enhanced after 24 h of incubation with anti-CD53 mAb, while the expression of CD62L was significantly reduced with anti-CD81 mAb. Conclusions: Cross-linking of some surface TM4SF molecules induced significant eosinophil homotypic aggregation, upregulation of CD11b expression, or CD62L shedding, consistent with activation of eosinophils. Our data suggest that several TM4SF molecules are functionally expressed on human eosinophils, and therefore might participate in allergic inflammation.
Circadian Variation in Nasal Reactivity in Children with Allergic Rhinitis: Correlation with the Activity of Eosinophils and Basophilic Cells
Authors: Aoyagi Masahiko , Watanabe Hiroko , Sekine Kunio , Nishimuta Toshiyuki , Konno Akiyoshi , Shimojo Naoki , Kohno Yoichi
Published: April 2003

Background: In allergic rhinitis, the major symptoms of runny nose, sneezing, and stuffy nose tend to become worse upon waking up in the morning, and yet the mechanisms underlying this phenomenon are poorly understood. We investigated whether the worsening of allergic rhinitis in the morning is associated with changes in the activity of inflammatory cells. Methods: Nasal reactivity to methacholine was assessed twice in 8 children with allergic rhinitis and 8 healthy control subjects at 6.00 a.m. and 3.00 p.m. The amounts of eosinophil cationic protein (ECP), histamine and tryptase in induced nasal secretions and peripheral blood were also measured. Results: Nasal reactivity to methacholine was higher at 6.00 a.m. not only in patients but also in healthy controls. Serum ECP and plasma histamine levels showed no circadian patterns. On the other hand, significantly higher levels of inflammatory activation products were found in nasal secretions at 6.00 a.m., thus showing a direct association with nasal reactivity. Conclusion: These results suggest that the circadian variation in nasal reactivity is associated with changes in the activity of eosinophils and basophilic cells in the nasal mucosa.