bluuebunny/crossref_metadata_2025 huggingface dataset:
Electromyographic Quantification of the Paralysing Effect of Botulinum Toxin in the Sternocleidomastoid Muscle
Authors: Dressler D. , Rothwell J.C.
Published: April 2003

The effect of botulinum toxin (BT) upon the human body has so far been measured by using clinical scales monitoring its overall therapeutic effect upon the disorders treated. Clinical scales, however, usually lack sensitivity, are rarely validated and are integrating a number of uncontrollable parameters. After validation of the methodology in a group of 10 controls, we investigated the BT-induced amplitude reduction of the maximal voluntary electromyographic activity (M-EMG amplitude reduction) of the sternocleidomastoid muscle in a group of 34 patients with cervical dystonia undergoing regular BT therapy with Botox® (Allergan, Irvine, Calif., USA; n = 16) or Dysport® (Ipsen, Maidenhead, UK; n = 18). With Botox doses of 20 mouse units the M-EMG amplitude reduction was 80% (SD = 3.9%, n = 4), with 40 it was 84% (SD = 10.8%, n = 4), with 60 it was 85% (SD = 2.6%, n = 2) and with 80 it was 91% (SD = 5.8%, n = 6). With Dysport doses of 100 mouse units the M-EMG amplitude reduction was 70% (SD = 7.6%, n = 4), with 200 it was 85% (SD = 10.4%, n = 5), with 300 it was 83% (SD = 9.2%, n = 3), with 400 it was 78% (SD = 6.7%, n = 3) and with 500 it was 91% (SD = 5.8%, n = 5). The methodology presented can measure M-EMG amplitude reductions with a precision of about 10%. Dose-efficacy relationships can be used for dose optimisation, evaluation of BT therapy failure and comparison of different preparations and types of BT.
Preclinical Impairment of the Striatal Dopamine Transporter System in Sporadic Olivopontocerebellar Atrophy: Studied with [123I]β-CIT and SPECT
Authors: Kim Gyeong-Moon , Kim Sang Eun , Lee Won Yong
Published: April 2003

We investigated whether the dopamine (DA) transporter system is impaired in sporadic olivopontocerebellar atrophy (sOPCA) patients without clinical parkinsonism using the DA transporter radiotracer [123I]β-CIT [2β-carboxymethoxy-3β-(4-iodophenyl)tropane] and single-photon emission computed tomography (SPECT). SPECT scans were acquired in 9 patients with sOPCA, 7 multiple system atrophy (MSA) patients with parkinsonism (MSA-P), and 7 age-matched healthy controls 20–24 h after the intravenous injection of [123I]β-CIT. [123I]β-CIT-specific binding in the striatum was determined as the radioactivity ratio of the striatum to the occipital cortex (specific binding ratio, SBR). In patients with sOPCA and MSA-P, SBRs in the right and left striatum and the mean SBR were significantly lower than those in controls (p < 0.05). The mean SBRs in patients with sOPCA and MSA-P were reduced to 69.0 and 60.7% of the control mean, respectively. However, there was no significant difference in SBRs between sOPCA and MSA-P patients. In sOPCA patients, the mean SBR was significantly correlated with the score of the clinical cerebellar function scale (r = –0.670, p = 0.024). These results indicate that even in the absence of clinical parkinsonism, the striatal dopaminergic system may be impaired in sOPCA. The DA transporter loss in sOPCA serves as another clue for sOPCA being a part of the spectrum of MSA.
Acute Brainstem Symptoms Associated with Cervical Syringomyelia
Authors: Meves Saskia H. , Postert Thomas , Przuntek Horst , Büttner Thomas
Published: April 2003

Syringomyelia classically presents with slowly progressing dissociated sensory and upper and lower motor deficits. Atypical and acute manifestations have rarely been described. We report here on 3 patients with syringomyelia, who had acute and atypical brainstem symptoms with regard to the underlying disease. These symptoms occurred after acute elevation of the intrathoracic and intra-abdominal pressure, respectively, and remitted subsequently. Vertebrobasilar ischemia was initially suspected.
Critical Illness Polyneuropathy
Authors: de Sèze M. , Petit H. , Wiart L. , Cardinaud J.P. , Gaujard E. , Joseph P.A. , Mazaux J.M. , Barat M.
Published: April 2003

Critical illness polyneuropathy (CIP) is a reported cause of varying degrees of neuromuscular weakness in patients with multiple organ failure. Little is known concerning predictive factors of neurological recovery. The critical care conditions, neurological explorations and 2-year clinical follow-up of 19 patients who suffered from severe forms (quadriplegia or quadriparesis) of CIP were analyzed. Characteristics of patients who recovered clinically were compared with those of patients who did not. Two patients died within 2 months, 11 recovered completely, 4 remained quadriplegic and 2 remained quadriparetic. All patients suffered from sepsis, multiple organ dysfunction syndrome and a catabolic state before the onset of CIP. Outcome appears difficult to predict with clinical or electrophysiological data. Three parameters were significantly correlated with poor recovery: longer length of stay in the critical care unit, longer duration of sepsis and greater body weight loss. A relationship seems to exist between the severity of CIP and that of sepsis and its associated hypercatabolism. The favorable outcome usually attributed to CIP must be reconsidered. The authors recommend aggressive measures against sepsis to limit CIP and its sequelae.
Apraxia of Single Tool Use
Authors: Hayakawa Yuko , Yamadori Atsushi , Fujii Toshikatsu , Suzuki Kyoko , Tobita Mari
Published: April 2003

We report a 72-year-old right-handed man who showed an ‘apraxia of tool use’ after a cerebral infarct in the territory of the left middle cerebral artery. His apraxia of tool use was characterized by a clear dissociation between the inability to use a single tool and the ability to use plural tools. Most of the errors occurred in selecting an appropriate target where a tool is expected to be applied. Detailed examinations confirmed that his conceptual knowledge of tool use was well preserved. Furthermore, when a target of a tool was provided as a cue, he used a single tool correctly. These results suggest that his inability to use a single tool originated from his inability to evoke a target image from an actual tool.
Type I Sialidosis: A Clinical, Biochemical and Neuroradiological Study
Authors: Palmeri Silvia , Villanova Marcello , Malandrini Alessandro , van Diggelen Otto P. , Huijmans Jean G.M. , Ceuterick Chantal , Rufa Alessandra , DeFalco Danilo , Ciacci Giuseppe , Martin Jean J. , Guazzi Giancarlo
Published: April 2003

We report biochemical, morphological and neuroradiological findings in a 40-year-old woman affected with type I sialidosis. The clinical symptoms, consisting of a cerebellar syndrome, were first noted at the age of 17 years. The macular cherry-red spot was first observed after 23 years of disease. A CT scan performed at 21 years of age showed enlargement of the fourth ventricle. Nuclear magnetic resonance imaging of the brain performed at the age of 40 showed severe atrophy of the cerebellum and pontine region; atrophy of cerebral hemispheres and of the corpus callosum was also observed. We emphasize the prolonged course of illness in this patient, observed over a long period of time. Of particular interest is the neuroradiological study showing our findings both at the beginning of the disease and after 20 years.
Blink Reflexes and Lateral Spreading in Patients with Synkinesia after Bell’s Palsy and in Hemifacial Spasm
Authors: Eekhof J.L.A. , Aramideh M. , Speelman J.D. , Devriese P.P. , Ongerboer de Visser B.W.
Published: April 2003

We compared various electrodiagnostical tests in patients with hemifacial spasm and in patients who developed synkinesia after Bell’s palsy. We examined the evoked blink reflexes in the orbicularis oculi (o. oculi) and orbicularis oris (o. oris) muscles in 23 patients with hemifacial spasm (HFS), in 10 patients with synkinesia after Bell’s palsy (BPS) and in 22 control subjects. In the patient groups, we recorded synkinesia, latency and amplitude of compound muscle action potential (CMAP) in the mental muscle after stimulation of the facial nerve and we examined electromyographic activity of the o. oculi and mental muscles synchronously. Furthermore, we studied the phenomenon of lateral spreading, also known as ephaptic transmission, between the different facial nerve branches. Patients with BPS had a prolonged R1 latency on the affected side in o. oculi and smaller mental CMAP amplitude as an indication of facial nerve damage and nerve fiber loss. This was not found in patients with HFS, who showed an increased amplitude of the R1 and R2 responses in o. oris. Patients with BPS showed only an increased R1 amplitude in o. oris. All patients had signs of synkinesia. Lateral spreading with different patterns was present in all patients with HFS and in half of the patients with BPS. Latencies of early and late responses showed no differences between HFS and BPS. In addition to alterations in facial nucleus excitability in both conditions, ectopic re-excitation of facial nerve axons in HFS may explain the differences in neurophysiological findings between HFS and BPS patients. A loss of control following synaptic stripping may also be a contributing factor.
Shoulder, Elbow and Wrist Components of Physiologic Tremor Amplitudeas Measured Using a Laser Penlight
Authors: Davis Bradley J. , O’Connell John
Published: April 2003

Objective: To measure the amplitude of physiological tremor in normal subjects using a novel method in an attempt to characterize some of the components of physiological tremor. Background: Current methods of measuring tremor are limited in their capability of measuring the contributions of various limb segments to physiologic tremor. Design and Methods: Subjects were asked to hold a laser penlight aimed at a target. Photographs with an exposure of 1 s were taken to record the path of the light. The angle of deflection was calculated under various conditions by averaging the results from four trials spaced at 15-second intervals. Results and Conclusions: The maximum amplitude under all conditions tested was less than 0.25°. Contributions from the wrist and fingers were significantly greater than contributions from the elbow or shoulder. Rotational movements were significantly more prominent than movements in other planes at the shoulder but not the elbow or wrist.
Age-Dependent Change in the Levels of Aβ40 and Aβ42 in Cerebrospinal Fluid from Control Subjects, and a Decrease in the Ratio of Aβ42 to Aβ40 Level in Cerebrospinal Fluid from Alzheimer’s Disease Patients
Authors: Fukuyama Ryuichi , Mizuno Toshiki , Mizuno Tetsuya , Mori Satoru , Nakajima Kenji , Fushiki Shinji , Yanagisawa Katsuhiko
Published: April 2003

In order to address an age-dependent alteration in the concentration of β-amyloid polypeptides (Aβs) within the central nervous system and its probable predisposition to amyloidgenesis in Alzheimer’s disease (AD), we measured two species of soluble Aβs, Aβ40 and Aβ42, in cerebrospinal fluids (CSF) from randomly selected Japanese control subjects at various ages (n = 33) and then compared these data with those of probable Japanese AD patients (n = 23). CSF concentrations of Aβ40 and Aβ42 peptides were age-dependent (ANOVA, Bonferroni’s multiple comparison; p < 0.01 and p < 0.05, respectively) and were lower in the infant than in adults. From mid-20, the Aβ40 concentrations were decreasing while Aβ42 were rather stable. Aβs in CSF from AD patients (n = 23), whose ε4 allele frequency of the apolipoprotein E gene was higher than in controls (n = 83, p < 0.03), were not statistically different from those of age-matched controls (n = 13). A linear relationship was detected between the Aβ40 concentration and the Mini-Mental State Examination score (p < 0.05). The ratio of the Aβ42 to the Aβ40 level measured in the AD CSF samples was approximately 38% decreased compared to age-matched controls (p < 0.05). These data suggest that the physiological metabolism of soluble Aβs in the brain is regulated in an age-dependent manner, and that the ratio of Aβ42 to Aβ40 level in the CSF would be a useful marker for monitoring progression of AD.
Meta-Analysis of Clinical Trials with Copolymer 1 in Multiple Sclerosis
Authors: La Mantia L. , Milanese C. , D’Amico R.
Published: April 2003

Glatiramer acetate (copolymer 1) was licensed in the USA in 1996 for the treatment of relapsing-remitting multiple sclerosis. In order to assess its efficacy, a meta-analysis of all randomized controlled trials was performed. Two double-blind studies, accounting for a total number of 299 patients, contribute to this analysis. Patients undergoing the treatment have decreased probability of relapse at 12 months (OR 0.17, 95% CI 0.05–0.51, p = 0.002) and of unsustained progression of disability at 24 and 35 months (OR 0.57, 95% CI 0.34–0.95, p = 0.031, and OR 0.50, 95% CI 0.28–0.90, p = 0.019). These data suggest that glatiramer acetate represents an alternative to interferon treatment in relapsing-remitting multiple sclerosis. However, further evidence of efficacy is required to justify its use in clinical practice.
The Serotonin Transporter Gene and Parkinson’s Disease
Authors: McCann Sally J. , McManus Michael E. , Johnson Anthony G. , Mellick George D. , Le Couteur David G. , Pond Susan M.
Published: April 2003

Dysfunction in the serotonin (5-hydroxytryptamine) system and reduced serotonin concentrations have been reported in patients with Parkinson’s disease (PD). Serotonin concentrations in neural tissue are controlled by a presynaptic serotonin transporter protein that is encoded by a single gene. Therefore, we investigated whether a polymorphic region in the serotonin transporter gene is associated with PD. Three variable-number tandem repeat (VNTR) elements of the serotonin transporter gene were detected by polymerase chain reaction, those with 9, 10, 11 and 12 copies of the repeat element. The 10-copy VNTR element was significantly less common in patients with PD than controls in the univariate analysis (p < 0.05). Logistic regression analysis revealed no significant differences between patients (n = 198) and controls (n = 200) in the distribution frequencies of 9- and 12-copy alleles and combined genotypes (odds ratio = 1.20; p = 1.71). A positive family history of PD was a strong predictor of disease risk (odds ratio = 2.98; 95% confidence interval 1.51–5.87; p = 0.001). Although slight differences were observed between patient and control groups, these data suggest that defects in serotonin concentrations in patients with PD are unlikely to be due to polymorphisms in the serotonin transporter gene in this large Australian cohort; however, the inverse association observed with the 10-copy allele warrants further investigation.
Effect of Bilateral Deep-Brain Stimulation on Oral Control of Patients with Parkinsonism
Authors: Gentil Michèle , Garcia-Ruiz Pedro , Pollak Pierre , Benabid Alim-Louis
Published: April 2003

We assessed the oral system of parkinsonian patients treated with bilateral chronic stimulation of the ventral intermediate nucleus of the thalamus (Vim), and of the subthalamic nucleus (STN) to compare the effects of these procedures on the articulatory organs. Force transducers were used to sample ramp-and-hold force contractions generated by the upper lip, lower lip and tongue at 1- and 2-newton target force levels, as well as maximal force. Fourteen healthy control subjects and 14 parkinsonian patients participated in this study. After an overnight fast the patients were evaluated under two conditions: during bilateral stimulation and 1 h after stopping stimulation. With Vim stimulation, dynamic and static control of the articulatory organs was worsened while with STN stimulation it was greatly improved. The target of stimulation differently influences the oral system and modulates neuronal structures involved in speech.
Posttraumatic Focal Dystonia of the Shoulder
Authors: Höllinger Peter , Burgunder Jean-Marc
Published: April 2003

Posttraumatic movement disorders remain a controversial issue with focal dystonia being a prominent representative. Focal dystonia of the shoulder without concomittant cervical dystonia is a rare event. We describe 2 patients who, after minor trauma, developed focal dystonia of the shoulder with severe chronic pain. Response to local botulinum toxin A was favorable in 1 patient.
Lymphocyte Subset Proportions in Guillain-Barré Syndrome Patients Treated with Plasmapheresis
Authors: Yoshii Fumihito , Shinohara Yokito
Published: April 2003

We examined the changes in the proportions of certain T cell subsets in 18 Guillain-Barré syndrome patients treated with plasmapheresis (PP). PP was performed within 8 days after the onset using a continuous-flow blood cell separator or immunoadsorption. The proportions of CD3+, CD4+ and CD4+CD45RA+ cells at the onset were decreased and that of CD19+ was increased compared with those of 25 normal controls. However, the proportions of CD4+CD45R–, CD4+HLADR+, CD4+CD25+ cells and the CD8+ subpopulations were similar in patients and controls. After PP, the altered subsets tended to normalize, particularly in the group that improved after PP.
Combined Therapy of Corticosteroid and Azathioprine in Hypertrophic Cranial Pachymeningitis
Authors: Choi Il Saing , Park Soo Chul , Jung Yeon Kyung , Lee Sung Soo
Published: April 2003

Hypertrophic cranial pachymeningitis (HCP) is a rare inflammatory disease of unknown origin in which recurrence is frequently observed in spite of the initial response to steroid therapy. Three patients, 1 man and 2 women, aged 63, 66, and 67 years, with severe intractable headache were evaluated by brain MRI. All patients were initially given prednisolone (60 mg/day, oral) or dexamethasone (20 mg/day, i.v.), and followed by long-term (at least 1 year) azathioprine therapy. All patients were evaluated by follow-up laboratory tests and brain MRI study, and completed the 2-year follow-up period. Symptoms including headache were initially improved with corticosteroid therapy, but patients became steroid-dependent. Azathioprine administration in these steroid-dependent patients permitted the complete cessation of corticosteroid and led to the clinical and radiological recovery. In conclusion, initial high-dose corticosteroid administration followed by long-term azathioprine therapy may be the ideal treatment of HCP at present.
Symptoms, Vascular Risk Factors and Blood-Brain Barrier Function in Relation to CT White-Matter Changes in Dementia
Authors: Wallin A. , Sjögren M. , Edman Å. , Blennow K. , Regland B.
Published: April 2003

The aim was to study the frequently found white-matter changes on computerized tomography (CT) in patients with dementia and to relate these changes to clinical regional brain symptomatology, vascular factors, albumin ratio [indicator of blood-brain barrier (BBB) function] and other CT changes. The study included 85 patients, average age 71 ± 8, with Alzheimer’s disease (n = 56) and vascular dementia (n = 29), who underwent CT (Siemens Somatome DR 1) of the brain. They were inpatients in a psychiatric department specialized in dementia investigations. The degree of CT white-matter changes (absence, mild-moderate, severe) was the basis for the division of the patients into three groups. As the patients without white-matter changes were significantly younger than those with such changes, all statistical analyses were controlled for age. Subcortical symptomatology was significantly more frequent in the group with severe white-matter changes, whereas the reverse was true for parietal symptomatology. Diabetes mellitus, hypertension, ischemic cardiac disease and lacunas were significantly more common in patients with white-matter changes, whereas the freqeuncy of transient ischemic attack/stroke episodes did not differ significantly between the groups. The albumin ratio was significantly higher in the groups with white-matter changes and highest in the group with severe white-matter changes. The findings indicate that white-matter changes in demented patients are at least partially an age- and stroke-independent disease manifestation of the vascular system and is associated with a specific symptom pattern. BBB dysfunction may be the link between the vasculature and the tissue damage.
Prevention of Lymphorrhea by Means of Fibrin Glue after Axillary Lymphadenectomy in Breast Cancer: Prospective Randomized Trial
Authors: Gilly F.N. , François Y. , Sayag-Beaujard A.C. , Glehen O. , Brachet A. , Vignal J.
Published: April 2003

A prospective randomized trial was carried out to evaluate the efficacy of fibrin glue in preventing lymphorrhea after axillary lymphadenectomy in breast cancer. One hundred and eight breast cancer patients, operated on by two senior surgeons, were randomized into two groups: group 1 (n = 58) without fibrin glue and group 2 (n = 50) with 2 ml of fibrin glue applied to the axillary dissection area at the end of the lymphadenectomy procedure. Early postoperative morbidity was 2/58 and 0/50 in groups 1 and 2, respectively. Mean daily postoperative drainage was significantly greater in group 1. The mean cumulative drainage quantity 6 days after the operation was 407.8 ml and 214.4 ml in groups 1 and 2, respectively (p = 0.001). The mean postoperative hospital stay was 10.1 days and 8.0 days in groups 1 and 2, respectively (p = 0.006). One delayed seroma was observed in each group. Fibrin glue seems to reduce daily postoperative drainage and hospital stay, but did not affect delayed seroma formation after axillary lymphadenectomy for breast cancer.
Xenogeneic Patch Closure of the Small Intestine: A Novel Approach to Fistula Management
Authors: Kirkpatrick J.R. , Nguyen W.D. , Kim D.H. , Fitzgerald T.L. , Provido H.S. , Alam H.B.
Published: April 2003

Previous work from our laboratory demonstrated the feasibility of utilizing placental-derived collagen tissue matrix (CTM) as a bowel wall substitute. We reasoned that this technique would also be suitable in managing intestinal fistulae. To test this hypothesis, we created a chronic cecal fistula in rats and randomly managed some with primary repair and others with CTM replacement. Leak rates, mortality, bursting pressures and histologic scores were similar, suggesting that a chronic fistula can be successfully managed with either a CTM or primary repair.
Omental Evisceration after Laparoscopic Treatment of a Tubal Pregnancy
Authors: Haeusler Guenther , Tempfer Clemens , Gitsch Gerald , Hanzal Engelbert
Published: April 2003

The increasing use of the laparoscopic surgery in the management of gynecologic diseases resulted in an increasing incidence of complications and the development of new complications. Postoperative complications are uncommon after laparoscopy. The most common complication is incisional herniation. A rare form of port-associated complications is omental evisceration. Since herniation through trocar incision sites might implicate severe complications, the use of safety techniques should be applied on a routine basis to reduce laparoscopy-associated morbidity.
Computerized Cardiotocography following Vibroacoustic Stimulation of Premature Fetuses
Authors: Bartnicki Janusz , Dimer Jane Ann S. , Hertwig Kai , Dudenhausen Joachim W.
Published: April 2003

Objective: The purpose of this study was to examine the effect of vibroacoustic stimulation (VAS) on the fetal heart rates (FHRs) in a group of premature fetuses. Study Design: The FHRs were analyzed using the Oxford Sonicaid Computer System 8000, 30 min preceding and then 3 times following VAS. Results: The changes of the mean FHR after VAS in the premature group and the control group of term fetuses occurred in the first 10 min after VAS. The greatest increase in the number of accelerations occurred in both groups during the 11–20 min following VAS. The long-term variability increased significantly in all 3 study periods in premature fetuses and only in the periods of 0–10 and 11–20 min in the control group. The increase in short-term variability was similar in both groups and it was greatest in the period of 11–20 min. Conclusion: Most of the heart rate changes of premature fetuses occur between 11 and 20 min following VAS.
Cervical Dilatation: Induction by Antigestagens via Adhesion Molecules
Authors: Kemp B. , Winkler M. , Hauptmann S. , Rath W.
Published: April 2003

Cervical ripening at term resembles an inflammatory reaction with invasion of activated granulocytes into the cervical stroma. Our objective was to investigate the influence of the antigestagen onapristone alone and in combination with other substances associated with cervical ripening on the expression of the inflammation-associated adhesion molecules ELAM-1, ICAM-1 and VCAM-1. Human endothelial cell cultures were stimulated with onapristone (200 ng/ml), TNF-α (100 U/ml), IL-8 (20 ng/ml) and PGE2 (3 ng/ml) separately and in combination (n = 6). The expression of adhesion molecules was determined qualitatively and quantitatively by immunofluorescence staining and flow cytometry with statistical evaluation by Kolmogorov-Smirnov analysis. Onapristone upregulated slightly the expression of ELAM-1 (19%). The costimulation of onapristone and TNF-α provoked an additive expression of VCAM-1 (64%) beyond the effect of TNF-α alone, while the costimulation of onapristone and PGE2 as well as the combination with IL-8 did not result in an additional stimulatory effect. All results were statistically significant (p < 0.001). This result supports our hypothesis that onapristone may lead to an increased adhesion of granulocytes to the capillary endothelium thereby initiating cervical ripening.
Evaluation of the Accuracy of Transvaginal Sonography for the Assessment of Retained Products of Conception After Spontaneous Abortion
Authors: Chung Tony K.H. , Cheung Lai P. , Sahota Daljit S. , Haines Christopher J. , Chang Allan M.Z.
Published: April 2003

Transvaginal sonography (TVS) was used to assess uterine contents in 100 consecutive subjects presenting with a diagnosis of spontaneous abortion. TVS assessments were correlated with findings at subsequent evacuation of retained products of conception (ERPC). There was a strong correlation between the weight of the surgical specimen at ERPC with both the sagittal (r = 0.76; p < 0.05) and transverse (r = 0.73; p < 0.05) plane area measurements of the uterine cavity. Combining the 2 sonographic measurements increased the correlation to r = 0.81 (p < 0.05). Fifteen of 25 subjects who had been categorised to have an ‘empty’ uterus had less than 5 g of tissue removed and the other 10 subjects less than 10 g of tissue. In 20 of these 25 cases, the surgeon described the amount of curettings as ‘small or non-significant’. TVS can accurately identify those women who do not have a significant amount of residual uterine tissue following spontaneous abortion.
Measurement of Intrauterine Human Decidua-Associated Protein 200 and Diagnosis of Ectopic Pregnancy
Authors: Halperin Reuvit , Hadas Eran , Bukovsky Ian , Schneider David
Published: April 2003

The aim of the current study was to examine whether the measurement of intrauterine human decidua-associated protein (hDP) 200 might be of clinical value in the diagnosis of ectopic pregnancy versus early missed abortion. Uterine fluid levels of hDP 200 were measured in two groups of patients: 20 women with ectopic pregnancy, diagnosed by laparoscopy, and 20 women diagnosed (after curettage) as having a missed abortion. No significant difference in hDP 200 levels was observed comparing patients with ectopic pregnancy (mean 114.0 ± 58.2 mU/ml) and patients with early missed abortion (mean 222.0 ± 116.0 mU/ml), although a trend towards lower levels of uterine fluid hDP 200 was noted in the group of patients presenting with tubal pregnancy. Thus, according to our data, intrauterine hDP 200 is not sufficiently discriminative to be of clinical value in the diagnosis of ectopic pregnancy.
Combined Ultrasonographically Guided Drainage and Laparoscopic Excision of Large Endometriomas
Authors: Garzetti Giuseppe Gioele , Ciavattini Andrea , Tiriduzzi Mauro
Published: April 2003

We report a prospective pilot study which evaluated the feasibility of combined ultrasonographically guided drainage and laparoscopic excision after pre-operative administration of a gonadotrophin-releasing hormone analogue for 3 months in the management of ovarian endometriotic cysts >5 cm. Ten patients with an ultrasonographic diagnosis of large unilateral or bilateral ovarian endometriotic cysts received an intramuscular injection of leuprorelinum acetate 3.75 every 4 weeks for 12 weeks. After 4 weeks of medical treatment, the endometrioma was carefully drained transabdominally under ultrasonographic control. Within 8 weeks since the last injection, the patients were submitted to a second ultrasonography, and laparoscopy-guided stripping of the endometrioma was performed. A videotape review was undertaken to evaluate duration and complexity of the different phases of surgery. Stripping of endometriomas with preservation of residual ovarian parenchymas was obtained in all cases; adhesiolysis was complete in 6 cases. There were neither intra-operative complications nor conversions in laparotomy. In conclusion, gonadotrophin-releasing hormone analogue and cyst drainage seem to permit an easy laparoscopic approach of large endometriomas; the findings of our pilot phase seem to justify a randomized trial to better define the effectiveness of this approach with respect to standard procedures.
Antenatal Molecular Diagnosis of X-Linked Ichthyosis by Maternal Serum Screening for Down’s Syndrome
Authors: Di Mario Marco , Ferrari Antonella , Morales Victor , Perosin Daniela , Pazzoni Flavia , Piazzi Gaia
Published: April 2003

A case of X-linked ichthyosis diagnosed antenatally by molecular analysis of fetal DNA is described. The diagnosis was made at 16 weeks gestation, following the finding of a maternal serum unconjugated estriol level lower than 0.1 MoM when performing a triple test. Fetal DNA was obtained from cultured amniocytes; two specific regions were amplified by polymerase chain reaction at 5′ and 3′ ends of the steroid sulfatase (STS) gene on Xp22.3 region. Analysis showed complete deletion of the STS gene on the distal tip of the X-chromosome short arm.
Dysuria due to Bladder Distortion after Repeat Cesarean Section
Authors: Jóźwik Maciej , Jóźwik Marcin , Łotocki Wiktor , Mironczuk Janusz
Published: April 2003

Abnormalities of the lower urinary tract resulting from cesarean section are rare. We present a patient who developed urinary frequency, nocturia and acute pains in the late phase of micturition which we think was due to bladder distortion after repeat cesarean section. She was diagnosed cystographically and treated successfully by bladder flap release.
Optimal Maternal Weight Gain during Singleton Pregnancy
Authors: Bracero Luis A. , Byrne Daniel W.
Published: April 2003

The aim of this study was to determine optimal maternal weight gain in a singleton pregnancy and evaluate the current recommendations. We used a historical prospective design to evaluate the association between pregnancy weight gain and perinatal outcome. All singleton pregnancies without congenital anomalies delivered between 1987 and 1993 at a single institution in New York City were analyzed. After adjusting for the prepregnancy body mass index, we determined the weight gain associated with optimal perinatal outcome. During this 6-year study period, 20,971 pregnant women met the inclusion criteria. Among them, 1,975 (9.4%) had adverse perinatal outcome. Prepregnancy weight and weight gain during pregnancy were strongly associated with adverse outcome. For women of average size, optimal outcome was found in those who gained between 31 and 40 pounds. For women underweight prior to pregnancy, optimal outcome occurred in those who gained 36–40 pounds. For women who were overweight or obese, a gain of 26–30 pounds was associated with optimal outcome. Weight gain during pregnancy is strongly associated with perinatal outcome, independent of important confounding factors, and should be carefully monitored during pregnancy. A randomized controlled trial is required to determine if perinatal and maternal outcome can be improved by advising pregnant women to gain weight using these new ranges rather than the Institute of Medicine’s recommendations.
Influence of Acupuncture on Duration of Labor
Authors: Zeisler Harald , Tempfer Clemens , Mayerhofer Klaus , Barrada Monir , Husslein Peter
Published: April 2003

The aim of this case control study was to evaluate the thus far controversially discussed influence of acupuncture (AP) on the duration of labor. Fifty-seven women with AP treatment (group A) were included in our study after spontaneous vaginal full-term delivery. The control group included 63 women (group B). Median duration of the first stage of labor was 196 min in group A and 321 min in group B (Wilcoxon 2-sample test, p < 0.0001). Median duration of the second stage of labor was 57 min in group A and 57 min in group B (Wilcoxon 2-sample test, p = 0.82). Thirty women had a premature rupture of the membranes (PROM), in group A 66.7% and in group B 33.3% (χ2 test, p = 0.02). Women without AP (group B) received significantly more often oxytocin during the first stage of labor compared with group A women (85 and 15%, respectively, χ2 test, p = 0.01) as well as during the second stage of labor (72 and 28%, respectively, χ2 test, p = 0.03). Our study suggests that AP treatment is a recommendable form of childbirth preparation due to its positive effect on the duration of labor, namely by shortening the first stage of labor.
Relation between Gestational Thrombocytopenia and the Syndrome of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP Syndrome)
Authors: Minakami Hisanori , Kohmura Yasuhiro , Izumi Akio , Watanabe Takashi , Matsubara Shigeki , Sato Ikuo
Published: April 2003

Objective: To define the clinical features of gestational thrombocytopenia and to determine its relationship to the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). Study Design: Retrospective cohort study. We reviewed the records of 24 women with gestational thrombocytopenia among 637 nonpreeclamptic women who had serial determinations of the platelet count during pregnancy between 1992 and 1995. Gestational thrombocytopenia was defined as an antenatal gradual decline in the platelet count to <150 × 109/l in nonpreeclamptic women. The control group consisted of 213 nonpreeclamptic women whose platelet counts were ≥150 × 109/l at –3 to 0 days from delivery and in whom the perinatal serum level of aspartate transaminase (AST) had been determined. Results: The platelet count decreased gradually, from 210 ± 31 × 109/l at <13 weeks’ gestation to 127 ± 24 × 109/l at –3 to 0 days from delivery, in the 24 women with gestational thrombocytopenia. The platelet count was 251 ± 62 × 109/l at –3 to 0 days from delivery in the 213 control women. The serum level of AST was elevated perinatally in 5 (21%) of 24 women with gestational thrombocytopenia compared with 6 (2.8%) of the 213 control subjects (p < 0.001). There had been 28 previous term or near-term pregnancies among 17 women with gestational thrombocytopenia, 14 of which were complicated by gestational thrombocytopenia or a decline in the platelet count by >50 × 109/l; 1 pregnancy was associated with the features typical of the HELLP syndrome. Conclusion: Gestational thrombocytopenia may be a risk factor for the development of the HELLP syndrome and is likely to recur in subsequent pregnancies.
Uterine Diffuse Adenomatoid Tumor
Authors: Di Stefano D. , Faticanti Scucchi L. , Covello R. , Martinazzoli A. , Meli C. , Bosman C.
Published: April 2003

Adenomatoid tumor represents a type of mesothelioma apparently confined to the genital tract and characterized by its benign behavior. Its morphological aspects are well known and, until now, it has been described as a nodular mass except for a case diffusely infiltrating the entire myometrium in an immunosuppressed patient. We report a case of benign mesothelial tumor characterized by histological, immunophenotypical and ultrastructural features of an otherwise typical adenomatoid tumor but diffusely growing below uterine serosal surface into the myometrium without discernible borders. The existence of a diffuse type of adenomatoid tumor might reflect a different nature of this neoplasm leading to the hypothesis that this variant of benign mesothelioma represents a distinct biological entity.
Effects of Ringer’s Lactate, Medroxyprogesterone Acetate, Gonadotropin-Releasing Hormone Analogue and Its Diluent on the Prevention of Postsurgical Adhesion Formation in Rat Models
Authors: Üstün C. , Yanık F.F. , Koçak İ. , Canbaz M.A. , Çaylı R.
Published: April 2003

Fifty adult female rats were randomly divided into five groups. Before the standard surgical procedure which consisted of creating a lesion with electrocautery over the uterus, leuprolide acetate (LA) together with its diluent, the diluent alone and medroxyprogesterone acetate (MPA) were injected to the third, fourth, and fifth groups, respectively. Ringer’s lactate (RL) solution was applied intraperitoneally to the second group at the end of the surgery. Group I received no medication. Relaparotomy was performed 3 weeks later to evaluate the adhesions. The mean adhesion scores were (mean ± SD) 2.6 ± 0.7, 1.4 ± 0.8, 0.9 ± 0.6, 2.3 ± 0.8, and 0.8 ± 0.6 in groups I, II, III, IV, and V, respectively. The postsurgical adhesions were significantly less in the groups treated with RL, LA, and MPA.
Sacrospinous Fixation for the Prolapsed Vaginal Vault
Authors: Özcan Utku , Güngör Tayfun , Ekin Murat , Eken Sinan
Published: April 2003

In 54 patients, transvaginal sacrospinous ligament fixation procedures were reviewed retrospectively. The mean operation time was 15 (12–45) min. The mean blood loss was 126 (110–175) cm3. The only intraoperative complication was a rectal laceration that was repaired primarily. The mean duration of follow-up was 28 (4–54) months. There were only 2 recurrent vaginal vault prolapses. There were 3 cases of cystocele (5.5%), 1 case of rectocele (1.8%), 5 cases of enterocele (9.2%), 3 cases of stress incontinence (5.5%), and 5 cases of dysparonia (9.2%). Sacrospinous ligament fixation can be used as an alternative treatment to vaginal hysterectomy in aged women with medical problems and young women suffering from genital descent with infertility. The procedure has the advantage of avoiding laparatomy, facilitating other vaginal repairs needed during the same operation, preserving vaginal function and shortening the time necessary for anesthesia and surgery.
Granulosa Cell Tumor of the Ovary
Authors: Horny Hans-Peter , Marx Lore , Kröber Stefan , Lüttges Jutta , Kaiserling Edwin , Dietl Johannes
Published: April 2003

Background and Methods: Because the use of immunohistochemistry in the diagnosis of granulosa cell tumor (GCT) has not been fully explored, routinely processed (formalin-fixed, paraffin-embedded) tissue from 11 GCT, adult type, was investigated immunohistochemically (ABC method) with a broad spectrum of antibodies against various markers, including p53 and Ki-67. All of the tumors exhibited typical morphology, were limited to the ovary (stage I), and 7 cases followed a benign clinical course. Results: All the tumors exhibited strong expression of vimentin, but most other antigens (including smooth muscle actin) were expressed infrequently by a minority of tumor cells or not at all. Tumor cells in 9 GCT expressed inhibin A. All the tumors exhibited very low proliferative activity, fewer than 10% of the tumor cell nuclei being stained by the antibody MIB-1 (Ki-67 antigen). The antibody D07 revealed marked overexpression of p53 protein in only one tumor. Clinical outcome was not found to be related to immunophenotypic differences. Conclusions: The diagnosis of GCT should be based primarily on the typical morphology revealed by conventional stains, but additional immunohistochemical staining with a small panel of selected antibodies (for example, against keratin, vimentin, and inhibin A) may be helpful in a few cases. The very low proliferative activity and the lack of overexpression of p53 protein are consistent with the benign clinical behavior of the majority of GCT.
Calcium Dobesilate Lowers the Blood Pressure in Mild to Moderate Midtrimester Hypertension
Authors: Tamás Peter , Csermely Tamás , Ertl Tibor , Vizer Miklós , Szabó István , Prievara Ferenc T.
Published: April 2003

To test the effects of calcium dobesilate (Doxium) in pregnancies complicated with pregnancy-induced hypertension or mild/moderate pre-eclampsia a double-blind, placebo-controlled pilot study was carried out. Primigravida patients (gestational age ≤34 weeks) daily took 2 g Doxium or placebo until delivery. Twelve patients received placebo for 53 days, and 11 patients took the drug for 57 days on average. At the start of the study 2 patients in the placebo group (PG) and 8 in the Doxium group (DG) had pre-eclampsia. The mean arterial pressure (mean ± SD) significantly decreased from 118 ± 7 to 99 ± 9 mm Hg in the DG (p = 0.003), while in the PG it had slightly increased by the end of the study. Proteinuria was higher in the DG at the start but not at the end; however, significant changes of this parameter were detected in neither of the groups throughout the study. Fibronectin decreased significantly in both groups but it was more pronounced in the DG (23.8 vs. 9.4%). Changes of platelet count, plasma and blood viscosity, and erythrocyte deformability were favourable in the DG but in the PG these parameters had deteriorated although the alterations were not significant. No marked differences were found between the two groups regarding fetal well-being, courses of deliveries, and the neonatal period. Neither maternal nor fetal/neonatal side effects were noticed. It seems that Doxium favourably influences the blood pressure and consequently decreases the requirement for medication and hospitalisation in cases of mild to moderate midtrimester hypertension.
Transforming Growth Factor-Alpha Levels in the Serum and Ascites of Patients withAdv anced Epithelial Ovarian Cancer
Authors: Saltzman Andrew K. , Hartenbach Ellen M. , Carter JonathanR. , Contreras Diana N. , Twiggs Leo B. , Carson LindaF. , Ramakrishnan S.
Published: April 2003

A variety of cytokines have been identified to play a role in ovarian cancer. In this pilot study, we sought to determine whether transforming growth factor-α (TGF-α) was detectable in the serum and ascites of women with advanced stage epithelial ovarian cancer. TGF-α was measured using an enzyme-linked immunosorbent assay and was present in 18 of 25 control sera. Prior to treatment for stage III or IV epithelial ovarian cancer, 18 patients had undetectable serum levels of TGF-α, while 18 had values ranging from 10.6 to 531.7 pg/ml. The group with undetectable levels had a 6-month greater median survival; detectable TGF-α might be a negative prognostic indicator. In a separate group undergoing second-look laparotomy, differences in median TGF-α values versus controls and the primary study group approached significance. TGF-α was detected in significantly more control peritoneal fluid samples than in patient ascites. A larger study is warranted.
Case Series of Labor Induction inTwin Gestations with an IntrauterineBalloon Catheter
Authors: Manor Moshe , Blickstein Isaac , Ben-Arie Alon , Weissman Ariel , Hagay Zion
Published: April 2003

The efficacy and safety of labor induction using an intrauterine balloon catheter in twin pregnancies has been evaluated. During the study period (1992–1997), labor was induced at 36–42 weeks in 17 twin gestations. Labor induction was indicated for preeclampsia (n = 10), birth weight discordance (n = 3), suspected fetal distress (n = 2) and postdates (n = 2). Twin A was in vertex presentation in all cases. An intrauterine balloon catheter was inserted transcervically followed by augmentation whenever required. Vaginal delivery was achieved in 15 (88.2%) patients. The mean interval from balloon insertion to delivery was 17.05 h, with 80% deliveries occurring within 24 h of catheter insertion and 80% occurring within 12 h of catheter expulsion. Birth weight was 2,514 ± 244 and 2,421 ± 367 g for twin A and B, respectively. Oxytocin was required in 4 patients. Postpartum hemorrhage was noted in 1 patient. One patient with no progress of labor and 1 with suspected intrapartum fetal distress required cesarean section. All neonates had a 5-min Apgar score of 10. The data suggest that an intrauterine balloon catheter appears to be safe and effective to induce labor in twin gestations.
Onapristone Suppresses Prolactin Production in Explant Cultures of Leiomyoma
Authors: Austin Douglas J. , Nowak Romana A. , Stewart Elizabeth A.
Published: April 2003

Objective: To assess the action of onapristone, a type I antiprogestin, on prolactin (PRL) production by explant cultures of leiomyoma and myometrium. Design: Explant cultures of myometrium and leiomyomas from 3 premenopausal women undergoing hysterectomy in the proliferative phase of the menstrual cycle. Main Outcome Measures: PRL secretion measured by radioimmunoassay. Results: PRL secretion was decreased in leiomyomas by onapristone. There was no effect in the myometrium. There was no additional effect with the addition of the type II antiprogestin mifepristone (RU 486). Conclusion: PRL production is suppressed in leiomyomas but not in myometrium after treatment with onapristone in vitro. This suppression may serve as a marker for the clinical effectiveness of agents used in the treatment of leiomyomas.
Pseudohypoparathyroidism Type 1b in Pregnancy
Authors: Seki K. , Osada H. , Yasuda T. , Sekiya S.
Published: April 2003

Calcium-regulating hormones were serially measured during the second pregnancy in a woman with pseudohypoparathyroidism type 1b. Calcium levels corrected for serum albumin were maintained almost normal during her second pregnancy with 1α-hydroxycalciferol (2.0 μg daily) though they were slightly decreased in late pregnancy. 1,25-Dihydroxyvitamin D levels were higher in early and mid-pregnancy, but not in late pregnancy compared to those after delivery. Parathyroid hormone levels were higher in late pregnancy than after delivery.
Pyelocaliectasis and Intrarenal Artery Doppler Indices in Uncomplicated Pregnancies
Authors: Kara Simay Altan , Toppare Mete F. , Saraç Ebru
Published: April 2003

The effect of pyelocaliectasis on intrarenal arterial Doppler indices was evaluated in healthy pregnant women with respect to nonpregnant controls. There was no significant difference between the pregnant and nonpregnant subjects regarding the systolodiastolic ratio, resistivity index and pulsatility index throughout the second and third trimesters (p for all > 0.05). There were 134 kidneys with grade 0, 38 kidneys with grade I and 24 cases with grade II pyelocaliectasis in the pregnant population. Grade II caliectasis was found only in the right kidneys. The nonpregnant women all had grade 0 caliectasis. Doppler indices were not significantly different in various grades of caliectasis, and right and left kidneys had similar Doppler indices. The results of this study suggest that pyelocaliectasis increases with advancing gestational age and is more frequent and prominent on the right side but has no effect on intrarenal Doppler indices in healthy pregnant women. In cases of prominent alterations in Doppler indices, renal pathological conditions should be sought.