bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraoperative Microelectrode Recording Equipment: What Features Are Necessary?
Authors: Shils Jay L. , Tagliati Michele , Alterman Ron L.
Published: April 2003

Intraoperative neurophysiologic methods for localizing targets deep in the brain require the use of specialized monitoring and recording equipment, including stimulators, neurophysiologic recording devices, and image manipulation tools. When using microelectrode recording devices there are some specifications that are more important than others, such as signal-to-noise ratios and amplifier impedance. As more companies develop tools to be used in the operating room, the end users have more choices. Some of the more important specifications are discussed and a comparison is made of the five major brands on the market today.
Motor Cortex Stimulation for Post-Stroke Pain: Comparison of Spinal Cord and Thalamic Stimulation
Authors: Katayama Yoichi , Yamamoto Takamitsu , Kobayashi Kazutaka , Kasai Masahiko , Oshima Hideki , Fukaya Chikashi
Published: April 2003

We analyzed the effects of spinal cord stimulation (SCS), deep brain stimulation (DBS) of the thalamic nucleus ventralis caudalis (VC) and motor cortex stimulation (MCS) in 45 patients with post-stroke pain. Satisfactory pain control was obtained more frequently as the stimulation site was moved to higher levels (7% by SCS, 25% by DBS and 48% by MCS). A painful sensation was sometimes produced by stimulation of the VC as well as the post-central, pre-central and pre-frontal cortices. Such a sensation occurred less frequently as the stimulation site was moved to higher levels (50% at the VC, 39% at the post-central cortex, 6% at the pre-central cortex and 3% at the pre-frontal cortex). These findings imply that abnormal processing of nociceptive information develops at the level of deafferentation and spreads to higher levels to a varying extent. This may be one of the reasons why satisfactory pain control was obtained more frequently as the stimulation site was moved to higher levels.
Global Prevention of All Folic Acid-Preventable Spina bifida and Anencephaly by 2010
Authors: Oakley Jr. Godfrey P.
Published: April 2003

Folic acid-preventable spina bifida and anencephaly are pandemic, affecting 225,000 children a year. These birth defects are as preventable as polio. As we near the eradication of polio, it is time to make the commitment to global prevention of all folic acid-preventable spina bifida and anencephaly (FA-P SBA) by 2010. Folic acid fortification of centrally processed foods, such as wheat and corn flour, could immediately prevent all of these birth defects for much of the world’s population. These fortification programs will also help adults by increasing serum folate concentration, eradicating folate deficiency anemia, providing human genome stability and reducing homocysteine serum concentration, which will probably prevent heart attacks and strokes, and may prevent colon cancer and Alzheimer’s disease. Where there is no centrally processed and distributed food to fortify, intense efforts must be made to increase consumption of synthetic folic acid through vitamin supplements. Geneticists can play a major role in preventing FA-P SBA by helping to create the political will in each country to implement fortification and supplement programs to eliminate disease caused by the current pandemic of folate deficiency.
Physical and Chemical Factors in the Home and Workplace before and during Pregnancy
Authors: Robert-Gnansia Elisabeth , Saillenfait Anne-Marie
Published: April 2003

Objective: To present and discuss current knowledge about the relationship between physical and chemical factors in the home and workplace and adverse reproductive outcomes in the offspring. Design and Methods: Critical review of the scientific literature, focusing mostly on epidemiological research. Reviews and original papers involving human occupational and home exposures to physical and chemical agents and their relation to adverse reproductive outcomes were screened and commented upon. Results: Only a small proportion of the several thousands of occupational/home exposures have been adequately assessed for reproductive or developmental toxicity. This is reflected in the difficulties of identifying causal associations in humans and in the lack of data. Conclusion: According to present knowledge, very few authors confirmed that reproductive hazards exist in environmental agents, but increased surveillance of occupational exposures in relation to workers’ reproductive health is highly desirable in order to assess moderate risks.
Cerebral Occlusive Artery Disease in Noonan Syndrome
Authors: Wilms H. , Neubauer B. , Deuschl G. , Zunker P.
Published: April 2003

Noonan syndrome is an autosomal-dominant inherited syndrome with variable expression of multiple malformations including cardiovascular and craniofacial anomalies. While cerebrovascular insults due to cardiogenic emboli, coagulation abnormalities or cerebrovascular malformations have been documented before, intracerebral occlusive artery disease is not well recognized as a cause of stroke in this syndrome. A 6-year-old girl with Noonan syndrome presented with repetitive transient ischemic attacks consisting of dysphasia and right-sided central facial and arm weakness. Neuroimaging showed acute ischemic lesions in the left putamen and caudate nucleus. Multiple intracranial stenoses were found during transcranial Doppler examination and MR angiography. Although hypertrophic cardiomyopathy was documented by transesophageal echocardiography, a cardioembolic origin of the ischemic attacks was unlikely in this case. The symptoms resolved and did not recur after antiplatelet and anticoagulant therapy was initiated. Stenoses of intracranial cerebral arteries should be considered among the causes of stroke in young patients with Noonan syndrome.
Prepubertal Growth in Children with Long-Term Parenteral Nutrition
Authors: Colomb V. , Dabbas M. , Goulet O. , Talbotec C. , Corriol O. , Ricour C.
Published: April 2003

In children who depend on long-term parenteral nutrition (PN), a major goal is to obtain optimal growth. The aim of this retrospective study was to analyze growth in children on long-term cyclic nocturnal home PN, over at least 8 years before puberty. Nine boys and 7 girls were studied. Their mean age at the time of study was 11 years with a mean PN duration of 10.5 (8.6–16.4) years. Diseases were short bowel syndrome (5), intractable diarrhea (4), chronic intestinal pseudo-obstruction (4) and long segment Hirschsprung’s disease (3). In each child, periods of at least 2 years were analyzed: either periods of regular growth (R: height gain >50th percentile), or slow growth (S: height gain ≤25th percentile). Results were expressed as mean ± SD. Comparisons were performed using either Student’s test for unpaired data or Wilcoxon’s test for paired data. PN provided a mean of 224 ± 80 mg nitrogen/kg/day and 43 ± 14 kcal/kg/day equivalent to 50% of recommended supplies. At the time of study, the population presented with weight (W) = –0.7 ± 0.8 SD and height (H) = –1.5 ± 1.3 SD. The difference between W and expected W for H (W/H) was significant (p < 0.002). W/H ratio was 105 ± 11%. For the total PN duration, weight gain was +0.2 ± 1.5 SD and height loss was –0.75 ± 1.4 SD. An excess weight gain occurred in parallel with the deflection of height gain. Of the 16 children, regular prepubertal growth was achieved in 4 only. The other 12 showed alternate periods of R and S. In 8 of them, 26.5 years of R and 33.5 years of S were compared, each child being his own control. PN nitrogen and energy supplies were significantly higher during R periods than during S periods. In the absence of any disease or treatment explaining the failure to thrive, inadequate PN supplies, especially in terms of nitrogen supply, are thought to be responsible for a negative nitrogen balance and slowed growth. In case of any deflection away from the individual growth curve, it is recommended to adjust the PN supply early, especially nitrogen supply.
Sexual Selection, Seminal Coagulation and Copulatory Plug Formation in Primates
Authors: Dixson Alan F. , Anderson Matthew J.
Published: April 2003

This study examines the question of whether multipartner matings by female primates, with resulting sperm competition among males, may have favored the evolution of biochemical mechanisms to enhance seminal coagulationand copulatory plug formation. Comparative ratings of seminal coagulation (using a four-point scale where 1 = no coagulation and 4 = copulatory plug formation) were obtained for 40 species representing 26 primate genera. Coagulation ratings were highest (mean = 3.64) in those genera where females commonly mate with multiple partners, and lowest (mean = 2.09) in genera where females are primarily monogamous or belong to polygynous (one male) units(p - 0.0001). This result remained significant (p - 0.001) after the use of comparative analysis of independent contrasts (CAIC) to control for possible phylogenetic biases in the data set. Results indicate that sexual selection has played an important role in the evolution of seminal coagulation, and copulatory plug function, in primates.
The Functions of Laryngeal Air Sacs in Primates: A New Hypothesis
Authors: Hewitt Gwen , MacLarnon Ann , Jones Kate E.
Published: April 2003

A possible function of laryngeal air sacs in apes and gibbons was investigated by examining the relationships between air sac distribution, call rate, call duration and body weight in a phylogenetic context. The results suggest that lack of sacs in the smaller gibbons and in humans is a derived feature. Call parameters in primates, such as rate and duration, scaled to resting breathing rate (and therefore to body weight) only in species without air sacs, which appear to modify these relationships. Apes and larger gibbons may be able to produce fast extended call sequences without the risk of hyperventilating because they can re-breathe exhaled air from their air sacs. Humans may have lost air sacs during their evolutionary history because they are able to modify their speech breathing patterns and so reduce any tendency to hyperventilate.
Duetting in the Titi Monkey Callicebus cupreus: Structure, Pair Specificity and Development of Duets
Authors: Müller Alexandra E. , Anzenberger Gustl
Published: April 2003

Duets from a total of 6 female and 6 male titi monkeys (Callicebus cupreus) were analysed in order to provide an in-depth analysis of the duet structure, to investigate whether duets are pair specific and to examine whether duets of newly formed pairs differ from those of established pairs. Callicebus duets are composed of alternately uttered male and female contributions. Duets were pair specific as a result of a summation of individual attributes of the two mates rather than due to unidirectional or reciprocal song adaptation by mates. The two examined newly formed pairs produced species-typical duets from the first day on, but their duets showed greater variability in sequence durations than those of established pairs.
Obsessive-Compulsive Symptom Dimensions as Predictors of Compliance with and Response to Behaviour Therapy: Results from a Controlled Trial
Authors: Mataix-Cols David , Marks Isaac M. , Greist John H. , Kobak Kenneth A. , Baer Lee
Published: April 2003

Background: Recent factor-analytic studies in obsessive-compulsive disorder (OCD) identified consistent symptom dimensions. Support for the validity of these dimensions comes from studies of psychiatric comorbidity, functional brain imaging, genetic transmission, and treatment response to medications. This study examined whether previously identified OCD symptom dimensions are associated with treatment compliance and response to behaviour therapy (BT) for OCD. Methods: One hundred and fifty-three OCD outpatients who participated in a multi-centre randomised controlled trial of computer- versus clinician-guided BT for OCD were included in the study. Logistic and multiple regression models tested for significant predictors of compliance with and response to BT and relaxation. Results: The patients studied were phenomenologically comparable (including the presence of ‘pure’ obsessions and mental rituals) to those in previous serotonin reuptake inhibitor (SRI) trials and those in clinical epidemiology studies. High scorers on the ‘hoarding’ dimension were more likely to drop out prematurely from the study and tended to improve less. For those completing treatment, the strongest predictor of outcome was pre-treatment severity. Initial depression scores were unrelated to outcome. After controlling for symptom severity, higher scores on the ‘sexual/religious obsessions’ factor predicted poorer outcome with BT, especially when computer-guided. Conclusions: BT is especially indicated for OCD patients with aggressive/checking, contamination/cleaning and symmetry/ordering symptoms. Previous accounts of unsuccessful BT in patients with hoarding symptoms may be due in part to their propensity to drop out earlier from treatment. Patients with sexual/religious obsessions, but not those with mental rituals, might respond less well to traditional BT techniques. Existing treatments need to be refined and/or new treatments developed to improve these patients’ adherence and response to treatment.
Fatal Basilar Artery Thrombosis after Chemotherapy for Testicular Cancer
Authors: Doehn Christian , Büttner Hartwig , Fornara Paolo , Jocham Dieter
Published: April 2003

We report a 31-year-old patient with a pT3N2M1 seminoma who received cisplatin-based chemotherapy. During the second course of chemotherapy, the patient suffered a thrombosis of the basilar artery. He died 14 h after hospital admission. Cerebrovascular events related to cisplatin-based chemotherapy are rare, however, these potentially fatal events should be kept in mind when treating patients with testicular cancer.
Recurrent Aggressive Angiomyxoma of the Urinary Bladder
Authors: May F. , Luther A. , Mohr W. , Bachor R. , Hautmann R.E.
Published: April 2003

Aggressive angiomyxoma is a rare neoplasm which predominantly involves the female pelvis and perineum. Forty-four cases have been reported in the world literature, including 10 cases in men. To the best of our knowledge, the first case of recurrent aggressive angiomyxoma of the urinary bladder is presented here. Operative management, radiologic features and pathological findings are discussed.
Is Systematic Sextant Biopsy Suitable for the Detection of Clinically Significant Prostate Cancer?
Authors: Manseck A. , Froehner M. , Oehlschlaeger S. , Hakenberg O. , Friedrich K. , Theissig F. , Wirth M.P.
Published: April 2003

Background: The optimal extent of the prostate biopsy remains controversial. There is a need to avoid detection of insignificant cancer but not to miss significant and curable tumors. In alternative treatments of prostate cancer, repeated sextant biopsies are used to estimate the response. The aim of this study was to investigate the reliability of a repeated systematic sextant biopsy as the standard biopsy technique in patients with significant tumors which are being considered for curative treatment. Methods: Systematic sextant biopsy was performed in vitro in 92 radical prostatectomy specimens. Of these patients, 81 (88.0%) had palpable lesions. Results: Of the 92 investigated patients, 70 (76.1%) had potentially curable pT2-3pN0 prostate cancers. In these patients, the cancer was detected only in 72.9% of cases by a repeated in vitro biopsy. In the pT2 tumors, there was a detection rate of only 66.7%. Conclusions: This study underlines the fact that a considerable number of significant and potentially curable tumors remain undetected by the conventional sextant biopsy. A negative sextant biopsy does not rule out significant prostate cancer.
Combination Therapy of Imipramine with Oxybutynin in Children with Enuresis Nocturna
Authors: Tahmaz Lütfü , Kibar Yusuf , Yildirim Ibrahim , Ceylan Süleyman , Dayanç Murat
Published: April 2003

Purpose: The treatment approach for enuresis is controversial due to the lack of consensus as to the exact causes of nocturnal enuresis. Despite various treatment modalities, pharmacotherapy still appears to be the common choice. The aim of this prospective study was the evaluation of the efficacy of combination therapy (imipramine and oxybutynin) in patients with enuresis nocturna. Patients and Methods: This prospective study was done with 77 monosymptomatic nocturnal enuretics between July 1996 and December 1998. Results: Even though there is no statistically significant difference between combination therapy (imipramine plus oxybutynin) and monotherapy, clinical data showed that combination therapy is more effective. Conclusions: We conclude that combination of imipramine with oxybutynin is a safe and new choice in the treatment of nocturnal enuresis.
Effects of Aging on Mitochondrial Enzyme Activity of Rat Urinary Bladder
Authors: Lin Alex Tong-Long , Hsu Ted H. , Yang Chin-Hua , Chang Luke S.
Published: April 2003

Objectives: Our previous study showed that aged rat bladders became fatigued faster than young bladders following repeated contraction induced by electrostimulation. One factor might be a lower energy-producing capability secondary to a decreased mitochondrial enzyme activity of the aged bladder. This study examined this possibility. Materials and Methods: Mitochondria from 3- (n = 11) and 24-month-old (n = 10) Sprague-Dawley rats were isolated. Activities of the following enzymes were assayed: two key enzymes in the citric acid cycle, citrate synthase and malate dehydrogenase, and three enzymes in the respiratory chain reaction, NADH-cytochrome c reductase, succinate-cytochrome c reductase and cytochrome c oxidase. The concentration of phosphocreatine and ATP in the aged rat bladders and a separate group of young bladders (n = 12) was determined using high-performance liquid chromatography. Results: (1) The aged bladders have a significantly lower level of phosphocreatine and ATP content than those of young bladders. (2) The activities of all five enzymes assayed were significantly lower in the aged bladders than in young bladders, especially for citrate synthase, which had only 46.8% of the activity of young bladders. Conclusions: Aging reduces the mitochondrial enzyme activity of the rat bladder resulting in a lower energy-production capability, which might explain some of the voiding dysfunctions found in the elderly.
Italian Urological Manpower: Employment Prospects and Future Scenarios
Authors: Martorana G. , Bertaccini A. , Carparelli F. , Bisceglie L. , Ceccarelli R. , Brini A.
Published: April 2003

Introduction: Italy delayed limiting access to the Faculty of Medicine and the reform of schools of specialization was not accompanied by programming the number of scholarships, so employment expectations are often disappointing. The aim of this study is to analyze the employment prospects of specialists in urology through the development of possible scenarios for the 5-year period 2000–2004. Materials and Methods: We recorded data received from Italian Schools of Specialization in Urology on specialists in the 5-year period 1994–1998. We also tried to obtain a picture of the national distribution of urologists and urological units. Statistical processing was done with SPSS for Windows 5.0. Results: In the last 5 years, 501 urologists were licensed at an average age of 37 years; 535 urological units exist; 2,332 doctors practice urology (2,235 males and 97 females) for a ratio of 1 urologist to 24,500 inhabitants. By comparing the ‘entrance’ forecast with the potential ‘exit’, we can hypothesize an annual excess of 80 units. There is no significant correlation between the number of urologists in each structure and the number of inhabitants for each urologist. Conclusions: The present government programme does not take into account continual changes in employment and many other variables when defining the actual need for specialists. For valid predictions, the data we obtain must be updated for at least 5 years.
Juxtaglomerular Cell Tumor of the Kidney Treated with Nephron-Sparing Surgery
Authors: Niikura Susumu , Komatsu Kazuto , Uchibayashi Tadao , Ise Takuyuki , Yokoyama Hitoshi , Kobayashi Ken-ichi , Matsui Osamu , Nonomura Akitaka , Namiki Mikio
Published: April 2003

A case of juxtaglomerular cell tumor of the right kidney is reported. A 30-year-old woman visited us with a complaint of headaches. Severe hypertension and an elevated level of plasma renin activity was seen at the initial evaluation. Computerized tomographic angiography revealed tumor vessels in the low-density mass in the right kidney. The preoperative diagnosis was renin-secreting tumor of the kidney, and nephron-sparing surgery was performed. The pathological findings showed a juxtaglomerular cell tumor. Postoperatively, prompt normalization of blood pressure and a reduced plasma renin activity level were observed.
Risk Factors for an Early Increase in Dose of Vasoactive Agents for Intracavernous Pharmacotherapy
Authors: Kim Sae Chul , Seo Kyung Keun , Park Byung Dae , Lee Sung Woon
Published: April 2003

Aims: This study was to identify factors that influence the early increase in the dose of intracavernous vasoactive agents to maintain erection for satisfactory intercourse and to elucidate when the dose increase would begin. Methods: Seventy-nine patients using intracavernous pharmacotherapy with tri-mix (PGE1, papaverine, and phentolamine) over a 3- to 4-year period were enrolled. At 3-month intervals, patients were questioned about changes in dose to maintain erection for satisfactory intercourse and frequency of injection, and underwent examination of the penis. The patients were divided into 2 groups: group A, dose increase of ≧20% after initiating home therapy, and group B, no change or an increase in dose <20%. Results: A significant increase (p < 0.01) in dose was started 2–3 years after initiating pharmacotherapy. The initial doses of group A at 2–3 and 3–4 years were significantly higher than those of group B (p < 0.01). There were no significant differences in the age of the patients, duration of erectile dysfunction, incidence of accompanying vascular risk factors, frequency of injection, or incidence of fibrous plaques between group A and group B, both at 2–3 and 3–4 years. Conclusion: The initial dose of intracavernous vasoactive agents (tri-mix) may be a unique risk factor for the early increase in dose to maintain erection for satisfactory intercourse.
Sacral Hydatid Cysts: An Uncommon Cause of Neurogenic Bladder
Authors: Dogra P.N. , Nabi G.
Published: April 2003

Hydatid cysts of the sacrum are rare entities, characterized by chronicity without any clinical manifestation and are usually misdiagnosed in the early stage resulting in significant loss of bone and destruction of surrounding tissue. One should keep this possibility in mind in cases of early sphincteric involvement with minimal sensorimotor deficit in the lower limbs and bone destruction on radiography.
An Accessory Spleen Mimicking a Nonfunctional Adrenal Tumor: A Potential Pitfall in the Diagnosis of a Left Adrenal Tumor
Authors: Tsuchiya Norihiko , Sato Kazunari , Shimoda Naotake , Satoh Shigeru , Habuchi Tomonori , Ogawa Osamu , Kato Tetsuro
Published: April 2003

We describe a case of accessory spleen mimicking a left adrenal tumor. A 66-year-old woman was referred to our hospital because of a suspected left adrenal mass detected by US. A laparoscopic adrenalectomy was performed, and examination of the surgical specimen revealed that the resected adrenal gland contained no tumorous lesion. A further investigation of the intraperitoneal space revealed an accessory spleen. This indicates that urologists should be aware of the possible existence of accessory spleens when left adrenal tumors are suspected on CT and MRI.
Das Subjekt in der Archetypenlehre C.G. Jungs
Authors: Holzhey-Kunz Alice
Published: April 2003

Der Aufsatz geht der Frage nach, wo in Jungs Psychologie das Subjekt situiert ist und welches Subjektverständnis dabei zugrundeliegt. Viele Beispiele belegen, dass er – entgegen der modernen Auffassung vom Ich als Subjekt – dem kollektiven Unbewussten den Status eines handelnden Subjekts zuerkennt, welches hinter dem Rücken des Ichs seine Absichten mit dem Individuum verfolgt. Diese Subjektivierung des Unbewussten auf Kosten des Ichs ist die Konsequenz davon, dass Jung an einem überhöhten Subjektverständnis festhält, welches Subjektivität mit Selbstmächtigkeit und Schöpferkraft identifiziert. Die Einsicht in die – angesichts archetypischer Erfahrungen – offenkundige Schwäche des Ichs führt darum nicht zu einem Begriff endlichen Subjektseins, sondern zur Installierung des autonomen Subjekts im Unbewussten. Damit verbindet sich das therapeutische Versprechen, durch Integration von archetypischen Inhalten Anteil an wahrem Wissen zu gewinnen, dessen Führung man sich anvertrauen kann.
A Novel Treatment for Constipation-Predominant Irritable Bowel Syndrome Using Padma®Lax, a Tibetan Herbal Formula
Authors: Sallon Sarah , Ben-Arye Eran , Davidson Roni , Shapiro Haim , Ginsberg Gary , Ligumsky Moshe
Published: April 2003

Background and Aims: Padma Lax, a complex Tibetan herbal formula for constipation was evaluated for safety and effectiveness in treating constipation-predominant irritable bowel syndrome in a 3-month double-blind randomised pilot study. Methods: Patients were recruited from Hadassah Hospital’s Gastroenterology clinic, using the Rome I Criteria for irritable bowel syndrome, and the international consensus criteria for constipation. Symptom severity was evaluated monthly by patients and gastroenterologist, using categorical and numerical rating scales. A patient diary recorded daily stool habit and trial medication. Results: In 61 patients, (34 Padma Lax, 27 placebo), significant improvement was demonstrated after 3 months in the Padma Lax group compared to placebo in constipation, severity of abdominal pain, and its effect on daily activities, incomplete evacuation, abdominal distension and flatus/flatulence. A global assessment indicated that significantly more Padma Lax patients, compared to placebo, rated the current treatment superior to previous therapies tried for irritable bowel. Laboratory parameters displayed no clinically significant changes. Side effects, primarily loose stools in 7 Padma Lax patients responded well to lowering treatment dosage from 2 to 1 capsule/day. Conclusions: Padma Lax is a safe and effective treatment for constipation-predominant irritable bowel syndrome and may offer an alternative to the current multi drug approach.
Lichen planus with Oesophageal Involvement
Authors: Menges Markus , Hohloch Karin , Pueschel Werner , Stallmach Andreas
Published: April 2003

Background: Lichen planus is a common mucocutaneous disease of unknown aetiology. Oral disease affecting the mouth and the pharynx occurs in 30–70% of the cases. Oesophageal disease is considered to be extremely rare. The diagnosis of oesophageal involvement is often not made until complications occur. Case Report: A 56-year-old woman with oral and genital erosive lichen planus for more than 4 years complained of odynophagia and dysphagia. Episodes of oesophageal bolus obstruction started 2 months earlier. Upper endoscopy revealed a high-grade concentric stenosis at 21–24 cm from the incisors. Biopsy specimens taken after bougienage showed a squamous epithelium with dense leukocyte infiltration and Civatte bodies. The bougienage led to complete relief, but due to recurrent symptomatic stenosis, endoscopic dilatation had to be performed another four times within 5 years of follow-up. Immunosuppressive therapy with systemic and local steroid application did not prevent recurrent stenosis. Conclusions: Patients with lichen planus should be evaluated for gastrointestinal symptoms because oesophageal involvement is a rare but severe complication leading to inflammatory stenosis. The benefit of immunosuppressive therapy in the prevention of recurrent stenosis is not established. A review of all reported cases is done with particular regard to therapy.
Repetitive Transcranial Magnetic Stimulation for the Treatment of Chronic Pain – A Pilot Study
Authors: Rollnik Jens D. , Wüstefeld Stefanie , Däuper Jan , Karst Matthias , Fink Matthias , Kossev Andon , Dengler Reinhard
Published: April 2003

Invasive electrical stimulation of the motor cortex has been reported to be of therapeutic value in pain control. We were interested whether noninvasive repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex might also act beneficially. Twelve patients with therapy-resistant chronic pain syndromes (mean age 51.3 ± 12.6, 6 males) were included in a pilot study. They were treated with rTMS of the corresponding motor cortex area for 20 min (20 Hz, 20 × 2 s trains, intensity 80% of motor threshold) and sham stimulation (sequence-controlled cross-over design). Some of the patients (6/6) had an analgesic effect, but for the whole group, the difference between active and sham stimulation did not reach a level of significance (active rTMS: mean VAS reduction –4.0 ± 15.6%; sham rTMS: –2.3 ± 8.8%). Further studies using different rTMS stimulation parameters (duration and frequency of rTMS) or stimulation sites (e.g. anterior cingulate gyrus) are strongly encouraged.
Neuroaxonal Leukoencephalopathy with Axonal Spheroids
Authors: Yamashita Mariko , Yamamoto Toru
Published: April 2003

A 51-year-old woman with no significant family history exhibited progressive presenile dementia followed by right-sided spastic hemiplegia and died 27 months after the onset of her illness. Brain MRI demonstrated a widespread abnormality in the cerebral deep white matter and corpus callosum. Neuropathologically, extensive destruction of axons and myelin and abundant axonal spheroids were found in the deep white matter, preferentially of the frontoparietal areas. The corpus callosum was also severely damaged. The cerebral cortex and subcortical U fibers remained intact. The pathological features were different among the lesions, reflecting the sequential degenerative processes of the white matter. This case is, to our knowledge, the third sporadic case of neuroaxonal leukoencephalopathy with axonal spheroids.
Is Heart Rate Reduction Beneficial to Patients with Chronic Congestive Heart Failure?
Authors: Henriksen Otto Mølby , Gadsbøll Niels
Published: April 2003

It has been suggested that drugs for the treatment of heart failure which lower heart rate (HR) have a beneficial effect on mortality, whereas the reverse is true for drugs that increase HR. The objective of this review was to examine the relationship between drug-induced changes in HR and prognosis in heart failure. We reviewed the epidemiological, pathophysiological and clinical evidence of a possible relationship between HR and mortality in heart failure patients. Several heart failure drugs improve patient status and survival without affecting HR. However, part of the beneficial effect of beta-blockers must be attributed to their effect of slowing HR.
Influence of rBAT-Mediated Amino Acid Transport on Cytosolic pH
Authors: Moschèn Ivano , Setiawan Iwan , Palacin Manuel , Bröer Stefan , Albers Alexandra , Lang Florian
Published: April 2003

rBAT, together with its subunit b0,+ AT mediates the hetero- and homoexchange of neutral and dibasic amino acids. Since the heteroexchange of dibasic amino acids against neutral amino acids is coupled to net transport of positive charge, this transport is electrogenic. Extracellular addition of histidine could create an inward or an outward current depending on extracellular pH (pHe) and cell membrane potential. It has been concluded that histidine may be transported in both its protonated and its neutral form. In this study measurements of cytosolic pH (pHi) were performed to test this hypothesis. As a result, addition of protonated histidine at acidic pHe to Xenopus oocytes expressing rBAT creates an inward current which is paralleled by cytosolic acidification. Both can be reduced by increase of pHe. At alkaline pHe and simultaneous depolarization of the cell membrane the effect of histidine on pHi is virtually abolished. The neutral amino acid leucine does not alter cytosolic pH at neither pH 6.0 nor at pH 8.0. In conclusion, histidine can be transported in either its neutral or its protonated form. Transport of the protonated form is facilitated by extracellular acidification and hyperpolarization of the cell membrane.
Cultures of Kidney Transplant Fine-Needle Aspiration Samples from Rejection-Free Patients Produce a Specific Antidonor Response Suppressive Factor
Authors: de Oliveira José Gerardo G. , Xavier Paula , Ramos João , Sampaio Susana , Magalhães Maria , Mendes Armando , Pestana Manuel
Published: April 2003

Background/Aims: Growth of T cell lines from kidney graft biopsy specimens that suppress the antidonor response, either directly or through a soluble factor, both specific and nonspecific to donor, has been reported. Fine-needle aspiration biopsy sample cultures synthesize a large array of cytokines/chemokines with significant differences between stable versus acute rejection transplants. We hypothesize that the products of such cultures may be endowed with antidonor response modulation abilities in kidney transplantation. Methods: From 46 patients, 21 rejection free (group A) and 25 developing 28 acute rejection crises (group B), samples were obtained on days 7 and 30 after transplantation in group A and on day 7 and on acute rejection day in group B. The supernatants obtained after 48 h of culture were studied for IL-1 receptor antagonist, IL-4, IL-4 soluble receptor alpha, IL-12, IL-13, IFN-γ, TGF-β1, TGF-β2, GM-CSF, and PGE2 and for their effects on mixed lymphocyte reactions, donor-recipient and recipient-third-party combinations. At the end, analysis by flow cytometry of donor-recipient cultures complemented the analysis done before cultures. Results: Day 7 supernatants from group A specifically and significantly inhibited the antidonor response; supernatants from group B nonspecifically stimulated the antidonor response. The IL-1 receptor antagonist production was significantly higher by day 7 in group A, and the PGE2 production was significantly higher in group B. Flow cytometry analysis did not disclose significant differences between inhibited versus stimulated antidonor responses. Conclusions: Cultures of aspiration biopsy samples done early after transplantation in rejection-free patients produce soluble suppression-specific antidonor response factor(s), not present in cultures from biopsy specimens taken before and during rejection. This was associated with IL-1 receptor antagonist synthesis.
Inflammatory Markers and Platelet Aggregation Tests as Predictors of Hemoglobin and Endogenous Erythropoietin Levels in Hemodialysis Patients
Authors: Borawski Jacek , Pawlak Krystyna , Myśliwiec Michał
Published: April 2003

Background/Aims: Chronic inflammation is a common cause of severe anemia and hyporesponsiveness to recombinant erythropoietin (EPO) therapy in maintenance hemodialysis (HD) patients. We compared various acute-phase markers and ex vivo platelet aggregation tests in relation to clinical conditions in order to find factors predictive of hemoglobin (Hb) and endogenous EPO levels in a cross-section of clinically stable HD patients. Methods: In 100 subjects, pre-HD blood levels of C-reactive protein (CRP), α1-acid-glycoprotein (AGP), α1-antitrypsin (AT), immunoglobulin (Ig) M and G (by nephelometry), antigens of endothelial von Willebrand factor (vWF), type 1 plasminogen activator inhibitor and thrombomodulin, interleukin-6, lipoprotein(a) [Lp(a)] and EPO (by ELISA), and albumin, fibrinogen, iron metabolism indices, thyroid-stimulating hormone, phosphorus, parathormone, total cholesterol, triglycerides, viral hepatitis B/C markers, liver enzyme, and aluminium were determined. Platelet aggregations in response to ristocetin (RIPA), adenosine diphosphate, and collagen were measured in whole blood (electric impedance method) and platelet-rich plasma (optical aggregometry). Results: Hb levels inversely correlated with IgM, Lp(a), soluble vWF antigen, phosphorus, and all platelet aggregations in whole blood, but not in platelet-rich plasma. HD duration and triglycerides were positive correlates of anemia. In a multivariable analysis, increased IgM, short HD duration, increased Lp(a) and enhanced whole blood RIPA (in descending order of significance) were independent predictors of low Hb levels. In 51 patients not treated with recombinant EPO, serum levels of this hormone inversely correlated with whole blood RIPA, AT, age, vWF antigen, AGP, and positively with viral hepatitis marker. Anemia and EPO levels were not affected by gender, body mass index, cause of renal failure, residual renal function, HD dose, protein catabolic rate, use of different heparins or dialysate buffers, ACE inhibitor therapy, and parathyroid or thyroid function. In additional 10 patients, single HD session resulted in an increase in IgM levels associated with a fall in total lymphocyte counts. Conclusion: Subclinical inflammation is an important determinant of anemia in maintenance HD patients. Increased serum IgM reflecting a microinflammatory effect of HD procedures, enhanced whole blood RIPA as a surrogate of vascular endothelial damage, and Lp(a) as its promoter could be markers of such impaired erythropoiesis.
Lovastatin Downregulates Renal Myofibroblast Function in vitro
Authors: Kelynack Kristen J. , Hewitson Tim D. , Martic Marina , McTaggart Steven , Becker Gavin J.
Published: April 2003

Interstitial fibrosis is recognised as the best histological predictor of progressive renal disease. Myofibroblasts contribute to this process through several functions including hyperproliferation, collagen and collagenase synthesis and reorganisation of extracellular matrix. Recent limited in vitro studies suggest that 3-hydroxy-3-methylglutaryl-coenzyme A (HMG CoA) reductase inhibitors may reduce renal injury not only through their lipid-lowering effects but also by antagonising myofibroblast function. This study therefore examined the effects of lovastatin on the above interstitial myofibroblast behaviours in vitro. Primary cultures of rat renal cortical myofibroblasts were grown by explantation and characterised by immunohistochemistry. Dose response effects of lovastatin (0, 15, 30 µM) in DMEM and 10% FCS were examined on myofibroblast kinetics, total collagen synthesis, collagen I lattice contraction and actin filament rearrangement. Lovastatin decreased myofibroblast proliferation and growth. Likewise, collagen I lattice contraction and actin filament rearrangement were partially inhibited when lovastatin was added at 30 µM. In addition, lovastatin decreased both collagen and collagenase synthesis. Our results suggest that myofibroblast function may be downregulated by lovastatin in vitro. Although a decrease in myofibroblast activity may offer potential benefit in the prevention of progressive scarring, further studies will be necessary to determine the relative importance of these functions.
Clinical Outcome in Children Undergoing Tethered Cord Release Utilizing Intraoperative Neurophysiological Monitoring
Authors: von Koch Cornelia S. , Quinones-Hinojosa Alfredo , Gulati Mittul , Lyon Russ , Peacock Warwick J. , Yingling Charles D.
Published: April 2003

Release of tethered spinal cord by sectioning of the filum terminale carries a risk of injuring neighboring motor and sensory nerve roots involved in bowel and bladder control. Therefore, intraoperative neurophysiological monitoring techniques have been developed to prevent neurological complications postoperatively. We performed a retrospective chart review of 63 patients who had undergone tethered cord release. We excluded adult patients, those lost to follow-up and patients with either a myelomeningocele and/or lipoma. This limited our study to 25 pediatric patients, aged 4 months to 12 years, who underwent tethered cord release for either a thickened filum terminale and/or a low-lying conus. For intraoperative monitoring, we utilized electrical stimulation of the filum terminale, lumbosacral nerve roots and electromyography recordings. Ventral nerve roots were identified and their electrical thresholds obtained. The mean was 0.32 V, the mode 0.1 V and the range 0.05– 1.0 V. These values were compared to electrical thresholds obtained by stimulation of the filum terminale. The mean was 26.1 V, the mode 20.0 V and the range 8–100 V. In over 70% of patients, muscle activation via the filum required 100 times the voltage needed to activate a motor root. This motor root to filum threshold of 1:100 was useful in identifying the filum. Clinical outcome showed no significant worsening with respect to bowel and bladder control or pain and motor indices. Significant bowel and bladder improvement was seen in 4 out of 25 patients, motor improvement in 9 out of 25 patients and improvement of pain in 4 out of 25 patients. Three patients developed postoperative urinary tract infections, but no cerebrospinal fluid leaks or pseudomeningoceles were encountered. These results suggest that patients with a thickened filum or low-lying conus can safely undergo tethered cord release. Intraoperative neurophysiological monitoring provides a helpful adjunct to distinguish nerve roots from the filum. A ratio, rather than an absolute number, is beneficial in distinguishing motor roots from the filum and eliminates variability due to patients’ individual differences in electrical thresholds.
Stellenwert der modernen stereotaktischen Biopsiemethoden bei mammographisch suspekten Läsionen
Authors: Fehr M.K. , Hornung R. , von Orelli S. , Haller U.
Published: April 2003

Die optimale Abklärungsmethode von mammopraphisch suspekten, nicht palpablen Mammabefunden sollte eine geringe technische Versagerrate aufweisen, keine falsch-negativen Resultate liefern sowie die suspekte Läsion vollständig entfernen. Da die Mehrzahl dieser Läsionen benigne ist, sollten die Abklärungen zudem ambulant und ohne Narkose durchführbar sein. Bei der offenen chirurgischen Biopsie nach präoperativer Drahtmarkierung wird in durchschnittlich 2,6% ein Karzinom verpasst. Zudem ist der therapeutische Wert der offenen Biopsien nach präoperativer Drahtmarkierung gering, da 50–83% der Patientinnen einer weiteren Operation zur definitiven chirurgischen Therapie bedürfen. Nach stereotaktischer Stanz- oder Schneiderohrbiopsie liegt die Rate an verpassten Karzinomen unter 0,7%. Dies trifft jedoch nur zu, wenn diskordante Resultate und histologische Hochrisikoläsionen weiter abgeklärt werden. Die Kosteneffizienz dieser neuen Methoden ist unter der Bedingung belegt, dass die Indikationsstellung gleich bleibt und die teuren Geräte ausgelastet sind.
Associations between Lateral Cephalometric Dimensions and Misarticulations of Finnish Dental Consonants in Cleft Lip/Palate Children
Authors: Pulkkinen Joonas , Ranta Reijo , Haapanen Marja-Leena , Heliövaara Arja , Laitinen Jaana
Published: April 2003

The purpose of this study was to examine the associations between lateral cephalometric variables and the misarticulation of /r/, /s/ and /l/ sound in cleft lip/palate children. The subjects were 134 Finnish-speaking 6-year-old boys with isolated cleft palate (CP, n = 33), unilateral (n = 44), bilateral (BCLP, n = 19) cleft lip and cleft lip/alveolus (n = 38); /r/, /s/ and /l/ distortions were obtained from original hospital records which were based on perceptual speech follow-ups performed by experienced speech pathologists. Cephalometric measurement points were determined from standardized lateral roentgen cephalograms and traced twice by a computer-connected digitizer. The data were entered into a microcomputer and analysed by NCSS 6.0 for Windows using appropriate tests. The results revealed new significant associations between cephalometric measurements and misarticulations, especially that of the /r/ sound in CP and BCLP groups. Children with /r/ distortion had upward rotation of the mandible, maxillary protrusion and a higher position of the hyoid bone in the CP group. In the BLCP group, on the contrary, the mandible had downward rotation, mandibular retrusion and narrower nasopharyngeal port. The /s/ and /l/ sounds were less clearly associated with craniofacial morphology. The anteroposterior relationship of the maxilla and the mandible did not have any association with dentoalveolar misarticulations, instead, the systematic vertical, particularly posterior relationship of the jaws seems to be associated with /r/ sound production in CP and BCLP boys.
Zur Schriftsprachkompetenz erwachsener Gehörloser
Authors: Eisenwort Brigitte , Vollmann Ralph , Willinger Ulrike , Holzinger Daniel
Published: April 2003

Obwohl die Schwächen in der Schriftsprachkompetenz bei gehörlosen Erwachsenen allgemein bekannt sind, gibt es wenige empirische Untersuchungen dazu. Ziel dieser Arbeit ist es, eine quantitative Analyse der grammatikalischen Fehler in Faxmitteilungen einer Stichprobe gehörloser Erwachsener durchzuführen. Dazu wurden 236 Faxmitteilungen aus zwei Institutionen von einer repräsentativen Stichprobe zufällig ausgewählt. Die Analyse umfasst die Bereiche Lexikon, Morphologie und Syntax. Es ergaben sich drei Schreibleistungsgruppen, die auch statistisch abzusichern waren: Schreibleistungsgruppe 1 umfasst Gehörlose, die weitgehend vollständige Regelkenntnisse des Deutschen aufweisen; Angehörige der Schreibleistungsgruppe 2 zeigen einfache Regelmuster mit geringer syntaktischer Komplexität; Schreibleistungsgruppe 3 verwendet Holophrasen, schafft nur mangelhafte Wortartunterscheidungen und zeigt nichtzielsprachliche Wortfolgeregeln.
Screening for Microalbuminuria Simplified by Urine Specific Gravity
Authors: Parikh Chirag R. , Gyamlani Geeta G. , Carvounis Christos P.
Published: April 2003

Background: The albumin-to-creatinine ratio and the 24-hour urine collection to measure microalbuminuria are inconvenient and expensive. The newer rapid and less expensive dipstick methods for screening of microalbuminuria estimate only albumin and are subject to errors caused by variation in volume. We determined the relation between urine-specific gravity (Usg) and urine creatinine (Ucr) so that Ucr can be derived from Usg to correct for albumin concentration in the urine which is influenced by urine volume. Methods: We randomly included 42 consecutive patients from the primary care clinic, and 34 patients from the diabetic clinic. Results: We found that a very good correlation existed between Usg and Ucr in the 42 patients from the primary care clinic (Ucr = 11.4 × Usg –11,509, r = 0.83, p < 0.001). Patients from the diabetic clinic who had well-controlled blood sugar (n = 21) showed a similar trend (Ucr = 10.82 × Usg –10,882, r = 0.87, p < 0.001). However, this was not the case with uncontrolled diabetics (Ucr = 2.53 × Usg –2,513, r = 0.26, NS). Using simple arithmetic, we derived a simplified formula where Ucr can be predicted from Usg. Using multiple regression to incorporate the urinary glucose level by dipstick, a more generic formula was obtained for estimating urinary creatinine. Conclusion: Usg can be used instead of Ucr to normalize for the varied urine concentration while screening for microalbuminuria. Poorly controlled diabetics should be screened after their blood sugars are well controlled or use the more generic formula that incorporates urinary glucose. Thus, by measuring spot urine albumin and specific gravity by dipsticks one gets an easy, immediate and accurate estimation of microalbuminuria in an office setting.
Coexistence of Autosomal Dominant Polycystic Kidney Disease and Neurofibromatosis: Report of a Family
Authors: Chen Meng-Hao , Chen Kuo-Su , Hou Jia-Woei , Lee Ching-Chang , Huang Jen-Seng
Published: April 2003

Autosomal dominant polycystic kidney disease (ADPKD) and neurofibromatosis are both autosomal dominant heredofamilial disorders. Concurrence of these two diseases is very rare. Herein, we report the coexistence of neurofibromatosis in 3 members, a mother and her 2 sons, of a family with preexisting ADPKD. The chromosomal studies of these patients show no translocation, deletion, or other gross abnormality. It is possible that a mutated neurofibromatosis gene developed in the ADPKD mother with subsequent inherence of both ADPKD and NF genes in her 2 sons.