bluuebunny/crossref_metadata_2025 huggingface dataset:
Sleep Disturbance in Unipolar and Bipolar Depression: Relationship to Psychiatric Family History
Authors: Papadimitriou George N. , Dikeos Dimitris G. , Soldatos Constantin R.
Published: October 2003

Eighty depressed patients (40 bipolar and 40 unipolar) were personally interviewed in order to assess the relationship of disturbed sleep with psychiatric family history. Complaints of unsatisfactory sleep quantity and/or quality were more common among patients with a negative than among those with a positive family history for either any major psychiatric disorder (74.5 vs. 43.3%, p < 0.01) or only a mood disorder (68.4 vs. 43.5%, p < 0.05); this was more pronounced in bipolar patients. Results were confirmed when demographic variables and clinical characteristics of the disease were taken into consideration through the use of multiple logistic regression analysis. It is, thus, suggested that the mechanisms underlying disturbed sleep during a major depressive episode are different to those associated with the familial predisposition for depression.
Pain Thresholds as a Putative Functional Test for Cerebral Laterality in Major Depressive Disorder and Panic Disorder1
Authors: Spernal Julia , Krieg Jürgen-Christian , Lautenbacher Stefan
Published: October 2003

Objective: Both major depressive disorder (MDD) and panic disorder (PD) exhibit an illness-related functional cerebral laterality with a frontal right/left asymmetry. Using experimental pain lateralization as a putative indicator of functional cerebral laterality, we assessed body side differences in pressure, cold and heat pain thresholds in patients with MDD and PD as well as in healthy control subjects (HC). To control for an attentional bias in perception, reaction times for selective attention were also measured for both visual fields. Method: 21 inpatients with MDD, 21 inpatients with PD (DSM-IV diagnosis) and 20 HC subjects, all right-handed, were investigated drug free. Pain thresholds for pressure, cold and heat were assessed at the right and left forearm or hand. A neuropsychological standard test was used to measure selective attention (signal detection, Wiener Testsystem), which allows for the discrimination between left and right visual field stimulus processing. Results: In all participants, a left-sided increased pain sensitivity could be verified by using pressure pain, but not by thermal pain (cold, heat). The diagnosis of MDD or PD had no influence on pain threshold lateralization. There were no differences in reaction times of selective attention between the groups of patients and the HC. Neither did stimulus presentation in the left or right visual field affect reaction time differently. Conclusion: Body side asymmetry of pain perception was only found for pressure pain targeting mainly deep tissue (muscle) nociception. This asymmetry, however, cannot be regarded as an indicator of a pathological functional cerebral laterality in MDD and PD.
Characterization of the CNS Effects of Naftidrofuryl (Praxilène®) by Quantitative EEG and Functional MRI: A Study in Healthy Elderly Subjects
Authors: Boeijinga P.H. , Nedelec J.F. , Demazières A. , Souan M.L. , Gamand S. , Gilles C. , Parot P. , Staner L. , Luthringer R. , Macher J.P.
Published: October 2003

In the present study, we investigated the effects of a single and a repeated (5 days) administration of naftidrofuryl, a serotonin 5-HT2 receptor inhibitor having neuroprotective properties, on functional brain physiology in male healthy elderly subjects, using quantitative electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). Twelve subjects aged 60 ± 3.8 years completed the quantitative EEG study, where the effects of 400 and 600 mg were assessed, and 12 other subjects (aged 56 ± 4.7 years) completed the fMRI study, where the effect of 400 mg was assessed on the brain activation induced by the continuous performance test (CPT). Naftidrofuryl induced a transient reduction in alpha activity followed by a specific synchronisation of the 9.5- to 11-Hz EEG activity most pronounced after repeated administration. Such regimen also increased the CPT-induced brain activation visualized by way of fMRI. The results of the present study can be interpreted at the functional level that naftidrofuryl induced an improved level of vigilance or an increased capacity of alertness in healthy elderly subjects.
Use of Sound-Absorbing Panel to Reduce Noisy Incubator Reverberating Effects
Authors: Bellieni Carlo V. , Buonocore Giuseppe , Pinto Iole , Stacchini Nicola , Cordelli Duccio M. , Bagnoli Franco
Published: October 2003

Objectives: To assess the amplification and distortion of noise in incubators by measuring noise levels from various sources under various conditions. Study Design: We recorded sound pressure levels (SPL) of background noise, baby crying, alarms and porthole closing with the incubator hood open or closed. Then we tried to reduce the sound level in the incubator by applying a sound absorbing panel to the ceiling of the hood. Results: The sound sources analysed produced very high SPL. In free field baby crying and porthole noise were, respectively, 81–83 dB and 70–71 dB, closing the hood they raised to 84–87 and 73–74 dB: this means that the noise perceived by a baby in the incubator had twice the SPL of the same noise emitted in a free field; alarm noise was 56–57 dB inside incubators. Sound emitted inside the hood was also distorted, i.e. it had different features from the same source in a free field. The insulating panel prevented amplification and distortion due to the hood and reduced the SPL of alarms. Only background noise did not decrease with the panel. Sound absorbing panel reduced baby’s crying, porthole noise and alarm noise SPL to 82–85, 70–71 and 50–51 dB, respectively. Conclusions: Incubators are reverberating environments, which amplify the baby’s cry and other noises produced inside the hood. The frequency components of noises are altered by the hood. The sound absorbing panel reduced this phenomenon.
Age-Related Changes in Intracellular Th1/Th2 Cytokine Production, Immunoproliferative T Lymphocyte Response and Natural Killer Cell Activity in Newborns, Children and Adults
Authors: Gasparoni Antonella , Ciardelli Laura , Avanzini Antonia , Castellazzi Anna Maria , Carini Roberta , Rondini Giorgio , Chirico Gaetano
Published: October 2003

To evaluate the development of the neonatal immune system, we measured T lymphocyte response to Con A, intracellular IL-2, IL-4, IFN-γ and IL-10 production, and natural killer cell (NKC) activity in 12 very preterm, 12 preterm and 20 term neonates, 10 children and 10 adults. Immunoproliferation to Con A was significantly lower in cord blood than in children or adults. The percentage of CD4+ lymphocytes was significantly higher in newborns while CD8+ cells were higher at older ages, with a resulting gradual decline of the CD4+/CD8+ ratio. The percentage of IL-2-producing CD4+ and CD8+ cells was higher in all newborn groups than in children and adults, while the percentage of IL-4-producing cells was higher for CD8+ and lower for CD4+ cells in cord blood than in children and adults. Neonates had substantially lower percentages of CD4+ and CD8+ IFN-γ-producing cells. A significant negative correlation was observed between gestational age and IFN-γ-CD4+-, IL-2-CD8+-, and IL-10- CD4+-producing cells. In addition, a positive correlation was found between gestational age and IL-10-CD8+-producing cells. Percentages of CD4+/CD45RA+ cells were higher and CD4+/CD45RO+ percentages were lower in newborns than in children and adults. NKC activity in infants was significantly correlated with gestational age and significantly impaired compared to children and adults. On the whole, these results suggest a gradual development of immunity during gestation and show significant immaturity of cellular immune response at birth. The reduction of NKC activity, the lower proliferative response of T cells, the reduced cytotoxic response and a dysregulated cytokine production may contribute to the neonatal increased risk of infection and to the low incidence of graft-versus-host disease after cord blood transplantation.
The Influence of Piglet Birth Weight on Physical and Behavioural Development in Early Life
Authors: Litten J.C. , Drury P.C. , Corson A.M. , Lean I.J. , Clarke L.
Published: October 2003

The objective of this study was to determine whether body weight at birth influences the physical and behavioural development of the neonatal pig. Sixteen sows and their litters were randomly allocated into four treatment groups. From the normal distribution curve of their birth weight, piglets were sub-divided into three groups: (1) low (<10th percentile) (2) normal (10–90th percentile) and (3) high (>90th percentile).To assess behavioural development, each litter was exposed to a ball placed in the creep area for a period of 1,800 s, and evaluated once over a 3-day period starting on either 5, 7, 14 or 21 days of postnatal life. Their response to, and interaction with, an object was used to calculate a numerical index of piglet behavioural development. Teat order was calculated following observations during consecutive suckling on days 11, 13 and 15 of life, and dominance hierarchy was assessed on day 12, 14 and 16. Individual body weight was recorded on days 0, 5, 7, 14 and 21 of postnatal life. Statistical differences between groups were analysed using general linear model, analysis of variance. Regression analyses were used to determine relationships between physical and behavioural development with teat order and dominance. There was a significant (p < 0.001) relationship between birth weight, growth performance and behavioural development. Behavioural developmental index (BDI) significantly improved (p < 0.001) with age and was also influenced by the day on which the ball was introduced (p < 0.01). Body weight on day 1 of the test was significantly (p < 0.001) correlated to BDI and age at test. Piglets demonstrating compensatory growth were more dominant and exhibited an improved behavioural developmental score than their slower growing littermates. In conclusion, compromised growth in utero can have a detrimental effect on the physical and behavioural development of the neonate. Animals with an enhanced developmental index in conjunction with a higher dominance value exhibited a improved neonatal growth performance.
Comparison of Pulmonary and Inflammatory Effects of Lipid- and Water-Soluble Components in Meconium in Newborn Piglets
Authors: Tølløfsrud Per Arne , Lindenskov Paal Haakonsen , Drevon Christian A. , Speer Christian P. , Seidenspinner Silvia , Saugstad Ola Didrik
Published: October 2003

To understand the pathogenesis of meconium aspiration syndrome, we compared the pulmonary and inflammatory effects of the water and lipid extracts of human meconium instilled into the lungs of newborn piglets. The piglets were artificially ventilated, made hypoxemic, and randomized into three groups. At start of reoxygenation, 3 ml/kg of one of the following mixtures was instilled intratracheally: (1) meconium (n = 12); (2) water extract of meconium (n = 12), and (3) lipid extract of meconium (n = 12). During 8 h of reoxygenation, hemodynamics, pulmonary gas exchange, lung mechanics, and interleukin-8 concentrations in tracheobronchial aspirates were monitored. Oxygenation index (p = 0.04) and mean airway pressure (p = 0.04) increased more in the lipid extract group than in the water extract group. Dynamic compliance and mean arterial blood pressure decreased (p < 0.05) in the meconium and lipid extract groups, but not in the water extract group. At 8 h of reoxygenation, the interleukin-8 concentration in the tracheobronchial aspirates was three times higher in the lipid extract group as compared with the water extract group (110 ± 102 vs. 37 ± 27 pg/ml; p = 0.02). In conclusion, pulmonary dysfunction in meconium aspiration syndrome is caused by both the water- and lipid-soluble fractions of meconium, with stronger inflammatory and more detrimental effects promoted by the lipid extract than the water extract.
Problems Associated with Collecting Breath Condensate for the Measurement of Exhaled Hydrogen Peroxide from Neonates on Respiratory Support
Authors: Cheah Fook-Choe , Darlow Brian A. , Winterbourn Christine C.
Published: October 2003

We developed a bedside method for collecting exhaled breath condensate (EBC) from neonates who were ventilated or receiving nasal continuous positive airway pressure (CPAP) and analyzed their EBC for hydrogen peroxide levels. A sufficient volume for analysis could be collected over 25–40 min from neonates on the ventilator and nasal CPAP (medians 5.3 and 2.7 ml, respectively). There was no significant difference between hydrogen peroxide levels from neonates on a ventilator or CPAP (median 0.28 vs. 0.38 µM, p = 0.06) and these were no different from a background with the ventilator or CPAP system alone (median for each 0.31 µM). The dilution of breath condensate by humidified gases plus the existence of background hydrogen peroxide resulted in this collecting setup being insufficiently sensitive to use for the detection of exhaled hydrogen peroxide in infants who were ventilated or on nasal CPAP.
The Serotonin Transporter is Required for Stress-Evoked Increases in Adrenal Catecholamine Synthesis and Angiotensin II AT2 Receptor Expression
Authors: Armando I. , Tjurmina O.A. , Li Q. , Murphy D.L. , Saavedra J.M.
Published: October 2003

High numbers of serotonin transporter (SERT) binding sites and high serotonin (5-HT) content are expressed in the adrenal medulla of wild-type (SERT+/+) mice. Acute restraint stress increases adrenomedullary 5-HT, norepinephrine (NE) and epinephrine (E) release, adrenomedullary tyrosine hydroxylase (TH) mRNA, and angiotensin II AT2 receptor expression. There are no alterations in adrenal catecholamine content during restraint. In littermate SERT–/– mice, which do not express SERT binding sites, the basal adrenomedullary 5-HT content is significantly reduced and does not increase after stress. The stress-induced increase in plasma E is higher in SERT–/– than in SERT+/+ animals. In SERT–/– mice, the stress-induced increase in expression of TH mRNA does not occur, and as a consequence, adrenal E content decreases, and adrenal E and NE content are lower than that of SERT+/+ mice during restraint. In addition, instead of increased expression, stress induces a profound decrease in the number of adrenomedullary AT2 receptors in SERT–/– mice. Our results indicate that SERT is necessary for the stress-induced increase in adrenomedullary catecholamine synthesis and AT2 receptor expression. These data further indicate a close relationship between the adrenomedullary 5-HT and angiotensin II systems, and an important role of adrenomedullary AT2 receptors in catecholamine synthesis and release during stress.
Both Selective COX-1 and COX-2 Inhibitors Aggravate Gastric Damage Induced in Rats by 2-Deoxy-D-Glucose
Authors: Takeuchi Koji , Miyazawa Tohru , Matsumoto Masahiro , Hayashi Yujiro
Published: October 2003

Background/Aim: 2-Deoxy-D-glucose (2DG), despite causing gastric hypermotility via vagal stimulation, does not by itself induce damage in the stomach but produces gross lesions under prostaglandin (PG) deficiency induced by non-ulcerogenic dose of indomethacin. In this study, we examined the roles PG and cyclo-oxygenase (COX) isozymes play in the gastric ulcerogenic effect of 2DG in the rat stomach under PG deficiency caused by indomethacin. Methods: The animals were given 2DG i.v. (200 mg/kg as a bolus injection followed by an infusion at 100 mg/kg), and the mucosa was examined for lesions 8 h later. SC-560 or/and rofecoxib was given p.o. 1 h before 2DG treatment. Results: 2DG alone caused slight damage in the stomach despite causing acid hypersecretion and hypermotility. Neither SC-560 nor rofecoxib alone caused any damage in the stomach, yet these agents significantly aggravated 2DG-induced gastric lesions; the severity of damage was much greater when SC-560 was given together with 2DG. SC-560, but not rofecoxib, enhanced both acid secretion and gastric motility in response to 2DG, with a decrease in mucosal PGE2 content. Expression of COX-2 was up-regulated in the stomach as early as 2 h after 2DG treatment, and the PGE2 content was increased when determined 6 h later, in a COX-2-dependent/rofecoxib-sensitive manner. Both the expression of COX-2 and gastric hypermotility during 2DG treatment were inhibited by prior administration of atropine but not omeprazole, although 2DG-induced gastric lesions were prevented by both agents. Conclusion: These results suggest that potentiation by indomethacin of 2DG-induced gastric lesions is related to inhibition of both COX-1 and COX-2, and that 2DG up-regulates COX-2 in the gastric mucosa, the event occurring in association with gastric hypermotility and contributing to suppression of later extension of the damage.
Influence of Somatostatin Receptor Scintigraphy and CT/MRI on the Clinical Management of Patients with Gastrointestinal Neuroendocrine Tumors: An Analysis in 188 Patients
Authors: Gotthardt Martin , Dirkmorfeld Larissa M. , Wied Matthias U. , Rinke Anja , Béhé Martin P. , Schlieck Anja , Höffken Helmut , Alfke Heiko , Joseph Klaus , Klose Klaus J. , Behr Thomas M. , Arnold Rudolph
Published: October 2003

Aim: Many studies describe the sensitivities and specificities of computed tomography (CT), magnetic resonance imaging (MRI), and somatostatin receptor scintigraphy (SRS) in patients with gastrointestinal neuroendocrine tumors (GNT). We performed a study to evaluate the influence of these techniques on the therapeutic management of patients with advanced stages of GNT. Patients and Methods: The results of either CT/MRI scans or SRS were reviewed by two independent observers who decided on the therapy of a patient. They then had to determine whether the results of the complementary imaging modality would change the decision. The study design was a matched cross-over study with two groups matching in respect to tumor type, imaging modality known first to the observer, and number of patients. For further analysis, patients were divided into three subgroups dependent on tumor stage (group 1, without metastases, group 2, liver metastases, group 3, recurrent disease/extrahepatic metastases). Results: 188 patients were included into the study. If SRS was known to the observers first, CT/MRI changed the therapeutic management in 16.2, 13.9 and 11.4% of the patients (subgroups 1–3). SRS changed the therapeutic management in 13.5, 12.5 and 10.3%. Overall, CT/MRI would have changed the management in 13.3% and SRS in 11.7% of the patients. Conclusion: Though the patients studied mainly suffered from already advanced stages of the disease, all imaging techniques change the therapeutic management to a comparable extent. Our results support the importance of combined imaging in the management of patients with GNT.
Adult Autoimmune Enteropathy Treated Successfully with Tacrolimus
Authors: Daum Severin , Sahin Ergün , Jansen Andreas , Heine Bernhard , Riecken Ernst-Otto , Zeitz Martin , Schmidt Wolfgang
Published: October 2003

Background: Autoimmune enteropathy is a life-threatening, chronic disease of the small bowel mucosa, which generally responds well to steroids. Treatment requires long-term immunosuppression, and steroid-sparing treatment strategies are desirable. Azathioprine and cyclosporine A have limitations, however alternatives have not been described in adults. Case Report: We present the case of a 54-year-old male patient with autoimmune enteropathy who responded initially to a standard treatment with steroids, but was dependent on 30 mg prednisolone. Medical treatment was changed to tacrolimus after renal function deteriorated under treatment with cyclosporine A. Under this regimen, small bowel histology normalized and the clinical condition is stable after 2 years of introduction of tacrolimus. Conclusion: This constitutes the first report of effective treatment of adult autoimmune enteropathy with tacrolimus, a substance with a similar mode of action to cyclosporine, but with fewer side effects and improved bioavailability.
Transarterial Chemoembolization of Advanced Liver Metastases of Neuroendocrine Tumors – A Retrospective Single-Center Analysis
Authors: Kress O. , Wagner H.-J. , Wied M. , Klose K.J. , Arnold R. , Alfke H.
Published: October 2003

Background: In neuroendocrine tumors, metastases are a negative prognostic factor for survival and quality of life. Transcatheter arterial chemoembolization (TACE) is thought to be an effective symptomatic and antiproliferative treatment in patients with otherwise progressive disease. Methods: 62 chemoembolization procedures in 26 patients with progressive neuroendocrine tumors were reviewed. The underlying disease was carcinoid syndrome in 10, non-functional midgut tumor in 2, non-functional pancreatic tumor in 7, malignant insulinoma in 2 patients, non-functional tumor of the stomach in 1 and of unknown origin in 4 patients. Tumor burden of the liver was <25% in 3, 25–50% in 11, 50–75% in 6 and >75% in 6 patients. Results: TACE was technically successful in 57 cases. Four patients developed minor and 5 major complications. The 30-day mortality rate was 7.7%. According to WHO criteria, 14 patients had no change in tumor burden, 2 had regression and 5 progress after chemoembolization. Patients with a tumor burden >75% of the liver did not benefit from TACE due to the development of major complications, whereas patients with low (<50%) tumor burden and high (>50%) lipiodol uptake showed a trend towards longer survival. Five-year survival time after diagnosis was 48%. Patients treated with octreotide and/or α-interferon had no benefit from chemoembolization with regard to their carcinoid syndrome. Conclusions: In this retrospective study, patients with low (<50%) tumor burden and high (>50%) lipiodol uptake responded better to TACE than end-stage patients.
Myoendothelial Gap Junctions May Provide the Pathway for EDHF in Mouse Mesenteric Artery
Authors: Dora Kim A. , Sandow Shaun L. , Gallagher Nicola T. , Takano Hiromichi , Rummery Nicole M. , Hill Caryl E. , Garland Chris J.
Published: October 2003

Endothelium-dependent hyperpolarization of vascular smooth muscle provides a major pathway for relaxation in resistance arteries. This can occur due to direct electrical coupling via myoendothelial gap junctions (MEGJs) and/or the release of factors (EDHF). Here we provide evidence for the existence of functional MEGJs in the same, defined branches of BALB/C mouse mesenteric arteries which show robust EDHF-mediated smooth muscle relaxation. Cyclopiazonic acid (CPA, 10 µM) was used to stimulate EDHF in arteries mounted under isometric conditions and constricted with phenylephrine. Simultaneous measurement of smooth muscle membrane potential and tension demonstrated that CPA caused a hyperpolarization of around 10 mV, reversing the depolarization to phenylephrine by 94% and the associated constriction by 66%. The relaxation to CPA was endothelium dependent, associated with the opening of Ca2+-activated K channels, and only in part due to the release of nitric oxide (NO). In the presence of the NO synthase inhibitor, L-NAME (100 µM), the relaxation to CPA could be almost completely inhibited with the putative gap junction uncoupler, carbenoxolone (100 µM). Inhibition of the synthesis of prostaglandins or metabolites of arachidonic acid had no effect under the same conditions, and small rises in exogenous K+ failed to evoke consistent or marked smooth muscle relaxation, arguing against a role for these molecules and ions as EDHF. Serial section electron microscopy revealed a high incidence of MEGJs, which was correlated with heterocellular dye coupling. Taken together, these functional and morphological data from a defined mouse resistance artery suggest that the EDHF response in this vessel may be explained by extensive heterocellular coupling through MEGJs, enabling spread of hyperpolarizing current.
Home ventilation: Table 1—
Authors: Simonds A.K.
Published: October 2003

Home ventilation is a growth area. Rapid expansion during the 1990s was stimulated by the development of noninvasive ventilation (NIV)viaa mask and the recognition that an increased number of patient groups can benefit. Although patients receiving NIV in the home outnumber those receiving invasive ventilationviatracheostomy, there is substantial variation in practice between European countries.

Evidence that individuals who develop ventilatory failure as a consequence of chest wall disease or stable neuromuscular disease such as old poliomyelitis benefit from nocturnal NIV is overwhelming. Patients with progressive neuromuscular disease such as Duchenne muscular dystrophy and amyotrophic lateral sclerosis can also derive prolongation of life, palliation of symptoms and an improvement in quality of life.

Home ventilation in chronic obstructive pulmonary disease (COPD) patients remains controversial. Multicentric randomised controlled trials of long-term oxygen therapy (LTOT)versusNIV plus LTOT in COPD have produced mixed results, although certain subgroups,e.g.those with recurrent infective exacerbations requiring short-term NIV, patients aged >65 yrs, and those with uncontrolled hypercapnia on LTOT or symptomatic nocturnal hypoventilation, may benefit.

At the other end of the age spectrum, children as young as a few months can be successfully treated with noninvasive ventilation. Most work on paediatric home ventilation centres on children with congenital neuromuscular disease. Pressure preset bilevel ventilators are now the dominant form of ventilator in adults and children. Discharge planning is vital for the home ventilator patient and a sensible risk management strategy should be in place.
Mechanical ventilation: invasiveversusnoninvasive: Table 1—
Authors: Brochard L.
Published: October 2003

Mechanical ventilation is the most widely used supportive technique in intensive care units. Several forms of external support for respiration have long been described to assist the failing ventilatory pump, and access to lower airways through tracheostomy or endotracheal tubes had constituted a major advance in the management of patients with respiratory distress. More recently, however, new “noninvasive” ventilation (NIV) techniques, using patient/ventilator interfaces in the form of facial masks, have been designed.

The reasons for promoting NIV include a better understanding of the role of ventilatory pump failure in the indications for mechanical ventilation, the development of ventilatory modalities able to work in synchrony with the patient, and the extensive recognition of complications associated with endotracheal intubation and standard mechanical ventilation.

NIV has been used primarily for patients with acute hypercapnic ventilatory failure, and especially for acute exacerbation of chronic obstructive pulmonary disease. In this population, the use of NIV is associated with a marked reduction in the need for endotracheal intubation, a decrease in complication rate, a reduced duration of hospital stay and a substantial reduction in hospital mortality. Similar benefits have also been demonstrated in patients with asphyxic forms of acute cardiogenic pulmonary oedema. In patients with primarily hypoxemic forms of respiratory failure, the level of success of NIV is more variable, but major benefits have also been demonstrated in selected populations with no contraindications such as multiple organ failure, loss of consciousness or haemodynamic instability.

One important factor in success seems to be the early delivery of noninvasive ventilation during the course of respiratory failure. Noninvasive ventilation allows many of the complications associated with mechanical ventilation to be avoided, especially the occurrence of nosocomial infections. The current use of noninvasive ventilation is growing up, and is becoming a major therapeutic tool in the intensive care unit.
Stage‐specific psychological determinants of stage transition
Authors: Dijkstra Arie , Tromp Debbie , Conijn Barbara
Published: October 2003

Objectives: The stages of change construct refers to the different psychological states people move through when they change their behaviour. However, the prediction that people in different stages of change need different sorts of interventions to stimulate the change process has scarcely been tested prospectively. An indirect test of this hypothesis would need to assess whether there are stage‐specific psychological determinants of forward stage transition.

Method: Smoking and quitting history, demographics, three potential psychological determinants of stage transition and stage of change were assessed in over 700 smokers and ex‐smokers (T1). After eight months (T2), stage of change was reassessed.

Results: The cross‐sectional relationships between two of the three psychological measures and stage of change were largely non‐linear. In the main prospective analyses on forward stage transition, stage‐specific determinants were identified for three of the four possible forward stage transitions. Furthermore, for three of the four possible backward stage transitions, stage‐specific determinants of backward stage transition approached significance. For the contemplation stage, none of the determinants under investigation were found to be related to either forward or backward stage transition.

Conclusions: The present data indirectly support the notion that stage‐specific interventions should target stage‐specific determinants of stage transition in smoking behaviour. However, with regard to smokers in the contemplation stage—who comprise a large proportion of smokers in Western countries—no conclusions can be drawn.
Facial palsy as first presentation of acute myeloid leukemia
Authors: Sood Bhrigu Raj , Sharma Brij , Kumar Satish , Gupta Dalip , Sharma Ashok
Published: October 2003

Granulocytic sarcoma or chloroma is a tumor composed of myeloblast or monoblast. These tumors may be found in any location of the body and occur in 5% of acute myeloid leukemia (AML) cases and are more common in pediatric patients. In this report we describe the case of a 27‐year‐old male who developed lower motor neuron seventh nerve palsy followed by swelling of the parotid gland. Fine‐needle aspiration cytology (FNAC) of the soft tissue swelling revealed scattered blasts, and peripheral smear and bone marrow aspirate examination suggested AML. This is a rare presentation of a granulocytic sarcoma leading to a diagnosis of AML. Am. J. Hematol. 74:200–201, 2003. © 2003 Wiley‐Liss, Inc.
Urinary excretion of retinol in patients with multiple myeloma: A preliminary study
Authors: Gavrilov Vladimir , Yermiahu Tikva , Gorodischer Rafael
Published: October 2003

Urinary excretion of vitamin A was studied in patients with multiple myeloma (MM). Eight of the 12 patients studied excreted retinol in urine; only one of them had elevated serum creatinine (115–150 μmol/L). There was a highly significant correlation between urinary retinol and serum creatinine (P < 0.0004). Urinary retinol correlated also with urine protein (P < 0.0001) and albumin (P = 0.001), but not with urinary immunoglobulin light chains. Urinary retinol excretion may be an early manifestation of renal dysfunction in MM patients. The effect of urinary retinol excretion on vitamin A homeostasis in MM deserves further study. Am. J. Hematol. 74:202–204, 2003. © 2003 Wiley‐Liss, Inc.
Visceral leishmaniasis masquerading as myelodysplasia
Authors: Kopterides Petros , Halikias Spyridon , Tsavaris Nikolaos
Published: October 2003

We report a case of a 61‐year‐old man with head and neck cancer who presented with pancytopenia two months after the completion of his chemotherapy and was diagnosed with myelodysplasia on the basis of two bone marrow examinations, before the correct diagnosis of visceral leishmaniasis was established with splenectomy. Am. J. Hematol. 74:198–199, 2003. © 2003 Wiley‐Liss, Inc.
Acute lymphoblastic leukemia without the Philadelphia chromosome occurring in chronic myelogenous leukemia with the Philadelphia chromosome
Authors: Jin Huh Hee , Won Huh Jung , Myong Seong Chu , Lee Miae , Soon Chung Wha
Published: October 2003

The blast crisis in chronic myelogenous leukemia (CML) is related to the evolution of a Philadelphia chromosome (Ph)‐positive clone. Secondary chromosomal abnormalities accompanied by t(9;22) are found in 70–80% of blast crises. Here we describe a patient with Ph‐positive CML, who developed Ph‐negative acute lymphoblastic leukemia (ALL). A 52‐year‐old man was diagnosed with CML with the Ph chromosome in the chronic phase. He achieved a partial cytogenetic response after 4 months of imatinib mesylate therapy. After 8 months, common ALL occurred. At that time his karyotype was normal and the Ph chromosome was not noted. Am. J. Hematol. 74:218–220, 2003. © 2003 Wiley‐Liss, Inc.
Disseminated Mycobacterium kansasii infection with pulmonary alveolar proteinosis in a patient with chronic myelogenous leukemia
Authors: Goldschmidt Neta , Nusair Samir , Gural Alexander , Amir Gail , Izhar Uzi , Laxer Uri
Published: October 2003

A 64‐year‐old woman with chronic myelogenous leukemia (CML) was admitted due to prolonged fever and lung infiltrates. An open lung biopsy was required to make the diagnosis of pulmonary alveolar proteinosis (PAP) and infection with Mycobacterium kansasii. She was treated successfully with combined antimycobacterial therapy for 14 months. However, the leukemia progressed and the patient developed recurrent bilateral lung infiltrates. Blood and bronchoalveolar fluid cultures yielded growth of Acinetobacter. She died shortly thereafter due to septic shock. The relationship between M. kansasii infection, PAP, and abnormal host defense in CML is discussed. Am. J. Hematol. 74:221–223, 2003. © 2003 Wiley‐Liss, Inc.
Sickle cell patient with an acute chest syndrome and a negative chest X‐ray: Potential role of the ventilation and perfusion (V/Q) lung scan
Authors: Feldman Lawrence , Gross Robert , Garon Jack , Nallari Anitha , Kaur Navleen , Motwani Bharat , Sukumaran Sunitha , Allen Sandra , Westerman Maxwell
Published: October 2003

Acute chest syndrome (ACS) in sickle cell disease is caused by thromboemboli in the pulmonary vasculature. The diagnostic criteria include the presence of pulmonary infiltrate(s) on chest x‐ray. This case report suggests that a V/Q scan may play a diagnostic role in sickle cell patients with symptoms of ACS and a negative chest x‐ray. Am. J. Hematol. 74:214–215, 2003. © 2003 Wiley‐Liss, Inc.
Significance of increasing adhesion of cord blood hematopoietic cells and a new method: Platelet microparticles
Authors: Liu Bin , Liao Can , Chen Jingsong , Gu Shaoling , Wu Shaoqin , Xu Zunpeng
Published: October 2003

Hematopoietic recovery after transplantation with cord blood (CB) is slower than with bone marrow (BM) and mobilized peripheral blood. Adhesion molecules (AMs) on hematopoietic cells are involved in hematopoietic cells' homing. It may be possible to enhance CB CD34+ cells engraftment by increasing their expressions of AM. Twenty‐three patients with childhood acute leukemia treated with unrelated CBT were studied. It was found that the time to neutrophil recovery correlated with CXCR4 and the time to platelet recovery correlated with both CD62L and CXCR4. Platelet microparticles (PMPs) carry some AMs such as aIIb b (CD41), P‐selectin (CD62P), and CXCR4, CD34+ cells express platelet‐binding antigens (CD162 and CD11b). It was found that AMs were increased dramatically on CD34+ cells surface in the presence of PMPs, and CD34+ cells covered with PMPs adhered better to human umbilical vein endothelial cells and fibronectin. These findings suggested that PMPs could increase adhesion of donor's cells to host BM in CBT. Am. J. Hematol. 74:216–217, 2003. © 2003 Wiley‐Liss, Inc.
Rapid detection of six common Mediterranean and three non‐Mediterranean α‐thalassemia point mutations by reverse dot blot analysis
Authors: Foglietta Enrica , Bianco Ida , Maggio Aurelio , Giambona Antonino
Published: October 2003

We describe the implementation of reverse dot blot (RDB) hybridization as a rapid nonradioactive method for the identification of six frequent globin gene point mutations in the Mediterranean population: αHphα: α2 IVS I donor site GGTGAGG → GG‐‐‐‐‐; αNcoIα: α2 initiation codon ATG → ACG; αTSaudiα: α2Poly A signal AATAA → AATAAG; αIcariaα: α2 termination codon TAA → AAA (Ter → LYS); αCSα: α2 termination codon TAA → CAA (Ter → gly); ααNcoI: α1 initiation codon ATG → GTG; and three α2 globin gene point mutations found in immigrants in Italy: αT‐Quongszeα: α2 codon 12 CTG → CCG (Leu → Pro); αSeal Rockα: α2 termination codon TAA → GAA (TER → GLU); and αKoyadoraα: α2 termination codon TAA → TCA (TER → SER). The method uses the principle of allele‐specific oligonucleotide (ASO) hybridization, but it is a nonradioactive method and permits rapid and simultaneous typing of point mutations and small deletions. Am. J. Hematol. 74:191–195, 2003. © 2003 Wiley‐Liss, Inc.
Overweight individuals are at increased risk for thrombotic thrombocytopenic purpura
Authors: Nicol Kathleen K. , Shelton Brent J. , Knovich Mary Ann , Owen John
Published: October 2003

Our understanding of the pathophysiology of thrombotic thrombocytopenic purpura, TTP, has increased dramatically in the past few years with the identification of the role of ADAMTS13. Nonetheless, risk factors for the development of acute TTP are few. Informally, obesity was felt to be common in patients with TTP and so a formal study was undertaken to further define this association. We report our data in 105 patients with classical TTP as defined by thrombocytopenia and microangiopathic hemolytic anemia. We found that marked obesity is a previously unrecognized risk factor with an associated odds ratio of 7.6. Interestingly, despite this increased risk, obesity might well be associated with lower mortality, although this did not reach statistical significance. Am J. Hematol. 74:170–174, 2003. © 2003 Wiley‐Liss, Inc.
High‐dose intravenous immunoglobulin treatment in two patients with acquired factor V inhibitors
Authors: de Raucourt Emmanuelle , Barbier Christophe , Sinda Patrick , Dib Mamoun , Peltier Jean‐Yves , Ternisien Catherine
Published: October 2003

We report two patients who developed acquired factor V (FV) inhibitors not related to exposure to bovine thrombin. Associated conditions were found in one patient (surgery, antibiotic administration) but none in the other one. Bleeding complications occurred only in the patient with idiopathic FV inhibitor, leading to packed red cell infusion. Laboratory findings showed the presence of specific FV inhibitors with titers of 5.5 and 5 Bethesda units, respectively. These two patients received high‐dose intravenous immunoglobulin and FV levels normalized within a few days with a concomitant disappearance of FV inhibitors. Am. J. Hematol. 74:187–190, 2003. © 2003 Wiley‐Liss, Inc.
β‐Globin gene cluster haplotypes in sickle cell patients from southwest Iran
Authors: Rahimi Z. , Karimi M. , Haghshenass M. , Merat A.
Published: October 2003

Sickle cell anemia in Iran is accompanied by a high level of HbF and mild clinical presentation. Here we report haplotypes of the β gene cluster found in 81 randomly selected sickle cell patients, including 47 sickle cell anemia (SS), 17 sickle cell trait (AS), and 17 sickle/thalassemia (S/thal) from southwest Iran. We found all five common typical haplotypes as well as five atypical haplotypes in our patients. Except for four patients with homozygous Benin haplotype, none of the other African typical haplotypes were found in a homozygous state. Arab‐Indian was found to be the most prevalent haplotype in the study population. This haplotype accounted for 51.1% as the homozygous form in SS patients, where 69.1% of chromosomes in these patients had the Arab‐Indian haplotype. Bantu A2 was the second most prevalent haplotype among all patients. The mean %HbF in SS patients was 27.83 and in the homozygous Arab‐Indian haplotype it was still higher (30.40%), while in AS patients the %HbF was only 1.20. The high %Gγ chain (71.81) in the Arab‐Indian homozygous haplotype was concomitant with the presence of an Xmn I site in both chromosomes. The presence of the Arab‐Indian haplotype as the predominant haplotype might be suggestive of a gene flow to/from Saudi Arabia or India. More haplotype investigations of a normal population can clarify the high incidence of Bantu A2 haplotype in our population. Am. J. Hematol. 74:156–160, 2003. © 2003 Wiley‐Liss, Inc.
β‐thalassemia in association with a new δ‐chain hemoglobin variant [δ116(g18)Arg→Leu]: Implications for carrier screening and prenatal diagnosis
Authors: Waye John S. , Patterson Margaret , Walker Lynda , Eng Barry , Nakamura Lisa M. , Lafferty John D. , Yong Sui‐Li , Wu John K. , Chui David H.K.
Published: October 2003

We describe a complicated genetic counseling and prenatal diagnostic case involving an East Indian couple that had lost two consecutive pregnancies. Hemoglobinopathy screening was conducted to investigate the possibility of Hb Bart's hydrops fetalis or Hb H hydrops fetalis. The initial work‐up indicated that α‐thalassemia was not a contributing factor, with both parents being carriers of single gene deletions (−α3.7/αα). However, the Hb electrophoresis results indicated that the couple might be at risk for having children with Hb E/Hb Lepore disease. Subsequent DNA testing demonstrated that the father carried the Hb E mutation, but failed to confirm that the mother carries the Hb Lepore deletion. Sequence analysis revealed that the mother was heterozygous for a common East Indian β0‐thalassemia mutation, yet had a normal level of Hb A2. The mother also carried a previously unreported missense mutation of the δ‐globin gene, in cis with the β0‐thalassemia mutation, which gave rise to the minor Hb variant originally misidentified as Hb Lepore. This case illustrates the importance of comprehensive molecular analyses for accurate assessment of genetic risks for hemoglobinopathy syndromes. Am. J. Hematol. 74:179–181, 2003. © 2003 Wiley‐Liss, Inc.
Initial management of immune thrombocytopenic purpura in adults: A randomized controlled trial comparing intermittent anti‐D with routine care
Authors: George James N. , Raskob Gary E. , Vesely Sara K. , Moore Dennis , Lyons Roger M. , Cobos Everardo , Towell Brenda L. , Klug Panpit , Guthrie Troy H.
Published: October 2003

We conducted a randomized clinical trial in adults with a new diagnosis of ITP and a platelet count <30,000/μL to test the hypothesis that initial intermittent treatment with anti‐D may avoid or defer the need for splenectomy when compared to current routine care (glucocorticoid treatment, followed by splenectomy). Splenectomy was to be performed in the anti‐D group if patients failed to respond to three consecutive anti‐D treatments given within 10 days. The incidences of splenectomy were 14 of 37 (38%) in the routine care group and 14 of 33 (42%) in the anti‐D group (absolute risk reduction = 4.6% in favor of the routine care group, 95% CI, −18.4 to 27.6%). However, splenectomy was performed prematurely, not according to the protocol, in 11 of 14 patients in the anti‐D group. The median time to splenectomy was 36 days (range, 9–78) in the routine care group and 112 days (range, 19–558) in the anti‐D group (P = 0.045 at 100 days after randomization, P = 0.840 at 1 year after randomization, using log‐rank analysis). Patients in the anti‐D group were treated with prednisone for fewer days (70 days) compared to the routine care group (112 days, P = 0.01). No major bleeding events occurred. In this study, initial treatment of patients with intermittent anti‐D initially deferred splenectomy. Whether our aggressive regimen of anti‐D could have prevented splenectomy if it had been adhered to in all patients remains uncertain. However, compliance with this anti‐D regimen was not feasible for many patients and/or their physicians. Am. J. Hematol. 74:161–169, 2003. © 2003 Wiley‐Liss, Inc.
Dermatomyositis and myelodysplastic syndrome with myelofibrosis responding to methotrexate therapy
Authors: Tsuji Goh , Maekawa Soichiro , Saigo Katsuyasu , Nobuhara Yumiko , Nakamura Tomoko , Kawano Seiji , Koshiba Masahiro , Asahara Shunichiro , Chinzei Tadanobu , Kumagai Shunichi
Published: October 2003

Dermatomyositis (DM) has not yet been reported as a complication of myelodysplastic syndrome (MDS). A 50‐year‐old man was diagnosed as having MDS because of the presence of anemia, the appearance of immature cells in peripheral blood, and the abnormal cellular morphology. A few months later, high fever, myalgia and erythema developed. Although DM symptoms were resistant to high‐dose corticosteroid administration, methotrexate (MTX) therapy improved not only the symptoms of DM but also hematologic findings related to MDS. This indicates that immunosuppressive therapy including MTX administration can be useful for patients with MDS with autoimmune symptoms. Am. J. Hematol. 74:175–178, 2003. © 2003 Wiley‐Liss, Inc.
Establishing schedule control over dropping to the floor
Authors: Hagopian Louis P. , van Stone Maureen , Crockett Jennifer L.
Published: October 2003

In contrast to inherently dangerous behaviors such as self‐injury and aggression, some behaviors are problematic because of the context in which they occur. In the current study, we report on a boy who engaged in dropping to the floor both excessively and at inappropriate times. During the functional analysis, dropping occurred across all conditions, suggesting that it was either multiply maintained or maintained by automatic reinforcement. Treatment involved the use of discriminative stimuli and differential reinforcement with response cost to teach the client when dropping to the floor was and was not appropriate. Copyright © 2003 John Wiley & Sons, Ltd.
Improving methodological and technological analyses of adaptive switch use of individuals with profound multiple impairments
Authors: Saunders Muriel D. , Smagner John P. , Saunders Richard R.
Published: October 2003

Basic response–event relations can be difficult to demonstrate with individuals with profound multiple impairments who participate in adaptive switch programs. Numerous variables that impede learning and contribute to performance variability present challenges to assessment methods. As switch use may be the only operant under stimulus control with some individuals, however, improvement in assessment methods and measurement technology is important. In three case studies, response–event relations were examined in individuals who were provided with an adaptive switch that could activate an electronic leisure device. With two individuals, evidence of learning was assessed in a novel alternating‐treatments design. Switch use was compared under conditions in which switch closures produced activation and conditions in which closures deactivated the device. With the remaining individual, the effects of momentary activation by switch closure were compared to timed activation. Data were collected with a combination of data collection technologies. Whole‐session rate and response‐duration data provided some evidence of learning in all participants. Data also were converted into within‐session cumulative graphs, which aided data interpretation. The results demonstrate advances in assessment of learning in people with profound multiple impairments. Copyright © 2003 John Wiley & Sons, Ltd.