bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential shared care for diabetes: does it provide the optimal partition between primary and specialist care?
Authors: Overland J. , Mira M. , Yue D. K.
Published: March 2003

Aims  To establish whether a system of differential shared care between general practitioners and specialists is compatible with patients receiving the level of care they require.

Methods We sought to trace 200 shared care patients whose care had been kept at the general practitioner level after initial referral and compared them with a group of patients who had been re‐referred to the Royal Prince Alfred Hospital Diabetes Centre for specialist review.

Results There were no significant differences in glycaemic, blood pressure and lipid levels of returned and non‐returned patients at initial assessment. However, non‐returned patients were less likely to have a history of macrovascular disease or risk factor (adjusted odds ratio (OR) 0.4; 95% confidence interval (CI) 0.2–0.6). Their referral letter was also more likely to emphasize their type and/or duration of diabetes (adjusted OR 4.6; 95% CI 2.5–8.4). Nearly half (47.1%) of the non‐returned group changed their doctor in the years following their initial specialist review, increasing their likelihood of not being re‐referred five‐fold (adjusted OR 5.0; 95% CI 2.9–8.8). At initial assessment, non‐returned patients were given less treatment recommendations (adjusted OR 0.5; 95% CI 0.3–0.7). Doctors registered with the Diabetes Shared Care Programme referred more patients than their non‐shared care counterparts. However, a higher proportion of these doctors (52.5% vs. 21.3%; χ2= 16.5, 1 d.f., P = 0.00005) were selective in whom they re‐referred.

Conclusion  Differential shared care encourages appropriate referral to specialist services, without compromise to standards of care.

Diabet. Med. 18, 554–557 (2001)
Efficacy and tolerance of intranasal insulin administered during 4 months in severely hyperglycaemic Type 2 diabetic patients with oral drug failure: a cross‐over study
Authors: Lalej‐Bennis D. , Boillot J. , Bardin C. , Zirinis P. , Coste A. , Escudier E. , Chast F. , Peynegre R. , Selam J‐L. , Slama G.
Published: March 2003

Aims  We have evaluated the local tolerance and the metabolic efficacy of a lyophilized nasal insulin preparation in 10 severely hyperglycaemic Type 2 diabetic patients.

Methods  The study included two 4‐month randomized periods: (A) three preprandial doses of nasal insulin secondarily combined with one evening subcutaneous NPH if the desired glycaemic control was not achieved; (B) two NPH injections daily. We assessed: (i) diabetes control on monthly HbA1c levels and occurrence of hypoglycaemic events; (ii) local tolerance on clinical symptoms, rhinoscopy, nasal muco‐ciliary clearance and nasal biopsies; (iii) insulin absorption at months 0 and 4.

Results  One patient was withdrawn because of cough and dizziness after each nasal application. HbA1c was not significantly different at month 4 (9.4 ± 0.5% vs. 8.8 ± 0.2%, A vs. B). Blood glucose control remained only fair in the majority of our patients. Nasal insulin was able to replace the daytime fraction of the subcutaneous insulin with a 18% efficacy. Side‐effects included transient nasal hyperactivity (pruritis, sneezing and rhinorrhoea) and chronic persistence of nasal crusts. Plasma insulin profiles were not significantly different between months 0 and 4.

Conclusions  The utilization of nasal insulin (with or without NPH) was associated with similar diabetes control compared with NPH twice daily. Nasal insulin alone was able to achieve an adequate glycaemic control in three of the 10 patients.

Diabet. Med. 18, 614–618 (2001)
Diabetes control deteriorates in girls at cessation of growth: relationship with body mass index
Authors: Tylleskär K. , Tuvemo T. , Gustafsson J.
Published: March 2003

Aim  Diabetic patients, particularly girls, often experience poor metabolic control during puberty and adolescence. The aim of this study was to investigate metabolic control during adolescence, especially in relation to pubertal stages, growth, insulin treatment and body mass index (BMI).

Methods  We studied the records of 38 (consecutive) girls with prepubertal onset of Type 1 diabetes mellitus. Data from the age of 10 to 18–20 years were obtained with regard to glycaemic control, growth, age at menarche, final height and BMI, and analysed in relation to both chronological age and age at menarche.

Results  HbA1c was lowest 3 years before menarche; mean (± sd) 7.6 (± 1.2). After the pubertal growth spurt, there was a marked impairment of metabolic control, the highest level of HbA1c occurring 3 years after menarche. Mean age at menarche was 13.3 (± 1.1) years and mean linear growth after menarche only 4.7 cm, giving a final height of 164.9 (± 5.3) cm which is 2.7 cm below the Swedish mean. During adolescence the degree of correlation between BMI and HbA1c continuously increased, pointing out the effect of body fat on metabolic control in this age group. The level of HbA1c at 10 years of age could not predict the metabolic control after cessation of puberty, but prepubertal BMI appears to be a risk factor for both obesity and poor glycaemic control in late adolescence.

Conclusions  The highest HbA1c was found after cessation of growth. Prepubertal BMI is a possible predictor of metabolic control in adolescent diabetic girls.

Diabet. Med. 18, 811–815 (2001)
Erythropoietin response to hypoxia in patients with diabetic autonomic neuropathy and non‐diabetic chronic renal failure
Authors: Bosman D. R. , Osborne C. A. , Marsden J. T. , Macdougall I. C. , Gardner W. N. , Watkins P. J.
Published: March 2003

Aims An erythropoietin (EPO)‐deficient anaemia is recognized in Type 1 diabetic patients with early nephropathy and symptomatic autonomic neuropathy (DN). The aim of this study was to determine whether the EPO response to hypoxia was deficient in order to clarify the mechanisms involved in this process.

Methods Five Type 1 diabetic patients DN (age 39 (28–48) years (mean (range))) with EPO‐deficient anaemia (haemoglobin, Hb 10.6 (9.5–12.0) g/dl, EPO 5.0 (3.2–6.5) IU/l) and early diabetic nephropathy (persistent proteinuria 1161.6 (130–2835) mg/day, serum creatinine 97.6 (63–123) µmol/l)) were compared with nine normal subjects (age 31 (24–39) years, Hb 13.4 (11.8–15.7) g/dl, EPO 7.6 (5.6–10.3) IU/l) and four patients with non‐diabetic advanced chronic renal failure RF (proteinuria 2157.5 (571–4578) mg/day, serum creatinine 490.2 (406–659) µmol/l, Hb 10.3 (9.0–11.3) g/dl, EPO 4.6 (2.9–8.5) IU/l). The subjects were exposed to 6 h of hypoxia (inspired oxygen 11.6–12.6%) by breathing a gas mixture via a hood. Hourly serum EPO levels were measured.

Results All groups showed a rise in EPO production after 2 h. The diabetic DN group achieved a similar maximal response to the normal subjects at 6 h (EPO 17.3 ± 5.4 vs. 17.8 ± 7.9 IU/l). The renal failure patients mounted an EPO response to hypoxia but at lower EPO levels.

Conclusions Although the DN patients have inappropriately low EPO levels for the severity of their anaemia, they can mount an appropriate EPO response to moderate hypoxia. The mechanism underlying the EPO‐deficient anaemia present in some diabetic patients remains unclear.
Design of the Collaborative AtoRvastatin Diabetes Study (CARDS) in patients with Type 2 diabetes
Authors: Colhoun H. M. , Thomason M. J. , Mackness M. I. , Maton S. M. , Betteridge D. J. , Durrington P. N. , Hitman G. A. , Neil H. A. W. , Fuller J. H. ,   the CARDS Investigators
Published: March 2003

BackgroundThere are few data on the role of lipid lowering in the primary prevention of coronary heart disease (CHD) in diabetic patients. This paper describes the design of a collaborative clinical trial between Diabetes UK, the NHS Research and Development Directorate and Pfizer UK, that addresses this question.

MethodsThe Collaborative AtoRvastatin Diabetes Study (CARDS) is a multicentre, randomized, placebo‐controlled, double‐blind clinical trial of primary prevention of cardiovascular disease in patients with Type 2 diabetes. The primary objective is to investigate whether treatment with the hydroxymethylglutaryl coenzyme A reductase inhibitor, atorvastatin, reduces the incidence of major cardiovascular events. At entry patients have at least one other risk factor for CHD in addition to diabetes, namely current smoking, hypertension, retinopathy, or micro‐ or macroalbuminuria. At randomization patients have been selected for a serum low‐density lipoprotein (LDL) cholesterol concentration ≤ 4.14 mmol/l (160 mg/dl) and triglycerides ≤ 6.78 mmol/l (600 mg/dl). Randomization was completed in June 2001. Patients will be followed until 304 primary endpoints have accrued (expected date early 2005). The trial includes 2838 men and women aged 40–75 years. This report describes the design and administration of the study and reviews the evidence to date of the effectiveness of lipid‐lowering therapy in Type 2 diabetes.

ConclusionsThe case for lipid‐lowering therapy for the primary prevention of CHD in diabetes has not been demonstrated. CARDS will provide essential information on the extent of any benefits and adverse effects of lipid‐lowering therapy in diabetic patients without prior CHD.

Diabet. Med. 19, 201–211 (2002)
Vascular effects of glibenclamide vs. glimepiride and metformin in Type 2 diabetic patients
Authors: Abbink E. J. , Pickkers P. , Van Rosendaal A. Jansen , Lutterman J. A. , Tack C. J. , Russel F. G. M. , Smits P.
Published: March 2003

Aims Glibenclamide attenuates the protective responses to opening of vascular ATP‐sensitive potassium (KATP) channels during ischaemia. Therefore, glibenclamide treatment of Type 2 diabetes mellitus may have hazardous cardiovascular effects when used under conditions of ischaemia. Glimepiride and metformin seem to lack such characteristics. Based on these data, we hypothesized that, in contrast to glibenclamide, chronic treatment of Type 2 diabetic patients with glimepiride or metformin will not impair the vasodilator function of KATP opening in vivo.

Methods Two groups of 12 Type 2 diabetes mellitus patients participated in a double‐blind randomized cross‐over study consisting of two 8‐week periods, in which treatment with orally administered glibenclamide (15 mg/day) was compared with either glimepiride or metformin (6 mg and 1500 mg/day, respectively). At the end of each treatment period, the increase in forearm blood flow (FBF, venous occlusion plethysmography) in response to intra‐arterial administered diazoxide (KATP opener), acetylcholine (endothelium‐dependent vasodilator) and dipyridamole (adenosine‐uptake blocker) and to forearm ischaemia was measured.

Results There were no significant differences in vasodilator responses to diazoxide, acetylcholine, dipyridamole and forearm ischaemia after glibenclamide compared with glimepiride and metformin.

Conclusions Chronic treatment of Type 2 diabetes mellitus with glimepiride or metformin has similar effects on vascular KATP channels compared with chronic glibenclamide treatment.

Diabet. Med. 19, 136–143 (2002)
Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly Koreans
Authors: Choi K. M. , Lee J. , Kim D. R. , Kim S. K. , Shin D. H. , Kim N. H. , Park I. B. , Choi D. S. , Baik S. H.
Published: March 2003

Aims This study was conducted to compare the prevalence and cardiovascular risk factors of different categories of glucose tolerance in the elderly Korean population using World Health Organization (WHO) and American Diabetes Association (ADA) criteria.

Methods This study included 1456 non‐diabetic subjects over the age of 60 years, selected from a cross‐sectional study, which was conducted in 1999 in Seoul, Korea. Fasting and post‐challenge 2‐h plasma glucose, insulin levels, body mass index (BMI), waist–hip ratio (WHR), blood pressure, and lipid profiles were examined. Prevalence of glucose tolerance categories and the level of agreement (κ statistics) were obtained using WHO 2‐h criteria and ADA fasting criteria. Comparison of cardiovascular risk factors among several concordant and discordant glucose intolerance groups was done.

Results The prevalence rates of newly diagnosed diabetes of elderly men defined by WHO 2‐h criteria and ADA fasting criteria were 11.8% and 4.8%, respectively. That of elderly women was 8.1% by WHO 2‐h criteria and 3.1% by ADA fasting criteria. The prevalence of impaired glucose tolerance (IGT) by WHO criteria was also higher than that of impaired fasting glucose (IFG) by ADA criteria (23.5% vs. 10.0% men, 23.7% vs. 7.5% women). The level of agreement between ADA fasting criteria and WHO 2‐h criteria was low (weighted κ = 0.228 men, weighted κ = 0.301 women). The concordant diabetic women by both ADA fasting criteria and WHO 2‐h criteria showed higher BMI, WHR, diastolic blood pressure, total cholesterol and triglyceride levels than concordant normal subjects. However, the isolated post‐challenge hyperglycaemia (IPH) women group was not different significantly from the concordant normal women group except in BMI.

Conclusions Our results clearly show that the 1997 ADA fasting criteria are less sensitive for diagnosing diabetes than oral glucose tolerance test (OGTT)‐based WHO criteria in elderly Koreans. Also, there is a poor agreement of different categories of glucose tolerance between ADA and WHO criteria; therefore, the OGTT remains a valuable test in diagnosing diabetes and classifying various categories of glucose intolerance, especially in elderly Koreans.
Platelet contractile force (PCF) and clot elastic modulus (CEM) are elevated in diabetic patients with chest pain
Authors: Carr M. E. , Krishnaswami A. , Martin E. J.
Published: March 2003

Aims Platelet function and clot structure may be altered in diabetes. We have noted increased platelet contractile force (PCF) and clot elastic modulus (CEM) in patients presenting to the emergency department with chest pain. Twenty‐six of the chest pain patients were diabetic. Here, we compare the PCF, CEM and platelet aggregation in diabetic chest pain patients, non‐diabetic patients with chest pain and asymptomatic controls.

Patients and methods PCF, CEM and collagen whole blood aggregations were measured in 100 chest pain patients and 25 asymptomatic controls.

Results Platelet concentrations for diabetic patients, non‐diabetic patients and controls were identical. PCF was significantly (P
 < 0.05) elevated in diabetic chest pain patients (9.42 
±
 0.59 kdynes) vs. controls (7.40 
±
 0.32 kdynes). CEM in diabetic patients (29.96 
±
 2.19 kdynes/cm2) was significantly elevated relative to that in non‐diabetic chest pain patients (25.22 
±
 0.84 kdynes/cm2) and normal controls (23.18 
±
 0.74 kdynes/cm2). Collagen‐induced whole blood aggregation was decreased (P
 < 0.05) in diabetic chest pain patients vs. controls. PCF values (10.23 
±
 0.76 kdynes) in diabetic patients with haemoglobin A1c  > 7% were higher than in any other group.

Conclusion PCF and CEM are elevated in diabetic chest pain patients. The significance of these laboratory findings awaits additional clinical studies.
Plant distribution and dispersal mechanisms at the Hassayampa River Preserve, Arizona, USA
Authors: Drezner Taly Dawn , Fall Patricia L. , Stromberg Juliet C.
Published: March 2003

This study focuses on the relationships between plant dispersal syndromes and plant distributions at the community scale. Species composition and cover are reported from 29 10 × 20‐m vegetation plots along five topographic cross‐sections in the riparian zone of the Hassayampa River Preserve, Arizona. We find that spatial patterns of dispersal guilds vary within the flood plain of this semiarid region river. Our main results are: (1) wind‐dispersed species are fairly evenly distributed at all elevations and distances from the river, whereas cover of animal‐dispersed species increases with elevation above, and at greater distances from, the river; (2) wind‐dispersed species are proportionally more abundant in the pioneer Populus–Salix community, whereas plants in the late‐seral Prosopis community are predominantly animal‐dispersed; (3) most of the species classified as obligate‐wetland and facultative‐wetland are wind‐dispersed, whereas facultative‐upland and obligate‐upland species are mostly animal‐dispersed; and (4) there are significantly fewer wind‐dispersed species in areas of high total vegetation cover. These results may reflect successional patterns resulting from periodic flooding. Low areas close to the river flood more frequently and with greater intensity than areas farther from the river. Many pioneer species that establish in disturbed areas are wind‐dispersed. Over successional time, pioneer species cede to more drought tolerant species that are predominantly animal‐dispersed.
Reproductive phenology of a wet forest understorey in the Western Ghats, South India
Authors: Krishnan Rani M.
Published: March 2003

The reproductive phenology of 60 understorey species was monitored at monthly intervals for 20 months in a medium elevation wet evergreen forest in the Southern Western Ghats. The life forms monitored were herbs (including terrestrial orchids), shrubs and small trees. Flowering and fruiting were non‐uniform with a dry season flowering peak and wet season fruiting peak. Flowering in the understorey correlated negatively with rainfall. No significant correlation was detected for fruiting. Life forms had flowering and fruiting peaks at different times of the year.
Seed dispersal facilitation and geographic consistency in bird–fruit abundance patterns
Authors: Burns K. C.
Published: March 2003

Avian seed dispersal mutualisms are characterized frequently by stochastic interactions between birds and fruits; however, many studies report coarse‐scale correlations in annual abundances of birds and fruits at particular locales (i.e. ‘phenological synchrony’). This study tested the geographical consistency of phenological synchrony in a meta‐analysis of data from 14 biogeographic locations. Data from a single site in British Columbia, Canada, were then used to test the dispersal facilitation hypothesis, which postulates that synchronous bird–fruit abundance patterns result from deterministic seed dispersal processes (i.e. avian fruit consumption). Results showed that phenological synchrony is a geographically consistent pattern. However, fruit production occurred after peak periods of bird abundances in British Columbia. Although phenological patterns were asynchronous at this site, observational and experimental fruit removal patterns supported the dispersal facilitation hypothesis. Avian fruit consumption covaried with bird abundances, suggesting selection may favour earlier fruit production and increased phenological synchrony. Environmental data suggest that earlier fruit production is constrained by cold spring temperatures, which inhibit the activity of pollinators and earlier dates of fruit maturation. Overall, the results show that phenological synchrony is a geographically consistent pattern in seed dispersal mutualisms. However, decoupled bird–fruit abundance patterns may occur despite deterministic processes favouring phenological synchrony.
The geographic distribution of pubescence in the sea daisy, Borrichia aborescens, on Bahamian Islands
Authors: Morrison Lloyd W.
Published: March 2003

Borrichia aborescens (L.) DC. is a salt‐tolerant perennial herb that is common on small islands in the central Bahamas. Two morphotypes are present: one with densely pubescent leaves and one with glabrous leaves. I conducted surveys in three archipelagos to document the geographical distribution of pubescence in this species and to infer the underlying mechanisms. B. aborescens was also grown from seed in a greenhouse. The pubescent form of B. aborescens was relatively more abundant on small islands than on nearby large ‘mainland’ islands. In two of the three archipelagoes, pubescence increased with distance on small islands. The pubescent form was relatively more abundant on small islands exposed to the open ocean compared to small islands that were protected by mainland islands or reefs on all sides. On a large mainland island, the pubescent form decreased in relative abundance inland from the coast. B. aborescens cultivated in a greenhouse revealed the effect of a genetic factor on the expression of pubescence. The observed patterns of variation are consistent with a physiological explanation for the adaptive benefit of pubescence. Trichomes may prevent physical blockage of the stomata by accumulation of salt in areas near breaking waves and salt spray.
Methods for studying spatial behaviour of freshwater fishes in the natural environment
Authors: Lucas M.C. , Baras E.
Published: March 2003

Spatial behaviour of fishes in fresh and brackish water ranges in temporal scales between localized diel movements, often associated with foraging and predator evasion, to seasonal or life‐cycle related events involving movements between freshwater habitats or freshwater and marine biotopes. Recent technological advances have resulted in dramatic improvements in the range of techniques available for the study of spatial behaviour of freshwater fishes in the natural environment, and broadly may be divided into two categories: capture dependent and capture independent. The former incorporates those methods that rely on sampling marked fish (mark–recapture) or unmarked fish (density estimates, catch per unit effort) over defined scales of time and space in order to derive information on distribution and movement. Captured fish may also be tagged with transmitters that radiate energy, enabling the fish to be tracked and/or environmental data to be gathered. Biochemical analysis of samples from fish, requiring non‐destructive sampling (genetic analysis and scale microchemistry) or destructive sampling (otolith microchemistry) may also provide information on migration and ontogenetic processes. Capture independent techniques include visual observation and video techniques, hydroacoustics and automated fish counting. Catch per unit effort and mark–recapture techniques are most efficient where long‐term fishery or monitoring studies are in place and data on crude spatial and temporal scales are acceptable. They also have the advantages of low technical requirements and low equipment costs. Where specific management or ecological questions are pertinent, recapture independent techniques may be more appropriate. Telemetric methods can provide high resolution information at the individual level, while hydroacoustics is increasingly providing information at the population level in large lake and river environments. Biochemical methods are becoming increasingly useful in determining the extent of population segregation, where DNA analysis is used, and in the study of migration and ontogenetic changes in behaviour, where otolith microchemistry and stable isotope analysis is used.
Testing for apraxia in neurological patients: a descriptive study in two diverse cultures
Authors: Kokmen E. , Ozekmekci F.S. , Cha R.H. , O'Brien P.J.
Published: March 2003

We constructed a detailed apraxia testing battery consisting of 55 items arranged in seven subparts and applied it to a convenience series of patients with a variety of neurological diseases and asymptomatic control subjects. A total of 173 subjects were evaluated in two culturally diverse settings: Rochester, MN, USA and in Istanbul, Turkey. There was little difference between performance scores in the two sites. The test could be completed within a reasonable time (5–10 min) in cases and in controls in both sites. Patients with Parkinson's disease performed just as well as controls but patients with Alzheimer's disease or other neurodegenerative disorders did less well than control subjects.
Heritability of cluster headache
Authors: Montagna Pasquale , Mochi Mirella , Prologo Guido , Sangiorgi Simonetta , Pierangeli Giulia , Cevoli Sabina , Cortelli Pietro
Published: March 2003

We conducted a pedigree analysis in 222 patients with cluster headaches (CHs) in order to assess a familial predisposition to the disease. Heritability was determined by Falconer's index (from the incidence of CH among first degree relatives of probands compared with a control population), which varies between 0 and 1 (none or full genetic causation). A positive family history (I/II degree relatives) was found in 2.3% of our CH patients. Three generations were affected in one family and two generations in another two families. The calculated Falconer's heritability index was, however, only 0.26 ± 0.25 SD. Our study confirms a higher familial occurrence of CH, some families showing a pattern compatible with autosomal dominant inheritance with reduced penetrance. The low Falconer's index indicates, however, a large non‐genetic causation in most cases of CH.
Natural evolution of sleepiness. A 5‐year follow‐up study in a middle‐aged population
Authors: Martikainen Kirsti , Partinen Markku , Hasan Jóel , Urponen Hélka , Vuori IIkka , Laippala Pékka
Published: March 2003

The prevalence and natural evolution of sleepiness were investigated in a 5‐year follow‐up study in a middle‐aged population in Finland. In the original study a structured sleep questionnaire was completed by 1190 subjects and a 5‐year follow‐up questionnaire was returned by 626.

The prevalence of sleepiness, meaning here an unintentional tendency to fall asleep weekly in the course of everyday living, was 9.6% in the first survey and 10.6% 5 years later in the same cohort; 3.7% had been sleepy in both surveys. Sleep fragmentation, leg jerking and awakenings during sleep were common findings among sleepy subjects in both surveys. Shift‐workers and those who had irregular working hours ran a risk of chronic sleepiness. Sleepiness was also associated with poor subjective health, obesity, depression, nervousness and tension. In particular, chronically sleepy subjects had an increased risk of sleepiness‐related traffic accidents and premature retirement. Contrary to common findings from sleep laboratories, neither snoring nor self‐ or spouse‐reported breathing pauses during sleep were significantly associated with long‐term sleepiness in a non‐selected middle‐aged population. It is suggested that more attention should be paid to subjects suffering from excessive daytime sleepiness even if they do not have a history of respiratory or other known organic sleep disorder.
Clinical patterns of acute stroke among the three health‐care systems in France
Authors: Giroud M. , Lemesle M. , Madinier G. , Menassa M. , Billiar Th. , Dumas R.
Published: March 2003

Data from 959 consecutive patients registered with the Dijon Stroke Registry were used to compare the characteristics of the patients who were admitted to the public hospital within the first days after their first stroke with those admitted to the private hospitals or who remained at home. Seven hundred and one patients (73%) were admitted to the public hospital, 185 (19%) were admitted to private hospitals and 73 (8%) remained in the community. The results show that the clinical patterns of the stroke are quite different among the three health‐care systems.

The clinical patterns of stroke managed in the public hospital are characterized by: a younger age (63‐years‐old vs, 77 and 76‐years‐old), earlier coma (29% vs 2.8 and 1.5%), more severe deficit (71% vs 15 and 5%), more hemorrhagic mechanism (23 vs 4.5% and 1.7%), more associated ischemic heart disease (31% vs 18 and 15%), more cardiac arrhythmia (38% vs 11 and 8%), higher case fatality rate (39% vs 8 and 2%).

Therefore, we have identified three clinical patterns among the three health‐care facilities. These three clinical patterns are quite different on the point of view of the clinical severity, and the associated co‐morbidities. The socio‐economic status is not a criteria in the choice of the health‐care facility. This observed distribution is not the consequence of a voluntary policy.
Association between deficiency of free protein S and anticardiolipin antibodies in patients ≤ 65 years of age with acute ischemic stroke and TIA
Authors: Vrethem Magnus , Dahle Charlotte , Lindahl Tomas , Ernerudh Jan
Published: March 2003

A possible association between anticardiolipin antibodies (ACA), which are a marker for increased risk of cerebral ischemia, and deficiency of free Protein S, a naturally occurring anticoagulant, has been suspected in some studies of ischemic stroke, particularly in young adults. In order to investigate this further, we prospectively studied all stroke patients ≤ 65 years of age admitted to our stroke unit during 1991–1992. A total of 66 patients with acute ischemic stroke or transient ischemic attacks (TIA) (embolic/thrombotic infarction n= 30, embolic infarction n= 13, thrombotic infarction n= 10, and TIA n= 13) were analysed for ACA, protein C and S, free protein S and antithrombin III (AT III). Traditional risk factors were scrutinized in each patient. Eight patients had some previously undetected derangement of the coagulation process; five had elevated ACA levels, four had low, free Protein S levels, and three had low AT III levels. None of the patients showed any decrease in total protein C or S levels. A striking association between the presence of ACA and free protein S deficiency was noted. All patients with free protein S deficiency had concomitant elevated ACA levels. Sixteen patients had had a previous episode of ischemic stroke/TIA or mycocardial infarction, two of them had lowered AT III levels. Thirty‐four patients had one or more elevated infectious parameters but with no clear correlation to derangement of the coagulation factors. We conclude that a probable association between ACA and free protein S deficiency exist in ischemic stroke patients, and that it may have a pathogenetic importance.
Intracerebral malignant lymphoma in a patient with long‐standing multiple sclerosis
Authors: Vrethem Magnus , Davidsson Leif , Bak Julia
Published: March 2003

We present a patient with long‐standing MS who developed a malignant intracerebral lymphoma, suspected on MRI and verified by brain biopsy. This raises the interesting question about whether the coexistence of the two conditions is explained by cause or is just coincidental. Our case report also illustrates that other pathological conditions may develop in MS patients and demand attention in the individual patient.
Botulism: a case associated with pyramidal signs
Authors: Santini Manuela , Fabri Sabatino , Sagnelli Paolo , Manfredi Mario , Francia Ada
Published: March 2003

Botulism is a widespread neuroparalytic disease that may be confused with other neurological disorders. As it is potentially lethal, clinicians are required to be aware of its diagnosis and management. We report a case of botulism complicated by pyramidal signs in a 35‐year‐old woman. Clinical aspects, differential diagnoses and therapeutic problems are discussed.
Serial SFEMG studies of orbicularis oculi muscle after the first administration of botulinum toxin
Authors: Bogucki Andrzej
Published: March 2003

Serial single fiber electromyography (SFEMG) examinations of orbicularis oculi muscle in patients with blepharospasm or hemifacial spasm treated with botulinum toxin injections were performed. The aim of the study was to evaluate the impairment of neuromuscular transmission, to follow reinervation after botulinum toxin administration and to find out whether there was a relationship between SFEMG parameters and clinical symptoms. Examinations were performed before injection, during early and late remission of symptoms, and after recurrence of the involuntary movement. Severe impairment of neuromuscular transmission, as revealed by increased jitter and increased presence of abnormal potential pairs and pairs with blocking, was found in early remission, but fiber density remained unchanged when compared with pretreatment values. In late remission, increased fiber density was registered for the first time. The recurrence of involuntary movements was related to the further increase of fiber density and tendency to normalization of jitter parameters. The study therefore suggests that formation of new neuromuscular junctions and their functional maturation is responsible for muscle recovery after botulinum toxin administration.
Serum and hair trace element levels in patients with epilepsy and healthy subjects: does the antiepileptic therapy affect the element concentrations of hair?
Authors: Ïlhan A. , Uz Efkan , Kali Sinem , Var Ahmet , Akyol Omer
Published: March 2003

In this study, hair magnesium (Mg), zinc (Zn), copper (Cu), and manganese (Mn) levels, and serum Zn and Mg levels were measured by atomic absorption spectrophotometer in patients with epilepsy (n = 33) and healthy subjects (n = 21), and results obtained were statistically compared. The mean hair Cu, Mg, and Zn levels of epileptic patients were significantly lower than the levels of control subjects. There was no significant difference between epileptic patients and control subjects in respect to the mean Mn levels. Mean serum Mg levels in epileptic patients showed significant difference, but serum Zn levels were similar among both groups. When the effects of anticonvulsant therapy on Cu, Zn, Mn, and Mg in the hair, and Mg and Zn in the serum were analyzed in epileptics, there was no significant difference between the patients with or without therapy. Likewise, the mean trace element levels in epileptics showed no significant difference according to the type of antielpileptic drug and seizure, and gender. We suggest that the changed element status (Zn, Mg, and Cu) in hair play an indicator role in the diagnosis of epileptic patients.
Problems associated with switch to modafinil – a novel alerting agent in narcolepsy
Authors: Guilleminault C. , Aftab F. A. , Karadeniz D. , Philip P. , Leger D.
Published: March 2003

Modafinil is a novel medication recently approved for the treatment of narcolepsy and idiopathic hypersomnia. Commonly, patients had already been prescribed medications for their syndrome.

This report outlines difficulties encountered in the clinical practice of switching patients to modafinil. Naïve subjects accepted modafinil best. Subjects withdrawn from amphetamine had the most problems and failure to withdraw. Venlafaxine hydrochloride combined well with modafinil to control cataplectic attacks. Usage of a progressive withdrawal protocol may ease the difficulties observed.
Validation of a migraine‐specific questionnaire for use in family studies
Authors: Kallela M. , Wessman M. , Färkkilä M.
Published: March 2003

The availability of valid migraine‐specific questionnaires is important when large numbers of migraine patients have to be analysed. The Finnish Migraine‐Specific Questionnaire has been validated in two stages. In the first, a clinical diagnosis of migraine was reached, using International Headache Society criteria, in 100 consecutive patients. Migraine was then diagnosed independently on the basis of responses to the Finnish Migraine‐Specific Questionnaire. In the second stage, responses to 100 questionnaires returned consecutively in a family study in progress were analysed, and respondents were contacted by telephone for interview and diagnosis of migraine. Contact proved impossible in six cases. The sensitivity of the questionnaire for migraine was 0.99 (167 out of 168; validation stages 1 and 2 combined) and specificity was 0.96 (25 out of 26 cases; validation stage 2). It also proved possible to differentiate between migraine with and without aura on the basis of responses to the Finnish Migraine‐Specific Questionnaire: chance‐corrected agreement (Cohen’s kappa) was 0.804 in relation to diagnoses reached on the basis of responses to the Finnish Migraine‐Specific Questionnaire and clinically was 0.858 in relation to diagnoses reached on the basis of responses to the Finnish Migraine‐Specific Questionnaire combined with the results of the telephone interviews. A value for Cohen’s kappa > 0.75 indicates good agreement. Therefore, use of the Finnish Migraine‐Specific Questionnaire in research into migraine genetics is justified.
Calculi and memory
Authors: Kettaneh A. , Gobron C. , Fain O. , Mohib S. , Thomas M.
Published: March 2003

We describe a case of transient global amnesia related to symptomatic renal stones. Transient global amnesia has been related to intense emotional or painful experiences, such as sexual intercourse, cold water bathing and trigeminal stimulation. Renal stones may be at the origin of a painful experience and thus may induce transient global amnesia.
Botulinum A toxin improves life quality in severe primary focal hyperhidrosis
Authors: Swartling C. , Naver H. , Lindberg M.
Published: March 2003

Focal hyperhidrosis is a condition that may disturb emotional, social and professional life. Treatment options for severe cases are surgical sympathectomy and local chemical sweat gland denervation by intradermal injections of botulinum toxin A (Btx A). The Dermatology Life Quality Index (DLQI) is a simple validated questionnaire designed to measure and compare disability in different skin diseases. The aim of this study was to assess quality of life with the DLQI before and after treatment with botulinum toxin injections in a group of patients with severe hyperhidrosis. DLQI was administered to 58 randomly chosen patients before and after treatment. All patients answered the DLQI questionnaire prior to treatment and 53/58 at mean 5.2 months after treatment. The mean DLQI score in the 58 patients before treatment was 10.3 (2–23). In the group of 16/53 patients who had a relapse of sweating when answering the DLQI a second time, no significant improvement was seen [score 10.6 before and 8.8 after treatment (P=0.21)]. In patients without relapse, a 76% improvement was obtained (DLQI was reduced from 9.9 to 2.4; P < 0.0001). The study showed that focal hyperhidrosis may considerably reduce life quality and the disability experienced by the patients can be largely reversed by botulinum toxin injections.
Systematic review of proton magnetic resonance spectroscopy of the striatum in parkinsonian syndromes
Authors: Clarke C. E. , Lowry M.
Published: March 2003

It has been suggested that proton magnetic resonance spectroscopy (MRS) of the striatum can differentiate between parkinsonian syndromes. The present study aims to examine this claim by performing a systematic review of the existing literature.

A MEDLINE search was performed between 1966 and October 1999, along with searches of conference abstracts and reference lists of papers identified.

Eleven groups have used MRS to examine metabolite ratios in the striatum in Parkinsonian syndromes. A number of these have shown reduced N‐acetylaspartate/choline (NAA/Cho) and/or N‐acetylaspartate/creatine (NAA/Cr) ratios in either idiopathic Parkinson’s disease (IPD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP) or corticobasal degeneration. However, the heterogeneity in the results precludes the use of any of these findings in differential diagnosis at the present time. The only group to use absolute metabolite concentrations rather than ratios showed that the decreased NAA/Cho ratio in IPD was because of an increase in choline which is of uncertain biological significance.

Further large multicentre trials are required using absolute quantitation of tissue metabolite concentrations and a standardized technique. The patients entering such studies must be rigorously assessed to establish the diagnosis of the type of parkinsonism as accurately as possible. Any discriminatory abnormality must be tested in a large prospective study of newly presenting parkinsonian patients with long‐term clinical follow up and ultimate pathological confirmation of the diagnosis as far as possible.
Post‐infectious central and peripheral nervous system diseases complicating Mycoplasma pneumoniae infection Report of three cases and review of the literature
Authors: Pfausler B. , Engelhardt K. , Kampfl A. , Spiss H. , Taferner E. , Schmutzhard E.
Published: March 2003

Three patients with a central and peripheral nervous system disease complicating a Mycoplasma pneumoniae (M. pn.) infection are presented. Patient 1 suffered from bilateral optic neuritis as well as acute Guillain–Barré syndrome recovering after plasmapheresis. The two other patients suffered from severe haemorrhagic leukoencephalitis (Hurst) which only could be contained by aggressive decompressive craniectomy with duraplasty. All three illnesses were clearly shown to be associated with M. pn. infection.

Our three patients represent the full scale of central nervous (CNS) (cerebral and myelitic) as well as peripheral nervous system (PNS) (GBS, optic neuritis) manifestation of a disease caused by the same pathogenetic – post‐infectious – mechanism; pathogenic CNS and PNS epitopes might be shared in post‐infectious neurological disease following M. pn. infection.
Polymorphisms in the tau gene in sporadic frontotemporal dementia and other neurodegenerative disorders
Authors: Panegyres P. K. , Zafiris‐Toufexis K.
Published: March 2003

The tau gene on chromosome 17 is fundamental in the pathogenesis of a number of neurodegenerative disorders. Mutations in tau are found in familial frontotemporal dementia (FTD) and the A0/A0 genotype associated with progressive supranuclear palsy (PSP). This study investigates the hypothesis that polymorphisms in the tau gene are associated with sporadic FTD. Western Australian populations of patients with sporadic frontotemporal dementia, PSP, Alzheimer's disease (AD), Huntington's disease (HD) and normal controls were studied. A new method was developed using fluorescently labelled probes to determine polymorphisms in the GT repeat region of intron 9. The A0/A0 genotype was found in 95% of PSP patients (n=20), 58.3% of FTD patients (n=48), 60.8% of AD patients (n=52), 75% of HD patients (n=40), and 75% of normal controls (n=40). None of these differences in genotype frequency were found to be significant by the Fisher exact test (P > 0.05). There were no significant differences in the frequencies of A0/A3 and A0/A1 haplotypes. We have not observed a significant increase in the A0/A0 genotype frequency in sporadic frontotemporal dementia suggesting that this polymorphism is unlikely to be related to the development of this condition. Furthermore, we have observed an increase in the A0/A0 genotype in PSP which did not reach statistical significance, suggesting that there may be population differences in the role of genetic factors in conferring risks to neurodegenerative disorders. Our work does not exclude that tau may interact with other genetic factors.
Transcranial Doppler and risk of recurrence in patients with stroke and patent foramen ovale
Authors: Anzola G. P. , Zavarize P. , Morandi E. , Rozzini L. , Parrinello G.
Published: March 2003

The importance of patent foramen ovale (PFO) in stroke of unknown cause remains disputed, as PFO may be present in up to 20% of normal people and in a high proportion of patients with non‐vascular disorders. Recent evidence suggests that the amount of right‐to‐left shunt (RLS) may be the crucial factor for stroke occurrence and relapse. The aim of the study was to assess predictors of recurrence in PFO‐related stroke patients with particular emphasis on amount of shunting. Patients less than 61 years old who had been admitted for a PFO‐related stroke within the previous 5 years, were re‐evaluated on a follow‐up visit. The clinical syndrome, residual disability, vascular risk factors and number of relapses as the index event were assessed. RLS sizing was semi‐quantitatively performed with saline‐enhanced transcranial Doppler (TCD), by assuming a cut‐off of more or less 10 bubbles recorded in the cerebral vessels as a criterion to discriminate large versus small shunt, respectively. Thereafter patients were prospectively followed‐up for a median time of 23 months. Total follow‐up was 61 months. Fifty‐nine patients (M/F = 23/36, mean age 43 ± 13) were studied. Overall there were 23 relapses in 13 patients. The amount of shunting was the only significant independent variable associated with relapse: at the end of the follow‐up period the recurrence rate was 0.66 and 8.2% per patient per year in patients with small and large shunt, respectively. This difference was statistically significant (χ2 = 10.39, P = 0.0012; OR 17.05, 95% CI 2.10–755.22). In patients with PFO‐related stroke, the amount of RLS as assessed with TCD is the only independent predictor of relapse. PFO sizing is mandatory in patients with PFO.
“SUNCT” Syndrome. A Case of Transformation from Trigeminal Neuralgia?
Authors: Bouhassira D , Attal N , Estève M , Chauvin M
Published: March 2003

A patient with typical trigeminal neuralgia involving the first branch of the nerve developed short-lasting unilateral attacks in the same area which were associated with severe vasomotor phenomena consistent with the recently described SUNCT syndrome. This evolution suggests that SUNCT might correspond, at least in this case, to a “transformed” trigeminal neuralgia and emphasizes the close relationship between these unilateral facial pain syndromes.
Characteristics of Headache in Migraine Without Aura and Episodic Tension-Type Headache in The Turkish Population According to the IHS Classification
Authors: Inan LE , Tulunay F Cankat , Guvener A , Tokgoz G , Inan N
Published: March 2003

We evaluated the characteristics of headache in migraine without aura and episodic tension-type headache diagnosed according to the International Headache Society (IHS) Classification. Fifty migraine without aura and 50 tension-type headache patients were selected prospectively. Fifty-eight percent of migraineurs had pain of a pulsating quality; 88% had severe pain and 74% had unilateral pain; aggravation by routine physical activity was reported by 96%. Episodic tension-type headache was of a pressing quality in 52%, moderate in 40%, bilateral in 82% and aggravated by routine physical activity in 16%. Nausea and/or vomiting, photophobia and phonophobia were reported significantly more commonly in migraineurs than tension-type headache patients.
The Mode of Action of Sumatriptan is Vascular? A Debate
Authors: Humphrey PPA , Goadsby PJ
Published: March 2003

Two mechanisms have been proposed to explain the primary mode of action of sumatriptan: vasoconstriction, and trigeminal nerve terminal inhibition. Sumatriptan is a potent vasoconstrictor of intracranial arteries. It has been shown to increase blood flow velocity in large intracranial arteries in man in a dose-dependent fashion both during and between migraine attacks. Since the vasoconstrictor response of sumatriptan is reproducible outside the migraine attack, this action appears to be a direct vascular effect and not indirectly mediated via neural mechanisms. Sumatriptan also causes rapid constriction of dural and meningeal vessels in vivo. It does not modify cerebral blood flow but does constrict arteriovenous anastamoses that may be dilated during a migraine attack. This evidence suggests that sumatriptan has a direct, dose-related, vasoconstrictor action on certain intracranial blood vessels that correlates with its antimigraine activity. Alternatively, sumatriptan may act directly on the trigeminal sensory nerve terminals within the cranial blood vessel, inhibiting the release of sensory neuropeptides. Experimental data from animal studies have shown that following electrical stimulation of the trigeminal ganglion there is a neurogenic inflammatory response with plasma protein extravasation from dural blood vessels. This response can be significantly reduced by sumatriptan at a dose level similar to that used in clinical treatment. This finding is further supported by the clinical observation that sumatriptan reduces the plasma levels of calcitonin gene-related peptide which are raised during a migraine attack.