bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathogenesis and Symptomatology of Cholelithiasis in Childhood
Authors: Schweizer P. , Lenz Mona P. , Kirschner H.J.
Published: April 2003

Questions: How may gallstones develop if there is no hemolytic disorder and no malformation or alteration of the gallbladder and cystic ducts? Was there a change in the incidence of stones and the assignment of the patients to different age groups? The literature gives answers to these questions on the basis of only few cases. Therefore, a relatively large prospective database of collected cases during 30 years shall be used to give additional answers. Methods: The data are derived from 111 children with symptomatic gallstones without hemolytic diseases. 109 of them required operative therapy. They were examined preoperatively and postoperatively maximum during 30 years of follow-up as well according to a defined program. This program includes taking the patient’s history, evaluation of clinical, radiological including sonographical examination, exclusion of hemolytic primary diseases, histological investigation of intraoperatively gained specimens of the gallbladder, and the spectroscopic qualitative as well as semiquantitative analysis of stones and bile. Results: (1) The qualitative and quantitative composition of the stones is different in the four age groups. (2) The causes of lithogenesis are different in the four age groups. (3) Children with long-term TPN, after cardiopulmonary bypass operations, after extended small bowel resection, suffering from obesity, and girls using hormonal contraception are at risk of developing gallstones. We recommend to observe these patients by repeated ultrasound controls for gallstone formation during a minimum of 10 years. (4) Malformations and pathological alterations of the gallbladder are rare causes for increased lithogenity. The gallbladder appeared morphologically normal in 61% of patients with symptomatic gallstones. (5) An increased frequency of gallstones during the last 30 years was only observed in the age group under 1 year.
Spontaneous Intramural Hematoma of Stomach
Authors: Hui J. , AhChong A.K. , Mak K.L. , Chiu K.M. , Yip A.W.C.
Published: April 2003

Background: Intramural hematoma occurs uncommonly in the gastrointestinal tract and very rarely in the stomach. In case of a spontaneous gastric hematoma, the few previously reported patients all had certain predisposing factors. However, truly spontaneous intramural hematoma of the stomach without an identifiable cause has not been reported before. Method: Emergency total gastrectomy was performed in a 49-year-old man with such pathology and the diagnosis was made postoperatively. Results: The patient required further laparotomy on day 10 for drainage and debridement of a subphrenic abscess. He recovered uneventfully from the second operation. After an extensive pathological search, no predisposing factors could be found. The patient remains in good health 18 months after the operations. Conclusion: Spontaneous intramural gastric hematoma is extremely rare. But even rarer is when predisposing conditions or lesions are absent.
Diffuse Leiomyomatosis of the Esophagus
Authors: Cheng Yeung-Leung , Hsu Jane-Yi , Hsu Hsian-He , Yu Cheng-Ping , Lee Shih-Chun
Published: April 2003

Background: Leiomyomas are rare esophagus neoplasms. They are usually solitary, and the diffuse lesion is extremely rare. Case Report: A 19-year-old male presented with a 3-year history of occasional dysphagia and postprandial regurgitation. The chest radiographs showed a huge mass in the posterior mediastinum. Barium esophagograms showed narrowing of the middle third esophagus with proximal dilatation. The fibroesophagoscopy demonstrated multiple submucosal nodules below a level 22 cm from the incisor and covered with intact mucosa. CT scans of the chest showed a long segment of circumferential soft tissue in the posterior mediastinum which encircled and involved the upper two thirds of the esophagus. An intrathoracic esophagectomy with cervical esophagogastrostomy via the substernal route was performed. Grossly, multiple confluent myomatous nodules circumferentially involved the upper and middle third of the esophagus. Histologic findings showed diffuse leiomyomatosis of the esophagus. Conclusion: Esophageal leiomyomatosis should be considered in a young patient with long-standing dysphagia in whom smooth, tapered esophageal narrowing on barium study and circumferential esophageal wall thickening on CT scan are seen. An esophagectomy combined with a reconstruction procedure is indicated.
Early Enteral Feeding in Severe Acute Pancreatitis: Can It Prevent Secondary Pancreatic (Super) Infection?
Authors: Lehocky Peter , Sarr Michael G.
Published: April 2003

Sepsis continues to account for a second peak in mortality in patients with severe acute pancreatitis. The prevention of these septic complications and subsequent development of multiple organ dysfunction syndrome remains a major focus for investigators, yet despite considerable clinical and experimental work addressing its etiology, septic complications remain high. Several studies have been designed to demonstrate the mechanism of origin of these septic complications with an attempt to define strategies for their prevention to improve patient outcomes. There is clear evidence that the origin of this secondary bacterial infection arises from enteric bacterial translocation secondary to disruption of the gut mucosal barrier during acute pancreatitis. Strategies designed to prevent secondary pancreatic infection include aggressive fluid resuscitation to maximize organ perfusion, early systemic antibiotic treatment or selective gut decontamination, and recently attempts to block mediators of the systemic inflammatory response. This discussion will summarize our present understanding of the etiopathogenesis of secondary bacterial ‘superinfection’ of necrotizing pancreatitis and how the initiation of enteral feeding early in the course of acute pancreatitis may prove to be an effective means of preventing and/or reversing the breakdown of the gut mucosal defense barrier.
Perforated Appendicitis: Is Laparoscopic Operation Advisable?
Authors: Stöltzing H. , Thon K.
Published: April 2003

Aims: A retrospective study was used to compare laparoscopic appendectomy for perforated appendicitis to open operation. Methods: Between July 1991 and June 1999 a total of 734 patients, all over 14 years of age, underwent operation for acute appendicitis. Of these patients, 125 (17%) displayed perforated appendicitis and were treated with either a laparoscopic appendectomy (n = 80; total conversion rate 36/80, 45%) or a primary open procedure (n = 45). Results: Due to selection, the 3 treatment groups (laparoscopic, laparoscopy with conversion, open operation) showed differences with respect to gender, duration of symptoms, proportion of obese patients and patients with generalized peritonitis. The median operating time was 75 min for the laparoscopic procedure, 90 min for a converted procedure and 70 min for open operation. Only 1 of 44 (2%) patients who had a laparoscopic operation, but 8 of 36 (22%) who had a converted operation, and 8 of 45 (18%) who had an open operation developed wound infection. A similar frequency of intra-abdominal abscess formation was observed in the 3 treatment groups (2/44, 5%; 3/36, 8%; 2/45, 5%). Fatal outcome occurred only in patients who underwent an open operation and presented with severe peritonitis (5/45, 11%). Conclusions: Despite limitations in comparability of patient groups, laparoscopic appendectomy was associated with a significantly lower rate of septic wound complications (p < 0.05). This was especially true for the subgroup of obese patients (BMI >26). Therefore, for patients with perityphlitic abscess or fresh purulent lower abdominal peritonitis, but not for patients with generalized peritonitis, laparoscopic appendectomy is not only justifiable but even recommended as the procedure of choice.
Cocaine-Induced Mesenteric Ischaemia
Authors: Osorio Javier , Farreras Núria , Ortiz de Zárate Luis , Bachs Esperanza
Published: April 2003

We report a 33-year-old man with distal ileum infarction after intravenous abuse of cocaine. He underwent resection of a gangrenous bowel segment and survived. We review the literature regarding intestinal ischaemia related to cocaine. To date, 19 cases have been published. Like most previously reported cases, our patient was young and had no previous history of arteriosclerosis. He suffered cocaine-induced rhabdomyolysis and acute renal failure. Mesenteric ischaemia should be considered in the differential diagnosis of acute or chronic abdominal pain in cocaine consumers.
Muir-Torre Syndrome: A Case for Surveillance of the Ampulla of Vater
Authors: Matthews J.J. , Roberts R. , O’Reilly D.A. , Schick S. , Kingsnorth A.N.
Published: April 2003

A 64-year-old man with Muir-Torre syndrome (MTS), a condition characterized by the association of multiple sebaceous tumours and kerato-acanthomas with internal malignancies, developed a carcinoma of the ampulla of Vater. This is the 2nd reported ampullary carcinoma in 205 reported cases of MTS, suggesting a higher prevalence in MTS patients than in the general population. As an ampullary carcinoma is potentially amenable to surgical resection, particularly when detected early, patients with MTS should undergo regular endoscopic surveillance of the ampulla of Vater.
Management of Spontaneous Rupture of Liver Tumours
Authors: Marini P. , Vilgrain V. , Belghiti J.
Published: April 2003

Spontaneous ruptures of a liver tumour are often considered as a potentially life-threatening situation. The aim of the present study was to evaluate both clinical features and treatment in a subgroup of patients with ruptured liver tumours. From 1995 to 2000, 20 patients were referred to our centre for spontaneous rupture of a liver tumour associated with haemoperitoneum. Hepatocellular carcinoma (HCC) was present in 13 patients (11 men and 2 women) aged from 48 to 72 years (mean 62) and adenoma in 7 women aged from 23 to 52 years (mean 35). Although all patients experienced sudden abdominal pain and anaemia, shock at admission was present in 4 (20%) patients including 3 with HCC. In patients with HCC, severe liver insufficiency (Child-Pugh C) was present in 5 cases including the 3 shocked patients. No treatment was undertaken in 2 patients, transarterial embolization was performed in 9 cases and 5 patients underwent delayed resection. In hospital, mortality was observed in 3 (23%) patients, all of them had severe liver insufficiency. Long-term survival was observed in patients with good liver function who underwent resection. In patients with adenoma, shock at admission was observed in only 1 patient under anticoagulation treatment. Emergency resection was performed in 3 cases. A decrease of the tumour size was observed in patients who underwent delayed resection resulting in a lower rate of peri-operative transfusion. In conclusion, this study confirms that the majority of patients with ruptured liver tumours had no evidence of haemodynamic instability and therefore should be initially managed conservatively. In patients with single ruptured HCC associated with good liver function, long-term survival can be observed after liver resection. Delayed resection facilitated the operative procedure in patients with ruptured adenoma.
Complications of Pancreatic Cancer Resection
Authors: Halloran C.M. , Ghaneh P. , Bosonnet L. , Hartley M.N. , Sutton R. , Neoptolemos J.P.
Published: April 2003

Pancreatic cancer is a common cause of cancer death in the developed world. Currently, resection is the only chance of long-term survival. The post-operative mortality in nonspecialist centres often exceeds 20% but is around 6% or less in specialist centres. The overall complication rate even in specialist centres is 18–54%. An analysis of eleven large series of pancreatic resections shows an incidence of common complications of 10.4% for fistula, 9.9% for delayed gastric emptying, 4.8% for bleeding, 4.8% for wound infection and 3.8% for intra-abdominal abscess. The median hospital stay is 13–18 days in different series. The re-operation rate varies from 4 to 9% with a mortality rate of 23 to 67%. Major complications are a significant factor in post-operative mortality, especially if they require re-operation. The use of octreotide or somatostatin to prevent complications is supported by several multicentre, double-blind, randomized controlled trials. The best way to improve outcome is to concentrate pancreatic cancer care in regional specialist centres.
Use and Abuse of Licit and Illicit Substances: Prevalence and Risk Factors among Students in Lebanon
Authors: Karam Elie , Melhem Nadine , Mansour Chantal , Maalouf Wadih , Saliba Sabah , Chami Adel
Published: April 2003

Objective: This study aims at examining the patterns of ‘substance’ use in Lebanon among an ’at risk’ population, the university students. Method: A stratified cluster sample of 1,851 students from two major universities was included in the study and the Diagnostic Interview Schedule (version 3) was administered. Results: The prevalence of nicotine users in the sample was 18.3% and of ever consuming alcohol 49.4%. 2.1% of the sample were alcohol abusers and 2.4% alcohol dependents according to DSM-III criteria. For the remaining substances, tranquilizers were found to have the highest rate of ever use (10.2%), whereas heroin had the lowest rate (0.4%); the rates of abuse and dependence in these categories (other than alcohol and nicotine) following DSM-III criteria ranged from 0.1 to 0.8%. Conclusion: University students in Lebanon in this study have relatively low rates of use and abuse of substances but this might be changing.
Prevalence and Distribution of Hepatitis C Subtypes in Patients with Opioid Dependence
Authors: Gombas Wolfgang , Fischer Gabriele , Jagsch Reinhold , Eder Harald , Okamoto Ichiro , Schindler Shird , Müller Christian , Ferenci Peter , Kasper Siegfried
Published: April 2003

Aim and Setting: The drug addiction out-patient clinic at the University Hospital for Psychiatry in Vienna performed a study to identify the prevalence of hepatitis C virus (HCV) infections in a group of opiate-dependent patients, to detect the distribution of HCV subtypes and to calculate the comorbidity of human immunodeficiency virus (HIV) and hepatitis B virus (HBV). Design and Participants: We consecutively investigated unselected patients (n = 173) during an observation period of 2 months with the diagnosis of opioid dependence (DSM-IV: 304.0) and polysubstance dependence (DSM-IV: 304.9). Measurements: Blood was investigated focusing on liver enzymes and on viral status including HIV, hepatitis B and hepatitis C, followed by subtyping of the virus. Findings: In 80.3% hepatitis C antibodies were found, 66.5% were HCV RNA (PCR) positive. 3a was the most frequent subtype (35.6%), followed by 1a (28.8%) and 1b (22.0%). Four patients had both subtypes 1a and 1b (6.8%), 3 were 2b positive (5.1%) and 1 patient had subtypes 2a/2c (1.7%). No significant difference in aspartate (AST) and alanine aminotransferases (ALT) concerning the different subtypes (AST: p = 0.290; ALT: p = 0.260) could be calculated; 11.6% showed co-infection with HIV, 2 patients had a chronic infection with hepatitis B. Conclusions: The rate of HCV infection in substance-dependent patients at our drug addiction out-patient clinic is extremely high. The distribution of subtypes showed a relatively homogeneous distribution of the types 1a, 1b and 3a. The recommended therapy with α-interferon should be initiated in drug-dependent patients under considerations of an enrollment in oral maintenance with synthetic opioids.
Therapy instead of Punishment for Drug Users – Germany as a Model?
Authors: Böllinger Lorenz
Published: April 2003

Germany underwent a sociolegal process from strict drug prohibition to a multi-focus approach: harsh repression of drug supply and specific treatment against consumption. Criminal law now opens pathways to four different manners of demand reduction by treatment: commitment to closed forensic hospitals, combination of probation or parole with a treatment order, treatment within penitentiaries and deferring indictment or punishment in favour of treatment. Although each of these modalities represents coerced treatment, the methods are diverse and can be of the drug-free or maintenance type as well as in- or out-patient treatment. Evidently there are conceptual and implementation problems to each of these strategies. But all in all they represent the insight that drug behaviour can only be changed by public health measures rather than by criminal law as such.
Seizure Disorders in Patients with Brain Tumors
Authors: Liigant Aive , Haldre Sulev , Õun Andre , Linnamägi Ülla , Saar Anu , Asser Toomas , Kaasik Ain-Elmar
Published: April 2003

The aim of this study was to analyze the clinical data of patients with epileptic seizures and diagnosed brain tumors. Analysis included 711 patients with primary and secondary brain tumors. 165 (23%) patients had experienced at least one seizure before tumor diagnosis. The mean time from the first epileptic seizure to tumor diagnosis was 16 months. The patient’s age, location and pathology of tumor were associated with occurrence of seizures. Seizures were more common in patients aged 30–50 years. Tumors involving the frontal, frontoparietal, temporal and frontotemporal lobes were associated with occurrence of seizures. According to the histological diagnosis, patients with mixed gliomas (62%), oligodendrogliomas (53%) and astrocytomas (42%) experienced seizures most frequently.
Effects of Transfusion on Gastrointestinal Anastomotic Wound Healing and Leukocyte Function in Rats
Authors: Ohwada S. , Sato Y. , Sato N. , Toyama Y. , Okano T. , Nakasone Y. , Ogawa T. , Morishita Y.
Published: April 2003

Background: This study was done to investigate the effects of blood transfusion on gastrointestinal anastomotic wound healing and leukocyte function. Methods: Closed-colony male Wistar rats were divided into five groups in a group-mixed fashion and underwent laparotomy (the CONT and WB groups) or gastrectomy and gastroduodenostomy (the GAST, GAST/WB and GAST/LDRWB groups). Immediately, they received 3 ml of saline (the CONT and GAST groups) or blood from Wistar donors (the WB and GAST/WB groups, whole blood; the GAST/LDRWB group, a transfusion of irradiated and leukocyte-depleted whole blood). The animals were killed 7 days after surgery. Results: The GAST/WB group had a higher incidence of anastomotic abscess, a lower level of factor XIII and a lower maximum breaking strength than the GAST group. Gastrectomy decreased L-DCL (luminol-dependent chemiluminescence) more than whole-blood transfusion. In the GAST/WB group, L-DCL was severely reduced, while in the GAST/LDRWB group it was roughly equivalent to the level in the GAST group. Conclusions: Whole-blood transfusion increased the incidence of anastomotic abscess and impaired anastomotic wound healing, and these might relate to the reduction of L-DCL. Irradiated and leukocyte-depleted transfusion can improve these effects.
Influence of Suture Material and Suture Technique on Collagen Fibril Diameters in Midline Laparotomies
Authors: Höer J. , Anurov M. , Titkova S. , Klinge U. , Töns C. , Öttinger A. , Schumpelick V.
Published: April 2003

Background: Although laparotomy closure is associated with a cumulative 15% failure rate, the effect of different suture techniques and materials on the ultrastructural composition of the healing incision has not been investigated. Method: in 40 Wistar rats the collagen fibril diameters and the regenerative tissue were compared using electron microscopy 14 and 28 days after midline laparotomy. Wounds were closed with single and running sutures using either polypropylene or polyglactin 910. Results: Closure with polypropylene led to significantly larger mean fibril diameters than closure with polyglactin. Regardless of time and suture material, running closure resulted in significantly smaller mean collagen fibril diameters than single sutures. Four weeks after laparotomy, inflammatory reactions, disorganization of collagen and irregularities of the vascular architecture were found after closure with absorbable suture material but not after closure with nonabsorbable material. Conclusion: Suture material and suture method significantly influence the ultrastructural composition of the healing incision. Persisting mechanical irritation around the suture threads after single sutures and severe persisting inflammatory reactions after the use of absorbable suture material are important influencing factors.
Alternative Surgical Exposure of the Rat Heart in vivo Using a Simple Abdominal Approach
Authors: Huikeshoven M. , van den Brink A. , Beek J.F.
Published: April 2003

Access to the heart in laboratory rats is usually performed via a median sternotomy or a lateral thoracotomy. An alternative, less traumatic approach to the in vivo rat heart with improved survival is described. The technique uses an upper median laparotomy extending alongside the xyphoid bone. The xyphoid bone is retracted in a rostral direction, and a T-shaped cut is made in the diaphragm thus opening the thoracic cavity. Using a retractor the opening in the diaphragm is spread and the heart is exposed. We performed this abdominal approach in 23 anaesthetised and mechanically ventilated (for 2 h) rats and found physiologic intra-operative haemodynamics, a good postoperative recovery and 0% mortality.
The Syllable Method: Proportion of Impaired Syllables as an Indicator of Spasmodic Dysphonia Severity
Authors: Kumada Masanobu , Bell-Berti Fredericka , Kobayashi Takeo , Makiyama Kiyoshi , Niimi Seiji
Published: April 2003

We have previously proposed the ‘mora method’ to evaluate the degree of impairment in spasmodic dysphonia (SD) in Japanese-speaking patients. With this method, impairment is judged as the proportion of impaired morae in a 25-mora sentence in a longer passage read aloud. As the mora is the phonologically isochronic unit in Japanese, the proportion of impaired morae in speech can be used to represent the temporal proportion of impaired Japanese speech. This proportional measure of impairment reflects the perceived severity of the impairment, and is a more reliable measure than a 4-point perceptual rating scale completed either by patients or by voice professionals. In this paper, we propose a ‘syllable method’ to characterize the severity of impairment in English-speaking SD patients. Instead of morae, the severity of SD was represented by the proportion of impaired syllables. It should be possible to characterize SD impairments more reliably and precisely with this method than using a 4-point rating scale completed by voice professionals. Ultimately, the syllable method should become a simple and effective method for evaluating the severity of SD. Furthermore, such methods can be applied to other languages, using the appropriate phonological unit (either mora or syllable).
The Influence of Acoustic and Perceptual Factors on Perceived Hypernasality in the Vowel [i]: A Preliminary Study
Authors: Kataoka Ryuta , Zajac David J. , Mayo Robert , Lutz Richard W. , Warren Donald W.
Published: April 2003

The purpose of this study was to examine the influence of acoustic and perceptual factors of speech on listeners’ perceived hypernasality in the vowel [i]. The isolated syllable [pi] produced by 22 children with hypernasal speech and 6 noncleft children was rated by 10 listeners. These speech samples were then divided into two groups: (1) the samples (n = 14) that received inconsistent ratings from each listener or variable ratings among listeners (i.e., unreliable ratings) and (2) the samples (n = 14) that received consistent ratings from each listener and similar ratings among listeners (i.e., reliable ratings). These results suggest that the severity of hypernasality was easy to rate in some speech samples and not in others. Voice quality deviation and a particular type of spectral change that related to the severity of hypernasality could be factors that influence perceived hypernasality.
Size Dependence in Prosimian Locomotion and Its Implications for the Distribution of Body Mass
Authors: Preuschoft Holger , Günther Michael M. , Christian Andreas
Published: April 2003

The mechanical requirements for arboreal life are reviewed and the constraints which these requirements impose on the body of a prosimian are defined. The mechanical necessities can be fulfilled only by animals which possess the appropriate morphological characters. It is incorrect to refer to these morphological traits directly as ‘adaptations’. Instead their a priori existence must be considered as the precondition for the acquisition of a certain life-style. Once such a life-style has been acquired, a strong selective pressure acts towards a further refinement of such ‘adaptations’ or ‘pre-adaptations’. Postcranial morphology must be seen in a context of following natural laws and is strictly related to the mechanics of posture and locomotion. The traits emphasised and explained here are body proportions – specifically the relative lengths of body segments and the distribution of (muscle) mass on these segments.
Long-Term Effects of Vitamin B12, Folate, and Vitamin B6 Supplements in Elderly People with Normal Serum Vitamin B12 Concentrations
Authors: Henning Bernhard F. , Tepel Martin , Riezler Reiner , Naurath Hans J.
Published: April 2003

Background: In the elderly, deficiencies of folate, cobalamin (vitamin B12) and pyridoxal phosphate (vitamin B6) are common. The metabolites homocysteine, methylmalonic acid, 2-methylcitric acid and cystathionine have been reported to be sensitive markers of these vitamin deficiencies. Objective: The long-term (269 days) effect of an intramuscular vitamin supplement containing 1 mg vitamin B12, 1.1 mg folate, and 5 mg vitamin B6 on serum concentrations of homocysteine (tHcy), methylmalonic acid (MMA), 2-methylcitric acid (2-MCA), and cystathionine (Cysta) was studied in 49 elderly subjects with normal levels of vitamin B12. Methods: Vitamin supplement was administered 8 times over a 21-day period, metabolite concentrations were measured until day 269 (e.g. 248 days after the end of vitamin supplementation). Results: From day 0 to 21, the serum levels of the 3 vitamins increased significantly, after cessation of supplementation the levels returned to baseline within the follow-up period. The MMA, 2-MCA and tHcy levels decreased during the treatment period significantly and did not reach baseline values within the 248-day period. Cysta levels did not differ significantly from baseline, either during or after treatment. Conclusion: MMA and 2-MCA levels rather reflect the availability of vitamins, especially cobalamin, than the actual serum levels. Since deficiencies of folate, cobalamin and pyridoxal phosphate in the elderly may cause hyerhomocysteinemia and hence may have unfavorable effects on mental performance, determination of MMA and 2-MCA levels in elderly patients with mental disturbances may be a cost-effective measure to improve or maintain mental performance.
Increased Bone Volume and Bone Mineral Content in Xylitol-Fed Aged Rats
Authors: Mattila Pauli T. , Svanberg Martti J. , Knuuttila Matti L.E.
Published: April 2003

Background: Our previous studies have shown that dietary xylitol supplementation protects against the loss of bone mineral after ovariectomy. The ovariectomy-induced decrease in trabecular bone volume is significantly retarded by dietary xylitol. Objective: To study whether dietary xylitol can protect against bone loss also during aging, a long-term experimental study was performed with rats. Methods: Twenty-four male Sprague-Dawley rats were divided into two groups. The rats in the control group were fed a basal RM1 diet, while the rats in the experimental group were continuously fed the same diet supplemented with 10% (w/w) xylitol. The rats were killed after 20 months. Their tibiae were used for the analyses of bone density and trabecular bone volume, and their femurs were used for the scanning analyses with peripheral quantitative computed tomography (pQCT). Results: The tibial density of the xylitol-fed aged group (1.73 ± 0.14 g/mm3) was significantly greater than that of the aged group without xylitol (1.56 ± 0.14 g/ mm3). The trabecular bone volume of the xylitol-fed rats was 21.2 ± 4.0%. It was significantly greater than that of the rats not receiving xylitol (9.3 ± 4.3%). The pQCT-measured cortical bone mineral density and the pQTC-measured cortical bone mineral content of the femoral diaphysis were significantly greater in the xylitol-fed group than in the control group. The trabecular bone mineral density and the trabecular bone mineral content of the femoral distal metaphysis were also significantly greater in the xylitol-fed group than in the non-xylitol group. The total bone mineral density and the total bone mineral content of the femoral neck in the xylitol-fed aged group significantly exceeded those in the aged group without xylitol supplementation. Conclusions: A continuous moderate dietary xylitol supplementation leads to increased bone volume and increased bone mineral content in the long bones of aged rats. This indicates a xylitol-induced protection against aging-related osteoporotic changes.
Cytokine Levels and Phagocytic Activity in Patients with Alzheimer’s Disease
Authors: Beloosesky Yichayaou , Salman Hertzel , Bergman Michael , Bessler Hanna , Djaldetti Meir
Published: April 2003

Background: Clinical observations indicate that patients with Alzheimer’s disease show a greater susceptibility to infections. One possible explanation is that this predisposition is due to alterations in their immune system. Objective: To investigate this assumption, pro- and anti-inflammatory cytokines, as well as the phagocytic activity and superoxide anion generation was examined in aged individuals with and without Alzheimer’s disease. Methods: The production of IL-1β, IL-2, IL-6, TNFα and IL-10 by peripheral blood mononuclear cells from 12 patients with Alzheimer’s disease was compared with that of 12 age-matched individuals without any signs of dementia and 12 middle-aged healthy volunteers who served as an additional control. The engulfing capacity of the phagocytic cells was detected by counting cells containing latex beads and the number of particles internalized by each individual cell. Results: The secretion of IL-2 was markedly low in the demented patients, compared with both elderly and middle-aged subjects. IL-1β and TNFα production was similar in the individuals of the 3 groups. The production of IL-6 and IL-10 was significantly lower when compared to that of the middle-aged, but did not differ between the elderly patients with and without dementia. The phagocytic function of both polymorphonuclear cells and monocytes was decreased in individuals of the elderly groups with a low number of engulfed latex particles by each individual polymorphonuclear cell. The production of superoxide anions was increased only by monocytes from the elderly groups. Conclusions: The results suggest that although the impaired immune function in patients with Alzheimer’s disease is related to the aging process, the significant low IL-2 production in these patients may play a role in their increased susceptibility to infections.
Cardiovascular Responses to Lower Body Negative Pressure in the Elderly: Role of Reduced Leg Compliance
Authors: Tsutsui Yuka , Sagawa Sueko , Yamauchi Katsuya , Endo Yutaka , Yamazaki Fumio , Shiraki Keizo
Published: April 2003

Background: It is warranted to test the hypothesis that the orthostatic tolerance does not diminish in the aging process per se in healthy individuals. Objective: The purpose of the present study was to examine the effects of aging on cardiovascular response and baroreflex sensitivity during lower body negative pressure (LBNP) with a special reference to leg compliance. Methods: Fifteen healthy old male subjects [mean age 68.2 ± (SE) 0.8 years] and 22 young male subjects [mean age 21.4 ± (SE) 0.3 years] underwent a 21-min bout of ramped LBNP (from 0 to –60 mm Hg, 10 mm Hg each for 3 min). Heart rate (HR), blood pressure, stroke volume (SV), forearm blood flow, and leg volume were measured throughout the experimental period. The arterial baroreflex sensitivity was calculated from spontaneous changes in beat-to-beat arterial pressure and HR during LBNP. Results: The leg compliance was lower, and the orthostatic tolerance index was higher in old than in young participants. The LBNP-associated increases in leg volume and HR and the decreases in SV were lower in old subjects, suggesting that the reduction of venous return was less in magnitude in old subjects during LBNP. The baseline value of baroreflex sensitivity evaluated by the sequence analysis was smaller, and no LBNP-related change was observed in old subjects, whereas a gradual LBNP-related reduction was observed in young subjects. The slope of regression between ΔSV and change in forearm vascular resistance during LBNP was identical in both age groups. Conclusions: We conclude that: (1) aging per se does not increase the intolerance to orthostatic stress induced by LBNP; (2) a low magnitude of venous return reduction during LBNP contributes to a higher tolerance in the old because of lower leg compliance, and (3) the sensitivity of baroreflex control of the HR is attenuated in the old; however, there is no deterioration of the sensitivity of the peripheral vasoconstriction during LBNP.
Positive Association between Total Lymphocyte Count and Femur Bone Mineral Density in Hip-Fractured Women
Authors: Di Monaco Marco , Di Monaco Roberto , Manca Mario , Cavanna Alberto
Published: April 2003

Background: Protein depletion appears to play a detrimental role in the causes of hip fracture and low bone mineral density has been observed in protein-depleted subjects. Objective: To investigate the association between femur bone mineral density and total lymphocyte count, a marker of the protein nutrition status, in elderly hip-fractured women. Methods: 210 white women affected by their first hip fracture either spontaneous or due to minimal trauma consecutively admitted to a rehabilitation hospital were studied. 34 women were ruled out because of confounding factors altering their lymphocyte count. Both total lymphocyte count and bone mineral density at the unfractured femur were evaluated. The correlation between these two variables was studied by Pearson’s coefficient. Bonferroni adjustment was used for multiple comparisons. Bone density was measured by DXA (Hologic QDR 4500W). Results: A positive correlation was observed between lymphocyte count and bone mineral density measured at both total proximal femur (r = 0.21; p < 0.05) and intertrochanteric area (r = 0.21; p < 0.05). Stepwise linear multiple regression analysis showed that the association with total lymphocyte count was independent of age, weight, height, body mass index, time between surgery and blood sample collection for lymphocyte count and type of hip fracture (cervical or trochanteric) when bone mineral density was evaluated both at total proximal femur (p < 0.05) and intertrochanteric area (p < 0.05). Conclusion: Our results support the role exerted by protein nutrition in bone health, at least in elderly frail women. From this point of view, a total lymphocyte count is a suitable, inexpensive marker.
Difficulties of Recruitment for a Randomized Controlled Trial Involving Influenza Vaccination in Healthy Older People
Authors: Allsup Stephen J. , Gosney Margot A.
Published: April 2003

Background: In a randomized controlled trial to determine the cost benefits of influenza vaccination in fit healthy individuals aged 65–74 years, recruiting individuals to the study was more difficult than anticipated. Objectives: To investigate reasons for poor recruitment. Materials and Methods: 6,058 people were initially identified as eligible for the study but only 729 (12%) were subsequently randomized. Individuals (n = 2,583) who returned cards indicating that they did not wish to participate were sent a postal questionnaire asking for reasons why they felt unable to consent for the study. Results: 1,173/2,583 (45.4%) questionnaires were returned. A total of 2,621 reasons were given for nonparticipation, i.e. a mean of 2.2 reasons per questionnaire returned. Reasons given for noninvolvement were: reluctance to participate in a research project (53%); concerned about side effects (34%); self-perceived view of not requiring influenza vaccination (31.7%); preference for own doctor to give the vaccine (29.1%); objection to name ‘Geriatric Medicine’ on the letter of invitation (25.2%); already been vaccinated (17.3%); illness requiring vaccination out of the study (13.8%); previous bad reaction to the vaccine (6.4%); unable to attend on day of vaccination (4.3%); unable to get to general practice surgery (4%); already involved in a clinical trial (2.5%); fear of needles/dislike of injections (1.6%); doubts about vaccine efficacy (0.3%); egg allergy (0.2%). Conclusion: Inaccurate beliefs about influenza vaccination persist across a wide section of the community. Efforts should be made by all health professionals to correct these false beliefs and ensure that those at risk can be easily recognized and targeted for vaccination.
On the Role of Aging in the Etiology of Autoimmunity
Authors: Urbán László , Bessenyei Beáta , Márka Marietta , Semsei Imre
Published: April 2003

Several types of diseases, among others autoimmune illnesses, could be coupled with the general processes of aging. The two-edged sword of immune defense is directed on one side against environmental attacks and on the other against the body itself. However, one has to make a difference between normal (physiological) clearance and autoimmune diseases, although both sides of autoimmunity are influenced by the general processes of senescence. Aging of the thymus seems to be one of the key elements in the etiology of autoimmunity, although other cell types and their aging also play a substantial role in this process. Spontaneous genetic instability, acquired genetic mutations due to aging and the age-related alterations in the information level of the body may together be important elements in the pathomechanism of both physiological autoimmunity and autoimmune diseases. Nevertheless, physiological autoimmunity seems to be directed mostly by natural factors (such as aging and apoptosis) but primary autoimmune diseases may be caused by genetic instability that is enhanced by aging as well.
Case-Control Study on Risk Factors for Premature Ovarian Failure
Authors: Testa Giovanna , Chiaffarino Francesca , Vegetti Walter , Nicolosi Annaelisa , Caliari Ilaria , Alagna Federica , Bolis Pier Francesco , Parazzini Fabio , Crosignani Pier Giorgio
Published: April 2003

Objective of this case-control study was to investigate the potential risk factors for premature ovarian failure (POF). Seventy-three patients with secondary hypergonadotropic amenorrhea and, as control group, 144 women with acute, non-gynecological, non-neoplastic, non-hormone-related diseases were included in the study. Information was obtained on sociodemographic characteristics, gynecological and obstetric data, general lifestile habits, smoking habits and history of selected gynecological and other clinical conditions. A statistically significant association between high education level and POF was found (p = 0.03). Parity was related to a reduced risk of POF and this reduction increased with the number of live births (p = 0.02). No association emerged between POF risk and age at menarche, cycle length and oral contraceptive use. Women with POF could not be distinguished from control women by behavioral and reproductive history, except for lower fertility. The minor influence that reproductive and lifestyle factors have on the occurrence of POF suggests that genetic inheritance plays a more important role.
Antenatal Three-Dimensional Sonographic Features of Pierre-Robin Syndrome
Authors: Matsumoto Minako , Yanagihara Toshihiro , Hanaoka Uiko , Maesato Taeko , Kuno Atsushi , Yamashiro Chizu , Tanaka Hirokazu , Hayashi Keiji , Hata Toshiyuki
Published: April 2003

A case of Pierre-Robin syndrome with polyhydramnios is described. Three-dimensional sonography clearly showed fetal micrognathia and hypoplastic ear antenatally. The benefits and advantages of the use of three-dimensional sonography to diagnose Pierre-Robin syndrome in utero are discussed.
Effect of Heparin on Activated Partial Thromboplastin Time in Patients Undergoing Gynecologic or Obstetric Surgery
Authors: Watanabe Takashi , Minakami Hisanori , Sakata Yoichi , Obara Hiromi , Wada Tomoaki , Onagawa Tamaho , Sato Ikuo
Published: April 2003

The exaggerated prolongation of the activated partial thromboplastin time (APTT) by heparin prophylaxis for postoperative thromboembolism may cause bleeding complications. We examined the effects of various doses of unfractionated heparin on the APTT in patients who underwent a gynecologic or obstetric operation. A total of 68 patients who underwent a gynecologic operation (n = 47) or a cesarean section (n = 21) with risk factors for thromboembolism received a continuous intravenous infusion of unfractionated heparin (110–285 IU/kg/day) after surgery until the patient was mobilized the next day. A group of 61 postoperative patients who did not receive heparin served as controls. The APTT was measured in these 129 patients preoperatively and on postoperative day 1. A clinical deep vein thrombosis occurred in only 1 patient, who was in the control group. No bleeding complications occurred in any patient. The percent change in the APTT was significantly correlated with the dose of heparin administered (p < 0.001). Compared with the control group, the mean APTT was not prolonged in the patients who received heparin at 110–149 IU/kg/day. It was prolonged significantly in the patients who received heparin at greater than 150 IU/kg/day. An exaggerated prolongation of the APTT, defined as an APTT greater than 150% of the preoperative value, was found in 0 of 32 patients in the 110–149 IU/kg/day group, 1 of 28 patients (3.6%) in the 150–199 IU/kg/day group and 2 of 8 patients (25%) in the 200–285 IU/kg/day group. The continuous postoperative administration of intravenous heparin at less than 200 IU/kg/day does not result in an exaggerated prolongation of the APTT.
Differential Regulation of Protein Kinase C Isoforms in Human Uterine Leiomyoma
Authors: Eude I. , Tertrin-Clary C. , Vacher-Lavenu M.C. , Chapron C. , Ferré F. , Breuiller-Fouché M.
Published: April 2003

The protein kinase C (PKC) isoenzyme expression pattern in human uterine leiomyoma was compared with that obtained in homologous myometrium distal from the tumor. The six PKC isoforms (PKCα, PKCβ1, PKCβ2, PKCδ, PKCΕ and PKCζ) evidenced in the myometrium were found to be similarly expressed in leiomyoma. Quantitative immunoblotting revealed that all PKC isoforms were preferentially localized in the particulate fraction. To gain insight into the possible functional consequences of PKC expression patterns, subcellular redistribution in response to the mitogenic peptide endothelin-1 (ET-1) was studied. After stimulation with ET-1, differential redistribution occurred in leiomyoma and myometrium, suggesting a selective role of PKC isoforms in the myometrial growth process.
Effect of p53 Polymorphism on the Susceptibility of Cervical Cancer
Authors: Yang Yuh-Cheng , Chang Chih-Long , Chen Mong-Liang
Published: April 2003

Using PCR amplification followed by confirmation with BstU I restriction enzyme digestion, the p53 Pro sequence was determined in tissues from 88 normal cervices, in 184 cervical swabs with mildly abnormal Pap smear, in 50 squamous cell cervical carcinoma specimens, and in 30 cervical adenocarcinoma samples. The frequencies for homozygous proline (Pro-72), homozygous arginine (Arg-72), and heterozygous proline/arginine (Pro/Arg-72) were 23% (n = 20), 28% (n = 25), and 49% (n = 43), respectively, in normal cervices; 24% (n = 45), 28% (n = 51), and 48% (n = 88), respectively, in samples with mild dyskaryotic changes in Pap smears; 26% (n = 13), 28% (n = 14), and 46% (n = 23), respectively, in squamous cell carcinomas, and 33.3% (n = 26), 46.2% (n = 36), and 20.5% (n = 16), respectively, in adenocarcinomas. In the present study, we have found that p53 polymorphism may have a role in the development of adenocarcinoma but not squamous cell carcinoma. The arginine-encoding allele may thus be an important factor affecting host susceptibility to the development of adenocarcinoma.
Useful Predictors of Ovarian Stimulation Response in Women Undergoing in vitro Fertilization
Authors: van der Stege Jolande G. , van der Linden Paul J.Q.
Published: April 2003

Eighty-seven patients undergoing in vitro fertilization were studied to evaluate the prognostic value of different tests in predicting ovarian stimulation response. We studied basal follicle-stimulating hormone (FSH) value on cycle day 3, the clomiphene citrate (CC) challenge test and serum estradiol levels on cycle day 3. Patients with elevated basal FSH levels needed more ampoules of gonadotropins for stimulation and had a higher cancellation rate because of poor response. Patients with abnormal CC challenge test results also needed more ampoules of gonadotropins, but the higher cancellation rate in this group did not reach statistical significance. The basal estradiol level did not contribute to further discrimination between groups. We conclude that basal FSH level on cycle day 3 is a useful prognosticator of ovarian stimulation response.
Correlation between Grade III Placenta and Plasma Antithrombin III Activity in Full Term Pregnancy
Authors: Asakura Hirobumi , Ohshita Tomoko , Suzuki Shunji , Araki Tsutomu
Published: April 2003

We evaluated whether the presence of a grade III placenta correlates with blood hypercoagulability in pregnancy between 37 and 39 weeks of gestation. The placenta was graded by ultrasound in 155 healthy full-term women and the plasma levels of antithrombin III (AT III) activity, thrombin-antithrombin complex (TAT) and D-dimer were correlated with each placental grade. AT III activity levels tended to decrease with advancing placental grade from I to III (p < 0.05). D-dimer showed the same tendency while TAT did not. The incidence of reduced AT III activity levels (<70%) in women with a grade III placenta was about twice those in women with a grade II or I placenta, and that of AT III <80% was 3-fold greater. We concluded that the presence of a grade III placenta in full-term pregnancies correlates with blood hypercoagulability.
Differential Levels of Interleukin 6 in Maternal and Cord Sera and Placenta in Women with Pre-Eclampsia
Authors: Al-Othman Saed , Omu Alexander E. , Diejomaoh F.M.E. , Al-Yatama Magda , Al-Qattan Fawzia
Published: April 2003

Background: Interleukin 6 (IL-6) is a T helper 2 cytokine with a variety of properties including pro-inflammatory characteristics. It has, therefore, been implicated in the pathophysiology of abnormal pregnancies. Objective: To investigate the association between IL-6 and pre-eclampsia by estimating the differential levels of IL-6 in maternal and cord serum and supernatant of homogenized placental tissue. Methods: 50 primigravidae with pre-eclampsia and 50 matched normotensive primigravidae served as controls. At delivery, maternal and cord blood were collected and the serum extracted. Placental blocks were homogenized and sonicated in RPMI solution and the supernatant collected. The total protein concentration was determined and IL-6 levels assayed with an ELISA technique. Results: Placental IL-6 (170 and 186 pg/mg protein) was threefold that in the maternal (64 and 58 pg/mg protein) and cord serum (63 and 72 pg/mg protein; p < 0.01). There was no significant difference in the mean IL-6 levels in maternal and cord serum or placenta in both pre-eclamptic women and normotensive controls nor in pre-eclamptic patients with babies with intra-uterine growth restriction or in pre-eclamptic patients with babies with an appropriate birth weight and in normotensive controls. Conclusion: There are no differences in the maternal and cord sera and placental levels of IL-6 in pre-eclamptic and normotensive women, indicating that IL-6 may not have a role in the pathophysiology of pre-eclampsia.