bluuebunny/crossref_metadata_2025 huggingface dataset:
Uterus-Sparing Vaginal Surgery of Genitourinary Prolapse Employing Biocompatible Material
Authors: Nicita Giulio , Li Marzi Vincenzo , Filocamo Maria Teresa , Dattolo Eugenio , Marzocco Michele , Paoletti Maria Cristina , Villari Donata
Published: December 2005

Objective: The study presents an original uterus sparing technique for transvaginal repair of total genitourinary prolapse. The technique employs a synthetic mesh of mixed polypropylene and 910 polyglactin fibers. Methods: The prosthesis creates a support for the cystocele, the cervix and the enterocele. It has four anchoring sites: two at the rear in the sacrospinous ligaments and two at the front in the arcus tendineous of the levator ani muscle. Between February 2001 and December 2004, 24 patients (mean age 66.9 years), presenting symptoms of uterine prolapse, cystocele and enterocele (POP-Q stage III-IV Aa associated to II-III-IV C), were treated with our procedure. Pre- and postoperative parameters were evaluated statistically. Results: No patient had any serious complications. The mean follow-up was 31.1 months (range 6–52). 19 patients (79.1%) have shown excellent results and have been completely cured. In 5 other cases (20.8%), the cystocele was completely cured and there was a significant improvement in the hysterocele and the enterocele. One patient required surgical treatment for postoperative stress incontinence. Statistical analysis of data regarding the pre- and postoperative prolapse stage demonstrated a high degree of objective cure rates (p < 0.0001). Conclusions: While hysterectomy remains the habitual treatment for severe uterine prolapse, our technique provides a promising alternative solution. It is also significant that there were no complications of erosion or infection associated with the prosthesis.
Using Two Ipsilateral Double J Ureteral Stents for Extrinsic Ureteral Obstruction due to Colon Carcinoma
Authors: Kilciler Mete , Erdemir Fikret , Bedir Selahattin , Çoban Hidayet , Erten Koray , Örs Önder , Özgök Yaşar
Published: December 2005

Although double J (DJ) ureteral stents are widely used in extrinsic ureteral obstruction, there are few studies using ipsilateral two DJ stents in the same ureter. We report using ipsilateral two ureteral DJ stents in the same ureter in a patient with extrinsic ureteral obstruction due to colon carcinoma.
Protective Effects of Increasing Vitamin E and A Doses on Cisplatin-Induced Oxidative Damage to Kidney Tissue in Rats
Authors: Dillioglugil Meltem Ozlen , Maral Kir Hale , Gulkac Mehmet Dogan , Özon Kanli Aylin , Ozdogan Hacı Kahya , Acar Oguz , Dillioglugil Ozdal
Published: December 2005

Objective: Cisplatin (DDP, cis-diamminedichloroplatinium II) is one of the most potent chemotherapeutic antitumor drugs, but is able to generate reactive oxygen species (ROS) and it also inhibits the activity of antioxidant enzymes in renal tissue. In the present study, we investigated the preventive effect of 100, 200 and 400 mg/kg b.w. doses of vitamin E (VE), and 25, 50, and 100 mg/kg b.w. doses of vitamin A (VA) combination on malondialdehyde (MDA), nitric oxide (NO), and glutathione (GSH) levels and superoxide dismutase (SOD) activity in cisplatin-induced toxicity in rat kidneys. Our literature survey indicated a lack of any experimental study showing the beneficial effect of VA on cisplatin-induced MDA, NO, GSH and SOD changes. For this reason, we hoped that this study would provide a unique contribution in that respect. Materials and Methods: 59 Wistar rats (11 to replace prematurely lost animals) were used. 48 evaluable rats were divided into 8 groups (n = 6 in each group): control group, DDP alone (5 mg/kg b.w.) group, 3 VE combination treatment groups of VE100+DDP, VE200+DDP, and VE400+DDP, and 3 VA combination treatment groups of VA25+DDP, VA50+DDP, and VA100+DDP. Kidney MDA, GSH, NO levels and SOD activities were determined for the assessment of oxidant-antioxidant balance. Results: While in the DDP group the tissue levels of MDA and NO were found to be significantly higher than in the control group, GSH levels and SOD activities were significantly lower. MDA and NO levels were found to be significantly lower and GSH levels and SOD activities significantly higher in the VE200+DDP and VE400+ DDP groups when compared with the DDP alone group. MDA and NO levels were found to be significantly lower in the VA50+DDP and VA100+DDP groups when compared with the DDP alone group. However, identical comparisons with the DDP alone group showed significantly higher GSH levels and SOD activities in the VA25+DDP, VA50+DDP, and VA100+DDP groups. Among the VE100+ DDP, VE200+DDP, and VE400+DDP groups, and VA25+ DDP, VA50+DDP, and VA100+DDP groups, MDA and NO levels decreased and GSH levels and SOD activities increased steadily and significantly as the doses of VE and VA increased. Conclusion: These vitamins would be effective in protecting against cisplatin-induced tissue damage in rat kidneys. It is possible that the toxic effect of cisplatin is somehow minimized by a compensatory mechanism involving VE and VA via induction of antioxidant enzyme activities following intraperitoneal injection of DDP.
Prostate Cancer Volume – Can It Be Predicted Preoperatively?
Authors: Alschibaja Michael , Wegner Mathias , Massmann Jörg , Funk Armin , Hartung Rudolf , Paul Roger
Published: December 2005

Introduction: The prostate cancer volume (PCvol) is described as a significant predictor for tumor progression after radical prostatectomy, but its determination has not become a routine procedure yet due to high demands on technical standards, labor intensity, and costs. The objective of this study is to predict the PCvol by using common preoperative variables. Material and Methods: Between 1996 and 2001, 365 whole-mounted prostatectomy specimens, processed according to the Stanford protocol, were used for computerized reconstruction of the total PCvol. Widely accepted preoperative variables such as prostate-specific antigen (PSA), digital rectal examination findings, and Gleason score and grading (WHO) of the biopsy cores were correlated and analyzed for a relation to the PCvol by Spearman rho method and Mann-Whitney U test. Integrating these parameters in a multiple linear regression model, independent variables predicting the PCvol were determined, multiplied by their risk factors, and used for calculation of the estimated PCvol. In order to evaluate the precision of our results, we correlated measured and estimated tumor volumes. A nomogram was constructed, in order to visualize our results. Results: Multiple linear regression analysis revealed categorized PSA, grading (WHO), and Gleason score to be independent predictors for the PCvol. The estimated PCvol ranged from 0.5 to 9.8 cm3 and the measured PCvol from 0.02 to 53 cm3. An identical mean value of 4.1 cm3 was observed. The Spearman rho method showed a highly significant correlation (coefficient = 0.5) between estimated and measured PCvol (p < 0.001). Conclusions: The PCvol is regarded as a significant predictive parameter of tumor progression after radical prostatectomy, but due to its time-consuming determination, it has not become a routine procedure yet. Currently used preoperative parameters such as PSA and grading (WHO) and Gleason score of the biopsy cores do predict the total tumor volume. These results were reconfirmed by correlation analysis. Consequently, by use of our nomogram, the labor-intensive measurement of the PCvol becomes unnecessary.
Interaction Effect in Bladder Cancer between N-Acetyltransferase 2 Genotype and Alcohol Drinking
Authors: Lu Chih-Ming , Chung Meng-Chu , Huang Chung-Hsiung , Ko Ying-Chin
Published: December 2005

Cigarette smoking, aromatic amines and ionizing radiation are known carcinogens of bladder cancer. NAT2 genotype might play a role in bladder cancer carcinogenesis. This hospital-based, case-control study was conducted in Kaohsiung, Taiwan, which neighbors the high incidence region of bladder cancer in the black-foot disease area. A total of 103 cases with diagnosed bladder cancer were collected. For each case, 1 control was selected from the same hospital. A structured questionnaire was applied for all cases and controls. DNA was extracted from peripheral blood cell. The ASO-PCR/RFLP technique was used to determine the NAT2 genotype. For bladder cancer, the significantly excessive risks were observed in regular drinkers (OR = 2.74, 95% CI = 1.28–5.87) and residents of the black-foot disease endemic area (OR = 7.53, 95% CI = 2.16–26.33), and interaction of regular drinking and slow type of NAT2 (OR = 18.04, 95% CI = 2.28–142.80). We suggested that NAT2 genotype might play a role of effect modifier in bladder cancer carcinogenesis.
Malignant Fibrous Histiocytoma Arising from the Renal Capsule
Authors: Eroğlu Muzaffer , Bakırtaş Hasan , Çimentepe Ersin , Ünsal Ali , Ataoğlu Ömür , Balbay M. Derya
Published: December 2005

We report a case of malignant fibrous histiocytoma arising from the renal capsule which is a rare condition. The patient was treated with surgical excision of the tumor including the renal capsule and subsequent radiotherapy of 6,600 rad. No recurrence was detected 15 months after surgery.
Bladder Perforation: A Potential Risk of Early Endovesical Chemotherapy with Mitomycin C
Authors: Racioppi Marco , Porreca Angelo , Foschi Nazario , Delicato Giampaolo , Destito Antonio , D’Addessi Alessandro
Published: December 2005

The use of chemotherapeutic agents in the treatment of superficial bladder cancer is well known. In particular, mitomycin C (MMC) is globally accepted also in the early treatment after an endoscopic resection. Complications related to MMC are usually scarce as a systemic absorption is quite absent, while its use is effective for the bladder recurrence reduction. In our experience we report a female patient with a bladder perforation after an early instillation of a single dose of MMC. In this case, systemic toxicity occurred requiring subintensive care for a complete repair.
Tissue Plasminogen Activator-Induced Ischemic Injury Is Reversed by NMDA Antagonist MK-801 in vivo
Authors: Kilic Ertugrul , Kilic Ülkan , Bähr Mathias , Hermann Dirk M.
Published: December 2005

In vitro studies suggested that tissue plasminogen activator (t-PA) may aggravate ischemic injury by enhancing N-methyl-D-aspartate (NMDA) receptor signalling. It remained unclear whether NMDA signalling is also relevant for t-PA toxicity in vivo. We herein examined effects of intravenous t-PA (10 mg/kg), administered alone or in combination with the NMDA antagonist MK-801 (0.2 mg/kg), following 90 min of middle cerebral artery occlusion in mice. In our study, MK-801 alone, administered intraperitoneally, neither affected infarct volume nor brain swelling at 24 h after reperfusion. t-PA significantly increased infarct size, in accordance with previous findings. t-PA-induced ischemic injury was completely abolished and brain swelling markedly reduced when t-PA-treated animals received additional MK-801 injections. To elucidate how t-PA influences brain damage, we examined actions of t-PA on the expression of NO synthases by immunohistochemistry, showing that t-PA does not influence neuronal NO synthase, but increases inducible NO synthase in ischemic areas. The effect of t-PA on inducible NO synthase levels was completely reversed after cotreatment with MK-801. Our study provides in vivo evidence in a model of focal cerebral ischemia that t-PA-induced brain injury involves an NMDA receptor-dependent mechanism.
Selecting Patients for Early Stroke Treatment with Penumbra Images
Authors: Maulaz Alexandre , Piechowski-Józwiak Bartlomiej , Michel Patrik , Bogousslavsky Julien
Published: December 2005

Review of results of experimental and clinical studies indicates that the area of physiologically impaired, but potentially salvageable, tissue surrounding the central core of focal cerebral ischemia that develops shortly after onset of vessel occlusion is complex and dynamic with severity and duration thresholds for hypoxic stress and injury that are specific to tissue site, cell type, molecular pathway or gene expression investigated, and efficiency of collateral or residual flow and reperfusion. Identification of this ischemic penumbra in the acute stroke clinical setting is an important goal for stroke researchers and clinicians. Recent advances in neuroimaging allowed a better understanding of this physiopathological process. However, there is not a perfect penumbra imaging technique and each one has its own advantages and disadvantages. Numerous thrombolytic and potentially neuroprotective agents have been studied in stroke patients, with little success, as the only approved therapy is thrombolysis with recombinant tissue plasminogen activator within 3 h of stroke onset in highly selected patients (<10% of all acute stroke patients in some specialized centers). One major obstacle in the development of effective therapies for ischemic stroke has been the lack of versatile imaging techniques. The development of penumbra concept and its detection through modern cerebral image techniques can extend the patients’ selection for thrombolysis. A number of multicenter clinical trials are now under way to test these models and confirm the utility of penumbra imaging for treatment decisions. Present knowledge about visualization of the salvageable penumbra suggests a promising future in which penumbra imaging studies are performed routinely in the acute stroke setting and the data provided by these studies assist in individualizing therapeutic decisions and identifying effective therapies that can be delivered at late time points. So, the main target of management is ‘penumbra’, or salvageable tissue, which is primarily dependent upon the expediency of the whole process, better expressed by the phrase ‘Penumbra (and not Time) is Brain’.
Basic Mechanisms in Intracranial Large-Artery Atherosclerosis: Advances and Challenges
Authors: Arenillas Juan F. , Álvarez-Sabín José
Published: December 2005

Intracranial large-artery atherosclerosis is a major cause of ischemic stroke worldwide. Patients affected by this disease are at a high risk of suffering recurrent ischemic events despite antithrombotic therapy. Progression and a greater extent of intracranial atherosclerosis imply a higher risk for recurrence. Studies performed by our group in patients with symptomatic intracranial large-artery atherosclerosis have shown that: (1) C-reactive protein predicts its progression and recurrence, suggesting that inflammation may play a deleterious role in this condition; (2) a high level of the anti-angiogenic endostatin is also associated with a progressive and recurrent intracranial atherosclerosis, which might support a beneficial role for angiogenesis in this group of patients; and (3) elevated lipoprotein(a) concentration and diabetes mellitus characterize those patients with a higher number of intracranial stenoses.
Benefits of Modifying the Predictive Factors of Stroke Recurrence
Authors: Egido José A.
Published: December 2005

The risk of stroke recurrence is high. With annual rates of around 4%, accumulative rates of 40% are reached within 10 years. Despite being underestimated, the risk is highest in the early stages; around 12% in the first year. The most important etiological subtypes have different levels of risk; the highest being for atherothrombotic infarction and the lowest for lacunar infarction. Each etiology has its own risk factors. For example, in carotid stenosis, the grade of stenosis, ulceration, and plaque morphology, silent infarction on neuroimaging, coexistence of intracranial disease, or microemboli detected on transcranial Doppler, all have predictive value for stroke recurrence. There is a paucity of data on the risk factors for intracranial stenosis. In cardioembolism due to atrial fibrillation age, coexistence of hypertension or diabetes, and echocardiographic data predict recurrence. Risk factors for recurrence do not parallel those for first stroke. Diabetes is the most consistent risk factor for recurrence in different studies, while control of hypertension has been shown to be effective in the prevention of recurrences. Among the inflammatory markers, C-reactive protein is the most effective in prediction of recurrence. Elevated levels of homocysteine also predict recurrence, but attempts to improve risk by the modification of these levels have, to date, been unsuccessful. To be effective, the modification of predictive factors needs to be multifactorial and should be taken into account corresponding to each etiological type. More research is needed on biological markers to establish their clinical relevance and the benefit of targeting them for therapeutic modification.
Vascular Dementia Prevention: A Risk Factor Analysis
Authors: Román Gustavo C.
Published: December 2005

Brain injury from ischemic or hemorrhagic cerebrovascular disease (CVD) produces decline in cognitive functions and vascular dementia (VaD). Likewise, CVD may cause VaD from hypoperfusion of susceptible brain areas. CVD may also worsen degenerative dementias such as Alzheimer’s disease. Significant advances have been made in the identification and control of risk factors for stroke and cardiovascular disease. The main risk factors for VaD include age, hypertension and absence of antihypertensive medication, diabetes, cigarette smoking, history of cardiovascular disease (coronary heart disease, congestive heart failure, peripheral vascular disease), atrial fibrillation, left ventricular hypertrophy, hyperhomocysteinemia, orthostatic hypotension, cardiac arrhythmias, hyperfibrinogenemia, and sleep apnea. Recently identified risk factors include chronic infection and elevation of C-reactive protein, particularly in patients with diabetes. Evidence from controlled clinical trials strongly suggests that control of vascular risk factors, in particular hypertension, could prevent the development of dementia.
Carotid Endarterectomy: Is It Still a Gold Standard?
Authors: Rubio Francisco , Martínez-Yélamos Sergio , Cardona Pedro , Krupinski Jerzy
Published: December 2005

Extracranial internal carotid artery stenosis accounts for 15–20% of ischemic strokes. Carotid endarterectomy has high efficacy in stroke prevention in selected patients with symptomatic (age <80 years) and asymptomatic carotid stenosis (age <75 years). Randomized clinical trials demonstrated that carotid endarterectomy reduces the stroke risk, compared to medical therapy alone, for patients with 70–99% symptomatic stenosis with 16% absolute risk reduction at 5 years. The benefit for patients with 50–69% symptomatic stenosis is lower i.e. absolute risk reduction 4.6% at 5 years. Endarterectomy is not indicated for symptomatic patients with <50% stenosis. There is no need for time-delay for surgery in patients after transient ischemic attack or minor stroke. Patients with more extensive strokes or hemorrhage should undergo surgery after 4–6 weeks following initial symptoms. Carotid endarterectomy for asymptomatic stenosis reduces the risk of ipsilateral stroke, and any stroke, by approximately 30% over 3 years. However, the absolute risk reduction is small over the first few years and decision should be based on individual institutional experience. In all situations, the best medical therapy should accompany surgery. In the recent years, appearance of angioplasty, stenting, and distal protection procedures provides competitive alternatives to classical endarterectomy. However, long-term benefits of carotid angioplasty should be confirmed by bigger, randomized, comparative clinical trials.
Safety and Security of Carotid Artery Stenting for Severe Stenosis with Contralateral Occlusion
Authors: González Alejandro , González-Marcos Jose Ramón , Martínez Eva , Boza Fernando , Cayuela Aurelio , Mayol Antonio , Gil-Peralta Alberto
Published: December 2005

Background: Despite advances in the surgical treatment of patients with severe internal carotid stenosis (ICA), there are selective groups of patients who, due to several reasons, are not good candidates for surgery. Patients with contralateral occlusion are one of these subgroups. Thereby, other therapeutic alternatives, such as angioplasty may be of value. So far, there has been little published data about carotid angioplasty (CA) or stenting (CAS) in those patients. The objective of this study was to evaluate the efficacy and safety of angioplasty and stenting in patients with severe internal carotid stenosis and contralateral occlusion. Methods: Between 1991 and June 2004, 519 consecutive patients who underwent CA or CAS for severe stenosis of the ICA were registered in our prospective CA Data Bank. Of them, we identified 96 with contralateral occlusion (18.5%), who formed the basis of the present analysis. Results: Mean age was 64 ± 9 (range 40–80), 85 (88.5%) were men, and 61 (63.5%) were symptomatic. Thirty-two patients (33.3%) did not meet the criteria to be included in the NASCET. CA was done in 25 patients (26%) and CAS in 71 (74%). Distal protection was used in 38 patients (39.6%). Asymptomatic stenosis was treated in cases of progression (>85%), exhausted vasoreactivity, positive microemboli detection in transcranial Doppler, and/or asymptomatic lesions in CT/MRI. Transient hemodynamic effects were frequent: hypotension (54.5%), bradycardia (61.5%), asystole (33.3%), and syncope (33.3%). TIA occurred in 1 patient (1%), minor stroke in 1 (1%), and disabling stroke in 2 patients (2.1%). Mortality was 0%. Morbidity was 0% in cases done with distal protection. Conclusion: In our experience, CA/CAS performed in patients with severe carotid stenosis and contralateral occlusion compared favorably with the results obtained with carotid endarterectomy (CEA), to the extent that if randomized series comparing CEA and CA/CAS are done, CA/CAS might be considered as the treatment of choice in this subgroup of patients.
Challenges of Neuroprotection and Neurorestoration in Ischemic Stroke Treatment
Authors: Martínez-Vila Eduardo , Irimia Pablo
Published: December 2005

Currently, the most important therapeutic approaches in the acute phase of ischemic stroke are focused on the restoration of regional cerebral blood flow, early admission to a stroke unit and the attempt to block, using neuroprotective drugs, the biochemical and metabolic changes involved in the ‘ischemic cascade’. Treatment with rt-PA in the acute phase, although very effective, is still limited to a small number of patients and positive preclinical results of neuroprotective treatment have not, as yet, been endorsed in clinical trials. The remarkable lack of concordance between the positive results in experimental models and the negative results obtained in clinical trials has led to a change in attitude in the conduct of preclinical studies as well as to a modification of the design of clinical trials, with special attention being paid to patient selection criteria and clinical evaluation. Some neuroprotective drugs, such as citicoline, have shown some efficacy in subgroups of patients with cerebral infarction, even with a therapeutic window of up to 24 h, which would suggest a possible neurorestorative effect. Different degrees of functional recovery, weeks or months after the ischemic event, are currently observed in clinical practice and have been related to endogenous self-repair mechanisms. The growing understanding of the mechanisms involved in the phenomena of brain plasticity and their modulation, together with the possibility of restoring functional deficits by encouraging endogenous neurogenesis or by cell therapy, open up new directions in the treatment of stroke patients.
Therapy of Severe Ischemic Stroke: Breaking the Conventional Thinking
Authors: Schwab S.
Published: December 2005

Large hemispheric infarcts must be recognized in the emergency department as a life-threatening condition that requires prompt and massive intervention. After stabilization of the airway, breathing, and circulation, the initial diagnostic work-up and transfer to a neurointensive care unit should not be delayed. Today several new therapeutic options can be offered. Surgical decompression seems to be effective in lowering increased intracranial pressure, preventing transtentorial herniation and reducing mortality in patients with malignant middle cerebral artery infarction. Another option may be therapeutic hypothermia, which has been found to be neuroprotective in animal models, as well as in clinical studies after cardiac arrest. Experience in stroke patients suggest that hypothermia may offer a new approach for the treatment of acute cerebral ischemia.
Seasonal Patterns of Hospital Treatment for Inflammatory Bowel Disease in Italy
Authors: Soncini M. , Triossi O. , Leo P. , Magni G. , Giglio L.A. , Mosca P.G. , Bertelè A.M. , Pompeo F. , Pietrini L. , Muratori R. , Marone G.P. , Belfiori V. , Sciampa G. , Tanzilli A. , Azzola E. , Ferraris L. , Grasso T. , Caruso S. , Bonecco S. , Casanova B. , Brambilla G. , Frulloni L. , D’Offizi V.
Published: December 2005

Aim: It is still debated whether clinical flare-ups of chronic inflammatory bowel disease follow a seasonal pattern, and the various reports are based on general practitioners’ records or hospital discharge charts. There are, however, no specific figures for treatment in hospital gastroenterology units, which serve as a reference point for these disorders. This study was therefore designed to investigate whether there is a seasonal pattern in admissions for inflammatory intestinal disease in Italy, differing from what is generally known about gastrointestinal pathologies, since there are no nation-wide figures on the subject. Methods: The RING (Ricerca Informatizzata in Gastroenterologia) project is an observational study collecting hospital discharge forms from 22 centers in Italy. Results: From winter 2000 to autumn 2003, the 22 gastroenterology units participating in the RING project discharged 32,357 patients following ordinary hospital admissions. Of these, 2,856 (8.8%) had a main diagnosis of inflammatory bowel disease: 1,541 Crohn’s disease, and 1,315 ulcerative colitis. No seasonal patterns were detected for either category, or when the analysis was done by age, sex and site of disease. Conclusions: The most serious flare-ups of inflammatory bowel disease, i.e. those requiring routine hospital treatment, do not appear to follow any seasonal pattern, regardless of the site of the disease or the patient’s age or sex.
Cyclin D1 Protein Tissue Detection in Laryngeal Cancer
Authors: Segas John V. , Lazaris Andreas C. , Nikolopoulos Thomas P. , Kavantzas Nikolaos G. , Lendari Irene E. , Tzagkaroulakis Antonios M. , Patsouris Efstratios S. , Ferekidis Eleftherios A.
Published: December 2005

Cyclin D1 (CCND1) is a set of periodic regulatory proteins that is believed to govern cell cycle transit from G1 into S phase. Overexpression of CCND1 leads to abnormal cellular proliferation which underlies processes of tumorigenesis; CCND1 can thus function as a cooperative oncogene in cell transformation. In the present study we investigate the immunohistochemical expression of CCND1 in a well-documented series of 58 laryngeal squamous cell carcinomas (LSCC) and search for statistical associations between CCND1 index and various clinicopathological parameters including several immunomarkers’ expression as well as patients’ disease-free survival. Tissue sections from archival paraffin blocks were stained using the avidin-biotin-peroxidase complex method; the H-295 rabbit polyclonal antibody was applied at dilution of 1:150. The percentage of CCND1 immunoreactive tumor cells for each tumor was counted by an image analysis system. CCND1 staining was confined to cell nuclei and, in the examined samples, ranged from undetectable (i.e. 0% of tumor cells, n = 6) to the majority of tumor cells (i.e. 89% of tumor cells) with mean value: 15.73%. In tumor adjacent, non invasive lesions, strong CCND1 staining was noticed in areas with cellular atypia. In cases with nodal metastases, no change in CCND1 expression in the nodal metastases compared with the primary tumors was observed. p53 protein accumulation in malignant cells was positively linked with CCND1 index (Mann-Whitney U: 205.5, p = 0.034). CCND1 expression appears to be an early event in processes of tumorigenesis and tumor progression in some LSCC. Apart from p53 protein accumulation, CCND1 immunohistochemical expression does not seem to correlate with nodal metastasis, disease recurrence or any other clinicopathological prognostic indicator.
Mandibular Access Osteotomies in Oral Cancer
Authors: Støre Geir , Boysen Morten
Published: December 2005

Purpose: Mandibulotomy is a recognised surgical approach to tumours of the oral cavity and oropharynx. However, the nature and frequency of complications associated with this procedure varies in many studies. We report our experience with access osteotomies, with special reference to radionecrotic complications. Procedures: A retrospective study of 18 consecutive patients undergoing planned mandibular osteotomies as part of the ablative surgery was performed. Various flaps were used for tissue closure: myocutaneous flap (n = 8), nasolabial flap (n = 1) and radial forearm free vascular flap (n = 6). Primary closure using remaining mucosa was achieved in 3 patients. Results: Complete healing of the osteotomy was noted in 13 patients, and 5 patients (27%) developed major wound healing problems and osteoradionecrosis. Dental problems with resorption of the alveolar bone crest and loosening of the teeth adjacent to the osteotomy were seen in 7 patients (39%). Conclusions: Adequate soft-tissue closure is as important for a successful outcome as the type of osteotomy and fixation method applied. Extraction of the incisors is recommended for easier and safer tissue adaptation, especially when flaps are used for coverage and the osteotomy site will be included in the radiation field.
Infiltrating Aggressive Epitheliosis of the Temporal Bone: A Newly Described Disease Entity
Authors: Manni J.J. , Pauwels P.A.A. , Creytens D.M.K.V.
Published: December 2005

Two patients with a highly destructive histologic nondysplastic squamous epithelial lesion of the temporal bone are described. Both tumors were characterized by the production of copious amounts of keratin material which progressively extended in the temporal bone, surrounding bony structures, soft tissue and intracranially, with concomitant functional disorders. Only small amounts of epithelial cells were found. CT scanning revealed extensive and progressive destruction of the temporal bone, skull base in both patients, clivus and arch of atlas in one patient, besides intracranial and intracerebellar abscess formation. Despite extensive surgical therapy, the disorder was unmanageable. Histology showed a normal squamous epithelial basal cell layer with remarkable acanthosis and extensive hyperkeratosis. Material obtained at autopsy demonstrated intracerebellar extension of keratin material in one patient and in the hemicerebellectomy specimen of the other patient. To our knowledge, this disease entity has not been reported before.
Cognitive and Demographic Determinants of Dementia in Depressed Patients with Subjective Memory Complaints
Authors: von Gunten Armin , Giannakopoulos Panteleimon , Duc René
Published: December 2005

Background: Previous studies showed that late-life depression with subjective memory complaints (SMC) may be associated with an increased risk of developing dementia. However, not all such patients have cognitive decline. The aim of this longitudinal study was to identify possible clinical determinants of progressive deterioration in depressed elderly patients with SMC. Method: Forty-one consecutive patients referred to a memory clinic because of persistent SMC were investigated and received an ICD-10 diagnosis of mild to moderate depression. Over a mean follow-up period of 15 months, 9 of them (22%) developed dementia. Statistical analysis included Mann-Whitney U and Fisher’s exact tests as well as univariate and multivariate logistic regression analyses to assess the relationship between cognitive decline and clinical, demographical and neuropsychological characteristics at baseline. Results: Age at baseline was associated with subsequent dementia, and performance on immediate verbal prose recall and a visual organization test at the initial assessment were worse in those who showed cognitive decline. In a multivariate model, age and immediate recall predicted 32.7% of the cognitive variability, with an additional 2.4% when a visual organization test was added. There was no correlation between cognitive performance and severity of depression at baseline. The study was limited by a small sample size, the nondistinction of depressive subtypes and the absence of a formal neuropsychological assessment on follow-up. Conclusion: Impairment of the executive component of working memory as well as limited access to visual knowledge may predict cognitive deterioration in depressed patients with subjective memory complaints.
Progesterone-Receptive Dopaminergic and Neuropeptide Y Neurons Project from the Arcuate Nucleus to Gonadotropin-Releasing Hormone-Rich Regions of the Ovine Preoptic Area
Authors: Dufourny Laurence , Caraty Alain , Clarke Iain J. , Robinson Jane E. , Skinner Donal C.
Published: December 2005

Progesterone inhibits gonadotropin-releasing hormone (GnRH) secretion in sheep through an interneuronal system located in the mediobasal hypothalamus. This study focused on known inhibitors of GnRH secretion in sheep, dopamine and neuropeptide Y (NPY). As the distributions of tyrosine hydroxylase (TH)- and NPY-immunoreactive neurons overlap with progesterone receptors (PR) in the arcuate nucleus, we hypothesized that, if these neurons mediate, at least partially, the inhibitory feedback signal of progesterone, then they should co-express PRs. Fluorogold (FG), a retrograde tracer, was injected into the preoptic area of ovariectomized ewes pretreated with estrogen and progesterone. When the FG injection site encompassed at least 80 GnRH neurons, sections from the arcuate nucleus were processed using dual immunocytochemistry for PR and either TH or NPY. We found that 30% of PR-immunoreactive, 12% of TH-containing and 21% of NPY-synthesizing neurons project toward this GnRH-rich region. Of the PR/TH dual-labeled cells, which represent 21% of PR and 31% of TH cells, respectively, 22% displayed FG labeling. Of the PR/NPY neurons, which account for 19% of PR and 67% of NPY neurons, respectively, 26% were FG fluorescent. This study suggests that subsets of arcuate nucleus dopaminergic and NPY neurons may transduce, at least in part, the progesterone-mediated inhibition of GnRH secretion.
Symptom-Based Questionnaire for Differentiating COPD and Asthma
Authors: Tinkelman David G. , Price David B. , Nordyke Robert J. , Halbert R.J. , Isonaka Sharon , Nonikov Dmitry , Juniper Elizabeth F. , Freeman Daryl , Hausen Thomas , Levy Mark L. , Østrem Anders , van der Molen Thys , van Schayck Constant P.
Published: December 2005

Background: Many patients with obstructive lung disease (OLD) carry an inaccurate diagnostic label. Symptom-based questionnaires could identify persons likely to need spirometry. Objectives: We prospectively tested questions derived from a comprehensive literature review and an international Delphi panel to help identify chronic OLD (COPD) in persons with prior evidence of OLD. Methods: Subjects were recruited via random mailing to primary-care practices in Aberdeen, Scotland, and Denver, Colorado. Persons aged 40 and older reporting any prior diagnosis of OLD or any respiratory medications in the past year were enrolled. Participants answered 54 questions covering demographics and symptoms and underwent spirometry with reversibility testing. A study diagnosis of COPD was defined by fixed airway obstruction as measured by post-bronchodilator FEV1/FVC <0.70. We examined ability of individual questions in a multivariate framework to discriminate between persons with and without the study diagnosis of COPD. Results: 597 persons completed all investigations and proceeded to analysis. The list of 54 questions yielded 52 items for analyses, which was reduced to 19 items for entry into a multivariate regression model. Nine items had significant relationships with the study diagnosis of COPD, including increased age, pack-years, worsening cough, breathing-related disability or hospitalization, worsening dyspnea, phlegm quantity, cold going to the chest, and receipt of treatment for breathing. Individual items yielded odds ratios ranging from 0.33 to 20.7. This questionnaire demonstrated a sensitivity of 72.0 and a specificity of 82.7. Conclusions: A short, symptom-based questionnaire identifies persons more likely to have COPD among persons with prior evidence of OLD.
Rheumatic and Nonrheumatic Valvular Heart Disease
Authors: Essop Mohammed Rafique , Nkomo Vuyisile T.
Published: December 2005

Background—

Unlike the Western world, valvular disease ranks among the major cardiovascular afflictions in Africa. Acute rheumatic fever and chronic rheumatic valvular disease in their most virulent form are still commonly encountered and impose a huge burden on limited healthcare resources.

Methods and Results—

We performed a systematic review of the literature with PubMed using
rheumatic fever
,
rheumatic heart disease
,
valvular disease
,
warfarin anticoagulation
, and
pregnancy
as search items. Literature emanating from Africa was emphasized. Epidemiology, current concepts on pathogenesis, and aspects of the medical and surgical management of this disease as seen from an African perspective are presented. The association of pregnancy with mitral stenosis is common and may be fatal if not managed appropriately. A practical approach to these patients is presented to optimize maternal and fetal outcome. Pregnant patients with mechanical valves require careful attention to ensure maternal survival and prevent fetal warfarin embryopathy. Prolonged subcutaneous heparin and frequent monitoring of the partial thromboplastin time are impractical in this setting, and the merits of different anticoagulation regimens are discussed. Congenital submitral aneurysms are a unique cause of mitral regurgitation, with the vast majority of cases originating from sub-Saharan Africa. Although the precise etiology is as yet unclear, the clinical and echocardiographic features are sufficiently characteristic to allow a preoperative diagnosis to be made. Transesophageal echocardiography allows much better definition of the size and anatomic relationships of the aneurysm. Surgical resection can be difficult but is usually curative. Mitral valve prolapse and endocarditis constitute the remaining frequent causes of valvular disease and are discussed briefly.

Conclusions—

The spectrum and presentation of valvular disease in Africa are uniquely different from elsewhere. Together with socioeconomic issues and the HIV pandemic, this fact makes it imperative that further epidemiological and clinical studies be undertaken and guidelines developed that are appropriate to the practice of medicine on the African continent.
Epidemiology and Etiology of Cardiomyopathy in Africa
Authors: Sliwa Karen , Damasceno Albertino , Mayosi Bongani M.
Published: December 2005

Background—

Cardiomyopathy, an often irreversible form of heart muscle disease that is associated with a dismal outcome, is endemic in Africa. The primary objective of this review was to summarize the current state of knowledge on the epidemiology and etiology of cardiomyopathy in people living in Africa and to identify new avenues for research.

Methods and Results—

We searched MEDLINE (January 1, 1966, through February 12, 2005) and reference lists of articles for relevant references. Unlike other parts of the world in which cardiomyopathy is rare, dilated cardiomyopathy is a major cause of heart failure throughout Africa. Similarly, peripartum cardiomyopathy is ubiquitous on the continent, with an incidence ranging from 1 in 100 to 1 in 1000 deliveries. There is an apparent marked regional variation in the pathogenesis of dilated cardiomyopathy and peripartum cardiomyopathy, underlining the heterogeneity of causative factors in these conditions. By contrast, endomyocardial fibrosis is restricted to the tropical regions of East, Central, and West Africa. Although the pathogenesis of endomyocardial fibrosis is not fully understood, it seems that the conditioning factors are geography and diet, the triggering factor may be an as yet unidentified infective agent, and the perpetuating factor is eosinophilia. Although epidemiological studies are lacking, hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy seem to have characteristics similar to those of other populations elsewhere in the world.

Conclusions—

There is a need for large-scale epidemiological studies of the incidence, prevalence, determinants, and outcome of cardiomyopathy in Africa to inform strategies for the treatment and prevention of heart muscle disease on the continent.
Risk Factors Associated With Myocardial Infarction in Africa
Authors: Steyn Krisela , Sliwa Karen , Hawken Steven , Commerford Patrick , Onen Churchill , Damasceno Albertino , Ounpuu Stephanie , Yusuf Salim
Published: December 2005

Background—

Cardiovascular disease (CVD) is rising in low-income countries. However, the impact of modifiable CVD risk factors on myocardial infarction (MI) has not been studied in sub-Saharan Africa (SSA). Therefore, we conducted a case-control study among patients with acute MI (AMI) in SSA to explore its association with known CVD risk factors.

Methods and Results—

First-time AMI patients (n=578) were matched to 785 controls by age and sex in 9 SSA countries, with South Africa contributing ≈80% of the participants. The relationships between risk factors and AMI were investigated in the African population and in 3 ethnic subgroups (black, colored, and European/other Africans) and compared with those found in the overall INTERHEART study. Relationships between common CVD risk factors and AMI were found to be similar to those in the overall INTERHEART study. Modeling of 5 risk factors (smoking history, diabetes history, hypertension history, abdominal obesity, and ratio of apolipoprotein B to apolipoprotein A-1) provided a population attributable risk of 89.2% for AMI. The risk for AMI increased with higher income and education in the black African group in contrast to findings in the other African groups. A history of hypertension revealed higher MI risk in the black African group than in the overall INTERHEART group.

Conclusions—

Known CVD risk factors account for ≈90% of MI observed in African populations, which is consistent with the overall INTERHEART study. Contrasting gradients found in socioeconomic class, risk factor patterns, and AMI risk in the ethnic groups suggest that they are at different stages of the epidemiological transition.
Muslim-Christian Encounters in Masuccio Salernitano's Novellino
Authors: Attar Karina
Published: December 2005

Close textual and contextualized analysis of two novellas drawn from Masuccio Salernitano's mid-fifteenth-century collection of short stories, Il Novellino, shows that, while the tales appear to present antithetical notions of Muslim identity, they also blur the categories of good and evil through often over-lapping positive and negative depictions of both Christian and Muslim protagonists. Both narratives discussed are also set within similar contexts (the guerra del corso, maritime travel, enslavement and ransom, inter-racial sexual relations) and can thus function as partial records of particular fifteenth-century cultural and social experiences. Although Salernitano's narratives have often been read as moralizing tales through which the author sought to expose the vices he perceived in society, as this article seeks to show, much more is at stake. The novellas offer significant insights into mid-fifteenth-century notions of Muslim identity and preoccupations about Christian-Muslim encounters and reflect a panorama of contemporary historical and social realities on a scale and in a fashion that remained unparalleled in the subsequent novella tradition.
What the Future May Bring
Authors: Hjerm Mikael
Published: December 2005

The educational system is assumed to facilitate our full participation in society by laying the foundation for participatory rights and possibilities and at the same time strengthening civil society by fostering its individuals into democratic citizens. The question is what the future may bring if continuous economic cutbacks in the educational system lead to diminishing resources for the teaching of values of liberal democracy and multiculturalism. I try to answer this question by focusing on how xenophobia among Swedish teenage school adolescents is related to other values in the democratic system. The empirical data are drawn from a national sample comprising more than 6000 adolescents between 14 and 15 years of age. I conclude that willingness to participate actively in the democratic process through both political participation and other legal action relates negatively to xenophobia, whereas willingness to undertake acts of civil disobedience and mistrust in the political institutions relate positively to xenophobia. These findings raise the question of what the educational system should focus on in trying to combat racism and xenophobia and of what will happen in the future in times of diminishing resources.
Working Conditions and Time Use
Authors: Blekesaune Morten
Published: December 2005

What we do when we get home is influenced by what we do at work. In this article I analyse the relationship between market work and domestic activities from the perspectives of economic theories of time use, i.e. the work–leisure model (compares income work versus other activities) and the household production model (compares income work and household work), and sociological theory treating the issue of how leisure activities compensate for work strains. The empirical analysis of time use is based on the Norwegian time-use survey from 2000–2001. Estimates on working conditions are based on the Norwegian level of living surveys from 1996 and 2000 for 100 occupations found in both surveys. The analyses indicate that both physical strains and low autonomy at the place of employment lead to an allocation of time away from paid work towards unpaid work and leisure, but with considerable differences for men and women. The findings indicate that working conditions are part of the trade-off between paid and unpaid work, and that leisure activities may compensate for human needs being neglected in the workplace.
Social Background, Credential Inflation and Educational Strategies
Authors: Van de Werfhorst Herman G. , Andersen Robert
Published: December 2005

The primary goal of this article is to examine the impact of credential inflation on educational attainment in twentieth-century United States. To do so, we create a measure of ‘intergenerational credential inflation’ (intergeneration inflation factor) and include it in regression models predicting educational transitions. Using the General Social Surveys of 1972–2000, we find that people are generally less likely to invest in schooling if its value is relatively low. An exception is the final transition to a postgraduate degree, where we find that when its value is low children of parents with postgraduate education are more likely to take it. This finding supports relative risk aversion theory, which assumes that the main goal of children is to avoid downward social class mobility. Perhaps most important, we find that credential inflation is particularly influential on transition probabilities if parents had made the same transition. This pattern is consistent with the information differential thesis that children are more informed about the value of education if their parents acquired it.
Johan Asplund: Ideas and Position
Authors: Eriksson Björn
Published: December 2005

Johan Asplund holds an exceptional position in Swedish sociology. Although widely read, his books do not fit the normal scientific pattern, which makes him into something of a riddle to many sociologists. In this essay, I consider Asplund's work as a whole, sketch the progression of central ideas and portray his way of working. I also attempt to characterize Johan Asplund's position in Swedish sociology, and to delineate some of its consequences for the reception of his work.