bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful Laser‐Assisted Removal of an Infected ICD Lead with a Large Vegetation
Authors: CALTON RAJNEESH , CAMERON DOULAS , CUSIMANO ROBERT J. , MERCHANT NAEEM , CHAUHAN VIJAY
Published: August 2006

Infective endocarditis involving transvenous pacing leads is an uncommon but potentially lethal complication of implantable cardioverter‐defibrillator (ICD) implantation. Complete removal of the device and the leads is presently considered to be the optimal treatment in such patients and laser‐assisted lead removal is an effective and safe nonthoracotomy approach. However, large vegetations (>10 mm) attached to the lead limit nonthoracotomy explantation because of the potential for hemodynamically embarrassing pulmonary embolization. Laser extraction of leads with vegetation area >300 mm2 has rarely been reported. In this case report, we describe a patient with an infected ICD lead with vegetation greater than 41 × 12.5 mm (512 mm2) in size that was explanted with laser‐assistance. The resulting pulmonary embolus produced a 33 × 20 mm pulmonary infarction without hemodynamic or respiratory compromise.
Avoidance of Electromagnetic Interference to Implantable Cardiovertor‐Defibrillator During Atrioventricular Node Ablation for Atrial Fibrillation Using Transvenous Cryoablation
Authors: SIU CHUNG‐WAH , TSE HUNG‐FAT , LAU CHU‐PAK
Published: August 2006

Transient or permanent malfunction of implantable device may result from electromagnetic interference during delivery of radiofrequency energy for treatment of cardiac arrhythmias. Therefore, there is a clinical need for an alternative energy source for cardiac arrhythmia ablation in patients with implantable device. This report presents a case of the absence of electromagnetic interference to an implantable cardioverter defibrillator during atrioventricular nodal ablation for atrial fibrillation to avoid inappropriate shock.
Management of Arterial Injuries Caused by Laser Extraction of Indwelling Venous Pacemaker and Defibrillator Leads
Authors: LAWTON JENNIFER S. , MOON MARC R. , CURCI JOHN A. , RUBIN BRIAN G. , SMITH TIMOTHY W. , GLEVA MARYE J. , DAMIANO RALPH J.
Published: August 2006

The use of laser technology for the removal of pacemaker and defibrillator leads has decreased the lead extraction time and improved the success rate for complete lead removal when compared to traditional techniques. However, this extraction method may be associated with significant complications. This report documents two cases of iatrogenic arteriovenous fistula created by laser lead extraction. Endovascular repair of these fistulas provides an effective and less invasive alternative to open repair.
Implant of a Biventricular Pacemaker in a Patient with Dextrocardia and Persistent Left Superior Vena Cava
Authors: POTT CHRISTIAN , BRAR RAMANDEEP , VALDERRÁBANO MIGUEL
Published: August 2006

Congenital anomalies of the heart can pose challenges to cardiac invasive procedures. Here, we present the case of a 40‐year‐old man with the combination of dextrocardia, a persistent left superior vena cava, and idiopathic dilated cardiomyopathy. We describe the successful implantation of a biventricular pacemaker–defibrillator under this complex anatomic condition.
Characterization of Conduction Recovery Across Left Atrial Linear Lesions in Patients with Paroxysmal and Persistent Atrial Fibrillation
Authors: ROSTOCK THOMAS , O'NEILL MARK D. , SANDERS PRASHANTHAN , ROTTER MARTIN , JAÏS PIERRE , HOCINI MÉLÈZE , TAKAHASHI YOSHIHIDE , SACHER FRÉDERIC , JÖNSSON ANDERS , HSU LI‐FERN , CLÉMENTY JACQUES , HAÏSSAGUERRE MICHEL
Published: August 2006

Background: Left atrial (LA) linear lesions are effective in substrate modification for atrial fibrillation (AF). However, achievement of complete conduction block remains challenging and conduction recovery is commonly observed. The aim of the study was to investigate the localization of gap sites of recovered LA linear lesions.

Methods and Results: Forty‐eight patients with paroxysmal (n = 26) and persistent/permanent (n = 22) AF underwent repeat ablation after pulmonary vein (PV) isolation and LA linear ablation at the LA roof and/or mitral isthmus due to recurrences of AF or flutter. In 35 patients, conduction through the mitral isthmus line (ML) had recovered whereas roof‐line recovery was observed in 30 patients. The gaps within the ML were distributed to the junction between left inferior PV and left atrial appendage in 66%, the middle part of the ML in 20%, and in 8% to the endocardial aspect of the ML while only 6% of lines showed an epicardial site of recovery. The RL predominantly recovered close to the right superior PV (54%) and less frequently in the mid roof or close to the left PV (both 23%). Reablation of lines required significantly shorter RF durations (ML: 7.24 ± 5.55 minutes vs 24.08 ± 9.38 minutes, RL: 4.24 ± 2.34 minutes vs 11.54 ± 6.49 minutes; P = 0.0001). Patients with persistent/permanent AF demonstrated a significantly longer conduction delay circumventing the complete lines than patients with paroxysmal AF (228 ± 77 ms vs 164 ± 36 ms, P = 0.001).

Conclusions: Gaps in recovered LA lines were predominantly located close to the PVs where catheter stability is often difficult to achieve. Shorter RF durations are required for reablation of recovered linear lesions. Conduction times around complete LA lines are significantly longer in patients with persistent/permanent AF as compared to patients with paroxysmal AF.
Clinical Course and Risk Stratification of Patients Affected with the Jervell and Lange‐Nielsen Syndrome
Authors: GOLDENBERG ILAN , MOSS ARTHUR J. , ZAREBA WOJCIECH , MCNITT SCOTT , ROBINSON JENNIFER L. , QI MING , TOWBIN JEFFREY A. , ACKERMAN MICHAEL J. , MURPHY LAURA
Published: August 2006

Introduction:
Data regarding risk factors and clinical course of patients affected with Jervell and Lange‐Nielsen syndrome (JLNS), an autosomal recesssive form of the congenital long‐QT syndrome (LQTS), are limited to several reported cases and a retrospective analysis.

Methods and Results:
We prospectively followed‐up 44 JLNS patients from the U.S. portion of the International LQTS Registry and compared their clinical course with 2,174 patients with the phenotypically determined dominant form of LQTS (Romano‐Ward syndrome [RWS]) and a subgroup of 285 patients with type 1 LQTS (LQT1). Mean (±SD) corrected QT interval (QTc) in the JLNS, RWS, and LQT1 groups were 548 ± 73, 500 ± 48, and 502 ± 46 msec, respectively (P < 0.001). The cumulative rates of cardiac events from birth through age 40 among JLNS and RWS patients were 93% (mean [±SD] age: 5.0 ± 7.0 years) and 54% (mean [±SD] age: 14.2 ± 9.3 years), respectively (P < 0.001). The JLNS:RWS and JLNS:LQT1 adjusted hazard ratios (HR) for cardiac events were highest among patients with a baseline QTc ≥550 msec (HR = 15.83 [P < 0.001] and 13.80 [P < 0.001], respectively). Among JLNS patients treated with beta‐blockers, the cumulative probability of LQTS‐related death was 35%; defibrillator therapy was associated with a 0% mortality rate during a mean (±SD) follow‐up period of 4.9 ± 3.4 years.

Conclusions:
Patients with JLNS experience a high rate of cardiac and fatal events from early childhood despite medical therapy. Defibrillator therapy appears to improve outcome in this high‐risk population, although longer follow‐up is needed to establish its long‐term efficacy.
Ablation of Atrial Fibrillation in Humans Using a Balloon‐Based Ablation System: Identification of the Site of Phrenic Nerve Damage Using Pacing Maneuvers and CARTO
Authors: ANTZ MATTHIAS , CHUN KR JULIAN , OUYANG FEIFAN , KUCK KARL‐HEINZ
Published: August 2006

Injury of the phrenic nerve during pulmonary vein isolation for the treatment of atrial fibrillation is a well‐recognized complication, especially when performing ostial ablations or using balloon‐based technologies. This report describes the exact anatomical location of phrenic nerve injury during an attempt of right superior pulmonary vein isolation using a balloon that delivered high intensity focused ultrasound. Electroanatomical three‐dimensional CARTO (Biosense Webster, Diamond Bar, CA, USA) mapping of the superior caval vein, the right and left atrium, as well as the right superior pulmonary vein was performed in conjunction with meticulous phrenic nerve pacing maneuvers before and after ablation and showed that the nerve was damaged at the level of the antero‐inferior ostium of the right superior pulmonary vein. Diaphragmatic denervation occurred despite using an oversized balloon fluoroscopically placed at the atrial side of the pulmonary vein ostium.
New Perspectives on the Role of Autonomic Nervous System in the Genesis of Arrhythmias
Authors: CHEN LAN S. , ZHOU SHENGMEI , FISHBEIN MICHAEL C. , CHEN PENG‐SHENG
Published: August 2006

Sudden cardiac death (SCD) is a major cause of morbidity and mortality in patients with coronary artery diseases and myocardial infarction (MI). There is a circadian variation of the frequency of SCD. Beta‐blocker therapy significantly reduces the incidence of SCD after MI. These clinical observations suggest a close association between ventricular arrhythmia and sympathetic activity in patients with MI. Following injury, peripheral nerves undergo Wallerian degeneration, which may be followed by neurilemma cell proliferation and axonal regeneration (nerve sprouting), resulting in sympathetic hyperinnervation. It is possible that the increased innervation after myocardial injury may result in increased sympathetic nerve density, which in turn increases the propensity for cardiac arrhythmia. While this Nerve Sprouting Hypothesis seemed to be intuitive, there was no experimental proof of a causal link between sympathetic nerve sprouting and arrhythmogenesis. We therefore performed several studies to determine the relationship between nerve sprouting and cardiac arrhythmia. We also performed direct sympathetic nerve recording in an animal model of SCD. We found that cardiac sympathetic nerves are highly plastic. In addition to MI and rapid pacing, nerve sprouting and heterogeneous sympathetic hyperinnervation may also be induced by radiofrequency ablation, hypercholesterolemia, and stem cells transplantation. The coexistence of denervated and hyperinnervated area in the diseased myocardium could result in increased electrophysiological heterogeneity during sympathetic activation, leading to ventricular arrhythmia and SCD.
The Relation Between Mitral Annular Calcification and Mortality in Patients Undergoing Diagnostic Coronary Angiography
Authors: Willens Howard J. , Chirinos Julio A. , Schob Alan , Veerani Anila , Perez Armando J. , Chakko Simon
Published: August 2006

To determine whether the observed association between mitral annular calcification (MAC) and mortality is independent of the severity of coronary artery disease (CAD), we analyzed data from 134 male veterans (age 63 ± 10 years) followed for 5 years who had undergone diagnostic coronary angiography and transthoracic echocardiography within 6 months of each other. Echocardiograms were retrospectively reviewed for the presence of MAC. The relation of MAC to all‐cause mortality was analyzed using logistic regression, and odds ratios (OR) were calculated. MAC was present in 49 (37%) subjects. Over the 5‐year follow‐up period, 38 (28%) patients expired. Five‐year survival was 80% for subjects without MAC and 56% for subjects with MAC (P = 0.003). MAC (OR = 3.16, 95% confidence interval [CI]= 1.43–6.96, P = 0.003), ejection fraction (OR = 0.76, 95% CI = 0.59–0.97, P = 0.02), and left main CAD (OR = 2.70, 95% CI = 1.11–6.57, P = 0.02) were significantly associated with mortality in univariate analysis. After adjusting for left ventricular ejection fraction, number of obstructed coronary arteries and the presence of left main coronary artery stenosis, MAC significantly predicted death (OR = 2.48, 95% CI = 1.09–5.68, P = 0.03). Similarly, after adjusting for predictors of MAC, including ejection fraction, age, diabetes, peripheral vascular disease, and heart failure, MAC remained a significant predictor of death (OR = 2.38, 95% CI = 1.02–5.58, P = 0.04). MAC also predicted death independent of smoking status, hypertension, serum creatinine, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and C‐reactive protein levels (OR = 3.98, 95% CI = 1.68–9.40, P = 0.001). MAC detected by two‐dimensional echocardiography independently predicts mortality and may provide an easy‐to‐perform and inexpensive way to improve risk stratification.
Left and Right Ventricular Function Is Impaired in Behçet's Disease
Authors: Yavuz Bunyamin , Sahiner Levent , Akdogan Ali , Abali Gulcan , Aytemir Kudret , Tokgozoglu Lale , Kalyoncu Umut , Karadag Omer , Kiraz Sedat , Ertenli Ihsan , Calguneri Meral , Nazli Nasıh
Published: August 2006

Objectives: Subclinical cardiac involvement may occur in patients with Behçet's disease (BD). The purpose of our study was to assess the noninvasive parameters of biventricular function derived from Doppler tissue imaging (DTI) of the tricuspid and mitral annular motion in BD. Methods: Twenty‐one patients with BD and 20 control subjects were enrolled in this study. All subjects were selected to exclude those with cardiovascular risk factors. Standard echocardiography and pulsed DTI were obtained in every patient. Results: Peak systolic (13.71 ± 2.09 vs 20.01 ± 1.57, P < 0.001), peak early diastolic (11.26 ± 2.52 vs 15.35 ± 2.06, P < 0.001) tricuspid annular velocities were significantly lower in patients than controls. Peak systolic (8.68 ± 1.4 vs 12.25 ± 1.7, P < 0.001), peak early diastolic (7.89 ± 1.07 vs 9.94 ± 1.12, P < 0.001), and peak end diastolic (8.30 ± 1.32 vs 9.23 ± 0.91, P = 0.013) lateral mitral annular velocities were significantly lower in patients than controls. Conclusions: We demonstrated that myocardial velocities, were affected in patients with BD. Therefore, we conclude that right and left ventricular function is impaired in patients with BD.
Incidence of Pericardial Effusion in Females Stimulated in “in Vitro Fertilization” Program
Authors: Marek Dan , Sovová Eliška , Dostál Jiří , Oborná Ivana , Kociánová Eva , Machač Štěpán , Talaš Miloslav , Lukl Jan , Březinová Jana
Published: August 2006

Aims: To evaluate the incidence of pericardial irritation in females after hormonal stimulation in in vitro fertilization program, and to set its clinical significance as a symptom of ovarian hyperstimulation syndrome (OHSS). Patients: Thirty‐nine females, aged 30 ± 5 years (20–46), with a normal echo finding prior to hormonal stimulation. Methods: Serial echocardiography: baseline A, in hCG application B, embryotransfer C. Results: Thirty‐nine, 39, and 35 echocardiography examinations were done on A, B, and C respectively. On B, in 7 (17.9%) of 39 patients either new pericardial effusion “1,” increased pericardial echogenity “2,” or both “3” were detected (4 patients, 2 patients, and 1 patient, i.e., 10.3%, 5.1%, and 2.6% respectively.). On C, in 8 of 35 patients (22.8 %) abnormalities were detected: “1” in 2 patients (5.7 %), “2” in 1 patient (2.9 %), and “3” in 5 patients (14.2 %). No clinical symptoms related to these findings were present. No OHSS occurred in these patients. On the contrary, clinical OHSS developed later in 2 patients, classified as medium degree (1 patient) and severe degree (1 patient)—both patients had negative echo during follow‐up
. Conclusion: Echocardiographic signs of mild pericardial irritation may appear also in patients with no clinical signs of OHSS. The incidence of these changes increases during stimulation procedure. Development of OHSS may not be preceded by the incidence of these warning signs. Consequently, routine echocardiographic examination during stimulation is not indicated, since significant pericardial effusion is rather a late sign of OHSS.
Relationship Between Outflow Obstruction and Left Ventricular Functional Impairment in Hypertrophic Cardiomyopathy: A Doppler Echocardiographic Study
Authors: Araujo Aloir Q. , Arteaga Edmundo , Ianni Barbara M. , Fernandes Fabio , Ramires Felix J. , Buck Paula C. , Salemi Vera M. C. , Nastari Luciano , Mady Charles
Published: August 2006

Left ventricular outflow tract (LVOT) obstruction is predictive of a worse outcome in hypertrophic cardiomyopathy (HCM). In a detailed Doppler echocardiographic study of 178 selected HCM patients, the group of patients (n = 73) with the obstructive form (resting peak gradient ≥ 30 mmHg) presented more hypertrophy and poorer systolic and diastolic left ventricular (LV) functions than the HCM group (n = 105) without obstruction. LVOT peak gradient was positively correlated with hypertrophy (P < 0.0001) and negatively to tissue Doppler mitral annulus systolic (P = 0.0001) and early diastolic (P < 0.0001) velocities. The gradient significantly correlated with E/Ea ratio (r = 0.67; P < 0.0001). By multiple regression, LVOT gradient was related to E/Ea, LV maximal thickness and left atrial size. In comparison with patients without obstruction, patients with obstruction presented greater hypertrophy (P < 0.0001), lower systolic and early diastolic mitral annulus velocities (both P < 0.0001), higher E/Ea ratio (P < 0.0001) and higher global function index (P < 0.0001). In HCM, beyond the effects on hypertrophy, LVOT obstruction is an independent determinant of LV functional abnormalities.
Detection of Patency of Internal Mammary Artery Grafts to the Left Anterior Descending Artery by Transthoracic Doppler Echocardiography
Authors: Tasaki Hiromi , Yamashita Kazuhito , Hirakawa Noriko , Suzuka Hiroshi , Morishita Tsuyoshi , Okazaki Masahiro , Nakashima Yasuhide , Nagano Ichiro
Published: August 2006

Background: To determine whether a coronary artery bypass graft (CABG) is patent, we examined the flow of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) by transthoracic Doppler echocardiography (TTDE). Patients and Methods: Eighty‐seven patients with CABG (LIMA to distal LAD) were enrolled in the study. The flows from each subject were analyzed by three criteria: mosaic flow at the anastomosis site, distal anterograde flow (ante flow), and proximal retrograde flow (retro flow). Results: On angiography, 79 grafts were patent and eight were not. TTDE study of 79 patent grafts demonstrated mosaic, ante, and retro flow in 63 (79.7%), 74 (93.7%), and 35 grafts (49.4%), respectively. The averaged diastolic peak velocity of ante flow was 26.3 ± 11.0 cm/sec, significantly higher than that (4.8 ± 7.1 cm/sec, P ≤ 0.0001) in eight patients without patent grafts. These eight patients had no mosaic or retro flow and only three had ante flow. The accuracies to predict patency were 81.6%, 90.8%, and 49.4% for mosaic, ante, and retro flows, respectively. Conclusions: The existence of mosaic, retro, or sufficient ante flows strongly indicated the patency of LIMA to the LAD. When symptoms are possible to be derived from the occlusion of CABG to LAD, TTDE is a promising method to examine whether a LIMA to LAD bypass is patent.
Tricuspid Annular Systolic Velocity: A Useful Measurement in Determining Right Ventricular Systolic Function Regardless of Pulmonary Artery Pressures
Authors: Saxena Neil , Rajagopalan Navin , Edelman Kathy , López‐Candales Angel
Published: August 2006

Assessment of right ventricular (RV) systolic function can be somewhat difficult, particularly in pulmonary hypertension (PH). RV fractional area change (FAC) and tricuspid valve annular motion (TAPSE) although useful in the assessment of RV performance, their use can be sometimes limited and tedious. Thus, a quicker but yet reliable alternative is needed. Accordingly, we compared peak tricuspid annulus systolic (TA Sa) velocities derived from Doppler tissue imaging (DTI) with both RVFAC and TAPSE to estimate RV function in 52 patients (53 ± 16 years) with varying degrees of PH. In this group, mean was RVFAC 49 ± 20, TAPSE was 2.3 ± 0.7 cm, peak TA Sa velocity by DTI was 10.4 ± 3.8 cm/s, left ventricular systolic function was 57 ± 18%, and pulmonary artery systolic pressure was 47 ± 28 mmHg. An excellent correlation was noted between TAPSE and RVFAC (r = 0.91, P < 0.001). Similar correlations were noted between peak TA Sa velocity and RVFAC (r = 0.84, P < 0.001) and between peak TA Sa velocity and TAPSE (r = 0.90, P < 0.001). A TA Sa >10.5 cm/s identified individuals with both a normal RV function and without significant PH. Therefore, we conclude that TA Sa velocity, an easily obtainable DTI measure, that has an excellent correlation with more time‐consuming methods to assess RV systolic function regardless of the degree of PH should be routinely assessed during the initial evaluation and eventual follow‐up of patients either at risk or with documented PH.
Evaluation of the Electrocardiographic Criteria for Left Ventricular Hypertrophy With Use of Three‐Dimensional Echocardiography
Authors: Gopal Aasha S. , Butkevich Alexander , Roychoudhury Debasish , Phillips Robert A.
Published: August 2006

Background: Left ventricular hypertrophy (LVH) is a common condition that carries an increased risk of cardiovascular events. Use of ECG in detection of LVH is limited because of the reported low sensitivity. Conventional echocardiographic techniques used as the standard for estimating left ventricular (LV) mass have limitations related to the position of the image plane and shape of the ventricle. Three‐dimensional echocardiography is free of these limitations and therefore is more accurate. We hypothesized that accuracy of ECG criteria for LVH would improve when LV mass was assessed by three‐dimensional echocardiography. Results: For most of the criteria, sensitivity, specificity and accuracy improved when LV mass was assessed by three‐dimensional echocardiography. Two‐dimensional echocardiography significantly overestimated LV mass as compared with the three‐dimensional method. Conclusions. Sensitivity, specificity, and accuracy of the ECG criteria improved when LV mass was estimated by three‐dimensional echocardiography. This improvement may be attributed at least in part to superior accuracy of three‐dimensional measurements.
Prosthetic Valve Thrombosis Presenting as an Acute Embolic Myocardial Infarction in a Pregnant Patient: Issues on Anticoagulation Regimens and Thrombolytic Therapy
Authors: Varadarajan Padmini , Isaeff Dale , Pai Ramdas G.
Published: August 2006

Mechanical valves are inherently thrombogenic and require meticulous anticoagulation. Pregnancy produces a hypercoagulable state and achieving adequate anticoagulation is difficult. We present a pregnant patient who had a nonobstructive thrombus of mechanical mitral valve causing embolic acute myocardial infarction. Issues surrounding management of anticoagulation and use of thrombolytic therapy during pregnancy are discussed. Education regarding the critical nature of adequate anticoagulation in these patients is important.
Congenital Partial Pericardial Defect and Herniated Right Atrial Appendage: A Rare Anomaly
Authors: Karakurt Cemşit , Oğuz Deniz , Karademir Selmin , Sungur Metin , Öcal Burhan
Published: August 2006

A congenital partial defect of the right‐sided pericardium is a rare cardiac anomaly and it represents defective formation of the pleuropericardial membrane. Patients can be asymptomatic, but they may experience chest pain, myocardial ischemia, emboli, arrhythmia, and sudden death. In this report, we present an 8‐month‐old boy with pericardial defect and right atrial appendage herniation. It was diagnosed by echocardiography and cardiac magnetic resonance imaging.
Congenital Right Ventricular Diverticulum Associated With a Ventricular Septal Defect: A Rare Echocardiographic Finding
Authors: Di Sessa Thomas G. , Howard Scott C. , Salim Mubadda A.
Published: August 2006

A neonate presented on the first day of life with tachypnea and poor feeding. The infant's initial echocardiogram demonstrated outpouching of the lateral wall of the right ventricle (RV) associated with a large ventricular septal defect (VSD). At 9 days of age he was diagnosed with osteogenesis imperfecta (OI). Despite treatment with digoxin, diuretics, and captopril he required hospitalization twice during his first 2 months of life for congestive heart failure (CHF). The VSD was closed at three and one‐half months of age without resection of the diverticulum and CHF symptoms resolved. At 26 months of age he is doing well despite the residual RV diverticulum. Congenital cardiac diverticula are rare forms of cardiac malformations and their echo‐Doppler features are herein discussed.
Incompetence of the Internal Jugular Venous Valve: Spectrum of Echo‐Doppler Appearances
Authors: D'Cruz Ivan A. , Khouzam Rami N. , Minderman Daniel P. , Munir Ahmad
Published: August 2006

The echocardiographic literature contains very scant reference to incompetence of the valve in the internal jugular vein. However, we found frequent Doppler evidence of such incompetence, especially in patients with congestive failure. This incompetence manifests as a variety of color Doppler and pulsed Doppler patterns, illustrated here in 3 patients.
On Hating to Hate
Authors: WEINGARTEN KAETHE
Published: August 2006

Hate may be the most dangerous of all emotions for the survival of the planet. The author addresses two questions: What obscures hate when it is actually present? and What masquerades as hate but isn't? Using illustrations from a wide range of fields, the author contends that discerning hate is both essential and far trickier than we think. She concludes by asserting that overcoming hate requires imagination. We must learn to imagine a world without hate and unimagine a world with hate.
Sacrifice as a Predictor of Marital Outcomes
Authors: STANLEY SCOTT M. , WHITTON SARAH W. , SADBERRY SABINA LOW , CLEMENTS MARI L. , MARKMAN HOWARD J.
Published: August 2006

We investigated the prospective associations between attitudes about sacrifice and marital outcomes in 38 married couples. Specifically, a measure of satisfaction with sacrifice was proposed to be a potent longitudinal predictor of marital adjustment and distress based on existing cross‐sectional studies and also to mediate the association between commitment and marital adjustment. Results demonstrated that attitudes about sacrifice discriminated between couples who would become distressed versus nondistressed over time. Sacrifice attitudes also predicted the maintenance of relationship adjustment over time even better than earlier relationship adjustment. Finally, sacrifice attitudes mediated the link between commitment and relationship adjustment for husbands, but not wives. Implications for intervention are discussed.
Success and Failure Among Polygamous Families: The Experience of Wives, Husbands, and Children
Authors: SLONIM‐NEVO VERED , AL‐KRENAWI ALEAN
Published: August 2006

In this study, we interviewed 10 polygamous families, all residing in a Bedouin Arab town in the south of Israel and consisting of 1 husband, 2 wives, and children. Five members were interviewed in each family: first wife, second wife, the oldest child of the first wife, the oldest child of the second wife, and the husband. Five families were considered well‐functioning families and five as poorly functioning. Findings suggest that polygamy in both well‐functioning and poorly functioning families is painful, particularly for wives. Yet, there are many ways and techniques that enable members of the family to function well. Among them are acceptance of polygamy as God's wish or destiny, equal allocation of resources among both families by the husband, separation between the two households, avoidance of “minor” conflicts and disagreements, maintaining an attitude of respect toward the other wife, and allowing open communication among all siblings, and among children and the other mother. We discuss the need to develop, implement, and evaluate family intervention programs for polygamous families among different communities in the world.
The Heart of the Matter: A Proposal for Placing the Self of the Therapist at the Center of Family Therapy Research and Training
Authors: SIMON GEORGE M.
Published: August 2006

As it faces the transition marked by the death or retirement of most of its first‐generation founders, the field of family therapy finds itself still unable to answer the critical question of what it is that makes family therapy work. The two dominant approaches to answering this question, the common‐factors perspective and the model‐specific factors perspective, remain divided at this juncture by a fundamental difference of emphasis between the two. This article proposes a way of integrating the two perspectives via the hypothesis that therapists achieve maximum effectiveness by committing themselves to a family therapy model of proven efficacy whose underlying worldview closely matches their own personal worldview. The implications of this hypothesis for the training of family therapists are examined.
Up Front and Personal: Confronting Dynamics in the Family Group Conference
Authors: CONNOLLY MARIE
Published: August 2006

The Family Group Conference is a participatory model of decision making with families in child protection. It is a legal process that brings together the family, including the extended family, and the professionals in a family‐led decision‐making forum. Bringing together extended family and professionals to discuss child protection concerns can create a highly charged dynamic. Workers are challenged by family, family are challenged by workers, and family members challenge each other. Practice is also exposed to wider scrutiny as professionals also challenge the work. This article briefly describes the development and practice of family group conferencing as a family‐centred legal process in Aotearoa New Zealand. It then examines the findings of a study exploring the dynamics emerging from family group conference practice from the perspective of the coordinators who convene them. Family group conferencing as a family strengthening practice is discussed.
Multiple‐Family Group Treatment of Outpatients With Schizophrenia: Impact on Service Utilization
Authors: MCDONELL MICHAEL G. , SHORT ROBERT A. , HAZEL NICHOLAS A. , BERRY CHRISTOPHER M. , DYCK DENNIS G.
Published: August 2006

The impact of multiple‐family group treatment (MFGT) on outpatient and inpatient mental health service utilization of 97 persons with schizophrenia was investigated. Participants were randomly assigned to standard care (n=44) or standard care plus MFGT (n=53). Service use for a year prior to randomization, the 2‐year study period, and a 1‐year follow‐up were examined. Relative to standard care participants, the MFGT group had reduced community hospitalization during year 1 of the intervention and reduced state hospitalization at follow‐up. During the intervention period, MFGT participants demonstrated a significant increase in outpatient utilization as a direct consequence of the intervention. However, when service use was summed across 3 years post‐randomization, no group differences were observed. Results suggest that implementation of MFGT in a community mental health setting reduces inpatient service at specific time periods, without significantly increasing outpatient service utilization. These findings add to other outcomes from this study that demonstrate decreased psychiatric symptoms and caregiver distress.
The Development of a Systemic School‐Based Intervention: Marte Meo and Coordination Meetings
Authors: AXBERG ULF , HANSSON KJELL , BROBERG ANDERS G. , WIRTBERG INGEGERD
Published: August 2006

Antisocial behavior is often persistent, and in addition to causing suffering to children and their families, it also poses considerable costs for society. Children who display externalizing behavior in their early years run a high risk of having severe problems later in life. There is a need for treatment methods that may be used in various settings because these children constitute a group that is hard to reach with conventional treatment methods. In addition, the dropout rate from ordinary treatment is often high. In the present study, a systemic school‐based model for early detection and intervention among 4–12‐year‐old children who displayed externalizing behavior problems was developed and examined in a nonrandomized study in the county of Skaraborg in Sweden. The intervention was collaborative and included a combination of the Marte Meo model and coordination meetings based on systemic theory and practice. Treatment effects in the group who had received the intervention were compared with a group who had received treatment as usual in their ordinary school setting. Assessments were carried out before, and 2 years after, the intervention. For the intervention group (N=33), there was a significant decrease in the children's reported symptoms in school and in the home. No decrease in externalizing behavior was found in the comparison group (N=16). There were no dropouts in the intervention group after the intervention had begun. The results are promising; the study demonstrates that it is possible to work effectively with many children who display externalizing behavior problems in a nonclinical setting.
Expression profiling of apoptosis‐related genes in enterocytes isolated from patients with ulcerative colitis
Authors: SEIDELIN JAKOB B. , NIELSEN OLE H.
Published: August 2006

Apoptosis regulation has been implicated as a main cause of epithelial dysfunction in patients with ulcerative colitis. Apoptosis can be divided into distinct pathways, which depend on the expression of a large number of apoptosis‐related genes. The aim was to elucidate which pathways are dominant in normal and inflamed colonic epithelial cells. An apoptosis‐specific gene array expression profiling system of 96 genes was used to determine the expression profile of apoptosis‐related genes. Epithelial cells isolated from three patients with active ulcerative colitis were pooled and compared to pooled epithelial cells isolated from three control subjects. Genes found to be three‐fold or more overexpressed in ulcerative colitis were subsequently analysed by PCR in a larger population (10 patients with ulcerative colitis, 8 control subjects). Selected genes found not to be regulated were additionally tested by PCR in the same population. Six genes were found to be highly expressed in epithelial cells from both controls and ulcerative colitis patients. These included Bcl‐2 antagonist/killer, B lymphoid tyrosine kinase, caspase 14, Harakiri, tumour necrosis factor (TNF) receptor 2, and TNF receptor‐associated factor 1 (TRAF1). Three genes were found to be upregulated in ulcerative colitis (p<0.01): caspase 1 and 5, and inhibitor of apoptosis protein 2 (c‐IAP2). Both receptor‐ and mitochondrion‐dependent apoptosis pathways are well expressed in enterocytes. Mainly activation‐dependent and cytoprotective genes were upregulated in ulcerative colitis.
Primary peritoneal carcinoma: a rare neoplasm with pleomorphic trophoblastic morphology
Authors: MADSEN CHARLOTTE WINTHER , HASSELBY JANE PREUSS , LARSEN LISE GRUPE
Published: August 2006

We report a case of primary peritoneal carcinoma with trophoblastic morphology in a 78‐year‐old woman, diagnosed by histological and immunohistochemical analysis of surgically resected specimens, including the omentum and part of the small bowel. Microscopically, the resected specimens showed diffuse infiltration of a poorly differentiated tumor. Numerous large, often multinucleated cells were seen, and mitotic figures were frequent. Immunohistochemical staining showed a positive reaction for most cytokeratins, EP4, EMA, CA‐125, Glut1, WT1, β‐hCG and PLAP. We reached a diagnosis of primary peritoneal carcinoma with trophoblastic morphology. To our knowledge this morphology of a primary peritoneal carcinoma has not been described previously.
Vulvar keratoacanthoma
Authors: OZKAN FERDA , BILGIÇ REMZIYE , CESUR SUNA
Published: August 2006

A keratoacanthoma of the vulva in a 33‐year‐old woman is described. The patient presented with a rapidly growing exophytic lesion of 1 cm in diameter over the clitoris that had been present for a couple of months. An excisional biopsy was performed. Pathologic examination of the exophytic nodule showed squamous proliferation with a characteristic central keratin‐ filled crater. There were pushing margins. High power microscopy showed squamous cells of cytologically bland appearance with glassy cytoplasm. There were few mitotic figures. Less than 10% Ki‐67‐positive staining nuclei were seen. There was no p53 oncoprotein overexpression. Keratoacanthoma of the vulva is rare with only five cases having been reviewed in the English literature since 1985. Keratoacanthomas are rapidly growing crateriform lesions on the sun‐exposed skin of the elderly. Because of its rarity in the vulva, the lesion can be misinterpreted as a malignant lesion such as squamous cell carcinoma. Awareness of vulvar occurrence of keratoacanthoma and its characteristic histopathologic features will help avoid misdiagnosis of a squamous cell carcinoma leading to radical surgery.
Effect of exposure to fluoroquinolones and beta‐lactams on the in vitro activity of other groups of antibiotics in Salmonella spp.
Authors: CEBRIAN LAURA , RODRÍGUEZ JUAN CARLOS , ESCRIBANO ISABEL , ROYO GLORIA
Published: August 2006

After designing in vitro models of repeated exposure of Salmonella spp. to various beta‐lactams and fluoroquinolones we studied the decrease in susceptibility to other antibiotic families of the mutants generated. There was a decrease in the susceptibility of all the mutants to tetracycline, cotrimoxazole and chloramphenicol. Mutants generated following exposure to fluoroquinolones showed reduced susceptibility to amoxicillin, amoxicillin/clavulanic acid, cefoxitin and cefuroxime, whereas mutants generated following beta‐lactam exposure showed reduced susceptibility to nalidixic acid and ciprofloxacin. We observed that the efflux pump systems are activated in the mutants generated and this may therefore be the cause of the decrease in susceptibility. In many cases the decrease is small and is not detected if the CLSI criteria are applied. Nevertheless, more detailed studies should be done to evaluate the importance of this phenomenon and rationalize the use of antibiotics in both humans and animals so as to control the increase in the number of multiresistant strains.
Role of ultrasound‐guided core biopsy in the evaluation of spleen pathology
Authors: LÓPEZ JOSÉ I. , DEL CURA JOSÉ L. , DE LARRINOA AITOR FERNÁNDEZ , GORRIÑO OLATZ , ZABALA ROSA , BILBAO FRANCISCO J.
Published: August 2006

Core biopsy has not traditionally been recommended in the study of spleen nodules due to the supposed fragility of this organ leading to a high risk of post‐core biopsy complications. A total of 13 patients who presented solid spleen nodules, diffuse splenomegaly, or both on imaging studies (CT, MR, US) were biopsied under ultrasound control with 18G BioPince® needles. Cytological (imprints and cytocentrifugates) and histological material were obtained for diagnosis in every case. Malignant lymphomas were the most commonly found pathology (four diffuse large B‐cell lymphomas, two follicular lymphomas, one Hodgkin's disease, one B‐cell lymphoma, NOS). In addition, there was one littoral‐cell angioma, one well‐differentiated neuroendocrine carcinoma, metastatic, and one haemangioma. The remaining two cases showed congestive features, and supposed spleen involvement by lymphoma in one of them was ruled out. On follow up, there were no complications related to the core biopsy. Splenectomy was performed in six cases, two diagnostic and four therapeutic. We conclude that core biopsy is a safe and efficient method in the diagnosis of spleen nodules that could be considered in the routine diagnostic algorithm of these lesions.
Pin1 gene mutation is a rare event in gastric cancer
Authors: KIM CHANG JAE , SONG JAE HWI , CHO YONG GU , CHAE HIUN SUK , NAM SUK WOO , YOO NAM JIN , LEE JUNG YOUNG , PARK WON SANG
Published: August 2006

The peptidyl‐prolyl isomerase Pin1 is strikingly overexpressed in human cancers and is a novel regulator of β‐catenin. To determine whether somatic mutation of the Pin1 gene is involved in the development and/or progression of gastric cancer, we searched for mutations of the Pin1 gene in 95 gastric cancer specimens. The effect of Pin1 on β‐catenin expression was further examined in wild‐ and mutant‐type Pin1‐transfected HEK 293T cells. We found only one missense mutation that led to the substitution of alanine by aspartic acid at codon 118 of the Pin1 gene. On transfection study, the mutant Pin1 showed an increased expression of β‐catenin. However, the mutation had no effect on expression of the Pin1 protein in the case with Pin1 mutation. These results suggest that Pin1 may not play a role in the development or progression of gastric cancer.
Effect of adamantylamide dipeptide as adjuvant therapy to praziquantel in mice infected with different S. mansoni isolates
Authors: BOTROS SANAA , MAHMOUD MADIHA , HAMMAM OLFAT , SALAH FATEN , ZIDEK ZDENEK , MASEK KAREL
Published: August 2006

This work investigated the possible use of AdDP as adjuvant therapy to praziquantel (PZQ) in mice infected with PZQ‐insusceptible Schistosoma mansoni isolate in a trial to increase the susceptibility of this isolate to the drug. Two batches of C57 BL/6 mice were infected with PZQ‐susceptible and ‐insusceptible S. mansoni isolates, and each batch was divided into five groups. Seven weeks postinfection, the experimental group received AdDP (5 mg/kg) in addition to PZQ in reduced dose (3×100 mg/kg). Three of the remaining four groups were treated controls; they received AdDP, PZQ in reduced dose and in full dose (2×500 mg/kg), and the fourth group was infected untreated. In mice infected with PZQ‐susceptible or ‐insusceptible S. mansoni isolate, praziquantel alone, and in addition to AdDP, reduced worm and egg loads and increased percentage dead eggs. Also, they improved the histopathological changes (reduction in granuloma diameter, percentage fibrotic area with increased percentage degenerated eggs). Inducible nitric oxide synthase (iNOS), nitric oxide (NO) in culture of peritoneal macrophages, and number of CD68‐positive cells were decreased with improved alanine amino transaminase. In mice receiving combined therapy AdDP+PZQ, the antischistosomal efficacy and the reductions in the inflammatory granulomatous reactions, NO in cultured peritoneal macrophages, percentage fibrotic areas recorded, were comparable to that in mice receiving full dose of PZQ, with significantly higher reduction in CD68 cells denoting enhanced antischistosomal efficacy and healing of the inflammatory reactions in the liver.
Osteosarcoma arising in the breast
Authors: SANDO NORIMASA , OKA KUNIYUKI , MORIYA TAKUYA , SAITO HIDETOSHI , NAGAKURA SHIGENORI , MORI NAOYOSHI , SUZUKI TOSHIMITSU , UEKI HAMAITI , OHTANI HARUO
Published: August 2006

We report on a 49‐year‐old woman with osteosarcoma arising in the breast. She had undergone two consecutive excision biopsies for right breast tumors at ages 40 and 42 years. The tumors were diagnosed as a fibroadenoma and a benign phyllodes tumor, respectively. At age 46 years, she noticed a gradually enlarging mass in the same breast. After 3 years, at age 49 years, total mastectomy was performed. The tumor occupied the entire breast and measured 12×9×8.5 cm. The tumor cells were spindle‐shaped and pleomorphic, with large, irregular nuclei and distinct nucleoli. Many tumor cells had characteristics of osteoblastic and chondroblastic elements producing osteoid, osseous, and cartilaginous intracellular substances. Pathologic mitoses and apoptotic cells were frequent. Neoplastic cells had infiltrated the skin. Blood and lymph vessel invasion was present. Tumor cells expressed vimentin, osteopontin, vascular endothelial growth factor, CD10, and alkaline phosphatase, but did not express keratin. Chemotherapy was not effective. The patient died of multiple pulmonary metastases 9 months after mastectomy.
Detection of Dirofilaria (Nochtiella) repens DNA by polymerase chain reaction in embedded paraffin tissues from two human pulmonary locations
Authors: RIVASI FRANCESCO , BOLDORINI RENZO , CRIANTE PATRIZIA , LEUTNER MONICA , PAMPIGLIONE SILVIO
Published: August 2006

We here report two new cases of human pulmonary dirofilariasis in men aged 62 and 64 from Northern and Central Italy, respectively. Both were asymptomatic and the infections were discovered incidentally when chest radiographs taken for another reason revealed the presence of a coin lesion. The initial clinical diagnosis was oriented towards a lung tumour, and an excisional lung biopsy after thoracotomy was necessary for the final diagnosis. Pathologically, the lesion consisted of a roundish subpleural infarct with a central thrombotic artery containing sections of an immature nematode: Dirofilaria repens was diagnosed histologically in one case, the necrotic condition of the worm allowing only genus identification, Dirofilaria, in the other case. In both samples, PCR analysis amplified a 246 bp product, specific for the IpS insert 11 of D. repens. The authors stress the role of PCR in the diagnosis of this parasite from paraffin samples, also in cases in which identification of the species was not possible by conventional morphology due to poor conservation of the worm. These cases represent the first PCR‐based diagnosis of D. repens in a human pulmonary dirofilariasis on samples embedded in paraffin.
Diagnosis of Chlamydia trachomatis in Russia – in‐house PCR assays may be effective but overall optimization and quality assurance are urgently needed
Authors: SHALEPO KIRA , SAVICHEVA ALEVTINA , SHIPITSYNA ELENA , UNEMO MAGNUS , DOMEIKA MARIUS
Published: August 2006

In the present study, the performance of the cell culture method, two non‐Russian direct immunofluorescence (DIF) assays, and three different in‐house polymerase chain reaction (PCR) tests used in St. Petersburg, Russia, for detection of Chlamydia trachomatis in urogenital specimens was evaluated. A total of 650 patients were examined and it was most disquieting that previous C. trachomatis positivity with Russian DIF assays could – 7 days later – be confirmed only in 26% of the women and 30% of the men. Overall, the highest diagnostic sensitivity was obtained using PCR analysis. However, the sensitivity varied significantly: from 79% to 100% between the different PCR assays, sex of the patients, and type of samples. The highest sensitivity was obtained for female vaginal and male urine samples (100%). The specificity of the PCR assays varied from 97% to 100%. The sensitivity of cell culture and both the examined DIF assays was low, i.e. it varied from 46% to 56% and 55% to 75%, respectively. Meanwhile, cell culture was 100% specific and the DIFs showed a specificity varying from 99% to 100%. In conclusion, in a Russian perspective, adequate in‐house PCR methods may be used quite effectively for detection of C. trachomatis in invasive as well as non‐invasive clinical material. Simultaneous analysis of two different specimens from women resulted in a significantly increased detection rate of C. trachomatis. Nevertheless, in Russia the need for optimization and quality assurance of diagnostic methods for C. trachomatis, especially Russian DIF assays, has to be emphasized.