bluuebunny/crossref_metadata_2025 huggingface dataset:
Les produits injectables et leur place dans le traitement de l’incontinence urinaire d’effort
Authors: Achtari Chahin , Meyer Sylvain , de Grandi Pierre
Published: February 2006

Les produits injectables sont utilisés dans le traitement de l’incontinence urinaire d’effort associée à un déficit sphinctérien intrinsèque. Le collagène d’origine bovine reste le produit de choix malgré certains inconvénients tels que réaction allergique et réabsorption du matériel injecté. De nombreux produits sont en cours d’évaluation ou sont utilisés pour tenter de pallier les inconvénients du collagène bovin. Le but de cette revue est de présenter les produits injectables disponibles et de mettre en perspective l’utilisation actuelle des produits injectables à la lumière des récents progrès dans le traitement de l’incontinence urinaire d’effort. Le traitement de choix du déficit sphinctérien intrinsèque est la bandelette sous-urétrale autologue ou synthétique. Les produits injectables trouvent leur indica tion dans l’incontinence urinaire d’effort associée à un déficit sphinctérien intrinsèque chez des patientes multiopérées. L’hypermobilité du col vésical n’est pas une contre-indication.
Left Ventricular Hypertrabeculation/Noncompaction with PMP22 Duplication-Based Charcot-Marie-Tooth Disease Type 1A
Authors: Corrado Giovanni , Checcarelli Nicoletta , Santarone Mauro , Stöllberger Claudia , Finsterer Josef
Published: February 2006

A 50-year-old women with Charcot-Marie-Tooth hereditary neuropathy type 1A due to the PMP22 duplication on chromosome 17p11.2-12 developed a left bundle branch block and progressive dilatation of the left ventricle since age 40 years and recurrent heart failure since age 44 years. At age 50 years left ventricular hypertrabeculation/noncompaction was first recognized on transthoracic echocardiography. A possible causal relation between the cardiac abnormalities and the PMP22 duplication is discussed.
Gene-Based Single Nucleotide Polymorphisms and Linkage Disequilibrium Patterns of 29 Asthma Candidate Genes in the Chromosome 5q31–33 Region in Koreans
Authors: Ryu Ha-Jung , Jung Ho-Youl , Park Jung-Sun , Ryu Gil-Mi , Heo Jee Yeon , Kim Jae-Jung , Moon Song-Mean , Kim Hung-Tae , Lee Jong-Young , Koh Insong , Kim Jun-Woo , Rho Jae Kyun , Han Bok-Ghee , Kim Hyungtae , Park Choon-Sik , Oh Bermseok , Park Chan , Lee Jong-Keuk , Kimm Kuchan
Published: February 2006

Background and Methods: Numerous genetic studies have mapped asthma susceptibility genes to a region on chromosome 5q31–33 in several populations. This region contains a cluster of cytokines and other immune-related genes important in immune response. In the present study, to determine the genetic variations and patterns of linkage disequilibrium (LD), we resequenced all the exons and promoter regions of the 29 asthma candidate genes in the chromosome 5q31–33 region. Results: We identified a total of 314 genetic variants, including 289 single nucleotide polymorphisms (SNPs), 22 insertion/deletion polymorphisms and 3 microsatellites. Standardized variance data for allele frequency revealed substantial differences in SNP allele frequencies among different ethnic groups. Interestingly, significant ethnic differences were observed mainly in intron SNPs. LD block analysis using 174 common SNPs with a frequency of >10% disclosed strong LD within most candidate genes. No significant LD was observed across genes, except for one LD block (CD14-IK block). Gene-based haplotype analyses showed that 1–5 haplotype-tagging SNPs may be used to define the six or fewer common haplotypes with a frequency of >5%, regardless of the number of SNPs. Conclusion: Overall, our results provide useful information for the identification of immune-mediated disease genes in the chromosome 5q31–33 region, as well as valuable evidence for gene-based haplotype analysis in disease association studies.
CD14 Promoter Polymorphisms in Atopic Families: Implications for Modulated Allergen-Specific Immunoglobulin E and G1 Responses
Authors: Jackola Duaine R. , Basu Saonli , Liebeler Carol L. , Willaert Rebecca , Luah San-San , Oetting William , King Richard A. , Blumenthal Malcolm N.
Published: February 2006

Background: CD14 promoter DNA sequence polymorphisms for the endotoxin receptor gene have been implicated in modulating allergen-specific immunoglobulin (Ig)E responses in randomly selected individuals with atopy. We sought to determine if a single nucleotide polymorphism in the CD14 promoter region is associated with atopy in atopic families, and to assess its influence on serum levels of CD14 and allergen-specific IgE and IgG1 responses. Methods: We screened 367 members of 91 Caucasian nuclear families with a history of asthma for pulmonary function by spirometry, including methacholine challenge to detect bronchial hyperreactivity, and atopy by serum total IgE and skin prick test to 14 allergens. The CD14 promoter single nucleotide polymorphism was analyzed in DNA isolated from peripheral blood mononuclear cells to identify C/C, C/T and T/T genotypes. Serum tests were done for soluble CD14 (sCD14) and dust mite-specific antibody (Der p 1-IgG1). Results: Serum sCD14 levels were not associated with clinical phenotypes (asthma, bronchial hyperreactivity or atopy). However, sCD14 levels were inversely related to both allergen-specific IgE and Der p 1-IgG1 production, but only among those with evidence of atopic sensitization. Linear regression analysis, accounting for random family effects, demonstrated a higher production of allergen-specific IgE or Der p 1-IgG1 associated with the T/T genotype and a lower level of specific IgE and IgG1 production associated with sCD14 levels. Conclusions: An element of the innate immune system (CD14) has profound effects upon modulating the acquired allergen-specific immunoglobulin responses among those with an inherited atopic predisposition.
Levalbuterol Inhibits Human Airway Smooth Muscle Cell Proliferation: Therapeutic Implications in the Management of Asthma
Authors: Ibe Basil O. , Portugal Ada Mae , Raj J. Usha
Published: February 2006

Background: Racemic albuterol is a mixture of (R)- and (S)-enantiomers of albuterol. Its pharmacological activity and clinical efficacy reside in the (R)-enantiomer (levalbuterol), but the (S)-enantiomer exacerbates airway reactivity in nonclinical models. The role of albuterols in airway smooth muscle cell (SMC) proliferation is not well understood. Methods: The effect of levalbuterol on human bronchial SMC growth was compared with the effects of racemic albuterol and (S)-albuterol. Cells were fed albuterols and 3H-thymidine in 5% FBS and incubated for 24 h. The effect of (S)-albuterol on levalbuterol actions was also studied and so were the effects of cAMP/PKA, PI-3 kinase, NK-ĸB, and retinoblastoma (Rb) proteins on albuterols and human bronchial SMC proliferation. Results: Levalbuterol inhibited cell proliferation at low concentrations. The growth-inhibitory effect of levalbuterol occurs via activation of the cAMP/PKA pathway. Addition of (S)-albuterol to levalbuterol decreased the growth-inhibitory effect of levalbuterol, and (S)-albuterol attenuated levalbuterol-induced cAMP release by 65%. Levalbuterol inhibited NF-ĸB and Rb protein expressions. ICI-118551 abrogated the inhibitory properties of levalbuterol. The PAF receptor antagonist CV-3988 inhibited (S)-albuterol-induced cell growth, with no effect on levalbuterol. Conclusions: Levalbuterol inhibits cell growth by activating the cAMP/PKA pathway and inhibiting PI-3 kinase, NF-ĸB and Rb protein expression, and (S)-albuterol induces cell growth by activating PAF-receptor-mediated cell signaling.
Immunoglobulin E and G4 Antibody Responses in Occupational Airway Exposure to Bovine and Porcine Plasma Proteins
Authors: Krop E.J.M. , Stapel S.O. , De Vrieze H. , van der Zee J.S.
Published: February 2006

Background: Production of both antigen-specific immunoglobulin (Ig)E and IgG4 antibodies is dependent on stimulation of B cells by T helper 2 cell-derived cytokines. However, there is controversy as to their interaction. In this study, we investigated the interdependency of IgE and IgG4 antibody responses to a relatively high range of airway exposure to animal-derived proteins in an occupational setting. Moreover, associations with self-reported airway symptoms and bronchial hyperresponsiveness were established. Methods: In a cross-sectional design, employees of an animal plasma spray-drying factory were questioned about airway symptoms, exposure was measured with personal sampling technique, and serology was performed. In a selection of subjects from this population, serology was repeated 15 months later, and bronchial hyperresponsiveness was measured. Results: IgE and IgG4 antibodies were detected in 17 and 57% of all employees and were both associated with degree of exposure. Only IgE antibodies showed an independent association with self-reported airway symptoms and bronchial hyperresponsiveness. The presence of IgE antibodies was limited to employees with high levels of IgG4. Employees with IgE and symptoms appeared to have less IgG4 than asymptomatic IgE-positive individuals. The level of specific IgG4 antibodies was stable over a 15-month period. Conclusions: In high-range airway exposure, development of IgE and IgG4 antibodies depended on the level of exposure. The threshold for development of IgG4 antibodies appeared to be less than that for IgE antibodies, and IgG4 antibodies may protect against the development of symptoms.
Increased Expression of RANTES, CCR3 and CCR5 in the Lesional Skin of Patients with Atopic Eczema
Authors: Kato Yoko , Pawankar Ruby , Kimura Yoichi , Kawana Seiji
Published: February 2006

Background: Atopic eczema (AE) is a relapsing inflammatory disease based on IgE sensitization and characterized by peripheral blood eosinophilia and eosinophil infiltration into the lesional skin. In the patch test reaction of AE by allergens, an increased infiltration of activated eosinophils has been demonstrated peaking at 24–48 h. Regulated on activation normal T cell expressed and secreted (RANTES/CCL5) is a chemokine that induces eosinophil migration, and CCR3 and CCR5 are the receptors of RANTES. Objective: In order to further clarify the pathomechanisms of eosinophil infiltration in ongoing chronic inflammation in the skin of patients with AE and its relation to disease severity, we examined the expression of RANTES and its receptors CCR3 and CCR5 in challenged and unchallenged lesional skin of AE. Methods: We examined the number of RANTES+ cells, CCR3+ cells, CCR5+cells, activated (EG2+) eosinophils and CD3+ T cells in normal skin of healthy volunteers, and in challenged lesional skin (24 h after mite patch test) as well as unchallenged lesional skin of AE patients by immunohistochemistry. The cellular source of RANTES, CCR3 and CCR5 was analyzed by double immunohistochemistry using specific antibodies to RANTES, CCR3 or CCR5, and antibodies to ECP (EG2) or CD3. Results: The numbers of RANTES+ cells, CCR3+ cells, CCR5+ cells, EG2+ cells and CD3+ cells were all significantly increased in challenged (mite patch-tested) lesional skin of AE patients as compared to those in unchallenged lesional skin and normal skin. The numbers of these cells in unchallenged lesional skin were greater than those in normal skin. The number of EG2+ cells in the unchallenged lesional skin correlated with both the peripheral blood eosinophil count and the SCORAD index. The number of EG2+ cells in challenged lesional skin correlated with the number of CCR5+ cells. Activated eosinophils and T cells expressed RANTES and various proportions of these cells were CCR3+ and CCR5+ in both challenged and unchallenged lesional skin. Conclusion: Taken together, these results suggest that RANTES as well as its receptors CCR3 and CCR5 may play important roles in the orchestration of eosinophil infiltration in ongoing chronic inflammation in AE, and also reflect the severity of disease.
Theophylline as ‘Add-on’ Therapy to Cetirizine in Patients with Chronic Idiopathic Urticaria
Authors: Kalogeromitros Dimitrios , Kempuraj Duraisamy , Katsarou-Katsari Alexandra , Makris Michael , Gregoriou Stamatis , Papaliodis Dean , Theoharides Theoharis C.
Published: February 2006

Background: Chronic urticaria is a prevalent condition associated with substantial disability. Its pathogenesis is not clearly understood and is divided into autoimmune and chronic idiopathic urticaria (CIU). We investigated if the non-specific phosphodiesterase inhibitor theophylline could provide additional benefit to the histamine-1 receptor (H-1R) antagonist cetirizine in CIU. Methods: This was a double-blind, placebo-controlled, parallel study. Patients were randomized to receive either cetirizine and theophylline (200 mg twice daily; group A, 67 subjects) or cetirizine and placebo for 6 months (group B, 67 subjects). Group A patients took theophylline for 6 more months. Response was assessed by visual analog scale (VAS) and treatment effectiveness score (TES). Blood theophylline levels were also determined at visit t = 1 and t = 7. Results: The study was completed by 54 of the 67 patients (80.6%) in group A and 51 of the 67 patients (76.1%) in group B. The physician VAS values for group A were lower after t = 3, while the patient VAS values were decreased after t = 2. The physician and patient TES values in group A were statistically higher (p < 0.05) at all time points except for t = 1. At least 1 month of theophylline addition was necessary to obtain statistically significant benefit over cetirizine, and reducing theophylline by 50% during phase 2 did not alter this benefit. Pruritus values were reduced, but not statistically significant. Conclusions: Addition of theophylline to conventional H-1R antagonists was well tolerated without any adverse effects and provided considerable additional benefit in the management of CIU.
Elevated Tryptase Levels Are Associated with Greater Bone Density in a Cohort of Patients with Mastocytosis
Authors: Kushnir-Sukhov Nataliya M. , Brittain Erica , Reynolds James C. , Akin Cem , Metcalfe Dean D.
Published: February 2006

Background: Mastocytosis is associated with a pathological increase in tissue mast cells. Associated skeletal problems include a decrease in bone density and pathological fractures. Methods: In order to explore the relationship between bone density and the severity of mastocytosis, 21 patients with mastocytosis who underwent dual-energy X-ray absorptiometry were entered into this study. Correlation coefficients were computed between Z-scores and demographic, clinical and laboratory data. Femoral neck Z-scores correlated with serum tryptase levels when all the patients were considered (p = 0.029). Results and Conclusion: Patients with less severe disease had significantly lower values at the L1–L4 spine (p = 0.046) and femoral neck (p = 0.029) Z-scores compared to patients with more severe disease. Most patients who had low Z-scores (between –1 and –2.5) were under 50 years of age, had less severe disease and had lower serum tryptase levels. A history of gastroesophageal reflux disease and a history of hypotensive episodes correlated with lower L1–L4 spine Z-scores (p < 0.05). Thus, patients with less severe disease and lower serum tryptase levels should in particular have their bone density determined with treatment appropriate to the findings.
Chemotherapy-Induced Carcinoembryonic Antigen Surge in Patients with Metastatic Colorectal Cancer
Authors: Ailawadhi Sikander , Sunga Annette , Rajput Ashwani , Yang Gary Y. , Smith Judy , Fakih Marwan
Published: February 2006

Objectives: To investigate the incidence of carcinoembryonic antigen (CEA) surge in patients with metastatic colorectal cancer (MCRC) and its implications on clinical outcome. Methods: A retrospective chart review of patients with MCRC treated with chemotherapy at Roswell Park Cancer Institute from January 2000 to May 2004 was conducted. A CEA surge was defined as an increase of >20% from baseline followed by a >20% drop in one or more subsequent CEA levels compared to baseline. The incidence of CEA surge and its association with clinical outcome was investigated. Results: Eighty-nine patients were evaluable for CEA surge. A CEA surge was documented in 10 patients. The CEA surge lasted <4 months in all 10 patients and was associated with a clinical benefit. No significant correlation was noted between CEA surge and site of primary tumor, site of metastatic disease, or tumor differentiation. Conclusions: CEA surges can be observed in patients receiving chemotherapy for MCRC and are often associated with a clinical benefit. None of the CEA surges satisfied the American Society of Clinical Oncology definition of CEA progression. A rise in CEA after initiation of chemotherapy, unless lasting >4 months, cannot be used as an indicator of progressive disease.
A Newly Identified MAGE-3-Derived, HLA-A24-Restricted Peptide Is Naturally Processed and Presented as a CTL Epitope on MAGE-3-Expressing Gastrointestinal Cancer Cells
Authors: Miyagawa Naoto , Kono Koji , Mimura Kousaku , Omata Hideo , Sugai Hidemitsu , Fujii Hideki
Published: February 2006

Purpose: In order to broaden the possibility for anti-MAGE-3 immune targeting, it is important to identify HLA-A24-restricted epitopes derived from MAGE-3, since HLA-A24 is one of the most common alleles in Japanese and Asian people. In the present study, we defined a new MAGE-3 derived, HLA-A24-binding peptide presented as a CTL epitope on gastrointestinal cancer cells. Materials and Methods: A panel of MAGE-3-derived peptides (9mer and 10mer) with the HLA-A24-binding motif was selected, and identification of MAGE-3-derived, HLA-A24-restricted CTL epitopes was performed by a reverse immunology approach. To induce MAGE-3-peptide specific CTLs, PBMCs were repeatedly stimulated with monocyte-derived, mature DCs pulsed with the peptides. Subsequent peptide-induced T cells were tested for their specificities by ELISPOT, tetramer and cytotoxic assay. CTL clones were then obtained from the CTL line by limiting dilution. Results: The peptide-inducing CTLs revealed that MAGE-3(113)-peptide was reacted as a CTL epitope in a HLA-A24-restricted fashion, confirmed by ELISPOT and cytotoxic assays. In addition, the MAGE-3(113)-specific CTL clones, confirmed by tetramer assay, showed that the MAGE-3(113) epitope is naturally processed and presented as the CTL epitope on MAGE-3-expressing gastrointestinal cancer cells by evaluating the cold target inhibition assays. Conclusion: The newly identified MAGE-3(113)-peptide epitope is naturally processed and presented as the CTL epitope on MAGE-3-expressing gastrointestinal cancer cells, indicating that anti-MAGE-3 immune targeting with the MAGE-3(113) peptide is a promising approach for treatment.
A Phase II Study of Infusional 5-Fluorouracil and Low-Dose Leucovorin with Docetaxel for Advanced Gastric Cancer
Authors: Jeung H.-C. , Rha Sun Young , Kim Yong Tae , Noh Sung Hoon , Roh Jae Kyung , Chung Hyun Cheol
Published: February 2006

Background: The standard chemotherapy regimen for advanced gastric cancer has not yet been established. We investigated the efficacy and the safety of the combination of docetaxel with infusional 5-fluorouracil (5-FU) and leucovorin (FLT) in advanced gastric cancer. Methods: Patients received docetaxel 75 mg/m2 (1-hour infusion) followed by a leucovorin bolus 20 mg/m2 and a 24-hour infusion of 5-FU 1,000 mg/m2 (day 1–3) every 3 weeks. The response was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria, and the toxicity was evaluated by National Cancer Institute common toxicity criteria (NCI-CTC). Results: Sixty-six patients were enrolled. Median relative dose intensity was 86%. Of 57 evaluable patients, the overall response rate was 25.7%. The response rate was 34.2% in chemonaïve patients and 14.2% in the patients who had previously received treatment. Median time to progression and overall survival duration were 5.2 and 9.7 months, respectively. The most frequent grade 3–4 toxicity was neutropenia, which was the major cause of treatment delay. Other hematological and nonhematological toxicities were rare. Conclusions: The FLT regimen showed a comparable efficacy with other second-generation regimens. Because of the low nonhematological toxicity, this could be a potential alternative to the cisplatin-containing regimens in gastric cancer.
Differential Protective Properties of Estradiol and Tamoxifen against Methamphetamine-Induced Nigrostriatal Dopaminergic Toxicity in Mice
Authors: D’Astous Myreille , Mickley Katherine R. , Dluzen Dean E. , Di Paolo Thérèse
Published: February 2006

Mechanisms implicated in protective potential of estrogens are poorly understood. Tamoxifen, a selective estrogen receptor modulator (SERM), presents a neuroprotective effect against methamphetamine (MA)- and methoxy-phenyltetrahydropyridine (MPTP)-induced toxicity when used alone but abolishes estrogen’s positive effects when combined with this hormone. In order to understand tamoxifen’s protective properties, the present study compared it to estradiol on several markers of dopaminergic neurons to achieve a relatively comprehensive comparison between these two agents. Estradiol benzoate (E) or tamoxifen were used at different concentrations (E: 1, 10 or 40 µg; tamoxifen: 12.5, 125 or 500 µg) 24 h prior to a MA injection in ovariectomized CD-1 mice. The effects of the lesion and treatments were studied on striatal dopamine (DA) concentrations, dopamine and monoamine vesicular transporters (DAT and VMAT2), and preproenkephalin (PPE) mRNA levels. Both treatments, at all concentrations, prevented the MA-induced decrease of striatal DA concentrations and VMAT2 binding. Only E was able to prevent loss of DAT binding in the lateral striatum and to attenuate the MA-induced increase in striatal PPE mRNA levels (at 1 or 40 µg). Therefore, in this paradigm, E and tamoxifen differentially modulated MA-induced neuronal damages. While both treatments prevented the DA decrease, E protected more efficiently other dopaminergic parameters suggesting that overall E is more effective than tamoxifen as a neuroprotectant of the nigrostriatal dopaminergic system.
Secretagogin Is a Novel Marker for Neuroendocrine Differentiation
Authors: Birkenkamp-Demtröder Karin , Wagner Ludwig , Brandt Sørensen Flemming , Bording Astrup Lone , Gartner Wolfgang , Scherübl Hans , Heine Bernhard , Christiansen Peer , Ørntoft Torben Falck
Published: February 2006

Our previous microarray-based studies identified secretagogin to be highly expressed in normal colon mucosa compared to basal expression in colon adenocarcinomas. The aim of this study was to analyze the differential expression of secretagogin in normal mucosa, adenocarcinomas, and neuroendocrine tumors. Western blotting, immunohistochemistry, immunofluorescence microscopy and ELISA were applied. Western blot analysis detected a 32-kDa secretagogin band in samples from normal mucosa. Immunohistochemical analyses on tissue specimens showed that secretagogin is exclusively expressed in neuroendocrine cells and nerve cells in normal mucosa of the digestive tract. Tissues adjacent to benign hyperplasic polyps and adenomas showed a decreased number of secretagogin-expressing neuroendocrine cells. Secretagogin co-localized with neuroendocrine markers (chromogranin A, neuron-specific enolase, synaptophysin) in neuroendocrine cells in crypts of normal mucosa, and in tumor cells of carcinoids. Secretagogin was strongly expressed in the cytosol and the nucleus of 19 well-differentiated neuroendocrine carcinoids and carcinoid metastases, as well as in neuroendocrine tumors from the lung, pancreas and adrenal gland. Secretagogin was detected in plasma from carcinoid patients with distant metastasis. Combined immunohistochemical analysis of secretagogin and FK506-binding protein 65, a protein de novo synthesized in adenocarcinomas, distinguished well-differentiated carcinoids, adenocarcinoids and undifferentiated carcinomas. We conclude that secretagogin is a novel marker for neuroendocrine differentiation.
Double-Bladed Scalpel: A New Option for Harvesting Margins in Head and Neck Cancers
Authors: Cernea Claudio R. , Velasco Otavio , Gomes Marcos Q.T. , Vellutini Eduardo , Hojaij Flavio C. , de Carlucci Jr. Dorival , Nishio Sunao , Morais-Besteiro Julio , Ishida Luis C. , Ferraz Alberto R.
Published: February 2006

Background: In advanced head and neck tumors margins are very rarely comprehensively checked by frozen sections. The goal of this study was to analyze a new proposal for harvesting margins using a double-bladed scalpel.Methods:Thirty-eight patients underwent a comprehensive resection of advanced head and neck tumors with a double-bladed scalpel. Margins were mapped and checked by frozen sections, while tumor resection continued. When positive margins were identified, they were excised again, and checked by frozen sections. Results: Thirty-three patients (87%) had clear skin and soft tissue margins at frozen sections. Five patients (13%) had focal skin and soft tissue-positive margins at frozen sections, which were re-excised. Two patients (5%) had skin and soft tissue-positive margins only at permanent sections. One was reoperated and 1 received radiation therapy. The 3-year local control rate was 58%. Conclusions: In this preliminary study, the double-bladed scalpel appeared to be an interesting option for complete intraoperative evaluation of surgical margins of advanced head and neck tumors.
Accessory Nerve Function in Lateral Selective Neck Dissection with Undissected Level IIB
Authors: Köybaşıoğlu Ahmet , Bora Tokçaer Ayşe , Inal Erdoğan , Uslu Sabri , Koçak Tuğba , Ural Ahmet
Published: February 2006

Background: To investigate the accessory nerve function in lateral selective neck dissections (LSND) performed in laryngeal squamous cell carcinoma patients without dissection of level IIB. Methods: Fifteen LSND were performed in 11 N0 laryngeal carcinoma patients with preservation of level IIB. Distal latencies, compound muscle action potentials (CMAP), and electromyography findings were investigated before surgery, during the 3rd postoperative week, and 3 months thereafter to compare the effects of the procedure on the accessory nerve. Results: Distal latencies and CMAP values were significantly lower in the early and late postoperative periods when compared with preoperative values. In 8 patients, there was no motor unit potential (MUP) in the early postoperative period. However, in the late postoperative period, there was no MUP loss. Conclusions: Only temporary functional deterioration of the accessory nerve was seen in patients in whom LSND was performed with undissected level IIB.
Is Small-Fenestra Stapedotomy a Safer Outpatient Procedure than Total Stapedectomy?
Authors: Vasama J.-P. , Kujala J. , Hirvonen T.P.
Published: February 2006

We compared two stapedoplasty techniques to evaluate whether one technique is safer than the other as an outpatient procedure and to demonstrate possible reasons for outpatient failures. We performed a retrospective study of patient records of 94 operated adult patients who were all initially scheduled for outpatient surgery for otosclerosis (47 total stapedectomies and 47 small-fenestra stapedotomies). Six patients (13%) with stapedectomy and 1 patient (2%) with stapedotomy had to stay overnight at the hospital due to postoperative vertigo and nausea. The number of outpatient failures was statistically significantly different between the stapedoplasty techniques (p = 0.05). Five patients (11%) with stapedectomy and 2 patients (4%) with stapedotomy had a drop in bone conduction threshold between 5 and 8 dB pre- to postoperatively (n.s.). The short-term hearing improvement did not differ statistically significantly between the techniques when compared to the preoperative values. Small-fenestra stapedotomy is the safer procedure to be performed as outpatient setting than total stapedectomy.
Suitability of Calcium Phosphate Cement for Injection Laryngoplasty in Rabbits
Authors: Ikeda Asako , Shiotani Akihiro , Mori Yuko , Fujimine Takekatsu , Tomifuji Masayuki , Takaoka Takuji , Kameyama Kaori , Ogawa Kaoru
Published: February 2006

Calcium phosphate cement (CPC) consists of powder and liquid, which become an injectable paste after mixing, self-hardening and recrystallizing to calcium hydroxylapatite (CaHA) after injection into a living body. In this study, we investigated the suitability of CPC as an injectable material for injection laryngoplasty using rabbits. All rabbits underwent left recurrent laryngeal nerve section and injection laryngoplasty with CPC. At 7 days, scanning electron microscopic findings revealed that complete recrystallization from CPC to CaHA was achieved in the larynx. At 1, 3, and 6 months, injected CPC stayed in the paraglottic space and did not migrate, and the average remaining CPC volume percentage was 91.7%. Focal foreign body reaction to injected CPC was almost the same as that of autologous fat for all time periods observed. These results indicated that CPC appears to be biocompatible, nonabsorbable, nonmigratory, and suitable for injection laryngoplasty.
Evaluation of the Mixing Point in Tinnitus Sound Therapy by a Psychoacoustic Matching Protocol with a Digital Tinnitus Evaluation System
Authors: Huang Chii-Yuan , Wu Jiunn-Liang , Cheng Chun-Chou , Sher Yung-Ji , Chung Kao-Chi
Published: February 2006

Directive counseling and sound therapy have been reported to effectively alleviate tinnitus suffering. Without objective evaluation, researchers doubt the real effect of sound therapy. This study was designed to evaluate the frequency and intensity of the theoretical ‘mixing point’ (MP) in sound therapy and to investigate its relationship with the minimal masking level (MML) of tinnitus. The tinnitus tones of 133 patients were successfully matched in frequency (dominant in 4–10 kHz) and loudness (83.09 ± 12.04 dB) using a psychoacoustic matching protocol and a newly designed tinnitus evaluation system. The matching rate was 83%. The relationship between the MP and MML is described by a linear regression equation: MP = 0.90 × MML + 1.98 (r2 = 0.82, p < 0.0001). The results of matching and correlation analysis confirmed the consistency of the MP in sound therapy. The psychoacoustic characteristics of tinnitus can be objectively evaluated with our matching protocol and evaluation system.
Artificial Ear: A Training Tool for Grommet Insertion and Manual Dexterity
Authors: Leong A. , Kundu S. , Martinez-Devesa P. , Aldren C.
Published: February 2006

Under European Working Time Directives, surgical trainees now have to attempt to gain adequate operative experience within newly-restricted working hours. Surgical skills training must therefore increasingly occur outside theatre and away from real patients, in a simulated environment. In ENT, we suggest that instruction and practice of grommet insertion may be greatly facilitated through the use of an artificial ear model, which can be assembled cheaply and quickly. Our ‘ear’ may also be used for manual dexterity exercises, which have the potential to be developed into validated tests of core ENT surgical skills in the future.
Intractable Otitis Media with Eosinophils: Importance of Diagnosis and Validity of Treatment for Hearing Preservation
Authors: Nakagawa Takashi , Matsubara Atsushi , Shiratsuchi Hideki , Kakazu Yasuhiro , Nakashima Torahiko , Koike Koji , Umezaki Toshiro , Komune Shizuo
Published: February 2006

This study investigated hearing levels in cases of intractable otitis media with eosinophils and validated the treatment strategy. Medical charts were reviewed retrospectively. The diagnosis was made when the proportion of eosinophils in middle ear secretions exceeded 10%. Twelve patients were identified and treated with an antihistaminergic agent, leukotriene receptor antagonist and topical steroid. The air-bone conductance gap decreased significantly with the relief of subjective symptoms. Bone conduction hearing levels at 4 and 8 kHz were higher than at lower frequencies. There was a significant correlation between subjective symptom duration and bone conduction hearing level at 8 kHz, which diminished with treatment. Compared with suppurative otitis, active otitis with eosinophilia damages high-tone sensory hearing in a time-dependent manner, and antiallergic treatment prevents progression of the high-tone sensory hearing loss. We emphasize the importance of diagnosis and the validity of treatment for intractable otitis media with eosinophils.
External and Extreme Capsular Stroke: Clinical, Topographical and Etiological Patterns
Authors: Kumral Emre , Çalli Cem
Published: February 2006

Background and Purpose: To characterize clinically acute external (EcC) and extreme capsular (ExC) strokes in 9 patients with first-ever acute stroke. Methods: Nine patients with a lesion limited to the EcC-ExC region proven by diffusion-weighted imaging included in our registry, corresponding to 0.3% of 3,600 patients with ischemic stroke, were studied. Results: We found three main groups of clinical manifestations: (1) motor deficits in all patients (4 with faciobrachial, 2 with faciobrachiocrural, and 1 with brachiocrural, crural and facial paresis each); (2) hypesthesia in 3 patients with partial distribution concerning light touching without involvement of other sensory modalities; (3) transient speech disturbance at stroke onset in 1 patient and dysarthria in 2 patients. Small artery disease in 4 patients and artery-to-artery embolism in 3 patients probably from atherosclerotic carotid artery were the main stroke mechanism. Conclusions: Strokes restricted to the EcC-ExC region may present with complete or partial motor syndromes and dysarthria as prominent clinical presentations, but also fou rire prodromique and transient speech arrest as prodromal signs. The main etiology of stroke were microangiopathy and artery-to-artery embolism, even though no obvious cause was found in 1 patient. The prognosis was good in almost all patients.
Analysis of Emboli during Carotid Stenting with Distal Protection Device
Authors: Chen Chin-I , Iguchi Yasuyuki , Garami Zsolt , Malkoff Marc D. , Smalling Richard W. , Campbell Morgan S. , Alexandrov Andrei V.
Published: February 2006

Background: The newly developed multi-frequency transcranial Doppler (TCD) is able to differentiate gaseous from solid emboli. Our goal was to apply this technology to initially characterize emboli detected during carotid stenting with distal protection. Methods: Patients undergoing carotid angiography and stenting were monitored with 2–2.5 MHz TCD (Embo-Dop, DWL) over the middle cerebral artery unilateral to stent deployment. Sonographers insured optimal signal recordings during the procedures. Automated emboli detection and classification software (MultiXLab version 2.0) was applied for offline count and analysis. Monitoring using the Filter Wire EX (Boston Scientific) and ACCUNET system (Guidant Corporation) was performed. Results: A total of 9,649 embolic signals were detected during 11 angiographic and 10 stenting procedures. An observer confirmed the signals using the International Consensus definition. Automated software classified these events into 5,900 gaseous and 3,749 solid emboli. During contrast injections without the protection device, 1,013 emboli were detected with 28% of these being solid. With deployment of the distal protection device, 8,636 emboli were found with 40% being solid (p < 0.001). During stenting and angioplasty with the protection device, 7,395 emboli with 42% solids were detected (p < 0.001). Finally injection of contrast after the procedure, with the protection device still deployed, yielded 1,241 emboli with 31% solids (NS). Only 1 patient developed transient hemiparesthesia during ballooning that reduced the flow velocity to zero for 14 s. Neither gaseous nor solid emboli resulted in a mean flow velocity decrease or clinical symptoms. Conclusions: Microembolization frequently occurs during stenting even with deployment of the distal protection device. More solid emboli are seen during manipulations associated with lesion crossing. Although novel TCD methods yield a high frequency of embolic signals, further validation of this technique to determine the true nature, size, and number of emboli is needed.
Does Age Predict Outcome in Stroke Rehabilitation? A Study of 878 Chinese Subjects
Authors: Luk James K.H. , Cheung Raymond T.F. , Ho S.L. , Li Leonard
Published: February 2006

Background: The predicting value of age on stroke rehabilitation has been controversial. There is a lack of large-scale studies in the Chinese population to examine the effect of age on stroke rehabilitation outcomes. This study examines the predictors of a good outcome after rehabilitation in Chinese stroke patients with special attention to age as a factor. Patients andMethods: This retrospective cohort study includes stroke patients receiving a standard inpatient multidisciplinary rehabilitation program in a neuro-rehabilitation ward of a convalescence hospital in Hong Kong from January 2000 to December 2003. Functional independence measure (FIM) ≧90 was used to define a good outcome. Multivariate regression analysis was used to assess the independent predictors of a good outcome. Results: There were important differences in clinical characteristics and complications of stroke among patients of three age groups: <65, ≧65 and <80, and ≧80 years. The total FIM scores both upon admission and at discharge were lower in the older age groups. No significant difference was observed in the changes in FIM scores across these age groups. Age was not an independent predictor for a good outcome. FIM upon admission was an independent predictor for a good outcome (discharge FIM ≧90) in all patients and in individual age groups. Having employment before stroke was a predictor for good outcome in all patients. Living at home prior to stroke was a predictor for the total population and the ≧65 and <80 years group. The length of stay predicted a good outcome in the group ≧80 years. Conclusions: Admission functional status, employment and living at home before stroke but not age per se are predictors of a good outcome following stroke rehabilitation. As older patients show comparable improvement during rehabilitation, intensive rehabilitation should not be withheld in stroke patients simply because of advanced age.
Comparison of Secondary Prevention Care after Myocardial Infarction and Stroke
Authors: Cheng Eric , Chen Alex , Vassar Stefanie , Lee Martin , Cohen Stanley N. , Vickrey Barbara
Published: February 2006

Background: Whether secondary prevention of atherosclerosis is performed as frequently after cerebrovascular events (stroke or transient ischemic attack) as after cardiac events (myocardial infarction or angina) is unknown. Methods: We compared the receipt of six secondary preventive care processes among 943 persons with a prior cardiac event to that among 523 persons with a prior cerebrovascular event using a representative sample of the US population. Results: The cardiac event group had higher rates for three care processes: antithrombotic medication use in the past year (83–77%, p = 0.01), ever advised to exercise more (66–52%, p < 0.001), and ever advised to eat fewer high-fat or high-cholesterol foods (70–54%, p < 0.001). Conclusions: Compared to the cardiac event group, the quality of care of the cerebrovascular event group is lower and should be improved.
Efficacy of Dual Antiplatelet Therapy in Cerebrovascular Disease as Demonstrated by a Decline in Microembolic Signals
Authors: Esagunde Romulo Urgel , Wong Ka Sing , Lee Moi Pin , Gan Hui Yee , Wong Meng Cheong , Chang Hui Meng , Chen Christopher Li Hsian
Published: February 2006

Background: The presence of microembolic signals (MES) may indicate an increased risk of recurrent ischemic events in patients with stroke. The optimal management of such patients is uncertain. We report the effect of clopidogrel in addition to aspirin on the number of MES in a series of patients with ischemic stroke and transient ischemic attack (TIA) due to large-vessel disease. Methods: 8 patients with either extracranial or intracranial artery stenosis were identified in 30-min MES studies by transcranial Doppler sonography as having MES. All patients were on antiplatelet therapy prior to baseline transcranial Doppler monitoring. The patients were subsequently treated with clopidogrel in addition to aspirin. Repeat MES studies were performed between day 3 and 7 with aspirin and clopidogrel. Results: All patients were Chinese. The median interval time from symptom onset to initial MES study was 7 days (range of 2–30). MES donor sites included 4 severely stenosed or occluded internal carotid arteries and 4 stenosed middle cerebral arteries. The median MES number at baseline was 8 (range 3–51). Repeat MES studies showed a significant decrease in MES (p = 0.012, Wilcoxon signed ranks test). 4 patients had complete cessation of MES and all patients showed a decline in MES. No patient had recurrent strokes or bleeding complications. Conclusion: The rapid and significant decline of MES in our stroke and TIA patients suggests the possible efficacy of dual antiplatelet therapy with aspirin and clopidogrel in patients with MES and symptomatic large-artery occlusive disease. Randomized controlled trials should be conducted to confirm this preliminary observation.
Effect of Smoking Status on Outcome after Acute Ischemic Stroke
Authors: Ovbiagele Bruce , Weir Christopher J. , Saver Jeffrey L. , Muir Keith W. , Lees Kennedy R.
Published: February 2006

Background: The status of smoking as a risk factor for the occurrence of stroke is well established. However, there is a paucity of data on the relationship between smoking status and acute stroke outcomes. We evaluated the role of recent smoking as a prognostic factor following acute ischemic stroke. Methods: We analyzed data from patients enrolled in the Intravenous Magnesium Efficacy in Stroke (IMAGES) trial. Outcome measures studied included change in IMAGES stroke score, poor functional outcomes at day 30 and 90 (defined as Rankin Scale >1 and Barthel Index <95), and survival over the first 3 months after stroke. The independent effect of smoking status (subjects who had smoked in the past year) on outcome was evaluated by logistic regression analysis and Cox’s proportional hazards model, adjusting for variables known to predict outcome after ischemic stroke. Results: There were 2,386 subjects in the IMAGES efficacy dataset, including 615 recent or current smokers and 1,771 nonsmokers, among whom smokers were younger (p < 0.0001). After adjusting for covariates, smokers had increased odds of poor 90-day functional outcome independently of other statistically significant predictor variables, as assessed by Rankin Scale (odds ratio 1.38; 95% confidence interval 1.09–1.75) and Barthel Index (odds ratio 1.42; 95% confidence interval 1.13–1.79) at day 90. Smoking status did not affect survival at day 90. Conclusions: Current or recent smokers experience poorer functional outcomes than nonsmokers 3 months after acute ischemic stroke.
Lack of Association of Lobar Intracerebral Hemorrhage with Apolipoprotein E Genotype in an Unselected Population
Authors: Seifert T. , Lechner A. , Flooh E. , Schmidt H. , Schmidt R. , Fazekas F.
Published: February 2006

Background: Both the υ2 and υ4 alleles of the apolipoprotein E gene (APOE) have been reported to be overrepresented in lobar intracerebral hemorrhage and to be associated with cerebral amyloid angiopathy (CAA). These studies were performed primarily on the North American population and investigated in partly selected patient cohorts. Methods: 193 consecutive patients suffering from primary intracerebral hemorrhage (ICH) were included in our study. The localization of the ICH, i.e. cortico-subcortical, deep white matter, basal ganglia, brainstem and cerebellum, was put in relation to the APOE genotype and vascular risk factors. In 101 of these patients, the APOE genotype was also correlated to the presence and distribution of microbleeds and other microangiopathy-related damage, as shown by magnetic resonance imaging (MRI). Results: We found neither an association of a specific APOE genotype with ICH localization nor with microangiopathy-related MRI findings. Conclusions: In our study of an unselected Central European population, the APOE genotype was not confirmed as a candidate for providing additional diagnostic and potentially prognostic information in patients with ICH.
Modified Rankin Scale with Expanded Guidance Scheme and Interview Questionnaire: Interrater Agreement and Reproducibility of Assessment
Authors: Shinohara Yukito , Minematsu Kazuo , Amano Takahiro , Ohashi Yasuo
Published: February 2006

Background:The modified Rankin scale (mRS) is commonly employed as a measure of functional outcome after stroke. The purpose of this study was to investigate the reliability of the mRS using an expanded guidance scheme and a corresponding questionnaire on an unprecedentedly large scale. Methods:Neurologists interviewed patients with cerebral infarction on the basis of the questionnaire. These interviews were recorded on videotape. Raters (10 neurologists, 6 nurses and 4 physiotherapists) watched the videotapes of 30 patients interviewed and assessed the mRS according to the guidance scheme. Results:The agreement between the raters, as estimated from the intraclass correlation coefficient, was found to be satisfactory with values of 0.947 for neurologists and 0.963 for nurses and physiotherapists. The reproducibility was also satisfactory with values of 0.865 and 0.871, respectively. Conclusion: The data obtained suggest that our guidance scheme and questionnaire are useful for ensuring the quality of assessments made with the mRS.
Cannabinoid Receptor Agonists Inhibit Ca2+ Influx to Synaptosomes from Rat Brain
Authors: Yoshihara Shigemi , Morimoto Hiroshi , Ohori Makoto , Yamada Yumi , Abe Toshio , Arisaka Osamu
Published: February 2006

We examined the effects of cannabinoid receptor agonists on 45Ca2+ uptake in rat brain synaptosomes. A cannabinoid receptor agonist, (R)-(+)-[2,3-dihydro-5-methyl-3-[(4-merpholino)methyl]pyrrolo-[1,2,3-de]-1,4-benzoxazin-6-yl](1-naphthyl)methanone (WIN 55212-2) dose-dependently inhibited 45Ca2+ uptake in rat synaptosomes. Only an endogenous cannabinoid receptor agonist, anandamide, dose-dependently inhibited 45Ca2+ uptake in rat synaptosomes, but not an endogenous cannabinoid receptor agonist, palmitoylethanolamide. Only a cannabinoid CB1 antagonist, [N-(piperidin-1-yl)-5-(4-chlorophenyl)-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole-3-carboxamidehydrochloride] (SR 141716A), reversed the inhibitory effect of these WIN 55212-2 and anandamide on 45Ca2+ uptake in rat synaptosomes, but not a cannabinoid CB2 receptor antagonist, [N-[(1S)-endo-1,3,3-trimethylbicyclo[2.2.1]heptan-2-yl]-5-(4-chloro-3-methylphenyl)-1-(4-methylbenzyl)pyrazole-3-carboxamide] (SR 144528). The inhibitory effects of WIN 55212–2 and anandamide on 45Ca2+ uptake in rat synaptosomes were reversed by the pretreatment of a voltage-sensitive A-type K+ channel blocker, dendrotoxin, but no other type of K+ channel blockers, i.e. iberiotoxin, charybdotoxin or glibenclamide. These findings suggest that cannabinoid receptors inhibit Ca2+ influx into rat brain nerves via the activation of CB1 receptors and the opening of voltage-sensitive A-type K+ channels.