bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple renal arteries do not pose an impediment to the routine use of laparoscopic donor nephrectomy
Authors: Johnston T. , Reddy K. , Mastrangelo M. , Lucas B. , Ranjan Dinesh
Published: March 2003

Since the first description by Ratner and collegues in 1996, laparoscopic live‐donor nephrectomy is gaining wide acceptance in an attempt to minimize the donor morbidity, length of hospital stay and length of time to return to work. It is unknown whether multiple renal arteries pose additional problems with laparoscopic donor nephrectomy. In November 1998, our institution initiated laparoscopic donor nephrectomy program. In the ensuing 19 months, we performed 25 living donor renal transplants, 24 of them using laparoscopic donor nephrectomy. The left kidney was procured in all cases. Eight donor candidates (33%) had two or more renal arteries (two arteries in five patients and three patients). Results: In six cases (25%), findings at surgery differed from the CT angography results (in four cases, CT angiogram reported fewer arteries than were found at surgery and in two cases it reported more). We found no significant differences in both donor outcomes and recipient, based on the presence or absence of multiple renal arteries. Among donor outcomes, we found equivalent results for donor warm ischemia time total donor operating time, and donor length of stay. For recipient outcomes, we found no significant differences between groups for the incidence of acute tubular necrosis (ATN), graft survival and most recent serum creatinine. In one case, we constructed two arteries into a single conduit on the backtable prior to transplantation. However, in most cases with multiple arteries, we implanted the arteries separately into the recipient external iliac artery. Based on this experience, we do not find the presence of multiple renal arteries to be a barrier to the successful use of kidney grafts procured by laparoscopic donor nephrectomy.
Skin infections in renal transplant recipients
Authors: Hogewoning Arjan A , Goettsch Wim , Van Loveren H , De Fijter Jw , Vermeer Bert J , Bouwes Bavinck Jan N
Published: March 2003

Background: Skin infection is a frequent complication in renal transplant recipients. The purpose of the study was to acquire long‐term, period‐specific incidence data on the most commonly occurring skin infections in renal transplant recipients.  Methods: A retrospective analysis was performed using medical records of 134 patients, covering a period between 10 and 29 yr. Cumulative incidences of the skin infections were calculated by counting the infections per patient for different time periods and were expressed as a percentage of the total group of patients. The incidence of the skin infections was determined for different post‐transplant time periods.  Results: A total of 340 skin infections in 105 out of 134 patients were recorded. Some infections, such as candidal infection, herpes simplex infection, and impetigo were most prominent during the first post‐transplant year and did not affect many new patients after the first year. Other infections, such as dermatomycoses, herpes zoster, and folliculitis were also affecting a substantial number of new patients after the first post‐transplant year.  Conclusions: This study confirms that skin infections among renal transplant recipients are very common and that the spectrum of skin infections differs according to the post‐transplant time period.
Mild hyperhomocysteinemia is not associated with cardiac allograft coronary disease
Authors: Giannetti Nadia , Herity Niall A , Alimollah Ayub , Gao Shao‐Zhou , Schroeder John S , Yeung Alan C , Hunt Sharon A , Valantine Hannah A
Published: March 2003

Background: Hyperhomocysteinemia is an independent risk factor for coronary disease and elevated plasma homocysteine levels have been documented in heart transplant recipients. The aim of this study was to test the hypothesis that homocysteine levels are associated with presence or absence of transplant coronary artery disease.  Methods: Forty‐three non‐smoking adults were recruited, all of whom had received a heart transplant between 2 and 7 yr previously. All 43 had blood drawn for fasting homocysteine level on the day of presentation. All patients had undergone diagnostic coronary angiography within the past 6 months.  Results: For all patients, the average fasting plasma homocysteine level was 17.0±SD 6.6 μmol/L with a range from 6.0 to 36.9 μmol/L. Twenty‐six patients (60%) had fasting plasma homocysteine levels above 15.0 μmol/L. On the basis of arteriography, patients were categorized as those with angiographically normal (n=22) or abnormal (n=21) coronary arteries. There was no difference in the mean plasma homocysteine level comparing patients with angiographically normal (17.2±SD 7.0 μmol/L) to those with abnormal (16.8±SD 6.2 μmol/L) coronary arteries. Plasma homocysteine levels increased with increasing plasma creatinine levels (r=0.63, p<0.0001) and with decreasing vitamin B6 levels (r=−0.56, p<0.0001).  Conclusions: Mild hyperhomocysteinemia is a consistent finding among heart transplant recipients. This finding was not associated with transplant coronary artery disease in our patients. The combination of renal dysfunction and vitamin B6 deficiency may explain the unusual prevalence of hyperhomocysteinemia in heart transplant recipients.
Selection of uremic patients for kidney transplantation
Authors: Nyberg Gudrun , Svensson Maria
Published: March 2003

Selection of patients for kidney transplantations is necessary due to the shortage of organs. The process has not been greatly studied. Twelve hypothetical cases were constructed, each with one or several relative contraindications, such as cardiovascular disease, diabetes, old age or a mental disorder. The cases were submitted to 40 nephrologists, chosen to represent the recruitment areas of the four Swedish transplant units. They were asked to declare whether the ‘patient’ was suitable for transplantation or not, and, independently, whether the patient would be referred to the transplant unit. The same cases were evaluated by 3–4 representatives of each transplant unit. The response rate was 100%. A median of 6 cases was considered suitable (range 3–11). The acceptance rate differed significantly between the four unit areas, from 4 cases (3–7) to 7 (4–11), p=0.014. Nephrologists would accept fewer patients than staff from the transplant units, 5 (3–10) vs. 7 (3–11), p=0.009. Most of the latter difference was compensated for by referral of borderline cases to the unit. Only 5 individual cases were equally judged by at least 75% of the respondents. Discrepancies in view were noted with respect to the significance of old or young age, the patient's determination and severe obesity.
Selective internal radiation therapy by yttrium‐90 microspheres for hepatocellular carcinoma after renal transplantation
Authors: Szeto Cheuk‐Chun , Wong Teresa Yuk‐Hwa , Leung Chi‐Bon , Leung Thomas Wai‐Tong , Wang Angela Yee‐Moon , Lui Siu‐Fai , Li Philip Kam‐Tao
Published: March 2003

We report a HBsAg‐positive patient who developed hepatocellular carcinoma (HCC) 7 years after cadaveric kidney transplantation. The tumor was unresectable because of coexisting cirrhosis. Selective internal radiation (SIR) therapy, a novel therapy with the technique recently perfected, was used. Yttrium‐90 microspheres were given via an angiographic catheter under fluoroscopy guidance. Serum alpha‐fetal protein (AFP) was normalized within 2 wk. A follow‐up abdominal CT scan revealed significant necrosis of the tumor and compensatory hypertrophy of non‐diseased liver. The treatment was well tolerated except for transient liver function deterioration. The patient enjoyed 15 months of symptom‐free survival before she died of liver failure. Practical aspects and potential applications of SIR therapy in this group of patients are discussed.
Laparoscopic treatment of lymphoceles in patients after renal transplantation
Authors: Duepree Hans‐Joachim , Fornara Paolo , Lewejohann Jan‐Christoph , Hoyer Jochem , Bruch Hans‐Peter , Schiedeck Thomas Hans Karl
Published: March 2003

Postoperative lymphoceles after renal transplantation appear in up to 18% of patients, followed by individual indisposition, pain or impaired graft function. Therapeutic options are percutaneous drainage, needle aspiration with sclerosing therapy, or internal surgical drainage by conventional or laparoscopic approach. The laparoscopic procedure offers short hospitalisation time and quick postoperative recovery. From 1993 to 1997, 16 patients underwent laparoscopic fenestration of a post‐renal transplant lymphocele, and were presented in a retrospective analysis. Three patients have had previous abdominal surgery. Following preoperative ultrasound and CT scan, 16 patients underwent laparoscopic drainage after drainage and staining of the lymphocele with methylene blue. No conversion was necessary. Mean operation time was 42 min, no intraoperative complications were seen. Oral nutrition and immunosuppression were continued on the day of surgery, and patients were discharged between the 2nd and 5th (median hospital stay 3.3 d) day after surgery. No recurrence was evident in a follow‐up time of 15–54 months (median 31.4 months). Renal function remained unchanged in all patients postoperatively.
Psychosocial data of potential living donors before living donor liver transplantation
Authors: Walter Marc , Bronner Ekkehard , Steinmüller Thomas , Klapp Burghard F , Danzer Gerhard
Published: March 2003

In view of the scarcity of organ resources for transplantation, donation by living donors is assuming greater significance now that the technical‐surgical problems involved have been solved. In the period between December 1999 and December 2000, 47 potential living liver donors were evaluated and a total of 27 hepatic lobes were transplanted at the Virchow‐Klinikum of the Charité Hospital in Berlin. The close personal relationships between recipients and donors gives reason to anticipate high levels of psychosocial pressure during the pre‐operative evaluation process; this process consists in part in looking into donor motivation, ambivalence and anxiety.

The pre‐operative psychometric evaluation of 40 potential living donors indicated that most of the potential donors see themselves as `super‐healthy' and tend to adapt to social expectations, while on the other hand those seven potential living donors not accepted for psychosocial reasons were marked by heightened values for anxious depression and pessimism. The results indicate in most cases a great willingness to donate and on the other hand a high level of obvious psychological pressure for a low number of potential donors. For the latter, both the clinical evaluation interview and the psychometric diagnostics used revealed clear‐cut feelings of anxiety and ambivalence towards transplantation.
Impact of hepatitis C virus status in pancreas transplantation: a case controlled study
Authors: Honaker Marsha R , Stratta Robert J , Lo Agnes , Egidi M Francesca , Shokouh‐Amiri M Hosein , Grewal Hani P , Alloway Rita R , Gaber Lillian W , Hardinger Karen L , Gaber A Osama
Published: March 2003

Available data suggest that hepatitis C virus positive (HCV+) renal transplant patients may be at an increased risk of morbidity and mortality compared with HCV− patients. Limited data are available regarding the impact of HCV status in pancreas transplant patients. We compared the outcomes of 10 HCV+ patients undergoing pancreas transplantation (seven simultaneous kidney‐pancreas, one pancreas after kidney, two pancreas alone) between 1/96 and 10/99 with 20 HCV− recipients that were matched for age, race, gender, timing of transplant, type of pancreas transplant, and surgical technique. Length of follow‐up was not significantly different between the HCV+ group compared with the HCV− group (24 ± 14 vs. 20 ± 13 months; p=0.45). There was a trend toward a higher incidence of all cause mortality in HCV+ recipients compared with HCV− recipients, 30 vs. 10%, respectively (p=0.17). Additionally, the HCV+ recipients had a trend toward a higher incidence of sepsis‐related mortality compared with HCV− recipients, 20 vs. 5%, respectively (p=0.19). Renal allograft survival was 50% in the HCV+ group compared with 94% in the HCV− group (p=0.02). Pancreas allograft survival was not significantly different between the groups, 60 vs. 80%, respectively (p=0.24). At 3, 6, 12 months, and end of follow‐up, there were no differences in serum creatinine, amylase, C‐peptide, or fasting glucose levels. However, there was a significantly higher incidence of proteinuria at last follow‐up in the HCV+ recipients with a renal allograft when compared with HCV− recipients, 50 vs. 12.5%, respectively (p=0.05). In order to maintain comparable glycemic control between the groups, there was a significant increase in oral hypoglycemic requirement in HCV+ recipients compared with HCV− recipients, 33 vs. 0%, respectively (p=0.01). These data suggest that HCV+ pancreas transplant patients may be at an increased risk of graft dysfunction and morbidity. Further studies with more patients and longer follow‐up are needed to fully define the impact of HCV status on pancreas graft survival and function.
Report of recombinations between HLA loci within two families: utility of high resolution typing
Authors: Muro M , Moya‐Quiles MR , Marin L , Torío A , Vallejo C , Moraleda JM , Álvarez‐López MR
Published: March 2003

Muro M, Moya‐Quiles MR, Marin L, Torío A, Vallejo C, Moraleda JM, Álvarez‐López MR. Report of recombinations between HLA loci within two families: utility of high resolution typing. Clin Transplant 2002: 16: 329–333. © Blackwell Munksgaard, 2002

We have analysed two Caucasian families in which recombinant individuals have been identified. In both families, initial low resolution typing of class I and II antigens of possible patients referred for bone marrow transplantation and their respective potential donors (based on inherited haplotypes analysis) revealed them to be HLA identical and supposedly inheriting‐non‐recombinant haplotypes. The mothers were found to be DRB1*04 generic allele homozygous, but possessing two DRB1*04 specific alleles, DRB1*0403 and DRB1*0404 (family A) and DRB1*0401 and DRB1*0402 (family B). In both cases the patients inherited a maternal haplotype that is the result of a recombination event between the mother's HLA‐DRB1 and ‐B genes on their chromosomes. Based on linkage disequilibrium it is likely that the recombinant haplotypes are present in the patients rather than their brothers. In both families, the results of the MLC in terms of relative response was positive. Thus, these cases illustrate the importance of high resolution DNA class II typing when assignment of MHC antigens is of extreme importance (i.e. bone marrow transplantation).
Impact of human herpesvirus‐6 on the frequency and severity of recurrent hepatitis C virus hepatitis in liver transplant recipients
Authors: Singh Nina , Husain Shahid , Carrigan Donald R , Knox Konstance K , Weck Karen E , Wagener Marilyn M , Gayowski Timothy
Published: March 2003

A role of tumor necrosis factor‐alpha (TNF‐α) In the immunopathogenesis of hepatitis C virus (HCV) infection has been proposed. The novel herpes virus, human herpes virus‐6 (HHV‐6), is amongst the most potent inducers of cytokines, including TNF‐α. The impact of HHV‐6 viremia on the progression of recurrent HCV hepatitis was assessed in 51 HCV‐positive liver transplant recipients. The frequency of recurrent HCV hepatitis did not differ between patients with HCV viremia (47.6%, 10/21) as compared with those without HCV viremia (46.7%, 14/30, p=0.9). However, the patients with HHV‐6 viremia had a significantly higher fibrosis score upon HCV recurrence than those without HHV‐6 viremia (mean 1.5 vs. 0.3, p=0.01). An association between cytomegalovirus (CMV) viremia and HCV recurrence was not documented; 50% (15/30) of the patients with CMV viremia and 42.8% (9/21) of those without CMV viremia had recurrent HCV hepatitis (p > 0.5). Receipt of ganciclovir (administered upon the detection of CMV viremia) was associated with lower total Knodell score (mean 5.2 vs. 6.9, p=0.05) and a trend towards lower fibrosis score (mean 0.44 vs. 1.00, p=0.12) in patients with recurrent HCV hepatitis. Thus, HHV‐6 viremia in HCV‐positive liver transplant recipients identified a subgroup of patients at increased risk for early fibrosis upon HCV recurrence.
Lithium and synaptic plasticity
Authors: Salinas Patricia C , Hall Anita C
Published: March 2003

Lithium, a small cation, has been used in the treatment of bipolar disorders since its introduction in the 1950s by John Cade. Extensive research on the mechanism of action of lithium has revealed several possible targets. For some time, the most widely accepted action of lithium was its inhibitory effect on the synthesis of inositol, resulting in depletion of inositol with profound effects on neuronal signal transduction pathways. However, several studies show that some effects of lithium are not mediated through inositol depletion. Recent findings demonstrate that lithium directly inhibits, in a non‐competitive fashion, the activity of glycogen synthase kinase (GSK)‐3β, a serine/threonine kinase highly expressed in the central nervous system. Interestingly, inhibition of GSK‐3β has been shown to regulate neuronal plasticity by inducing axonal remodelling and increasing the levels of synaptic proteins. These findings raise the possibility for developing new therapeutic approaches for the treatment of bipolar disorders.
Cholesterol levels in mood disorders: high or low?
Authors: Ghaemi S Nassir , Shields Gregory S , Hegarty James D , Goodwin Frederick K
Published: March 2003

Objectives:

To assess cholesterol levels in patients with mood disorders.   Methods: All consecutively admitted patients meeting inclusion criteria (n=50) who were hospitalized in an affective disorders unit received assessments of cholesterol levels. Correlations were made with diagnosis using DSM‐IV criteria, current mood states, and other clinical and demographic features of illness. Exclusion criteria included current alcohol abuse, medical illnesses that could influence cholesterol levels, eating disorders, and age greater than 70 years.   Results: Cholesterol levels did not differ based on diagnostic status of unipolar depression or bipolar disorder. In the total sample, cholesterol levels were lower in patients with current manic (170.2±38.9, p=0.05) and depressive (182.0±42.0) than in mixed (226.4±43.3) episodes (p=0.05). In subgroups of patients with bipolar disorder, manic episodes (169.9±38.8, n=9) were associated with lower cholesterol levels than depressive (201.0±49.4) or mixed (226.4±44.4) episodes (p=0.02 for comparison of manic and mixed episodes). Body mass index (BMI), age, alcohol use, and gender did not account for these findings.   Conclusions: Cholesterol levels were lower in manic and depressive than in mixed episodes. No differences were found between diagnoses of unipolar or bipolar mood disorders. Cholesterol may be a state rather than a trait function, and may be influenced by the acute mood state.
No evidence of association from transmission disequilibrium analysis of the hKCa3 gene in bipolar disorder
Authors: Bowen Timothy , Ashworth Lindsay , Kirov George , Guy Carol A , Jones Ian R , McCandless Fiona , Craddock Nick , O'donovan Michael C , Owen Michael J
Published: March 2003

Objective:
A recent case–control study has suggested that modest enlargements of a highly polymorphic CAG repeat in exon 1 of the gene encoding potassium channel hKCa3 may be associated with bipolar disorder (BPD). We have examined this hypothesis by genotyping this locus in a family‐based association study.   Method: One hundred and twenty‐eight parent–offspring trios of British Caucasian origin were examined where the proband was diagnosed with the American Psychiatric Association's Diagnostic and Statistical Manual (DSM)‐IV BPD I (n=123) or II (n=5). An improved assay was used, with redesigned polymerase chain reaction (PCR) primers, permitting quicker and higher resolution genotyping. The resultant genotypes were analysed using the extended transmission/disequilibrium test (ETDT).   Results: The experimental data did not provide evidence for the preferential transmission of large alleles to bipolar cases (χ2=11.12, df=10, p=0.349).   Conclusions: Our data provide no support for the hypothesis that variation at the hKCa3 gene contributes to susceptibility to BPD.
fMRI during affect discrimination in bipolar affective disorder
Authors: Yurgelun‐Todd Deborah A , Gruber Staci A , Kanayama Gen , Killgore William DS , Baird Abigail A , Young Ashley D
Published: March 2003

Objective:

It has been hypothesized that disturbances in affect may represent distinct etiologic factors for bipolar affective disorder. The neural mechanisms mediating affective processes and their relationship to brain development and the pathophysiology of bipolar affective disorder remain to be clarified. Recent advances in neuroimaging techniques have made possible the non‐invasive examination of specific brain regions during cortical challenge paradigms. This study reports findings based on fMRI data acquired during fearful and happy affect recognition paradigms in patients with bipolar affective disorder and in healthy adult subjects.

  Methods: Prior to the scan, subjects were instructed to view the stimuli and to identify the type of facial expression presented. Echo planar scanning was performed on a 1.5 Tesla scanner which had been retrofitted with a whole body echo planar coil, using a head coil.

  Results: The data indicate that in adult subjects with bipolar affective disorder, there is a reduction in dorsolateral prefrontal cortex activation and an increase in amygdalar activation in response to fearful facial affect. In a healthy comparison group, signal intensity changes were not found in these regions. In addition, although the patients with bipolar affective disorder completed the task demands, they demonstrated an impaired ability to correctly identify fearful facial affect but not the happy facial affect displayed.

  Conclusion: These findings are consistent with the hypothesis that in some patients with bipolar affective disorder, there may be a reduction of frontal cortical function which may be associated with affective as well as attentional processing deficits.
Reduced inositol content in lymphocyte‐derived cell lines from bipolar patients
Authors: Belmaker RH , Shapiro J , Vainer E , Nemanov L , Ebstein RP , Agam G
Published: March 2003

Objectives:
The study aimed to determine whether low inositol content and uptake previously reported in brain and peripheral tissue of bipolar patients are also reflected in lymphocyte‐derived cell lines from these patients.

Methods:
Inositol content and uptake were studied in lymphocyte‐derived cell lines grown in vitro for at least five generations to eliminate influences of drug treatment. Inositol content was studied gas chromatographically and inositol uptake by following 3H‐inositol incorporation at various concentrations.

Results:
Inositol levels of cell lines derived from bipolar patients were significantly lower than those of cell lines from controls.

Conclusions:
Low inositol content in lymphocyte‐derived cell lines from bipolar patients corroborates previous findings in frontal cortex and in lymphoblastoid cell lines and are consistent with the notion that the phosphatidylinositol signaling system is involved in the pathophysiology of this disorder.
Cell pathology in bipolar disorder
Authors: Rajkowska Grazyna
Published: March 2003

Objectives:
The objective of this paper is to review findings of morphometric postmortem studies conducted on tissues from subjects with bipolar disorder (BPD) to demonstrate that impairments of cell morphology and resilience may underlie the neurobiology of BPD.

Methods:
Reports of alterations in number, density and size of neurons and glial cells in BPD are reviewed. Owing to the low number of postmortem studies on cellular pathology in BPD, abstracts of recent symposia are also discussed.

Results and Conclusions:
In BPD, significant reductions in the volume of several brain regions, as well as region‐ and layer‐specific reductions in the number, density and/or size of neurons and glial cells have been demonstrated. Moreover, the results of recent clinical and preclinical studies investigating the molecular and cellular targets of mood stabilizing and antidepressant medications provide intriguing possibilities that impairments in neuroplasticity and cellular resilience may underlie the neurobiology of BPD. Future studies will likely examine the role of both genetic and environmental factors in the pathogenesis and cellular changes in BPD.
Laterality of pain in migraine with comorbid unipolar depressive and bipolar II disorders
Authors: Fasmer Ole Bernt , Oedegaard Ketil Joachim
Published: March 2003

Objectives:  The purpose of the present study has been to examine differences in the laterality of pain in patients with migraine and comorbid unipolar depressive (UP) and bipolar II (BP II) disorders.

Methods:  Semi‐structured interviews of 102 patients with major affective disorders were conducted, using DSM‐IV criteria for affective disorders combined with Akiskal's criteria for affective temperaments and International Headache Society criteria for migraine. The group of patients reported on in the present study encompass 47 subjects with UP (n=24) or BP II (n=23) disorders. Fifteen of the bipolar II patients fulfilled DSM‐IV criteria while eight were diagnosed according to the broader criteria of Akiskal.

Results:  Sixteen of the 38 patients with migraine headaches had bilateral pain or pain equally often on the left or right side while 22 had pain predominantly located on one side. Among the UP patients the pain was most often on the right side (8/10) while among the BP II patients the pain was most often on the left (9/12, p = 0.01). Apart from the presence of hypomanic symptoms in the BP II group there were no clinical or demographic characteristics that distinguished these two sub‐groups of affective disorders.

Conclusions:  These results indicate that there may be a differential affection of the cerebral hemispheres in patients with migraine and comorbid unipolar depressive disorder versus patients with migraine and comorbid bipolar II disorder.
Glycogen synthase kinase‐3β, mood stabilizers, and neuroprotection
Authors: Li Xiaohua , Bijur Gautam N , Jope Richard S
Published: March 2003

Glycogen synthase kinase‐3β (GSK‐3β) is a central component in many critical intracellular signaling mechanisms. These include the phosphatidylinositol 3‐kinase/Akt cell survival pathway, which inhibits GSK‐3β activity. GSK‐3β itself inhibits the activation of several transcription factors, which are important cell survival factors, such as heat shock factor 1. These factors likely contribute to the recent revelation that GSK‐3β is a pro‐apoptotic enzyme. Recently, lithium has been identified as a selective and direct inhibitor of GSK‐3β. Based on these findings, we have proposed that part of the neuroprotectant properties of lithium is due to its ability to inhibit GSK‐3β, and thus block the facilitation of apoptosis produced by GSK‐3β. Since several anticonvulsants recently have been shown to be effective mood stabilizers, we examined if these agents are capable of protecting cells from GSK‐3β‐facilitated apoptosis. In addition to lithium, both valproic acid and lamotrigine, but not carbamazepine, provided protection from GSK‐3β‐facilitated apoptosis in human neuroblastoma SH‐SY5Y cells. These results demonstrate that several drugs therapeutic for bipolar disorder can provide neuroprotection by inhibiting the pro‐apoptotic effects of GSK‐3β, providing new evidence that dysregulation of GSK‐3β may contribute to the pathophysiology of bipolar disorder.
Left prefrontal transcranial magnetic stimulation (TMS) treatment of depression in bipolar affective disorder: a pilot study of acute safety and efficacy
Authors: Nahas Ziad , Kozel F Andrew , Li Xingbao , Anderson Berry , George Mark S
Published: March 2003

Objectives:  Repetitive transcranial magnetic stimulation (rTMS) has been shown to improve depressive symptoms. We designed and carried out the following left prefrontal rTMS study to determine the safety, feasibility, and potential efficacy of using TMS to treat the depressive symptoms of bipolar affective disorder (BPAD).

Methods:  We recruited and enrolled 23 depressed BPAD patients (12 BPI depressed state, nine BPII depressed state, two BPI mixed state). Patients were randomly assigned to receive either daily left prefrontal rTMS (5 Hz, 110% motor threshold, 8 sec on, 22 sec off, over 20 min) or placebo each weekday morning for 2 weeks. Motor threshold and subjective rating scales were obtained daily, and blinded Hamilton Rating Scale for Depression (HRSD) and Young Mania Rating Scales (YMRS) were obtained weekly.

Results:  Stimulation was well tolerated with no significant adverse events and with no induction of mania. We failed to find a statistically significant difference between the two groups in the number of antidepressant responders (>50% decline in HRSD or HRSD <10 – 4 active and 4 sham) or the mean HRSD change from baseline over the 2 weeks (t=−0.22, p=0.83). Active rTMS, compared with sham rTMS, produced a trend but not statistically significant greater improvement in daily subjective mood ratings post‐treatment (t=1.58, p=0.13). The motor threshold did not significantly change after 2 weeks of active treatment (t=1.11, p=0.28).

Conclusions:  Daily left prefrontal rTMS appears safe in depressed BPAD subjects, and the risk of inducing mania in BPAD subjects on medications is small. We failed to find statistically significant TMS clinical antidepressant effects greater than sham. Further studies are needed to fully investigate the potential role, if any, of TMS in BPAD depression.
Longitudinal outcome in patients with bipolar disorder assessed by life‐charting is influenced by DSM‐IV personality disorder symptoms
Authors: Bieling Peter J , MacQueen Glenda M , Marriot Michael J , Robb Janine C , Begin Helen , Joffe Russell T , Young L Trevor
Published: March 2003

Objectives:  Few studies have examined the question of how personality features impact outcome in bipolar disorder (BD), though results from extant work and studies in major depressive disorder suggest that personality features are important in predicting outcome. The primary purpose of this paper was to examine the impact of DSM‐IV personality disorder symptoms on long‐term clinical outcome in BD.

Methods:  The study used a ‘life‐charting’ approach in which 87 BD patients were followed regularly and treated according to published guidelines. Outcome was determined by examining symptoms over the most recent year of follow‐up and personality symptoms were assessed with the Structured Clinical Interview for DSM‐IV (SCID‐II) instrument at entry into the life‐charting study.

Results:  Patients with better outcomes had fewer personality disorder symptoms in seven out of 10 disorder categories and Cluster A personality disorder symptoms best distinguished euthymic and symptomatic patients.

Conclusions:  These results raise important questions about the mechanisms linking personality pathology and outcome in BD, and argue that conceptual models concerning personality pathology and BD need to be further developed. Treatment implications of our results, such as need for psychosocial interventions and treatment algorithms, are also described.
Deep white matter hyperintensities in patients with bipolar depression, unipolar depression and age‐matched control subjects
Authors: Silverstone Trevor , McPherson Heather , Li Qunhuan , Doyle Terry
Published: March 2003

Objective: Hyperintensities in the white matter of the brain (DWH) and in the periventricular area (PVH) seen on magnetic resonance imaging (MRI) have been reported to be more frequent in patients with bipolar disorder (BP) than in normal subjects. To examine this further we compared MRI of patients with BP with age‐matched patients with major depressive disorder (unipolar depression, UP) and healthy control subjects.

Methods: T2 weighted axial and coronal brain MRI scans were obtained from 13 patients in the depressive phase of BP, 11 with current UP and 19 age‐matched control subjects. The degree of DWH and PVH present in each scan was determined using a standardized scoring method.

Results: The PVH ratings were similar in the three groups of subjects. However, proportionately more BP patients had higher DWH scores than either UP patients or controls. Although this difference did attain statistical significant, a main effect of age was noted. Further, subjects over the age of 50 were under‐represented in the UP group.

Conclusions: Notwithstanding the small total sample size and relative lack of older subjects in the UP group, the fact that almost twice as many BP patients showed more severe DWH suggests that patients with BP may be more vulnerable to develop these changes than UP patients and healthy controls.
Effect of chronic Li+ treatment on free intracellular Mg2+ in human neuroblastoma SH‐SY5Y cells
Authors: Abukhdeir Abde M , Layden Brian T , Minadeo Nicole , Bryant Fred B , Stubbs Evan B. , De Freitas Duarte Mota
Published: March 2003

Objectives:  Previous findings have demonstrated Li+/Mg2+ competition at therapeutic intracellular Li+ levels after acute Li+ treatment in human neuroblastoma SH‐SY5Y cells. In the current study, we examined whether Li+/Mg2+ competition exists at therapeutically relevant extra‐ and intracellular [Li+] after chronic Li+ loading times.

Methods:  In human neuroblastoma cells, intracellular free Mg2+ was determined by fluorescence spectroscopy with the fluorophore furaptra. Intracellular Li+ and Mg2+ were measured by atomic absorption spectrophotometry.

Results:  After loading of the neuroblastoma cells with 1–2 mM extracellular Li+ for 24–72 h, the observed, increased intracellular free [Mg2+] levels were significantly higher (p < 0.03) than those in matched Li+ free cells, and intracellular [Li+] was found to be at therapeutic intracellular levels (0.7–1.5 mM).

Conclusions:  The results demonstrate that Li+/Mg2+ competition exists after chronic treatment with Li+ at therapeutically relevant intracellular Li+ levels in neuroblastoma cells. We found differences between acute and chronic Li+ treatment effects on the extent of Li+/Mg2+ competition. Possible reasons for these differences are discussed.
Behavioural insensitivity to sad facial expressions is associated with attenuated activation of amygdala and cingulate regions in patients with mania
Authors: Lennox Belinda , Jacob Rebecca , Calder Andy , Lupson Vicky , Bullmore Ed
Published: March 2003

Lennox B, Jacob R, Calder A, Lupson V, Bullmore E. Behavioural insensitivity to sad facial expressions is associated with attenuated activation of amygdala and cingulate regions in patients with mania.  Bipolar Disord 2002: 4(Suppl. 1): 89. © Blackwell Munksgaard, 2002
The mechanism of action of psychotherapy
Authors: Colom F
Published: March 2003

Colom F. The mechanism of action of psychotherapy.   Bipolar Disord 2002: 4(Suppl. 1): 102. © Blackwell Munksgaard, 2002
Evaluation of parent‐of‐origin effect in bipolar affective disorder relating to susceptibility loci on chromosome 18
Authors: Lambert David , Gill Michael
Published: March 2003

Lambert D, Gill M. Evaluation of parent‐of‐origin effect in bipolar affective disorder relating to susceptibility loci on chromosome 18. Bipolar Disord 2002: 4(Suppl. 1): 31–32. ©Blackwell Munksgaard, 2002
Aggressive angiomyxoma in females: is radical resection the only option?
Authors: CHAN IK MING , HON EDMUND , NGAI SUK WAI , NG TONG YOW , WONG LING CHUI
Published: March 2003

Background. Aggressive angiomyxoma is a rare mesenchymal tumor, characterized by frequent local recurrences. Our aim is to assess the role of radical resection.

Methods. Retrospective case review. The records of five patients with aggressive angiomyxoma during the period from 1984 to 1998 were reviewed and analyzed. A MEDLINE search from 1983 to May 1999 was performed. The clinical presentation, surgical treatment, resection margin involvement and clinical outcomes were analyzed.

Results. Together with our five cases, 106 cases have been reported in the world literature. The female‐to‐male ratio was 6.6:1. The age distribution was wide, with the peak incidence at 31 to 35. The local recurrence rate was high. Seventy‐one percent of recurrence occurred within the first 3 years. Patients with clear resection margins have similar chances of remaining disease‐free compared with those having tumor‐involved resection margins. There was no correlation between the size of the tumors and the chance of recurrence.

Conclusions. Though we aim for complete resection, incomplete or partial resection is acceptable, especially when high operative morbidity is anticipated and preservation of fertility is an issue. Long‐term follow‐up and careful monitoring with imaging techniques are essential for timely identification of recurrence and prompt resection.
Laparoscopic colposuspension: a short term urodynamic follow‐up and a three‐year questionnaire‐study
Authors: PERSSON JAN , BOSSMAR THOMAS , WØLNER‐HANSSEN PÅL
Published: March 2003

Background. The purpose of the study was to evaluate outcome, urodynamic correlates and adverse effects of laparoscopic colposuspension using polytetrafluoroethylene sutures.

Methods. Eighty‐five consecutive women with primary stress urinary incontinence at one university hospital were included in this prospective non‐controlled study. During videolaparoscopic surgery, two polytetrafluoroethylene sutures were placed on each side of the urethra and fixed to the Cooper ligaments. Pre‐ and postoperative clinical and urodynamic evaluations, including pad‐test, were performed. A mailed questionnaire was used to evaluate cure‐rate and complication‐rate three years after surgery.

Results. At follow‐up examination, we considered 62 of 76 women (82%) as being cured, ten (13%) improved, and four (5%) as being failures. The questionnaires were returned by 80 women; 41 (51%) considering themselves as cured and 31 (39%) improved, and eight women (10%) as unimproved or minimally improved. Clinical outcome was not associated with alterations in urethral functional length or in urethral closing pressure. Short preoperative urethral functional length was associated with failure (p=0.04).The incidence of new onset urge symptoms and of new onset recto/enterocele was 13% and 9% respectively.

Conclusions. Laparoscopic colposuspension resulted in acceptable cure rate in short‐, and medium long term evaluation. However, a decline in cure rate was observed. Cured women had significantly longer preoperative urethral functional length than women still leaking after surgery.
Second lower genital tract squamous cell carcinoma following cervical cancer
Authors: SENKUS ELŻBIETA , KONEFKA TOMASZ , NOWACZYK MONIKA , JASSEM JACEK
Published: March 2003

Background. Patients after treatment for cervical cancer have increased risk of developing second squamous cell malignancy of the lower genital tract.

Material and methods. A retrospective study of 46 patients with second lower genital tract epidermoid cancers following previous treatment for invasive cervical carcinoma.

Results. Patient age at diagnosis of cervical cancer was 27 to 68 years (median 44 years) and at diagnosis of the second malignancy – 43 to 72 years (median 63 years). There were four cases (9%) of synchronous cancers. Time span between metachronous malignancies ranged from 66 to 406 months (median 206 months). In 32 cases (70%) second lesion was located in the vagina and in 14 (30%) – in the vulva. Out of 35 previously irradiated patients, in 24 (69%) second tumor was located within the high dose volume and in 11 (31%) – outside it. Treatment of second cancer consisted of surgery in 12 patients (26%), radiotherapy – in 23 (50%), combined surgery and radiotherapy – in five (11%), chemotherapy – in four (9%) and surgery plus chemotherapy – in one case. Median survival was 52 months and five‐year survival from the diagnosis of second malignancy – 47.5%. No prognostic factors for survival were identified.

Conclusion. Treatment outcome in patients with second lower genital tract carcinoma is unsatisfactory due to poor feasibility of another definite treatment after previous radical surgery and/or radiotherapy.
Transverse uterine incision non‐closure versus closure: an experimental study in sheep
Authors: GÜL ABDÜLAZIZ , ŞİMŞEK YALÇIN , UĞRAŞ SERDAR , GÜL TALIP
Published: March 2003

Subject. This study was designed to investigate whether the non‐closure of the layers of the uterus during low transverse cesarean section would result in healing and have advantage on closure.

Material and method. Thirty pregnant ewes randomly divided into two groups. Each group included 15 ewes. Each ewe was anesthetized at para‐vertebral region with the injection of 20 ml Prilocine 2%. Following left transverse abdominal incision, a transverse incision was made on the uterus and lambs were delivered. In the first group, uterine incision line was left open. In the second group, uterine incision line was sutured with no. 1 Chromic catgut by Schimiden technique. In both groups, all layers of abdominal wall except skin were sutured as en‐bloc with Vicryl® no. 2, by continuous suture technique. Skin was sutured with no. 00 silk interrupted sutures. The ewes were slaughtered four months after cesarean section. A coworker was asked to open the abdominal cavities, and score the intra‐abdominal adhesions. Tissues taken from incision line of each uterus were fixed in 10% neutral buffered‐formalin and were embedded in paraffin‐block. Sections were cut and stained with hematoxylin‐eosin. A pathologist, who knew nothing about the study, evaluated all sections, and reported the findings. Student's t test was used for comparison of mean ewe age, gestational age, and mean operation time of the two groups. Z test was used for comparing the ratio of the two groups by means of histopathological findings.

Results. No cervical dilatation and delivery of the placenta were seen during the four week follow up period. The average operating time was significantly less for the non‐closure group (48.07±3.83 minutes) than for the closure group (62.53±6.57 minutes; p=0.001). The ranges of myometrial necrosis (100% versus 13.3%; p=0.001) and endometriosis (53.3% versus 00.0%; p=0.001) were significantly higher for closure group than for non‐closure group.

Conclusion. It was found that non‐closure layers of the uterus along low transverse cesarean incision proves to have no adverse effect on immediate and late postoperative period in ewes. Our data showed that non‐closure of all layers of the uterus results in significantly less muscular necrosis and endometriosis than closure group. We suggest that lower uterine incision can be left unclosed or, at least, simple closure can be preferable instead of vigorous locking technique.
High prevalence of the prothrombin gene mutation in women with intrauterine growth retardation, abruptio placentae and second trimester loss
Authors: KUPFERMINC MICHAEL J. , PERI HAVA , ZWANG ETI , YARON YUVAL , WOLMAN IGAL , ELDOR AMIRAM
Published: March 2003

Background. It has been reported recently that obstetric complications are associated with thrombophilias. Our objective was to investigate the association between pregnancy complications and the guanine 20210 adenine (G20210A) mutation in prothrombin gene.

Methods. Two hundred and twenty‐two women (study group) with obstetric complications were tested for the prothrombin mutation. Indications for testing were: severe preeclampsia, mild preeclampsia, intrauterine growth retardation, severe abruptio placentae, unexplained stillbirth, second trimester loss, and three or more consecutive spontaneous abortions. We also tested 156 healthy women who had at least one normal pregnancy and comprised the control group.

Results. Demographic data of the study and control groups were similar. Twenty‐eight women of the study group (13%) were found to be heterozygous carriers of the 20210 variant of the prothrombin gene compared to five (3.2%) of the control group, p=0.001, odds ratio (OR) 2.9; 95% confidence interval (CI) 1.3–6.5. Compared to the control women, the prothrombin gene mutation was significantly more prevalent in women with IUGR, abruptio placentae, and second trimester loss but not in women with mild or severe preeclampsia, stillbirth and habitual abortion.

Conclusions. Our data demonstrate that the mutation in the prothrombin gene is associated with specific pregnancy complications.
Primary treatment of cervical carcinoma
Authors: HAGEN BJØRN , SKJELDESTAD FINN EGIL , HALVORSEN TORE , STRICKERT TROND , TINGULSTAD SOLVEIG , LORENZ ELKE , ONSRUD MATHIAS
Published: March 2003

Objective. To study the primary care of cervical carcinoma with regard to clinical and pathological factors, treatment decisions, complications and survival.

Design. A historical cohort comprising all women hospitalized with invasive cervical carcinoma (n=293) during the period 1987–1996.

Results. Median age was 52 years (range 23–90). FIGO stage distribution was 62%, 15%, 18% and 5% in stages I, II, III and IV, respectively. Early stage disease correlated with young age. Histologic types were: squamous cell carcinoma 84%, adenocarcinoma 11%, adenosquamous carcinoma 4% and small cell/anaplastic carcinoma 1%. Primary therapies were: surgery 188 women (64%), radiotherapy 99 women (34%), chemotherapy two women (0.7%); four women not treated (1.3%). Complications after surgery in 25 women (13%), none were fatal. Acute or late complications after primary or postoperative radiotherapy in 39 women (25%), seven (4.6%) were late serious complications. Three women died from complications related to radiotherapy. Mean follow‐up of surviving patients was 58 months. Overall disease specific five‐year survival was 70%. Five‐year survival in stages IA, IB, II and III was 100%, 88%, 58% and 20%, respectively. One‐year survival in stage IV was 31%. Median survival in stages III and IV according to curative or palliative aim of treatment was 20 and 6 months, respectively (p<0.005).

Conclusion. Satisfactory quality of diagnosis and therapy have been maintained through regional care for cervical cancer patients.
Concentration of Interleukin‐12 in the peritoneal fluid is not influenced by the presence of endometriosis, its stage or the phase of the menstrual cycle
Authors: Gazvani Rafet , Bates Michelle , Vince Gillian , Christmas Stephen , Lewis‐Jones Iwan , Kingsland Charles
Published: March 2003

Background. IL‐12 is a key immunomodulatory cytokine. Its presence or concentration in peritoneal fluid is not related to the presence of endometriosis or the stage of the disease. A study was carried out to gain insight into the role of IL‐12 in the development and maintenance of endometriosis in relation to menstrual cycle.

Methods. A prospective study recruiting 64 consecutive women undergoing laparoscopic surgery for benign gynecological indications. Peritoneal fluid was obtained during laparoscopy. Concentration of IL‐12 was measured and correlated to the presence of endometriosis, its stage and the phase of the menstrual cycle.

Result(s). Peritoneal fluid concentrations of IL‐12 showed no correlation with the presence of endometriosis, the AFS stage of the disease or the phase of the menstrual cycle.

Conclusion(s). IL‐12 is a normal constituent of peritoneal fluid in around one third of the population tested and is not involved in the pathogenesis of endometriosis at any stage of the disease or the phase of the menstrual cycle.