bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the Effectiveness of Scanning Laser Polarimetry and Optical Coherence Tomography for Estimating Optic Nerve Fibre Layer Thickness in Patients with Glaucoma
Authors: Furuichi Mieko , Kashiwagi Kenji , Furuichi Yoshiharu , Tsukahara Shigeo
Published: April 2003

Purpose: The effectiveness of scanning laser polarimetry (by the nerve fibre analyser, NFA) and of optical coherence tomography (OCT) in estimating nerve fibre layer thickness (NFLT) and the correlations between NFLT and cup-to-disc (C/D) ratio or values of mean deviation (MD) from static visual field tests were compared using patients with glaucoma. Materials and Methods: Twenty-four eyes from 24 glaucoma patients were enrolled. The NFLT was measured along a circle with a diameter 1.5 times that of the optic disc around the optic disc. The averaged estimated NFLT of the circle or of each quadrantal NFLT (nasal, temporal, superior, inferior) was compared. Results: The co-variant indexes measured by the NFA were significantly smaller than those measured by OCT in both the averaged NFLT (p = 0.0002) and in each quadrantal NFLT (p < 0.05). The C/D ratio was significantly correlated with the averaged NFLT when measured by OCT (r = 0.425, p = 0.038), but not by the NFA (r = 0.179, p = 0.407). However, when measured by OCT, these values showed a significant correlation (r = 0.425, p = 0.039). Although both the OCT and NFA data showed significant correlations between NFLT and the MD (p = 0.0002 and p = 0.038, respectively), the OCT data showed a stronger correlation than did the NFA data (r = 0.677 and r = 0.422, respectively). The correlation between the averaged NFLTs obtained by NFA and OCT was not significant (r = 0.289, p = 0.172). Conclusion: OCT is thought to have an equal or better effectiveness for estimating NFLT, in spite of a lower reproducibility than that of the NFA.
Ocular Surface Changes Induced by Topical Antiglaucoma Monotherapy
Authors: Cvenkel Barbara , Ihan Alojz
Published: April 2003

Purpose: To investigate the expression of inflammatory markers HLA-DR in impression cytology specimens from patients receiving topical antiglaucoma monotherapy. Methods: Impression cytology specimens were obtained from patients taking no topical medication (n = 13) and from primary open-angle glaucoma or ocular hypertensive patients taking one topical medication for at least 3 months (latanoprost n = 14; betaxolol n = 12; timolol n = 14). None of the patients had any signs of ocular surface inflammation as detected by slit-lamp examination, a normal Schirmer’s test and tear breakup time. The expression of HLA-DR on epithelial cells and T lymphocytes was analysed by flow cytometry. Results: A significant increase in HLA-DR on epithelial cells in patients on monotherapy was detected (latanoprost p < 0.05; betaxolol p < 0.01; timolol p < 0.01). Although the duration of treatment differed significantly between individual groups, there was no significant correlation between the length of monotherapy and the expression of inflammatory markers by epithelial cells and T lymphocytes. In the latanoprost group, the increased expression of HLA-DR was associated with a shorter duration of treatment. Conclusions: The flow-cytometric results indicate that administration of a single topical medication preserved with benzalkonium chloride, irrespective of type, for 3 months or more induced a significant degree of subclinical inflammation detected as increased expression of HLA-DR on conjunctival epithelial cells.
Normal-Tension Glaucoma Is Associated with Sleep Apnea Syndrome
Authors: Mojon Daniel S. , Hess Christian W. , Goldblum David , Boehnke Matthias , Koerner Fritz , Gugger Matthias , Bassetti Claudio , Mathis Johannes
Published: April 2003

Introduction: In normal-tension glaucoma, optic nerve damage occurs without elevated intraocular pressures, hence vascular and pathogenic mechanisms other than intraocular pressure effects have been postulated. However, the exact cause(s) remain unknown. We have looked for an association between normal-tension glaucoma and sleep apnea syndrome, a disease characterized by repetitive upper airway obstructions during sleep, inducing hypoxia and sleep disruption with the risk of late cardiovascular and neurological sequelae. Methods: We performed overnight polysomnography in 16 consecutive Caucasian patients with normal-tension glaucoma. The respiratory disturbance index (RDI) during night sleep was used to diagnose and grade obstructive sleep apnea. Patients with an RDI of 10 or more were diagnosed as having obstructive sleep apnea. Results: We observed the following prevalences of obstructive sleep apnea in normal-tension glaucoma patients: 0% (0 of 2) for the group of patients younger than 45 years, 50% (3 of 6) for the age group 45–64 years, and 63% (5 of 8) for the group older than 64 years. Prevalences in the middle and older age group were significantly higher than in a historic control group (p < 0.025 for both, binomial test). Conclusion: Normal-tension glaucoma patients constitute a high-risk population for sleep apnea syndrome. Therefore, they should be screened for sleep apnea syndrome, and, if necessary, be treated to avoid late cardiovascular and neurological sequelae.
Hypometabolism and Interictal Spikes during Positron Emission Tomography Scanning in Temporal Lobe Epilepsy
Authors: Hong Seung Bong , Han Hyun Jeong , Roh Suk-Young , Seo Dae Won , Kim Sang Eun , Kim Myoung-Hee
Published: April 2003

To study the influence of interictal spikes on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), EEG monitoring was performed during PET scanning in 21 patients with temporal lobe epilepsy. Asymmetry indices were calculated in the polar, mesial, anterior-lateral, mid-lateral and posterior-lateral temporal region of interests of FDG-PET (PET-AI). 70.7% of spikes were recorded with their maximum at the anterior temporal region (F7, F8, FT9, FT10), 29.3% at mid-temporal (T7, T8), and none at posterior temporal region (P7, P8). Regardless of the side of epileptic focus, right-left difference of the total spikes had a significant negative correlation with right/left PET-AIs of the anterior-lateral temporal region (Spearman’s ρ = –0.565, p = 0.009), polar (ρ = –0.500, p = 0.021) and whole temporal region (ρ = –0.480, p = 0.028). FDG-PET hypometabolism may reflect not only a permanent functional deficit but also a transient regional cerebral dysfunction related to the occurrence of interictal spikes.
Genotype Correlation with Fine Motor Symptoms in Patients with Wilson’s Disease
Authors: Hermann Wieland , Caca Karel , Eggers Birk , Villmann Thomas , Clark Daniel , Berr Frieder , Wagner Armin
Published: April 2003

Wilson’s disease, an autosomal recessive disorder of copper metabolism, is caused by about 200 different mutations of the ATP7B gene. Using a genotype-phenotype correlation, 36 patients were examined to see whether the disorder of the automatic handwriting movement depends on the genotype. The findings of this study indicated that no such link exists. Neither the profile of the impairment of the fine motor parameters nor the severity and frequency of pathological findings were different among the three genotype groups (homozygous for H1069Q, compound homozygous for H1069Q and other mutations). By contrast, fine motor disorders were found to correlate with the clinical symptoms recorded when therapy began. The pathophysiology of the basal ganglia and the cerebellar loop therefore cannot be directly attributed to the genotype of the mutation in the ATP7B gene.
Foreign Body Reaction to Cochlear Implant
Authors: Kronenberg Jona , Wolf Michael , Migirov Lela , Shapira Yisgav , Aviel-Ronen Sarit , Hildesheimer Minka
Published: April 2003

Two cases of foreign body reaction to a cochlear implant are described. A Nucleus-22 cochlear implant encased in silicone rubber was implanted in both. The first is a 66-year-old patient with idiopathic hearing loss. A year following the procedure, a fistulous tract developed over the implant with a typical histological foreign body reaction. The implant was removed and another Nucleus-22 device implanted on the contralateral side. No reaction to the new implant was noticed during a follow-up period of 7 years. The second case is a 6-year-old boy who developed a stubborn suppurative wound infection immediately following implantation. Upon removal of the implant, 2 months after implantation, granulation tissue was found to be encapsulating all parts of the device. Immediately following explantation, the scar and infection rapidly resolved. The tissue was histologically proven to be due to a foreign body reaction.
Epidemiologie der Otosklerose in den vergangenen 20 Jahren
Authors: Neuner N.T. , Häusler R.
Published: April 2003

Ziel: In einer retrospektiven Studie wurden insgesamt 916 Krankengeschichten von Otosklerosepatienten, die an der HNO-Universitätsklinik Bern zwischen 1978 und 1997 stapedektomiert wurden, untersucht. Patienten und Methoden: Verglichen wurden die Inzidenz, die Prävalenz, die Geschlechter- und Altersverteilung der Patienten von 1978–1987 (Gruppe 1) mit denen von 1988–1997 (Gruppe 2). Zusätzlich wurde eine konsekutive Serie von 250 Patienten auf Einseitigkeit oder Beidseitigkeit der Erkrankung, auf ihre familiäre Häufung, auf das Durchschnittsalter zum Operationszeitpunkt sowie auf die durchschnittliche subjektive Krankheitsdauer untersucht. Resultate: Die Inzidenz der Otosklerose anhand der im Universitätszentrum Bern durchgeführten Stapedektomieoperationen beträgt 0,01% (ungefähr 100 Stapedektomien jährlich bezogen auf etwa eine Million Menschen Gesamtbevölkerung). Der Anteil der Frauen aller untersuchten Patienten war 66,3%. Eine beidseitige Otosklerose trat bei den Männern in 46,7%, bei den Frauen in 55,9% auf. Eine familiäre Häufung war bei den Männern in 26,7%, bei den Frauen in 32,2% vorhanden. Das durchschnittliche Erkrankungsalter zum Zeitpunkt der Operation war bei den Männern 41 Jahre in der Gruppe 1, 43 Jahre in der Gruppe 2; bei den Frauen lag es bei 42 Jahren in der Gruppe 1 und bei 45 Jahren in der Gruppe 2. Hörminderung und Tinnitus waren durchschnittlich bei den Männern 10 Jahre, bei den Frauen 8,5 Jahre vor dem Operationszeitpunkt aufgetreten. In den letzten 10 Jahren verglichen mit den vorherigen 10 Jahren wird ferner eine Zunahme von 17% der an der HNO-Klinik Bern operierten Otosklerosepatienten festgestellt, welche als Zeichen einer zunehmenden Zentralisierung der Stapeschirurgie gedeutet wird. Die Altersverteilung zeigt eine auffällige Abnahme in der jüngeren Altersgruppe (20–39jährige) sowie eine Zunahme in der mittleren Altersgruppe (40–59jährige) in den letzen 10 Jahren (1988–1997) verglichen mit den Patienten vor 20 Jahren (1978–1987); diese Alterszunahme ist vor allem bei den Frauen ausgeprägt. Schlussfolgerung: Als Ursache für die demographische Veränderung werden u.a. eine veränderte Inzidenz der Otosklerose besprochen oder in Bezug auf die Inzidenz bei Frauen Veränderungen im Hormonhaushalt, wie spätere Schwangerschaften als früher, Verminderung des Hormongehaltes in modernen Antikonzeptiva bei jungen Frauen und eine erhöhte Zufuhr von Hormonen bei der menopausalen Substitution.
Differences in Biliary Lipid Excretion after Major Hepatectomy in Obstructive Jaundiced Rats with Preoperative Internal, External, or No Biliary Drainage
Authors: Mizuta A. , Chijiiwa K. , Saiki S. , Kuroki S. , Nakamura K. , Tanaka M.
Published: April 2003

Necessity of preoperative biliary drainage for patients with obstructive jaundice is still controversial. We recently reported that liver regeneration after major hepatectomy was better restored in a rat model of obstructive jaundice with preoperative internal biliary drainage than that without biliary drainage or with external biliary drainage. The aim of this study was to investigate the differences in biliary lipid excretion after hepatectomy in obstructive jaundiced rats with or without preoperative internal or external biliary drainage. After bile duct ligation for 7 days, rats were randomly divided into the three groups; obstructive jaundice-hepatectomy (OJ-Hx), internal biliary drainage-hepatectomy (ID-Hx), and external biliary drainage-hepatectomy (ED-Hx) groups. 70% hepatectomy and internal biliary drainage were carried out 7 days after biliary decompression in the latter two groups and without biliary decompression in the OJ-Hx group. On the day of and on days 1, 2, 3 and 7 after hepatectomy, the liver weight, DNA synthesis rate, biliary lipids excretion rates, and bile acid composition were determined. In the ID-Hx group, the DNA synthesis rate and relative liver weight were significantly higher than those of the OJ-Hx and ED-Hx groups. The excretion rates of biliary lipids were disturbed in the ED-Hx group compared with those in the ID-Hx group and the values in the OJ-Hx group were in-between the ID-Hx and ED-Hx group. The liver regeneration rate was significantly correlated with bile flow and excretion rates of biliary lipids. The maintenance of enterohepatic circulation of biliary lipids before hepatectomy may be important for the liver regeneration.
Early Gastrointestinal Function and Nutritional Status in Preterm Infants with Cystic Periventricular Leukomalacia
Authors: Murase Masanori , Ishida Akihito , Momota Tetsuya
Published: April 2003

Objective: To retrospectively investigate the early gastrointestinal function and the nutritional status of very low birth weight (VLBW) infants with cystic periventricular leukomalacia (PVL). Methods: Sixty-five VLBW infants who were admitted to Kakogawa Municipal Hospital were divided into 2 groups: 5 infants were in the PVL group, and the remaining 60 infants were in the normal group. The gastrointestinal function of the infants in the early neonatal period was compared between the 2 groups using an analysis of gastric aspirates and abdominal radiographs, and pulsed-Doppler ultrasonographic measurement of the flow velocity in the superior mesenteric artery (SMA). Results: In the first week, there were more days in which abdominal gastric residual fluids occurred in the PVL group than in the normal group. The occurrence of abnormal findings in the abdominal radiograph within the first 7 days was significantly higher in the PVL group than in the normal group. Longitudinal ultrasonographic comparisons of the SMA flow velocity showed that the mean values in peak systolic velocity and in time-averaged velocity were both significantly higher in the PVL group than in the normal group before 7 days of life. Both the total volume of milk ingested and the total energy intake in the PVL group were significantly lower than in the normal group within the first 2 weeks of life. Conclusions: Despite the low number of infants with PVL, we may suggest that the gastrointestinal function of the preterm infants with cystic PVL may deteriorate significantly compared to normal infants in the early neonatal period of life, and consequently, the early nutritional intakes in the PVL infants are inferior to those in the normal infants.
Effects of Exogenous Surfactant and Recombinant Human Copper-Zinc Superoxide Dismutase on Oxygen-Dependent Antimicrobial Defenses
Authors: Walti Hervé , Nicolas-Robin Armelle , Assous Marc V. , Polla Barbara S. , Bachelet Maria , Davis Jonathan M.
Published: April 2003

The use of human recombinant CuZn superoxide dismutase (rhSOD) in addition to exogenous surfactant has been studied as a therapeutic strategy to prevent acute and chronic lung injury in premature infants with blood monocytes (MO). However, scavenging of superoxide by rhSOD may compromise bacterial killing by phagocytes. In the present study, we investigated the interaction of exogenous surfactant and rhSOD with the antibacterial activity of human blood MO. MO were preincubated in the presence or absence of: (1) modified natural surfactant (Curosurf®; 1 mg/ml); (2) rhSOD (2,500 U/ml) and (3) bovine catalase (25,000 U/ml). Bacteria (Legionella pneumophila or Escherichia coli) were then added and incubated for 6 h. Viable bacteria were determined by counting colony-forming units. The ability of the MO to generate superoxide anions (O–2) in response to bacterial infection was also investigated. The antibacterial capacity of MO was not impaired by the presence of rhSOD either alone or combined with Curosurf®. In some instances, bactericidal activity was even potentiated by the addition of rhSOD. Exposure of MO to catalase interfered with the increased bacterial killing of MO and rhSOD, suggesting that hydrogen peroxide (H2O2) production was critically important in the process of bacterial killing. Both bacterial species were also found to induce the generation of intra- and extracellular O–2 by MO. Data indicate that rhSOD potentiates the killing of bacteria by human MO. The mechanism of action appears to be related to the ability of bacteria to induce the generation of O–2, which in turn is converted to H2O2 in the presence of rhSOD. This has important implications in the development of therapeutic intervention strategies using antioxidant therapy in premature infants with respiratory distress syndrome.
Sudden Death of an Infant with Prader-Willi Syndrome – Not a Unique Case?
Authors: Nordmann Yves , Eiholzer Urs , l’Allemand Dagmar , Mirjanic Slavko , Markwalder Christoph
Published: April 2003

Only in the recent past has Prader-Willi syndrome (PWS) also been diagnosed in newborns and infants, and the first descriptions of respiratory disturbances in young, not yet obese patients have been published only recently. We report an infant with PWS and respiratory problems, who suffered sudden death. To our knowledge, this is the first such case. In order to avoid fatalities, it seems mandatory to monitor respiratory function in infants with PWS and to suspect PWS in all hypotonic newborns to determine the frequency of the syndrome more accurately, and, more importantly, to diagnose PWS at an earlier stage in order to take appropriate measures.
Downregulation of Metabolic Gene Expression in Failing Human Heart before and after Mechanical Unloading
Authors: Razeghi Peter , Young Martin E. , Ying Jun , Depre Christophe , Uray Ivan P. , Kolesar June , Shipley Gregory L. , Moravec Christine S. , Davies Peter J.A. , Frazier O.H. , Taegtmeyer Heinrich
Published: April 2003

Background: We have previously shown that several metabolic genes are downregulated in the failing human heart. We now tested the hypothesis that mechanical unloading might reverse this process. Methods: Clinical data and myocardial tissue were collected from 14 failing hearts paired for the time of implantation and explantation of a left ventricular assist device (LVAD) and compared to 10 non-failing hearts. Transcript levels for key regulators of energy metabolism and for atrial natriuretic factor (ANF) were measured by real-time quantitative RT-PCR. Results: The expression of the glucose transporter 1 and 4 (GLUT1, GLUT4), muscle carnitine palmitoyl transferase-1 (mCPT-1), and uncoupling protein 3 (UCP3) were downregulated by up to 80% in the failing heart. Although LVAD treatment improved clinical markers of heart failure (decrease of left ventricular diastolic dimension and normalization of serum sodium), only UCP3 expression reversed to non-failing transcript levels following mechanical unloading. Conclusions: LVAD treatment only partially reverses depressed metabolic gene expression in the failing human heart. Reversal of depressed UCP3 expression may be an important mechanism for reducing the formation of oxygen-derived free radicals. Further studies are necessary to define the effects of mechanical unloading on post-transcriptional mechanisms.
Fetal Development of the Human Tympanic Ossicular Chain Articulations
Authors: Whyte J.R. , González L. , Cisneros A.I. , Yus C. , Torres A. , Sarrat R.
Published: April 2003

Objectives: To obtain further knowledge on the morphogenesis of the articulations in the tympanic ossicular chain in humans. Material and Methods: In 25 temporal bones of human fetuses the structural development of incudomallear, incudostapedial and stapediovestibular articulations was studied. The chronological ages were between the 7th week (21 mm) and the 29th week (270 mm). Results and Discussion: Incudomallear articulation showed diarthrosis and sellar joint characteristics. It showed a homogenous interzone in the 7th week of development, a three-layered interzone in the 8th week, the first cavitation signs in the 9th week and the presence of an articular cavity in the 10th week. The presence of a hyaline cartilage covering articular surfaces was observed starting in the 20th week of development. Incudostapedial articulation showed typical characteristics of a diarthrosis and spheroidal joint with a homogenous interzone at the 7th week, showing similar characteristics for 12 weeks, and completed its cavitation at the 16th week. We observed hyaline cartilage on articular surfaces from 29 weeks. Stapediovestibular articulation showed typical characteristics of syndesmosis. The annular ligament primordium derived from cartilage differentiation, both from stapedial footplate and from the surrounding otic capsule, into mesenchyme and its subsequent transformation into fibrous tissue, reaching definitive characteristics from the 12th week.
Photodynamic Therapy for Mucosal Esophageal Adenocarcinoma and Dysplastic Barrett’s Esophagus
Authors: Wolfsen Herbert C.
Published: April 2003

Photodynamic therapy is a novel endoscopic technique that combines a photosensitizer and laser light to destroy target cells. Photodynamic therapy has been used in Europe, North Africa and Japan to treat esophageal neoplasms and dysplastic Barrett’s esophagus. This paper summarizes the available published experience of photodynamic therapy for the treatment of each esophageal cancer and Barrett’s esophagus. These studies suggest that photodynamic therapy is a promising modality for esophageal mucosal disease. More long-term studies, however, are needed to document the efficacy of photodynamic therapy in reducing the morbidity and mortality from esophageal cancer for patients with high-grade dysplasia and early adenocarcinoma in Barrett’s esophagus.
E-Cadherin Mutations and Hereditary Gastric Cancer: Prevention by Resection?
Authors: Fitzgerald R.C. , Caldas C.
Published: April 2003

Background: A small percentage of gastric cancers (1–3%) arise as a result of clearly identified inherited gastric cancer predisposition syndromes. Recently, linkage analysis has implicated E-cadherin (CDH1) mutations in a subset of dominantly inherited gastric cancers termed hereditary diffuse gastric cancer (HDGC). Heterozygotes with the CDH1 mutation have a 70–80% chance of developing gastric cancer and once patients have invasive, symptomatic disease there is a high associated morbidity and mortality. As a result prophylactic gastrectomy has been advocated for affected family members identified by genetic screening. There are many issues to be considered in order to determine whether prophylactic gastrectomy is the optimal management strategy for these patients. Methods: A MEDLINE literature search was performed and combined with our own experience in order to identify relevant background information on hereditary gastric cancer. In particular we extracted information about prophylactic gastrectomy in HDGC patients. Results: Once the decision has been undertaken to perform genetic testing, the therapeutic options are either endoscopic screening with the aim of identifying an early, curable lesion or prophylactic surgery. Two groups have published their data on prophylactically resected stomachs in asymptomatic patients from affected families. In these series all of the post-gastrectomy specimens had microscopic evidence of diffuse gastric cancer confined within the mucosal layer. These early cancers had not been identified by endoscopic surveillance. Technical issues surrounding the age at which to operate, the best operation to reduce the risk of post-operative complications and the risk of other cancers developing in other organs in these patients are still controversial. Long-term follow-up studies in specialist centres are required to resolve these issues. Conclusions: From the limited experience so far the estimated risk reduction of gastric cancer by gastrectomy is significant.
Neuroendocrine Tumors of the Gastro-Entero-Pancreatic System: The Role of Early Diagnosis, Genetic Testing and Preventive Surgery
Authors: Plöckinger U. , Wiedenmann B.
Published: April 2003

Surgery is the only curative approach in neuroendocrine gastro-entero-pancreatic (GEP) tumors. As cure is highly dependent of tumor size, early diagnosis is a prerequisite for surgical success. Diagnosis of nonfunctioning tumors of the pancreas or midgut origin is due to symptoms related to the tumor burden, thus early diagnosis is mostly incidental. Functioning pancreatic tumors should be operated early in the course of the disease to provide cure. No genetic screening is available for sporadic GEP tumors. In patients with MEN-1 syndrome genetic screening is recommended to restrict the burden of clinical screening to those with positive test results. Due to the nature of the disease cure may not be achieved, however prevention of cancer may be obtained for one or two decades of life, especially in patients with gastrinoma or nonfunctioning tumors.
Surveillance Strategies in Patients after Polypectomy
Authors: Reinacher-Schick A. , Schmiegel W.
Published: April 2003

Colorectal cancer (CRC) is a major cause of cancer death in the Western world. It develops slowly over several years from premalignant lesions (most prominently adenomatous polyps) to invasive cancer. The molecular basis of CRC pathogenesis has been well characterized. The most effective method to prevent CRC is endoscopic polypectomy. However, adenomatous polyps are known to recur at significant rates. The aim of surveillance programs after polypectomy is to further reduce the incidence of CRC in individuals where percancerous lesions have been identified and treated. However, the medical risks and the costs of repeated examinations must be kept as low as possible. Therefore, the identification of patient subgroups with a particular low cancer risk who may be followed-up less frequently seems important. There is recent evidence that other colorectal lesions, namely flat and depressed type adenomas (F&D adenoma) and possibly some hyperplastic polyps and serrated adenomas may also carry a malignant potential which could influence our screening, treatment and surveillance strategies for the colorectum in the future. General surveillance guidelines regarding these entities have not been issued to date. This article will first discuss the biology, natural history, present surveillance recommendations and future issues for sporadic adenomatous polyps. Then, recent literature on F&D type adenomas, hyperplastic polyps and serrated adenomas will be reviewed with respect to their malignant potential and the potential necessity for treatment and surveillance of these lesions.
Effects of Phalloidin on the Biliary Excretion of Cholephilic Compounds in Rats
Authors: Ohashi Masaki , Sano Naoyo , Takikawa Hajime
Published: April 2003

Phalloidin is known to cause cholestasis by preventing microfilament depolymerization. In addition, phalloidin is reported to inhibit the vesicular targeting of canalicular transporters. The aim of the present study was to examine the effect of phalloidin on the biliary excretion of substrates typical for various canalicular transporters in rats. Phalloidin decreased the biliary excretion of tracer amounts of taurocholate, leukotriene C4, pravastatin, and vinblastine. Increases in bile flow and biliary bile acid excretion caused by taurocholate infusion were completely inhibited by phalloidin. These data indicate that, in addition to multidrug resistance protein 2 and P glycoprotein, the vesicular targeting of the bile salt export pump, a major canalicular bile acid transporter, is also impaired by phalloidin. The decrease of biliary excretion of glutathione may also relate to the increase in the bile acid independent canalicular bile flow in phalloidin-treated rats.
Urinary Levels of Macrophage Migration Inhibitory Factor in Patients with IgA Nephropathy
Authors: Matsumoto Koichi , Kanmatsuse Katsuo
Published: April 2003

Background/Aim: The processes involved in development of IgA nephropathy (IgAN) are not yet well understood. Macrophage migration inhibitory factor (MIF) is a potent pro-inflammatory cytokine and is an essential component of immune and inflammatory responses. To examine further the possible role of MIF in IgAN, we measured MIF levels in the urine. The purpose of the present study was to evaluate the involvement of MIF in IgAN. Methods: Urine samples were obtained from 20 IgAN patients. The disease controls included 20 patients with minimal-change nephrotic syndrome (MCNS). A group of healthy subjects served as control. The samples were assayed for MIF protein by a sandwich enzyme-linked immunosorbent assay (ELISA). Results: The MIF levels in the urine of patients with IgAN examined were significantly higher than those of the healthy control subjects. In contrast, the levels of urinary MIF (uMIF) in patients with MCNS did not differ significantly from normal values. In IgAN patients, uMIF significantly correlated with the magnitude of proteinuria, but not with the grade of hematuria. We also investigated the relationship between uMIF levels and pathological features. Among patients with IgAN, uMIF levels were significantly correlated with the grade of glomerular crescent formation and that of mesangial cell proliferation. There was also a significant correlation between uMIF levels and the number of both intraglomerular and interstitial macrophages. Conclusion: Although the underlying mechanisms remain to be determined, these data provide evidence that urinary excretion of MIF is increased in IgAN patients with active renal lesions.
A Down Syndrome Patient Treated by Peritoneal Dialysis
Authors: Hausmann Michael J. , Landau Daniel
Published: April 2003

Down syndrome patients are apparently not suited for peritoneal dialysis because of lacking cooperation. We report on an adult Down syndrome patient living in a difficult social environment suffering from ESRD due to posterior urethral valve. Comorbid conditions include decreased left ventricular function, hepatitis B carrier stage and hypothyroidism. The commited mother of the patient treats the patient successfully by peritoneal dialysis for a period of two years without episode of peritonitis.
Grade III Ischemia on Presentation with Acute Myocardial Infarction Predicts Rapid Progression of Necrosis and Less Myocardial Salvage with Thrombolysis
Authors: Birnbaum Yochai , Mahaffey Kenneth W. , Criger Douglas A. , Gates Kathy B. , Barbash Gabriel I. , Barbagelata Alejandro , Clemmensen Peter , Sgarbossa Elena B. , Gibbons Raymond J. , Rahman M. Atiar , Califf Robert M. , Granger Christopher B. , Wagner Galen S.
Published: April 2003

We assessed the relation between baseline electrocardiographic ischemia grades and initial myocardial area at risk (AR) and final infarct size (IS) in 49 patients who had undergone 99mTc sestamibi single-photon emission computed tomography before and 6 ± 1 days after thrombolysis. Patients were classed as having grade III ischemia (ST segment elevation with terminal QRS distortion, n = 19) or grade II ischemia (ST elevation but no terminal QRS distortion, n = 30). We compared AR and IS by baseline ischemia grade and treatment (adenosine vs. placebo) and assessed relations of infarction index (IS/AR ratio ×100) to time to thrombolysis, baseline ischemia grade, and adenosine therapy. Time to thrombolysis was similar for grade II and grade III. For placebo- treated patients, the median AR did not differ significantly between grade II (38%) and grade III patients (46%, p = 0.47), nor did median IS (16 vs. 40%, p = 0.096), but the median infarction index was 66 vs. 90% (p = 0.006). For adenosine-treated patients, median AR (21 vs. 26%, p = 0.44), median IS (5 vs. 17%, p = 0.15), and their ratio (31 vs. 67%, p = 0.23) did not differ significantly between grade II and grade III patients. The infarction index independently related to grade III ischemia (p = 0.0121) and adenosine therapy (p = 0.045). Infarct size related to baseline ischemia grade and was reduced by adenosine treatment. Necrosis progressed slowlier with baseline grade II versus III ischemia, which could offer more time for myocardial salvage with reperfusion.
Exanthems in Hospitalized Pediatric Patients: Concordance between Pediatric and Dermatological Diagnoses
Authors: Soriano-Hernández Yaara L. , Orozco-Covarrubias Luz , Tamayo-Sánchez Lourdes , Durán-McKinster Carola , Sosa-de-Martínez Cristina , Ruiz-Maldonado Ramón
Published: April 2003

Background: Exanthems in children often represent a diagnostic challenge. Purpose: To determine the concordance between pediatric and dermatological diagnoses of exanthems. Design: Prospective study. Procedure: Exanthems that appeared in hospitalized pediatric patients were diagnosed by pediatricians. Pediatric dermatologists, by consensus, either confirmed or modified the diagnoses. Whenever possible, laboratory tests were used to confirm the final clinical diagnoses. Age and evolution were compared with the Kruskal-Wallis test; the ĸ coefficient was used to determine concordance. Setting: Institutional tertiary referral pediatric care center. Results: Concordance between pediatric and dermatological diagnoses was found in only 44 patients. When pediatric and dermatological diagnoses of exanthems were classified, the concordance between both diagnoses was very low (ĸ = 0.165). Conclusions: Pediatric specialists, other than dermatologists, failed to diagnose common skin diseases. This may be a consequence of insufficient training in dermatology by medical schools and pediatric residency.
Verrucae vulgares in Children: Successful Simulated X-Ray Treatment (a Suggestion-Based Therapy)
Authors: Meineke Viktor , Reichrath Jörg , Reinhold Uwe , Tilgen Wolfgang
Published: April 2003

Background: Treatment of verrucae vulgares is sometimes difficult. Invasive methods should not be used for young children. Objective: Evaluation of a special suggestion therapy for treatment of verrucae vulgares in children. Methods: Nine children with warts on the hands and/or feet and in the face were treated with a simulated X-ray treatment. Results: Five children showed a complete remission of warts, 3 children a partial remission. For 1 child, there was no response. On average, 3 treatment sessions were needed for children showing a complete remission. Conclusion: This therapy offers an easy-to-perform, alternative treatment option. It is noninvasive and does not depend on special psychological techniques for which training is required.
POEMS Syndrome Revealed by Multiple Glomeruloid Angiomas
Authors: Scheers Christel , Kolivras Athanassios , Corbisier Alexandra , Gheeraert Patrick , Renoirte Charles , Theunis Anne , de Saint-Aubain Nicolas , André Josette , Sass Ursula , Song Micheline
Published: April 2003

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin disorders) is a rare multisystemic disease associated with plasma cell dyscrasia. A 68-year-old woman with chronic renal insufficiency and arterial hypertension included in her medical history was admitted to the hospital with confusion, somnolence and asthenia. She presented ascites, hepatosplenomegaly, leg oedema, distal dysesthesias, leuconychia and multiple nodular purple red angiomas on the trunk, upper limbs and fingers. Hypothyroidism was revealed in the laboratory investigations and monoclonal IgG peak in immunoelectrophoresis. Electromyography showed both demyelinisating and axonal degenerative neuropathy. The diagnosis of POEMS syndrome was based on the dermatopathological examination of a cutaneous angioma; histology revealed features of glomeruloid angioma, a specific marker of this syndrome.
Treatment of Kaposi’s Sarcoma with Human Chorionic Gonadotropin
Authors: Simonart T. , van Vooren J.P. , Meuris S.
Published: April 2003

Clinical-grade preparations of human chorionic gonadotropin (hCG) have been shown to be toxic to Kaposi’s sarcoma (KS) cells. However, the mechanism of the anti-KS activity achieved with these preparations remains unclear. The results of clinical studies using commercial hCG preparations in human KS are also highly contradictory. The apparent controversy between different studies may be due to the fact that pro- and anti-KS components are present in varying proportions in different hCG preparations. As certain hCG preparations could not only lack the ability to control KS but also contain some contaminant KS growth factor(s), we suggest a cautious use of crude hCG for the treatment of KS.
Diffuse Plane Normolipaemic Xanthomatosis in a Patient with Chronic Lymphatic Leukaemia and Monoclonal Gammopathy
Authors: Stockman Annelies , Delanghe Joris , Geerts Marie-Louise , Naeyaert Jean Marie
Published: April 2003

Diffuse plane normolipaemic xanthomatosis is a well-defined uncommon condition characterized by yellow-orange plaques involving the eyelids, neck, upper trunk, buttocks and flexural folds. Over half of the reported cases are associated with lymphoproliferative disorders. The condition may arise as a result of perivascular deposition of lipoprotein-immunoglobulin complexes. We present a female patient with clear clinical features of diffuse plane xanthomatosis associated with chronic lymphatic leukaemia and monoclonal gammopathy. In this patient, we found evidence of complement consumption supporting the hypothesis that complexes of lipoprotein and paraprotein are formed. Lipid electrophoresis of fasting serum revealed the presence of a faint precipitate at the application slot, also indicative of the presence of protein-lipid complexes.
Hyperosmolality Induced by Betaine or Urea Stimulates Endothelin Synthesis by Differential Activation of ERK and p38 MAP Kinase in MDCK Cells
Authors: Kramer H.J. , Hashemi T. , Bäcker A. , Bokemeyer D.
Published: April 2003

We have previously shown that cultured porcine inner medullary collecting duct cells produce endothelin (ET) which suppressed arginine vasopressin (AVP)-induced cyclic adenosine monophosphate (cAMP) generation in an autocrine/paracrine feedback-like fashion. Moreover, hyperosmolality, e.g. induced by sodium chloride and urea, stimulated ET synthesis. Since others showed that hyperosmolality also activates mitogen-activated protein (MAP) kinases and that p38 MAP kinase facilitates cellular influx of betaine to protect the cell from high extracellular solute (urea) concentrations, we were tempted to investigate a potential interaction of MAP kinases with ET production in cultured MDCK cells in response to extracellular hyperosmolality induced by betaine and urea, respectively. Increased extracellular tonicity (602 ± 8 vs. control of 323 ± 3 mosmol/kg H2O) induced by betaine stimulated ERK and, more strongly, p38 kinase activity at 0.5–2 h of incubation with a rise in ET-1 synthesis to 1,713 ± 68 vs. 378 ± 51 fmol/mg protein/24 h under control conditions (p < 0.01). The p38 MAP kinase inhibitor SB203580 suppressed the rise in betaine-induced ET-1 synthesis by 91% to 494 ± 38 fmol/mg protein/24 h, whereas the MEK/ERK inhibitor U0126 suppressed it moderately by 34%. Hypertonicity induced by urea moderately stimulated ERK but not p38 MAP kinase activity at 0.5–2 h and at 24–48 h and resulted in a modest rise in ET-1 synthesis to 681 ± 61 fmol/mg protein/24 h (p < 0.05) which was significantly suppressed by U0126 to 484 ± 16 fmol/mg protein/24 h. These results suggest that a functional interaction between the MAP kinases ERK and p38 MAP kinase and ET-1 synthesis is involved in betaine’s protection of MDCK cells in vitro which may represent an in vivo mechanism of protection from hyperosmotic stress induced by high extracellular solute concentrations.
Results from the TIP (Tritace in Proteinuria) Intensified Monitoring Project
Authors: Mayer G.
Published: April 2003

Albuminuria has been shown to identify patients with an increased cardiovascular risk, and in clinical studies ACE inhibitors reduce the urinary protein excretion. It was the primary aim of this intensified monitoring project to determine whether these results can be reproduced in a clinical practice setting. Micro- (2.7–22.6 mg albumin/mmol creatinine) or macroalbuminuria (>22.6 mg/mmol) was confirmed by a central laboratory in 598 out of 773 patients with hypertension who had albuminuria >50 mg/l on a Micral Test® II performed by 147 general practitioners. Coronary heart disease (prevalence rates 15% in patients with normalbuminuria, 33% in patients with microalbuminuria, and 40% in patients with macroalbuminuria), heart failure (prevalence rates 19, 29, and 32%, respectively), left ventricular hypertrophy (prevalence rates 30, 42, and 38%, respectively), and peripheral vascular disease (prevalence rates 7, 15, and 20%, respectively) were significantly more common in patients with elevated urinary albumin excretion. 230 patients with microalbuminuria and 202 subjects with macroalbuminuria were treated with the angiotensin-converting enzyme inhibitor ramipril for 6 months. The treatment significantly lowered mean arterial blood pressure (from a median value of 120 mm Hg, quartiles 113–125 mm Hg, to 103 mm Hg, quartiles 100–109 mm Hg) as well as urinary albumin excretion (from a median value of 18 mg/mmol creatinine, quartiles 7.2–54.6 mg/mmol creatinine, to 6.5 mg/mmol creatinine, quartiles 1.6–23.1 mg/mmol creatinine). The treatment efficacy was unaffected by age, body mass index, and smoking status. Patients with diabetes mellitus type II and heart failure also had a significant, although less pronounced reduction of albuminuria. In summary, we conclude that ramipril is able to reduce the urinary albumin excretion in a clinical practice setting, as has been shown in clinical studies. However, the treatment response is not completely uniform, as special patient populations seem to be more resistant to therapy.
Neuronal Vacuolation in the Basal Nucleus of Meynert Caused by Fetal Hydrocephalus
Authors: Ulfig Norbert
Published: April 2003

The basal nucleus of Meynert, which provides the major source of cholinergic input to the cerebral cortex, was investigated in fetal hydrocephalic brains (n = 5) in comparison to controls (n = 5). To detect alterations, the neurons of the basal nucleus were immunostained with an antibody against the calcium-binding protein calbindin. In the basal nucleus of hydrocephalic brains, a moderate number of vacuolated neurons were observed. Such vacuolation was not seen in control brains. Vacuolation is interpreted as a degenerative change after injury of basal nucleus axons in cases of fetal hydrocephalus. The neuronal alterations in the basal nucleus may account at least in part for residual deficits observed after shunt placement.
Brain Perfusion in Autism Varies with Age
Authors: Wilcox James , Tsuang Ming T. , Ledger Elizabeth , Algeo James , Schnurr Thomas
Published: April 2003

Oursubjects consisted of 14 autistic individuals and 14 controls ranging in age from 3 to 37 years. A 99mTc HMPAO single photon emission computed tomogram (SPECT) was used to examine blood flow variations between autistic subjects, compared to an age- and gender-matched control group. We found significant hypoperfusion in the prefrontal areas of autistic individuals as compared to normals in every case (p < 0.01). As the age of the autistic individuals increased the hypoperfusion of verbal-associated areas in the left temporal lobe and frontal areas became more evident. The findings were significant at the p < 0.001 level. The changes in perfusion over time correlated with language development and acquisition as individuals matured. We conclude that autistic individuals have a deficiency in prefrontal areas associated with word identification and language formation skills. This subsequently prevents development of true verbal fluency and development in the temporal and frontal areas associated with speech and communication.
Natural History of Serum Immunoglobulin Concentrations in Low Birth Weight Infants and Association with Respiratory Tract Infections
Authors: Sierig Gabriele , Labitzke Birgit , Diez Ulrike , Kiess Wieland , Borte Michael
Published: April 2003

Infections are a significant cause of morbidity and mortality among low birth weight (LBW) infants. The aims of our study were: (1) to investigate whether serum antibody concentrations in 62 LBW infants (1,500–2,500 g) were normalized by 1 year of life, and (2) to determine the clinical relevance of humoral immaturity in these children during the 1st year compared to 20 appropriate-for-gestational-age (AGA) term infants. At 1 year of life, immunoglobulin serum concentrations in LBW infants were comparable to those of the control group. The incidence of respiratory tract infections during the 1st year of life was not significantly different between LBW and AGA term infants. Interestingly, we demonstrated that LBW infants with a higher frequency of reported febrile upper respiratory tract infections had more elevated serum total IgG, IgG1, IgG3, total IgA, and IgA1 concentrations. Thus, infants with a birth weight of 1,500–2,500 g do not appear to have an increased risk of respiratory tract infections compared to AGA term children during the 1st year of life. Furthermore, our data suggest that especially febrile infections induce higher serum immunoglobulin concentrations in LBW infants.
The Somatics of Psyche: Structural Neuromorphometry of Bipolar Disorder
Authors: Benabarre A. , Vieta E. , Martinez-Arán A. , Reinares M. , Colom F. , Lomeña F. , Martin F. , Valdés M.
Published: April 2003

Many neuroimaging investigations report structural differences in subjects with bipolar disorder; however, conflicting results are common in the limited number of available investigations. Thus, the structural correlates of bipolar disorders remain poorly understood. The authors reviewed the early investigations using computed tomography and examined gross structural differences, such as cerebral atrophy, ventricular enlargement, or cerebellar atrophy. Many of these investigations report significant differences in these features compared with controls, whereas others found no such differences. More recent magnetic resonance imaging (MRI) investigations have employed increasingly sophisticated imaging and research methodologies, allowing for the quantitative examination of specific brain regions. Because neuropsychological and functional studies suggest abnormalities in frontal, temporal and subcortical regions, many investigators have focused their MRI neuromorphometric studies on these temporal limbic structures. However, the number of investigations examining each of these regions remains small, and conflicting results continue to be reported. It seems clear that for many brain regions, the structural changes from normal may be subtle, and that the differences in the reported studies may be due to differences in research methodologies between studies and across centers.