bluuebunny/crossref_metadata_2025 huggingface dataset:
Insomnia in Diabetic Hemodialysis Patients
Authors: Han Sang-Youb , Yoon Jong-Woo , Jo Sang-Kyung , Shin Jin-Ho , Shin Chol , Lee Jung-Bok , Cha Dae-Ryong , Cho Won-Yong , Pyo Heui-Jung , Kim Hyoung-Kyu , Lee Kyu-Bec , Kim Hyang , Kim Kyung-Wook , Kim Yong-Seop , Lee Jeong-Ho , Park Sang-Eun , Kim Chang-Soo , Wea Kyeong-So , Oh Kyung-Shik , Chung Tae-See , Suh Sang-Yeol
Published: April 2003

Background: Insomnia is one of the most common problems in dialysis patients, and likely to contribute impairment in quality of life, which has a positive correlation with patients’ survival. In diabetic patients, morbidity and mortality are substantially higher than in the nondiabetic counterparts, and also the incidence of sleep disturbances. However, there is no means to predict sleep disturbance in the dialysis patients especially in diabetics. To define the prevalence and risk factors for insomnia in diabetic patients on hemodialysis, we undertook a cross-sectional multicenter study. Methods: Eighty-two diabetic patients (50 men/32 women, aged 58.7 ± 9.23 years) on maintenance hemodialysis for more than 6 months from 12 different hospitals were enrolled. The demographic data, subjective symptoms, depression scale, and insomnia were assessed by questionnaires, and lean body mass, BMI, Kt/V, subjective global assessment, nursing assessment score (NAS), and biochemical parameters were examined. Results: The number of patients with and without insomnia were 56 and 26, respectively, which amounted to 68.2% for insomnia. NAS (28.1 ± 3.81 vs. 30.8 ± 2.88, p = 0.002), serum albumin concentration (3.82 ± 0.44 vs. 4.09 ± 0.36 g/dl, p = 0.008), and depression scale (25.2 ± 12.1 vs. 18.9 ± 10.3, p = 0.025) were significantly different between them. Patients with insomnia were older (60.5 ± 9.0 vs. 56. 1 ± 9.60 years, p = 0.053) and felt pain (38.5 vs. 15.3%, p = 0.06) more frequently than those without insomnia. The scale of depression was correlated with NAS (r = –0.455, p < 0.001) and the serum albumin concentration was correlated with NAS (r = 0.337, p = 0.002). NAS, age, and serum albumin concentration were the major risk factors for insomnia in logistic regression analysis. Conclusion: The prevalence of insomnia in diabetic hemodialysis patients was 68.2%. Age, nutritional status, and depression were the major risk factors for sleep disturbance in diabetic patients.
Influence of Spontaneous Platelet Aggregation on Progression of Glomerular Disease
Authors: Zdrojewski Z. , Lizakowski S. , Raszeja-Specht A. , Skibowska A. , Rutkowski B.
Published: April 2003

Platelet secretion products may play an important role in the pathogenesis and progression of the kidney disease. Amongst the parameters describing platelet hyperactivity the measurement of spontaneous platelet aggregation (SPA) seems particularly useful. In this study SPA as well as mean platelet volume (MPV), modal platelet volume (PLT Mode) and platelet count (PLT) were investigated in 60 patients with biopsy proven primary glomerulonephritis. SPA was measured using the turbidimetric method according to Born with no enhancers added. Serum creatinine concentration (Cr), reciprocal serum creatinine concentration (1/Cr) and endogenous creatinine clearance (ClCr) were used for the renal function estimation. Protein and lipid profiles as well as coagulo-fibrinolytic balance were measured in parallel. The investigated group consisted of 30 non-nephrotic patients (CGN) – in 9, SPA was found (CGN-B) while 21 had SPA <10% (CGN-A), and 30 nephrotic patients (CGN+NS) – 19 with SPA (CGN+NS-B) and 11 without (CGN+NS-A). SPA was found to be a constant platelet feature in patients with chronic glomerulopathy. The group remained under observation for 36 months. 41 patients were included in the 3-year prospective study which revealed the significant influence of the blood platelet hyperaggregability on the renal disease progression. A significantly increased serum creatinine concentration, decreased 1/Cr parameter and decreased glomerular filtration rate (ClCr) were noted in subgroups showing SPA. A significant correlation between SPA and ΔCr/month (r = 0.41), Δ1/Cr/month (r = 0.38) as well as ΔClCr/month (r = 0.52) was found. The platelet activity and thus SPA can be altered by various factors: albumin and fibrinogen plasma concentrations, thrombosis activation and possibly lipoprotein metabolism disturbances. A characteristic feature of spontaneously aggregating platelet is their increased volume (MPV). Conclusion: Platelet hyperaggregation in one of nonimmunological factors stimulates the progression of glomerulonephritis.
Pro12Ala Substitution in the Peroxisome Proliferator-Activated Receptor-Gamma Is Associated with Increased Leptin Levels in Women with Type-2 Diabetes mellitus
Authors: Simón I. , Vendrell J. , Gutiérrez C. , Fernández-Real J.M. , Vendrell I. , Gallart Ll. , Fontova R. , Richart C.
Published: April 2003

Objective: To analyze the relationship between the peroxisome proliferator-activated receptor-γ (PPARγ2) Pro12Ala variant and type-2 diabetes mellitus and its correlation with some cytokine determinants of insulin resistance such as tumor necrosis factor (TNF)-α and leptin. Methods: The PPARγ2 Pro12Ala genetic polymorphism was studied in 167 type-2 diabetic patients and 63 healthy controls. Serum leptin and plasma-soluble TNF-R2 were measured. Results: Women carriers of the Pro12Ala mutation exhibited higher leptin levels than women non-carriers (median 31.4 vs. 17.5 ng/ml; p < 0.005). sTNF-R2 levels did not show differences between the two genotypes. Analysis by the multiple linear regression model of leptin-body mass index controlled by the PPARγ2 genotype showed that leptin levels were determined by the Pro12Ala mutation in type-2 diabetic women but not in men. Conclusions: PPARγ2 seems to be implicated in leptin homeostasis in type-2 diabetic women.
A Three-Dimensional Quantitative Analysis of Restenosis Parameters after Balloon Angioplasty: Comparison between Semi-Automatic Computer-Assisted Planimetry and Stereology
Authors: Salu Koen J. , Knaapen Michiel W.M. , Bosmans Johan M. , Vrints Chris J. , Bult Hidde
Published: April 2003

Semi-automatic computer-assisted planimetry is often used for the quantification of restenosis parameters after balloon angioplasty although it is a time-consuming method. Moreover, slicing the artery to enable analysis of two-dimensional (2-D) images leads to a loss of information since the vessel structure is three-dimensional (3-D). Cavalieri’s principle uses systematic random sampling allowing 3-D quantification. This study compares the accuracy and efficiency of planimetry versus point-counting measurements on restenosis parameters after balloon angioplasty and investigates the use of Cavalieri’s principle for 3-D volume quantification. Bland and Altman plots showed good agreement between planimetry and point counting for the 2-D and 3-D quantification of lumen, internal elastic lamina (IEL) and external elastic lamina (EEL), with a slightly smaller agreement for intima and media. Mean values and induced coefficients of variation were similar for both methods for all parameters. Point counting induced a 6% error in its 3-D quantification, which is negligible in view of the biological variation (>90%) among animals. However, point counting was 3 times faster compared to planimetry, improving its efficiency. This study shows that combining Cavalieri’s principle with point counting is a precise and efficient method for the 3-D quantification of restenosis parameters after balloon angioplasty.
Elimination of Electrically Induced Iontophoretic Artefacts: Implications for Non-Invasive Assessment of Peripheral Microvascular Function
Authors: Ferrell William R. , Ramsay Jane E. , Brooks Naomi , Lockhart John C. , Dickson Sylvia , McNeece Grainne M. , Greer Ian A. , Sattar Naveed
Published: April 2003

Iontophoretic assessment of skin microvascular function is complicated by the occurrence of electrically induced hyperaemia, especially at the cathode. Studies were performed to identify means of reducing such effects. Skin vasodilator responses were measured using a laser Doppler imager that controlled iontophoretic current delivery. A novel feature involved monitoring voltage across the iontophoresis chambers. Comparison between responses to vehicle (distilled H2O), acetylcholine (ACh) and sodium nitroprusside (SNP) showed electrically induced hyperaemia at the cathode associated with the vehicle, whose time course overlapped with that of the SNP response. Voltage across the chambers containing drugs dissolved in H2O was significantly (p = 0.018, n = 7) lower than the voltage profile of H2O alone. H2O iontophoresis was associated with cathodal hyperaemic responses in most subjects, whereas a 0.5% NaCl vehicle produced lower voltages and eliminated this artefact. Voltage·time integral rather than charge was the prime determinant of electrically induced hyperaemic responses. No significant correlation was found between skin fold thickness and either calculated skin resistance (r2 = 0.0002) or vascular response to ACh (r2 = 0.13). Smaller chamber size led to higher voltages and greater electrically induced hyperaemic responses. These appear to be prostaglandin dependent as they were ablated by cyclooxygenase inhibition. Use of a low-resistance vehicle combined with larger chamber sizes and lower currents can prevent such artefacts, thereby increasing the robustness of this methodology for clinical assessment of endothelial function.
A Novel Rat Model of Carotid Artery Stenting for the Understanding of Restenosis in Metabolic Diseases
Authors: Finn Aloke V. , Gold Herman K. , Tang Anita , Weber Deena K. , Wight Thomas N. , Clermont Allen , Virmani Renu , Kolodgie Frank D.
Published: April 2003

The effects of risk modifiers such as diabetes, obesity and hypertension on vascular healing after stent deployment are largely unknown, because of a lack of an appropriate animal model to study. Since many inbred strains of rats expressing these phenotypes are available, we validated a carotid artery model of in-stent restenosis in the rat. A detailed histomorphometric analysis was performed on 2-cell Multi-LinkTM stents (1.5 × 5 mm) deployed in the common carotid artery of male Wistar rats. Early focal thrombus formation around stent struts with adherent leukocytes was evident by day 3. The number of ED-1-positive macrophages was maximal by day 7 and declined markedly thereafter. Neointimal cell proliferation peaked by day 7 (19.3 ± 6.9) and progressively decreased to <2% by day 60. By day 14, neointimal area was significantly increased (0.39 ± 0.03 vs. 0.18 ± 0.05 mm2 at day 7, p = 0.003) characterized by an enhanced number of α-actin-positive smooth muscle cells surrounded by extracellular matrix rich in versican and hyaluronan. At day 28, neointimal area was maximal accompanied by an appreciable decrease in the staining intensity for hyaluronan and versican. By day 60, neointimal area decreased significantly (0.28 ± 0.04 vs. 0.45 ± 0.07 mm2 at day 28, p = 0.04) independent of a change in cell density. This regression phase was accompanied by a marked increase in elastin fibrils and collagen type I. In summary, vascular healing following carotid artery stenting in the rat parallels that of larger animals; however, it is accelerated relative to humans.
Transendothelial Transport: The Vesicle Controversy
Authors: Rippe Bengt , Rosengren Bert-Inge , Carlsson Ola , Venturoli Daniele
Published: April 2003

The relative contribution of transcytosis vs. large pore transport to the passage of macromolecules across microvascular endothelia has been a controversial issue for nearly half a century. To separate transcytosis from ‘porous’ transport, the transcytosis inhibitors N-ethylmaleimide (NEM) and filipin have been tested in in situ or ex vivo perfused organs with highly conflicting results. In continually weighed isolated perfused organs, where measurements of pre- and post-capillary resistances, capillary pressure and capillary filtration coefficients can be repeatedly performed, high doses of NEM and filipin increased the bulk transport of macromolecules from blood to tissue, despite producing vasoconstriction. By contrast, in in situ perfused organs, marked reductions in the tissue uptake of albumin tracer have been observed after NEM and filipin. When tissue cooling has been employed as a means of inhibiting (active) transcytosis, results have invariably shown a low cooling sensitivity of albumin transport, compatible with passive transendothelial passage of albumin. This observation is further strengthened by the commonly observed dependence of albumin transport upon the capillary pressure and the rate of transcapillary convection. For low-density lipoprotein (LDL), a cooling-sensitive, non-selective transport component has been discovered, which may be represented by filtration through paracellular gaps, lateral diffusion through transendothelial channels formed by fused vesicles, or by transcytosis. From a physiological standpoint there is little evidence supporting active transendothelial transport of most plasma macromolecules. This seems to be supported by studies on caveolin-1-deficient mice lacking plasmalemmal vesicles (caveolae), in which there are no obvious abnormalities in the transendothelial transport of albumin, immunoglobulins or lipoproteins. Nevertheless, specific transport in peripheral capillaries of several hormones and other specific substances, similar to that existing across the blood-brain barrier, still remains as a possibility.
Carotenoids and Protection against Solar UV Radiation
Authors: Stahl Wilhelm , Sies Helmut
Published: April 2003

Upon exposure to UV light photooxidative reactions are initiated which are damaging to biomolecules and affect the integrity of cells and tissues. Photooxidative damage plays a role in pathological processes and is involved in the development of disorders affecting the skin. When skin is exposed to UV light, erythema is observed as an initial reaction. Carotenoids like β-carotene or lycopene are efficient antioxidants scavenging singlet molecular oxygen and peroxyl radicals generated in during photooxidation. When β-carotene was applied as such or in combination with α-tocopherol for 12 weeks, erythema formation induced with a solar light simulator was diminished from week 8 on. Similar effects were also achieved with a diet rich in lycopene. Ingestion of tomato paste corresponding to a dose of 16 mg lycopene/ day over 10 weeks led to increases in serum levels of lycopene and total carotenoids in skin. At week 10, erythema formation was significantly lower in the group that ingested the tomato paste as compared to the control group. No significant difference was found at week 4 of treatment. Thus, protection against UV light-induced erythema can be achieved by ingestion of a commonly consumed dietary source of lycopene. Such protective effects of carotenoids were also demonstrated in cell culture. The in-vitro data indicate that there is an optimal level of protection for each carotenoid.
The Role of Nuclear Factor-kappaB and Melanogenesis in Tumor Necrosis Factor-Alpha-Induced Apoptosis of Normal Human Melanocytes
Authors: Shang Jing , Eberle Jürgen , Geilen Christoph C. , Hossini Amir M. , Fecker Lothar F. , Orfanos Constantin E. , Tebbe Beate
Published: April 2003

The proapoptotic potential of tumor necrosis factor-alpha (TNF-α) has been demonstrated for various cell types, whereas nuclear factor-kappaB (NF-ĸB) is known to support the transcription of prosurvival genes. In the present study, investigation of normal human melanocytes revealed induction of apoptosis after TNF-α treatment (100 U/ml) in only 3 out of 11 cultures analyzed, whereas 8 cultures remained largely resistant. In sensitive cultures, NF-ĸB binding activity was found increased after TNF-α treatment; apoptosis-resistant cells were characterized by relatively high basic NF-ĸB binding activities and did not show NF-ĸB activation after TNF-α treatment. Inhibition of NF-ĸB by a specific inhibitor, Bay-11, either induced apoptosis itself or resistant melanocyte cultures became sensitive to TNF-α treatment. No correlation was found between apoptosis sensitivity and the expression of TNF receptor-1 or the expression of Bax, Bcl-2 and Bcl-XL. A strong correlation, however, was found regarding the pigmentation degree, as high pigmentation correlated with apoptosis resistance and sensitive melanocyte cultures were weakly pigmented. These data may indicate that in cultured melanocytes, high levels of melanogenesis lead to an increase in oxidative stress which itself causes NF-ĸB activation. NF-ĸB mediates the transcription of antiapoptotic factors which may block TNF-α-induced apoptosis at early steps of the signal cascade.
Effects of UVA and L-Ascorbic Acid on Nuclear Factor-κB in Melanocytes and in HaCaT Keratinocytes
Authors: Shang Jing , Schwarz C. , Sanchez Ruderisch H. , Hertting T. , Orfanos C.E. , Tebbe B.
Published: April 2003

Nuclear factor-ĸB (NFĸB) is a pleiotropic transcriptional activator, which is a sensitive transcriptional factor for free radicals and activates multiple target genes. UVA is very efficient in inducing free radicals in human skin cells. L-ascorbic acid is regarded as a scavenger of UVA-induced free radicals in human keratinocytes. In epidermis, melanocytes and keratinocytes play an important protective role against skin photodamage. In the present study, we aimed to investigate the role of NFĸB on photodamage in melanocytes and keratinocytes. Normal human melanocytes (NHM) and HaCaT keratinocytes were treated with UVA (500 mJ/cm², 1,000 mJ/cm2) and/or L-ascorbic acid (100 µM, 250 µM). NFĸB binding activity was analysed by electrophoretic mobility shift assay. NFĸB binding activity was increased by UVA irradiation in HaCaT keratinocytes, but it was not affected in NHM. On the other hand, L-ascorbic acid decreased NFĸB binding activity both in UVA-irradiated and in non-irradiated NHM. In contrast, NFĸB binding activity in HaCaT keratinocytes was increased after treatment with L-ascorbic acid. In addition, L-ascorbic acid synergistically induced NFĸB binding activity with UVA irradiation. The contrary response on NFĸB binding activity in NHM and HaCaT keratinocytes indicated that the redox regulation might be different on photoprotective action in melanocytes and keratinocytes.
β-Carotene Plasma Levels and Content in Oral Mucosal Epithelium Is Skin Type Associated
Authors: Gollnick Harald P.M. , Siebenwirth Carina
Published: April 2003

β-Carotene is one of the important antioxidants in the defence mechanisms of the body against reactive oxygen species and, in particular, against UV radiation in the skin. The aim of our study was to measure if differences of β-carotene in the peripheral blood and oral mucosa exist in relation to skin types I–IV (according to Fitzpatrick). One hundred and seventy-four subjects were studied with regard to β-carotene plasma levels. Out of these, 63 healthy volunteers (24–28 years) with skin type I–IV were studied with regard to plasma levels and content of β-carotene in the oral mucosa. Ten millilitres of venous blood was obtained and oral mucosa cells (OMCs) were taken by gently brushing the oral cavity without contamination of capillary leak blood. A modified method by Stich et al. was used for preparing cells and measuring β-carotene in OMCs by HPLC. Plasma levels of skin type I were 0.1565 µmol/l and increased via skin types II with 0.2989 and III with 0.5457 to 1.221 µmol/l in skin type IV. A similar skin type-dependent increase in β-carotene could be measured in the oral mucosa epithelium (OMC) either when measured in micromoles/litre (0.0056–0.0217) or in nanograms/106 cells (0.2090–0.9989). Smokers had significantly lower levels of β-carotene in plasma and OMC as compared with non-smokers. Non-melanoma and melanoma skin cancer patients also showed lower β-carotene plasma levels and in the OMCs as well. From our results, we conclude that plasma levels and content of β-carotene in the cytoplasm of OMCs show marked and significant differences with regard to skin types I–IV. The question arises whether these differences are genetically controlled.
Magnetic Resonance Imaging and Endometriosis: Deeply Infiltrating Endometriosis Does Not Originate from the Rectovaginal Septum
Authors: Chapron Charles , Liaras Etienne , Fayet Patricia , Hoeffel Christine , Fauconnier Arnaud , Vieira Marco , Barakat Habib , Dousset Bertrand , Legmann Paul , Bonnin André , Dubuisson Jean-Bernard
Published: April 2003

The goal of this study was to describe the magnetic resonance (MR) imaging signs of deeply infiltrating endometriosis (DIE) lesions and above all to find out if MR imaging can pinpoint the location of these lesions. We made a retrospective study of 8 patients presenting with histologically proven DIE lesions. The MR imaging results were compared with intraoperative findings. Nodules revealed on T1-weighted images as isointense to myometrium with hyperintense spots remained visible on the fat-suppressed spin echo images. When there was no rectal involvement, the T1- and T2-weighted images showed a hypointense transition area between the nodule and the rectum. The DIE nodules were in identical locations in every case, lying below the torus uterinum, level with the posterior vaginal fornix and the upper third of the posterior vaginal wall. Without exception, the DIE nodules were located above the upper edge of the rectovaginal septum, with the latter appearing fine and regular with no image of any nodule. Our MR imaging results suggest that DIE lesions do not originate from the rectovaginal septum.
Hyperreactio luteinalis Associated with Severe Twin-to-Twin Transfusion Syndrome
Authors: Takeda Takashi , Minekawa Ryoko , Makino Mayuko , Sugiyama Takashi , Murata Yuji , Suehara Noriyuki
Published: April 2003

Twin-to-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies, with high perinatal loss and significant morbidity. The etiology of this syndrome remains unclear. Hyperreactio luteinalis is a rare benign condition characterized by maternal ovarian enlargement due to theca lutein cysts. We present 4 cases of hyperreactio luteinalis associated with severe TTTS. We detected maternal ovarian enlargement by prenatal ultrasonography in 2 cases, at the cesarean section in 1 case, and postpartum in 1 case. Three cases showed hydrops fetalis and all cases showed congestive cardiac failure. Serial amnioreduction was performed in all cases, and regression of hydrops fetalis and maternal ovarian enlargement occurred in 1 case. These cases suggest that the pathophysiology of TTTS is closely related to the etiology of hyperreactio luteinalis.
The Expression of Apoptosis-Related Proteins Bcl-2 and Ki67 in Endometrium of Ovulatory Menstrual Cycles
Authors: Mertens Helena J.M.M. , Heineman Maas J. , Evers Johannes L.H.
Published: April 2003

Background: During the menstrual cycle, a rapid sequence of proliferation, differentiation and cell death occurs in the human endometrium. Mechanisms involved in cell proliferation have been studied extensively. Apoptosis has recently been recognized to be a physiologic phenomenon. The aim of this study was to investigate the mechanisms involved in hormone-dependent tissue remodeling by measuring Bcl-2, an apoptosis inhibitor, and Ki67, a proliferation marker, as expressed in normal human endometrium. Methods: Paraffin-embedded endometrial sections of 30 uteri were immunostained for Bcl-2 and Ki67; expression was scored in cavitary epithelium, functional and basal glandular epithelial and stromal cells of the endometrium. Results: Bcl-2 expression increased in the proliferative phases and decreased significantly in the secretory phases, especially in glandular epithelial cells (131 ± 45 for functional laminal cells and 227 ± 68 for basal laminal cells to 0). Ki67 expression showed the same cyclic pattern with a later onset (145 ± 63 for functional laminal cells and 13 ± 8 for basal laminal cells to 0). Conclusion: Bcl-2 promotes cell survival by preventing apoptosis. Proliferation is the result of increasing estradiol concentration, high estrogen receptor expression and growth hormones and high Bcl-2 and Ki67 expression. After the onset of progesterone production, Bcl-2 levels decrease and Ki67 levels and androgen receptor expression in stromal cells disappear resulting in cell disintegration and menstruation. Persistent Bcl-2 expression, like we saw in basal laminal stromal and epithelial cells, accounts for the privilege of escaping from apoptosis-inducing signals. This allows reconstruction of the functional endometrium from its preserved basal layer after menstruation.
My 50 Years of Interest in Stereotactic and Functional Neurosurgery
Authors: Laitinen Lauri V.
Published: April 2003

The author describes his personal reflections over the last 50 years. Special attention is drawn to Jean Talairach and Lars Leksell, who greatly influenced his work in stereotactic neurosurgery.
Intrathecal Therapy for Chronic Pain
Authors: Miles John
Published: April 2003

With the improved utilisation and widespread availability of opiates, the oral treatment of pain due to malignancy has changed radically, so that the expected need for intrathecal (IT) delivery systems for this pain has largely failed to materialise. Instead, the lack of equal progress in the design and production of non-opiates for treating non-malignant pain, in the long term, has resulted in a greater interest in the development of these IT systems in this non-malignant area.
Lesioning the Subthalamic Nucleus in the Treatment of Parkinson’s Disease
Authors: Parkin S. , Nandi D. , Giladi N. , Joint C. , Gregory R. , Bain P. , Scott R. , Aziz T.Z.
Published: April 2003

Ever since it was demonstrated about twenty years ago by two independent groups (Aziz et al. and Bergman et al.) that the cardinal clinical features of MPTP-induced Parkinson’s disease (PD) in non-human primate models can be alleviated by lesions of the subthalamic nucleus (STN), this structure has been the focus of interest for functional neurosurgeons involved in the treatment of PD. Initially lesioning and later chronic high frequency stimulation of the STN has become the standard surgical target of akinetic PD. In this brief report we present our experience with 14 STN lesions (8 unilateral and 3 bilateral) confirmed by post-operative imaging. We found significant improvement in OFF rigidity and in ON tremor following unilateral lesions. The major complications were speech disturbance and L-Dopa resistant limb dystonia. Functional disability scores showed inconsistent reduction. There was insufficient data to comment on the significance of bilateral lesions; however, there was a similar pattern of improvement in tremor and speech disturbance. In addition, there was worsening of gait. We comment on the lower degree of improvement in motor scores in our series compared to the few others in recent literature and stress that even in these studies the UPDRS benefits did not translate directly into functional benefit for the patients.
Stereotactic Subthalamic Nucleus Lesioning for the Treatment of Parkinson’s Disease
Authors: Vilela Filho Osvaldo , Silva Delson J. , Souza Herbert A.O. , Cavalcante José E. S. , Sousa Joaquim T. , Ferraz Fernando P. , Silva Luis G. , Santos Lucilene F.
Published: April 2003

This study was performed to evaluate the effectiveness and safety of unilateral STN lesioning in 23 patients with PD. L-Dopa intake and dyskinesia, Hoehn & Yahr, Schwab & England, and UPDRS motor scores were recorded pre- and postoperatively. Stereotactic MRI and CT and macrostimulation were used to establish target coordinates. A single RF lesion was performed. All patients underwent postoperative MRI. Contralateral tremor arrest and decrease of rigidity and bradykinesia should be regarded as hallmarks to STN stimulation. All recorded parameters were significantly improved after a mean follow-up of 13.5 months. Patients with STN lateral territory lesioning (α <0.05), younger than 61 years and with a duration of the disease between 6 and 9 years (α >0.05) did better than the others. The recurrence rate was 10%. Two patients developed dyskinesias which were completely resolved by a Vim/VOp lesion. Other significant complications were rare. The authors conclude that unilateral STN lesioning is a safe and very effective procedure to treat PD.
Experimental Parkinsonism in Primates
Authors: Matsumura Masaru
Published: April 2003

Early in the1960s the primate model of Parkinson’s disease was first introduced by placing an electrolytic lesion in the midbrain. In the 1980s, a dopaminergic neurotoxin, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) was accidentally shown to induce parkinsonism in humans, and subsequently was confirmed to reproduce an almost perfect model of parkinsonism in primates. In the late 1980s chemical manipulations of the basal ganglia were shown to induce parkinson symptoms, especially dyskinesia, and more recently, chemical lesioning of the pedunculopontine tegmental nucleus has also been shown to induce parkinsonism. We still do not have a perfect animal model of parkinsonism, however, these models have offered excellent opportunities to study the basic mechanisms in parkinsonism and the function of the basal ganglia.
History of Lesioning for Pain
Authors: Tasker Ronald R.
Published: April 2003

The history of open and subsequently stereotactic brain lesions for the relief of pain is traced. Important steps included recognition of the importance of the non-specific pain pathways and the differential effects of lesioning on nociceptive pain and on different elements of neuropathic pain. Although the advent of morphine infusion and deep brain stimulation has greatly eroded the number of destructive lesions made, new technical and conceptual advances must be carefully evaluated.
Microelectrode Findings in the Thalamus in Chronic Pain and Other Conditions
Authors: Tasker Ronald R.
Published: April 2003

Functional neurosurgery usually requires physiological corroboration of the target site, particularly by eliciting characteristic responses to stimulation, or else by microelectrode recording of single cell responses to appropriate stimuli. Understanding pain physiology with both strategies has proven elusive, particularly microelectrode recording in response to noxious or thermal stimuli. The limited experience with stimulation and recording in pain pathways of the brain will be reviewed as well as the apparently pathophysiological observations made in certain patients with neuropathic pain.
Temporal Lobe Epilepsy –Current Wisdom
Authors: Ojemann George A.
Published: April 2003

Issues related to resective surgery for patients with medically refractory temporal lobe epilepsy (TLE) who have mesial temporal sclerosis (MTS), those with normal imaging, and the related issue of those at risk for verbal memory deficits are discussed.
Hemispherotomy for Paediatric Hemispheric Epilepsy
Authors: Daniel R.T. , Joseph T.P. , Gnanamuthu C. , Chandy M.J.
Published: April 2003

We present here the results of our series of peri-insular hemispherotomy for intractable hemispheric epilepsy. There were 6 children in this series with a mean age of 10.2 years and mean duration of seizures of 7.2 years. The seizure results were excellent in all children and they also showed significant improvement in functional status. This procedure has significant advantages when compared to other forms of hemispherectomy. However, a larger experience with longer periods of follow-up is needed.
Surgical Treatment of Intractable Epilepsy Combined with Bipolar Electrocoagulation on Functional Cortex
Authors: Luan Guoming , Sun Zhenrong , Bai Qin , Wang Chongcheng
Published: April 2003

Objective: Resecting epileptogenic foci combined with bipolar electrocoagulation of functional cortex has been successfully used to treat intractable epilepsy. Method: 124 cases with intractable epilepsy have been treated from 1996 to 1999, 75 cases with temporal lobe epilepsy and 48 cases with extra-temporal lobe epilepsy, and one case with infantile hemiplegia. Electrocorticography (ECoG) was used pre- and postoperatively. 108 cases were followed-up from one to three years. Results: The general efficiency of bipolar electrocoagulation on functional cortex (BCFC) for epilepsy is 91.7%. The pathological features indicate that the damage by coagulation of the cortex is only in the supra- and infra-granular layers, similar to multiple subpial transection (MST). Conclusion: When the epileptogenic foci are located in functional cortex, the method of resecting the foci combined with BCFC has been effective and improves the results greatly. BCFC is safe and easy to use.
Microvascular Decompression Surgery for Trigeminal Neuralgia
Authors: Kondo Akinori
Published: April 2003

Long-term follow-up data were analyzed to evaluate the surgical results of microvascular decompression (MVD). Among 1,324 patients with trigeminal neuralgia (TGN), who underwent MVD between 1976 and 2000, a consecutive 281 patients were followed and studied for 5–20 years as of the year of 1997. When the data were analyzed and compared in two groups (A: 1976–1986, B: 1987–1991), the postoperative cure rate increased from 92.9 to 96.7%, satisfaction rate with the results of MVD increased from 80.3 to 82.5%, incomplete cure rate decreased from 7.1 to 3.3%, and recurrence rate decreased from 10.2 to 6.5%. Advances in surgical techniques may have increased the success rate in Group B.
Gene Expression of Stromelysin and Aggrecan in Osteoarthritic Cartilage
Authors: Stöve Johannes , Gerlach Christina , Huch Klaus , Günther Klaus Peter , Brenner Rolf , Puhl Wolfhart , Scharf Hanns-Peter
Published: April 2003

Objective: To analyze cartilage gene expression of patients with osteoarthritis (OA) in correlation with radiographic and histological findings. Materials and Methods: Twenty-one patients with OA of the knee admitted for total knee replacement were analyzed clinically and radiographically by the Kellgren and Lawrence system. During surgery, cartilage samples from the medial and lateral condyles and tibial plateaus were harvested separately. Specimens were analyzed histologically (Mankin score) and total RNA was extracted directly from cartilage tissue. Steady state levels of stromelysin (MMP-3), aggrecan (AGG) and the house-keeping gene β-actin were measured using quantitative PCR. Results: Histology of medial and lateral knee compartments corresponded to radiographic changes (Spearman correlation coefficient: r = 0.7 (p < 0.01)). There was a positive correlation between MMP-3 and AGG gene expression (r = 0.4; p < 0.01). We found considerable variation of expression levels of MMP-3 and AGG and no correlation of gene expression with histological or radiographic scoring. Conclusion: The positive correlation between AGG and MMP-3 suggests a common regulation of anabolic and catabolic metabolism. There was no simple dependency between gene expression and histological and radiological findings in cartilage.
Factors Influencing the Growth Hormone Response to Growth Hormone-Releasing Hormone in Children with Idiopathic Growth Hormone Deficiency
Authors: Groisne C. , Trivin C. , Souberbielle J.C. , Brauner R.
Published: April 2003

Objective: To evaluate the factors influencing the growth hormone (GH) response to GH-releasing hormone (GHRH) test in idiopathic GH deficiency. Methods: 28 patients aged 4.9 ± 0.7 years with certain GH deficiency were given GHRH (2 µg/kg). Results: The GH peak after GHRH was correlated negatively with age at evaluation (r = –0.37, p < 0.05) and body mass index (r = –0.44, p = 0.02), and positively with anterior pituitary height (r = 0.47, p = 0.02), GH peak after non-GHRH stimulation (r = 0.78, p < 0.0001) and spontaneous GH peak (r = 0.82, p = 0.007). It was lower in the patients aged >5 years than in the youngest (p = 0.04), but it was similar in the patients with and without features suggesting a hypothalamic origin. Conclusion: The GH response to GHRH test cannot be used to differentiate between hypothalamic and pituitary forms of idiopathic GH deficiency, probably because the GH response decreases after the first 5 years of life, whatever the origin of the deficiency.
Cardiac Structural Involvement in Mucopolysaccharidoses
Authors: Rigante Donato , Segni Giuseppe
Published: April 2003

Mucopolysaccharidoses (MPS) are lysosomal storage disorders due to impaired glycosaminoglycan degradation. Cardiac involvement is present in most patients with MPS although its clinical impact is still undetermined. Cardiovascular abnormalities were evaluated in 39 patients with MPS aged 4–22 years. Valvular lesions and different forms of cardiac involvement were detected. The most common lesion was thickening of the mitral valve with regurgitation or stenosis, regardless of the MPS type. Mitral valve thickening was observed in 23 patients, aortic valve thickening in 11 patients and congestive heart failure in only 1 patient with MPS III. The most severe changes were registered for MPS types I and II. Complete cardiological investigation should be routinely warranted in every patient inflicted with MPS.
Application of the Vena contracta Method for the Calculation of the Mitral Valve Area in Mitral Stenosis
Authors: Abacı Adnan , Oguzhan Abdurrahman , Ünal Şükrü , Kıranatlı Burhanettin , Eryol Namık Kemal , Basar Emrullah , Ergin Ali , Cetin Servet
Published: April 2003

Objectives: The vena contracta is the narrowest region of the regurgitant or stenotic jet just downstream the orifice and reflects the size of that orifice. This study was performed to assess the accuracy of the vena contracta width (VCW) in evaluating the severity of mitral stenosis (MS) and to compare the mitral valve area (MVA) determined by VCW with MVAs obtained by other more traditional echocardiographic methods. Methods: We studied 59 patients (43 females, 42 ± 14 years) with MS. VCW was measured in the apical four chamber view by Doppler color flow mapping. The largest diameter of the VCW during diastole was measured for at least three cardiac cycles and averaged. MVA was calculated from the following equation: πr2, where r = VCW/2. MVA was also determined by planimetry, the pressure half-time method, and by the Gorlin formula. Results: In this study, the width of the vena contracta ranged from 0.89 to 1.73 cm (mean 1.30 ± 0.21). MVA, calculated based on the VCW, ranged from 0.63 to 2.35 cm2 (mean 1.36 ± 0.41). MVA by VCW (1.36 ± 0.41 cm2) showed good correlations with three comparative techniques: (1) the cross-sectional area by planimetry (1.35 ± 0.36 cm2, mean difference = 0.21 ± 0.16 cm2, y = 0.91x + 0.14, r = 0.79, SEE = 0.26 cm2, p < 0.001); (2) the area derived from the Doppler pressure half-time (1.27 ± 0.32 cm2, mean difference = 0.22 ± 0.19 cm2, y = 0.97x + 0.13, r = 0.76, SEE = 0.27 cm2, p < 0.001), and (3) the area derived from the Gorlin equation in the 18 patients who underwent catheterization (1.27 ± 0.35 cm2, mean difference = 0.19 ± 0.16, y = 0.98x + 0.05, r = 0.81, SEE = 0.26 cm2, p < 0.001). Conclusions: These findings suggest that Doppler color flow imaging of the MS jet in the vena contracta can provide an accurate estimation of MVA and appears to be potentially applicable in the assessment of the severity of MS.
Oscillations in Peripheral Arterial Tone in Congestive Heart Failure Patients: A New Marker for Cheyne-Stokes Breathing
Authors: Freimark Dov , Adler Yehuda , Sheffy Jacob , Schechter Doris , Schwammenthal Ehud , Wiser Itay , Motro Michael , Lavie Peretz
Published: April 2003

Cheyne-Stokes breathing (CSB), which is a prevalent finding in congestive heart failure (CHF) patients, has been shown to be of prognostic value. The oscillations in respiration were shown to be associated with oscillations in sympathetic nerve activation. We tested the hypothesis that the peripheral arterial tone (PAT) as measured by a novel finger plethysmograph can be used to detect CSB. Using a novel technique to measure the PAT, we monitored 10 patients with advanced CHF simultaneously with conventional polysomnographic recordings for either 1 or 2 nights. Records were scored for CSB during 3-min periods based on either respiratory effort and nasal-buccal airflow or on the PAT signal alone. The PAT sensitivity and specificity for the detection of periods containing CSB were 91 and 91% for the entire recording, 90.7 and 92.9% for non-REM sleep, 90.7 and 70% for REM sleep, and 73 and 97.3% for awake periods, respectively. PAT is a reliable marker of CSB in CHF patients. The novel finger plethysmograph can be used for screening and monitoring CSB.
Myocardial Perfusion Abnormalities Early (12–24 h) after Coronary Stenting or Balloon Angioplasty: Implications Regarding Pathophysiology and Late Clinical Outcome
Authors: Jaffe Ronen , Haim Simona Ben , Karkabi Basheer , Front Avi , Gips Sara , Weisz Giora , Khader Nader , Merdler Amnon , Flugelman Moshe Y. , Halon David A. , Lewis Basil S.
Published: April 2003

Objective: We prospectively examined the prevalence of reversible perfusion defects on very early (12–24 h) thallium-201 single photon emission computed tomography (SPECT) scintigraphy after angiographically successful percutaneous coronary intervention (PCI) by stenting and/or stand-alone balloon angioplasty and the predictive value of these defects for late target lesion revascularization (TLR). Patients and Methods: 83 consecutive patients undergoing PCI for 88 lesions (38 balloon angioplasties, 50 stents) underwent very early (12–24 h) SPECT thallium-201 scintigraphy at rest and following administration of 0.7 mg/kg intravenous dipyridamole after PCI. Univariate and multivariate clinical, procedural and scintigraphic correlates of target lesion revascularization during long-term follow-up were examined. Results: Coronary stenting achieved a larger immediate post-PCI minimal luminal dimension (2.7 ± 0.4 vs. 2.1 ± 0.4 mm, p < 0.001) and less residual stenosis (4 ± 12 vs. 19 ± 11%, p < 0.001) than stand-alone balloon angioplasty. Nonetheless, early reversible perfusion defects were similarly present in the territory supplied by 36% of stented lesions and 32% of lesions treated by balloon angioplasty (NS). Of 81 lesions (76 patients) available for long-term clinical follow-up, TLR was performed in 11% of the stent group and 14% of the balloon angioplasty group (NS). By multivariate logistic regression analysis, diabetes mellitus was the only predictor of late TLR (p < 0.05). The type of intervention (balloon or stent) predicted neither early perfusion defects nor late TLR. Conclusions: Early 201-thallium SPECT scintigraphy was abnormal in a third of patients treated by stand-alone balloon angioplasty or by stent placement. The very early SPECT scintigraphic findings did not differentiate between balloon and stent and did not predict late TLR.
Left Ventricular Diastolic Dysfunction as an Early Manifestation of Diabetic Cardiomyopathy
Authors: Schannwell C.M. , Schneppenheim M. , Perings S. , Plehn G. , Strauer B.E.
Published: April 2003

Aims/Hypothesis: Early determination of myocardial manifestations of diabetes mellitus is of major importance, since myocardial involvement considerably influences the prognosis of diabetic patients. The aim of this study was to investigate whether young patients with insulin-dependent diabetes mellitus and normal systolic left ventricular (LV) function already show a diastolic LV dysfunction and an increased risk of arrhythmias. Methods: Echocardiography was performed in 87 patients suffering from type I diabetes mellitus, without known cardiac disease and in 87 controls. Patients with a known manifest cardiac disease or a long-term diabetic syndrome were excluded. Morphological parameters were determined using M-mode echocardiography. Doppler echocardiography was used to evaluate parameters of LV diastolic function. The risk of arrhythmia was assessed by means of electrocardiography, heart rate variability, and late potential analysis. Results: The left atrial and ventricular dimensions and systolic functional parameters of all patients were normal. A diastolic dysfunction with a reduction in early diastolic filling, an increase in atrial filling, an extension of isovolumetric relaxation and deceleration time was documented in diabetic patients, as well as an increased number of supraventricular and ventricular premature beats. Conclusion: Even young patients with diabetes mellitus suffer from a diastolic dysfunction while systolic ventricular function is normal. Therefore, echocardiography with measurements of diastolic functional parameters appears to be a sensitive method for evaluating the manifestation and course of early diabetic cardiomyopathy.
Diagnosis of Ureterocele with Transvaginal Sonography
Authors: Shimoya Koichiro , Shimizu Takashi , Hashimoto Kazumasa , Koyama Masayasu , Sawamura Arata , Murata Yuji
Published: April 2003

We report here the case of a 49-year-old Japanese woman who presented to the clinic for uterine cervical cancer screening and who had a history of repeated cystitis. Normal imaging demonstrated no abnormalities of the genital organs; however, transvaginal ultrasound revealed ureterocele. Given the lack of ureterocele-related symptoms and the absence of hydronephrosis, the patient was followed up using repeat sonographic studies and intravenous pyelography. In conclusion, transvaginal sonography is a useful tool in the diagnosis of urinary diseases. In patients with recurring urological symptoms, it is important to check for gynecological diseases as well as urologic diseases. This can be provided well with transvaginal sonography.
Preoperative Administration of Recombinant Human Erythropoietin in Patients Undergoing Gynecologic Surgery
Authors: Sesti Francesco , Ticconi Carlo , Bonifacio Simone , Piccione Emilio
Published: April 2003

The effect of preoperative recombinant human erythropoietin (r-HuEPO) in anemic women undergoing gynecologic surgery for benign diseases was evaluated in this prospective, not randomized study. One hundred and twenty women were included in the study. Sixty women were treated preoperatively with r-HuEPO at three different cumulative doses: 80,000, 120,000 and 160,000 IU. Sixty nonanemic women were not treated. Baseline hemoglobin (Hb) levels were measured. Hb levels were also measured on the day of the surgery before starting the procedure, on postoperative day 1 and on the day of discharge from the hospital. Treatment with r-HuEPO significantly increased both preoperative Hb levels and Hb levels at discharge. Conversely, Hb levels at discharge were lower than baseline levels in untreated women. The effect of r-HuEPO on Hb levels was exerted in a dose-dependent fashion. No adverse and/or side effects of treatment were observed. Preoperative treatment with r-HuEPO in selected anemic patients undergoing gynecologic surgery for benign diseases seems to be a safe and useful tool to reduce the need for red blood cell transfusions.