bluuebunny/crossref_metadata_2025 huggingface dataset:
The Implications of Different Approaches to Evaluating Intervention: Evidence from the Study of Language Delay/Disorder
Authors: Law J.
Published: July 2004

There is a pressure to both identify and expand the evidence base with regard to the treatment of speech and language disorders in children, as there is in other areas of speech and language therapy. This paper addresses two sources of evidence, a systematic review and meta-analysis of early language interventions and the monitoring of an early language target for socially disadvantaged children in Sure Start programmes in England. There is a growing number of efficacy studies in the field of speech and language disorders in children. For example, in a recent review for the Cochrane Collaboration in the UK 36 articles reporting a total of 33 different trials. Twenty-five of these articles provided sufficient information for use in a series of meta-analyses. The results indicate that speech and language therapy may be effective for children with phonological or expressive vocabulary difficulties. There is mixed evidence concerning the effectiveness of intervention for children with expressive syntax difficulties and little evidence available considering the effectiveness of intervention for children with receptive language difficulties. No significant differences were found between interventions administered by trained parents and clinicians. A number of gaps in the evidence base are identified. But such reviews are essentially retrospective and, while the results may be interesting for practitioners, they do not provide the whole picture. The paper then turns to a very different data set and the role of population monitoring, an approach to assessing the value of interventions which has not hitherto been used in any area of speech and language therapy. The data are derived from a year-on-year monitoring of the language output of 2-year-olds in Sure Start programmes in England. This is a programme funded by central government in the UK to reduce the impact of social disadvantage on children, parents and their communities. The practice and policy implications of these two different sources of information are considered. Who is the consumer of such information and what can they do with it once they have it?
CT Diagnosis and Outcome of Primary Brain Tumours in the Elderly: A Cohort Study
Authors: Myint Phyo K. , May Helen M. , Baillie-Johnson Hugo , Vowler Sarah L.
Published: July 2004

Background: The incidence of primary brain tumours (PBT) increases with age. Survival outcome depends on the treatment modality and histological type of the tumour. Objectives: To compare the survival outcome between those who had brain biopsy and those who did not among those who had PBT diagnosed by computerised tomography (CT). Methods: We analysed data from 82 elderly patients who were admitted to a UK centre with close links to a neurosurgical unit. Results: Age range was 62–99 years (median 74 years); 49 males and 33 females. 44 cases (54%) had brain biopsies of which 2 (5%) were not PBT. Both cases were malignant conditions, 1 case of metastasis and 1 leiomyosarcoma. Of 42 PBT, 34 (77%) were malignant gliomas. The remaining 8 cases were 4 astrocytomas, 2 meningiomas, 1 cerebellar tumour and 1 cerebral lymphoma. Initial clinical misdiagnosis of cerebrovascular disease (CVA) or transient ischaemic attack (TIA) was very common, 70% in our cohort. Those who had brain biopsy were younger (median age 72, range 62–81) compared to those who did not have brain biopsy (median age 77, range 65–91). A survival analysis for those who died comparing biopsy-proven malignant tumours (combined gliomas and astrocytomas (n = 37)) and those who did not have a biopsy (n = 37) showed that the latter had a shorter median time to receive definitive treatment after diagnosis, 8.0 days (95% CI; 5.4, 8.6) (n = 20) compared to 40.0 days (95% CI; 32.5, 47.5) (n = 26) but shorter median length of survival, 47.0 days (95% CI; 32.3, 61.7) compared to 81.0 days (95% CI; 66.7, 95.3) for those who had brain biopsy. Subgroup analysis of malignant gliomas between patients aged ≤70 years and those >70 years showed no significant difference in median length of survival, 74.0 days (95% CI; 54.0, 94.0) vs. 85.0 days (95% CI; 59.0, 111.0), respectively. Conclusions: Our findings suggest that the older elderly are less likely to have aggressive therapy, and more likely to be diagnosed initially as cerebrovascular event (CVA/TIA). However, when they were given similar definitive treatment, their survival is comparable with their younger counterparts and therefore, age alone should not contraindicate radical treatment. Elderly patients should be selected for radical treatment on existing criteria, but age itself should not preclude radical treatment where it is otherwise appropriate to offer it.
Resistance of Cultured Human Skin Fibroblasts from Old and Young Donors to Oxidative Stress and Their Glutathione Peroxidase Activity
Authors: Matsuo Mitsuyoshi , Ikeda Hidefumi , Sugihara Takehiko , Horiike Satomi , Okano Yuri , Masaki Hitoshi
Published: July 2004

Background: It has been suggested that oxidative stress is involved in the aging process and that the resistance of animals to oxidative stress may decrease with advancing aging. However, there are only a limited number of reports of studies on the relationship between aging and resistance to oxidative stress. Objective: The aim of this work is to examine the relationship between the resistance of human skin fibroblasts to oxidative stress and donor age, and the relevance of antioxidant enzyme activities to this resistance. Methods: Percent cell survival was determined by the trypan blue exclusion test and the neutral red method. Superoxide dismutase activity was assayed by the method of Oyanagi, catalase activity by the method of Aebi, and glutathione peroxidase activity by the method of Flohé and Günzler. Reduced glutathione concentration was measured by the method of Griffith. Antioxidant enzyme mRNA levels were estimated by reverse transcription polymerase chain reactions (RT-PCR). Results: The percent survivals of cultured human skin fibroblasts, derived from young and old donors (referred to as young and old cells, respectively), under oxidative stress from hydrogen peroxide, linoleic acid hydroperoxide, or ultraviolet light B were examined. Old cells were more resistant to such oxidative stress than young cells. The activity of glutathione peroxidase was higher by 46.1% in old cells than in young cells, although there was no difference between their relative glutathione peroxidase mRNA levels. Further, there was no difference between their activities of copper/zinc superoxide dismutase, manganese superoxide dismutase, or catalase. However, the relative mRNA levels of copper/zinc superoxide dismutase and manganese superoxide dismutase were lower by 13.9 and 20.9% in old cells than in young cells, respectively, while there was no difference between the levels of catalase. Conclusions: These results suggest that old cells are more resistant to oxidative stress than young cells, presumably because of an increase in cellular glutathione peroxidase activity.
Long-Term Influence of Perinatal Asphyxia on the Social Behavior in Aging Rats
Authors: Weitzdoerfer Rachel , Gerstl Nicole , Pollak Daniela , Hoeger Harald , Dreher Wolfgang , Lubec Gert
Published: July 2004

Background: Various groups have been addressing the question of whether perinatal asphyxia (PA) affects the behavior of young animals, but no information is available on long-term effects of PA on the behavior in aged rats, although it has been postulated that PA may lead to neurological and psychiatric deficits in adult life. Objective: We, therefore, decided to study the effects of PA on social and anxiety-related behaviors in 2-year-old rats, using a noninvasive animal model resembling the clinical situation. Methods: For the behavioral studies, the open-field test, the elevated plus-maze test, and a social interaction test in pairs were performed. Magnetic resonance imaging of the brain was selected to rule out neuropathological changes due to the aging process per se, as well as asphyxia-induced pathologies in the brain areas known to play an important role in the modulation of behavior. Results: The social interaction test revealed a statistically significant increase in the number of social grooming episodes and the time spent running alone, whereas the numbers of social sniffing and fighting episodes and the time spent running together were decreased in the asphyxiated group. The elevated plus- maze test revealed a higher presence of entries into the closed arm. Furthermore, sniffing and self-grooming episodes were significantly increased in the asphyxiated group. Conclusions: We found a significantly decreased social aggressiveness and an increased social contact behavior as well as increased anxiety levels in the asphyxiated animals. The present findings may provide important information on the long-term behavioral sequelae of PA in the aged individual.
Impaired Lipid Metabolism in Aged Mice as Revealed by Fasting-Induced Expression of Apolipoprotein mRNAs in the Liver and Changes in Serum Lipids
Authors: Araki Sachiko , Okazaki Mitsuyo , Goto Sataro
Published: July 2004

Background: Changes in apolipoprotein (Apo) metabolism can cause an increased incidence of diseases such as cardiovascular disorders and diabetes with advancing age. Limited reports are available on this topic, however. Objective: To investigate age-related changes in mobilization of stored lipid, we studied the effects of fasting on the gene expression of Apos in the liver as well as serum triglyceride (TG) and cholesterol levels in the serum. Methods: Using young (6- to 8-month-old) and old (24- to 28-month-old) fasted and re-fed mice, Northern blots of hepatic mRNAs for Apos A-I, A-IV, C-II, C-III, and liver-type fatty acid-binding protein and HPLC analyses of serum lipids were conducted. Results: Fasting induced 4- and 20-fold increases in the mRNA of Apo C-II and A-IV, respectively, in young mice while only 1.1- and 7-fold increases, respectively, were detected in old mice. In contrast, the Apo C-III gene expression was significantly reduced by fasting in the young mice but the reduction was small in the old. In view of the stimulating effect of Apo C-II and A-IV and the inhibiting effect of C-III on lipoprotein lipase (LPL), these findings suggest that the fasting-induced activation of LPL may be considerably decreased in old mice. The amount of TG in very low-density lipoprotein (VLDL), a major form of the transport of TG to peripheral tissues, was significantly greater in the young than in the old mice. Despite possible activation of LPL by fasting, the amount of TG in VLDL, a major form of the transport of TG to peripheral tissues, was significantly greater in the young mice than in the old. It is indicated that the synthesis of VLDL in the liver is high in the young but low in the old mice, which also may be true for the rate of transport of TG. Conclusion: The present findings suggest that mobilization of lipids is impaired in old animals due to decreased gene expression of Apos, possibly leading in the long run to excessive lipid accumulation in tissues such as the liver, adipose tissues and blood vessels even in normal feeding, and resulting in an increased incidence of age-related diseases.
Relationship between Somatotype and Blood Pressure in a Group of Institutionalized Venezuelan Elders
Authors: Herrera H. , Rebato E. , Hernández R. , Hernández-Valera Y. , Alfonso-Sánchez M.A.
Published: July 2004

Background: Somatotype, as an indirect measure of estimating body composition, provides an easy and comprehensive picture of body shape. Multiple investigations have shown the existence of an association between somatotype components and cardiovascular disease. Objective: The aim of the present study was to examine the association of somatotype with blood pressure during ageing. Methods: The Heath-Carter anthropometric somatotype and both systolic (SBP) and diastolic (DBP) blood pressures were recorded. The sample included 809 healthy institutionalized elders (370 males and 439 females) from geriatric units in Caracas, Venezuela. Ages ranged from 60 to 102 years. Product-moment correlation coefficients between somatotype components and both blood pressure readings were calculated. Principal component analysis and homogeneity analysis by means of alternative least squares tests were also performed. Results: Females were more endomorphic and mesomorphic than males. Males were more ectomorphic than females. SBP showed a downward tendency with age in males, while in females the tendency was for the SBP to increase. Correlations among variables were from low to moderate and ranged from –0.37 to +0.34 in males, and from –0.18 to +0.32 in females. Correlations tended to be stronger in the younger age group and differences between sexes were found. A negative tendency in the correlation between ectomorphy and both SBP and DBP was found, except for the oldest age group, for which the correlation was positive. Endomorphy and mesomorphy showed a stable correlation pattern with blood pressure in males, while in females this pattern was more irregular and less consistent. Conclusion: Individuals with high levels of SBP and DBP had mean somatotypes, which were similar to those of other male groups characterized by myocardial infarct, coronary heart disease and the risk of hypertension, indicating that these somatotypes may be associated with cardiovascular risk factors. In particular, our results indicate that individuals who present a cardiovascular risk profile are more endomorphic and mesomorphic and less ectomorphic than those with a lower cardiovascular risk profile.
Association of Pulmonary Function with Cognitive Performance in Early, Middle and Late Adulthood
Authors: Anstey Kaarin J. , Windsor Timothy D. , Jorm Anthony F. , Christensen Helen , Rodgers Bryan
Published: July 2004

Background: Pulmonary function has been associated with some measures of cognitive performance, mostly in late adulthood. This study investigated whether this association is present for a range of cognitive measures, at three stages of adulthood, and whether it remains after controlling for demographic, health and lifestyle factors. Method: The relationship between forced expiratory volume at 1 s (FEV1), a measure of pulmonary function, and cognitive test performance was examined in three cohorts aged 20–24, 40–44 and 60–64. Results: After controlling for demographic variables, smoking, physical activity, and respiratory disease, significant associations between FEV1 and cognitive test performance were evident in each age group for most cognitive measures. The association between FEV1 and measures of speed increased with age. Conclusion: FEV1 has a small but reliable positive association with cognitive test performance throughout adulthood, possibly reflecting a common physiological factor.
Living Will, Resuscitation Preferences, and Attitudes towards Life in an Aged Population
Authors: Laakkonen Marja-Liisa , Pitkala Kaisu H. , Strandberg Timo E. , Berglind Saila , Tilvis Reijo S.
Published: July 2004

Background: The growth of life-sustaining medical technology and greater attention to medical care at the end of life have provoked interest in issues related to advance care planning. Objective: To investigate how having a living will (LW), resuscitation preferences, health condition, and life attitudes are related in home-dwelling elderly people. Methods: In a cross-sectional descriptive study, detailed assessments were made of 378 home-dwelling elderly individuals participating in a cardiovascular prevention study (DEBATE Study). The participants were inquired about a preexistence of a written document (LW) concerning life-sustaining care, preferences of cardiopulmonary resuscitation (CPR) in their current situation, and attitudes towards life. General health, physical and cognitive functioning, the presence of depression, and quality of life were also assessed. Results: Forty-four of the 378 participants (12%) had a LW. As compared with those without one (n = 334), there were more women [82% (36/44) vs. 63% (210/334)] and widows [57% (25/44) vs. 41% (135/334)] among those with a LW. They were also more educated and considered their health to be better. Despite having a LW, 46% (20/44) of them preferred CPR in their current condition, a proportion not statistically different from the 58% (194/334) of the individuals without a LW. In the whole sample, 39% (149/378) of the individuals preferred to forgo CPR. As compared with those preferring CPR, they were older, more often women, and widowed. Participants preferring to forgo CPR had a poorer quality of life, were more lonely, and showed signs of depression more often than those preferring CPR. The preference to forgo CPR was related to attitudes towards life regardless of physical or cognitive functioning. Conclusions: Having a LW does not reduce the reported preference of CPR which is related more to current mental status and life attitudes. In-depth assessment of the patient’s preferences should be performed in any comprehensive care plan.
Within-Person Variability as a Dynamic Measure of Late-Life Development: New Methodologies and Future Directions
Authors: Anstey Kaarin J.
Published: July 2004

Background: Intra-individual variability is becoming a focus of research in behavioural gerontology due to theoretical and methodological advances. Objective: New directions in the study of intra-individual variability are described and unanswered questions are proposed. Methods: Papers from the special issue of Gerontology on Intra-individual Change are reviewed. Results: Key findings and approaches from this set of papers are identified, including types of latent growth curve models that incorporate dynamic elements and applications to the study of late-life cognition and affect. Theoretical issues that remain unresolved are outlined. Conclusion: Dynamic approaches to the measurement of change provide novel methods to answer new questions and evaluate existing theories. The focus on intra-individual variability adds a valuable dimension to gerontological research that may refine the way we describe behaviour and measure change.
Incidence of Dementia in a Rural Community in Spain: The Girona Cohort Study
Authors: López-Pousa Secundino , Vilalta-Franch Joan , Llinàs-Regla Jordi , Garre-Olmo Josep , Román Gustavo C.
Published: July 2004

Background: Information on dementia incidence in Spanish populations is still scarce, and there is a dearth of prospective studies. Objective: To estimate the incidence rates of dementia, Alzheimer’s disease (AD) and vascular dementia (VaD) in a population cohort aged 75 and over in a rural area in Spain. Methods: A prospective population cohort study over a 5-year period in 8 rural villages in the province of Girona. The baseline study in 1990 identified 200 prevalent cases of dementia. The dementia-free cohort included 1,260 persons aged 75 and over. This was the sample used for the incidence study. We rescreened and selectively reexamined this group in 1995 using a two-phase procedure consisting of a screening interview at home using the MMSE. Diagnoses of dementia, AD and VaD were established using the Cambridge Examination for Mental Disorders of the Elderly for surviving participants. For deceased participants, we used the Retrospective Collateral Dementia Interview to establish a diagnosis of dementia and AD according to DSM-III-R diagnostic criteria. Results: Information was obtained for 91% of the subjects at risk; 122 incident cases of dementia were identified. Incidence rates per 1,000 person-years at risk were 23.2 (95% CI = 19.1–27.3) for dementia, 10.8 (95% CI = 7.8–13.7) for AD and 9.5 (95% CI = 6.7–12.1) for VaD. All dementia subtypes showed an age-dependent pattern. Females had a relative risk of 1.8 (95% CI = 1.0–3.4) to develop AD. The inclusion of deceased cases with manifestations of dementia increased the rate of dementia incidence in 7.1 cases/1,000 person-years at risk. Conclusion: Incidence rates were similar to those reported by other cohort studies. All dementia subtypes increased with age, but incidence rates did not increase exponentially in the oldest old. Females were at increased risk for AD. The inclusion of information about dementia symptoms from relatives of deceased participants was useful in order to avoid underestimation of the dementia incidence rates. Underestimation of the incidence rates was more important in those aged 75–84 years.
Cerebral Haemodynamics in the Elderly: The Rotterdam Study
Authors: Bakker Stef L.M. , de Leeuw Frank-Erik , den Heijer Tom , Koudstaal Peter J. , Hofman Albert , Breteler Monique M.B.
Published: July 2004

Transcranial Doppler ultrasonography allows the non-invasive assessment of cerebral haemodynamics. Data on the frequency distribution of these parameters in the oldest old are scarce, which makes a distinction between physiological and pathophysiological ageing difficult. We studied the relation between cerebral haemodynamic parameters and age and sex in 1,720 participants of a population-based study by means of transcranial Doppler ultrasonography. The end-diastolic, peak systolic and mean cerebral blood flow velocity, and cerebrovascular CO2 reactivity declined significantly with increasing age up to 90 years (per year –0.6 cm/s; –0.3 cm/s; –0.5 cm/s, and –0.6%/kPa, respectively). The pulsatility index increased with age (per year 0.01). End-diastolic, peak systolic and mean cerebral blood flow velocities were lower in men compared to women (age-adjusted difference 1.6 cm/s; 4.1 cm/s, and 2.5 cm/s, respectively). Cerebrovascular CO2 reactivity was higher in men compared to women. Adjusting for carotid atherosclerosis did not change the observed sex differences. These findings provide insight into physiologic changes of haemodynamics during ageing and may serve as a starting point for investigations on determinants of pathophysiologic changes in cerebral haemodynamics in the elderly.
Misclassification Is Likely in the Assessment of Mild Cognitive Impairment
Authors: Royall Donald R. , Chiodo Laura K. , Polk Marsha J.
Published: July 2004

We estimated the relative frequency of isolated memory impairment versus isolated and comorbid impairment in executive control function (ECF). One hundred and ninety-three noninstitutionalized residents of a single Comprehensive Care Retirement Community (mean age 79.2 years) were investigated. The subjects were tested with multiple measures of memory and ECF. Test scores were standardized to minimize scaling effects. ‘Impairment’ was defined as performance ≤1.5 standard deviations below the mean for the entire sample (i.e., a z score ≤–1.5). Disability was estimated as the sum of self-reported activities of daily living and instrumental activities of daily living. The cognitive test performance was significantly associated with functional impairment, independently of age. ECF and memory measures were significantly intercorrelated. Both were significantly and independently associated with disability ratings. 6–10% of the subjects had memory impairment; 25–35% of the memory-impaired subjects had comorbid ECF impairments. An additional 4–7% of the subjects had isolated ECF impairment. A significant fraction of the cases otherwise meeting the criteria for ‘mild cognitive impairment’ may have comorbid ECF impairment. This raises the issue of whether they might be more properly classified as ‘demented’. In addition, isolated ECF impairment may affect almost as many persons as isolated memory impairment. Isolated ECF impairment is not consistent with the natural history of preclinical Alzheimer’s disease, suggests other conditions, and can be disabling, independently of age and/or memory loss.
Incidence of Amyotrophic Lateral Sclerosis and of the Parkinsonism-Dementia Complex of Guam, 1950–1989
Authors: Waring Stephen C. , Esteban-Santillan Cony , Reed Dwayne M. , Craig Ulla-Katrina , Labarthe Darwin R. , Petersen Ronald C. , Kurland Leonard T.
Published: July 2004

Studies representing the accumulated information from the first 30 years of research effort on Guam (1950–1979) have demonstrated a varying degree of decline in the incidence of amyotrophic lateral sclerosis (ALS) and the parkinsonism-dementia complex (PDC) of Guam. Analysis with more complete information for the period 1980–1989 provides more valid estimates of the later patterns in the incidence of ALS and PDC and affords a more extensive assessment of trends over a 40-year period. The annual age-adjusted incidence of ALS was 7/100,000 and the annual age-adjusted incidence of PDC was 22/100,000 in 1989. The incidence was much higher for the period 1980–1989 than suggested in previous reports. These findings provide compelling evidence that this spectrum of neurodegenerative diseases continues to have a significant impact on the health of the Chamorro people of Guam.
Is Sentinel Lymph Node Biopsy of Therapeutic Relevance for Melanoma?
Authors: Möhrle M. , Schippert W. , Rassner G. , Garbe C. , Breuninger H.
Published: July 2004

Introduction: It is still unclear whether sentinel lymph node biopsy (SLNB) has an effect on the survival or recurrence-free survival of patients. It would be necessary to draw comparisons between patients with SLNB (or with selective lymph node dissection in the case of positive SLNB) and patients without SLNB who underwent only close clinical and sonographic follow-up. To date no results from prospective, randomized studies of SLNB are available. Material and Methods: Patients with SLNB (n = 283) and patients in clinical stage I and II with close follow-up examinations only (n = 3,514) were studied retrospectively in this investigation with regard to prognostic factors established in the literature: sex, age, tumor thickness, histological tumor type, ulceration and localization. Results: Multivariate analysis showed an independent significant advantage with regard to survival when SLNB had been performed (p = 0.017). Compared with patients in clinical stage I and II with close follow-up only (n = 2,617), patients in stage I with negative SLNB (n = 238) had a significantly lower melanoma-related mortality (p = 0.0042) and, especially, fewer recurrences in the regional lymph node station area (p = 0.0026). With regard to survival without distant metastases, patients with positive SLNB (n = 33) did not significantly benefit by comparison with patients who developed lymph node metastasis identified clinically or sonographically later during follow-up examinations (n = 246; p = 0.0084). Conclusion: In the relatively short follow-up period after SLNB, patients for whom SLNB had been performed had on the whole a prognostic advantage over patients who were subject only to close follow-up monitoring. Patients for whom subclinical lymph node metastases had been removed as the result of a positive SLNB did not have a better prognosis than patients without SLNB who had developed lymph node metastases within the follow-up period.
In situ Expression of CD40 and CD40 Ligand in Psoriasis
Authors: Ohta Yukinori , Hamada Yuko
Published: July 2004

Background: The interaction between CD40 and CD40 ligand (CD40L) provides a signal that contributes to the initiation of cellular immune responses. However, little information on the in vivo expression of CD40 and CD40L in cutaneous inflammation has been reported. Objective: To investigate the potential role of CD40-mediated signals in the pathogenesis of psoriasis. Materials and Methods: In situ CD40 and CD40L expression was examined immunohistochemically in different stages of psoriatic lesions: fully developed and initial pinpoint. Results: In normal skin, faintly positive immunoreactivity for CD40 was seen in the basal keratinocytes and dermal endothelial cells. These showed almost the same intensity as that seen in psoriatic lesional skin. In the dermal infiltrates of psoriatic lesions, CD40 was intensely expressed and some of these positive cells appeared to be dendritic in shape. Whereas CD40 expression was observed almost in all specimens of psoriatic lesions, the expression of CD40L was predominantly detected in the initial pinpoint lesions of psoriasis. These seemed to be distributed close to CD40-positive cells. Conclusion: These results suggested that CD40L-triggered signals could be involved in the early stage of psoriatic lesion formation.
Successful Desensitization to Fixed Drug Eruption: The Presence of CD25+CD4+ T Cells in the Epidermis of Fixed Drug Eruption Lesions May Be Involved in the Induction of Desensitization
Authors: Teraki Yuichi , Shiohara Tetsuo
Published: July 2004

Background: Fixed drug eruption (FDE) is a distinct type of drug-induced eruption, in which intraepidermal CD8+ T cells in the lesional skin are the final effector cells in the epidermal injury of FDE. Desensitization is a unique approach for the management of drug eruption, which has been reported to be effective in treating FDE. However, the mechanisms underlying desensitization to FDE are quite unknown. Objective and Methods: We reported a case of successful desensitization to allopurinol-induced FDE. To clarify the mechanisms underlying desensitization to FDE, we examined the phenotype of T cells in the epidermis of FDE lesions before and after desensitization using flow cytometry. Results: The overwhelming majority of intraepidermal T cells in the FDE lesion before desensitization consisted of CD8+ T cells, whereas a significant number of CD25+CD4+ T cells were present in the epidermis of FDE lesions after desensitization. Conclusion: The presence of CD25+CD4+ T cells in the epidermis of FDE lesions may be involved in the induction of desensitization to FDE.
Family History and Risk of Hair Loss
Authors: Chumlea W. Cameron , Rhodes Thomas , Girman Cynthia J. , Johnson-Levonas Amy , Lilly Flavius R.W. , Wu Ruishan , Guo Shumei S.
Published: July 2004

Introduction: The genetic basis of androgenetic alopecia (AGA) is well accepted in the medical community and among the general population. However, rigorous studies investigating the familial basis of AGA are lacking. The purpose of the current study was to explore the relationship between family history and expression of AGA in a sample of men from the general community. Methods: Hair loss was assessed by an independent observer trained by an expert dermatologist using the Norwood/Hamilton classification scale and a 7-point global description of hair loss. Men were classified into two groups, one as having little or no hair loss and the other having hair loss. The family history of hair loss in parents and grandparents was assessed by subject self-report. Results: Adjusting for age, men whose fathers had hair loss were 2.5 times as likely to have had some level of hair loss compared to men whose fathers had no hair loss (95% CI: 1.3–4.9). Likewise, men whose fathers had hair loss were twice as likely to have hair loss than men whose fathers had no hair loss even after adjusting for age (OR = 2.1, 95% CI: 1.2–3.7 and OR = 2.5, 95% CI: 1.4–4.7 for Norwood/Hamilton and global description of hair loss assessments, respectively). Conclusion: Results suggest that the probability of male pattern hair loss is dependent on family history and age. Hair loss in a man’s father also appears to play an important role in increasing a man’s risk of hair loss, either in conjunction with a history of hair loss in the mother or hair loss in the maternal grandfather.
Human Papillomavirus and Extragenital in situ Carcinoma
Authors: Quéreux G. , N’Guyen J.M. , Dreno B.
Published: July 2004

Background: The relation between human papillomavirus (HPV) and extragenital Bowen’s disease (BD) is controversial. Methods: This study used in situ hybridisation to evaluate the rate of HPV in extragenital cutaneous BD and investigated possible relations with immune status and exposure of skin to light. Results: HPV DNA was detected in 58% of 69 samples from 50 patients. The percentage of HPV detection was not significantly higher in exposed (55%) than unexposed areas (65%), and no difference in HPV rate was found between immunosuppressed and immunocompetent patients. Conclusion: Thus, this study confirms the high rate of HPV detection in extragenital cutaneous BD and suggests that there is no apparent relation concerning exposed areas and immune status.
Comparison of Intralesionally Injected Zinc Sulfate with Meglumine Antimoniate in the Treatment of Acute Cutaneous Leishmaniasis
Authors: Iraji Fariba , Vali Anahita , Asilian Ali , Shahtalebi Mohamad-Ali , Momeni Ali Z.
Published: July 2004

Background: Cutaneous leishmaniasis is an endemic disease in developing countries. The first-line drugs for its treatment are the pentavalent antimony compounds such as meglumine antimoniate (MA). High cost, side effects, multiple injections and incomplete efficacy are limitations of this therapy. Zinc sulfate (ZS) has been reported to be effective in the treatment of cutaneous leishmaniasis. Objective: To compare the efficacy of intralesional injections of ZS 2% with those of MA in the treatment of cutaneous leishmaniasis. Methods: This was a prospective, double-blind, case-control clinical study. 104 patients with typical lesions of acute cutaneous leishmaniasis (ACL) were included. The duration of treatment was 6 weeks. Improvement was evaluated by clinical examination and direct smear. Results: The study was completed in only 66 patients: 35 patients received MA and 31 received ZS. The cure rates were 60% for MA and 83.8% for ZS. After the second and fourth weeks, the efficacy of treatment with ZS was higher than that with MA (p < 0.01), but after 6 weeks no significant differences were observed between the two groups (p > 0.05). Conclusion: On the basis of this trial and despite the high number of drop-outs, we consider that the intralesional injection of ZS 2% is an alternative treatment in ACL.
Acute Generalized Exanthematic Pustulosis: A Case and an Overview of Side Effects Affecting the Skin Caused by Celecoxib and Other COX-2 Inhibitors Reported So Far
Authors: Goeschke B. , Braathen L.R.
Published: July 2004

A 55-year-old woman who was treated for periarthritis humeroscapularis with celecoxib (Celebrex) developed a generalized pustular exanthema on the head and upper trunk, accompanied by fever, leukocytosis and increased erythrocyte sedimentation rate. The histological findings were subcorneal pustules, necrotic keratinocytes, edema in the upper dermis and polymorphic perivascular infiltrates. Four days after stopping celecoxib, the pustules disappeared without any treatment. Four weeks after disappearance of the skin lesions, celecoxib demonstrated a positive lymphocyte stimulation test. In this article, we present to our knowledge the first case of acute generalized exanthematic pustulosis caused by celecoxib, and we give an overview of the side effects affecting the skin caused by celecoxib and other cyclooxygenase type 2 inhibitors reported so far.
Langerhans Cell Histiocytosis and Juvenile Xanthogranuloma
Authors: Patrizi Annalisa , Neri Iria , Bianchi Federica , Guerrini Valentina , Misciali Cosimo , Paone Giuseppina , Burnelli Roberta
Published: July 2004

Background: Histiocytoses represent a large, puzzling group of diseases which may involve the skin and other organs. At present, juvenile xanthogranuloma is the disorder most often confused with Langerhans cell histiocytosis. A complex overlap exists between juvenile xanthogranuloma and Langerhans cell histiocytosis, with lesions showing clinical and/or pathological features of both disorders. Observations: We report 2 patients affected by Langerhans cell histiocytosis who, during chemotherapy, presented cutaneous lesions with clinical and histological features of juvenile xanthogranuloma. During the therapy, in both cases, histological examination of new biopsies revealed the presence of Touton giant cells in the dermis with a few histiocytic cells; immunohistochemical staining was negative for CD1a, and no Birbeck granules were seen by ultrastructural examination. Results and Conclusion: A possible explanation for the link between Langerhans cell histiocytosis and juvenile xanthogranuloma regards the lineage development and the relationships of histiocytes. We suggest that chemotherapy can modify the production of cytokines by influencing the conversion or ‘maturation’ of pathological cells into macrophages or xanthomatous cells and fusing them to form multinucleated giant Touton cells. In our opinion, the modification of the cutaneous lesions during chemotherapy in Langerhans cell histiocytosis patients, as observed in our cases, could be a favorable prognostic factor.
Ginkgo biloba Compared with Cholinesterase Inhibitors in the Treatment of Dementia: A Review Based on Meta-Analyses by the Cochrane Collaboration
Authors: Kurz A. , van Baelen B.
Published: July 2004

Data were derived from the Cochrane Collaboration meta-analyses of the efficacies of ginkgo, donepezil, rivastigmine and galantamine on changes in cognitive function in patients with dementia and, where necessary, were transformed to standardized mean differences. The proportion of patients discontinuing trials was used as a proxy measure of tolerability. Outcomes were assessed after 6 months of treatment. Trial data for cholinesterase inhibitors were more consistent than those for ginkgo, particularly regarding patient populations and outcome measures. Significant benefits on cognition vs. placebo were seen with donepezil, 5 and 10 mg, rivastigmine, 6–12 mg, and galantamine, 16 and 24 mg. Significant benefit vs. placebo with ginkgo was seen only when all doses were pooled. Similar proportions of patients discontinued treatment with ginkgo and placebo. Cholinesterase inhibitors were also well tolerated, although a significantly greater proportion of patients receiving active treatment discontinued vs. placebo with some doses. An evidence-based medicine approach, taking into account the quality of clinical trials, is essential when assessing the safety and efficacy of medications.
Current Clinical Spectrum of Neurosyphilis in Immunocompetent Patients
Authors: Conde-Sendín Miguel Ángel , Amela-Peris Raul , Aladro-Benito Yolanda , Maroto Alfonso Angel-Moreno
Published: July 2004

Background: Neurosyphilis (NS) is nowadays a less frequent disease. Its incidence and clinical spectrum have changed over time. Objective: To estimate the incidence of NS and describe the clinical spectrum of NS in immunocompetent patients in the last decade. Methods: Demographic and clinical features, cerebrospinal fluid (CSF) changes, neuroimaging findings and outcome were retrospectively analyzed. Results: Forty-three patients met NS criteria. The yearly incidence was 0.2– 2.1 cases per 100,000 inhabitants. The mean age was 48.1 years, males being more frequently involved. The most frequent clinical patterns were meningovascular (30.2%), meningeal (25.6%) and general paresis (25.6%). Compared to prepenicillin series, we observed a decrease in late forms, mainly tabes dorsalis. CSF titers studied by the Venereal Disease Research Laboratory were higher in early NS. Neuroimaging findings were nonspecific. Outcome was better for early forms. Conclusions: Compared to the preantibiotic era, a lower frequency of late NS was observed, similar to that reported in other modern series which include patients with HIV infection. Therefore, this trend seems to be due to the impact of antibiotics rather than to HIV infection.
CoQ10 Plasmatic Levels in Breast-Fed Infants Compared to Formula-Fed Infants
Authors: Compagnoni G. , Giuffrè B. , Lista G. , Mosca F. , Marini A.
Published: July 2004

Background: Coenzyme Q10 has been recognized as an important antioxidant factor besides its main role in bioenergetic metabolism. CoQ10 tissue levels depend both on exogenous dietetic intake and on endogenous biosynthesis, as this compound can be partly synthesized in human cells. Q10 plasma levels reflect the tissue content of the coenzyme and can be used to evaluate the presence of this compound in the human organism. Design/Methods: Aim of the study was to measure CoQ10 plasmatic levels in a newborn breast-fed population and to compare them to CoQ10 levels in a newborn formula-fed population in order to verify whether changes in CoQ10 plasmatic contents could be related to a different dietetic intakes. We measured CoQ10 plasmatic levels in 25 healthy term neonates with different dietetic intakes: 15 breast-fed and 10 bottle-fed with a common infant formula. These infants were evaluated prospectively during the first month of life. The analyses were performed on the mothers’ blood samples and cord blood samples at the time of delivery, then on infants at 4 and 28 days of age. Results: Our results showed markedly reduced Q10 levels in cord blood samples compared to maternal Q10 plasmatic levels at the time of delivery, suggesting placental impermeability towards this molecule or increased fetal utilization during labor and delivery. At 4 days of age Q10 levels had increased in both groups of neonates, but significantly more in breast-fed infants compared to formula-fed babies (p < 0.05). At 4 weeks of age no significant changes occurred in breast-fed infants, while values increased significantly in formula-fed infants (p < 0.05). The content of Q10 in breast milk samples was lower than in infant formula. Conclusions: The results of this study show that CoQ10 plasmatic levels are at least partly influenced by the exogenous dietetic supply.
Relevance of Anger and Irritability in Outpatients with Major Depressive Disorder
Authors: Pasquini M. , Picardi A. , Biondi M. , Gaetano P. , Morosini P.
Published: July 2004

Introduction: Current psychiatric classification systems underestimate the part played by anger and aggressiveness in unipolar depression. This study was designed to assess the relevance of anger, irritability, aggressiveness, hostility, and psychomotor activation in major depressive disorder. Methods: A total of 222 newly admitted consecutive outpatients with major depressive disorder (mean age 48.9 years, 64.4% females) were enrolled in the study. They had no comorbid axis I or II DSM-IV disorder, and they received no treatment with antidepressants in the preceding 2 months. They were assessed with the SVARAD, a validated scale for the rapid assessment of the main psychopathological dimensions. Principal component analysis was performed on SVARAD items. Results: We obtained a three-factor solution accounting for 47.4% of total variance. The factors were interpreted as ‘anger/irritability’, ‘depression’, and ‘anxiety’, respectively. The anger/irritability dimension was clinically relevant in 23% of patients. Anger/aggressiveness was especially frequent (21.6%), whereas psychomotor activation was infrequent (0.9%). Discussion: In depressive disorders, there are psychopathological dimensions other than depressed mood and anxiety that deserve greater clinical recognition and research. Our study suggests that one of these symptom clusters includes anger, irritability, aggressiveness, and hostility. The relevance of this dimension was not related to concurrent pharmacological treatment. Misdiagnosis of bipolar II disorder is also unlikely to explain our findings. Possibly, personality factors might at least partly explain the occurrence of anger and aggressiveness in several depressed patients. Attachment theory suggests that anger might also be conceived as part of the protest-despair-detachment reaction to a loss, either actual or symbolic.
Nonschizophrenic Psychotic Disorders: The Case of Cycloid Psychoses
Authors: van der Heijden F.M.M.A. , Tuinier S. , Kahn R.S. , Verhoeven W.M.A.
Published: July 2004

Background: Cycloid psychosis is a psychiatric disorder known for about 100 years. This disorder is at present partly and simplified represented in the ICD-10. Sampling and Methods: Over a period of 15 months, 139 consecutively acutely admitted psychotic patients were assessed, by means of different diagnostic instruments, in order to investigate the prevalence and the symptom profile of cycloid psychoses. In addition, the concordance between the diagnoses cycloid psychosis, brief psychotic disorder, and acute polymorphic psychotic disorder with or without symptoms of schizophrenia was calculated. Results: Cycloid psychoses were present in 13% of the patients. There was a significant but small overlap with the DSM brief psychotic disorder and the ICD acute polymorphic psychotic disorder. Conclusions: This study demonstrates that cycloid psychoses can be identified with the proper diagnostic instruments in a proportion that is also found in other studies. Since this type of psychosis entails a distinct prognosis and may require a specific treatment, its identification is of clinical importance. Limitations are the nature of the psychiatric facility with an inherent bias in the selection of patients and the lack of a long-term evaluation.
Clinical, Psychopathological and Personality Correlates of Interoceptive Awareness in Anorexia nervosa, Bulimia nervosa and Obesity
Authors: Fassino Secondo , Pierò Andrea , Gramaglia Carla , Abbate-Daga Giovanni
Published: July 2004

Objective: To determine the levels of interoceptive awareness (IA), which measures the ability of an individual to discriminate between sensations and feelings, and between the sensations of hunger and satiety, in eating disorder patients and to identify the clinical, psychopathological and personal variables correlated with IA. Sampling andMethods: Sixty-one restrictor anorectics, 61 binge-purging anorectics, 104 purging bulimics, 49 obese subjects with binge eating disorder (BED) and 47 obese subjects without BED were compared. They were assessed with the Eating Disorder Inventory-2, the Temperament and Character Inventory, and the Beck Depression Inventory, and their clinical and sociodemographic features were recorded. Results: In all patients, the levels of IA were higher than the ‘normal’ ones; in bulimia nervosa, they were higher than in anorexia nervosa and obesity. Similar personal features and eating attitudes are shared by patients with bulimia nervosa and BED. In the total sample, the following variables independently correlate with IA: the Beck Depression Inventory, self- directedness and persistence. Conclusions: The importance of an altered IA in eating disorders is supported. Both depression and a perfectionist and poorly self-directive personality can lead to greater difficulties in discriminating hunger and satiety.
Correlates of Coping Styles in Psychotic Illness
Authors: Modestin J. , Soult J. , Malti T.
Published: July 2004

Background: Both integration and sealing over have been identified as global, clinically distinct coping styles with the psychotic illness and integration was found to be associated with a better outcome. We studied a series of potential correlates of these coping styles. Sampling and Methods: A total of 75 psychiatric patients in a recovery phase after a psychotic episode were studied. All patients filled out the Frankfurt Self-Concept Inventory and the Parental Bonding Instrument; the Integration/Sealing over Scale and the Positive and Negative Syndrome Scale were completed by an investigator for all patients during a semistructured interview. Besides, some sociodemographic and clinical data were collected. Results: A relationship was found between the integrative coping style and absence of negative symptoms, housing with partner or alone indicating more social competence and a diagnosis of psychotic illness other than (paranoid) schizophrenia. Conclusions: As only 25% of the variance were explained, other – still unknown – factors are also of importance.