bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Insulin-Like Growth Factor-I and Insulin-Like Growth Factor-Binding Protein-3 in Localized, Metastasized Prostate Cancer and Benign Prostatic Hyperplasia
Authors: Aksoy Yılmaz , Aksoy Hülya , Bakan Ebubekir , Atmaca Ali Fuat , Akçay Fatih
Published: January 2004

Objective: Insulin-like growth factors (IGF-I and IGF-II) are important mitogenic peptides and are thought to be significant factors involved in normal and malignant cellular proliferation including benign prostatic hyperplasia (BPH) and prostate cancer (PC). In particular, the association between IGF-I and PC has received much attention. Insulin-like growth factor binding protein-3 (IGFBP-3) is the major carrier protein in serum for the IGF-I, thus is an important functional modulator of it. On the other hand, one of the functions of prostate-specific antigen (PSA) is to cleave IGFBP-3. Epidemiological studies have shown that decreased levels of serum IGFBP-3 are associated with increased PC risk. Controversial results have also been reported on the value of serum IGF-I and/or IGFBP-3 in the detection of PC, especially of metastatic PC; as increased, decreased or unchanged when compared to BPH. The aim of the present study was to investigate whether serum IGF-I and IGFBP-3 levels change in localized and metastasized PC cases compared with BPH as the control cases. Method: The study included 45 BPH, 24 localized PC and 19 metastasized PC cases. Serum IGF-I and IGFBP-3 levels were measured by two-site immunoradiometric assay kits, and serum total and free PSA levels were assayed by chemiluminescence method. Results: Serum IGF-I levels in both localized and metastasized PC cases were similar to BPH cases (138.3 ± 58.2, 137.7 ± 39.0 and 147.7 ± 44.2 ng/ml, respectively), whereas serum IGFBP-3 levels were lower in metastasized PC group than in BPH group (1,795.6 ± 305.6 and 2,196.0 ± 505.7 ng/ml; p = 0.005). In localized PC, serum IGFBP-3 levels (1,911.00 ± 349.58 ng/ml) were similar to metastasized PC. There were significant correlations between serum IGFBP-3 and serum free PSA in three groups (r = –0.46, p = 0.02 for localized PC; r = –0.56, p = 0.01 for metastasized PC, and r = –0.31, p = 0.03 for BPH). Conclusion: These data reveal that serum IGF-I levels may not change either in localized or metastasized PC, and that decreased serum IGFBP-3 levels may be attributed to its proteolysis by PSA which is increased in PC.
Retroperitoneal Laparoscopic Radical Nephrectomy: Experience of 23 Cases
Authors: Yoshimura Koji , Ichioka Kentaro , Terada Naoki , Matsui Yoshiyuki , Terai Akito , Arai Yoichi
Published: January 2004

Introduction: Retroperitoneal laparoscopic radical nephrectomy has recently been performed in several institutions for renal cancer. We report our experience with this type of operation and discuss the anatomy of perirenal fascial structures. Patients and Methods: From July 2000 to May 2002, we performed retroperitoneal laparoscopic radical nephrectomy in 23 patients. We began this operation with longitudinal cutting of two layers of the posterior renal fasciae, and removed specimens without any fascial structure. Results: Mean operative time was 203 min (range 129–314 min) with an average estimated blood loss of 113 ml (range 0–837 ml). There was 1 patient who required open conversion due to uncontrollable hemorrhage, but no complication was observed. Conclusions: Retroperitoneal laparoscopic radical nephrectomy is a safe and reliable method when the anatomy of the perirenal fasciae is clearly understood. Long-term follow-up of patients undergoing this procedure is warranted to its effect on the prognosis of renal cancer.
A New Testis Prosthesis Material: Polymethylmethacrylate
Authors: Karademir Kenan , Senkul Temucin , Demir Suat , Erden Dogan , Iseri Cuneyd , Baykal Kadir
Published: January 2004

Introduction: Silicone has been the standard prosthesis material for the last three decades but new materials are being searched because of the known disadvantages of silicone such as migration and high cost. We wanted to test in rats whether or not polymethylmethacrylate could be an alternative to silicone. Materials and Medhods: We prepared polymethylmethacrylate and silicone testis prostheses which were similar to testis size of rats. Eleven rats were implanted with polymethylmethacrylate, 11 others were implanted with a silicone prosthesis and sham operation was performed in 10 rats. Three months later the scrotums of the animals were removed with the prosthesis for a quantitative analysis of the chronic inflammation and fibrotic reaction and to measure the thickness of the capsule. Result: Rejection and infection were not observed in any of the prosthesis-implanted rats. Both prosthesis groups displayed increased vascularization, hemosiderin accumulation and fibrotic and hyalinized tissue formation that replaced the muscle. Chronic inflammation was measured and found to be higher in the polymethylmethacrylate group and the difference was not found to be significant. The average thicknesses of the capsules around the polymethylmethacrylate and silicone groups were found to be 58.4 and 46.8 µm, respectively, and that difference was not significant again. Conclusions: In the short term polymethylmethacrylate was equally well tolerated, but the low cost of polymethylmethacrylate made it more advantageous.
Role of Inflammation in Stroke and Atherothrombosis
Authors: Chamorro Ángel
Published: January 2004

The onset of cerebral ischaemia triggers a cascade of proinflammatory molecular and cellular events. Clinical studies suggest that the strength of this acute response is important in early and late clinical outcomes, early clinical worsening, and extent of brain damage. Variables that are predictors of adverse stroke outcome include erythrocyte sedimentation rate, and levels of C-reactive protein (CRP), interleukin-6, tumour necrosis factor-α and intercellular adhesion molecule-1. Current data indicate that inflammation serves to fuel atherosclerosis and can act as the link between atherosclerosis and atherothrombosis. Growing evidence indicates that platelets act as prominent players in the inflammatory component of these disease processes. Thus, upon activation, platelets release a series of cytokines and growth factors and express CD40 ligand, which interacts with the CD40 receptor on other major cell types involved in atherosclerosis/atherothrombosis. In healthy volunteers, CD40L expression in platelets is not significantly inhibited by acetylsalicylic acid (ASA) alone, but is inhibited after treatment with the ADP-receptor antagonist clopidogrel or with clopidogrel plus ASA. Of a range of potential inflammatory biomarkers that have been reported in the literature, the best studied is CRP. Such biomarkers may have clinical utility for refined identification of patients at high risk for atherothrombosis in different arterial beds and for monitoring of therapeutic agents in clinical trials.
The Unstable Plaque
Authors: Hennerici Michael G.
Published: January 2004

Ischaemic strokes and transient ischaemic attacks are commonly caused by cerebral embolism originating from formation of a platelet-rich thrombus superimposed on an atherosclerotic plaque or by atherothrombotic plaque rupture in a carotid or intracranial artery. Despite advances made through ultrasound imaging in our understanding of atherosclerotic plaque progression and regression, the issue of whether differences in plaque structure alone can distinguish between lesions that become symptomatic and others that remain clinically silent continues to be debated. Recent biochemical and imaging studies have identified characteristics that may reflect a high risk of vulnerability, such as outward, abluminal plaque remodelling, the presence of intra-plaque haemorrhage, inflammation, severe flow disturbances around the encroaching lesion, plaque cap thinning and ulceration, and abnormal plaque motion. Plaque stability may be improved through management of traditional cardiovascular risk factors or with biological or pharmacological agents that target pathways involved in plaque pathophysiology. Unstable plaques place patients at risk of unpredictable ischaemic events and in patients with such lesions, specific preventive treatment beyond long-term antiplatelet therapy can be used to prevent new or recurrent events.
Imaging Viable Brain Tissue with CT Scan during Acute Stroke
Authors: Meuli Reto A.
Published: January 2004

Viability of the cerebral parenchyma is dependent on cerebral blood flow (CBF). The assessment of cerebral perfusion in patients with acute stroke, in a clinically relevant time frame, could be of utmost importance for patient selection before thrombolytic therapy. In individual patients, quantitative mapping of CBF to indicate the severity and potential reversibility of neuronal damage can be used to predict which brain tissue will be salvaged with reperfusion or die without it (penumbra), as well as which brain tissue is already infarcted. Recent investigations of perfusion CT have shown major advances in the assessment of acute stroke patients. Perfusion CT offers a number of practical advantages over other cerebral perfusion imaging methods as it can be performed immediately after unenhanced CT, and used, in general, to exclude cerebral haemorrhage. It is fast (typical procedure time <5 min) and does not require specialized computer hardware. The accuracy of cerebral perfusion maps has been demonstrated for normal and decreased CBF value by comparison with xenon CT used as a gold standard. Perfusion CT infarct and penumbra maps provide a potential recuperation ratio (PRR) (or Lausanne Stroke Index), defined as PRR = penumbra/ (penumbra + infarct). This index is correlated with the improvement of the National Institutes of Health Stroke Scale (NIHSS) in case of arterial recanalization. Also, the size of the ischaemic area (infarct + penumbra) is correlated with the NIHSS score on hospital admission. Further studies may demonstrate the use of perfusion CT for the assessment of penumbra dynamics in function-specific brain areas. Perfusion CT is now ready to be used in clinical trials as a decision-making tool to tailor more precisely the thrombolytic therapy to the individual patient.
Towards a New Mapping of Brain Cortex Function
Authors: Ward Nick S. , Frackowiak Richard S.J.
Published: January 2004

The aim of imaging neuroscience is to describe the functional organization of human brain at the level of large neuronal groupings, networks and systems. The systems level of description addresses how integrated brain functions are embodied in the physical structure of the brain. Magnetic resonance imaging is currently the technique of choice for the study of cerebral structure–function relationships and the analysis of structural and functional brain images can now be carried out automatically using statistical parametric mapping. The resultant ability to perform clinical–functional–anatomical correlative studies with complete objectivity and unparalleled sensitivity is providing powerful new opportunities for studying the relationship between structure and function, and how these parameters interact with pathology. One of the most exciting and dramatic observations to come from human brain mapping has been the dynamic plasticity of function in both normal brains and the brains of patients with neurological and neuropsychiatric disorders. Recent activation studies have provided interesting information about the brain’s capacity to reorganize after injury and in association with practice and learning. The emerging studies of brain plasticity and its modulation by drugs and other therapies indicate potentially useful approaches to the rehabilitation of adults with brain damage, including damage resulting from cerebral ischaemia. Brain maps must therefore be viewed as dynamic, changing with development, disease progression, normal learning and in parallel with the recovery of function after acute injury. The dynamic plasticity of functional brain maps provides an exciting opportunity to study these processes.
Altered Habituation in the Auditory Cortex in a Subgroup of Depressed Patients by Functional Magnetic Resonance Imaging
Authors: Michael Nikolaus , Ostermann Jens , Sörös Peter , Schwindt Wolfram , Pfleiderer Bettina
Published: January 2004

The aim of this study was to measure and quantify habituation effects to auditory stimulation within the auditory cortex of 11 depressed patients with major depressive disorder compared to 11 healthy subjects. Habituation was visualized by functional magnetic resonance imaging (fMRI) employing a block design (repeated stimulation with sine tones). A subgroup of patients (n = 5) presented the following abnormal habituation fMRI pattern: significantly lower activation after the first stimulation block (p = 0.05), missing characteristic signal decay to repeated acoustic stimulation and a marked undershoot after each stimulation block. This abnormal pattern may indicate functional deficits in auditory processing occurring with depression, but our results need be confirmed in a larger, more homogeneous patient group. This paradigm may be a useful tool for assessing cortical dysfunction in mood disorders.
Association Analysis of Brain-Derived Neurotrophic Factor Val66Met Polymorphisms with Alzheimer’s Disease and Age of Onset
Authors: Tsai Shih-Jen , Hong Chen-Jee , Liu Hsiu-Chih , Liu Tsung-Yun , Hsu Li-En , Lin Ching-Hua
Published: January 2004

Because of a decrease in central brain-derived neurotrophic factor (BDNF) levels in Alzheimer’s disease (AD) and the important role of BDNF in neuronal survival, BDNF may represent a candidate gene conferring susceptibility to AD. Recently, a functional BDNF Val66Met polymorphism has been associated with AD in an Italian population. In the present study, we investigated a possible role of this BDNF polymorphism in the susceptibility of AD or AD onset in a Chinese population. Comparing AD patients and controls, the distribution of the BDNF genotypes and alleles did not differ significantly. The onset age was not significantly different comparing the three BDNF genotype groups. Our negative findings suggest that it is unlikely that the BDNF Val66Met polymorphism plays a major role in the pathogenesis of AD in the Chinese population and do not support previous findings that homozygosity for the 66Val allele confers an increased risk for AD. Further studies with genetic variations in BDNF relating either to AD-associated depression or to the AD treatment response are suggested.
Association Study of a Brain-Derived Neurotrophic Factor (BDNF) Val66Met Polymorphism and Personality Trait and Intelligence in Healthy Young Females
Authors: Tsai Shih-Jen , Hong Chen-Jee , Yu Younger W.-Y. , Chen Tai-Jui
Published: January 2004

Brain-derived neurotrophic factor (BDNF), a member of the nerve-growth-factor family, plays an important role in neuronal survival and development, and it can modulate serotonergic activity. Further, BDNF has been implicated in the expression of personality traits and in cognitive function. We tested the associations between functional BDNF Val66Met genetic variants, and personality trait and intelligence in a cohort of 114 healthy young Chinese females. Subjects with the Val/Val genotype had a significantly higher mean performance IQ than Val/Met carriers, especially for the Object Assembly subtest. No significant association was demonstrated for the BDNF polymorphism and any of the Tridimensional Personality Questionnaire personality-factor scores, including harm avoidance. These results suggest that genetic variants of the BDNF gene may play a role in specific cognitive functions, but not in overall intelligence. In contrast to a recent report, however, this polymorphism does not appear to be associated with the neuroticism-related personality trait.
Psychobiological Aspects of Somatoform Disorders: Contributions of Monoaminergic Transmitter Systems
Authors: Rief Winfried , Pilger Florian , Ihle Daniel , Verkerk Robert , Scharpe Simon , Maes Michael
Published: January 2004

Objective: To evaluate the possible biological aspects of ‘unexplained physical symptoms’, this study examined serotonergic and noradrenergic monoamino acids in somatoform disorders and/or depression. Methods: Blood samples of 150 subjects from 4 groups (somatization syndrome; depression; depression and somatization; controls) were analyzed for amino acids contributing to the serotonergic and noradrenergic system and peripheral muscle energy balance (tryptophan, valine, leucine, isoleucine, phenylalanine and tyrosine). Results: Tryptophan, branched chain amino acids and other serotonergic amino acids were decreased in patients with somatoform symptoms, even when no depression was present. Conclusions: We conclude that serotonergic amino acids are biological correlates of multiple unexplained symptoms. Ways of action do not only involve brain mechanisms, but also energy metabolism in peripheral muscles.
Recanalization of Cervical Artery Dissection: Influencing Factors and Role in Neurological Outcome
Authors: Caso Valeria , Paciaroni Maurizio , Corea Francesco , Hamam Mohammed , Milia Paolo , Pelliccioli Gian Piero , Parnetti Lucilla , Gallai Virgilio
Published: January 2004

Background and Purpose: Generally, the prognosis for cervical artery dissection (CAD) is uncertain. The recanalization rate of CAD can be up to 85% within 3 months. This study evaluates the variables that might affect recanalization and the role of recanalization as a predictor for neurological outcome. Patients and Results: This study prospectively included 38 patients with acute stroke following occlusion due to CAD (18 males, 20 females, median age 50.5 years, range 16–82). Vertebral and carotid dissections were equally distributed (19 carotid dissections). The recanalization rate was influenced by the presence of hypertension (p = 0.001). Outcomes were dependent on infarct location. Patients with lateral medullary infarction returned to functional independence (p = 0.026), while patients with deep hemispheric infarction tended to have a disabling stroke (p = 0.068). The presence of good collaterals seemed to influence functional independence (p = 0.03). Conclusion: There seemed to be no relationship between outcome and the rate of recanalization following CAD. Recanalization appeared to be a spontaneous mechanism, which could have depended on the intrinsic condition of the vessels. Finally, neurological outcome was dependent on lesion localization and the presence of good collaterals.
Incidence, Etiology, and Outcome of Stroke in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Toyoda Kazunori , Fujii Kenichiro , Ando Takashi , Kumai Yasuhiro , Ibayashi Setsuro , Iida Mitsuo
Published: January 2004

Background: Little information exists on clinical features of stroke in patients receiving continuous ambulatory peritoneal dialysis (CAPD). The goals of this study was to clarify features of stroke in CAPD patients, to determine factors to predict onset of stroke during chronic CAPD, and to determine whether CAPD had an advantage over hemodialysis (HD) for prevention of stroke. Methods: We determined features of stroke in 12 patients (14 attacks including 7 parenchymal and 1 subarachnoid hemorrhage and 6 infarction) among 188 consecutive patients on CAPD, and compared them with those of 137 stroke patients among 1,681 consecutive patients on hemodialysis. Results: Incidence of stroke for CAPD patients (15.7 per 1,000 person-years) was high compared with that of HD patients (approximately 12) or general residents in our suburban town. Patients with stroke on CAPD were younger than those on HD (52 ± 12 vs. 62 ± 11 years, p = 0.008). Mean arterial pressure (MAP) of patients with stroke increased after the introduction of CAPD (p = 0.01), whereas that of patients without stroke did not change. Increase in MAP during chronic CAPD was related independently to the occurrence of total stroke or brain hemorrhage. The majority of CAPD patients with stroke (67%) were dead or dependent in the chronic stage of stroke. Conclusion: CAPD patients seem to have a greater risk of stroke than the general population primarily because of poor control of hypertension, presumably in part due to overhydration. CAPD does not seem to have an advantage over HD for the prevention of stroke.
High Intensity Transient Signals in Patients with Carotid Stenosis May Persist after Carotid Endarterectomy
Authors: Kimura Kazumi , Stork Jacinda L. , Levi Christopher R. , Abbott Anne L. , Donnan Geoffrey A. , Chambers Brian R.
Published: January 2004

Background: This study was undertaken to elucidate the natural history of high intensity transient signals (HITS) after carotid endarterectomy (CEA) and to determine whether this differs between patients with and without HITS detected preoperatively. Methods: A 30-min transcranial Doppler (TCD) recording was performed to detect HITS in 141 patients at 0–1 h, 2–3 h, 4–6 h and 24–36 h following CEA. 104 of these patients also had 30-min TCD monitoring within 48 h prior to CEA. Results: In the preoperative HITS-negative group, the proportion with postoperative HITS fell from 53% at 0–1 h to 17% at 24–36 h. In the preoperative HITS-positive group, the proportion with postoperative HITS remained steady (43% at 0–1 h, 52% at 24–36 h). During the 24–36 h postoperative epoch, 11 of 21 (52%) of the preoperative HITS-positive group had at least one HITS compared to 11 of 66 (17%) of the preoperative HITS-negative group (p = 0.001). In a multiple logistic regression analysis, preoperative HITS was the only factor associated with persistent postoperative HITS. Conclusion: The proportion of cases with postoperative HITS diminished in the 24–36 h after CEA except for preoperative HITS-positive patients. About half of our patients undergoing CEA with preoperative HITS might have another embolic source.
L-Arginine-Mediated Vasoreactivity in Patients with a Risk of Stroke
Authors: Zimmermann Carolin , Wimmer Martin , Haberl Roman L.
Published: January 2004

Objectives:L-arginine is the substrate for nitric oxide (NO) production and has been shown to induce an endothelium-dependent increase in cerebral blood flow in humans. We studied the hypothesis that L-arginine-mediated vasoreactivity is impaired in patients with cardiovascular risk factors and a risk of stroke. Methods: 55 patients with cardiovascular risk factors (mean age 63.0 ± 8.5 years) were included in the study. 45 of them had a history of previous minor stroke or transient ischemic attack (TIA) while 10 patients had cardiovascular risk factors but no previous cerebral ischemic event. Endothelium-dependent changes in cerebral blood flow during the infusion of 30 g L-arginine were assessed by continuous transcranial Doppler sonography of both middle cerebral arteries, intima-media thickness (IMT) of the common carotid artery, by Duplex sonography. Associations between risk factors, IMT, L-arginine reactivity and previous cerebrovascular events were analyzed by stepwise multiple linear regression analysis and patient groups were compared. Results: Normal young volunteers showed an L-arginine-mediated increase in mean flow velocity of 22 ± 8%; L-arginine reactivity of the 55 patients was 28 ± 10%. Patients with a history of stroke or TIA had significantly higher flow velocity responses to L-arginine (29 ± 10%) than patients with cardiovascular risk factors but no previous cerebrovascular event (21 ± 8%, p < 0.05). Stepwise multiple linear regression analysis showed a significant association of enhanced L-arginine reactivity with previous stroke/TIA (p < 0.001) and elevated fibrinogen levels (p < 0.05) but not with age, IMT, hypertension, cholesterol or other risk factors. The same regression model showed an association between IMT and previous stroke/TIA (p < 0.001) and serum cholesterol levels (p < 0.05) but not L-arginine reactivity. Conclusions: L-arginine reactivity of the cerebral vessels may be assessed by Doppler sonography and was enhanced in patients with a history of stroke or TIA. It was independent of IMT of the carotid arteries. We conclude that enhanced L-arginine reactivity is a potential marker for cerebral endothelial dysfunction and an independent indicator for an increased risk of stroke.
Hyperhomocysteinemia and Other Newly Recognized Inherited Coagulation Disorders (Factor V Leiden and Prothrombin Gene Mutation) in Patients with Idiopathic Cerebral Vein Thrombosis
Authors: Ventura Paolo , Cobelli Milena , Marietta Marco , Panini Rossana , Rosa Maria Cristina , Salvioli Gianfranco
Published: January 2004

Background: Idiopathic cerebral vein thrombosis (iCVT) represents approximately 30% of the cases of cerebral vein thrombosis (CVT). New, inherited – factor V Leiden (FVL) and prothrombin gene mutation (PTHRA20210) – and inherited/acquired – hyperhomocysteinemia (HHcy) – prothrombotic conditions have been detected recently. Methods: We assessed fasting plasma homocysteine (Hcy) levels and main Hcy determinants, FVL and PTHRA20210 in 30 patients with documented iCVT and 40 age- and sex-matched healthy subjects. Results: A strong and significant association of PTHRA20210 [30% (9/30) vs. 2.5% (1/40) iCVT vs. controls, respectively, p = 0.001; OR = 16.174, p = 0.002] and HHcy [13/30 (43.3%) vs. 4/40 (10%) iCVT vs. controls, respectively; p = 0.002, OR = 6.88, p = 0.002] with iCVT was found. Conclusions: PTHRA20210 and HHcy should be considered when screening for thrombophilia and should be assessed in patients with a family or personal history of CVT.
Angioplasty and Stenting for High-Grade Internal Carotid Artery Stenosis: Safety Study in 39 Selected Patients
Authors: Debette S. , Hénon H. , Gauvrit J.Y. , Haulon S. , Mackowiak-Cordoliani M.A. , Gautier C. , Deplanque D. , Lucas C. , Leclerc X. , Koussa M. , Pruvo J.P. , Leys D.
Published: January 2004

Background: Carotid angioplasty and stenting (CAS) is sometimes used as an alternative to surgery, despite the lack of evidence for its safety and efficacy. Method: Over a 33-month period, 39 consecutive patients with a stenosis ≧70% underwent CAS (4 in a randomized trial and 35 because of contra-indications for surgery). Results: In 5 patients (13%; 95% CI: 3–23), a major complication occurred (3 disabling ischaemic strokes, 1 myocardial infarction, 1 acute interstitial nephropathy). In 7 patients (18%; 95% CI: 6–30), a minor complication occurred (5 transient ischaemic attacks, 1 transient confusional state, 1 non-disabling ischaemic stroke). Conclusion: CAS cannot be considered as a routine procedure and should be restricted to high-risk patients unfit for surgery.
Cellular Lipid Metabolism and the Role of Lipids in Progressive Renal Disease
Authors: Abrass Christine K.
Published: January 2004

Dyslipidemia contributes to the rate of progression of atherosclerosis and chronic kidney disease. Also, chronic kidney disease leads to the development of secondary abnormalities in lipid metabolism that contribute to increased cardiovascular morbidity and mortality. This review presents the mechanisms that underlie this risk. The mechanisms of normal cellular lipid metabolism and the abnormalities that develop in association with inflammation are reviewed. There is a special emphasis on foam cells in the kidney and on lipid-mediated changes in intrinsic kidney cells that lead to glomerulosclerosis and interstitial fibrosis. Correlates to studies performed in whole animals and humans are included.
Does Ursodeoxycholic Acid Change the Proliferation of the Colorectal Mucosa?
Authors: Ochsenkühn Thomas , Marsteller Igor , Hay Ulrich , Diebold Joachim , Paumgartner Gustav , Göke Burkhard , Sackmann Michael
Published: January 2004

Background: In animal models ursodeoxycholic acid (UDCA) showed a chemoprotective effect against colon cancer. To explain this, a reduced proliferation of the colorectal mucosal proliferation was suggested. We, therefore, examined the influence of UDCA on the proliferation of normal colorectal mucosa in humans. Methods: Following endoscopic polypectomy, 20 patients with colorectal adenomas were randomized to receive either UDCA (750 mg/day, n = 10, group A) or placebo (n = 10, group B) for 6 months in a double-blinded way. Colorectal biopsies were sampled before and at the end of the medication by total colonoscopy. Colorectal mucosal proliferation was measured by FACScan analysis of propidium iodine labeling. Serum was sampled, and serum bile acids were analyzed by gas chromatography. Results: The proliferation rates at the end of the study were similar in both groups (median 15.4%; range 12.0–20.9 in group A; median 16.0%, 14.0–20.2 in group B, p = 0.41). Serum lithocholic acid levels at the end of the study were significantly higher in group A (1.3 µmol/l, 0.9–1.8) than in group B (0.7 µmol/l, 0–1.7, p < 0.02), whereas serum deoxycholic acid levels were similar in both groups. Conclusions: In this study, UDCA treatment for 6 months does not seem to induce changes in the proliferative behavior of the colorectal mucosa in patients with adenomas. It seems likely that a putative chemopreventive effect of UDCA in humans is not exerted by a reduction of the colorectal proliferation.
Relationship of Lumen Diameter to Type and Degree of Arterial Remodeling at Sites of Expanding Wall or Plaque Thickness in Human Carotid Artery
Authors: Boyajian Robert A. , Otis Shirley M.
Published: January 2004

Background: Arterial remodeling exhibits a bidirectional capacity. Whether lumen size affects remodeling response to lesion change is unknown. Methods: Prospective study by duplex ultrasonography over 2 years in 61 subjects with coronary artery disease. Direction and magnitude of vessel remodeling are calculated for internal carotid, bifurcation, and common carotid artery segments. Results: A linear trend is discernible between lumen diameter and direction and magnitude of remodeling at sites of expanding intima-media thickness (IMT) or plaque. Rate of lesion change varied inversely with lesion thickness with an inflection between rates for low-dimension IMT and plaque. Conclusions: Dilatation versus shrinkage in the remodeling response to expanding lesions appears related to lumen size. IMT and plaque exhibit independent biologies.
Misoprostol for Cervical Ripening and Labor Induction in Pregnancies with Oligohydramnios
Authors: Dede F. Suat , Haberal Ali , Dede Hulya , Sivaslioglu Akin , Arslanpence Ilhan
Published: January 2004

The efficacy and safety of misoprostol for cervical ripening and labor induction in patients with oligohydramnios was investigated. 57 pregnancies with oligohydramnios and 58 cases with a normal amniotic fluid volume (controls) were enrolled in this prospective trial. All patients received 50 µg of intravaginal misoprostol every 5 h. Primary outcomes were: cesarean section rate; induction to delivery time; oxytocin augmentation; uterine hyperstimulation; meconium passage; fetal heart rate (FHR) changes; fetal distress requiring delivery, and Apgar scores. There were no differences in the mean time to delivery, cesarean section rate, oxytocin augmentation or Apgar scores. The mean induction to delivery time in oligohydramnios and control groups were, 11 h 43 min and 11 h 18 min, respectively (p > 0.05). FHR changes were observed in 26.3% of oligohydramnios group and 32.7% of control group (p > 0.05). There was no statistically significant difference in the cesarean section rate and the uterine hyperstimulation between the 2 groups. These data suggest that misoprostol can be used as an effective agent for cervical ripening and labor induction in pregnancies with oligohydramnios without increasing the risk for perinatal outcome, compared to those with normal amniotic fluid volumes.
Long-Term Renal Function after HELLP Syndrome
Authors: Jacquemyn Yves , Jochems Lisbeth , Duiker Evelien , Bosmans Jean-Louis , van Hoof Viviane , van Campenhout Christel
Published: January 2004

This study was set up to determine the long-term (5 or more years) renal function after HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome during pregnancy and to answer the question whether long-term renal follow-up is necessary. Women with HELLP syndrome were compared with healthy control subjects who delivered their first child during the same period. There was no difference between groups for body mass index, serum and urinary creatinine levels, creatinine clearance, total urinary protein/creatinine ratio, and urinary microalbumin/creatinine ratio. Women who previously had HELLP syndrome had significantly higher diastolic and systolic blood pressures. Women with HELLP syndrome do not need continued renal follow-up, but have higher systolic and diastolic blood pressures, even 5 years after HELLP syndrome.
Endoscopic Management of Common Bile Duct Stones Leaving the Gallbladder in situ
Authors: Schreurs W.H. , Vles W.J. , Stuifbergen W.H.N.M. , Oostvogel H.J.M.
Published: January 2004

Background: Obstructive jaundice caused by stones is a common disorder, mostly managed by endoscopic sphincterotomy followed by cholecystectomy. The aim of this study was to evaluate whether or not clearance of the common bile duct alone is sufficient as treatment for patients with choledocholithiasis. Methods: A cohort with 447 patients with symptomatic cholecystocholedocholithiasis, undergoing endoscopic retrograde cholangiography (ERC) and if necessary sphincterotomy (ES). In 164 patients common bile duct stones were proven and treated endoscopically, without performing a subsequent cholecystectomy. All 164 patients were free of symptoms after the endoscopic intervention. This group of patients was compared with 78 patients who underwent cholecystectomy after endoscopic treatment of common bile duct stones. Patients were followed for 1–13 years after ERC and sphincterotomy results and complications were registered. Results: The ages of the 164 patients in the in situ group were significantly higher than in the cholecystectomy group and the ASA classification (American Society of Anesthesiologists) was significantly higher in the in situ patients. Mean follow-up was 70.9 months. Of the in situ patients 27 (16%) returned with biliary symptoms; 12 with common bile duct stones, three with cholangitis, and one with stenosis of Vater’s papilla. Eight patients returned with cholecystitis and 3 with symptomatic cholecystolithiasis. Thirteen patients underwent cholecystectomy and 11 were managed (also) endoscopically. Minor complications were 2 wound infections and 1 bleeding after cholecystectomy. Two patients (1%) died of abdominal sepsis due to cholecystitis. Of the patients who underwent cholecystectomy, 6 (7.6%) returned during follow-up. Three patients had common bile duct stones, 2 had cholangitis and 1 patient presented with papillostenosis. Three patients needed surgical common bile duct exploration and the other 3 were treated endoscopically. After reintervention, cardiopulmonary complications were observed in 1 patient. There was no related death. Conclusion: When common bile duct stones are treated successfully by endoscopic sphincterotomy and patients are free of symptoms, there is no need for routine prophylactic cholecystectomy.
Effects of Eplerenone on Heart and Kidney in Two-Kidney, One-Clip Rats
Authors: Hao Lirong , Kanno Yoshihiko , Fukushima Rie , Watanabe Yusuke , Ishida Yuji , Suzuki Hiromichi
Published: January 2004

Background: The role of aldosterone has been less investigated compared to the renin-angiotensin-aldosterone system in renovascular hypertension. The purpose of the present study was to compare the effects of a selective aldosterone receptor blocker, eplerenone (EP), and an angiotensin II receptor type 1 antagonist (AT1RA), losartan (LO) on cardiac and renal damage produced by two-kidney, one-clip (2K-1C) renovascular hypertension in rats. Method: Wistar rats (n = 48) were placed on one of six groups. Group 1 received sham operation. From group 2 to 6, all rats were made as 2K-1C renovascular hypertension. Group 2 received vehicle. Group 3 orally received 100 mg/kg/day of EP from the initiation of the study. Group 4 received 100 mg/kg/day of LO, from the initiation of the study. Groups 5 and 6 received EP and LO from the 4th week after the clipping respectively. Systolic blood pressure (SBP) and urinary protein excretion (UPE) were measured before and every 2 weeks. The remnant kidney was obtained for histopathological analysis and for measurement of endothelial cell nitric oxide synthase (ecNOS) gene expression (GE). Results: SBP increased in the placebo group (132.1 ± 2.4 vs. 115.0 ± 0.6 mm Hg in sham group at week 10, p = 0.019). Treatment with LO or EP from the beginning of the study decreased SBP significantly as measured in the sham group at week 10. The placebo group developed significant UPE (21.7 ± 1.9 mg/day) compared with the sham group (13.4 ± 0.8 mg/day, p < 0.05). Treatment with both LO (12.5 ± 1.5 mg/day, p < 0.01 vs. placebo) and EP (14.8 ± 1.0 mg/ day, p < 0.05 vs. placebo) significantly decreased UPE. On the other hand, the late start of treatment with EP failed to decrease the increased UPE. UPEs were not significantly different between the LO- and EP-treated groups throughout the study. There was no significant pathological change in heart and kidney in all groups. In heart, ecNOS GE was significantly increased in the EP-treated (from the beginning of the study) rats compared with placebo group (0.47 ± 0.01 vs. 0.43 ± 0.01, p < 0.05). LO did not have an effect on ecNOS GE in heart. In aorta, ecNOS GE was significantly increased in the two EP-treated groups compared with the placebo group (0.22 ± 0.01, 0.22 ± 0.02 vs. 0.15 ± 0.01, p < 0.05, respectively). LO also did not have an effect on ecNOS GE in aorta. In kidney, ecNOS GE was significantly increased in the LO group (from the beginning of the study) and two EP-treated groups compared with placebo. Conclusion: This study demonstrated that EP treatment significantly reduced SBP and UPE compared with placebo in both development and established 2K-1C renovascular hypertension. EP was as effective as LO in lowering the blood pressure of this renin-dependent animal model.
Treatment of Climacteric Symptoms with Herbal Formulas of Traditional Chinese Medicine
Authors: Pan Bochen , Kato Yasuhito , Sengoku Kazuo , Takuma Naoyuki , Niizeki Noriyasu , Ishikawa Mutsuo
Published: January 2004

Hormone replacement therapy (HRT) is not successful or is contraindicated for the treatment of climacteric symptoms in some patients. To investigate whether certain herbal formulas of traditional Chinese medicine (Kampo in Japanese) could be used as an alternative treatment, a longitudinal ‘before and after’ comparative study was carried out in 18 Japanese women, and the results were compared with those of 16 women who underwent HRT. Kampo improved all the climacteric symptoms. In contrast, improvement of cold limbs, sleeping disorders, shoulder stiffness/lumbago, and fatigue in the HRT group was either not significant or of limited extent. In addition, the serum level of estradiol in postmenopausal women was raised by the combined use of two Kampo formulas. These results suggest that Kampo may be considered an alternative to HRT for the treatment of climacteric symptoms, but vigorous monitoring for potential side effects of increased estrogen levels in some postmenopausal patients is needed.
Tibial Speed of Sound in Term and Preterm Infants
Authors: Yiallourides M. , Savoia M. , May J. , Emmerson A.J. , Mughal M.Z.
Published: January 2004

The tibial speed of sound (SOS) was measured in 91 healthy singleton infants between 31 and 42 weeks of gestation and 12 sick preterm infants. In healthy infants, the tibial SOS was associated with corrected gestational age (r = 0.40, p < 0.001) but not birth weight. The median tibial SOS in 12 sick preterm infants (2,772, range 2,566–2,934 m/s), whose corrected gestational age was between 31 and 42 weeks, was lower (p < 0.001) than that of 69 healthy gestation-matched healthy infants (3,100, range 2,870–3,381 m/s). Tibial SOS measurements may allow radiation-free assessment of metabolic bone disease of prematurity.
Tension-Free Vaginal Tape Efficacy in Relation to Collagen Quantity of Pubocervical Fascia
Authors: Bakas P. , Liapis A. , Salamalekis E. , Pafiti A. , Creatsas G.
Published: January 2004

Objective(s): To investigate whether the quantity of collagen types I and III in the pubocervical fascia of women with genuine stress incontinence (GSI) affects the efficacy of the tension-free vaginal tape (TVT) procedure. Methods: Sixty-three patients participated in the study and were divided in 2 groups as follows: 37 patients with GSI and pelvic organ prolapse stage I (group 1), and 26 patients with pelvic organ prolapse stage I but not GSI (control group). Urodynamic studies confirmed the diagnosis of GSI. Biopsies were obtained during surgery from the pubocervical fascia. Results: The quantity of collagen types I and III was statistically significantly reduced in patients with GSI compared to the control group. The efficacy of the TVT procedure in patients with a significant reduction in collagen type I was an 82.1% cure. In patients with a significant reduction in collagen type III, the TVT efficacy was an 85.1% cure. The efficacy of the TVT procedure was not statistically significantly different between patients with GSI and a significant reduction in collagen types I and III, and patients with no reduction in collagen types I and III. Conclusions: The significantly reduced quantity of collagen types I and III in the pubocervical fascia of women with GSI does not affect the efficacy of the TVT procedure at an average of 25 months of follow-up.
Rate-Limiting Steps in the Development of Atherosclerosis: The Response-to-Influx Theory
Authors: Weinberg Peter D.
Published: January 2004

A large number of processes are involved in the pathogenesis of atherosclerosis but it is unclear which of them play a rate-limiting role. One way of resolving this problem is to investigate the highly non-uniform distribution of disease within the arterial system; critical steps in lesion development should be revealed by identifying arterial properties that differ between susceptible and protected sites. Although the localisation of atherosclerotic lesions has been investigated intensively over much of the 20th century, this review argues that the factor determining the distribution of human disease has only recently been identified. Recognition that the distribution changes with age has, for the first time, allowed it to be explained by variation in transport properties of the arterial wall; hitherto, this view could only be applied to experimental atherosclerosis in animals. The newly discovered transport variations which appear to play a critical role in the development of adult disease have underlying mechanisms that differ from those elucidated for the transport variations relevant to experimental atherosclerosis: they depend on endogenous NO synthesis and on blood flow. Manipulation of transport properties might have therapeutic potential.
Insulin-Stimulated Myocardial Glucose Uptake and the Relation to Perfusion and the Nitric Oxide System
Authors: Søndergaard Hanne M. , Bøttcher Morten , Schmitz Ole , Nielsen Torsten Toftegaard , Bøtker Hans Erik
Published: January 2004

In skeletal muscle, insulin increases glucose uptake through endothelium-derived nitric oxide (EDNO)-dependent vasodilation. Insulin also enhances myocardial glucose uptake, but it is unknown whether vasodilation participates in the underlying mechanism. We studied whether insulin-stimulated myocardial glucose uptake (MGU) is associated with perfusion changes and whether MGU is EDNO dependent. Myocardial perfusion (MBF) and MGU were measured three times with positron emission tomography in 8 healthy volunteers (56 ± 6 years): (1) During a hyperinsulinemic euglycemic clamp (clamp), (2) during clamp and blockage of the nitric oxide synthesis by L-NMMA and (3) during clamp and nitric oxide stimulation with nitroglycerin. We measured MBF at rest before and during clamp utilizing 13N-ammonia and 18F-fluoro-deoxy-glucose as perfusion and glucose tracers, respectively. Hemodynamics were affected neither by insulin nor by L-NMMA. Nitroglycerin reduced rate-pressure product. Insulin did not affect MBF. L-NMMA reduced MBF (0.60 ± 0.15 vs. 0.66 ± 0.14 ml/g/min; p < 0.05), while MGU was unchanged. Nitroglycerin did not alter MBF, while MGU was reduced (0.44 ± 0.11 vs. 0.52 ± 0.13 µmol/g/min; p = 0.05). Insulin-stimulated MGU does not rely on a simultaneous increment of MBF. Myocardial glucose uptake can be stimulated even when MBF decreases, suggesting that autoregulation of MGU is preserved despite uncoupling of vascular autoregulation.
Can Optimal Primary Cytoreduction Be Predicted in Advanced Stage Epithelial Ovarian Cancer? Role of Preoperative Serum CA-125 Level
Authors: Obeidat Basil , Latimer John , Crawford Robin
Published: January 2004

The aim of this study was to determine the ability of preoperative serum CA-125 levels to predict optimal cytoreduction in patients with stage III epithelial ovarian cancer. A retrospective review was made of the records of 40 patients with FIGO stage III ovarian carcinoma who underwent primary cytoreductive surgery. A receiver operating characteristic (ROC) curve was used to determine the most useful CA-125 level in predicting optimal versus suboptimal tumour cytoreduction. Twenty-two (55%) patients were optimally cytoreduced (residual disease ≤1 cm). A preoperative serum CA-125 level of 500 U/ml was found to be the value with the most predictive power. Optimal cytoreduction was obtained in 16 of the 21 cases (76%) with a CA-125 <500 U/ml compared to only 6 of the 19 cases (32%) with a CA-125 >500 U/ml. At this threshold, preoperative serum CA-125 level was able to predict optimal versus suboptimal cytoreduction with a sensitivity of 72%, specificity of 73%, positive predictive value of 68%, and negative predictive value of 76%. In the management of patients with advanced epithelial ovarian carcinoma, preoperative serum CA-125 level may help to predict optimal primary cytoreduction and to identify candidates for alternative approaches other than traditional primary cytoreductive surgery, such as neoadjuvant chemotherapy.
24-Hour Electrocardiogram before and during Cisapride Treatment in Neonates and Infants
Authors: Zamora Samuel A. , Belli Dominique C. , Friedli Beat , Jaeggi Edgar
Published: January 2004

We studied prospectively the effects of cisapride on heart rate and rhythm using standard ECG and 24-hour ECG recordings in term and preterm neonates and infants. We studied subjects with gastroesophageal reflux disease (apparent life-threatening events, apneas, bradycardias) before and 3 days after starting cisapride (0.8 mg/kg/day in 4 doses). We performed standard ECGs for determination of corrected Q-T interval (QTc) and Q-T dispersion (QTd) and 24-hour ECG recordings for analysis of heart rate, heart rate variability, and heart rhythm. Fourteen term and 17 preterm subjects (gestational age range 28–36 weeks) were studied at a median chronological age of 29 (range 3–132) days. Cisapride significantly increased the QTc in preterm infants (before vs. after: 408 ± 7 vs. 433 ± 7 ms, p = 0.001). Two preterm and 1 term infant had a QTc >450 ms before cisapride. Four preterm (4/15 = 27%) and 2 term (2/13 = 15%) subjects had a QTc >450 ms on cisapride. After cisapride the QTd remained normal, and no relevant arrhythmias were documented on Holter recordings. Cisapride significantly decreased peak and mean heart rates of all study subjects without affecting the heart rate variability, while it increased the minimal heart rate of preterm infants only (before vs. after: 66 ± 5 vs. 78 ± 5 bpm, p = 0.02). The maximally measured R-R intervals (pauses) decreased after cisapride in preterm infants (before vs. after: 1.33 ± 0.2 s vs. 1.05 ± 0.2 s, p = 0.04). Although cisapride did cause a significant prolongation of the ventricular action potential duration in preterm infants, the QTd remained unaffected, and no clinically relevant arrhythmias were documented in this small sample. On the other hand, cisapride had a direct lowering effect on the maximal and mean heart rates of both term and preterm infants, while the drug increased the minimal heart rate and reduced the severity of bradycardia episodes in preterm infants.