bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal Treatment Strategies for Acute Exacerbations of Chronic Bronchitis: High-Risk Patients
Authors: Norrby S. Ragnar
Published: April 2003

Diagnosis of high-risk patients with acute exacerbations of chronic bronchitis (AECB) should include an evaluation of the patient’s respiratory function, chest X-ray to exclude pneumonia, and sputum culture. Increasing resistance to amoxicillin, cephalosporins, macrolides, trimethoprim-sulfamethoxazole, and doxycycline means that fluoroquinolones are often the only oral empiric treatment available. Levofloxacin, a new respiratory fluoroquinolone with a wide spectrum of antibacterial activity and no cross-resistance with other classes of antibiotics, can be administered as an intravenous formulation as well as orally. Sequential therapy is easily administered due to its high oral bioavailability, and the dosing schedule can be a convenient once-daily dose. Clinical trials have established that levofloxacin is effective in AECB and is well tolerated.
Incorporation of Long CDR3s into V Domains: Implications for the Structural Evolution of the Antibody-Combining Site
Authors: Ramsland Paul A. , Kaushik Azad , Marchalonis John J. , Edmundson Allen B.
Published: April 2003

Available data suggest that ‘primitive’ antibody-combining sites often include longer than average HCDR3s. Long HCDR3 sequences have been reported in diverse vertebrates, including humans, cattle, camels and sharks. These long HCDR3 segments contain unusual sequence features such as stretches of Gly or Pro residues and multiple Cys residues. We examined how longer than average HCDR3s were accommodated in the V domains of human, murine and camel antibodies with known three-dimensional structures. The main conclusions were that (1) HCDR3s longer than 12 residues should protrude outward from the V domains; (2) descending HCDR3 polypeptides may utilize VL (including LCDR3) constituents as a platform, supporting the protruding segments; (3) intra- and inter-HCDR disulfides are frequently formed to rigidify the structure of HCDR3 or the combining site, and (4) V and C domains were possibly more similar in primordial antibodies than they are in their present day counterparts.
Percutaneous Endoscopic Gastrostomy in Head and Neck Cancer Patients
Authors: Riera L. , Sandiumenge A. , Calvo C. , Bordas J.M. , Alobid I. , Llach J. , Bernal M.
Published: April 2003

Objective: To present our experience with the indications and complications of percutaneous endoscopic gastrostomy (PEG) in head and neck cancer patients. Materials and Methods: In a retrospective study of the patients treated, we reviewed the records of 43 patients diagnosed with head and neck cancer at the Otorhinolaryngology Department, in which a PEG was performed by the Unit of Digestive Endoscopy. Results: All cases had squamous cell carcinoma. Larynx was the most frequent primary site, with 21 cases (49%), followed by hypopharynx, 12 patients (28%). Indications for PEG were: dysphagia (53.5%) and pharyngocutaneous fistula (43.5%). The most frequent complication was a local infection. Conclusion: PEG is a good choice for long-term enteral feeding in head and neck cancer patients due to its low complication rate and easy handling.
Delayed Facial Nerve Palsy following Uneventful Stapedectomy
Authors: Marioni Gino , de Filippis Cosimo , Gaio Elena , Staffieri Alberto
Published: April 2003

Facial nerve palsy is a rare complication of stapedectomy. Its onset may be immediate or delayed by several days. The authors present a case of a 59-year-old man who developed right delayed peripheral facial nerve palsy occurring after uncomplicated ipsilateral stapedectomy. The incidence, treatment and prognosis of this complication are discussed.
Relationship between Depression, Anxiety and Quality of Life: A Study of Stroke Patients Compared to Chronic Low Back Pain and Myocardial Ischemia Patients
Authors: Frühwald Stefan , Löffler Henriette , Eher Reinhard , Saletu Bernd , Baumhackl Ulf
Published: April 2003

The prevalence of anxiety disorders and depression is assessed as between 20 and 50% following stroke. Depressive persons tend to give their overall life situation a worse rating than their relatives or physicians because of negative cognitions. Nevertheless, research concerning Quality of Life (QoL) after stroke hardly ever takes into account the methodological bias of assessing QoL only by self-rating. The aim of this study was to point out the important relationship between depression, anxiety and the autoassessment of QoL. QoL was markedly affected in the poststroke patients and in the chronic low back pain and myocardial ischemia patients, and it was rated worst by the most seriously depressed subjects. Clinical studies focusing on the ever more significant evaluation criterion ‘health-related QoL’ after stroke should take into account the high prevalence of anxiety and depressive symptoms and their major influence on the patients’ self-evaluated QoL.
Anxiety Comorbidity in Referred Children and Adolescents with Dysthymic Disorder
Authors: Masi Gabriele , Mucci Maria , Favilla Letizia , Millepiedi Stefania
Published: April 2003

Anxiety disorders are common in patients with depressive disorders. This preliminary study investigated some clinical correlates of comorbidity between dysthymic disorder (DD) and generalized anxiety disorder (GAD) in a clinically referred sample of children and adolescents. After psychiatric evaluation, including a diagnostic clinical interview (DICA-R), 51 patients (25 males and 26 females, mean age 13.1 years) with an index diagnosis of DD associated with GAD were compared with 22 patients (13 males and 9 females, mean age 12.9 years) diagnosed as having pure DD. The comparison between subjects (DD with or without GAD) regarding the number of depressive symptoms did not show a significant main effect of group. Suicidal ideation was significantly more frequent in the group with comorbid GAD. Internalizing disorders were more frequent in the group of DD with GAD, while externalizing disorders were more frequent in the group without GAD. Functional impairment, assessed with the Children’s Global Assessment Scale, did not show significant differences between the two groups. Data are discussed in the light of conceptualizations about the relationship between chronic anxiety and depressive disorders.
Functional Psychosis in Middle-Aged People Presenting as a Long-Lasting Confusion State: A Report of Two Cases
Authors: Liappas J. , Paparrigopoulos T. , Kouzoupis A. , Gouzaris A. , Christodoulou G.N.
Published: April 2003

Two cases of functional psychosis in middle-aged people are reported. These patients manifested a long-lasting confusion, which eventually resolved. Attention is drawn to the fact that the clinical presentation of psychosis with predominant confusion symptoms is much more frequently encountered than usually believed. This particular clinical feature has been rather underestimated and only vaguely described in the current diagnostic classification systems. This often results in diagnostic perplexity in everyday psychiatric practice and delays the initiation of appropriate treatment. Finally, these reports are briefly discussed in the context of various proposed nosological entities, and the need for more systematic clinical information that would provide guidance on the classification of such psychotic disorders is suggested.
The Delusions of Capgras and Intermetamorphosis in a Patient with Right-Hemisphere White-Matter Pathology
Authors: Edelstyn Nicola M.J. , Oyebode Femi , Barrett Ken
Published: April 2003

Previous neuropsychological studies have demonstrated an association between person misidentification and right-hemisphere dysfunction. In the study reported here, we explore the contribution of facial and visual recognition impairments in a patient with right-hemisphere subcortical white-matter pathology in the frontal and parietal lobes and a diagnosis of vascular cognitive impairment. The patient displayed false recognition of unfamiliar faces and deficient retrieval of key biographic detail for famous faces. These results are discussed in the context of the contribution of deficiencies in the visual system and subcortical white-matter lesions to the development of Capgras delusion.
Body Dissatisfaction and Its Interrelations with Other Risk Factors for Bulimia nervosa in 12 Countries
Authors: Jaeger B. , Ruggiero G.M. , Edlund B. , Gomez-Perretta C. , Lang F. , Mohammadkhani P. , Sahleen-Veasey C. , Schomer H. , Lamprecht F.
Published: April 2003

Background: It is widely accepted that risk factors for bulimia nervosa, mainly body dissatisfaction, are dependent on cultural factors. However, to date few studies have compared data from different cultures with an appropriate methodology. Therefore we aimed to gather reliable information on body dissatisfaction and other risk factors for bulimia from different nations and to reveal their functional interrelations. Methods: A series of 10 silhouettes, designed to be as far as possible free from cultural and other detailed aspects, was shown to 1,751 medical and nursing students in 12 nations. A functional model was applied to each sample and tested by structural equation methodology. Results: The most extreme body dissatisfaction was found in northern Mediterranean countries, followed by northern European countries. Countries currently undergoing a process of westernization show an intermediate amount of body dissatisfaction, and non-western countries demonstrate rather low values. Body dissatisfaction is the most important influence on dieting behaviour in most countries. Conclusions: Despite ongoing adoption of western values worldwide, we observe remarkable differences in body dissatisfaction between different cultures. That body dissatisfaction seems disturbingly partly detached from the actual BMI, i.e. possible overweight, as well as from feelings of low self-esteem in some western countries, raises new questions about the possible origin of the pressure to be thin.
Recurrence Risk of Preterm Birth due to Preeclampsia
Authors: Koike Toshimitsu , Minakami Hisanori , Izumi Akio , Watanabe Takashi , Matsubara Shigeki , Sato Ikuo
Published: April 2003

There may be an increased risk of preterm birth due to preeclampsia among women whose previous pregnancies ended in preterm birth due to preeclampsia. We studied 1,130 women who delivered 2 successive singleton infants in our hospital, excluding women who delivered an abnormally formed infant during the study period. We reviewed the gestational week at delivery in these 2,260 pregnancies and found a total of 182 preterm deliveries (8.1%) by 156 women. The causes of preterm birth were reviewed. Failed tocolysis, including premature rupture of membranes and clinical chorioamnionitis, and preeclampsia accounted for 135 (74.2%) and 30 (16.5%) of the 182 preterm deliveries, respectively. Women whose 1st delivery was preterm had a 3.26 times (95% CI 2.21–4.79) higher risk of a subsequent preterm delivery than women whose 1st delivery was term (26/96 vs. 60/1,034). The risk of preeclampsia-related preterm delivery was 54.4 times (17.2 to 172.5) higher in women with a previous preeclampsia-related preterm delivery than in women with a previous term delivery (5/19 vs. 5/1034). Women who had a history of preeclampsia-related preterm birth had a greater risk of preeclampsia-related preterm birth in a subsequent pregnancy as compared with women with a previous term birth.
Shoulder Dystocia and Brachial Plexus Injury: A Population-Based Study
Authors: Christoffersson Magnus , Rydhstroem Hakan
Published: April 2003

The objective of this work was to identify and evaluate risk factors for shoulder dystocia and for brachial plexus injury in a population-based study. In all, 1,397 parturients with shoulder dystocia occurring in Sweden between 1987 and 1996 were identified among 1,076,545 deliveries using information stored in the Medical Birth Registry (MBR) of the National Board of Health and Welfare, Stockholm. Information is missing for about 1.0% of singleton deliveries in the MBR. Validation of the diagnosis ‘shoulder dystocia’ in the MBR was performed using data of 4 of 63 delivery units and was confirmed in 96.5% of the original medical records. A total of 368 infants had brachial plexus injury (26.3%). However, a considerable variation in the rate of recorded shoulder dystocia was evident when comparing the 63 delivery units throughout Sweden. Overall, the incidence was 1.3 per 1,000 deliveries. A close association was found between birth weight and shoulder dystocia, with an odds ratio (OR) over 30 for a birth weight ≧5,000 g. In the presence of maternal diabetes mellitus or gestational diabetes, the OR for shoulder dystocia was significantly increased in newborns weighing ≧4,000 g. The overall perinatal mortality because of shoulder dystocia was 1.2%. This was increased to 6.4% if the mother had diabetes mellitus. About 25% of all infants suffered a brachial plexus injury. This potentially serious injury even occurred in connection with birth by cesarean section, and an OR for plexus injury over unity was seen in 7 of 9 weight groups; a significantly increased OR was seen for birth weights ≧4,500 g. The birth weight is a strong risk factor for shoulder dystocia, as is diabetes mellitus. A considerable variation in the rate of shoulder dystocia was observed among the different delivery units, probably reflecting difficulties in definition. Brachial plexus injury is observed even after cesarean section, especially if the birth weight is ≧4,500 g.
Effect of Prostaglandin E1 on Ophthalmic Artery Velocimetry in a Pre-Eclamptic Woman with Visual Disturbance Caused by Retinal Arterial Narrowing
Authors: Ohno Yasumasa , Kawai Michiyasu , Arii Yoshitaro , Mizutani Shigehiko
Published: April 2003

We reported the ophthalmic arterial velocimetry and the effect of prostaglandin E1 on that using color Doppler ultrasonography in a 29-year-old pre-eclamptic woman with postpartum weakness of vision due to retinal arterial narrowing. In this case, we found higher pulsatility index and lower mean velocity than that in normal pregnancy. The 30.8% reduction of ophthalmic artery pulsatility index and 53.9% acceleration of mean velocity were observed at 25 min after intravenous administration of prostaglandin E1. Normalization of these values preceded the recovery of vision. These findings suggest a vasodilated effect of prostaglandin E1 on orbital circulation in a pre-eclamptic woman with weakness of vision due to retinal arterial narrowing.
Pathogenesis of Endometriosis
Authors: Witz Craig A.
Published: April 2003

Various theories have been promulgated to explain the pathogenesis of endometriosis. Interest in the genesis of the endometriotic lesion has been a focus since the earliest investigations. More recently, investigators have addressed aspects of the immune system and local peritoneal factors that may be involved with both the histogenesis of endometriosis as well as its sequelae. This review will consider evidence for different theories of histogenesis and will discuss our current understanding of the contribution of the immune system to the etiology of endometriosis. Data will be presented regarding recently described models of the early endometriotic lesion. The interaction of endometrial cells with the peritoneal mesothelium seems critical to our understanding the formation of the early endometriotic lesion. Evidence of rapid transmesothelial migration and invasion of the peritoneum will be considered. As well, candidate adhesion molecules that may facilitate the initial binding of endometrium to the peritoneum will be discussed.
Hypoallergenic Variants of the Parietaria judaica Major Allergen Par j 1: A Member of the Non-Specific Lipid Transfer Protein Plant Family
Authors: Bonura Angela , Amoroso Saverio , Locorotondo Giovanni , Di Felice Gabriella , Tinghino Raffaella , Geraci Domenico , Colombo Paolo
Published: April 2003

Background: Par j 1 represents a major allergenic component of Parietaria judaica (Pj) pollen, since it is able to induce an immunoglobulin E (IgE) response in 95% of Pj-allergic patients. It belongs to the non-specific lipid transfer protein family, sharing with them a common three-dimensional structure. Methods: Disulphide bond variants of the recombinant Par j 1 (rPar j 1) allergen were generated by site-directed mutagenesis, and the immunological activity of rPar j 1 and its conformational mutants was compared with the use of the skin prick test (SPT). The ability to bind IgE antibodies was evaluated by Western blot, ELISA and ELISA inhibition. T cell reactivity was measured by peripheral blood mononuclear cell proliferation assay. Results: The disruption of Cys14–Cys29 and Cys30–Cys75 bridging (PjA mutant) caused the loss of the majority of specific IgE-binding activity. Additional disruption of the Cys4–Cys52 bridge (PjC mutant) and the latter Cys50–Cys91 bridge (PjD mutant) led to the abolition of IgE-binding activity. On the SPT, PjB (lacking the Cys4–Cys52 and Cys50–Cys91 bridges) was still capable of triggering a type I hypersensitive reaction in 9 out of 10 patients, and PjA in 3 out of 10 patients, while PjC and PjD did not show any SPT reactivity. All the mutants preserved their T cell reactivity. Conclusion: Recombinant hypoallergenic variants of the rPar j 1 allergen described herein may represent a useful tool for improved immunotherapy.
Antigenic Determinants of Bovine Serum Albumin
Authors: Beretta Barbara , Conti Amedeo , Fiocchi Alessandro , Gaiaschi Antonella , Galli Corrado L. , Giuffrida Maria Gabriella , Ballabio Cinzia , Restani Patrizia
Published: April 2003

Background: Bovine serum albumin (BSA) is one of the most widely studied proteins; its structure is well known and its antigenic characteristics have been described in several papers. The aim of this research was the identification of the BSA antigenic determinants. Methods: This study was performed using limited proteolysis and an immunoblotting technique, in which a commercial murine antibody and sera from children sensitized to BSA were used. Results: Findings suggest amino acids (aa) 524–598 as an epitopic area for human species. The most critical sequence seems to be aa 524–542, even if it must be included in a longer fragment to be recognized by antibodies. Murine IgG antibodies also recognize fragments contained in the first half (NH2-terminal portion) of BSA. Conclusions: The results presented in this study indicate that the epitopic sites of an antigenic protein can be different when different species are considered, so that data obtained with antibodies from animal species cannot be directly extrapolated to the behavior of human IgEs.
Breaking Strength of Native and Sutured Trachea
Authors: Behrend M. , Kluge Eva , Schüttler W. , Klempnauer J.
Published: April 2003

Tracheal anastomoses are, even more so than other sutures, often only possible to prepare under tension and thus in danger of breakage. No information is available regarding native tracheae and freshly sutured tracheae. For this reason, our objective was to examine the tensile strength of native tracheae and compare it with freshly sutured specimens. Fresh tracheae were collected from the local slaughterhouse within 30 min of slaughter. With the help of a suitable holding device, 24 fresh tracheae were mounted on a material testing machine and stretched to breaking point, during which the force and distance required were recorded. The same study was carried out on each 10 freshly anastomosed tracheae using three different suturing techniques. The mean value of the maximum force required for native tracheae was 198 N. With continuous suturing (polypropylene), a mean value of 171 N was attained, and with single interrupted suturing (polydioxanone and polyglactin 910), 123 N, respectively, 108 N. Differences between the groups proved to be highly significant. With respect to the mechanical strain from traction, the continuous suture proved to be statistically identical to native tracheae, whereas single interrupted sutures revealed a considerably lower stability under burden. Therefore, the continuous suture is of advantage in respect of the mechanical strain from traction and the suture protection of tracheal anastomoses. Further studies with differing survival times in vivo with this method provide insight into the stability of tracheal anastomoses during the healing process.
Party Size and Diet of Syntopic Atelids (Ateles chamek and Lagothrix cana) in Southwestern Brazilian Amazonia
Authors: Iwanaga Simone , Ferrari Stephen F.
Published: April 2003

Syntopic Alouatta seniculus, Ateles chamek and Lagothrix cana (Atelidae) were studied in southwestern Amazonia. Primate populations were first surveyed, and then the party size, diet and vertical spacing were monitored over a 5-month period. Atelids accounted for more than half the survey sightings and Lagothrix was the most abundant. Party sizes recorded for both Alouatta and Lagothrix during monitoring were significantly larger than those recorded during surveys, but no such difference was found for Ateles. Monitored parties were significantly larger in Lagothrix in comparison with either Alouatta or Ateles, as were groups of Ateles in comparison with Alouatta. Mean party size in Ateles decreased progressively during the course of the study, from 8.9 ± 3.4 in June to 3.9 ± 2.3 in October. Moraceae was the most important dietary resource for Ateles and Lagothrix, in terms of both feeding records and number of species exploited. There was considerable overlap in the plant taxa exploited, but some notable differences, such as the exclusive use of Hymenaea courbaril (Caesalpinaceae) by Lagothrix and of Euterpe precatoria (Arecaceae) by Ateles. As at other sites in the region, Ateles occupied significantly higher forest strata in comparison with Lagothrix. Despite the preliminary nature of the study, the results indicate a number of ecological differences between species that undoubtedly play an important role in niche separation.
Crested Eagle (Morphnus guianensis ) Predation on Infant Tamarins (Saguinus mystax and Saguinus fuscicollis, Callitrichinae)
Authors: Vasquez Marcos Roland Oversluijs , Heymann Eckhard W.
Published: April 2003

//8RDue to their small size, callitrichines are subject to predation pressure by a wide array of predators. Observed predator attacks and strong responses to less dangerous or non-dangerous stimuli support this contention [1–4]. Since twin births are the rule in callitrichines but populations do not grow drastically, a large proportion of infants and juveniles is probably lost to predators. Pertinent evidence is scanty [2, 5]. Here we report on two successful attacks by crested eagles, Morphnus guianensis, on infant Saguinus mystax and Saguinus fuscicollis .
Genome Segment S8 of Grass Carp Hemorrhage Virus Encodes a Virion Protein
Authors: Qiu Tao , Zhang Jing , Lu Renhou , Zhu Zuoyan
Published: April 2003

The complete nucleotide sequence of the genome segment S8 of grass carp hemorrhage virus (GCHV) was determined from cDNA corresponding to the viral genomic RNA. It is 1,287 nucleotides in length and contains a large open reading frame that could encode a protein of 409 amino acids with a predicted molecular mass of 44 kD. The S8 was expressed using the pET fusion protein vector and detected by Western blotting analysis using the chicken egg IgY against intact GCHV particles, indicating that S8 encodes a virion protein. Amino acid sequence comparisons revealed that the protein encoded by S8 is closely related to protein σ2 of mammalian reovirus, suggesting that the deduced protein of S8 is an inner capsid protein.
Dehiscence of Gastrojejunal Stapled Anastomosis after Lithotripsy for Nephrolithiasis
Authors: Fernández-Lobato R. , Cerquella C. , Serantes A. , Martínez-Santos C. , Díaz-Giménez L.M. , Moreno-Azcoita M.
Published: April 2003

We report the case of a 76-year-old woman with previous bariatric surgery and a large renal calculus following a prolonged lithotripsy session. The patient presented with peritonitis due to dehiscence of the gastrojejunal stapled anastomosis.
Hepatic Tissue Engineering on 3-Dimensional Biodegradable Polymers within a Pulsatile Flow Bioreactor
Authors: Török É. , Pollok J.-M. , Ma P.X. , Vogel C. , Dandri M. , Petersen J. , Burda M.R. , Kaufmann P.M. , Kluth D. , Rogiers X.
Published: April 2003

Background: An optimal method for hepatocyte transplantation is not yet determined. With the principles of tissue engineering in vitro conditioning of hepatocytes on biodegradable polymer in a flow bioreactor before implantation forming spheroids may achieve increased cell mass and function to replace lost organ function in vivo. Methods: Biodegradable poly-L-lactic (PLLA) polymer discs were seeded with rat hepatocytes in a concentration of 10 × 106 cells per ml and exposed to a medium flow of 24 ml/min for 1, 2, 4 and 6 days. The number and diameter of spheroidal aggregates was measured by phase-contrast microscopy. H&E histology was performed. Albumin production as hepatocyte specific function was determined by ELISA. Results: Spheroids of viable hepatocytes of 50–200 µm in diameter were formed. Both the number and diameter of the spheroids increased during the first 2 days and then remained constant until day 6. Albumin production was maintained throughout the culture period. Conclusion: Short (2– 3 days) pre-transplant conditioning of hepatocytes in a flow bioreactor on biodegradable PLLA resulted in formation of spheroids with a liver-like morphology and preserved specific metabolic function. Tissue engineered hepatocyte spheroids on polymer may represent a functionally active and easy transplantable neotissue and may serve as an in vivo substitute for lost liver function.
Genotypes of Hepatitis C Virus in Kuwait
Authors: Pacsa A.S. , Al-Mufti S. , Chugh T.D. , Said-Adi G.
Published: April 2003

Hepatitis C virus (HCV) genotypes in 144 patients in Kuwait were determined by the Murex Anti-HCV Serotyping Assay. Twenty-nine (38%) of 77 Kuwaiti patients were found to be infected with genotype 4 and 27% with genotype 1 while of the 41 Egyptian expatriate patients 37 (90%) were infected with genotype 4. Results show that although in native Kuwaiti patients the dominant genotype is 4, other genotypes, especially type 1, occur frequently.
Establishment and Evaluation of Polymerase Chain Reaction for Detection of Y-Chromosome-Specific Fetal DNA in Maternal Blood Circulation during Pregnancy and after Delivery
Authors: Al-Yatama M.K. , Mustafa A.S. , Omu A.E. , Ali S. , Abraham S. , Zohra K. , Khaja Nawal
Published: April 2003

Objective: To establish and evaluate nested polymerase chain reaction (PCR) for detection of Y-chromosome-specific fetal DNA in maternal blood circulation during pregnancy and its clearance several days after delivery. Materials and Methods:  Genomic DNA was isolated from a male donor to amplify Y-chromosome-specific DNA sequences by using four pairs of oligonucleotide primers targeting single or multiple copy genes in standard and nested PCR. The nested PCR was evaluated for detection of Y-chromosome-specific sequences in the maternal blood circulation of pregnant women bearing a male fetus during pregnancy and at 2 and 24 h and 7 days after delivery. Results: Although both standard and nested PCR assays were established by using genomic DNA from a male donor to detect Y-chromosome-specific DNA sequences, the nested PCR was 10 times more sensitive than standard PCR. Further experiments showed that nested PCR was able to detect Y-chromosome-specific DNA in the peripheral blood cells as well as in the plasma and serum of pregnant women carrying a male fetus. When tested with plasma samples from women carrying male fetuses during pregnancy, nested PCR was positive with 53/55 (96%), 22/22 (100%), 16/22 (73%) and 0/30 (0%) specimens obtained before and at 2 and 24 h and 7 days after delivery, respectively. These results showed that fetus-specific Y-chromosome DNA was cleared from maternal circulation within 7 days of delivery. Conclusion: Our results suggest that nested PCR is useful in fetal sex determination and that prenatal diagnosis can be done without interference from previous pregnancy.
Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma in a Patient with Common Variable Immunodeficiency Syndrome
Authors: Reichenberger F. , Wyser C. , Gonon M. , Cathomas G. , Tamm M.
Published: April 2003

Common variable immunodeficiency syndrome (CVID) is a primary immunodeficiency typically presenting with recurrent sinopulmonary infections. Non-Hodgkin’s lymphoma and other secondary cancers are typical late complications of CVID. We report on a patient suffering from CVID with a history of recurrent sinopulmonary infections, interstitial pulmonary changes and hepatic granulomas. Despite treatment with intravenous immunoglobulin followed by a reduction in the number of pulmonary infections, reticular and nodular lung changes progressed. Video-assisted thoracoscopic lung biopsy showed a low-grade B cell lymphoma of the mucosa-associated lymphoid tissue (MALT) of the bronchus without evidence of pulmonary infection. In conclusion, MALT lymphoma of the lung should be considered in the differential diagnosis of progressive lung disease in CVID.
Treatment of Pancreatic Cancer: The Role of Surgery
Authors: Ozawa Fumiaki , Friess Helmut , Künzli Beat , Shrikhande Shailesh V. , Otani Taiichi , Makuuchi Masatoshi , Büchler Markus W.
Published: April 2003

Pancreatic cancer shows an aggressive growth behavior which results in an extremely poor prognosis. It is presently the 4th to 5th leading cause of cancer-related deaths in Western countries with an incidence of 8–10 new cases per 100,000 inhabitants. Since current conservative oncological therapies fail to influence the long-term outcome, curative resection remains the only possibility with a potential for cure. During the past decades, a considerable decrease in postoperative mortality after pancreatic resection and a significant increase in the resection rate have been achieved. Although several types of pancreatic resection have evolved, standard procedures are the classical Whipple resection for cancers of the pancreatic head and left resection for cancers of pancreatic body and tail. Since the pylorus-preserving Whipple resection and extended Whipple resection are still debated as better alternatives to the classical Whipple procedure, large, controlled clinical trials in patients need to be conducted to reach reliable conclusions. However, there is mounting evidence that the pylorus-preserving Whipple procedure offers a better postoperative outcome than the classical Whipple operation without compromising radicality and thereby the long-term prognosis. Despite the progress in surgical treatment of pancreatic cancer, the overall prognosis following resection remains unsatisfactory to date. It is hoped that progress in multimodality treatment and modern therapies, resulting from both clinical and advanced basic research, can improve the prognosis of this malignancy in the near future.
Current Options for Palliative Treatment in Patients with Pancreatic Cancer
Authors: Ridwelski Karsten , Meyer Frank
Published: April 2003

Palliative treatment is often the only remaining option in the management of pancreatic carcinoma, but its efficacy is poor due to low tumor sensitivity and inadequate treatment protocols. There are several options of palliative treatment with antitumor or supportive intention. Classical end points of palliative treatment are survival, tumor response, and quality of life. A decade ago, palliative chemotherapy consisted mainly of 5-fluorouracil as the standard agent in combination with either other agents and/or radiotherapy. Only the new antineoplastic drug gemcitabine, which was introduced simultaneously with the definition of novel end points of chemotherapy such as clinical benefit, allowed to achieve some progress. However, while gemcitabine monotherapy appeared to be superior to 5-fluorouracil and improved important parameters of quality of life, it could not provide a significant improvement of survival. A novel concept, therefore, is to improve this beneficial cytostatic response in pancreatic carcinoma using a gemcitabine-based protocol by combining it with antineoplastic drugs such as taxanes or platin analogs. This strategy may have the potential to improve the outcome in palliative chemotherapy of pancreatic carcinoma patients with advanced tumor growth or metastases. Best supportive care in pancreatic cancer consists of the treatment of symptoms, such as pain, jaundice, duodenal obstruction, weight loss, exocrine pancreatic insufficiency, and tumor-associated depression.
Involuntary Treatment of Alcohol-Dependent Patients: A Study of 17 Consecutive Cases of Civil Commitment
Authors: Bourquin-Tièche Dominique , Besson Jacques , Lambert Henry , Yersin Bertrand
Published: April 2003

Aim: To investigate the baseline and follow-up characteristics of a group of alcohol-dependent patients being treated under civil commitment. Methods: This study involved a cross-sectional comparative analysis of baseline characteristics and a follow-up survey of a group of committed alcoholic patients. The study was undertaken in the Alcohol Unit of a 1,000-bed general and university hospital. The study included 17 consecutive cases of civil commitment (representing 15 patients, of whom 2 were committed twice) and a comparative group of 34 randomly selected age- and sex-matched patients. Baseline characteristics of the cases (at the time of commitment) and of patients from the comparative group were collected from medical records, including sociodemographic data, medical condition, patterns of drinking and number and dates of previous treatments for alcohol-related problems. A structured follow-up interview of the cases provided information on their medical condition, social status, patterns of alcohol use, type and duration of residential treatment as well as their perceptions of commitment. Results: During a 4-year period, our Unit referred 23 cases of alcohol-dependent patients (out of 367) to the Guardianship Authority, requesting civil commitment. On 17 occasions, patients were committed to residential treatment, including 2 patients who underwent commitment on two separate occasions, thus representing a total of 15 different patients. In comparison with age- and sex-matched patients seen at the Unit, the cases were characterized by multiple medical, social and psychological alcohol-related impairments. At the time of follow-up, 14 out of 15 patients were alive, among whom 10 agreed to be interviewed. Eight of these reported complete abstinence, whereas 9 considered their alcohol problem as less severe than before. The average duration of commitment was 29 weeks. The majority of patients retrospectively considered the measure as having been justified and useful. The patients’ satisfaction with the decision to commit was higher among women than among men. Health-related quality of life at the time of follow-up, as assessed by the MOS 36-Item Short Form Health Survey questionnaire, was good on average and better than that usually reported by other cohorts of alcoholics undergoing treatment. Conclusions: The usefulness of residential civil commitment of certain severely impaired alcohol-dependent patients is underscored. This study suggests that civil commitment not only may save the lives of endangered patients but could also be a health-promoting measure that may sometimes allow for recovery from dependence. Unexpectedly, this measure was retrospectively well accepted by many patients, who considered the commitment decision as having been justified and useful.
A World Health Organization Perspective on Alcohol and Illicit Drug Use and Health
Authors: Monteiro Maristela G.
Published: April 2003

Alcohol and illicit drug use has a significant impact on global health. Alcohol consumption is increasing worldwide, particularly in developing countries and countries in transition, leading to an increasing number of health and social problems, both acute and chronic. Illicit drug use is also increasing, particularly injection drug use, followed by an epidemic spread of HIV and other blood-borne infections. Alcohol and illicit drug use are related to key determinants of population health and are also an outcome of poor health. Globalized marketing and trade, and rapid social changes and development in the absence of strong policies and investments in public health have led to an increased availability, use and problems related to alcohol and other substance use. Public health policies and substantial investments in effective prevention and treatment approaches are needed in order to reduce the negative impact of alcohol and other drug use at national and global levels.
Steps towards Constructing a Global Comparative Risk Analysis for Alcohol Consumption: Determining Indicators and Empirical Weights for Patterns of Drinking, Deciding about Theoretical Minimum, and Dealing with Different Consequences
Authors: Rehm Jürgen , Monteiro Maristela , Room Robin , Gmel Gerhard , Jernigan David , Frick Ulrich , Graham Kathryn
Published: April 2003

In order to conduct a comparative risk analysis for alcohol within the Global Burden of Disease Study (GBD 2000), several questions had to be answered. (1) What are the appropriate dimensions for alcohol consumption and how can they be categorized? The average volume of alcohol and patterns of drinking were selected as dimensions. Both dimensions could be looked upon as continuous but were categorized for practical purposes. The average volume of drinking was categorized into the following categories: abstention; drinking 1 (>0–19.99 g pure alcohol daily for females, >0–39.99 g for males); drinking 2 (20–39.99 g for females, 40–59.99 g for males), and drinking 3 (≧40 g for females, ≧60 g for males). Patterns of drinking were categorized into four levels of detrimental impact based on an optimal scaling analysis of key informant ratings. (2) What is the theoretical minimum for both dimensions? A pattern of regular light drinking (at most 1 drink every day) was selected as theoretical minimum for established market economies for all people above age 45. For all other regions and age groups, the theoretical minimum was set to zero. Potential problems and uncertainties with this selection are discussed. (3) What are the health outcomes for alcohol and how do they relate to the dimensions? Overall, more than 60 disease conditions were identified as being related to alcohol consumption. Most chronic conditions seem to be related to volume only (exceptions are coronary heart disease and ischemic stroke), and most acute conditions seem to be related to volume and patterns. In addition, using methodology based on aggregate data, patterns were relevant for attributing harms for men but not women.
Sensitivity of the Addiction Severity Index Physical and Sexual Assault Items: Preliminary Findings on Gender Differences
Authors: Langeland Willie , van den Brink Wim , Draijer Nel , Hartgers Christina
Published: April 2003

Objective: Evaluation of the Addiction Severity Index (ASI) as a screen for identifying sexual and physical assault histories. Method: The sensitivity and specificity of the ASI assault items were examined in 146 alcoholic patients with the assault questions of the Composite International Diagnostic Interview posttraumatic stress module as external criterion. Results: The sensitivity of the ASI items was lower than their specificity for both physical (sensitivity = 0.35, specificity = 0.83) and sexual abuse (sensitivity = 0.69, specificity = 0.94). These findings indicate an underestimation of such abuse histories in male patients due to screening for a narrow range of possible perpetrators. Conclusion: The ASI method as a screen for sexual and physical assault histories could be improved, considering that men clearly outnumber women in persons applying for alcohol treatment.
Restless Legs Syndrome among Working-Aged Women
Authors: Ulfberg Jan , Nyström Birgitta , Carter Ned , Edling Christer
Published: April 2003

A random sample of 200 women, aged 18–64 years, living in a county in mid-Sweden, was sent a questionnaire that included questions about sleep habits, symptoms of sleepiness and neuropsychiatric complaints. Standardized diagnostic criteria determined by the International Restless Legs Syndrome Study Group were used to investigate the prevalence of restless legs syndrome (RLS). Possible associations between RLS and neuropsychiatric complaints were also investigated. Odds ratios for different variables were calculated by means of multivariate logistic regression. 11.4% of the women suffered from RLS. Sleep-related complaints were more frequent among RLS sufferers than among nonsufferers. Complaints of daytime headache were reported 5 times more frequently among RLS sufferers, and there was a tendency towards social isolation related to RLS. Subjective problems in performing work due to sleepiness were ninefold among the women with RLS. These results indicate that RLS together with an association to neuropsychiatric symptoms is common among working-aged women.
Analysis of α-synuclein, parkin, tau, and UCH-L1 in a Japanese Family with Autosomal Dominant Parkinsonism
Authors: Hasegawa K. , Funayama M. , Matsuura N. , Furusawa H. , Sakai F. , Kowa H. , Obata F.
Published: April 2003

We examined whether autosomal dominant parkinsonism of a Japanese family, Sagamihara family, was due to the mutations of α-synuclein, parkin, tau, and UCH-L1, which have been reported as the causal genes for parkinsonism in other families. Restriction-enzyme digestion of polymerase-chain reaction (PCR) amplified genomic DNA fragments of α-synuclein exons 3 and 4 detected no point mutation. PCR-amplification of parkin exons 3, 4, 5, 6 and 7 detected no exon deletion. Direct sequencing of PCR-amplified DNA fragments of tau exons 9, 10, 12, and 13 and intron 10, and of UCH-L1 exon 4 revealed that all these exons and intron were normal including a polymorphic nucleotide substitution. These results indicated that the parkinsonism of the Sagamihara family seems not to be due to previously identified point mutations of α-synuclein, tau, or UCH-L1, or to exon deletion of parkin.
Three-Dimensional Computed Tomography Angiography and Magnetic Resonance Angiography of Carotid Bifurcation Stenosis
Authors: Binaghi Stefano , Maeder Philippe , Uské Antoine , Meuwly Jean-Yves , Devuyst Gerald , Meuli Reto A.
Published: April 2003

Purpose: To evaluate the role of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) in the quantification of atherosclerotic stenosis of carotid artery bifurcation in comparison with digital substraction angiography (DSA) and Doppler sonography (DS). Materials and Methods: Twenty-five patients with atherosclerotic disease of the carotid arteries with proven stenosis by DSA, had spiral CTA, MRA using two- and three-dimensional time-of-flight gradient echo techniques, and DS using Doppler flow signal recording (total 47 carotid artery bifurcations). The degree of stenosis was measured according to the North American Symptomatic Carotid Endarterectomy Trial criteria: total occlusion (100%), severe (70–99%), moderate (30–69%) and mild (0–29%). The degree of stenosis measured by CTA, MRA and DS was compared to DSA, used as the gold standard. Results: Ninety-seven percent of MRA measures were equivalent to DSA, and 3% were underestimated; 96% of CTA measures were equivalent to DSA, and 4% were underestimated; 77% of DS measures were equivalent to DSA, 21% were overestimated and 2% were underestimated. Conclusions: CTA and MRA are equally accurate methods in quantifying the degree of carotid bifurcation stenosis.
Hypertension and Neurovascular Compression of the Left Lateral Medulla oblongata in Ischemic Stroke
Authors: Kimura Kazumi , Minematsu Kazuo , Yonemura Kiminobu , Koga Masatoshi , Yasaka Masahiro , Yamaguchi Takenori
Published: April 2003

Hypertension is a major risk factor for stroke. Neurovascular compression (NC) of the left ventrolateral medulla oblongata may cause arterial hypertension. We evaluated the relationship between the two ischemic stroke patients. We classified 69 patients under 50 years old (49 men and 20 women, aged 43.6 ± 7.3 years) based on magnetic resonance imaging findings as follows: NC patients (n = 38; 10 with NC on the right side, 18 with NC on the left side, and 10 with NC on both sides) and non-NC patients (n = 31). We compared the following clinical characteristics between the two groups: (1) risk factors for stroke, including hypertension, diabetes mellitus, hypercholesterolemia, and smoking and (2) stroke subtype. Hypertension was more frequent in the NC group than in the non-NC group (58 vs. 19%, p = 0.001). Hypertension was more frequent in patients with left-side NC than in those with right-side NC (78 vs. 20%, p = 0.005). No other differences were observed between the two groups. Twelve patients presented with atherothrombotic stroke, 16 with cardioembolic stroke, 24 with lacunar stroke and 17 with stroke of miscellaneous etiology. NC was significantly more common in patients with lacunar stroke as compared with those affected by other stroke subtypes (p = 0.015). We found a significant relationship between hypertension and NC of the ventrolateral medulla oblongata on the left side in ischemic stroke patients younger than 50 years of age. Some patients with lacunar stroke may have hyptertension related to NC.
Orbicularis oculi and Orbicularis oris Reflexes in Blepharospasm and Torticollis spasmodica during Spasm-Free Intervals
Authors: Eekhof J.L.A. , Aramideh M. , Speelman J.D. , Ongerboer de Visser B.W.
Published: April 2003

To investigate possible abnormalities of the blink reflex pathways, we analyzed the latencies and amplitudes of the blink reflex responses in the orbicularis oculi (Ooculi) muscle, following supraorbital nerve stimulation, in 19 patients with blepharospasm, 16 patients with torticollis spasmodica and 22 control subjects. Furthermore, in order to examine the suprasegmental control of the responses, the reflex responses were also evoked in the orbicularis oris (Ooris) muscle after stimulation of the ipsilateral supraorbital nerve. The responses were recorded only when subjects had no contractions of the eyelid muscles, either involuntarily, voluntarily or spontaneously; this could be controlled by a sound signal. The metrics of the reflex responses in the Ooculi and Ooris muscles in patient groups were comparable to those in controls. Our data indicate that the afferent and efferent pathways of the reflex arc and the suprasegmental control of the reflex are intact in patients with blepharospasm and torticollis spasmodica, at least during spasm-free intervals. Alterations of responses may occur during spasms due to either segmental or suprasegmental changes.
Mycophenolate Mofetil in the Therapy of Severe Myasthenia gravis
Authors: Schneider C. , Gold R. , Reiners K. , Toyka K.V.
Published: April 2003

Mycophenolate mofetil is a novel immunosuppressive drug already established in transplantation medicine. Recently, results of three open clinical trials on mycophenolate mofetil in myasthenia gravis have been reported. Mycophenolate mofetil in a dose of 1.0–2.0 g/day was given in 2 patients with severe refractory myasthenia gravis and in 1 patient with myasthenia gravis-polymyositis syndrome. Apart from dose-dependent reversible hemolytic anemia in 1 patient, no severe side effects occurred. Considerable improvement of myasthenic symptoms was seen in all patients within 3–6 months after the initiation of this therapy. Mycophenolate mofetil may be considered as a useful alternative in the treatment of severe myasthenia gravis when standard therapeutic regimens fail. It is usually well tolerated and its application is simple.