bluuebunny/crossref_metadata_2025 huggingface dataset:
Preliminary Assessment of a10-Day Rapid Detoxification Programme Using High Dosage Buprenorphine
Authors: Vignau Jean
Published: April 2003

The original French therapeutic strategy for the treatment of opioid addiction was a rapid detoxification occasionally accompanied by treatment for withdrawal symptoms. In 1995, substitution therapy using opioids was introduced with the aim of maintenance, utilising methadone and the partial agonist buprenorphine, introduced in 1996. As well as being a maintenance agent, buprenorphine has been prescribed for rapid detoxification due to its reduced tendency to cause any withdrawal effects and its ability to block the effects of other opioids. This trial was initiated to measure the efficacy of buprenorphine in rapid detoxification and to assess whether additional medication would be required. Participants in this open study had requested rapid detoxification and were referred to the addiction clinic as inpatients. Patients were assessed by the clinician and during counselling sessions, and an initial dose was agreed upon. This dose was then gradually decreased over ten days in a flexible dosing schedule, with concurrent toxicological urinalysis to ensure no illicit drug use. During the trial, 25% of patients transferred to a maintenance programme and 58% remained in the study. The large transfer of patients to maintenance programmes may indicate that many people requesting rapid detoxification are actually asking for a more generalised form of assistance. No opioid-positive urines were noted after the fourth day in any patients, and the study indicates that buprenorphine should prove to be a useful detoxification agent, particularly in less hardened addicts. Step-down buprenorphine detoxification minimises withdrawal symptoms and, therefore, reduces the need for concurrent medication.
Risk Factors for Cerebral Degenerative Changes and Dementia
Authors: Meyer John S. , Terayama Yasuo , Konno Shizuko , Akiyama Hisanao , Margishvili Gaiane M. , Mortel Karl F.
Published: April 2003

It is concluded that the most important determinants for cerebral neurodegenerative changes and cognitive decline during aging are neuronal shrinkage and/or loss, which are accelerated by certain risk factors: e.g. TIAs, hypertension, heart disease, hyperlipidemia, smoking, heavy alcohol consumption, male gender, low educational status, family history of cerebrovascular disease and absence of estrogen replacement therapy among women. Some of these risk factors are remediable by therapeutic interventions, including prevention of TIAs and medications that control hypertension, heart disease, hyperlipidemia and estrogen replacement in postmenopausal women, as well as abstention from abuse of tobacco and alcohol. Cerebral neurodegenerative changes measured by neuroimaging appear to be premorbid markers for depleted neuronal and synaptic reserves which predispose to the onset of dementias of both VAD and DAT types. Normal subjects at risk for cognitive decline include those with TIAs, hypertension and heart disease since these risk factors measurably accelerate cerebral atrophy, ventricular enlargement, leukoaraiosis, and decline in cortical perfusion.
Human Studies of Recombinant Human Nerve Growth Factor and Diabetic Peripheral Neuropathy
Authors: Freeman Roy
Published: April 2003

Recombinant human nerve growth factor (rhNGF) is the first neurotrophin to be investigated in clinical trials of diabetic peripheral neuropathy (DPN). To date, the drug has been administered to 60 healthy volunteers and 209 patients with DPN in phase I and II studies. Results from phase I have demonstrated rhNGF to be safe and generally well tolerated in doses up to 1.0 µg/kg given intravenously or subcutaneously for up to 12 doses. Doses investigated in phase II were 0.1 or 0.3 µg/kg s.c. 3 days a week for 6 months. Preliminary results from this trial suggest that rhNGF specifically improves the function of small-fibre sensory peripheral neurons, which is consistent with its postulated mode of action. Two pivotal 12-month phase III trials are underway in diabetic patients with symptomatic peripheral neuropathy to confirm the therapeutic effects of rhNGF. Results from these trials are expected in 2000.
Diabetic Peripheral Neuropathies: Their Cost to Patient and Society and the Value of Knowledge of Risk Factors for Development of Interventions
Authors: Thomas Peter K.
Published: April 2003

Diabetic peripheral neuropathies are a variety of syndromes which affect sensory, autonomic and motor nerve function. The commonest form, distal symmetric sensory polyneuropathy, is a major risk factor for foot ulceration, which may eventually lead to lower limb amputation. By 2010, it is estimated that globally 220 million people will have diabetes, and epidemiological studies estimate that more than 50% of diabetic patients with a 25-year history will develop diabetic peripheral neuropathies. In 1986, the USA expenditure for care of these neuropathies was estimated at $240 million, and, as the incidence of diabetes is predicted to increase, this cost is likely to escalate. Risk factors associated with diabetic peripheral neuropathy need to be identified so that interventions can be devised. Recombinant nerve growth factor, a putative treatment for diabetic peripheral neuropathies, is currently being evaluated in phase III trials for this indication.
Restless Legs Syndrome: A Clinical Study of 55 Patients
Authors: Bassetti Claudio L. , Mauerhofer Doris , Gugger Matthias , Mathis Johannes , Hess Christian W.
Published: April 2003

Background: Restless legs syndrome (RLS) is a common sleep disorder. In 1995, clinical criteria for the diagnosis of RLS were defined. Objective: To describe the clinical spectrum in a series of unselected RLS patients meeting the new diagnostic criteria. Methods: We prospectively assessed by questionnaire and clinical assessment the characteristics of 55 consecutive RLS patients (35 women, 20 men; mean age = 62 ± 16 years). Results: In 27% of the patients, RLS started before the age of 20 years (early-onset RLS). Sensory disturbances were painful in 56% of patients and felt in legs (98%), arms (35%), and ‘internally’ (45%). Motor disturbances included ‘dyskinesias while awake’ (36%). Insomnia (58%) was commoner than hypersomnia (24%). In 67% of the patients, no etiology of RLS was found (idiopathic RLS). Early-onset RLS was more commonly familial (p = 0.01) and associated with ‘growing pains’ (p = 0.005) than late-onset RLS. Patients with RLS and hypersomnia were younger (p = 0.01) and less commonly had painful sensations (p = 0.04) than patients with RLS and insomnia. Patients with idiopathic RLS were younger (p = 0.004), and less commonly had insomnia (p = 0.01) than patients with symptomatic RLS. Conclusions: RLS is a clinically pleomorphic syndrome, reflecting the contribution of multiple genetic and acquired factors in the pathogenesis of RLS.
Effects of Moderate and High Doses of Alcohol on Carotid Atherogenesis
Authors: Bo P. , Marchioni E. , Bosone D. , Soragna D. , Albergati A. , Micieli G. , Trotti R. , Savoldi F.
Published: April 2003

The role of alcohol consumption on pathophysiology of atherosclerosis is not completely well established. Past studies were conducted with different methodological approaches, sometimes leading to opposing conclusions. The aim of this study was to determine the weight of alcohol intake on carotid atherosclerosis in a group of subjects asymptomatic for cardio-cerebrovascular diseases. They were examined by ultrasonographic assessment during the period 1993 through 1997. Common risk factors of atherosclerosis and drinking habit were assessed by a standardized questionnaire. In this survey we confirm the J-shaped relationship between atherosclerosis and alcohol consumption. The effect of alcohol intake is more evident if we consider the presence of multiple internal carotid stenosis, or those greater than 25%, as outcome variables. These effects are independent from the other risk factors included in logistic regression paradigms (age, arterial hypertension, dyslipidemia, diabetes mellitus, family history of cardio-cerebrovascular disease, smoking and social status). Our study supported that a high level of alcohol intake plays a role as an independent factor in carotid atherogenesis.
Atherosclerotic Aortic Arch Plaques in Cryptogenic Stroke: A Microembolic Signal Monitoring Study
Authors: Castellanos Mar , Serena Joaquín , Segura Tomás , Pérez-Ayuso M. Jesús , Silva Yolanda , Dávalos Antoni
Published: April 2003

Background and Purpose: To find out the prevalence of relevant atherosclerotic plaques in the aortic arch and their potential role as a source of embolism in cryptogenic stroke. Methods: We performed a transoesophageal echocardiography (TEE) on 49 patients with cryptogenic stroke from a total series of 212 non-selected patients with acute ischaemic stroke studied prospectively by cranial computed tomography (CT), colour-duplex and transcranial Doppler (TCD) sonography with micro-embolic signal (MES) monitoring. Cryptogenic stroke was diagnosed in those patients without carotid or intracranial stenosis >50%, nor lacunar or cardio-embolic strokes. We defined relevant plaques as those ≧4 mm thick located in the ascending aorta or proximal arch. Results: Twenty-three patients (46.9%) had atherosclerotic aortic plaques (AAP): 3 in the ascending aorta (in 1 ≧4 mm), 11 in the proximal aortic arch (in 4 ≧4 mm) and 9 in the descending aorta (in 5 ≧4 mm). Hence, 5 patients (10.2%) had relevant plaques. Aortic plaques were significantly related to older age (p < 0.001) and male gender (p = 0.042). A carotid artery stenosis <50% was found in 39% of patients with AAP and in 8% of those without AAP (p = 0.009). MES were detected in 3 patients with plaques ≧4 mm thick, but not in those without AAP or with AAP <4 mm thick (p = 0.006). Conclusion: Although few patients with cryptogenic stroke had relevant plaques in our non-selected population, our results support the hypothesis that relevant aortic plaques have embolic potential.
Drug-Induced Headache: Long-Term Follow-Up of Withdrawal Therapy and Persistence of Drug Misuse
Authors: Fritsche G. , Eberl A. , Katsarava Z. , Limmroth V. , Diener H.C.
Published: April 2003

Patients suffering from migraine, tension-type headache (TTH), or combined headache (CH) are at risk of developing drug-induced headache (DIH) due to regular use of analgesics, ergot alkaloids, and triptans. The aim of our study was to determine (1) the clinical features of DIH, (2) the outcome of withdrawal therapy using high methodological standards, and (3) predictors which could explain the high relapse rate (more than 40%) after a previously successful withdrawal therapy. We retrospectively reviewed 103 patients with migraine or TTH who underwent withdrawal therapy between 1994 and 1998. The long-term follow-up (2–4 years after therapy) was conducted by phone and by specially trained psychologists using a structured interview which enclosed characteristics of headache and medication behavior as well as patients global assessment of success. Complete sets of data were available from 83 patients (38 migraine, 26 TTH, 19 CH). The most frequently abused drugs were caffeine-combined analgesics (24%), followed by caffeine-combined ergotamines (19%), pure ergot alkaloids (17%), and monoanalgesics (17%). 48.5% of the patients suffered an abuse relapse within 4 years and developed the complete features of DIH again. Analgesic and ergot alkaloid combinations with caffeine lead significantly more often to a relapse. A long-term successful therapy is connected with a significant reduction of the frequency of headache attacks. Under relapse conditions, the patients reached their former headache frequency level. The data show a higher relapse rate than previously assumed and that certain substance groups bear a higher relapse risk.
Functional Properties of Circulating and Transmigrated Neutrophils in a Rat Peritonitis Model
Authors: Mori T. , Masuda M. , Takahashi H. , Hioki K.
Published: April 2003

Using a rat peritonitis model, we examined the pattern of expression of adhesion molecules and H2O2 productivity of neutrophils by indirect immunofluorescence and flow cytometry. H2O2 production in blood neutrophils was significantly increased after peritonitis induction. The expression of CD11b and CD18 antigens on blood neutrophils was also significantly increased after peritonitis induction. In contrast, H2O2 production in peritoneal neutrophils was significantly lower than that in blood neutrophils. The expression of CD11b and CD45 antigens on peritoneal neutrophils was significantly higher than on blood neutrophils. Although no function has been assigned to LFA-1 on neutrophils, the expression of LFA-1 (CD11a/CD18) on peritoneal neutrophils was significantly decreased.
Measurement of Voice Onset Time in Dysarthric Patients: Methodological Considerations
Authors: Özsancak Canan , Auzou Pascal , Jan Mary , Hannequin Didier
Published: April 2003

Voice onset time (VOT) reflects the timing control between laryngeal and supralaryngeal adjustments. It has been studied both in normal speakers and patients with speech disorders, but very little information has been published on the feasibility of this measure in clinical practice. We examined 10 repeated utterances involving the voiceless stop consonants [p], [t] and [k] in 110 subjects (27 controls, 48 with spastic dysarthria and 35 with hypokinetic dysarthria). The mean rate of measurable VOT was 95% for normal speech, 80% for hypokinetic dysarthria and 84% for spastic dysarthria. The main obstacle to successful measurement was lack of the burst signifying the release of the plosive. The posterior stop [k] presented the greatest measurement difficulties for the dysarthric subjects, which is in accordance with previous perceptual reports on dysarthria.
Symptomatic Differences in Decreased Alternating Motion Rates between Individuals with Spastic and with Ataxic Dysarthria: An Acoustic Analysis
Authors: Ozawa Yoshiaki , Shiromoto Osamu , Ishizaki Fumiko , Watamori Toshiko
Published: April 2003

Acoustic analysis was conducted to investigate symptomatic differences in decreased oral alternating motion rates (AMRs) between individuals with spastic and with ataxic dysarthria. The subjects were 6 individuals with spastic dysarthria, 6 with ataxic dysarthria and 6 normal speakers. Monosyllables /pa/ and /ta/ were used to examine alternating motions of the lips and tongue, respectively. In the decreased AMRs of the spastic group, the mean syllable durations were generally longer in the individuals where the mean total syllable durations were longer, and in the decreased AMRs of the ataxic group, the mean gap durations were generally longer in the individuals where the mean total syllable durations were longer. It was suggested that each syllable component could represent a separate function and contribute differently to the decreased AMRs in these dysarthric groups.
Multiparametrische Stimmqualitätserfassung männlicher und weiblicher Normalstimmen
Authors: Pützer Manfred
Published: April 2003

Die vorliegende Studie hat die Definition von Stimmprofilen zur männlichen und weiblichen Normalstimme zum Gegenstand. Für die Stimmqualitätserfassung, die mit Hilfe zweier kommerziell erhältlicher Stimmanalyseprogramme (MDVP und EGG-Programm von Kay Elemetrics) mit akustischer bzw. elektrophysiologischer Untersuchungsausrichtung angegangen wird, wurden Vokalproduktionen von 300 stimmgesunden erwachsenen Personen (150 männliche und 150 weibliche) analysiert. In einem ersten Schritt wird für die beiden Programme getrennt auf der Grundlage der Analysen ein geschlechtsdifferenziertes mittleres Stimmprofil präsentiert. Hierbei belegen die signifikant unterschiedlichen Mittelwerte der Analyseparameter die Notwendigkeit einer separaten Bearbeitung der männlichen und weiblichen Signale. In einem zweiten Schritt werden mit Hilfe der MDVP-Parameter zwei durch Clusterverfahren gewonnene numerisch bedeutsame Untergruppen für beide Geschlechter dargelegt. Für eine Profildifferenzierung erweisen sich die MDVP-Parameter geeigneter als diejenigen des EGG-Programms, weil diese keine weitere Differenzierung liefern. Eine abschliessende Betrachtung der Relevanz der Analyseparameter beider Programme für normalstimmliche Profildifferenzierungen durch eine Faktorenanalyse unterstreicht ebenfalls den Vorzug, den die MDVP-Parameter gegenüber den EGG-Parametern geniessen.
Velopharyngeal Function from the Age of Three to Eight Years in Cleft Palate Patients
Authors: Pulkkinen Joonas , Haapanen Marja-Leena , Paaso Marjukka , Laitinen Jaana , Ranta Reijo
Published: April 2003

The purpose of this investigation was to study changes of velopharyngeal function between the ages of 3 and 8 years. The subjects were 65 (30 girls and 35 boys) Finnish-speaking non-syndromic children with isolated cleft palate (CP, n = 35) and with unilateral cleft lip and palate (UCLP, n = 30) operated primarily at the age of 1.0–2.0 years. Before the age of 8 years, 16 children required velopharyngoplasty (VPP, ad modum Hoenig). The children were followed up for speech at the age of 3, 6 and 8 years. The perceptual speech characteristics nasal air emission, hypernasality, weakness of pressure consonants and compensatory articulations were registered. Indications for a velopharyngeal flap (by VPP) were identified on the basis of perceptual speech characteristics and confirmed by instrumental examinations. The results indicated that the method and timing of primary palatoplasty and sex did not correlate with the quality of velopharyngeal function. It was good both in children treated conservatively or with VPP at the age of 8 years. The children with a flap required speech therapy significantly more often than other children. No child with VPP and only 12% of the children without VPP had simultaneous nasal air emissions and hypernasality. Compensatory articulation was completely eliminated and weakness of pressure consonants was diagnosed only in 1 child without VPP. The CP children required significantly more often a velopharyngeal flap than the UCLP children. In conclusion, the CP and UCLP children develop a similar velopharyngeal function but in a different way.
A Comparison between the Daytime and Night Time Diet, Activity and Feeding Height of the Black Lemur, Eulemur macaco (Primates: Lemuridae), in Lokobe Forest, Madagascar
Authors: Andrews Josephine R. , Birkinshaw Christopher R.
Published: April 2003

The monthly daytime and night-time diet, activity and feeding height of an habituated black lemur group were compared by ‘auditory group sampling’ for a total of 561 daytime hours and 472 night-time hours in Lokobe Forest, Madagascar. Both the daytime and night-time diets were dominated by fruit, but the former was more diverse than the latter and included more leaves. Some food items were eaten mainly or solely at night or during the day. The proportion of total time spent feeding was variable and was lowest between March and June, coinciding with a dearth of ripe fruit. The proportion of night-time spent feeding exceeded the proportion of daytime spent feeding during August, September, October and December. The group fed more frequently in the undercanopy during the day and the canopy during the night. The ratio of time spent feeding to time spent travelling was significantly smaller during the day compared to the night. These differences can be best explained by the group preferring to feed in the undercanopy during the day and the canopy at night.
Managing Expectations in the Long-Term Treatment of Alzheimer’s Disease
Authors: Gauthier S.
Published: April 2003

Alzheimer’s disease (AD) is rare before the sixth decade of life, but becomes more prevalent with age. As the elderly proportion of the population is increasing, the prevalence of AD is predicted to expand. Although there is no ’cure’ for AD, focused therapeutic interventions may be initiated at a treatable stage of the disease if a diagnosis of AD is established early. For example, cholinesterase inhibitor therapy that is targeted towards the mild to moderate disease stages might be initiated. Results from an open-label study suggest that the benefits of donepezil are maintained for at least 2 years. The disease has major implications for the patients’ caregivers, who experience a burden that increases over time and which may result in a significant loss of income. Both patients and caregivers can benefit from pharmacological and nonpharmacological therapeutic strategies. For example, caregiver support programmes may ease the burden of AD and result in a greater potential for the successful treatment of patients with AD, and may delay or even prevent the early institutionalization of the patient. Currently, therefore, pharmacological treatments, supported by nonpharmacological strategies, are the mainstay of therapy for AD patients and their caregivers. In the future, studies are required to clarify whether other compounds, including oestrogen replacement therapy, antioxidants and anti-inflammatory, may slow or delay disease onset, or halt disease progression.
The Inverse Association between Age and Cholesterol Level among Older Patients: The Role of Poor Health Status
Authors: Volpato Stefano , Zuliani Giovanni , Guralnik Jack M. , Palmieri Elisabetta , Fellin Renato
Published: April 2003

Background: The total cholesterol concentration decreases with age in older people. The reasons for this phenomenon are controversial. This study investigated the hypothesis that poor health status is a determinant of the inverse association between age and cholesterol in older persons. Methods: Cross-sectional study of 2,486 (53% women) older medical patients (≧65 years) admitted at 35 centers of the Gruppo Italiano di Farmacovigilanza nell’Anziano (GIFA) study in Italy. Total cholesterol was measured on the first day after admission to the hospital. Disease burden and comorbidity were assessed by the Charlson index; low serum albumin and iron were considered markers of frailty and poor health. Results: In men there was a significant, inverse age-cholesterol relationship (–0.97 mg/dl per year, p < 0.001). In women the association was nonlinear and cholesterol significantly decreased after the age of 75 (–0.95 mg/dl per year, p < 0.005). In multiple linear regression analysis, indicators of poor health accounted for almost two thirds of the crude effect of age on the cholesterol level in both men and women (adjusted coefficients for age were: for men, –0.38 mg/dl per year, p = 0.044; for women after the age of 75, –0.37 mg/dl per year, p = 0.205). The unadjusted probability of having low cholesterol significantly increased with age among men (p for trend <0.005). In multiple logistic regression, indicators of poor health were strongly associated with low cholesterol in both men and women. After adjusting for indicators of poor health, the association between age and low cholesterol in men was no longer present. Conclusion: These findings suggest that the age-dependent reduction of cholesterol often observed in clinical and epidemiologic studies is substantially explained by the effect of poor health status. Low cholesterol in older persons may be a marker of poor health.
Changing Colour Preferences with Ageing: A Comparative Study on Younger and Older Native Germans Aged 19–90 Years
Authors: Dittmar Manuela
Published: April 2003

Background: Previous studies have shown that colour preferences change from early childhood to adulthood. Objective: The main objective of this study was to assess whether colour preferences undergo further changes during adult life. Methods: Cross-sectional data on colour preferences were collected in 842 adults (aged 19–90 years) living in Mainz, Germany. The sample was split by age into younger (183 men, 232 women) and older (157 men, 270 women) adults. The subgroups were compared for their most and least preferred colours that they had chosen by name out of four given colours (blue, green, red, yellow). Differences in the pattern of frequencies between sexes and age groups were assessed for statistical significance using chi-square analyses. Results: Both age groups and both sexes chose blue as most preferred colour and yellow as least preferred one; green and red fluctuated in the middle position of the rank order of preferences. All frequency distributions departed significantly from chance (p < 0.001). In both younger and older adults, significant sex differences did not exist for the ranking of the most preferred colours (p > 0.2), but were evident in the ranking of the least preferred colours (p < 0.01); men stated more often yellow and less often red as least preferred than women did. Age group differences in colour preferences were highly significant. With advancing age, the preference for blue decreased steadily, whereas the popularity of green and red increased (p < 0.001). Conclusions: The results suggest that colour preferences change during the course of the adult life span. These changes seem to be a reversal of the trend reported in the literature for children. Changed colour preferences in the aged might be attributed to alterations in colour discrimination and visual imagery, the yellowing of the crystalline lens, and the decreased function of the blue cone mechanism with ageing.
Smoking Cessation
Authors: Gosney Margot
Published: April 2003

Smoking cessation has been shown to be cost effective, even in older individuals. It is therefore important that this health promotion is not missed in this vulnerable group.
Risk Factors of Aspiration Pneumonia in Alzheimer’s Disease Patients
Authors: Wada Hideki , Nakajoh Kazushi , Satoh-Nakagawa Takuma , Suzuki Tomoko , Ohrui Takashi , Arai Hiroyuki , Sasaki Hidetada
Published: April 2003

Background: Pneumonia is the reported cause of death of a high proportion of Alzheimer’s disease (AD) patients. Objectives: This study assessed swallowing function to explore the potential risk factors of aspiration pneumonia in AD patients. Methods: Data were gathered on 121 AD patients (mean age 78.2, SD 7.5, male/female ratio = 48/73) treated in two psychiatric hospitals. Multiple logistic regression analysis was used to estimate odds ratios for the risk of aspiration pneumonia. The following risk factors were considered: age, severity of dementia, silent brain infarction (SBI) in the basel ganglia, use of psychotropic drugs (neuroleptics and benzodiazepines), and gender. The latency time of the swallowing reflex was analyzed (1) among groups based on the severity of dementia; (2) between groups with and without SBI in the basal ganglia; (3) before and after the use of psychotropic drugs in the group without SBI in the basal ganglia, and (4) between males and females. Results: Aspiration pneumonia in ambulatory AD patients was significantly and independently associated with severe dementia, presence of SBI in the basal ganglia, intake of neuroleptics, and the male gender. The mean latency of the swallowing reflex in the severe AD group was significantly longer compared to that in the mild-to-moderate AD group. The mean latency of the swallowing reflex after the intake of neuroleptics was significantly prolonged compared to that obtained before any neuroleptic intake, whereas there was no significant difference in the mean latency of the swallowing reflex before and after benzodiazepine intake. Conclusion: We recommend the use of the smallest efficacious dosage of neuroleptics especially in treating severely demented AD patients with basal-ganglia infarction. As soon as the behavioral and psychiatric problems are resolved, drug tapering or discontinuation should be considered in order to prevent life-threatening aspiration pneumonia.
Comparison of Four Bioelectrical Impedance Analysis Formulas in Healthy Elderly Subjects
Authors: Genton Laurence , Karsegard Véronique L. , Kyle Ursula G. , Hans Didier B. , Michel Jean-Pierre , Pichard Claude
Published: April 2003

Background: Changes of body composition occur with aging and influence health status. Thus accurate methods for measuring fat-free mass (FFM) in the elderly are essential. Objective: The purpose of this study was to compare FFM obtained by three bioelectrical impedance analysis (BIA) published formulas specific for the elderly and one equation intended for all age groups, with FFM derived from dual-energy X-ray absorptiometry (FFMDXA), in healthy elderly subjects. Methods: Healthy Caucasian subjects over 65 years (106 women, age 75 ± 6.2, body mass index 25.2 ± 4.1 and 100 men, age 74.6 ± 6.6, body mass index 25.8 ± 3.0) were measured by DXA (Hologic QDR-4500) and BIA (Xitron, 50 kHz). FFMBIA was calculated by the published formulas of Deurenberg, Baumgartner, Roubenoff and Kyle and compared to FFMDXA by a Bland-Altman analysis. Results: The Deurenberg and Roubenoff BIA formulas underestimated FFM compared to DXA by –7.1 and –2.9 kg in women and –6.7 and –2.3 kg in men, respectively. The Baumgartner formula overestimated FFM by 4.3 kg in women and 1.4 kg in men. The Kyle formula showed differences of 0.0 kg in women and 0.2 kg in men, and the limits of agreement of FFMBIA (Kyle) relative to FFMDXA were –3.3 and +3.3 kg for women and –3.8 and +4.3 kg for men. Conclusion: The Kyle BIA formula accurately predicts FFM in elderly Swiss subjects between 65 and 94 years, with a body mass index of 17 to 34.9 kg/m2. The other BIA formulas developed especially for the elderly are not valid in this population.
The Aging Liver
Authors: Zeeh J. , Platt D.
Published: April 2003

Background/Objective: Numerous age-related changes in hepatic structure and function have been described, although liver function seems to be quite well maintained in old age. Few consistent and reproducible observations and a lack of correlation between structural and functional data characterize the present state of our knowledge. In contrast to renal clearance, no equally reliable method exists to estimate hepatic drug clearance. The contribution of age to altered drug clearance in the elderly is difficult to assess as drug interactions, numbers and types of drugs taken at a time, underlying disease and increased interindividual variability are superimposed to the aging process. Methods: A comprehensive computer-assisted search of the literature. Results: A decline in liver volume and blood flow and a reduction in in vitro and in vivo metabolic capacity have been shown in older subjects, and the physiologic basis of reduced hepatic drug clearance in this age group. Conclusions: After decades of research into the matter, the old and well-known aphorism ‘start lower – go slower’ is valid more than ever in the field of geriatric prescribing. Not only renally excreted drugs but also substances which are metabolized and excreted by the liver should be used at a starting dose which is 30–40% smaller than the average dose used in middle-aged adults.
Pathogenesis of Endometriosis: The Role of Peritoneal Fluid
Authors: Koninckx P.R. , Kennedy S.H. , Barlow D.H.
Published: April 2003

Peritoneal fluid is a specific microenvironment. It originates mainly as an ovarian exudation product due to increased vascular permeability, and contains large amounts of macrophages and their secretion products, which include growth factors, cytokines and angiogenic factors. Similarly, within the ovary, there is also a specific microenvironment, best characterised by the follicular milieu with steroid hormone concentrations that are 1,000 times higher than in plasma. Since endometrial cells in peritoneal fluid and superficially implanted cells will be influenced by peritoneal fluid concentrations, any differences found between minimal endometriosis and eutopic endometrium could be the consequence of their different local environments, rather than inherent cellular differences. Superficial endometrial implants may be regulated by factors in peritoneal fluid, while deep endometriosis and cystic ovarian endometriosis may be under the influence of factors in blood and within the ovary, in which case minimal endometriosis may be physiologic only, while deep endometriosis and cystic ovarian endometriosis, both associated with pelvic pain and infertility, may be a pathological state. In conclusion, the local endocrine environment, that is, in blood, peritoneal fluid, and within the ovary, should be taken into account to explain the differences between superficial, deep and cystic ovarian endometriosis, together with inherent differences in the endometrial cells of women with and without endometriosis.
Expression of Aromatase Cytochrome P450 in Eutopic Endometrium and Its Application as a Diagnostic Test for Endometriosis
Authors: Kitawaki Jo , Kusuki Izumi , Koshiba Hisato , Tsukamoto Katsumi , Honjo Hideo
Published: April 2003

Endometriotic implants, like other estrogen-dependent tumors, contain both estrogen receptors and aromatase cytochrome P450 (P450arom), suggesting that at a local level, endometriotic implants produce estrogens, which may be involved in tissue growth through interaction with the estrogen receptors. P450arom is also expressed in the eutopic endometria of patients with endometriosis, adenomyosis, and/or leiomyomas, whereas neither P450arom protein nor mRNA is expressed in the eutopic endometria of normal menstruating women with cervical carcinoma in situ yet showing no other gynecological disease (disease-free). Examination of P450arom expression in endometrial biopsy specimens enables the physician to discriminate between the presence and absence of endometriosis, and may be used as an initial screening at outpatient infertility clinics.
Prevalence of Endometriosis in Ovarian Cancer
Authors: Yoshikawa Hiroyuki , Jimbo Haruko , Okada Satoshi , Matsumoto Koji , Onda Takashi , Yasugi Toshiharu , Taketani Yuji
Published: April 2003

Endometriosis may be the precursor of clear cell or endometrioid ovarian cancer. In this review, we focus on the prevalence of endometriosis in ovarian cancer and related clinical and epidemiological issues. According to 15 published reports, the rank order of the prevalence of endometriosis in each histologic type was clear cell (39.2%) > endometrioid (21.2%) > serous (3.3%) > mucinous type (3.0%). The high prevalence of endometriosis in clear cell and endometrioid types is a consistent finding in Japan and western countries. However, the incidence of the clear cell type is much higher (15–20% vs. 7–8%), and that of the endometrioid type is lower (7–16% vs. 18–26%), in Japan compared with western countries. This review is also concerned with the relationship between the presence of ovarian endometriosis and clinical features such as age, parity, menopausal status, clinical stage, and survival in ovarian cancer patients.
Invasive Capacity of Heterotopic Endometrium
Authors: Kobayashi Hiroshi
Published: April 2003

Because endometriotic tissue is capable of implantation and invasion, it resembles neoplastic tissue. This biologic behavior is likely regulated by cell adhesion molecules and enzymes that degrade the extracellular matrix. A potential factor in the local regulation of tumor cell invasion is the urokinase-type plasminogen activator (uPA) system. This study was undertaken to characterize the expression of both uPA and its receptor (uPAR) in the eutopic and heterotopic endometrial cells from women with adenomyosis by testing both types of epithelial cells for invasive ability. By Western blot and zymographic analyses, stromal cells from heterotopic endometrium secreted 12 times more uPA antigen and uPA-dependent caseinolytic activity than did the eutopic stromal cells. The heterotopic epithelial cells overexpressed uPAR by a factor of four times the expression seen in the eutopic epithelial cells. When respective stromal cells were cocultured, the heterotopic epithelial cells exhibited significantly higher invasive ability through Matrigel than did the eutopic epithelial cells. uPAR overexpression in the epithelial cells and high secretion of uPA from the stromal cells may contribute to the invasive phenotype of heterotopic endometrium.
Proliferative Activity and Genetic Alterations in TP53 in Endometriosis
Authors: Toki Toshihiko , Nakayama Kuniaki
Published: April 2003

In the secretory phase of the menstrual cycle, proliferative activity and expression levels of cell cycle-regulatory molecules are higher in endometriotic lesions than in the corresponding eutopic endometrium. In some endometriotic lesions, proliferative activity remains high in the postmenopausal period. By immunostaining, one can recognize TP53 overexpression in epithelial cells in a considerable number of endometriotic lesions. In those endometriotic lesions that show TP53 overexpression, neither TP53 point mutations (exons 5 to 8) nor microsatellite alterations (microsatellite instability or loss of heterozygosity) has been detected. Thus, the TP53 overexpression demonstrated in endometriotic epithelia seems to result from an overproduction of wild-type TP53 protein. The biological role of TP53 in endometriotic lesions is still unclear.
Common Genetic Changes between Endometriosis and Ovarian Cancer
Authors: Obata Koshiro , Hoshiai Hiroshi
Published: April 2003

We analyzed 81 ovarian cancers for loss of heterozygosity (LOH) on 10q23 and for mutations in PTEN. LOH was common among the endometrioid (43%) and serous (28%) cancers, but was infrequent among the other histological subtypes. Somatic PTEN mutations were detected in seven (21%) endometrioid cancers and the mutation in all informative cases was accompanied by loss of the wild-type allele. One mucinous cancer without 10q23 LOH was shown to harbor two somatic PTEN mutations. Frequent LOH was observed on chromosome 6q (60.0%) and chromosome 10q (40.0%) in ovarian atypical endometriosis, but no PTEN mutations were observed. These findings support the hypothesis that endometrioid and clear cell ovarian carcinomas may arise through malignant transformation of endometriotic lesions.
Vaginal Ultrasound as an Adjunct to Cervical Digital Examination in Women at Risk of Early Delivery
Authors: Zlatnik Frank J. , Yankowitz Jerome , Whitham Jacalyn , Burmeister Leon F.
Published: April 2003

Aim: To study the utility of transvaginal ultrasound (TVU) in women at high risk of preterm delivery. Methods: Women who were scheduled for frequent digital examinations of the cervix from 16 to 26 weeks of gestation had TVU determinations of cervical length before their clinical examinations. Clinicians were blinded to the TVU results. Therefore, clinical decision-making was independent of the unreported TVU data. The plan was to relate the ultrasound characterization of the cervix to the study’s primary endpoint, the need for hospitalization prior to 26 weeks of gestation for: preterm premature rupture of membranes, preterm labor, cerclage placement, or delivery. Results: Seventeen subjects completed the study. All 3 who met the primary endpoint had ultrasound cervical lengths <20 mm on earlier prenatal visits, when digital examinations of the cervix did not detect problems. A 4th woman had ultrasound lengths <20 mm (she delivered at 276/7 weeks). Conclusion: TVU determination of cervical length provides an earlier warning of cervical shortening than does digital examination.
Postcesarean Small Bowel Volvulus
Authors: Sherer David M. , Abulafia Ovadia
Published: April 2003

Volvulus is an uncommon cause of bowel obstruction during pregnancy. We present an unusual case in which cesarean delivery at 26 weeks of gestation was complicated by volvulus of the small bowel 1 week following delivery. At laparotomy, detorsion of the loop of the terminal ileum sufficed, and bowel resection was not required. We review the literature pertaining to volvulus of the bowel during pregnancy and discuss recent new diagnostic imaging modalities for midgut volvulus, which may assist early noninvasive diagnosis of this condition.
Pregnancy in Women with Epilepsy
Authors: Laskowska Marzena , Leszczyńska-Gorzelak Bożena , Oleszczuk Jan
Published: April 2003

The aim of this study was to analyze the outcome of pregnancy and delivery in epileptic women. A retrospective review of the 41 pregnant women with epilepsy who delivered in the Department of Obstetrics and Perinatology of the University School of Medicine in Lublin over 7 years (1993–1999) was carried out. Women with epilepsy had more pregnancy complications including premature labor, anemia, hypertension, vaginal bleeding, urinary tract infection, nausea and vomiting. An increased risk of congenital malformations and intrauterine fetal growth retardation was observed. Women with epilepsy require more extensive pregnancy planning including neurologic and preconceptional care.
Regulation of Human Endometrial Stromal Decidualization by Macrophage Colony-Stimulating Factor
Authors: Tanaka Tetsuji , Sakamoto Tomoko , Umesaki Naohiko , Ogita Sachio
Published: April 2003

Decidualized human endometrial stromal cells and human decidual CD56+ cells are reported to produce macrophage colony-stimulating factor (M-CSF), although its physiological roles remain unclear. In this study, the effects of M-CSF on cell viability and 8-Br-cAMP-stimulated decidualization of normal human endometrial stromal cells are examined by using an in vitro decidualization activity assay system. M-CSF alone affected neither the viable cell numbers nor PRL release of nonstimulated stromal cells, while high concentrations of M-CSF strongly suppressed the viable cell numbers and PRL secretion of stromal cells costimulated with 8-Br-cAMP and M-CSF. However, M-CSF did not suppress the viable cell numbers and PRL secretion of 8-Br-cAMP-induced decidualized cells. These results indicate that high concentrations of M-CSF can suppress the cell viability of stromal cells in the decidualization process, and inhibit decidualization of endometrial stromal cells. Thus, nonpregnant decidual M-CSF may autoregulate decidualization and the viable cell numbers of endometrial stromal cells in a paracrine manner.
Fetal Circulatory Responses to Maternal Blood Loss
Authors: Suzuki Shunji , Tateoka Sachi , Yagi Shutaro , Ishikawa Gen , Ohshita Tomoko , Sawa Rintaro , Yoneyama Yoshio , Asakura Hirobumi , Araki Tsutomu
Published: April 2003

We examined the fetal circulatory responses to maternal blood loss in pregnant women during the third trimester. Seven healthy women with placenta previa and singleton pregnancies underwent phlebotomies in an autologous donation program. Four hundred milliliters of blood was collected within 15 min at 34 and 35 weeks of gestation. Continuous electric recordings of fetal heart rate were performed during the first blood collection, and the maternal uterine artery (UtA), umbilical artery (UmA) and fetal middle cerebral artery (MCA) Doppler velocity waveforms were recorded before, immediately after and 24 h after the second collection in each patient. The average fetal heart rate, maternal UtA and UmA pulsatility indices did not change measurably during or after maternal blood collections. However, the average fetal MCA pulsatility index decreased significantly 24 h after maternal blood loss. The observation of a decrease in fetal MCA pulsatility index may indicate delayed fetal asphyxia following mild maternal hemorrhage.
Combined Tension-Free Vaginal Tape and Prolapse Repair under Local Anaesthesia in Patients with Symptoms of Both Urinary Incontinence and Prolapse
Authors: Jomaa Martin
Published: April 2003

Objective: To study the combination of tension-free vaginal tape (TVT) and prolapse repair under local anaesthesia in patients suffering from stress incontinence and prolapse. Study Design: The study was designed as a prospective, open, nonrandomized study. A standardized protocol was used for pre- and postoperative evaluation. Check-ups were performed after 2, 6, 12 and 24 months. The protocol included medical history, stress test (supine and standing position with a comfortably filled bladder), life quality assessment including a visual analogue scale, 24- to 48-hour pad test, and 48-hour micturition diary. Patients: In total 32 patients participated. All suffered from urinary stress incontinence (grade 1–3) and prolapse (grade 1–3). 2 patients had previously undergone surgery 2 and 3 times, respectively, for urinary incontinence with methods other than TVT (traditional anti-incontinence surgery). 3 patients had a history of total hysterectomy. 1 patient had a large rectocele with urinary and faecal incontinence. Mean age was 54 (range 31–74) years, mean parity 2 (range 0–5), and mean duration of incontinence 13 (range 2–29) years. Surgical Technique: TVT was carried out according to the standarized technique as originally described. The prolapse repair included anterior and/or posterior colporrhaphy. All operations could be performed under local anaesthesia. Results: 30 of 32 patients (93%) were cured. One patient (3%) was considerably improved, and 1 patient (3%) was considered a failure. Mean urinary leakage in 24 h was 96 (range 12–355) g preoperatively, and postoperatively 2.7 (range 0–28) g. Mean intraoperative bleeding was 75 (range 25–300) ml. Mean residual urine preoperatively was 15 (range 0–85) ml, and postoperatively 7 (range 0–40) ml. The mean stay in hospital after surgery was 2 (range 1–5) days. No postoperative urinary retention, no defective healing, and no tape rejection occurred. There was one uneventful bladder perforation in a patient who had previously undergone traditional incontinence surgery. This patient left the hospital the day after surgery without postoperative catheterization. Conclusion: The study clearly demonstrates that TVT can be combined with prolapse surgery to effectively treat symptoms of prolapse and urinary stress incontinence.
Assisted Reproductive Technologies in Conjunction with Conservatively Treated Endometrial Adenocarcinoma
Authors: Ogawa Shuichi , Koike Toshimitsu , Shibahara Hiroaki , Ohwada Michitaka , Suzuki Mitsuaki , Araki Shigeo , Sato Ikuo
Published: April 2003

This case report illustrates the successful use of assisted reproductive technologies (ARTs) in a patient receiving conservative treatment for endometrial adenocarcinoma. A 31-year-old infertile woman, diagnosed as FIGO stage Ia endometrial adenocarcinoma (grade 1), received oral medroxyprogesterone acetate 400 mg/day for 12 weeks. Endometrial curettage was performed and the absence of endometrial carcinoma was confirmed. A single pregnancy was achieved with in vitro fertilization and embryo transfer. A healthy female infant was born via cesarean section at 42 weeks’ gestation. The carcinoma has not recurred, and the patient now desires a second child. We conclude that ART combined with progesterone treatment might be a powerful option for the treatment of infertile patients with early stage, well-differentiated endometrial adenocarcinoma.
CD26 and CD30 Expression on the Surface of Lymphocyte during Normal Pregnancy
Authors: Hoshimoto Kazunori , Hayashi Masatoshi , Ohkura Takeyoshi
Published: April 2003

It is increasingly apparent that the Th1/Th2 cell ratio is decreased during pregnancy. In a previous study, we revealed that combined analysis of soluble CD26 and CD30 might be a potent surrogate tool for evaluating the Th1/Th2 balance during pregnancy. Therefore, in the present study, we elucidated whether the CD26 and CD30 expression on the surface of lymphocyte is useful marker for Th1 and Th2 lymphocytes, respectively, during pregnancy with flow cytometric technique. The peripheral blood samples were obtained from 6 non-pregnant healthy women, 8 healthy pregnant women in the first trimester and 12 pregnant women in the third trimester. The mean percentages of CD26 expression did not differ significantly among these groups (p = 0.45). Also, the mean percentages of CD30 expression did not differ significantly among these groups (p = 0.32). From the present study, the expression of CD26 and CD30 did not appear to be a useful marker for Th1 and Th2 lymphocytes during pregnancy.