bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in Cyst Volume following Intraoperative MRI-Guided Ommaya Reservoir Placement for Cystic Craniopharyngioma
Authors: Vitaz Todd W. , Hushek Stephen , Shields Christopher B. , Moriarty Thomas
Published: April 2003

Introduction: Intracavitary treatment of solitary cystic craniopharyngiomas with 32P is an emerging treatment option, especially for pediatric patients. We have treated two patients with solitary cystic craniopharyngiomas using intraoperative MRI (iMRI)-guided catheter placement. Methods: The optical tracking system of the General Electric Signa SP iMRI system was utilized for preoperative planning and intraoperative catheter tracking during insertion. Intraoperative volumetric imaging was then used to confirm final catheter position. Patients were brought back to the iMRI suite approximately 8 weeks later and diluted gadolinium was injected with further MRI to confirm the absence of communication between the cyst lumen and surrounding CSF spaces and for volumetric analysis. Results: Intraoperative imaging illustrated deformation and changes in the cyst wall during catheter placement and cyst aspiration and confirmed final catheter placement. Images acquired 8 weeks following catheter placement prior to the instillation of 32P showed decreases in cyst volume of 40 and 85%. Conclusion: iMRI-guided catheter placement for cystic craniopharyngiomas helps to assure successful catheter placement. Significant decreases in cyst volume occur in the interval between catheter placement and 32P administration and must be accounted for to prevent overdosing of the radioisotope.
Prognostic Factors for Cerebellar Astrocytomas in Children: A Study of 102 Cases
Authors: Desai Ketan I. , Nadkarni Trimurti D. , Muzumdar Dattatraya P. , Goel Atul
Published: April 2003

Objective: To evaluate the prognostic factors influencing the length of survival of pediatric patients with cerebellar astrocytomas. Methods: The clinical data of 102 patients under the age of 12 years with cerebellar astrocytomas were retrospectively analyzed. The radiological features, surgical findings, histology and adjuvant radiotherapy were reviewed. Patients were followed up on an outpatient basis. Computerized tomography (CT) scans of the brain were performed to detect recurrence. Results: The age of the patients at presentation varied from 10 months to 12 years. The mean age at presentation was 7 years and 11 months. The average duration of symptoms was 5.8 months. The clinical features were predominantly related to intracranial hypertension and the location of the tumor. Twenty-six tumors were located in the vermis and 76 in the cerebellar hemisphere. The brain stem was involved in 20 patients. All 102 patients had a preoperative contrast-enhanced CT scan. Midline vermian tumors were predominantly solid and enhancing, whilst the hemispheric tumors were cystic and nonenhancing. The tumors were graded into three subgroups based on histological characteristics: pilocytic astrocytoma, low-grade fibrillary astrocytoma and high-grade fibrillary astrocytoma. Total, radical and subtotal excision, as determined by the surgical impression, were performed in 82, 16 and 4 patients, respectively. Postoperative radiotherapy was administered to 12 patients. CSF diversion was carried out in 11 of 79 cases who had moderate to severe hydrocephalus. Conclusions: Our study has shown that the location of the tumor (p < 0.05), histological grade (p < 0.001) and the extent of tumor resection (p < 0.001) have a significant and definitive relationship to the length of survival of pediatric patients with cerebellar astrocytomas. The patient’s age (p > 0.05) does not influence the outcome. We could not evaluate the effect of brain stem involvement and adjuvant radiotherapy in our study because of the small sample size.
Assessment of Maximum Inspiratory Pressure
Authors: Volianitis S. , McConnell A.K. , Jones D.A.
Published: April 2003

Background: The variability of maximal inspiratory pressure (PImax) in response to repeated measurement affects its reliability; published studies have used between three and twenty PImax measurements on a single occasion. Objective: This study investigated the influence of a specific respiratory ‘warm-up’ upon the repeated measurement of inspiratory muscle strength and attempts to establish a procedure by which PImax can be assessed with maximum reliability using the smallest number of manoeuvres. Methods: Fourteen healthy subjects, familiar with the Mueller manoeuvre, were studied. The influence of repeated testing on a single occasion was assessed using an 18-measurement protocol. Using a randomised cross-over design, subjects performed the protocol, preceded by a specific respiratory warm-up (RWU) and on another occasion, without any preliminary activity (control). Comparisons were made amongst ‘baseline’ (best of the first 3 measurements), ‘short’ series (best of 7th to 9th measurement) and ‘long’ series (best of the last 3 measurements). Results: Under control conditions, the mean increase (‘baseline’ vs. ‘long’ series) was 11.4 (5.8)%; following the RWU, the increase (post RWU ‘baseline’ vs. ‘long’ series) was 3.2 (10.0)%. There were statistically significant differences between measurements made at all 3 protocol stages (‘baseline’, ‘short’ and ‘long’ series) under control conditions, but none following the RWU. Conclusions: The present data suggest that a specific RWU may attenuate the ‘learning effect’ during repeated PImax measurements, which is one of the main contributors of the test variability. The use of a RWU may provide a means of obtaining reliable values of PImax following just 3 measurements.
Multiple Logistic Regression Analysis of Risk Factors for the Development of Steroid-Dependent Asthma in the Elderly: A Comparison with Younger Asthmatics
Authors: Ishioka Shinichi , Terada Michikazu , Haruta Yoshinori , Hiyama Keiko , Hozawa Soichiro , Yamakido Michio
Published: April 2003

Background: The percentage of the aged among all patients with bronchial asthma is increasing. Objective: To investigate the risk factors for the development of steroid-dependent asthma in the elderly. Methods: A multiple logistic regression analysis involving various clinical factors between steroid-dependent and -independent asthma was carried out for 59 asthmatics aged over 60 years, including 16 patients with steroid-dependent asthma. The calculated risk for each factor was compared with that obtained from 122 younger asthmatics aged 20–59 years. Results: Among the factors examined (sex, age, period from onset of asthma, type of asthma and family history of asthma, plus history of smoking, atopic dermatitis, allergic rhinitis, chronic sinusitis and nasal polyps), the significant risk factors for the development of steroid dependency in the elderly asthmatics were only family history of bronchial asthma (relative risk 3.6) and smoking history (relative risk 6.9). Conclusions: Some risk factors for steroid-dependent asthma in younger individuals were not significant in the elderly. Since the smoking history was most closely associated with the development of steroid dependency in the elderly, even though most of them had quit smoking, it is important for patients with asthma to avoid smoking.
Longitudinal Changes of Sensitization to Farming-Related Antigens among Young Farmers
Authors: Prior Christian , Falk Markus , Frank Alexander
Published: April 2003

Background: We have shown previously that the prevalence of allergic sensitization in Tyrolean farming students is high, with a clear relationship to occupational exposure. Objectives: It was the aim of this investigation to assess longitudinal changes in sensitization and a possible impact on lung function. Methods: Of the 147 farming students in the original cohort, we could re-examine 42 after a mean interval of 4.0 years. All individuals completed a questionnaire and had spirometry, skin prick tests, total and specific IgE analysis, and testing for precipitating antibodies. Results: As compared to the first study, there was a decrease in the frequency of IgE-mediated allergy (30.1 vs. 54.8%; p < 0.05) and in total serum IgE levels (107.4 ± 254 vs. 157.8 ± 304 U/ml; p < 0.001). Conversely, 3 individuals had developed precipitating antibodies de novo, and those who had initially had a positive precipitin test (n = 6) were still positive. A larger-sized estate, the lack of a hay dryer, and the presence of moldy hay were confirmed as risk factors for allergic sensitization. Although there was a slight overall decrease in forced vital capacity, no new cases of occupational lung disease were found. Conclusions: In young Tyrolean dairy farmers, the prevalence of precipitins is constantly high and rising while IgE-mediated allergy declines. Within 4 years, no clinically relevant impact of allergy on lung function was noticed.
Airway Foreign Body with Clinical Features Mimicking Bronchial Asthma
Authors: Matsuse Hiroto , Shimoda Terufumi , Kawano Tetsuya , Fukushima Chizu , Mitsuta Kazuko , Obase Yasushi , Tomari Shin-ya , Saeki Sachiko , Kohno Shigeru
Published: April 2003

A 56-year-old Japanese male with persistent cough, stridor and diffuse wheezing for 6 months had obstructive pulmonary dysfunction and airway hyperresponsiveness (AHR) to inhaled methacholine. Because of a poor response to glucocorticoid therapy and neutrophilia in the peripheral blood and sputum, chest computed tomography was performed and a plate-like tumor in the truncus intermedius was identified. Fiberoptic bronchoscopy demonstrated a plate-like green-colored tumor firmly impacted into the truncus intermedius and diffuse inflammatory changes spreading to both main bronchi. A piece of ‘kombu’ (Japanese kelp) was successfully removed by fiberoptic bronchoscopy under general anesthesia. Pulmonary function and methacholine inhalation tests became normal after the removal of the foreign body. In this case, it is suggested that asthma-like symptoms were due to localized airflow limitation in the right bronchus as well as to AHR associated with diffuse airway neutrophilic inflammation.
An Isoflow-Volume Technique for Assessing Airway Dynamics in Children and Adults
Authors: Schibler A. , Frey U. , Kraemer R.
Published: April 2003

Background: We propose a new approach to the measurement of small airway function as an alternative to recordings of maximal expiratory flow-volume (MEFV) curves. Objectives: A newly developed technique to record isoflow-volume (IFV) curves to be tested against maximal respiratory flow curves. Methods: An isoflow whistle (IFW; Iflopen®) measures the length of a constant expiration after full inspiration. The note of the whistle enables a subject to generate an even expiration, and the isoflow maintenance times at 1 l·s–1 (IFMT1) and 2 l·s–1 (IFMT2) are recorded. The accuracy and reproducibility of the IFV technique were evaluated in 17 healthy adults (age 17–55 years) and in 14 asthmatic children (age 6–14 years). Comparisons with standard lung function parameters, such as forced expiratory volume in 1 s (FEV1), maximal expiratory flow at 50% (MEF50) and 25% (MEF25) vital capacity and peak expiratory flow (PEF), obtained with a Wright® Peakflow Meter were undertaken in 102 healthy (aged 8–14 years) and 101 asthmatic children (aged 6–17 years). A bronchial challenge test was performed in 13 asthmatic children. Results: The expired volume measured by the IFW showed an acceptable agreement with that of a pneumotachograph (mean error of 4.32% for IFMT1 and 5.93% for IFMT2). In healthy and in asthmatic children, the correlations between FEV1 and IFMT1 or IFMT2 (r = 0.92 and 0.94, respectively) were found to be greater than that between FEV1 and PEF (r = 0.68). During bronchial challenge tests in 13 asthmatic children, the FEV1 decreased to 69% of baseline and IFMT1 to 58% of baseline. Conclusions: The IFV technique accurately measured airway obstruction and closely followed changes in standard parameters of the MEFV curve.
The Homeostatic Rôle of Bronchoconstriction
Authors: Blyth David I.
Published: April 2003

This article argues in favour of the hypothesis that the homeostatic rôles of bronchoconstriction are to retract the airway tree during expiration, and to assist in the expulsion of mucus from peripheral airways by increasing the velocity of outgoing air. In asthma, this function may be dangerously exaggerated because of the presence of unusually viscous airway secretions and the remodelling of airway walls.
Obstructive Sleep Apnoea Syndrome Is Common in Subjects with Chronic Bronchitis
Authors: Larsson L.G. , Lindberg A. , Franklin K.A. , Lundbäck B.
Published: April 2003

Background: In previous studies we have found that subjects with bronchitis have a higher prevalence of ‘snoring as a problem’ than respiratory healthy subjects. Objectives: We aimed to study whether the high prevalence of snoring among subjects with bronchitis also represents a high prevalence of obstructive sleep apnoea (OSA). Method: Subjects in three age groups born 1919–1920, 1934–1935 and 1949–1950 had been identified as bronchitic in an earlier study (n = 471) and without respiratory symptoms (n = 108). Of the 91 subjects reporting snoring to be a problem, 70 were invited to participate in the study.Sleep investigation was performed in 52 of these 70 subjects. Results: ‘Snoring as a problem’, predicted OSA to a similar degree in both bronchitic and respiratory healthy subjects. The estimated prevalence for obstructive sleep apnoea with an apnoea/hypopnoea index (AHI) 10 as the cut-off point and concomitant daytime symptoms such as daytime sleepiness or liability to nodding off during breaks in activity in the daytime, was 5.4% for bronchitic subjects and 2.3% for respiratory healthy subjects. Apnoea in addition to snoring predicted OSA better than did snoring alone. Age correlated significantly with AHI, and OSA was most common in the middle-aged group, 61–62 years old. Conclusion: OSA is twice as common in subjects with chronic bronchitis as in subjects free of pulmonary disease or symptoms.
Central Venous and Mixed Venous Oxygen Saturation in Critically Ill Patients
Authors: Ladakis Charalambos , Myrianthefs Pavlos , Karabinis Andreas , Karatzas Gabriel , Dosios Theodosios , Fildissis George , Gogas John , Baltopoulos George
Published: April 2003

Background: Although mixed venous O2 saturation (SvO2) accurately indicates the balance of O2 supply/demand and provides an index of tissue oxygenation, the use of a pulmonary artery (PA) catheter is associated with significant costs, risks and complications. Central venous O2 saturation (ScvO2), obtained in a less risky and costly manner, can be an attractive alternative to SvO2. Objectives: To investigate whether the values of ScvO2 and SvO2 are well correlated and interchangeable in the evaluation of critically ill ICU patients and to create an equation that could estimate SvO2 from ScvO2. Methods: Sixty-one mechanically ventilated patients were catheterized upon admission and ScvO2 and SvO2 values were simultaneously measured in the lower part of the superior vena cava and PA respectively. Results: SvO2 was 68.6 ± 1.2% (mean ± SEM) and ScvO2 was 69.4 ± 1.1%. The difference is statistically significant (p < 0.03). The correlation coefficient r is 0.945 for the total population, 0.937 and 0.950 in surgical and medical patients, respectively. In 90.2% of patients the difference was <5%. When regression analysis was performed, among 11 models tested, power model [SvO2 = b0(ScvO2)b1] best described the relationship between the two parameters (R2 = 0.917). Conclusions: ScvO2 and SvO2 are closely related and are interchangeable for the initial evaluation of critically ill patients even if cardiac indices are different. SvO2 can be estimated with great accuracy by ScvO2 in 92% of the patients using a power model.
Parallel Induction of Nitric Oxide and Tetrahydrobiopterin Synthesis in Alveolar Macrophages
Authors: Yoshida Satoshi , Lee Yi-Hyeong , Hassan Mahmood , Shoji Tatsuhiro , Onuma Kazuya , Hasegawa Hiroshi , Nakagawa Hiroshi , Serizawa Shiro , Amayasu Hideaki
Published: April 2003

Background: Nitric oxide (NO) and an essential cofactor for both constitutive and inducible NO synthase (NOS) activity, tetrahydrobiopterin (6R-L-erythro-1′,2′-dihydroxypropyl-2-amino-4-hydroxy-5,6,7,8-tetrahydropteridine; BH4), are thought to be important modulators of function in normal and inflamed airways. However, the exact pathologic roles of NO and BH4 remain obscure. Even less is known about the effects of cytokines on alveolar macrophages. Objective: This study was designed to determine whether NO and BH4 are induced by cytokines in mouse alveolar macrophages and to investigate whether NO synthesis is affected by changes in intracellular BH4 levels in alveolar macrophages. Methods: We compared the induction by lipopolysaccharide (LPS), interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), and interleukin-2 (IL-2) of NO production and BH4 synthesis in alveolar macrophages. To determine whether NO synthesis is affected by changes in intracellular BH4 levels in alveolar macrophages, we used inhibitors of BH4 biosynthesis. Results: Activation of alveolar macrophages induced parallel increases in NO and intracellular BH4 levels, although induction of the latter appears to be somewhat more sensitive than that of the latter to diverse cytokines. Inducible NO production in alveolar macrophages was blocked by inhibitors of BH4 biosynthesis. IL-2, an important component of the immunomodulatory system, was only a weak activator of alveolar macrophages by itself but potently synergized with IFN-γ to stimulate the production of both NO and BH4. Conclusion: Our results suggest that BH4 synthesis in alveolar macrophages is a potential target for therapeutic intervention in airway inflammatory diseases, such as asthma, cystic fibrosis, and acute bronchial infections whose pathology may be mediated by overproduction of NO.
Invasive Thymoma: A Clinical Study of 23 Cases
Authors: Froudarakis Marios E. , Tiffet Olivier , Fournel Pierre , Briasoulis Evangelos , Karavasilis Vasilis , Cuilleret Jacques , Vergnon Jean-Michel
Published: April 2003

Background: Invasive thymoma is a rare mediastinal tumor. Clinicopathological characteristics that influence survival of patients with this tumor are under debate. Treatment is based on tumor resection. The benefice of therapies, such as radiation therapy (RT) and/or chemotherapy (CT) as adjuvant treatments to surgery, or palliative therapy to unresectable or recurrent thymoma are discussed. Objectives: The aim of this study was to assess patients with invasive thymoma, with specific emphasis on factors predicting survival. Methods: We studied retrospectively 23 patients with invasive thymoma. Parameters assessed were age, presenting symptoms, histological features, stage at diagnosis, treatment modalities and survival. All patients received primary therapy: 11 patients (48%) had tumor resection associated with CT and/or RT, while 12 patients had palliative therapy including RT and/or CT. Regimens for CT were based on cisplatin. Results: Patients’ mean age was 58 years. Three patients had stage II disease at diagnosis (13%), 8 patients had stage III (35%) and 12 patients had stage IV (52%). Median overall survival was 20 months (range: 4–160) and five-year survival rate was 43.5% (10 patients). Surgical resection had a significant impact on survival (p < 0.0001). Survival was also related to stage of the disease at diagnosis (p = 0.006), but not to histology of the tumor (p = 0.12). Salvage treatment was of clinical importance: 5 out of 15 patients (33.3%) who relapsed during a 5-year follow-up responded to a multimodality therapeutic approach that affected survival (p = 0.019). Conclusion: Factors determining the outcome of these tumors are the stage of the disease at diagnosis, and the adequacy of surgical removal. Salvage treatment of recurrent thymoma may give a moderate response rate and improve survival.
Future Advances in COPD Therapy
Authors: Barnes Peter J.
Published: April 2003

There is a pressing need for more effective drug treatments for COPD. New bronchodilators include a long-acting anticholinergic tiotropium bromide and a dual β2-dopamine2-receptor agonist. But no treatments prevent the progression of COPD. Mediator antagonists in development include leukotriene B4 antagonists, chemokine receptor antagonists and more potent antioxidants. The inflammation of COPD is resistant to corticosteroids, so new anti-inflammatory drugs need to be developed. These include phosphodiesterase-4 inhibitors, nuclear factor-ĸB inhibitors and p38 MAP kinase inhibitors. Small molecule protease inhibitors, including neutrophil elastase inhibitors and selective matrix metalloproteinase inhibitors are also in development. Future drug targets may be identified by gene array and proteomics.
Fibrogenic and Inflammatory Cytokines Modulate mRNA Expressions of Matrix Metalloproteinase-3 and Tissue Inhibitor of Metalloproteinase-3 in Type II Pneumocytes
Authors: Hoshino Yuma , Mio Tadashi , Nagai Sonoko , Ito Isao , Shigematsu Michio , Izumi Takateru
Published: April 2003

Background: Imbalance between proteinases and their inhibitors released from alveolar type II pneumocytes may cause development of inflammatory lung diseases. Objectives and Methods: We examined mRNA expressions of matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of metalloproteinase-3 (TIMP-3) in a cell line (A549) and in primary culture of normal adult human type II pneumocytes using reverse transcription-competitive polymerase chain reaction. Results: Interleukin-1β (IL-1β) and transforming growth factor-β1 (TGF-β1) increased MMP-3 and TIMP-3 expressions in A549 cells in a time- and concentration-dependent manner. IL-1β mainly augmented MMP-3 expression, while TGF-β1 mainly augmented TIMP-3 expression. Dexamethasone attenuated both IL-1β- and TGF-β1-stimulated expressions of MMP-3 and TIMP-3. Interleukin-10 had no significant effect. Hepatocyte growth factor alone had no effect on constitutive MMP-3 expression or TIMP-3 expression, but it augmented TGF-β1-stimulated MMP-3 expression. The constitutive expressions were higher in normal type II pneumocytes than in A549 cells, but the regulations were similar. Conclusions: These data indicated that the matrix degradation is enhanced by IL-1β and suppressed by TGF-β1 via regulations in the balance between MMP-3 and TIMP-3. Further, these regulations were shown to be modulated by glucocorticoids and growth factors.
A Newly Recognized Syndrome – Radiation-Related Bronchiolitis obliterans and Organizing Pneumonia
Authors: Stover Diane E. , Milite Fulvia , Zakowski Maureen
Published: April 2003

Bronchiolitis obliterans and organizing pneumonia (BOOP) is a syndrome that has been associated with a variety of underlying disorders, including infection, collagen vascular diseases and toxic fume inhalation. Rarely, however, BOOP has been associated with radiation- or chemotherapy-induced pulmonary toxicity. Over the past 3 years, several case series have reported BOOP in the unique setting of radiation in breast cancer patients. This study describes our experience with this newly recognized syndrome and a review of the English-language literature on this syndrome.
Effect of Oxygen on Sleep and Breathing in Patients with Interstitial Lung Disease at Moderate Altitude
Authors: Vázquez Juan-Carlos , Pérez-Padilla Rogelio
Published: April 2003

Objective: To investigate the impact of oxygen on sleep and breathing in patients with interstitial lung disease (ILD) in Mexico City, at 2,240 m of altitude. Participants: Nineteen ILD patients with a mean FVC of 58 ± 17% pred. (SD) and a mean PaO2 of 51 ± 6 mm Hg were recruited from a pulmonary clinic in a tertiary referral center. In addition, 14 normal control subjects, matched for age and gender, were studied. All patients underwent two consecutive full polysomnographies (PSG), one breathing room air and one breathing supplementary oxygen through nasal prongs, in random order. Controls were studied for one night breathing room air. Results: The mean oxygen saturation (SaO2) in ILD patients was 82.3 ± 9.1% during sleep on air and 94.8 ± 2.9% on oxygen (p < 0.001). In controls it was 92.9 ± 1.9% (p < 0.001). Sleep efficiency was similar in patients and controls (75 vs. 82%, p > 0.05) and did not change with oxygen (77%). Arousal index was 12.4 ± 6.9·h–1 in ILD patients breathing room air and 12.9 ± 9.1·h–1 breathing oxygen while in controls it was 11.4 ± 5.4·h–1. Breathing frequency (f) during sleep was 24.7 ± 4.2 in ILD patients and decreased breathing oxygen to 22.5 ± 3.6 (p < 0.001) but was still higher than in controls (15.6 ± 2.7; p < 0.001). Similarly, the heart rate (HR) in ILD and controls was 79 ± 12 and 68 ± 8, respectively (p < 0.001), and decreased to 68 ± 4 when patients breathed oxygen (p < 0.001). Conclusions: Oxygen substantially decreases HR and f, but does not normalize the f in ILD patients. The impact of hypoxia on sleep efficiency and arousal index was not demonstrable in our patients acclimatized to moderate altitude.
Resolution of Ménétrier’s Disease after Helicobacter pylori Eradicating Therapy
Authors: Di Vita Gaetano , Patti Rosalia , Aragona Federico , Leo Pietro , Montalto Giuseppe
Published: April 2003

Some cases of Ménétrier’s disease associated with Helicobacter pylori (HP) have recently been reported in the literature. We report here the case of a 51-year-old man with a diagnosis of Ménétrier’s disease who had previously been unsuccessfully treated with H2 antagonists. A subsequent demonstration of HP infection led us to treat the patient with an eradicating therapy which prompted complete regression of clinical symptoms, resolution of the gastric endoscopic picture, and absence of HP on gastric histology. This result, in accordance with others in the literature, indicates an eventual association of HP infection with Ménétrier’s disease and that consequent therapy is mandatory.
Treatment Options for Functional Dyspepsia
Authors: Vakil Nimish
Published: April 2003

Non-ulcer dyspepsia is a common condition in primary care. The treatment of this condition is still controversial and no single therapy is uniformly effective. In this article we review currently available treatment trials for non-ulcer dyspepsia.
Prevention of Hepatocellular Carcinoma in Chronic Liver Disease: Molecular Markers and Clinical Implications
Authors: Plesch F.N. , Kubicka S. , Manns M.P.
Published: April 2003

The development of hepatocellular carcinoma is generally preceded by chronic liver damage leading to cirrhosis. Prevention of chronic liver diseases can decrease the incidence of hepatic cancer impressively. Many recent investigations have also explored the power of secondary and tertiary prevention in established liver cirrhosis. Screening programs for patients at high risk, antiviral treatment of patients with progressed hepatitis, and adjuvant interventions after curative resection are some of the approaches. However, the cost effectiveness and benefits of such procedures and the prognosis is also dependent on the remaining liver function, there is no consensus to date on how patients should be handled. In the future molecular markers and prognostic scores may help better define the group at risk of developing. To give a perspective to these patients, it is necessary to improve the treatment of hepatocellular carcinoma as well as cirrhosis.
The Use of Drugs within the Techno Party Scene in European Metropolitan Cities
Authors: Tossmann Peter , Boldt Susan , Tensil Marc-Dennan
Published: April 2003

In 1998, a total of 3,503 visitors of techno parties in Amsterdam, Berlin, Madrid, Prague, Rome, Vienna and Zurich were interviewed. With this data, a subtly differentiated portrait of the techno party visitor was drawn, especially with a view to his/her involvement in the scene and the use of psychotropic substances. First of all, the results show that the use of illegal substances such as cannabis, ecstasy, amphetamines and cocaine is relatively widespread in the examined techno party scenes. A central characteristic of the drug use could be described as the polydrug occasional user model characterised by the occasional use of diverse substances that are usually taken together. The significance of the findings is discussed with regard to the practice of drug prevention.
Sociodemographic and Psychological Characteristics Associated with Smoking among Greek Medical Students
Authors: Livaditis M. , Samakouri M. , Kafalis G. , Tellidou C. , Tzavaras N.
Published: April 2003

This study aims to investigate associations between sociodemographic and psychological characteristics and smoking among Greek medical students. The students studied were separated into four groups: non-smokers and occasional, regular and heavy smokers. The students completed a battery of inventories and checklists. Immigrant students, users of other psychoactive substances, students more prone to minor delinquency and students with high scores on activity level, approach to new situations, sociability and novelty seeking showed higher smoking rates. A better understanding of these differences could be useful for the planning of antismoking policy.
Myocardial Infarction Associated with Methadone and/or Dihydrocodeine
Authors: Backmund Markus , Meyer Kirsten , Zwehl Werner , Nagengast Otto , Eichenlaub Dieter
Published: April 2003

Chest pain and myocardial infarction occurring in young people with angiographically normal coronary arteries is well documented. Opiates have a cardioprotective effect and are used in acute heart attacks. We described a 22-year-old opioid addicted male patient who suffered a myocardial infarction following the consumption of methadone and dihydrocodeine.
Are the Twelve Steps More Acceptable to Drug Users than to Drinkers?
Authors: Best D.W. , Harris J.C. , Gossop M. , Manning V.C. , Man L.H. , Marshall J. , Bearn J. , Strang J.
Published: April 2003

The present study is a cross-sectional interview-based investigation comparing experiences of and attitudes towards Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) in a sample of 200 patients attending inpatient substance misuse detoxification services. Two hundred consecutive admissions were recruited; 100 each from one drug and one alcohol in-patient treatment service in which attendance at AA/NA was a voluntary adjunct to a generic treatment programme. Although there were no differences in the history of AA/NA attendance, the drug users (who were on average younger) reported significantly more positive attitudes towards AA/NA, more willingness to attend during their in-patient treatment and greater intention to attend following completion of their detoxification. In particular, despite no differences in spiritual/religious orientation, the drug users reported more positive views of the Twelve Steps. As AA/NA remain popular and accessible forms of substance misuse support, it is critical that we develop a clearer understanding of their impact and of the scope for their integration with generic forms of substance misuse treatment.
Prevention of Suicide by Naltrexone in a Recently Detoxified Heroin Addict
Authors: Krupitsky E.M. , Masalov D.V. , Didenko T.Y. , Burakov A.M. , Romanova T.N. , Zvartau E.E. , Woody G.
Published: April 2003

This case describes a heroin addict who was participating in a placebo-controlled randomized trial of naltrexone as an aid to relapse prevention. The patient tried to commit suicide by taking a heroin overdose after learning that he was HIV-positive. He was on naltrexone at the time and, as a result, survived what would probably have been a fatal overdose. This case demonstrates that naltrexone can have immediate as well as long-term positive effects in persons who are attempting to recover from heroin addiction.
Role of Aggressivity on Reactivity and Craving before and after Cue Exposure in Recently Detoxified Alcoholics: Results from an Experimental Study
Authors: Chiang Sonnig S.W. , Schuetz Christian G. , Soyka Michael
Published: April 2003

The role of aggressivity and cue exposure in induction of craving were investigated in a clinical setting. Thirty abstinent alcoholic patients were divided into a low and a high aggressive group based on scores on the physical aggression subscale of the Buss-Durkee Hostility Inventory and exposed to alcohol cues. Craving was measured by means of the Alcohol Craving Questionnaire (ACQ) and Visual Analogue Scales (VAS). Important findings are: (1) main effects of aggressivity on ‘emotionality’, ‘purposefulness’ and ‘expectancy’ of ACQ were very significant; (2) on ‘drinking intention’ and ‘craving for alcohol’ of VAS, aggressivity and cue exposure showed a significant interaction; (3) the main effect of cue exposure on heart rate also reached a significance level of 0.007. The results were discussed in the context of the Classical, Operant Conditioning Theory, the Cognitive Craving Theory of Tiffany, Gilbert’s STAR Model, and the Self-Medication Hypothesis
Familial Chronic Central Serous Chorioretinopathy
Authors: Weenink Andrea C. , Borsje Raphaël A. , Oosterhuis Jendo A.
Published: April 2003

Twenty-seven patients with characteristic, mostly bilateral, fundus lesions of chronic central serous chorioretinopathy (CSC) and a progressive course, and 80 of their relatives, mainly siblings, were examined. Ophthalmologic examination included assessment of visual acuity, Amsler grid testing, ophthalmoscopy and fluorescein angiography. The fundus findings were classified as normal fundus, multiple areas of retinal pigment epithelium (RPE) atrophy or chronic CSC: RPE atrophy with leakage of fluorescein. In 14 (52%) of the 27 families, 1 or more relatives were affected. Thirty-five (44%) of the 80 investigated relatives had fundus lesions: 22 had chronic CSC in one eye, 20 of these had chronic CSC or RPE atrophy in the fellow eye. Thirteen relatives had RPE atrophy in one or both eyes. The mode of inheritance could not be established.
Long-Term Behavior of Secretory Immunity in Ileocecal and Ileal Orthotopic Neobladders
Authors: d’Addessi Alessandro , Racioppi Marco , Fanasca Angelo , Menchinelli Paolo , Alcini Antonio , Delicato Giampaolo , Alcini Eugenio , Scuderi Flavia
Published: April 2003

Objective: To compare secretory immunity in cecal and ileal orthotopic neobladders, and to detect its permanence over time. Patients and Methods: IgA was studied in the urine of 33 patients with ileocecourethrostomy (ICUS) and 13 patients with ileal reservoir (IR). The mean follow-up was 55 months. Results were compared in terms of the type of operation, a healthy control group, and the time since surgery. Results: Urinary IgA levels were significantly higher in ICUS and IR patients than in normal controls. No significant differences in IgA concentrations were detected in patients with different reservoirs and with regard to time. Conclusion: Both the reservoirs maintain the function of producing IgA. In particular no differences were detected over time and urine could be a permanent antigenic stimulus. IgA could be considered an adjunctive factor for upper urinary tract protection. For this reason we prefer to use a simple, indirect antireflux mechanism, thus avoiding direct manipulation of the uretero-intestinal anastomosis.
Finasteride: A Long-Term Follow-Up in the Treatment of Recurrent Hematuria Associated with Benign Prostatic Hyperplasia
Authors: Delakas Dimitrios , Lianos Emannuel , Karyotis Ioannis , Cranidis Angelos
Published: April 2003

Objectives: To assess the effectiveness and long-term results after finasteride treatment of recurrent hematuria associated with benign prostatic hyperplasia (BPH). Materials and Methods: The study comprised 80 patients, aged 62–86 (mean 74) years, of whom 50 received finasteride 5 mg once daily for 4 years and 30 were used as controls. Patients with malignancy, severe hepatic or renal failure and hematologic disorders were excluded. Patients were divided into 3 groups according to the severity of hematuria (minor, moderate, severe). All patients were followed up at 3, 12, 24 and 48 months. Results: The follow-up ranged from 8 to 48 (mean 22) months in the finasteride group and 3–42 (mean 23) months in the control group. Hematuria recurrence rates were 6/50 (12%) and 23/30 (77%) in the finasteride and control groups, respectively. Surgical treatment was needed in 6 patients of the finasteride group and 19 of the control group. Patients with minor hematuria experienced no recurrence of symptoms in the finasteride group in contrast to 13 of 17 patients in the control group. For the patients with moderate hematuria, recurrence of symptoms was observed in 3 of 13 in the finasteride group and 3 of 5 in the control group. Three of six patients with severe hematuria had a recurrence of symptoms after finasteride treatment in contrast to 7 of 8 in the control group. Conclusion: Finasteride has proved to be a safe, well tolerable and effective medication in reducing or preventing recurrent hematuria related to BPH.
Spontaneous Erections in a Patient with Erectile Dysfunction after Palliative Chemotherapy for Non-Small Cell Lung Cancer
Authors: Hejna Michael , Fiebiger Wolfgang C.C. , Reiter Werner J. , Raderer Markus
Published: April 2003

Erectile dysfunction is a common problem, especially among older men. It is often caused by psychological problems, and is also the reason for pronounced impairment of psychosocial well-being. Many systemic diseases, genitourinary surgery, drugs, particularly antihypertensive and psychotropic drugs, and also chemotherapeutic agents and dexamethasone are attributed as being causes of erectile dysfunction. In our case, severe erectile dysfunction was present for 8 months before non-small cell lung cancer was diagnosed. Normal sexual function, observed for a short period immediately following chemotherapy, is a highly unusual finding and has not been published before. Chemotherapeutic agents have repeatedly been shown to result in cessation of sexual function including erection. While we cannot offer a definite explanation for our findings, undefined paraneoplastic processes leading to erectile dysfunction amenable to successful cytotoxic intervention could be a possible explanation for our observation.
Solitary Cervical Lymph Node Manifestation of a Seminoma without Detectable Primary
Authors: Berdjis Navid , Offergeld Christian , Lossnitzer Arndt , Hakenberg Oliver W. , Wirth Manfred P.
Published: April 2003

The rare case of a 65-year-old male with a cervical lymph node manifestation as the only tumour manifestation is reported. The diagnostic and therapeutic management of the case is discussed. This represents the fourth case with such a condition reported in the literature.
Prostatic Abscess due to Candida with No Systemic Manifestations
Authors: Collado A. , Ponce de León J. , Salinas D. , Salvador J. , Vicente J.
Published: April 2003

Prostatic abscess due to fungi is a rare condition. It is generally secondary to systemic disease in immunosuppressed patients. It usually occurs with affection of other organs in a septic patient. Only in exceptional cases does it occur isolatedly. We present the case of a prostatic abscess due to Candida albicans with no systemic manifestations. The diagnosis is helped by transrectal ultrasound, which allows to differentiate this condition from nonabscessed acute prostatitis. The treatment of choice is ultrasound-guided transrectal needle aspiration after antibiotic therapy has been started. As with abscesses of bacterial origin, an ultrasonographic follow-up is required due to the possibility of persistence or recurrence.
Radical Prostatectomy in Patients with Previous Groin Hernia Repair Using Synthetic Nonabsorbable Mesh
Authors: Borchers Holger , Brehmer Bernhard , van Poppel Hein , Jakse Gerhard
Published: April 2003

Objective: Identification of patients in whom the perineal route is the optimal approach to perform radical prostatectomy. Material and Methods: During 1992–1999, 376 patients with prostate cancer underwent radical perineal prostatectomy. Four patients were identified in whom the perineal approach was indicated because of previous bilateral groin hernia repair using synthetic meshes. In addition, 1 patient underwent perineal prostatectomy elsewhere for similar reasons. Results: The perineal approach offered an uneventful surgical solution for an adequate and straightforward radical perineal prostatectomy without complications and without biochemical recurrence during the follow-up. Conclusion: Radical perineal prostatectomy is suggested to be the optimal approach in patients with previous bilateral groin hernia repair using synthetic, nonabsorbable meshes.
Endoscopic Treatment of Vesico-Ureteral Reflux: Twelve Years’ Experience
Authors: Capozza N. , Patricolo M. , Lais A. , Matarazzo E. , Caione P.
Published: April 2003

Introduction: Over the past 12 years, endoscopic treatment of vesico-ureteral reflux (VUR) has gained in popularity and has proved successful in a high percentage of cases. With improvements in injectable materials and more experience with the technique, the indications for endoscopic treatment have broadened. In the present paper we report our experience on 679 patients and 953 refluxing ureters, treated over the past 12 years. Materials and Methods: Reflux ranged from grade II to grade IV. In the first 14 cases Teflon was injected. After 1989, bovine dermal collagen was used in 442 children and, more recently, the Deflux® system, a nonallergenic, biodegradable dextranomer in sodium hyaluronan in 223 children. All patients were clinically investigated for voiding dysfunctions and all completed a 1-year follow-up. Results: After 1 or 2 injections the 1-year cystogram showed no VUR in 686 ureters (72%). In grade II, III and IV success rates were, respectively, 83, 69 and 41%. Complications were minimal (1%). Conclusions: Our results confirm endoscopic treatment of VUR is a valid alternative to long-term antibiotic prophylaxis and to open surgery in selected patients. The treatment often failed because of injected material displacement possibly due to voiding dysfunction. The short hospital stay, absence of significant postoperative complications, safety of the available injectable materials and high success rate suggest that endoscopic treatment should be offered to all children with grade II and III VUR, whereas it is questionable in patients with grade IV VUR. In patients with voiding dysfunction, appropriate therapy and voiding rehabilitation should precede treatment of VUR.
Intravesical Combined Chemoimmunotherapy with Epirubicin and Bacillus Calmette-Guérin Is Not Indicated for Superficial Bladder Cancer
Authors: Tozawa Keiichi , Okamura Takehiko , Sasaki Shoichi , Kawai Noriyasu , Ito Yasunori , Hayashi Yutaro , Kohri Kenjiro
Published: April 2003

Purpose: The short-term effects of intravesical chemoimmunotherapy with epirubicin and bacillus Calmette-Guérin (BCG) administered repeatedly for prophylaxis of recurrence of superficial bladder cancer (pTa, pT1) were investigated in 24 patients aged a median of 70 years between March 1996 and February 1999, and were compared with those of BCG monotherapy in 50 patients from March 1990 to February 1999. Patients and Methods: The patients underwent intravesical instillation of the Tokyo strain BCG with or without epirubicin after transurethral resection (TUR) of bladder cancer. For the combined treatment, at 1–2 weeks after TUR, epirubicin (40 mg) and BCG (80 mg) were istilled into the bladder by turns once a week for 12 weeks. For the group receiving only BCG, 80-mg instillations were done with the same schedule. Thereafter, the patients were followed by cystoscopy and urinary cytology every 3 months for up to 3 years after intravesical therapy. Results and Conclusions: At 2 years after treatment, the simple recurrence rate was 26.1% (6/23) in patients with chemoimmunotherapy and 32.0% (16/50) in BCG-treated patients. Adverse reactions, including increased frequency of urination, urgency and miction pain, were observed in 18 patients (85.7%) undergoing chemoimmunotherapy and 58.0% undergoing BCG monotherapy. One patient receiving chemoimmunotherapy was withdrawn from treatment because of symptoms of severe bladder irritation due to the instillation. Intravesical chemoimmunotherapy using epirubicin and BCG was finally found to be inferior in comparison with BCG monotherapy for the prophylaxis of recurrence of superficial bladder cancer.
Megacystis Secondary to Myenteric Plexus Pathology
Authors: Perk Hakkı , Serel T. Ahmet , Anafarta Kadri , Koşar Alim , Uluoğlu Ömer , Sarı Aliye
Published: April 2003

Herein, 2 cases of megacystis secondary to myenteric plexus pathology are reported. Unlike the entity of visceral myopathy, there was ganglion cell loss both in the bladder and in the colon of these 2 cases. Moreover, they did not present any gastrointestinal symptoms. Megacystis was the common pathology in these patients, whereas 1 of them suffered from unilateral vesicoureteral reflux. We could not find any similar report dealing with this phenomenon up to this time in the literature.
Genetics and Society Project
Authors: Avard Denise , Knoppers B.M.
Published: April 2003

Faced with rapid advances in human genetics, policy makers are struggling to come to grips with a host of complex ethical, legal and social questions. The HUMGEN website gives policy makers and the public access to legislation, policy, guidelines and recommendations of government and nongovernmental organizations worldwide.
Social Issues of Molecular Biology Applications in Communities: Focussing on Social Representations and the Public’s Perceptions
Authors: Perron Michel , Veillette Suzanne
Published: April 2003

Some say the reformation generated by advances in molecular biology will be as important as that induced by the current revolution in information technologies. Impacts and issues of this transfer of knowledge, taking the form of prognostic medicine, must therefore be examined. In this respect, one of sociologists’ contributions will surely be to examine the various actors’ points of view (geneticists, physicians, scientists, affected or at-risk individuals, citizens) in order to determine, in perceptions as much as in facts, how technical innovations issued from molecular biology can be disseminated in the social imagery as well as in practice. Based on Saguenay-Lac-St. Jean’s experience and the public interventions of the Corporation for Research and Action on Hereditary Diseases, we propose viewing community genetics as a ‘frontier discipline’, a complex network of actors in which social representations, social participation, as well as service evaluation, must be properly understood.
Community Genetics in South Africa
Authors: Christianson A.L.
Published: April 2003

The development of medical genetics in South Africa paralleled in many respects that of the industrialized nations. In the early 1990s the concept of community genetic services to cater for the needs of the majority and mainly rural population of South Africa was conceived. Subsequently, through clinical genetic outreach programs, significant developments in the principles, practice and policy for the initiation and development of a national medical genetic service based on primary health care has been achieved.
The Challenge of Validating Genetic Testing
Authors: Kristoffersson Ulf
Published: April 2003

Validation of genetic testing is a multidisciplinary task that involves medical/clinical geneticists, other medical specialists, legislative authorities and the public. It is an area in which many issues are unresolved. Validation should not focus on the laboratory process alone, but should also include the prerequisites for service delivery, such as education and staffing, data collection and banking and information transfer, as well as pre- and post-test genetic counselling in a cost-effective perspective. It must thus be seen as an ongoing process at laboratory, familial and societal levels which involves many different actors. The challenges for the near future are to continue to develop technical standards for the laboratory and counselling procedures, and, in collaboration among professionals, lay persons and state authorities, to define a legal framework for the actions of the various players. This chapter discusses some problems related to the validation process for genetic testing, broadly defined.