bluuebunny/crossref_metadata_2025 huggingface dataset:
Interferon-Alpha Induces Transient Suppressors of Cytokine Signalling Expression in Human T Cells
Authors: Brender Christine , Nielsen Mette , Röpke Carsten , Nissen Mogens Holst , Svejgaard Arne , Billestrup Nils , Geisler Carsten , Ødum Niels
Published: April 2003

The suppressors of cytokine signalling (SOCS) proteins comprise a newly identified family of negative feedback regulators of cytokine signalling. SOCS expression is differentially induced upon cytokine stimulation in different cell types. Here we show that interferon-α (IFNα) is a potent inducer of SOCS expression in human T cells, as high expression of CIS, SOCS-1, SOCS-2, and SOCS-3 was detectable after IFNα stimulation. After 4 h of stimulation, CIS, SOCS-1, and SOCS-3 expression had returned to baseline levels, whereas SOCS-2 expression had not declined. In contrast, after IL-2 induction neither CIS, SOCS-1, nor SOCS-2 expression levels declined after 6 h. In conclusion, we provide the first evidence that IFNα induces SOCS expression in human T cells. Moreover, we show that IFNα and IL-2 induce distinct patterns of expression kinetics, suggesting that dynamic changes in cytokine sensitivity might be mediated via induction of SOCS expression with different kinetics in T cells.
Immunoglobulin GM and KM Allotypes in Systemic Lupus erythematosus
Authors: Pandey Janardan P. , Cooper Glinda S. , Treadwell Edward L. , Gilkeson Gary S. , St. Clair E. William , Dooley Mary Anne
Published: April 2003

Genetic variation in immunoglobulin γ (GM) and ĸ (KM) chains was associated with systemic lupus erythematosus (SLE) in some studies. However, the data are conflicting, and only one study examined associations in African-Americans. We examined GM and KM allotypes, by race, in a population-based case-control study of SLE. Sera from patients (n = 222) and controls (n = 273) were typed for GM and KM allotypes by a hemagglutination inhibition method. GM phenotypes were not significantly associated with SLE in African-Americans or Caucasians. However, the frequency of KM phenotypes in Caucasian patients was significantly different from that in controls (p = 0.032). KM3,3 was associated with an increased risk, whereas KM1,3 was associated with a lower relative risk of SLE. In African-Americans, however, the pattern of associations with KM phenotypes differed from that in Caucasians, and the overall difference between patients and controls was not statistically significant.
Rapid Detection of the ERV-K(C4) Retroviral Insertion Reveals Further Structural Polymorphism of the Complement C4 Genes in Old World Primates
Authors: Schneider Peter M. , Witzel-Schlömp Konstanze , Steinhauer Constanze , Stradmann-Bellinghausen Beate , Rittner Christian
Published: April 2003

The fourth component of complement (C4) is coded for by two tandem-duplicated genes located in the class III region of the MHC of humans as well as a number of primates. A C4 gene size polymorphism giving rise to two gene variants of 16 and 22.3 kb length can be attributed to a complete endogenous retroviral insertion of 6.3 kb termed ERV-K(C4) in intron 9 of the long C4 genes. We developed a simple PCR-based screening assay to detect the presence of this insertion, and tested a number of unrelated animals from old world primate species. The presence of the ERV insertion in the orangutan, rhesus macaque and green monkey as well as its absence in gorillas and chimpanzees could be confirmed. In addition, the insertion was also detected in the baboon and the cynomolgus macaque whereas it was not found in a single gibbon. Among rhesus and cynomolgus macaques one individual was identified in each species only carrying short C4 genes demonstrating further structural heterogeneity in these species. Based on these findings we propose that the primigenial retroviral integration occurred prior to the radiation of old world primate species, and that both the long and the short forms of the C4 gene have existed side by side since then.
Interleukin-1β Induced Synthesis of Protein Kinase C-δ and Protein Kinase C-ε in EL4 Thymoma Cells: Possible Involvement of Phosphatidylinositol 3-Kinase
Authors: Varley Claire L. , Royds Janice A. , Brown Barry L. , Dobson Pauline R.M.
Published: April 2003

We present evidence here that the proinflammatory cytokine, interleukin-1β (IL-1β) stimulates a significant increase in protein kinase C (PKC)-Ε and PKC-δ protein levels and increases PKC-Ε, but not PKC-δ, transcripts in EL4 thymoma cells. Incubation of EL4 cells with IL-1β induced protein synthesis of PKC-Ε (6-fold increase) by 7 h and had a biphasic effect on PKC-δ levels with peaks at 4 h (2-fold increase) and 24 h (4-fold increase). At the level of mRNA, PKC-Ε, but not PKC-δ levels, were induced after incubation of EL4 cells with IL-1β. The signalling mechanisms utilized by IL-1β to induce the synthesis of these PKC isoforms were investigated. Two phosphatidylinositol (PI) 3-kinase-specific inhibitors, wortmannin and LY294002, inhibited IL-1β-induced synthesis of PKC-Ε. However, the PI 3-kinase inhibitors had little effect on the IL-1β-induced synthesis of PKC-δ in these cells. Our results indicate that IL-1β induced both PKC-δ and PKC-Ε expression over different time periods. Furthermore, our evidence suggests that IL-1β induction of PKC-Ε, but not PKC-δ, may occur via the PI 3-kinase pathway.
Delusions in First-Admitted Patients: Gender, Themes and Diagnoses
Authors: Gutiérrez-Lobos Karin , Schmid-Siegel Brigitte , Bankier Bettina , Walter Henriette
Published: April 2003

Whether there is a specific link between certain delusional symptoms and particular etiologies has not yet been completely clarified. In this study, 639 first ever admitted deluded patients were investigated in order to find out whether age and gender are associated with certain delusional contents, whether age at first admission may be linked to certain etiologies and whether it is possible to detect indicators particularly related to basic dysfunctions. At first admission, delusional female patients were older than men with a significant predomination of delusions of persecution, while men presented significantly more frequently delusions of jealousy and grandiosity. Within delusions of persecution, of religious or metaphysical content and of grandiosity, women were even significantly older than men. Religious or metaphysical and grandiosity contents occurred significantly more frequently in ICD-8 schizophrenia, indicating that these themes seem to be particularly linked to ICD-8 schizophrenia. Additionally, some target symptoms not included in the delusional symptomatology were investigated to test the relationship between delusions and schizophrenia. Overall, the results of the present investigation indicate that delusions are not specific for schizophrenia, and therefore, other symptomatological criteria should be applied for the nosographic attribution.
Insight and Resistance in Patients with Obsessive-Compulsive Disorder
Authors: Catapano Francesco , Sperandeo Raffaele , Perris Francesco , Lanzaro Massimo , Maj Mario
Published: April 2003

The aim of this study was to evaluate the degree of insight and resistance in a sample of obsessive-compulsive patients, and the predictive value of poor insight with respect to response to treatment with serotonin reuptake inhibitors (SRIs). Ninety-three patients fulfilling DSM-IV criteria for obsessive-compulsive disorder were evaluated. Seventy patients were treated with an SRI in a 24-week open-label trial. Sixteen percent of the patients did not recognize obsessions and compulsions as unreasonable or senseless. Fifty-two percent of the patients did not try to resist, 72% had little or no control over obsessions, and 64% were not able to exercise an effective control over compulsions. Patients with poor insight had a greater severity of obsessive-compulsive symptoms, a higher rate of schizophrenia spectrum disorders in their first-degree relatives and a higher frequency of a history of psychiatric disorders during childhood. Fifty-two percent of the patients with normal insight responded to SRIs, whereas none of the patients with poor insight were found to be responders. These results suggest the utility of the assessment of insight and resistance in obsessive-compulsive patients, also for the prediction of response to treatment with SRIs.
The Clinical Picture of Bipolar II Outpatient Depression in Private Practice
Authors: Benazzi Franco
Published: April 2003

Uncertainties exist about whether depressive episodes differ phenomenologically in unipolar and bipolar II patients. The aim of the present study was to better define the clinical picture and course of bipolar II depression. Three hundred and ninety-nine consecutive outpatients, presenting for treatment of unipolar and bipolar II depression, were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery-Asberg Depression Rating Scale and the Global Assessment of Functioning Scale. Bipolar II depression had significantly lower age at onset, more recurrences and more patients with DSM-IV atypical features. Gender, duration of illness, psychosis, chronicity, severity, axis I comorbidity, melancholic features, individual atypical symptoms and other symptoms of depression were not significantly different. The presence of DSM-IV atypical features predicted bipolar II diagnosis with 63% probability.
Memory Deficits in Patients with DSM-IV Obsessive-Compulsive Disorder
Authors: Zitterl Werner , Urban Claudia , Linzmayer Leopold , Aigner Martin , Demal Ulrike , Semler Brigitte , Zitterl-Eglseer Karin
Published: April 2003

Neuropsychological testing provides increasing evidence that certain memory deficits might play an essential role in the emergence of doubts and, as a result, in perpetuating checkers’ rituals. Another account of doubting implicates metacognitive factors, such as confidence in memory. The present study examined mnestic functioning and self-perception of memory ability in a group of 27 nondepressed patients with obsessive-compulsive disorder (OCD) and 27 normal controls. All patients met DSM-IV and ICD-10 criteria for OCD, displayed prominent behavioral checking rituals and had to show a score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) of at least 16. Significant deficits in intermediate (Lern- und Gedächtnistest; LGT-3) and immediate (Corsi Block-Tapping Test) nonverbal memory were identified in the patients with OCD compared to normal controls. Contrary to predictions, OCD patients also showed a significant deficit in general memory and verbal memory (LGT-3). With respect to metacognition, OCD patients reported less confidence in their memories than controls. These findings suggest that obsessional doubt reflects a deficit in memory as well as a deficit in memory confidence. Depending on which dysfunction predominates, different therapeutic procedures seem to be required.
Misclassification of Suicide – The Contribution of Opiates
Authors: Cantor Chris , McTaggart Philippa , De Leo Diego
Published: April 2003

The reliability of suicide reporting remains a concern. Problems include procedural deficiencies, ambiguous evidence and the determination of intent. In this study, Queensland Suicide Register (QSR) data were compared to the usual official source – the Australian Bureau of Statistics (ABS). QSR deaths were coded as beyond reasonable doubt, probable and possible. These categories were analysed by methods and demographic variables to determine the nature of difficult-to-classify suicides. QSR suicides exceeded ABS especially for females, ages 25–44, and the methods overdose, drowning and ‘other methods’. Opiate overdoses were most difficult to code. Ambiguous circumstantial information and unclear intent were major impediments. Nations witnessing rising rates of deaths due to drug abuse need to monitor undetermined and accidental deaths as well as suicides.
Early Behavioral Development in Autistic Children: The First 2 Years of Life through Home Movies
Authors: Maestro Sandra , Muratori Filippo , Barbieri Filippo , Casella Cristina , Cattaneo Valeria , Cavallaro M. Cristina , Cesari Alessia , Milone Annarita , Rizzo Lenio , Viglione Valentina , Stern Daniel D. , Palacio-Espasa Francisco
Published: April 2003

Objective: The main aim of the research is to study the early behavioral development in autistic children through home movies. Methods: fifteen home movies, regarding the first 2 years of life of autistic children are compared with the home movies of 15 normal children. The films of the two groups were mixed and rated by blind ratings with the Grid for the Assessment of Normal Behavior in Infants and Toddlers. The grid is composed of 17 items grouped into three developmental areas: social competence, intersubjectivity and symbolic activity. For every area, we have identified specific children’s behaviors. Results: Significant differences between the two groups are found both in the range of age 0–6 for intersubjectivity, and in the ranges of age 6–12 and 18–24 for symbolic activity. Conclusions: The authors pose some hypotheses about an early-appearing impairment of intersubjectivity, the ability to represent other’s state of mind, in subjects with autistic disorder.
Gender-Specific Differences in the Process of Coping in Families with a Parent Affected by a Chronic Somatic Disease (e.g. Multiple Sclerosis)
Authors: Steck B. , Amsler F. , Kappos L. , Bürgin D.
Published: April 2003

Based on the investigation of 52 families and their 87 offspring by means of semistructured interviews, we evaluated the coping abilities of the parent affected by multiple sclerosis (MS), the healthy parent and their children. The results show that the gender of the child significantly influences his or her coping behaviour. Daughters cope better than sons, independently of the gender of the MS-affected parent. Only the daughter’s coping is positively affected by age and disease variables. The correlation between the coping behaviour of parents and children is significant between children and their healthy parents and even stronger between children and healthy parents of the same gender. Healthy mothers and daughters cope better with the increasing disability of the father. This is not the case for healthy fathers and sons. Gender seems to be an important moderating factor in chronic parental disease and it has complex effects on the coping capacity of children.
Psychogenic Mania and Bereavement
Authors: Morgan John F. , Beckett Jon , Zolese Gabriella
Published: April 2003

Early notions of mania invoked a combination of psychogenic and organic factors, but psychogenic mania has not endured as a concept. We present a 37-year-old woman with an acute manic episode precipitated by the prolonged death of her husband from cancer. To our knowledge this is the first published account of ‘maniacal grief’ in the absence of pre-existing affective disorder, and with clear causal relations. Mania was clearly induced by the bereavement and we argue that the loss represented more than a non-specific life event. This case supports a re-examination of mania as potentially a ‘reactive’ or psychogenic phenomenon.
Concordance of Acute and Transient Psychoses and Cycloid Psychoses
Authors: Pillmann F. , Haring A. , Balzuweit S. , Blöink R. , Marneros A.
Published: April 2003

Objective: We prospectively investigated a sample of 42 patients with acute and transient psychotic disorder (ATPD) as defined by the 10th revision of the International Classification of Diseases (ICD-10; F23) to determine the clinical and demographic features of this entity and its relationship to cycloid psychoses. Methods: During a 5-year period, all in-patients with ATPD were identified. We systematically evaluated demographic and clinical features and carried out follow-up investigations on average 2 years after the index episode, using standardised instruments. Results: We found 42 cases of ATPD (4.1%) among 1,036 patients treated for psychotic disorders or a major affective episode. There was a marked female preponderance in ATPD (79%). Fifty-five percent of cases concurrently met the criteria of cycloid psychosis according to Perris and Brockington [in Perris C, Struwe G, Jansson B (eds): Biological Psychiatry. Amsterdam, Elsevier, 1981, pp 447–450]. There was no difference in gender distribution between cycloid and non-cycloid ATPD. As expected, abrupt onset and polymorphic features were significantly more common in cycloid than in non- cycloid ATPD. At follow-up, patients with cycloid ATPD showed less persistent alterations and better social functioning. Conclusion: ATPD as defined by ICD-10 is a heterogeneous category. A diagnosis of cycloid psychosis is made in half of the cases of ATPD, and in these cases, the prognosis is more favourable.
Assessment of the Efficacy of a Cognitive-Behavioural Group Psychotherapy Programme for HIV-Infected Patients Referred to a Consultation-Liaison Psychiatry Department
Authors: Blanch Jordi , Rousaud Araceli , Hautzinger Martin , Martínez Esteban , Peri Josep-Maria , Andrés Susana , Cirera Esteve , Gatell Josep-Maria , Gastó Cristóbal
Published: April 2003

Background: Most HIV-infected patients attending a consultation-liaison psychiatry service show symptoms of anxiety and depression. The present study sought to evaluate the immediate and long-term efficacy of a structured cognitive-behavioural group therapy reducing anxiety and depression in HIV-infected patients referred to a consultation-liaison psychiatry department, and to identify baseline variables predictive of greater improvement. Methods: Repeated-measures ANOVA was used to analyse changes in the Beck Depression Inventory (BDI) and the state subscale of the State/Trait Anxiety Inventory (STAI) administered to 39 participants at 4 time points: T1 (1 month before beginning the therapy), T2 (during the first session), T3 (during the last session) and T4 (3 months after the last session). The therapy consisted of 16 weekly 2-hour sessions following a structured time-limited cognitive-behavioural group psychotherapy programme. Results: During the intervention time (between T2 and T3) an improvement was observed in depression and anxiety, which persisted after the 3-month follow-up period (between T3 and T4). No changes were observed during baseline (between T1 and T2). Patients with higher levels of anxiety at baseline showed greater improvement in STAI state subscale scores. Transmission of HIV infection through intravenous drug use was associated with less improvement on the BDI. Conclusions: This is the first report of an ongoing study which suggests long-lasting efficacy of a structured cognitive-behavioural group psychotherapy programme in a heterogeneous sample of HIV-1-infected patients referred to a consultation-liaison psychiatry unit.
Prognostic Value of Serum Tumor Markers in Patients with Lung Cancer
Authors: Hatzakis Kostas D. , Froudarakis Marios E. , Bouros Demosthenes , Tzanakis Nikolaos , Karkavitsas Nikolaos , Siafakas Nikolaos M.
Published: April 2003

Background: The role of tumor markers in the diagnosis and prognosis of lung cancer is under investigation. Objectives: The aim of this study was to investigate the diagnostic and prognostic significance of pre-therapeutic levels of various serum tumor markers, CYFRA 21-1, neuron-specific enolase (NSE), tissue polypeptide antigen (TPA), carcinoembryonic antigen (CEA), CA 125 and squamous cell carcinoma antigen (SCCAg), in patients with lung cancer. Methods: We studied 102 consecutive patients (mean age 65.2 ± 11 years) with newly diagnosed lung cancer (96 males, 94%, with a mean age of 66.3 ± 10.5 years). All patients had a 5-year follow-up. Measurements of the serum tumor markers were performed on initial diagnosis. Results: Eighty-four patients (82%) had non-small-cell lung cancer (NSCLC) and 18 (18%) small-cell lung cancer (SCLC). From the 84 patients with NSCLC, 34 patients (33%) had squamous-cell lung cancer, 23 (22%) adenocarcinoma and 23 (22%) large-cell carcinomas. The overall median survival was 8.5 months. All SCLC patients had extensive disease with a median survival of 10.1 months and NSCLC patients of 8.4 months. Significant differences in the mean values of NSE and CYFRA 21-1 were observed between SCLC and NSCLC. In NSCLC, CYFRA 21-1, TPA, CA 125 and SCCAg serum levels were related to the stage of the disease at diagnosis, and CYFRA 21-1, NSE, TPA and CA-125 were related to a poor outcome. None of the above tumor markers was related to survival in the SCLC group. Conclusion: CYFRA 21-1 and NSE may help to differentiate cell types in lung cancer patients. Also, CYFRA 21-1 with TPA and CA 125 may provide useful information regarding the staging of the disease at diagnosis and the prognosis of patients with NSCLC.
Correlation among the Indices of High-Resolution Computed Tomography, Pulmonary Function Tests, Pulmonary Perfusion Scans and Exercise Tolerance in Cases of Chronic Pulmonary Emphysema
Authors: Fujita Etsuo , Nagasaka Yukio , Kozuka Takenorii , Ebara Hidemitsu , Fukuoka Masahiro
Published: April 2003

Background: Mismatched distribution of pulmonary blood flow is a common characteristic in emphysematous patients. But few reports have mentioned the relationships between the morphological changes in the lungs as assessed by high-resolution computed tomography (HRCT), pulmonary blood flow (PBF) scan and the indices of exercise tolerance. We investigated these relationships. Objective: Pulmonary function tests (PFT), HRCT, single photon emission computed tomography (99mSPECT) and treadmill exercise tests were performed on emphysematous patients, and the correlations between these examinations were studied. Methods: We evaluated 20 patients (M 18, F 2, age 66 ± 8.0 years). CT evaluation was performed according to the grade of emphysematous change. 99mSPECT was performed to evaluate mismatched PBF by the score method. The better flow of the middle lobe was selected to be the standard lobe for the basic PBF. That score was set to 1 when the blood flow was below 60 or above 140%. PBF between 60 and 140% was scored as 0. Results: FEV1 (r = 0.648, p = 0.002) and VC (r = 0.767, p = 0.001) correlated significantly with v̇O2 peak . FEV1 (r = 0.667, p = 0.0018) correlated significantly with anaerobic threshold (AT). CT grade did not correlate with PBF mismatch score (r = 0.266, p = 0.3376). %v̇O2 peak did not correlate with CT grade (r = –0.467, p = 0.0689) or with mismatch PBF score (r = –0.327, p = 0.2377). Conclusions: HRCT and 99mSPECT were advantageous for detecting the progression of disease and emphysematous changes. However, the severity of anatomical emphysematous changes did not necessarily correlate with the indices of exercise tolerance and pulmonary function tests.
Double Aortic Arch Masquerading as Asthma for Thirty Years
Authors: Stoica Serban C. , Lockowandt Ulf , Coulden Richard , Ward Richard , Bilton Diana , Dunning John
Published: April 2003

A case of a 30-year-old woman with a double-barrelled aorta misdiagnosed as asthma is presented. The patient was significantly improved after surgical treatment but a degree of airway symptoms persisted. She was further investigated and diagnosed with tracheomalacia. The paediatric experience with managing tracheomalacia is briefly reviewed and recommendations for the treatment of the rare adult cases are made. Our report emphasises the importance of early diagnosis and treatment of aortic arch abnormalities.
Massive Pleural Effusion as the Presenting Feature of a Subarachnoid-Pleural Fistula
Authors: D’Souza Ryan , Doshi Amita , Bhojraj Shekhar , Shetty Prashant , Udwadia Zarir
Published: April 2003

A 14-year-old boy presented with a large symptomatic transudative pleural effusion 4 months after spinal surgery for kyphoscoliosis. Computed tomography myelography confirmed a subarachnoid-pleural fistula (SPF) with a pseudo-meningocele communicating with the left pleural space. A review of the literature indicates this to be a rare finding. The possibility of SPF should be entertained in patients who present with a pleural effusion following transthoracic spinal surgeries.
Comparison of 25 and 50 μg Vaginally Administered Misoprostol for Preinduction of Cervical Ripening and Labor Induction
Authors: Has Recep , Batukan Cem , Ermis Hayri , Cevher Erdal , Araman Ahmet , Kılıç Gökhan , İbrahimoğlu Lem’i
Published: April 2003

Our purpose was to compare the efficacy of 25 µg and 50 µg intravaginally administered misoprostol tablets for cervical ripening and labor induction. Either 25-µg (n: 58) or 50-µg (n: 56) misoprostol tablets were randomly administered intravaginally to 114 subjects with an unripe cervix for labor induction. The physician was blinded to the medication. Intravaginal misoprostol was given every 4 h until the onset of labor. The mean Bishop score before misoprostol administration was 2.1 ± 1.6 in the 25-µg group and 2.0 ± 1.4 in the 50-µg group (p > 0.05). With the 25-µg dose the time until delivery was significantly longer (991.2 ± 514.4 min vs. 703.12 ± 432.6 min in the 50-µg group). The use of oxytocin augmentation was significantly higher in the 25-µg group (63.8%) than the 50-µg group (32.1%; p < 0.05). The proportions of patients with tachysystoles and hypersystoles were not significantly different between the two groups (19 and 6.9%, respectively, in the 25-µg group and 25 and 17.8%, respectively, in 50-µg group; p > 0.05). Overall, in the 25-µg group more women achieved vaginal delivery (79.3 vs. 60.7%; p < 0.05). The rate of cesarean sections due to nonreassuring fetal status was higher in the 50-µg misoprostol group (28.6 vs. 10.3%; p < 0.05). The number of neonates with a low 1-min Apgar score (<7) was significantly higher in the 50-µg misoprostol group (26.8 vs. 8.6%; p < 0.05), but 5-min Apgar scores and umbilical artery blood gas values at the time of delivery were not significantly different between the groups (p > 0.05). One patient in the 25-µg group suffered a ruptured uterus. Intravaginal administration of 25 µg of misoprostol is a clinically effective labor induction regimen and has the least adverse effects and complications.
Sonographic Evaluation of the Puerperal Uterus: Correlation with Manual Examination
Authors: Shalev J. , Royburt M. , Fite G. , Mashiach R. , Schoenfeld A. , Bar J. , Ben-Rafael Z. , Meizner I.
Published: April 2003

Objectives: To document uterine involution after vaginal delivery and cesarean section by abdominal sonography and to compare the efficacy of manual examination and ultrasonography. Study Design: Postpartum manual and sonographic assessment of uterine involution was performed in 120 patients following vaginal and cesarean delivery with an attempt to build a database of changes in uterine dimensions. The patients’ reports on the intensity of uterine contractions and vaginal bleeding were compared to the results of sonographic imaging. Results: Palpation revealed proper uterine involution in 80 and 25% of patients after vaginal delivery and cesarean section, respectively. It could not be performed in 2.5% after vaginal delivery compared to 50% after cesarean section. Uterine length was found to be significantly greater after cesarean section than after vaginal delivery (p = 0.0001), and the anterior uterine wall was significantly thinner than the posterior wall (p = 0.0001). Uterine length was significantly greater in the presence of blood accumulation in the uterine cavity (20.7 cm), than when the uterus was empty (18.8 cm) (p = 0.001). In correlating between the patient’s report of intense bleeding and the sonographic picture of blood in the uterine cavity sonography had a sensitivity of 0.56 and a specificity of 0.83, whereas the patients’ reports had a positive predictive value of 0.22. The difference in information provided by the patients versus that provided by sonography was highly significant (p = 0.001, χ2 test). Conclusion: Within 3 days after delivery, patients particularly those having had a cesarean section, should undergo uterine sonographic scanning and manual palpation to evaluate involution and presence of blood in the uterine cavity.
Endometriosis and Infertility: Is There a Cause and Effect Relationship?
Authors: Witz Craig A. , Burns William N.
Published: April 2003

An association between endometriosis and infertility has long been noted. Endometriosis affects approximately 5% of the general population. In infertile women, the prevalence may be as high as 30%. Multiple studies, the majority of which are retrospective, indicate that the monthly fecundity of patients with endometriosis may be decreased by half compared to women without the disease. The precise cause-effect relationship between endometriosis and infertility remains controversial. In advanced cases of endometriosis, with distorted pelvic anatomy, the mechanism of infertility is more easily explained. Recent evidence suggests that treatment of early-stage endometriosis may increase pregnancy rates. Many etiologies of infertility in early-stage endometriosis have been proposed. These include endocrine dysfunctions such as luteal phase defect and luteinized unruptured follicle syndrome. In the last 15 years, alterations in the local pelvic immune environment have been the subject of multiple basic science investigations. Unfortunately, there is no satisfactory hypothesis that unequivocally explains the association of early stages of endometriosis with infertility.
HELLP-Syndrom als Indikation für eine Lebertransplantation
Authors: Hommann M. , Schotte U. , Richter K.K. , Möller U. , Basciani R. , Scheele J.
Published: April 2003

Manifestes Multiorganversagen ist der dramatische Endpunkt der schwersten Verlaufsform des HELLP-Syndroms (hemolysis, elevated liver function, low platelets). Spezifische Therapiestategien sind noch nicht routinemässig geklärt. Wir präsentieren die Kasuistik einer kombinierten chirugischen Therapie (Hepatektomie, portokavale Anastomose, orthotope Lebertransplantation). Eine 26-jährige Primapara entwickelte post partum (39.SSW) eine Leberruptur bei HELLP-Syndrom. Notfallmässige Hepatektomie und portokavale Anastomose waren eine suffiziente Überbrückung bis zur Lebertransplantation. Die Patientin konnte bei komplikationslosem Verlauf nach Lebertransplantation bei exzellenter Organfunktion frühzeitig entlassen werden. Der portokavale Shunt und die Lebertransplantation repräsentierten für unsere Patientin eine effektive Therapie. Eine aggressive chirurgische Therapie sollte als frühe Option der Behandlung der Leberruptur bei HELLP-Syndrom in Erwägung gezogen werden.
Lesen und Bewerten von Literatur: ein pragmatischer Ansatz
Authors: Steurer Johann
Published: April 2003

Aufgrund der enormen Menge medizinischer Informationen in Zeitschriften und im Internet wird es für den einzelnen Arzt immer schwieriger, auf dem Laufenden zu bleiben. Ein pragmatischer Lösungsansatz ist, eine erste Selektion aufgrund der im Titel oder eventuell in der Zusammenfassung angegeben Thematik zu treffen. Nach der Selektion genügt das alleinige Lesen der Zusammenfassungen meist nicht. Informationen, die für die Umsetzung der Studienresultate in die Praxis wichtig sind, fehlen in den Zusammenfassungen. Das Lesen eines ganzen Artikels ist zwar zeitaufwändig, aber Fragen der Validität und damit der Aussagekraft müssen geklärt werden, bevor die Resultate in die Betreuung der Patienten einfliessen können.
Psychosoziale und psychosomatische Basiskompetenz des Frauenarztes – von der inneren Überzeugung zum lernbaren Curriculum
Authors: Bitzer J. , Schwendke A. , Tschudin S. , Alder J.
Published: April 2003

Der Gynäkologin, dem Gynäkologen stellen sich bei der Betreuung von Patientinnen zahlreiche Aufgaben, die eine psychosoziale Kompetenz erfordern: Gesundheitsförderung, Beratung und Umgang mit psychosozialen Problemen im Rahmen der verschiedenen Lebensabschnitte der Frau, Betreuung bei chronischen Erkrankungen usw. Zum Erwerb dieser Kompetenz braucht es ein Curriculum, in dem für die Frauenheilkunde ausgewählte Elemente der Psychologie, der psychosozialen Medizin und der Psychiatrie vermittelt werden. Wissen und Fertigkeiten aus dem Bereich der Kommunikationstheorie und Praxis umfassen das semiotische und pragmatische Modell, arzt- und patientenzentrierte Kommunikation, Gesprächsführung zur Gesundheitsförderung und Prävention, Mitteilung schlechter Nachrichten und bewältigungsorientierte, supportive Gespräche.
Co-Ordination and Continuity of Care in Substance Abuse Treatment
Authors: Vanderplasschen Wouter , de Bourdeaudhuij Ilse , van Oost Paulette
Published: April 2003

Considering the complexity of drug dependence and the multiplicity of services for substance abusers, co-ordination and continuity of care are important prerequisites for the quality of substance abuse treatment. However, several shortcomings concerning co-operation, communication and co-ordination have been reported in most European countries. In this study, different aspects of co-ordination and continuity (e.g. first contact, intake, referral, follow-up) have been studied among all services (n = 27) that are addressed by substance abusers in a clear-cut region in Belgium. Structured interviews with key informants show a lack of systematic communication between services and a lack of follow-up of clients. A study of 57 client records in 12 of these 27 centers illustrates that relatively little information is registered concerning the course of the treatment process and that only 10% of all client files contain a treatment plan. Following the introduction of a formalized plan that was regarded as a precondition for systematizing and optimizing communication between services, key informants considered the implementation of a model of case management as an appropriate way of improving co-ordination and continuity of care in this region.
One-Year Follow-Up of Dual Diagnosis Patients Attending a 4-Month Integrated Inpatient Treatment
Authors: Moggi Franz , Brodbeck Jeannette , Költzsch Kerstin , Hirsbrunner Hans-Peter , Bachmann Kurt Marc
Published: April 2003

The purpose of this study was to assess a 4-month inpatient treatment program based on integrated models for patients with substance use and psychiatric disorders (dual diagnosis patients). On admission and at the 1-year follow-up, a consecutive sample of 118 dual diagnosis patients who entered the program were assessed by interview. Eighty-four patients (70.6%) completed the 1-year follow-up interview, reporting less frequent substance use, less severe psychiatric symptoms, a lower rehospitalization rate, and better housing conditions than on admission. Patients diagnosed with a comorbid personality disorder had a better improvement in the frequency of drinking and were less likely to be rehospitalized than patients with schizophrenia or depression. The results suggest that the integrated inpatient program may be a promising treatment approach for dual diagnosis patients. The results await replication in controlled studies that need to include an assessment of outpatient treatment following inpatient programs.
The Relationship between Revascularisation and Osteogenesis in Fresh or Demineralised Bone Grafts
Authors: Solheim E. , Pinholt Else M. , Talsnes O. , Larsen Trine Berg , Kirkeby O.J.
Published: April 2003

Bone formation generally depends on adequate blood flow. Failure of bone grafts has been attributed to delayed revascularisation of the graft. We compared the relationship between revascularisation and osteogenesis, evaluated as entrapment of 141Ce-labelled microspheres and uptake of 85Sr, respectively, in fresh or demineralised syngeneic bone grafts 3 weeks after heterotopic implantation in rats. Whereas a moderately high linear correlation between 85Sr and 141Ce radioactivity was found both in the (intact) host iliac bone (r = 0.75, p = 0.0001) and implanted fresh syngeneic grafts (r = 0.50, p = 0.001), no correlation could be demonstrated in demineralised grafts (r = 0.09, p = 0.6). The results may indicate differences in the mechanisms of vascularisation and osteogenesis in the grafts used fresh or after demineralization but are, at present, difficult to fully explain.
Attenuation of Liver and Lung Injury after Hepatic Ischemia and Reperfusion by a Cytokine-Suppressive Agent, FR167653
Authors: Hato S. , Urakami A. , Yamano T. , Uemura T. , Ota T. , Hirai R. , Shimizu N.
Published: April 2003

Background: Hepatic ischemia/reperfusion (I/R) injury is an important clinical problem and leads to the release of the proinflammatory cytokines, TNF-α and IL-1. These cytokines play important roles in the induction of polymorphonuclear neutrophil (PMN) activation and infiltration, and induce not only localized hepatic injury but also remote organ injury, especially pulmonary injury. Using a total hepatic ischemia model in rats, we tested our hypothesis that suppression of TNF-α and IL-1 by FR167653 ameliorates I/R injury in the liver and lung. Methods: Male Wistar rats, weighing 240–280 g, were divided into 3 groups, an FR group, a control group and a sham group. In the FR group, FR167653 (1 mg/kg/h) was administered continuously to the animals for 30 min prior to the onset of ischemia and for 2 h after reperfusion. The control group received normal saline. A porto-systemic shunt was placed between the cecal branch of the portal vein and the jugular vein, and total hepatic ischemia was produced for 90 min. The sham group was treated with placement of the porto-systemic shunt only. The 1-week survival rate, liver enzyme activity, hepatic tissue blood flow (HTBF), cytokine mRNA expression, myeloperoxidase (MPO) activity and histological results were studied. Results: The 1-week survival rate and HTBF were significantly higher in the FR group than in the control group. Serum AST, ALT, and LDH levels were significantly lower in the FR group at 30 min, 1 h and 3 h after reperfusion. MPO levels in liver and lung tissue were also significantly lower in the FR group. The expression of IL-1β mRNA remarkably decreased up to 6 h after reperfusion in the FR group. Conclusions: We concluded that the inflammatory cytokines, IL-1β, play important roles in hepatic I/R injury. FR167653 might ameliorate I/R injury and be useful in liver surgery with ischemia.
Role of CD18-Dependent Neutrophil Recruitment in Skin and Intestinal Wound Healing
Authors: Törkvist L. , Månsson P. , Raud J. , Larsson J. , Thorlacius H.
Published: April 2003

CD11/CD18 is an important adhesion molecule mediating recruitment of leukocytes, which, in turn, may cause postoperative injury in the skin and gastrointestinal tract. The objective of the present study was to investigate the effects of inhibiting the function of CD18 on surgery-induced dermal and intestinal infiltration of neutrophils and on the healing of surgical skin flaps and colonic anastomosis. A flap in the dorsal skin or an end-to-end colonic anastomosis were created in Sprague-Dawley rats. Skin necrosis and anastomotic breaking strength were analyzed 6 and 3 days after surgery, respectively. Tissue myeloperoxidase (MPO) was used as a marker of neutrophil recruitment. Administration of a monoclonal antibody directed against rat CD18 (WT.3, 2 mg/kg) significantly decreased dermal and anastomotic MPO activity by more than 80%. Passive immunization against CD18 significantly improved flap survival, i.e. the survival was 80% in the anti-CD18 antibody group as compared to 38% in the control group. In contrast, this passive immunization against CD18 had no effect on the reconstitution of the integrity of the colonic anastomosis, i.e. the anastomotic breaking strength was 1.3 ± 0.1 and 1.3 ± 0.3 N in the control and anti-CD18 antibody group, respectively. These findings suggest that specific inhibition of CD18 function and reduced neutrophil recruitment may improve the survival of experimental skin flaps and, thus, may represent a potential target for therapeutic intervention. In contrast, we also found that blocking CD18-dependent neutrophil infiltration in the intestine had no effect on breaking strength of colonic anastomosis. Thus, neutrophils may influence the wound-healing process differently in specific organs and this needs to be considered when applying an anti-inflammatory treatment regime in order to improve tissue healing.
Effects of Insulin-Like Growth Factor-1 on Short Bowel Syndrome without Ileocecal Valve in Rats
Authors: Yamaguchi M. , Asakawa K. , Kuzume M. , Nemoto H. , Sanada Y. , Kumada K.
Published: April 2003

Insulin-like growth factor-1 (IGF-1) can promote enterocyte proliferation which may be beneficial to postoperative conditions after massive small bowel resection (SBR) including the ileocecal valve (ICV). Wistar rats were subjected to SBR including or preserving ICV and continuously received IGF-1 or saline alone. Nutritional status, enterocyte proliferation, liver damage and hepatic IGF-1 mRNA levels were analyzed. Body weights, serum levels of total protein and transferrin, and enterocyte proliferation were significantly lower after SBR including ICV than preserving it. IGF-1 mRNA levels in the liver were decreased after SBR, especially after SBR including ICV. However, IGF-1 therapy significantly attenuated those decreased levels after SBR including ICV. Furthermore, IGF-1 significantly decreased serum liver transaminase levels which were increased after SBR including ICV. Continuous administration of IGF-1 may be available as a supplemented therapy for short bowel syndrome without ICV.
Qualitative Evaluation of the Blood-Brain Barrier after the Use of Hypertonic Saline Solution in Young Rats
Authors: Carrera R.M. , Pacheco Jr. A.M. , Mastroti R.A.
Published: April 2003

The blood-brain barrier (BBB) controls the biochemical environment of the brain with variable permeability when comparing adults to children. Based on the knowledge that there is a greater vulnerability in the BBB of young subjects submitted to biochemical variations in the blood and in the brain, an experimental model was designed to study small volume resuscitation. Young Wistar rats were submitted to hemorrhage and resuscitated with 7.5% NaCl solution before undergoing a qualitative evaluation of their BBB. Thirty male rats were anesthetized and divided into four groups: Group 1 – submitted to hemorrhagic shock restored with hypertonic saline solution (HSS); Group 2 – submitted to hemorrhagic shock without volume restoration; Group 3 – receiving only HSS, and Group 4 – control. The data analyzed were: mean arterial blood pressure, base excess, sodium, chloride, urea, blood osmolarity and blood glucose levels. After infusing a 2% Evans blue solution, qualitative analysis of the BBB was carried out. Group 1 presented final mean blood pressure levels equivalent to groups 3 and 4. Group 2 had a significant difference in the final base excess when compared to the other groups. In groups 1 and 3, mean sodium and chloride, as well as serum osmolarity, were more elevated than groups 2 and 4. Macroscopic examination of the brain did not reveal any changes in color, which could be attributed to the opening of the BBB. It was concluded that the 7.5% NaCl solution in this experimental model did not promote qualitative changes in the BBB.
The Solution to Hyperglucagonemia after Pancreas Transplantation in Inbred Rats
Authors: Kissler H.J. , Hennig R. , Gepp H. , Hohenberger W. , Schwille P.O.
Published: April 2003

Background: We studied the possible role of the diseased host pancreas and site of venous graft drainage in the development of hyperglucagonemia after pancreas transplantation, to identify the crucial steps of the technique capable of eliminating hyperglucagonemia and its possible diabetogenic effect. Methods: Therefore, we compared 4 groups of inbred rats: (1) heterotopic pancreas transplantation with either systemic (n = 9); or (2) portal (n = 5) venous drainage after prior induction of diabetes with streptozotocin; (3) orthotopic pancreaticoduodenal transplantation with portal venous drainage after prior pancreaticoduodenectomy (n = 7), and (4) sham-operation (Sham; n = 10). The postoperative period was 6 months. Results: Only heterotopic transplantation with systemic venous drainage and loss of glucagon’s first pass hepatic extraction, resulted in arterial hyperglucagonemia, whereas the arterial plasma insulin level was only slightly higher in comparison with the other groups. After either type of heterotopic transplantation the glucagon content of host pancreata remained unchanged, whereas the insulin content was approximately 5% of that in the pancreas of Sham rats. The insulin and glucagon contents of all grafts were similar to those of the control pancreas in Sham rats, and the insulin release was sufficient to normalize fasting plasma glucose and lipids after either type of transplantation. Conclusion: To remove the diseased host pancreas appears unnecessary, as the hyperglucagonemia and the concomitant slight hyperinsulinemia, capable of preventing glucagon’s diabetogenic effects, are due to loss of the first pass hepatic extraction by systemic venous drainage alone. This disadvantage can be eliminated by portal venous graft drainage.
Heat Shock Protein Upregulation Lowers Cytokine Levels after Ischemia and Reperfusion
Authors: Grünenfelder J. , Zünd G. , Stucki V. , Hoerstrup S.P. , Kadner A. , Schoeberlein A. , Turina M.
Published: April 2003

Objective: Studies showed that the expression of heat shock protein 70 (HSP70) by whole-body hyperthermia or warming of the heart is associated with protection against ischemia/reperfusion injury. The aim of this study is to determine a time-related response of HSP70 expression through topical cardiac warming with correlation to cytokine production. Methods: 30 rats were divided into three groups: no heat shock, heat shocked, and controls. Heat shock was performed with 42°C saline solution applied to the heart for 5, 30, and 60 min. HSP70 and cytokines were measured. Results: Heat shock treated animals showed a 1.2-fold increase after 5 min (NS) in HSP70 expression, a 2.0-fold increase (p < 0.02) after 30 min, and a 2.3-fold increase (p < 0.012) after 60 min compared to controls. The IL-1β levels decreased from 14.3 pg/ml (normal controls) to 7.1 pg/ml after 5 min, to 1.6 pg/ml after 30 min (p < 0.002), and to 1.4 pg/ ml after 60 min of heat shock treatment (p < 0.002). The TNF-α levels also decreased, but not significantly. Conclusions: Upregulation of HSP70 through this novel method is instant and detectable within hours. The amount of HSP70 expression induced is time dependent, showing an indirect correlation with cytokine levels. These results suggest that the protective effect of HSP70 is immediate and might be explained by reduced cytokine levels. No prior recovery period is needed.
Social Organization, Reproduction and Rearing Strategies of Callimico goeldii: New Clues from the Wild
Authors: Porter Leila M.
Published: April 2003

The callitrichines are a specialized radiation of primates that are characterized in part by variable social systems and cooperative infant care. Callimico goeldii, unlike the other callitrichines, have single rather than twin offspring, reducing the need for allocare and permitting synchronous breeding within groups. Low mortality rates among offspring and unstable social groups are suggested to be possible factors that have led to single births among C. goeldii. Single offspring may benefit from greater maternal investment and more frequent food sharing than twin offspring, factors that may help to explain why C. goeldii reaches sexual maturity more rapidly than other callitrichines. In addition, increased breeding opportunities for young C. goeldii females may have selected for rapid maturation rates among this species. Postpartum ovulation and aseasonal resource availability appear to permit females to have biannual birth seasons, further increasing the potential reproductive output.