bluuebunny/crossref_metadata_2025 huggingface dataset:
Franchising Reproductive Health Services
Authors: Stephenson Rob , Tsui Amy Ong , Sulzbach Sara , Bardsley Phil , Bekele Getachew , Giday Tilahun , Ahmed Rehana , Gopalkrishnan Gopi , Feyesitan Bamikale
Published: November 2004

Objectives. Networks of franchised health establishments, providing a standardized set of services, are being implemented in developing countries. This article examines associations between franchise membership and family planning and reproductive health outcomes for both the member provider and the client.

Methods. Regression models are fitted examining associations between franchise membership and family planning and reproductive health outcomes at the service provider and client levels in three settings.

Results. Franchising has a positive association with both general and family planning client volumes, and the number of family planning brands available. Similar associations with franchise membership are not found for reproductive health service outcomes. In some settings, client satisfaction is higher at franchised than other types of health establishments, although the association between franchise membership and client outcomes varies across the settings.

Conclusions. Franchise membership has apparent benefits for both the provider and the client, providing an opportunity to expand access to reproductive health services, although greater attention is needed to shift the focus from family planning to a broader reproductive health context.
Impact of Globalization on Social Mobility in Japan and Korea: Focusing on Middle Classes in Fluid Societies*
Authors: Sato Yoshimichi , Arita Shin
Published: November 2004

Abstract:  We argue that the social mobility of the Japanese middle classes is becoming closer to that of their Korean counterparts thanks to their increasing exposure to globalization. Globalization upsets the balance between transaction costs and opportunity costs of Japanese economic institutions such as Japanese management practices and the long‐term relationship between the principal contractor and its subcontractors (the shitauke relationship). As a result, it makes social mobility of the new and old middle classes, which have been protected by such institutions, more fluid. Thus we make this argument based on the assumption that the Korean middle classes have already been exposed to globalization and thus are more mobile than their Japanese counterparts. Then we test its empirical validity by analyzing absolute and relative mobility of the middle classes in the two societies with national representative data sets assembled in Japan in 1975, 1985 and 1995 and in Korea in 1990. The results of the analysis show: (1) that the Korean middle classes are more fluid than their Japanese counterparts; and (2) that globalization has affected the social mobility of the old middle class much more than that of the new middle class in Japan. The second finding implies that Japanese management customs that have protected a certain portion of the new middle class are less affected by globalization than the institutions that have protected the old middle class. In other words, the practices have a stronger inertia of institution.
Social Resources and Occupational Status Attainment: Comparison of Japanese and American Employees’ Personal Networks
Authors: Nakao Keiko
Published: November 2004

Abstract:  The present study compares Japan and the USA in the ways in which individuals’ personal relationships affect the social standing they achieve. The conceptual framework applied here is similar to that used in established research in Western countries, which examines the effects of both human capital and social capital. The analyses are based on the data collected from a random sample of adult residents in Tokyo, which contains information about their personal networks. This data set is compared with the social network module of the 1985 General Social Survey in the United States.

The analyses supported both human capital and social capital theories in the process of status attainment in both countries. Human capital, however, seems to have a stronger influence especially in the USA sample, because certain structural characteristics are associated with one's own educational achievement, which in turn are instrumental in attaining social capital. Unlike the USA, however, the access to social capital in Japan was found primarily through homophily, showing little effect based upon the type of networks they have. The results suggest the difference between the two countries in terms of the function of social resources and the strength of ties that are instrumental in the process of status attainment.
Managing Categorization and Social Withdrawal in Japan: Rehabilitation Process in a Private Support Group for Hikikomorians
Authors: Ogino Tatsushi
Published: November 2004

Abstract:  Social withdrawal among Japanese youth has been noticed since the latter‐half of the 1990s. It is called Hikikomori in Japan. Though some clinicians in the mental health field have referred to social backgrounds of this problem, only a few sociological studies have been conducted. I have conducted participant observation in a private support group and recorded the rehabilitation processes of people with Hikikomori for two years. My study has two aspects. First, it is a short ethnography concerning the features of the group efforts. Second, it is intended to interpret relations between the features and rehabilitation processes. The first feature is the group dynamics arising from friendly and competitive relationships among the people with Hikikomori—called Hikikomorians. The second feature is “managing categorization”. It is a tendency to be vague about categories that indicate their social status accompanied with some roles. This tendency could be observed in various aspects of the group activities, for example, concerning diseases’ names, schedules, definition of space and so on. Managing categorization allows Hikikomorians to easily participate in and experience social activities. They are people who do not have social categories to explain themselves easily in social settings and do not have the self‐confidence to perform some roles. Under social pressures, however, they tend to maintain a behavioral principle that is based on categories. Managing categorization therefore functions to provisionally release their attitudes and allow them to attempt trial and error based situations more easily. Finally, I also indicate some difficulties of managing categorization.
Juvenile Chondrodermatitis Nodularis Helicis: A Case Report and Literature Review
Authors: Rogers Nicole E. , Farris Patricia K. , Wang Alun R.
Published: November 2004

Abstract:  Chondrodermatitis nodularis helicis (CNH) is a disorder that affects adults. Only one case of juvenile CNH has been reported, in an 8‐year‐old child who suffered from dermatomyositis. We report another child with juvenile CNH who was not afflicted with dermatomyositis or other systemic disorders. The clinical and histologic evaluations demonstrated CNH on the helix of the right ear in a 16‐year‐old Caucasian girl who was otherwise healthy. Serologic analysis ruled out an underlying autoimmune disorder. We conclude that juvenile CNH is extremely rare and may occur in patients without dermatomyositis or other systemic disorders.
Incontinentia Pigmenti Associated with Cerebral Palsy and Cerebral Leukomalacia: A Case Report and Literature Review
Authors: Shah Syed N. , Gibbs Sam , Upton Chris J. , Pickworth Fred E. , Garioch Jennifer J.
Published: November 2004

Abstract:  Incontinentia pigmenti (IP) is a multisystem disorder with characteristic cutaneous signs. After the skin, the central nervous system is the next most affected system. We report a child with IP and left‐sided hemiparesis and cerebral periventricular leukomalacia on magnetic resonance imaging (MRI). The MRI findings would support ischemia sustained perinatally.
Ecthyma Gangrenosum Caused by Disseminated Exserohilum in a Child with Leukemia: A Case Report and Review of the Literature
Authors: Levy Itzhak , Stein Jeremiah , Ashkenazi Shai , Samra Zmira , Livni Gilat , Yaniv Itzhak
Published: November 2004

Abstract:  We report an 8‐year‐old boy with acute leukemia who developed ecthyma gangrenosum secondary to infection with Exserohilum spp., a rare cause of human disease. The skin, paranasal sinuses and lungs were involved. To the best of our knowledge, this is the first report of ecthyma gangrenosum caused by Exserohilum spp. This case emphasizes the importance of prompt skin biopsy for early diagnosis and treatment of this life‐threatening infection.
Linear Porokeratosis Associated with Disseminated Superficial Actinic Porokeratosis: A New Example of Type II Segmental Involvement
Authors: Boente María del Carmen , López‐Baró Ana M. , Frontini María del Valle , Asial Raúl A.
Published: November 2004

Abstract:  The coexistence of linear porokeratosis (LP) and disseminated superficial actinic porokeratosis (DSAP) in a 3‐year‐old girl with a family history of DSAP is presented. Happle proposed loss of heterozygosity (LOH) to explain the origin of this unusual phenomenon. Homozygosity would explain why lesions in LP are far more pronounced than those of the associated heterozygous DSAP lesions. LOH would also explain the early age of presentation of the linear lesions, the family history of DSAP, and why LP cases are particularly prone to malignant transformation. This case is also important for molecular studies because of the presence of heterozygous and homozygous mutated cells in the same patient and the familial occurrence of the heterozygous form of the disease.
Noma‐like Gangrenous Cheilitis in a Child with Cyclic Neutropenia Associated with Myeloperoxidase Deficiency
Authors: Erbagci Zülal
Published: November 2004

Abstract:  An unusual case of cyclic neutropenia and hereditary myeloperoxidase deficiency complicated by noma‐like gangrenous cheilitis is described. Klebsiella pneumoniae and Candida albicans were cultured from the involved area. We present this case to increase physician awareness of the possible association of both quantitative and qualitative defects of neutrophils and to stress the importance of the early and effective management of skin infections that can rapidly progress to severe sequelae when associated with profound neutropenia.
Harlequin Baby with Ecthyma Gangrenosum
Authors: Gunes Tamer , Akcakus Mustafa , Kurtoğlu Selim , Çetin Neşide , Karakükçü Musa
Published: November 2004

Abstract:  Pseudomonas aeruginosa bacteremia or sepsis often occurs in hospitals, affecting mainly children with underlying disease. Ecthyma gangrenosum is classically considered a pathognomonic sign of sepsis by P. aeruginosa. The harlequin baby, a severe variant of ichthyosis, occurs rarely, and these infants are at high risk of cutaneous infections and sepsis. We herein report a harlequin baby who developed ecthyma gangrenosum.
Somatic Symptoms in Headache Patients: The Influence of Headache Diagnosis, Frequency, and Comorbidity
Authors: Maizels Morris , Burchette Raoul
Published: November 2004

Background.—Mood disorders of anxiety and depression are well known to be comorbid with primary headache disorders. Less is known of the comorbidity of other somatic symptoms with headache.

Methods.—Headache Clinic patients were screened with the Primary Care Evaluation of Mental Disorders (PRIME‐MD), a multidimensional psychiatric screening tool. The prevalence of somatic symptoms was compared by headache diagnosis, frequency of severe headache, and psychiatric diagnosis. Follow‐up data were obtained 6 months after consultation.

Results.—Clinical diagnoses and PRIME‐MD data were available for 289 patients. Associated somatic symptoms were more frequent in patients with chronic migraine (mean 5.5, P < .001) and chronic daily headache (CDH) (6.3, P= .008) compared to episodic migraine (4.0); in patients with severe headache >2 days per week compared to ≤2 days per week (6.15 vs. 4.15, P < .001); and in patients with a clinical diagnosis of anxiety or depression, or both, compared to no anxiety or depression, (5.7, P= .05, 5.2, P <. 05, and 6.8, P < .001, respectively, vs. 4.5). The most common specific symptoms were fatigue (73%), sleep difficulty (60%), and nausea/indigestion (55%). Compared to a primary care sample, patients with severe headache >2 days per week had significantly higher somatic counts (P= .01).

Six‐month follow‐up data were available for 140 patients. Associated symptoms decreased both for patients with and without decrease in severe headache frequency (mean reduction of 1.0, P= .01 and 0.8, P= .003, respectively).

Conclusion.—Associated somatic symptoms are more common in patients with chronic migraine and CDH, with more frequent severe headaches, and with associated anxiety or depression. Patients with episodic migraine have similar somatic prevalence as a previously studied primary care population. The spectrum of headache disorders may be characterized as showing increasing somatic prevalence as headaches, particularly severe headaches, become more frequent.
Dynamic Mechanical (Brush) Allodynia in Cluster Headache
Authors: Ashkenazi Avi , Young William B.
Published: November 2004

Objective.—To examine the occurrence of dynamic mechanical (brush) allodynia (BA) in patients with cluster headache (CH).

Background.—Cutaneous allodynia was described in migraine. It was related to sensitization of neurons in the trigeminal nucleus caudalis (TNC). This phenomenon has not been previously described in cluster headache.

Methods.—We examined adult patients with episodic or chronic CH for the presence of BA. Demographic data and the characteristics of CH were obtained through a questionnaire. Allodynia testing was performed by repetitively applying a 4 × 4‐inch gauze pad to skin areas in the trigeminal and cervical dermatomes. Degree of allodynia was measured on a 100‐mm visual analog scale (VAS). The relations between the location and severity of headache and allodynia were assessed.

Results.—Ten patients (all male, mean age 39.3) were included in the study. Seven had episodic CH (ECH) and 3 had chronic CH (CCH). Two patients were in acute attack when tested for BA. In total, 4 (40%) of the 10 patients had BA (2 [28.6%] of the 7 with ECH and 2 [66.7%] of the 3 with CCH). Median disease duration was 22 years for patients with BA and 12 years for patients without BA. Of the two patients in acute attack, one had BA, ipsilateral to the headache, which was reduced 20 minutes after treatment, along with reduced headache severity.

Conclusions.—This is the first report on the occurrence of cutaneous allodynia in CH. The presence of BA in CH may be related to CH type (episodic vs. chronic) and to the duration of disease. These results support the concept that allodynia in CH may result from a time‐dependent process of neuronal sensitization.
Osmophobia and Taste Abnormality in Migraineurs: A Tertiary Care Study
Authors: Kelman Leslie
Published: November 2004

Objectives.—This study assesses osmophobia and taste abnormality for the first time in a large sample of migraine patients.

Methods.—Seven hundred and twenty seven migraineurs were evaluated. Osmophobia, taste abnormality, and perfume or odor trigger were graded from 0 to 3.

Results.—In patients with data, 24.7% of 673 patients complained of osmophobia (12.5% occasional, 7% frequent, and 5.2% very frequent) and 24.6% of 505 of taste abnormality (13.5% occasional, 6.1% frequent, and 5.0% very frequent). Perfume or odor trigger of acute migraine occurred in 45.5% of 724 patients (22.7% occasional, 10.2% frequent, and 12.6% very frequent). Perfume or odor trigger was associated with osmophobia in 61.5% and taste abnormality 62.1%. Osmophobia without taste abnormality occurred in 28.3% and taste abnormality without osmophobia in 40.3%. A greater percentage of females than males had osmophobia (25.7 vs. 17.5), taste abnormality (25.4 vs. 17.9), and perfume or odor trigger (49.3 vs. 22.1), all P < .0001.

Conclusions.—Osmophobia and taste abnormality occur in about one quarter of migraineurs during an acute migraine attack while perfume or odor trigger migraine in almost 50% of patients. Osmophobia and taste abnormality in the acute migraine attack, as well as perfumes or odor as a migraine trigger, are more common in females than in males.
Dextroamphetamine Pilot Crossover Trials and n of 1 Trials in Patients With Chronic Tension‐Type and Migraine Headache
Authors: Haas David C. , Sheehe Paul R.
Published: November 2004

Objective.—To examine the preventive effects of dextroamphetamine in select small groups of patients with chronic tension‐type and migraine headache.

Background.—Neither amphetamine nor methylphenidate is used as a headache preventive. This study was undertaken after a chance observation led one of us to prescribe dextroamphetamine with apparent successes in specific patients with chronic tension‐type or migraine headaches.

Methods.—Two pilot trials were done. Trial 1 tested patients who were taking dextroamphetamine, while Trial 2 tested patients who had never taken this drug. Each trial obtained full data on eight subjects with chronic tension‐type headache and eight subjects with migraine headache. A randomized, double‐blinded, controlled, multiple‐crossover design was used. Subjects took capsules containing dextroamphetamine or equi‐stimulatory caffeine (the control) during four alternating 20‐day periods. Trial 1 subjects took their pretrial dextroamphetamine dose at breakfast and lunch. Trial 2 subjects took 10 mg at these times. Subjects recorded the integer from 0 to 3 that represented their headache intensity during the previous 24 hours. The subject's data were the average daily headache grade for the two dextroamphetamine periods and for the two caffeine periods. The differential effect of amphetamine and caffeine on each group of eight subjects and on each individual was analyzed by t‐tests.

Results.—In both trials, the tension‐type and migraine groups had lower mean daily headache grades in the amphetamine than in the caffeine periods. P values for these differences indicated that there were real drug effects, on the average, in the migraine groups (P < .05) and suggestive but inconclusive effects in the tension‐type groups (P < .10). The individual n of 1 analyses showed that five tension‐type and three migraine subjects in Trial 1 and three tension‐type and three migraine subjects in Trial 2 had considerably lower mean daily headache grades on amphetamine with P values indicating, at various levels of significance (from P < .05 to P < .001), real amphetamine effects. Twelve of the remaining 18 patients had lower, albeit not significant, mean daily grades with amphetamine. No subject in either trial had a significantly lower mean daily headache grade on caffeine.

Conclusions.—Dextroamphetamine had real preventive effects on chronic tension‐type and migraine headaches in some subjects. These results should encourage other investigators to study its effects on these headaches.
Pharmacoeconomics: The Cost of Prophylactic Migraine Treatments
Authors: Adelman Leon C. , Adelman James U. , Freeman Marshall C. , Von Seggern Randal L.
Published: November 2004

Migraine preventive medications considered effective reduce headache frequency by 50 percent in approximately 50 percent of treated patients. In spite of similar effectiveness, these medications vary tremendonsly in their prices. Knowledge of medication prices and employing cost‐effective strategies may greatly reduce treatment costs.
Laser Lithotripsy for Treatment of Canine Uroliths
Authors: Davidson Ellen B. , Ritchey Jerry W. , Higbee Russell D. , Lucroy Michael D. , Bartels Kenneth E.
Published: November 2004

Objective—To confirmin vivooptimal laser energy settings previously determinedin vitrofor lithotripsy, to develop a technique for Ho:YAG laser lithotripsy, and to evaluate acute and chronic tissue effects of laser lithotripsy.

Study design—Prospective, randomized preclinical trial.

Animals or Sample Population—Nineteen intact, adult male dogs.

Methods—Via cystotomy, a single urolith was inserted into the urethra to the level of the base of the os penis to simulate obstruction. Uroliths (calcium oxalate, urate, or magnesium ammonium phosphate) were fragmented by Ho:YAG laser, in contact mode through a 320 μ optic fiber, passed through the operating channel of a 2.8 mm flexible endoscope. The time and total energy to fragmentation were recorded. Dogs were euthanatized immediately after lithotripsy (3 dogs) or at 3 days (7 dogs), and urethral lesions and any stone remnants were evaluated. Urethral integrity was also evaluated in 9 other dogs by endoscopy on day 10; these were also monitored clinically for 30 days.

Results—The mean time for adequate fragmentation was 166.7 seconds (range, 47–494.5 seconds). The mean±SD energy used was 1418±851.2 J. In part 1, 2 dogs were obstructed with urolith fragments at necropsy. Eight dogs had minimal (<30 mg) or no urolith material evident within the urethra. Four dogs had gross focal or circumferential erosion, ulceration, or hemorrhage of the urethral mucosa. Lesions were not associated with the site of laser irradiation in 2 dogs. In dogs observed for 30 days, hematuria, pollakiuria, and stranguria that were observed after lithotripsy, resolved in all affected dogs by day 5. No mucosal lesions were observed by endoscopy and none of the dogs became obstructed.

Conclusion—Laser lithotripsy with the Ho:YAG laser in contact mode successfully fragmented obstructive uroliths in male dogs.

Clinical relevance—Laser lithotripsy may be a clinically relevant technique for treatment of urolithiasis in male dogs; clinical studies to evaluate long‐term effects on urethral mucosa and the role of repeat treatment for recurrence are indicated.
Prognostic Implications of the Degree of Shunt Narrowing and of the Portal Vein Diameter in Dogs with Congenital Portosystemic Shunts
Authors: Kummeling Anne , Van sluijs Frederik J. , Rothuizen Jan
Published: November 2004

Objective—To determine prognostic evaluation and correlation of the degree of narrowing and the diameter of the portal vein in dogs with a congenital portosystemic shunt (CPS).

Study Design—Longitudinal prospective study.

Animals—Ninety‐seven dogs with CPS.

Methods—Shunt diameter was recorded before and after silk ligation to calculate degree of closure. Portal vein diameter was measured in 74 dogs. Short‐term (30 days) and long‐term (>1 year) outcome were evaluated. Dogs with clinical signs after 1 year were re‐examined to assess the degree of portosystemic shunting and compared with matched operated dogs without clinical signs. Correlations between clinical outcome, degree of closure, and portal vein diameter were statistically analyzed.

Results—Short‐term and long‐term mortality were 27% and 2.9% respectively. Clinical recurrence occurred in 10% of dogs. The degree of closure was significantly associated with mortality, but not with clinical recurrence. A significant correlation was found between degree of closure and the diameter of the cranial part of the portal vein. Portal vein diameter was only significantly associated with mortality in extrahepatic CPS. Subclinical portosystemic shunting was confirmed in 3 of 10 dogs.

Conclusion—The degree of shunt closure depended on portal development. Long‐term outcome did not depend on the degree of closure or portal development at the time of surgery. This suggested that factors such as hepatic and portal regeneration after surgery may be important.

Clinical Relevance—Determination of factors that predict the outcome after surgical treatment of CPS in dogs is important to gain insight in treatment selection or new therapeutic options.
Self‐Retaining Braces For Canine Arthroscopy
Authors: Schulz Kurt S. , Holsworth Ian G. , Hornof William J.
Published: November 2004

Objective— To describe self‐retaining braces for canine shoulder, elbow, hip, and stifle arthroscopy.

Study Design— Clinical design and application.

Sample Population— Clinical patients admitted for elective arthroscopy.

Methods— Self‐retaining braces were designed and constructed from commercially available products, steel tubing, and upholstery. The design efficacy was determined by clinical use.

Results— A shoulder/hip retraction device was constructed from a heavy‐duty Mayo stand and a steel T frame. An elbow brace and a stifle brace were constructed from a commercially available positioning arm and steel tubing. These devices were used successfully in clinical canine arthroscopy and provided consistent stability for arthroscopic surgery without the need of a surgical assistant.

Conclusions— Arthroscopic self‐retaining braces can be constructed from commercially available products and other simple materials to provide reliable patient positioning without the need for a surgical assistant.

Clinical relevance— Self‐retaining braces may provide improved patient stabilization and eliminate the need for a surgical assistant in most cases of canine arthroscopy.
A New Dissection Technique for Approach to Right‐sided Intrahepatic Portosystemic Shunts: Anatomic Study and Use in Three Dogs
Authors: Tobias Karen M. , Byarlay Judy M. , Henry Robert W.
Published: November 2004

Objective—To determine the feasibility of indirect suture passage around the right portal vein for attenuation of right‐sided intrahepatic portosystemic shunts (IHPSS).

Study Design—Anatomic study of cadavers and prospective evaluation of clinical cases.

Animals—Nine canine cadavers (median weight, 20.5 kg) and 6 client‐owned dogs suspected of having right‐sided IHPSS.

Methods—Silicone casts of the caudal vena cava and pre‐ and intrahepatic portal veins were made in fresh canine cadavers. A suture was passed dorsal to the portal vein above and below its bifurcation and pulled laterally so that it surrounded the right portal vein. The number and size of portal and caudal vena cava branches that interfered with the suture passage were recorded. Intra‐ and postoperative complications were evaluated in 3 dogs with right‐sided IHPSS and 3 dogs suspected of having right‐sided IHPSS that had right portal vein dissection and occlusion using this technique.

Results—Suture passage and placement around the right portal vein were easily accomplished in all 9 specimens. A 1 mm branch from the dorsal surface of the right portal vein was included in the encircling ligature in 4 specimens. The dissection technique was used successfully in 3 dogs with right‐sided IHPSS and 2 other clinical cases. The portal branch to the papillary process of the caudate lobe interfered with suture placement in 1 dog with a central IHPSS.

Conclusions—Indirect suture passage for ligation of the right portal vein can be successfully performed in normal dogs and dogs with congenital portosystemic shunts.

Clinical Relevance—Hemorrhage, vascular trauma, and surgery time may be reduced using this technique for attenuation of right‐sided IHPSS.
Stability of Ventricular Repolarization in Conscious Dogs with Chronic Atrioventricular Dissociation and His‐Bundle Pacing
Authors: SANDERS ROB , BAILIE MARC , OLIVIER N. BARI
Published: November 2004

Following AVN ablation, eight dogs were surgically instrumented for chronic (continuous) HIS‐bundle pacing. For data collection, implanted pacemakers were transiently programmed to pace in stepwise ascending ramps at rates from 50 to 200 beats/min in 30‐beat/min steps. Each rate was held for 60 seconds. At each rate, ECG signals were collected from conscious dogs for measurements of QT intervals during the last 10 seconds of each paced rate to construct a QT‐HR ramp. This QT‐HR ramp was repeated twice on each day of study 10 minutes apart. Dogs were randomly assigned to two groups and studied weekly for a minimum of 6 weeks. Group 1 dogs had pacemakers programmed to a rate of 80 beats/min for the duration of the study. Group 2 dogs were paced at 80 beats/min for weeks 1–3, then increased to 140 beats/min for weeks 4–6. The difference between paired QT‐HR ramps within 1 day was <3 ms. QT‐HR ramps were statistically indistinguishable over the 6‐week study for group 1 dogs. Group 2 dogs experienced a slight flattening in the slope of the QT‐HR ramps from week 3 to week 6 due to a reduction in QT interval at low HRs (50 and 80 beats/min) only. This conscious HIS‐pacing model in dogs is a sensitive, stable, and reproducible method to define ventricular repolarization characteristics over a range of programmable HRs and experimental conditions.
Autonomic Modulation of the U Wave During Sympathomimetic Stimulation and Vagal Inhibition in Normal Individuals
Authors: MAGNANO ANTHONY R. , HOLLERAN STEVE , RAMAKRISHNAN RAJASEKHAR , REIFFEL JAMES A. , BLOOMFIELD DANIEL M.
Published: November 2004

Prolonged repolarization time, an important contributor to the pathogenesis of ventricular arrhythmias, is usually identified by a long QT interval (QT) on the ECG but is frequently confounded by the presence of a U wave. The physiological basis and clinical relevance of the U wave is unresolved. To better understand the relationship between the T and U waves, this study examined their behavior during nonresting autonomic conditions. Twenty‐five healthy subjects were evaluated during sympathomimetic infusion with isoproterenol and vagal inhibition with atropine. As heart rate (HR) increased in response to isoproterenol, the QU interval (QU) decreased by an eightfold greater extent than QT. Furthermore, a marked increase in U wave amplitude and decrease in T wave amplitude were observed with T and U wave fusion at higher HRs. During atropine, QU decreased by only a threefold greater extent than QT, T and U wave amplitudes were affected only minimally, and T‐U wave fusion was not observed. These results demonstrate that sympathomimetic stimulation causes striking alterations in the timing and amplitude of U waves that differ from effects on the T wave. These effects are not observed during vagal inhibition. Thus, the U wave represents a component of cardiac repolarization that is electrocardiographically and physiologically distinct from the T wave with a unique response to sympathomimetic stimulation.
Relationship of Baseline Electrocardiographic Characteristics with the Response to Cardiac Resynchronization Therapy for Heart Failure
Authors: REYNOLDS MATTHEW R. , JOVENTINO LILIAN P. , JOSEPHSON MARK E. ,   miracle icd investigators
Published: November 2004

Prospective identification of patients most and least likely to respond to cardic resynchronization therapy (CRT) for congestive heart failure (CHF) will allow clinicians to target this intervention most efficiently. The authors hypothesized that ECG variables including RBBB and indicators of RV dysfunction and extensive prior myocardial infarction would correlate with diminished response to CRT. This study analyzed preimplantation ECGs in 110 patients with ICD indications and CHF due to left ventricular systolic dysfunction randomized to active biventricular pacing in the MIRACLE ICD trial. Clinical and ECG variables on the outcome of change in peak oxygen consumption from baseline to 6 months (Δ‐VO2) were evaluated. For this cohrt, average peak VO2 improved from 13.4 to 14.3 mL/kg per minute. Among clinical variables, the strongest predictors of increasing Δ‐VO2 were reduced exercise time and peak VO2 at baseline. A dominant R wave in lead a VR, RBBB, and evidence of prior anterior infarction were each associated with significantly smaller average improvements in Δ‐VO2 than their absence in univariate analysis. Alternative ECG criteria, including QRS duration, had no relationship with the outcome. In a multivariate model, only baseline VO2 (β=−0.3, P = 0.001) and ECG evidence of prior anterior infarction (β=−1.3, P = 0.03) were associated with the outcome. ECG markers of anterior infarction and RV dilation may help identify CHF patients unlikely to benefit from biventricular pacing. Further assessment is needed of these and other predictors of therapeutic response to CRT.
Pacemakers and Implantable Cardioverter Defibrillators:
Authors: WILD DAVID M. , FISHER JOHN D. , KIM SOO G. , FERRICK KEVIN J. , GROSS JAY N. , PALMA EUGEN C.
Published: November 2004

The size of pacemakers and implantable cardioverter defibrillators (ICDs) has been diminishing progressively. If two devices are otherwise identical in components, features and technology, the one with a larger battery should have a longer service life. Therefore, patients who receive smaller devices may require more frequent surgery to replace the devices. It is uncertain whether this tradeoff for smaller size is desired by patients. We surveyed 156 patients to determine whether patients prefer a larger, longer‐lasting device, or a smaller device that is less noticeable but requires more frequent surgery. The effects of subgroups were evaluated; these included body habitus, age, gender, and patients seen at time of pulse generator replacement (PGR), initial implant, or follow‐up. Among 156 patients surveyed, 151 expressed a preference. Of these, 90.1% preferred the larger device and 9.9% the smaller device (P < 0.0001). Among thin patients, 79.5% preferred a larger device. Ninety percent of males and 89.2% of females selected the larger device. Among younger patients (≤72 years), 89.6% preferred the larger device, as did 90.5% of older patients (>72 years). Of patients undergoing PGR or initial implants, 95% favored the larger device, as did 86% of patients presenting for follow‐up. The vast majority of patients prefer a larger device to reduce the number of potential replacement operations. This preference crosses the spectrum of those with a previously implanted device, those undergoing initial implants, those returning for routine follow‐up, and patients of various ages, gender, and habitus.
Thebesian Valve Imaging with Electron Beam CT Angiography:
Authors: SHINBANE JEROLD S. , GIRSKY MARC J. , MAO SONGSHOU , BUDOFF MATTHEW J.
Published: November 2004

We report visualization of a prominent coronary sinus os valve (Thebesian valve), by electron beam computed tomographic angiography, which impeded an endocardial approach to left ventricular pacing. Resynchronization therapy was therefore performed with an epicardial approach to left ventricular lead placement. Electron beam computed tomographic angiography can provide detailed information for coronary sinus instrumentation, including anomalies potentially affecting the approach to resynchronization therapy.
An Unusual Obstacle in Lead Extraction
Authors: NANDAKUMAR RAMASAMI , BROADHURST PAUL
Published: November 2004

This case report deals with an unusual complication in the removal of an active fixation implantable cardioverter defibrillator (ICD) lead. We were not able to pass the stylet beyond the point of lead fracture and this was subsequently found to be due to the stylet passing between the electrode and the outer layer of the lead insulation. The lead was removed by rotation extraction of the entire lead.
Autologous Skeletal Myoblasts for Myocardial Regeneration
Authors: SIMINIAK TOMASZ , KALMUCKI PIOTR , KURPISZ MACIEJ
Published: November 2004

We overview the current knowledge about the use of skeletal myoblasts in regeneration of infarcted myocardium. Myoblasts are attractive candidates for cell source for cardiomyoplasty in chronic postmyocardial injury as indicated by experimental and initial clinical experience. We also review the recent developments in skeletal myoblasts transplantaion techniques with special attention to percutaneous transvenous approach to deliver therapeutic agents into myocardium from the lumen of coronary veins under intravascular guidance.
Relationship between Size of Myocardial Infarctions Assessed by Delayed Contrast‐Enhanced MRI after Primary PCI, Biochemical Markers, and Time to Intervention
Authors: HAASE JÜRGEN , BAYAR RUSEN , HACKENBROCH MATTHIAS , STÖRGER HANS , HOFMANN MANFRED , SCHWARZ CLAUS‐EBERHARD , REINEMER HARALD , SCHWARZ FRANZ , RUEF JOHANNES , SOMMER TORSTEN
Published: November 2004

Background The quantitative assessment of myocardial infarctions using delayed contrast‐enhanced magnetic resonance imaging (MRI) has recently been validated using postmortem histopathological animal studies. In a prospective study, we investigated the correlation between infarct size as assessed by delayed contrast‐enhanced MRI, elevation of creatine kinase (CK), and c‐reactive protein (CRP) as well as the time from onset of symptoms to intervention.

Methods Four to 10 days after immediate PCI in 45 acute ST‐segment elevation myocardial infarction (STEMI) patients (<24 hour) with stenting of the infarct‐related artery and treatment with abciximab, we performed gadolinium contrast‐enhanced three‐dimensional inversion recovery gradient‐echo MR sequences with complete coverage of the LV‐myocardium in short‐axis slices. The mass of infarcted tissue based on the volume of hyperenhanced myocardium was calculated and linear regression analysis was performed to assess the correlation between absolute size of infarctions (g) as well as relative size (LV%) with peak values of CK, CRP, and the time to PCI.

Results There was a significant correlation between absolute size of infarctions (g) and peak CK values (r = 0.72; P < 0.001) as well as the relative size (LV%) and peak CK (r = 0.77; P < 0.001). No correlations were found between absolute size (r = 0.33) as well as relative size (r = 0.27) of infarctions and peak CRP. There was also no correlation between absolute (r = 0.29) as well as relative size of infarctions (r = 0.27) and the time from onset of symptoms to PCI.

Conclusions In patients with acute STEMI (<24 hour) undergoing immediate PCI with stenting and treatment with abciximab, peak CK values correlated well with infarct size as assessed by delayed contrast‐enhanced MRI. There were no correlations between infarct size and peak CRP as well as the time to intervention.
New Approaches to Ostial and Bifurcation Lesions
Authors: HOYE ANGELA , VAN DER GIESSEN WIM J.
Published: November 2004

Percutaneous coronary intervention of bifurcation lesions is associated with lower procedural success rates, and an increased subsequent rate of major adverse cardiac events and restenosis. Currently, an array of stenting possibilities suggests a rational approach to treat various bifurcation lesions with appropriate techniques. This is howeever seldom the case. The main problems of treating bifurcation lesions remain plaque shift leading to (threatened) side branch occlusion, and either too much or insufficient side branch ostial stent coverage predisposing to impaired side branch access or restenosis, respectively. This paper reviews the available technologies and their relative merits.
Influence of Doxycycline on Clinical and Angiographic Outcome Following Percutaneous Coronary Intervention
Authors: KANNENGIESSER MATTHIAS , KALTENBACH MARTIN , STILLE WOLFGANG , REIFART NICOLAUS , HAASE JÜRGEN
Published: November 2004

Background: Infection with Chlamydia pneumoniae may be involved in atherosclerosis. Neointima proliferation after percutaneous coronary intervention (PCI) could be aggravated by proinflammatory action of chronic vascular chlamydial infection. We investigated the influence of doxycycline therapy on restenosis rate and adverse clinical event rates after PCI.

Methods: We followed 1,019 consecutive patients in a single center nonrandomized observational study. During a 3‐month period, all patients having PCI (n = 541; treatment group) received oral doxycycline 100 mg/day for 50 days starting from the day of the procedure. A control group (n = 478) consisted of consecutive post‐PCI patients recruited from immediately preceding (n = 250) and ensuing periods. Event rates were gained by questionnaires after 259 ± 57 days. Restenosis rate was derived from the routine angiographic restudies after 172 ± 15 days.

Results: No significant differences between treatment and control group were found in adverse clinical event rates (myocardial infarction: 0.7% vs 1.3%; repeat‐PCI: 24.0% vs 20.9%; coronary bypass grafting: 5% vs 3.9%; overall death after 6 months: 3.5% vs 2.1%) and overall restenosis rate (21.6% vs 23.4%). A subgroup analysis of nondiabetic male smokers revealed a lower restenosis rate in the treatment group (10.9% vs 30.9%; P = 0.0195).

Conclusion: Doxycycline therapy for 50 days following PCI does not appear to have a substantial influence on the clinical and angiographic outcome in unselected patients. The observed reduction in restenosis rate among nondiabetic male smokers defines a new hypothesis that should stimulate further investigations.
On Imagination: Reconciling Knowledge and Life, or What Does “Gregory Bateson” Stand for?
Authors: Pakman Marcelo
Published: November 2004

This article presents a reading of Gregory Bateson's oeuvre, focusing on his interest in the representational gap between map and territory, and its importance in the development of his redefinition of the concept of “mind,” his new discipline called “ecology of ideas,” and a methodology congruent to it based on the logics of metaphor. Inquiries on three initial stories from different domains allow the use of homologies between form and content in the article. This reading of Bateson's oeuvre stresses his questioning (like Derrida's) of the metaphysics of presence on which Western philosophy has been mostly based, and of the central role of imagination as a balancing factor for a family therapy that he both contributed to and saw with reservations.
The Formation of the Therapeutic Alliance in Couple Therapy
Authors: Knobloch‐Fedders Lynne M. , Pinsof William M. , Mann Barton J.
Published: November 2004

This study examines the predictive validity of several clinical variables—including marital distress, individual symptomatology, and family‐of‐origin experiences—on the formation of the alliance in couple therapy. Eighty people who were treated with a naturalistic course of integrative conjoint psychotherapy at a large midwestern outpatient clinic were assessed on the clinical variables before session 1. They also completed ratings of the therapeutic alliance after sessions 1 and 8. Individual symptomatology did not predict alliance formation at either treatment stage. Higher levels of marital distress predicted poorer alliances to treatment between partners at session 1. Marital distress also predicted therapeutic alliance quality for men and women at session 8. Family‐of‐origin distress predicted alliance quality for men at session 1, and for women at session 8. Family‐of‐origin distress for men and women predicted split alliances early in treatment, and marital distress predicted split alliances for women at session 8. Clinical implications for the assessment and treatment of couples are discussed.
Adult Attachment and Patterns of Extradyadic Involvement
Authors: Allen Elizabeth S. , Baucom Donald H.
Published: November 2004

Relationships between patterns of extradyadic involvement (EDI) and adult attachment were examined separately with undergraduates and community adults reporting prior EDI. Those with fearful or preoccupied styles reported more intimacy motivations for EDI, and undergraduates with these styles also reported more self‐esteem motivations. Conversely, those with a dismissive style reported more autonomy motivations for EDI. Those with a fearful attachment style reported ambivalence about intimacy in the EDI. Fearful and preoccupied undergraduates and community males reported a more obsessive extradyadic relationship. However, dismissive individuals did not report more casual EDI. Gender effects also emerged, with females reporting more intimacy motivations than males, and undergraduate males reporting more casual EDI than undergraduate females. In the undergraduate sample, dismissive males had the most extradyadic partners over the prior 2 years relative to all other groups, and preoccupied females reported more partners than secure females. Clinical implications of these findings are discussed.
Late Adolescent Perceptions of Parent Religiosity and Parenting Processes
Authors: Blake Snider J. , Clements Andrea , Vazsonyi Alexander T.
Published: November 2004

The current investigation examined the relations between adolescent reports of parent religiosity and parenting processes, using both a dimensional and a typological conceptualization of parenting. Self‐report data were collected from 357 late adolescents. Partial correlations indicated that parent religiosity was associated with both parenting dimensions and parenting styles in conceptually expected directions. Regression analyses provided evidence that the dimensional conceptualization of parenting explained additional variability in perceived parental religiosity above and beyond parenting style effects. Findings suggest that a dimensional conceptualization of parenting processes extends the literature on parent religiosity because it yields more nuanced information about how parental religiosity may be related to differentiated parenting behaviors. Potential therapeutic implications of the findings are discussed.
A multivariate study of predictors of repeat parasuicide
Authors: Colman I. , Newman S. C. , Schopflocher D. , Bland R. C. , Dyck R. J.
Published: November 2004

Objective:  To identify variables which differentiate future repeaters of parasuicide from non‐repeaters in a multivariate analysis.

Method:  Interviews were conducted with 507 parasuicide cases; data were collected on precipitating factors for the index parasuicide, psychiatric and medical history, stressful life events, prior history of parasuicide, hopelessness, anger, self‐esteem and social adjustment. Individuals were followed for 1–2 years to determine if a repeat parasuicide occurred.

Results:  A logistic regression model identified four significant predictors of repeat parasuicide: prior history of parasuicide, a history of depression, a history of schizophrenia and poor physical health. A risk factor scale constructed from these four variables showed that the risk of repeat parasuicide increases as the number of risk factors increases.

Conclusion:  This study identifies four key predictors of repeat parasuicide, and provides evidence that the risk of repeat parasuicide increases when multiple risk factors are present.
Histomorphometry of human sinus floor augmentation using a porous β‐tricalcium phosphate: a prospective study
Authors: Zerbo Ilara R. , Zijderveld Steven A. , De Boer Anje , Bronckers Antonius L. J. J. , De Lange Gert , Ten Bruggenkate Christiaan M. , Burger Elizabeth H.
Published: November 2004

Abstract: Tricalcium phosphate (TCP) has been historically a well‐accepted material for bone augmentation. We examined the use of a porous β‐TCP (100%) in a split mouth model for sinus floor augmentation. Five patients were treated bilaterally, receiving 1–2 mm‐sized β‐TCP particles (Cerasorb®) on one side (test side) and autologous chin bone particles on the other (control) side. Four other patients were treated with a unilateral sinus floor augmentation using 100% β‐TCP (no controls). Biopsies of the augmented sites were taken at 6 months. Histomorphometry measurements were carried out in order to quantify bone augmentation at test and control sides. The average bone volume (BV) formed in the augmented sinus at the control side was 41% (32–56%) and 17% (9–27%) in the test side when all nine patients were included (statistically significant, P=0.04). When only the five bilateral patients were included, mean BV of the test side was 19% (13–27%), which was also significantly different from the control side (P=0.009). Osteoid formation tended to be higher in the test side biopsies (1.3%) than in the controls (0.3%) (marginally significant, P=0.1), indicating ongoing bone formation in the TCP material. The amount of lamellar bone at the test side was less than half the amount in the control side, indicating that remodelling had only recently started in the TCP‐augmented side. The resorption surface, however, did not differ significantly between the two sides. These histological results indicate that Cerasorb® is an acceptable bone substitute material for augmentation of the maxillary sinus. Due to the osteoconductive, but not osteoinductive properties of this material, the rate of bone formation is somewhat delayed in comparison to autologous bone.