bluuebunny/crossref_metadata_2025 huggingface dataset:
An Innovative Mobile Lithotripter for Extracorporeal Shock Wave Lithotripsy and Therapy
Authors: Küfer Rainer , Volkmer Björn , Nesslauer Thomas , Schneider Peter , Hautmann Richard E. , Gschwend Jürgen E.
Published: April 2003

Introduction: To assess the performance of a new mobile device for extracorporeal shock wave lithotripsy (ESWL) and therapy (ESWT). Materials and Methods: 278 patients underwent 399 treatment for stone disease. 28 patients received 64 treatments for orthopaedic issues such as pseudarthrosis or enthesiopathies resistant to conservative treatment. Results: During ESWL, minor pain symptoms were well resolved with analgesics intravenously. 45% of patients were stone-free and 50% had irrelevant fragments at the time of discharge. 66% of patients underwent a single treatment. Auxiliary measures after ESWL were necessary in 5%. After ESWT, pain symptoms of all patients were reduced on average to 5.2 points on a numerical rating scale from 1 to 10. Patients with bony nonunions produced callus if the bone scan before ESWT showed activity. No complication related to either form of treatment was observed. Conclusions: This innovative mobile lithotripter fulfils all expectations a user can have in an upt-to-date equipment: good disintegration, low side effects, easy handling, fast installation, dual imaging and suitability for ESWL and ESWT.
Application of the Microwave Tissue Coagulator: Is It Beneficial to Partial Nephrectomy?
Authors: Matsui Yoshiyuki , Fujikawa Keita , Iwamura Hiroshi , Oka Hiroya , Fukuzawa Shigeki , Takeuchi Hideo
Published: April 2003

Background/Aim: The indications of partial nephrectomy have expanded after the introduction of new techniques for preventing excessive blood loss and avoiding deterioration of the renal function after clamping the renal pedicle. We present our clinical experience of partial nephrectomy for renal tumors using a microwave tissue coagulator. Patients and Methods: Between April 1996 and January 2000, 34 patients underwent open partial nephrectomies in the Kobe City General Hospital. The microwave tissue coagulator was used for resection of the renal parenchyma, but in deeper lesions a sharp dissection was performed. Twenty-two patients (groups 1 and 2) underwent partial nephrectomy without vascular control (14 renal pedicles were not disturbed in group 1 patients, and 8 renal pedicles were dissected but not clamped in group 2 patients). Another 12 patients (group 3) underwent vascular control with ligation of the tumor-feeding segmental arteries before parenchymal resection. The patients of group 1 underwent wedge resections, while those of groups 2 and 3 underwent segmental or transverse partial nephrectomies. Results: Complete tumor resection was done in all 34 patients. In group 1, the microwave tissue coagulator was very effective to control the blood loss (mean 330 ml). In larger resections, this method only was inadequate to control the blood loss (mean 489 ml in group 2), so that we needed vascular control. However, despite vascular control, mean blood losses of about 943 ml because of deeper venous bleeding occurred in group 3, and, moreover, postoperative renal infarctions occurred in 2 patients. Other complications were urinary fistula formation in 16 patients (47%) and renal pelvic stenoses in 2 patients (5.8%). All of the urinary fistulas were easily repaired by simple suturing intraoperatively. Conclusions: Especially in wedge resection, the microwave tissue coagulator achieved safe resection without vascular control which differs from other new techniques. However, in larger resections, a combination with other techniques may be necessary to decrease blood loss and the rate of complications.
Effect of Tumor-Infiltrating Lymphocyte Subsets on Prognosis and Susceptibility to Interferon Therapy in Patients with Renal Cell Carcinoma
Authors: Igarashi Tatsuo , Takahashi Hidenori , Tobe Toyofusa , Suzuki Hiroyoshi , Mizoguchi Kenichi , Nakatsu Hiro-omi , Ito Haruo
Published: April 2003

Introduction: Immunotherapy effectively treats advanced renal cell carcinoma in only a limited number of patients. However, the predicted prognosis for each patient in relation to immune status and response to immunotherapy remains problematic. We analyzed tumor-infiltrating lymphocyte (TIL) subsets to determine whether these correlated with the prognoses for the patients and the response to α-interferon therapy. Materials and Methods: TIL subsets from resected specimens of 79 patients were analyzed by two-color flow cytometry and then compared with the patients’ long-term clinical courses and responses to interferon therapy. Results: In patients with stages III and IV, an increased infiltration of CD4+ cells and decreased CD8+ cells constituted a fair prognostic factor. In 17 patients with metastatic lesions, 8 of 10 patients who had disease progression after interferon therapy showed an increase in CD8+ cells above 25%, whereas 2 responders and 5 patients who had stable disease showed infiltration of CD8+ cells below 25%. Conclusions: The TIL subset is a prognostic factor for advanced renal cell carcinoma, and its analysis provides a method to predict the susceptibility to interferon therapy.
Stroke and Pediatric Human Immunodeficiency Virus Infection
Authors: Narayan Prithvi , Samuels Owen B. , Barrow Daniel L.
Published: April 2003

Stroke is an uncommon complication in pediatric patients with acquired immunodeficiency syndrome (AIDS). However, with the increasing life span of this patient population, more cases of stroke are being reported. We report the case of a 13-year-old girl with a known history of AIDS who presented with new-onset seizures and right hemiparesis. Serial imaging studies revealed progressive occlusion of the left middle cerebral artery and both anterior cerebral arteries with development of collateral circulation. The workup for other etiologies of stroke was negative. This nonatherosclerotic occlusive disease is most likely secondary to vasculopathy caused by the human immunodeficiency virus (HIV). HIV infection should be included in the differential diagnosis of children who present with seizures, mental status change or focal neurological deficits. Treatment options are limited. The different prognoses associated with the etiologies of stroke in this patient population mandate a careful and thorough evaluation.
Neuropathological Findings in a Child with Slit Ventricle Syndrome
Authors: Del Bigio Marc R.
Published: April 2003

The histopathological changes in shunted hydrocephalic children with slit ventricle syndrome have never been described. Periventricular gliosis is presumed to be an important feature. A girl who was shunted in infancy following meningitis developed headaches at 10 years of age and suffered a respiratory arrest, from which she was resuscitated. CT scan of the head showed very small ventricles. A diagnosis of slit ventricle syndrome was made. She died 33 h later. Autopsy revealed a large head and brain, small ventricles with glial adhesions, obstruction of the cerebral aqueduct, complete obstruction of the shunt catheter and reactive astroglia in the periventricular white matter. The latter change was no more severe than in hydrocephalic children with enlarged ventricles who have died following shunt failure. Periventricular astrogliosis may not necessarily be the major determinant of the slit ventricle syndrome.
Aging and Increased Hypothalamic Glial Fibrillary Acid Protein (GFAP) mRNA in F344 Female Rats
Authors: Anderson Christopher P. , Rozovsky Irina , Stone David J. , Song Yubei , Lopez Lori M. , Finch Caleb E.
Published: April 2003

During reproductive aging, female rodents show impaired inducibility of the estradiol (E2)-induced (preovulatory) surge of luteinizing hormone (LH), which is associated with hypothalamic neuronal impairments of aging. To evaluate if astrocytes show comparable age changes, we analyzed the regulation of glial fibrillary acidic protein (GFAP) mRNA which is transiently increased in the arcuate nucleus in association with the proestrus LH surge in young rats. In aging (18-month-old) F344 rats in persistent estrus, the loss of the E2-induced LH surge was paralleled by the lack of increased GFAP mRNA in the arcuate nucleus (in situ hybridization with X-ray film). We then tested the hypothesis that restoration of the LH surge by chronic ovariectomy (OVX) in aging rats would restore or block GFAP mRNA induction, respectively. Despite restoration of the inducible LH surge in aging rats by chronic OVX, there was no induction of GFAP mRNA in the arcuate nucleus. Moreover, young rats given chronic E2 implants for 6 weeks as a model for persistent estrus, retained induction of arcuate nucleus GFAP mRNA, despite loss of the induced LH surge. The aging rats were highly sensitive to gross pituitary enlargement from chronic E2 with 50% mortality; thus, the F344 genotype is not optimum for studies of aging-E2 interactions that require prolonged E2 treatments. More detailed cellular level analysis of GFAP mRNA is needed to define the relationship of GFAP expression to synaptic reorganization during the LH surge. The aging rats also showed higher levels of GFAP mRNA in the arcuate nucleus and ventromedial nucleus, consistent with the general trend for elevated GFAP mRNA during aging in other brain regions and in both sexes.
Calcitonin Gene-Related Peptide and Choline Acetyltransferase Colocalization in the Human Vestibular Periphery
Authors: Popper Paul , Ishiyama Akira , Lopez Ivan , Wackym Phillip A.
Published: April 2003

Within the vestibular system, calcitonin gene-related peptide (CGRP) has been localized in the efferent terminals and their brainstem neuronal cell bodies in several animal models. Presently, very few studies have verified these findings in the vestibular system in adult primates or humans. CGRP immunoreactivity (CGRPi) and its colocalization with choline acetyltransferase immunoreactivity (ChATi) in human vestibular end organs and Scarpa’s ganglion were studied using polyclonal antibodies against CGRP and ChAT, at the light-microscopic level. The CGRPi axons ramified to produce numerous CGRPi terminals throughout the neurosensory epithelium of the maculae and cristae, primarily in the basal and midbasal areas. Numerous CGRPi efferent terminals made contact with both type II vestibular hair cells and the afferent chalices surrounding type I vestibular hair cells. All CGRP immunoreactive fibers also exhibited ChATi. As in the animal models, no CGRPi was found within Scarpa’s ganglion. This study provides evidence for CGRPi in the human vestibular periphery and validates the biomedical relevance of the current animal models.
Renal Tubular Dysfunction in a Patient with Beta-Thalassemia Minor
Authors: Oktenli Cagatay , Bulucu Fatih
Published: April 2003

β-Thalassemia minor is a hemoglobinopathy which has been known as a symptomless carrier state. Although there are many causes leading to renal tubular dysfunction, β-thalassemia minor has not been reported among them in reviewing the literature. In a 20-year-old male patient referred to us because of glucosuria detected with dipstick, there was also anemia (hemoglobin, 11.5 g/dl; mean cell volume, 60 fl; and mean cell hemoglobin concentration, 19.5 pg). The 24-hour urinary glucose excretion rate was 5 g and, additionally, he had tubular proteinuria (albumin/β2-microglobulin ratio in urine was 17.32). Based upon the detailed evaluation for both asymptomatic urinary abnormality and anemia, he was diagnosed as having renal tubular dysfunction and β-thalassemia minor (hemoglobin A1 was 91%, and hemoglobin A2 was 9%). In conclusion, further reports are needed to reveal whether there is an association between these two distinct disorders.
An Unusual Presentation for Nephrotic Syndrome
Authors: Yalcin Ahmet Ugur , Akcar Nevbahar , Can Cavit , Kasapoglu Emine , Sahin Garip
Published: April 2003

We present a 30-year-old man with nephrotic syndrome presenting with bilateral perirenal massive collection compatible with transudation. After drainage of collections kidney biopsy was performed and the histologic diagnosis was focal and segmental glomerulosclerosis. The patient was treated with cyclophosphamide, prednisone, furosemide and enalapril. After remission of nephrotic syndrome renal ultrasound showed complete resolution of perirenal collections. In conclusion, the case shows that perirenal subcapsular transudation is a rare complication of nephrotic syndrome and massive collections can be treated successfully by percutaneous drainage.
Assessment of Haemostatic Risk Factors in Patients with Acute Renal Failure Associated with Severe Systemic Inflammatory Response Syndrome
Authors: García-Fernández Nuria , Lavilla Francisco Javier , Rocha Eduardo , Purroy Andrés
Published: April 2003

Background/Aim: The prognosis of acute renal failure (ARF) in the Intensive Care Unit (ICU) is variable and depends mainly on the underlying disease. Consequently, the outcome prediction is difficult. The majority of the prognostic measures used include clinical parameters and routine laboratory tests but not no study has considered the prognostic value of haemostatic disturbances. These disturbances play a key role in the evolution of multiple organ dysfunction syndrome (MODS) in patients with ARF, which occurs as part of systemic inflammatory response syndrome (SIRS). The aim of the present study was to search for early significant predictive factors among a group of haemostatic parameters in these patients. Methods: Forty patients (age: 60.1 ± 14.1 years) with ARF (requiring renal replacement therapy) associated with SIRS and haemodynamic instability (systolic blood pressure <90 mm Hg and/or vasopressor drugs) were included. The plasmatic levels of the following haemostatic factors were measured within the first 6 h of the SIRS evolution: von Willebrand Factor (vWF), thrombomodulin, plasminogen activity inhibitor type 1 (PAI-1 antigen), tissue type plasminogen activator (t-PA antigen), prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complexes (TAT) and D-dimer. Age, sex, medical or surgical disease, septic status or not, type of ARF (prerenal or acute tubular necrosis, oliguric or nonoliguric), and requirement for inotropics and mechanical ventilation were also considered. Univariate and multivariate logistic regressions were used to identify the risk factors for death and to develop a possible mortality prediction model on this basis. Results: By univariate analysis, high levels of PAI-1 antigen (≧60 ng/ml) and F1 + 2 (>2.5 nmol/l) at early phases of ARF-severe SIRS were found to be independent risk factors for death (odds ratio (OR) = 6.37, p = 0.0181 and OR = 5.49, p = 0.0238, respectively). Age over 61 years and requirement of mechanical ventilation were independent death risk factors (OR = 4.33, p = 0.0251 and OR = 2.4, p = 0.0078, respectively). A possible mortality prediction model was obtained including the age and the PAI-1 antigen and F1 + 2 variables. Conclusion: In patients with ARF associated with severe SIRS, the independent risk factors from the early phases of the process are not only the known variables such as advanced age, but also high levels of PAI-1 antigen and F1 + 2. In the future, the individual probability of death could be calculated by a prediction model which includes these variables.
Distinct Role of Intrarenal Cyclooxygenase-1/2 in Chronic Unilateral Renal Ischemia
Authors: Tokuyama Hirobumi , Hayashi Koichi , Matsuda Hiroto , Kubota Eiji , Honda Masanori , Okubo Ken , Ozawa Yuri , Saruta Takao
Published: April 2003

Aims: The role of cyclooxygenase (COX)-1/2-induced prostaglandins (PG) in unilateral chronic renal ischemia of anesthetized dogs was examined. Methods: Ischemic kidneys were established by reducing renal blood flow of left renal artery to 10% of baseline with an adjustable clip. After 4 weeks, changes in intrarenal contents of PGE2/PGI2 and angiotensin (Ang) II were evaluated with renal microdialysis and biopsy. Furthermore, the effect of a non-specific COX inhibitor (sulpyrine), a COX-2-specific inhibitor (NS398), and an Ang receptor antagonist (CS866) on renal function and renal PG contents were evaluated. Results: Unilateral renal artery clipping reduced renal plasma flow (RPF) in clipped (from 59 ± 2 to 17 ± 1 ml/min, n = 18) and nonclipped kidneys (from 59 ± 2 to 44 ± 2 ml/min) and natriuresis. Intrarenal PGE2 increased only in clipped kidneys (from 114 ± 7 to 375 ± 25 pg/ml), whereas 6-keto-PGF1α increased in both kidneys. Sulpyrine reduced intrarenal PG contents, and decreased RPF, GFR, and urinary sodium excretion (UNaV), whereas NS398 reduced UNaV in clipped (from 4.0 ± 0.9 to 1.7 ± 0.2 µEq/min) and nonclipped kidneys (from 5.4 ± 0.5 to 2.9 ± 0.3 µEq/min), without affecting renal hemodynamics. Intrarenal Ang II contents increased in clipped (from 0.70 ± 0.06 to 2.32 ± 0.33 pg/mg, n = 18) and nonclipped kidneys (from 0.65 ± 0.06 to 2.45 ± 0.33 pg/mg, n = 18), and CS866 improved renal hemodynamics and natriuresis. The elevated intrarenal Ang II content was suppressed by NS398 only in clipped kidneys. Conclusion: Unilateral renal ischemia elevates intrarenal PGE2 contents in clipped kidneys, which serves to countervail the aggravation of renal function. Furthermore, intrarenal COX isoforms may play differential roles, with COX-1 participating in modulation of renal hemodynamics, and COX-2 contributing to sodium excretion and Ang II formation.
Mesothelial Dysplastic Changes and Lipid Peroxidation Induced by 7.5% Icodextrin
Authors: Gotloib Lazaro , Wajsbrot Valeri , Shostak Avshalom
Published: April 2003

Background: The issue of icodextrin biocompatibility is somehow ambiguous. Whereas some experimental data point at better bicompatibility of icodextrin compared with high glucose concentration fluid, other reports showed substantial cytotoxic effects upon monocytes and cultured mesothelial cells. The present investigation exposes the first attempt to investigate the biocompatibility issue in an in vivo and in situ setup. Methods: Mice were intraperitoneally injected once a day with the 7.5% icodextrin solution, during 30 consecutive days. Imprints of the mesothelial monolayer covering the anterior liver surface were taken after 2 h, 15 and 30 injections, as well as after recovery periods of 7, 30 and 60 days. Changes on the cell population were evaluated as a function of: density, cell surface area, cell radius, nuclear surface area, number of nucleoli per nucleus, nuclear cytoplasmic index, as well as for prevalence of multinucleation, mitosis, non-viable cells and apoptotic bodies. Additionally, peritoneal dialysis was performed in 3 groups of rats exposed to 4.25% glucose dialysis fluid, 1.1% amino acids solution, or to 7.5% icodextrin. Samples were taken for thiobarbituric acid reactive substances (TBARS) from each group. Results: Mesothelial cell populations of mice exposed to 7.5% icodextrin displayed significantly reduced density, increased cell size, higher increased nuclear/cytoplasmic index, increased numbers of heterogeneous nucleoli, extremely low prevalence of mitosis, atypical mitosis, micronuclei, reduced cell viability as well as a significantly higher prevalence of apoptosis. Rats exposed to the same experimental solution showed significantly higher levels of TBARS (basically malondialdehyde), testifying for an undergoing process of lipid peroxidation. Conclusions: Overall, these results suggest that the 7.5% icodextrin dialysis solution induced, through a mechanism of lipid peroxidation, substantial DNA injury, leading the exposed monolayer to commit protective cellular suicide. Consequently, this information raises some doubts about the safety of 7.5% icodextrin solution in peritoneal dialysis patients.
Treatment Modalities and Outcome of the Renal Victims of the Marmara Earthquake
Authors: Sever Mehmet Sükrü , Erek Ekrem , Vanholder Raymond , Koc Mehmet , Yavuz Mahmut , Ergin Hulya , Kazancioglu Rumeyza , Serdengecti Kamil , Okumus Gunay , Ozdemir Nurhan , Schindler Ralf , Lameire Norbert
Published: April 2003

Background/Aims: Treatment of renal problems during natural catastrophes is highly complicated both for medical and logistic reasons. The therapeutic interventions applied to and the outcome of 639 victims with acute renal problems during the catastrophic Marmara earthquake have been the subject of this study. Methods: Questionnaires regarding information about 63 clinical and laboratory variables were sent to 35 reference hospitals that treated the victims. Information considering therapeutic interventions and outcome obtained through these questionnaires was submitted to analysis. Results: At least one form of renal replacement therapy was administered to 477 (74.6%) of the 639 victims. Of these, 437, 11, and 4 were treated solely by intermittent hemodialysis, continuous renal replacement therapy, and peritoneal dialysis, respectively; 25 victims needed more than one dialysis modality. In total, 5,137 hemodialysis sessions were performed. Also, 2,981, 2,837 and 2,594 units of blood, fresh frozen plasma, and human albumin were administered, respectively. Transfusion of these products was usually associated with higher rates of dialysis needs and mortality. Ninety-seven patients (15.2%) died. The mortality rate of dialyzed victims was higher as compared to nondialyzed ones (17.2 vs. 9.3%, p = 0.015). Conclusions: Massive amounts of dialysis treatment as well as blood and blood product transfusions can be necessary in the treatment of catastrophic earthquake victims with nephrological problems. Despite the potential risk of a high mortality, in the case of appropriate and energetic medical interventions, reasonable final outcomes can be achieved.
Maternal Adrenalectomy Abrogates the Effect of Fetal Alcohol Exposure on the Interleukin-1β-Induced Febrile Response: Gender Differences
Authors: Taylor Anna N. , Tritt Susan H. , Tio Delia L. , Romeo Horacio E. , Yirmiya Raz
Published: April 2003

Fetal alcohol exposure (FAE) has been shown to blunt the febrile component of the primary host-defense response to infection induced experimentally by systemic administration of interleukin (IL)-1β. Given that maternal adrenalectomy (ADX) can prevent various postnatal effects of FAE, the present experiments were designed to determine whether maternal ADX would prevent the blunted IL-1β-induced febrile response of fetal alcohol-exposed offspring and whether the effects of maternal ADX would be gender related. Timed-pregnant rats underwent ADX or were sham-operated on gestation day (GD) 7, or remained intact (without any surgery), and were fed ethanol-containing (E) or pair-fed (PF) liquid diets or normal (N) rat chow and water from GD 8 to GD 21. As adults, male and female E, PF and N offspring were injected with saline on day 1 and with IL-1β (2 µg/kg, i.p.) on day 2 at 09.00 h and the body temperature was recorded biotelemetrically for 8.5 h. IL-1β produced significantly lower febrile responses in female than in male offspring of intact dams, irrespective of prenatal diet. Furthermore, prenatal surgical stress differentially affected the IL-1β-induced febrile response of male and female normally fed offspring. Additionally, in both male and female offspring of intact dams, FAE significantly attenuated the IL-1β-induced febrile response. In males, FAE also attenuated the febrile response in the offspring of maternal sham-operated dams, and this effect was completely reversed by maternal ADX. In females, both maternal sham surgery and ADX reversed the effect of FAE on the febrile response. These findings suggest that maternal adrenal mediators are essential for the long-term effect of FAE on the febrile response in male offspring. In females, early prenatal surgical stress is sufficient to reverse the effects of FAE, possibly via adrenal-independent mechanisms that affect the thermoregulatory system.
Enhanced Glucocorticoid Feedback Inhibition of Hypothalamo-Pituitary-Adrenal Responses to Stress in Adult Rats Neonatally Treated with Dexamethasone
Authors: Kamphuis Patrick J.G.H. , Bakker Joost M. , Broekhoven Mark H. , Kunne Cindy , Croiset Gerda , Lentjes Eef G. , Tilders Fred J.H. , van Bel Frank , Wiegant Victor M.
Published: April 2003

We studied the long-term effect of neonatal treatment with the synthetic glucocorticoid dexamethasone (DEX) on stress responsivity later in life. It was found that the plasma adrenocorticotropin hormone (ACTH) and corticosterone (CORT) responses induced by novelty or conditioned fear stress were markedly attenuated in adult rats that had been neonatally treated with DEX as compared with saline (SAL)-treated controls. Since there were no differences in the heart rate, body temperature, plasma noradrenaline, plasma adrenaline and behavioral responses to these stressors, this points to a deficit within the hypothalamic-pituitary-adrenal (HPA) axis of DEX rats. We found no differences between DEX and SAL rats in basal plasma CORT concentrations measured throughout the circadian cycle, nor in the fraction unbound of CORT circulating under resting conditions, indicating normal tonic regulation of the HPA axis in DEX rats. Since we also found no differences in the hormonal responses induced by intravenous injection of graded doses of ACTH or corticotropin-releasing hormone (CRH), we investigated the sensitivity of the HPA response to stress for inhibition by glucocorticoids. Pretreatment with a low dose of CORT that did not affect the HPA response of SAL rats markedly inhibited the ACTH and CORT responses induced by novelty stress in DEX rats. This strongly suggests that an enhanced corticosteroid feedback underlies the blunted HPA response to stress in DEX rats. Finally, using quantitative immunocytochemistry, we found an increase in arginine-vasopressin (AVP) but not CRH stores in the external zone of the median eminence, suggesting an altered AVP/CRH ratio in the secretory output of the hypophysiotropic paraventricular nucleus. Taken together, our results show that exposure to DEX during early life leads to hyporesponsivity of the HPA axis to stress most likely due to hypersensitivity of the axis for negative feedback by corticosteroids at the suprapituitary level.
Nuchal Translucency Thickness and Fetal Cardiac Flow Velocity in Normal Fetuses at 11–13 Weeks of Gestation
Authors: Hata Toshiyuki , Inubashiri Eisuke , Kanenishi Kenji , Akiyama Masashi , Tanaka Hirokazu , Shiota Atsuko , Yanagihara Toshihiro , Ohno Masayuki
Published: April 2003

Objective: To investigate the relationship between nuchal translucency thickness and cardiac flow velocity in normal fetuses at 11–13 weeks of gestation. Subjects and Methods: Eighteen normal pregnancies were prospectively studied with transvaginal sonography and pulsed and color Doppler ultrasound. Flow velocities at the fetal atrioventricular valves (mitral and tricuspid valve) and outflow tract levels (ascending aorta and pulmonary artery), and at the descending aorta were recorded. Nuchal translucency thickness was also measured. Results: Mitral peak velocity during early diastolic filling correlated with gestational age. Mitral peak velocities during early diastolic filling and atrial contraction, tricuspid peak velocity during early diastolic filling, ascending aorta peak velocity, and pulmonary artery peak velocity correlated well with nuchal translucency thickness. There was an inverse correlation between umbilical artery pulsatility index and gestational age. Conclusions: These results suggest that the increase of nuchal translucency thickness in normal fetuses at 11–13 weeks of gestation may be the consequence of changes in fetal cardiac functions.
Comparison of Total Laparoscopic Hysterectomy and Laparoscopically Assisted Vaginal Hysterectomy
Authors: Long Cheng Yu , Fang Jia Hong , Chen Wei Chin , Su Jinu Huang , Hsu Shih Cheng
Published: April 2003

We compare the surgical results of 60 women undergoing laparoscopically assisted vaginal hysterectomy (LAVH) and 41 having total laparoscopic hysterectomy (TLH) under the indications of uterine fibroids or adenomyosis. With similar specimen weight, TLH required longer surgery duration (140.4 vs. 115.1 min; p < 0.05) than LAVH. Among women with uteri weighing ≤200 g, TLH resulted in relatively smaller blood loss with comparable operating time (115.6 vs. 116.0 min for LAVH; p > 0.05) although the TLH group had a significantly higher rate of previous abdominal surgery (57.7 vs. 20%; p < 0.05). There were no significant differences between the two groups with respect to the mean cost, length of hospital stay and rate of various complications (p > 0.05). As for sexual symptoms, dyspareunia decreased significantly post-operatively in the LAVH group (p < 0.05), but not in the TLH group. A significant reduction in the frequency of orgasms after surgery was detected in both groups (p < 0.05). In conclusion, LAVH has advantages over TLH with reduced operating time. Although it is a technical challenge, TLH can be effectively performed within reasonable time limits in selected cases. The effects on sexual function, following either LAVH or TLH, are found to be similar.
Mucin-Secreting Bile Duct Adenoma – Clinicopathological Resemblance to Intraductal Papillary Mucinous Tumor of the Pancreas
Authors: Oshikiri Taro , Kashimura Nobuichi , Katanuma Akio , Maguchi Hiroyuki , Shinohara Toshiya , Shimizu Michio , Kondo Satoshi , Katoh Hiroyuki
Published: April 2003

We describe a case of mucin-secreting biliary adenoma associated with obstructive jaundice due to mucin production. Duodenal endoscopy revealed mucin secretion through an enlarged papilla of Vater. On the cholangiogram, large filling defects caused by mucin were observed in the dilated bile duct. Granular and/or papillary mucosa was noted from the hilar to the common bile duct by using percutaneous transhepatic cholangioscopy. Biopsy specimens taken from the papillary mucosa revealed slightly papillary projection without any evidence of malignancy. This lesion was diagnosed as mucin-secreting superficial adenoma and pancreatoduodenectomy was performed according to the malignant behavior. Using a histologic examination of the specimen, pure adenoma was documented. Since the surgical margin was positive, radiation was added for the residual adenoma in the intrahepatic bile ducts. The patient has been well without any evidence of recurrence for 21 months since her operation. It is only recently that the term ‘intraductal papillary mucinous tumor (IPMT)’, which is accepted as a distinct disease entity of pancreas, has begun to be used for mucin-secreting bile duct tumor. This case also seemed to clinicopathologically resemble an IPMT of the pancreas.
Aboral Pouch with Preserved Duodenal Passage – New Reconstruction Method after Total Gastrectomy
Authors: Horváth Örs Péter , Kalmár Katalin , Cseke László
Published: April 2003

A new reconstruction method – the aboral pouch with preserved duodenal passage – has been introduced after total gastrectomy. After removal of the stomach, preparation of the Roux loop and construction of the esophago-jejunostomy, a jejuno-duodenostomy is performed approximately 50 cm away from the esophageal anastomosis between the Roux limb and the duodenal stump. Right below this second anastomosis, the Roux limb is closed with a stapling device to provide a unidirectional food passage through the duodenum. The aboral pouch is constructed as a side-to-side anastomosis between the Roux limb under the stapled segment and the aboral end of the Y limb. The advantages of the reservoir-constructing methods and the interposition methods are combined in this new reconstruction type. Our experiences of 17 cases having undergone this reconstruction method are presented.
Pancreatic Injury in Severe Trauma: Early Diagnosis and Therapy Improve the Outcome
Authors: Mayer Jens M. , Tomczak Reinhold , Rau Bettina , Gebhard Florian , Beger Hans G.
Published: April 2003

Background: Pancreatic injury is a dangerous complication in multiple injury, and experience with its diagnosis and treatment is usually limited. Method: Retrospective analysis of 3,840 patients admitted after multiple trauma from January 1, 1982, until May 31, 2000. Results: A laparotomy was performed in 121 cases (3.15%) due to suspected intra-abdominal lesion. 32% of the patients (39/121) had a pancreatic lesion; 23% (9/39) had a rupture of the major pancreatic duct. Primary laparotomy was performed in 72% of the patients (28/39). Superficial lesions were treated by explorative laparotomy alone (n = 7), debridement and external drainage (n = 20), or necrosectomy and lavage (n = 3). Complex pancreatic lesions were treated by pancreatojejunostomies (n = 5), pancreatic left resections (n = 2), or exploration alone (n = 2). 8 of 39 patients died (20%), 4 intraoperatively. Of the surviving 35 patients, a pancreas-associated complication developed in 8 patients (23%): pancreatic abscesses (n = 4), traumatic pancreatitis (n = 3), pancreatic fistulas (n = 2), and pseudocysts (n = 2). Conclusions: Pancreatic injury is an infrequent but dangerous complication in severe trauma. Superficial lesions not affecting the major pancreatic duct can be managed by debridement and external drainage. If the major pancreatic duct is ruptured, organ-preserving, complex reconstructive procedures are necessary. When diagnosed timely and treated according to severity and overall situation, pancreatic injuries have an acceptable morbidity, but usually a high mortality.
Peripheral Neurotomy for Torticollis: A New Approach
Authors: Taira Takaomi , Hori Tomokatsu
Published: April 2003

Most of spasmodic torticollis is classifical as cervical dystonia and the treatment of choice is chemical or surgical denervation. There are two major procedures for surgical denervation, intradural ventral rhizotomy and extradural peripheral neurotomy (Bertrand procedure). Both have advantages and disadvantages. The authors have modified these procedures to minimize the complications, with unilateral intradural ventral rhizotomy of C1 and C2, extradural denervation of the C3–C6 posterior rami, and contralateral peripheral sectioning of the branches of the spinal accessory nerve to the sternocleidomastoid muscle. 30 patients underwent this modified operation (Group A) and the results were compared with those in a matched control group of 20 patients who underwent the traditional Bertrand procedure (Group B). Only one patient in Group A showed a sensory deficit in the C2 area, while all the patients in Group B had C2 sensory disturbance. Pre- and postoperative rating scores did not differ between the two groups. The intraoperative blood loss was significantly smaller in Group A. Compared with the traditional Bertrand’s operation, our procedure involves fewer complications and significantly less intraoperative blood loss.
Complications of Deep Brain Stimulation Surgery
Authors: Beric Aleksandar , Kelly Patrick J. , Rezai Ali , Sterio Djordje , Mogilner Alon , Zonenshayn Martin , Kopell Brian
Published: April 2003

Although technological advances have reduced device-related complications, DBS surgery still carries a significant risk of transient and permanent complications. We report our experience in 86 patients and 149 DBS implants. Patients with Parkinson’s disease, essential tremor and dystonia were treated. There were 8 perioperative, 8 postoperative, 9 hardware-related complications and 4 stimulation-induced side effects. Only 5 patients (6%) sustained some persistent neurological sequelae, however, 26 of the 86 patients undergoing 149 DBS implants in this series experienced some untoward event with the procedure. Although there were no fatalities or permanent severe disabilities encountered, it is important to extend the informed consent to include all potential complications.
Chronic Motor Cortex Stimulation for Phantom Limb Pain: Correlations between Pain Relief and Functional Imaging Studies
Authors: Sol J.Ch. , Casaux J. , Roux F.E. , Lotterie J.A. , Bousquet P. , Verdié J.Cl. , Mascott Ch. , Lazorthes Y.
Published: April 2003

Chronic motor cortex stimulation (CMCS) has provided satisfactory control of pain in patients with central or trigeminal neuropathic pain. We used this technique in 3 patients with intractable phantom limb pain after upper limb amputation. Functional magnetic resonance imaging (fMRI) correlated to anatomical MRI permitted frameless image guidance for electrode placement. Pain control was obtained for all the patients initially and the relief was stable in 2 of the 3 patients at 2 year follow-up. CMCS can be used to relieve phantom limb pain. fMRI data are useful in assisting the neurosurgeon in electrode placement for this indication.
CT-Guided Percutaneous Punctate Midline Myelotomy for the Treatment of Intractable Visceral Pain: A Technical Note
Authors: Vilela Filho Osvaldo , Araujo Maisa R. , Florencio Rodopiano S. , Silva Marco A.C. , Silveira Mariluza T.
Published: April 2003

Surgical treatment of intractable visceral pain has always been a challenge. The relatively recent discovery of a specific visceral pain pathway brought a new insight to this matter. The authors describe a new technique to interrupt this pathway, the CT-guided percutaneous punctate midline myelotomy, successfully applied in two patients with intractable pelvic visceral pain. Due to its simplicity, safety and high effectiveness, it may become the treatment of choice for intractable visceral pain.
Teratology Information Services in Europe and Their Contribution to the Prevention of Congenital Anomalies
Authors: Clementi Maurizio , Di Gianantonio Elena , Ornoy Asher
Published: April 2003

Objectives: To inform on Teratology Information Services (TIS) in Europe, their history, function and activity in preventing congenital malformations. Conclusions: Clinical teratology tries to identify human teratogens. TIS play an important role in public health by providing counsel on known reproductive risks and conducting specific research. This has led to a reduction in unnecessary fears of pregnant women and pregnancy terminations, as well as to better, more appropriate drug selection to treat acute or chronic disease. In addition, TIS units also conduct prospective studies and inform the public and physicians of the possible effects of environmental agents on the developing embryo and fetus.
Warm-Antibody Autoimmune Hemolytic Anemia Developing after Thrombotic Thrombocytopenic Purpura
Authors: Morgensztern Daniel , Kharfan-Dabaja Mohamed A. , Tsai Han-Mou , Lian Eric C.-Y.
Published: April 2003

Thrombotic thrombocytopenic purpura (TTP) and warm-antibody autoimmune hemolytic anemia (AIHA) are uncommon diseases. Although TTP has been increasingly described in association with autoimmune antibodies, there are very few reports of the association with autoimmune hematological conditions, including idiopathic thrombocytopenic purpura and AIHA. Here we describe a patient with classic manifestations of TTP, who was successfully treated with plasma exchange. A few weeks later, she developed warm-antibody AIHA, which responded promptly to prednisone.
Cytogenetic and Molecular Genetic Aspects of Idiopathic Myelofibrosis
Authors: Reilly John T.
Published: April 2003

Idiopathic myelofibrosis is a chronic myeloproliferative disorder in which the characteristic fibroblast proliferation is thought to be a secondary phenomenon resulting from the inappropriate release of megakaryocyte- and/or monocyte-derived growth factors, including PDGF, TGF-β, bFGF and calmodulin. In contrast, the haematopoietic cells are clonal, although the underlying pathogenetic mechanisms remain essentially unknown. Cytogenetic studies have highlighted that 13q–, 20q–, +8 and abnormalities of chromosomes 1, 7 and 9 constitute more than 80% of the chromosomal changes. A third of idiopathic myelofibrosis cases have abnormal karyotypes at diagnosis, a figure that increases if follow-up analyses are performed. Evolution to more complex karyotypes may accompany clinical progression, with abnormalities increasing to around 90% following acute leukaemic transformation. Cytogenetic abnormalities have been associated with prognosis and to a lack of treatment response to androgens. Oncogene mutations are rare and include point mutations in N-RAS, c-KIT and TP53.
Polycythaemia vera: Will New Markers Help Us Answer Old Questions?
Authors: Pahl Heike L.
Published: April 2003

The publication of the first molecular markers for polycythaemia vera (PV) has led to a renewed interest in finding the mutations leading to the development of this myeloproliferative disorder. A substantial amount of cell biological data on the PV stem cell, however, have been available for over two decades. This review will summarise, combine and integrate both fields of investigation. Based on this analysis, two alternative models for the development of myeloproliferative disorders are proposed.
Longitudinal Study of Carotid Atherosclerosis and White Matter Hyperintensities: The EVA-MRI Cohort
Authors: Pico Fernando , Dufouil Carole , Lévy Claude , Besançon Véronique , de Kersaint-Gilly Axel , Bonithon-Kopp Claire , Ducimetière Pierre , Tzourio Christophe , Alpérovitch Annick
Published: April 2003

Background and Purpose: White matter hyperintensities (WMHs) are often observed on cerebral magnetic resonance imaging (MRI) of elderly individuals. Epidemiological studies have shown that age and hypertension are associated with WMHs, suggesting a vascular mechanism in WMH pathogenesis. In a population-based prospective study, we examined the association of carotid atherosclerosis measured at baseline and 4-year follow-up with severity of WMHs assessed at 4-year follow-up. Methods: The sample consisted of 640 healthy subjects aged 59–71 years at entry enrolled in the prospective EVA Study. Systolic and diastolic blood pressures were measured at each wave. Ultrasonographic measures of intima-media thickness (IMT) of the common carotid arteries and plaques were made at baseline and at 4-year follow-up examination. An MRI examination was performed at 4-year follow-up. The presence and severity of WMHs were evaluated by a single radiologist. Results: After adjusting for age, gender, and hypertension, the presence of carotid plaques at baseline was significantly associated with the presence of severe WMHs 4 years later [odds ratio (OR) = 1.70; 95% confidence interval (CI): 1.05–2.74]. The association was stronger in men than in women. A 0.1-mm increase of baseline IMT was associated with an increased risk of severe WMHs in both sexes (adjusted OR = 1.17; 95% CI: 0.96–1.41), but the association was not significant (p = 0.12). Cross-sectional relationships between carotid plaques and severe WMHs at 4-year follow-up showed that the risk of having severe WMHs was stronger in the group of subjects who had already plaques at study entry compared to the group of subjects whose plaques occurred during 4-year follow-up. Conclusion: This study confirmed an association between carotid atherosclerosis and WMHs independently of age and hypertension. It also suggested that the older the carotid plaques, the higher the risk of having severe WMHs.
Effects of the Ultrasound Contrast-Enhancing Agent Levovist® on the Detection of Intracranial Arteries and Stenoses in Chinese by Transcranial Doppler Ultrasound
Authors: Hansberg T. , Wong K.S.L. , Droste D.W. , Ringelstein E.B. , Kay R.
Published: April 2003

Proper assessment of intracranial arteries by transcranial Doppler sonography (TCD) in patients with intracranial stenoses is occasionally made difficult by an insufficient temporal bone window, an unfavourable insonation angle, or low flow velocity or volume. This condition is frequently found in Chinese. In these cases, echocontrast could be helpful. We investigated 48 temporal windows of 24 acute Chinese stroke patients with insufficient native transtemporal insonation conditions before and after the application of the echo enhancer Levovist® (galactose/palmitic acid) by an injection pump. We classified the signal quality from four segments of the main intracranial arteries: anterior cerebral artery (A1), main stem of the middle cerebral artery (MCA, M1), intracranial segment of the carotid artery (C1), and posterior cerebral artery (P1). The signal quality was classified as follows: 0 = no signal, 1 = poor, envelope curve does not follow spectrum, 2 = adequate, envelope curve follows spectrum. As compared to the pre-contrast scans, echocontrast allowed for more segments to be evaluated by pulsed Doppler sonography. Before Levovist, only 12% of the segments could be detected, after Levovist 63%. For all arteries, signal quality was better after Levovist, p between 0.0180 and 0.0003. In 3 patients, MCA stenoses with peak systolic Doppler flow velocities above 160 cm/s were found only after Levovist. In patients with poor pre-contrast detection, echocontrast-enhanced TCD allows for more arterial segments to be insonated and for the detection of stenoses unnoted during the non-enhanced investigation.
Past and Present Distribution of the Red-Bellied Monkey Cercopithecus erythrogaster erythrogaster in Benin
Authors: Sinsin B. , Nobimè G. , Téhou A. , Bekhuis P. , Tchibozo S.
Published: April 2003

This study provides data on the past and present distribution of the red-bellied monkey, Cercopithecus erythrogaster erythrogaster, a subspecies that is endemic to Benin’s southern ecosystems. The original distribution of this subspecies was between the Couffo River and the Nigerian border, but it has since been reduced to regions degraded by intense human settlement (such as the Oueme river valley) and to some better preserved areas, such as the Lama protected forest and some sacred grove forests in wet areas. Local people participated in this research programme and, as a result, many new localities have been discovered. All of these have been in wetlands in southern Benin, mainly in sacred groves. Conservation action for this subspecies will succeed only if local people are involved in its protection.
Politano-Leadbetter Ureteroneocystostomy
Authors: Steffens J. , Langen P.H. , Haben B. , Hiebl R. , Steffens L. , Polsky M.S.
Published: April 2003

Purpose: We evaluated the results and complications of children with reflux treated with the Politano-Leadbetter ureteroneocystostomy. In particular, we evaluated pre- and postoperative renal parenchymal scarring and the late development of hypertension. Materials and Methods: From 1965 through 1996, 666 children (814 renal units) were reimplanted by nine urologists. The average postoperative evaluation was 10.3 years, and 68.8% of all patiens were evaluable 10 years after surgery. Results: Postoperative complications occurred in 7.8% and consisted of small bowel serosal injury (0.3%), vesicocutaneous fistula (0.4%) and retrovesical hematoma (0.3%). Persistent reflux was the most common postoperative complication (5.6%) and was found to occur in higher grades of vesicorenal reflux. Ureteral stricture and hydronephrosis were seen in 1.2% of children, and was corrected with a secondary reimplantation. Late stricture occurred in all but 1 patient (0.2%). Renal parenchymal scarring was found in 21.2% of patients preoperatively, and this increased over time postoperatively to 27.7%. In 8.7% of these patients, hypertension developed between the 6th and 17th postoperative year. In 6.1%, nephrectomy was carried out, which normalized blood pressures in 87.9% of these 30 patients. Conclusions: The Politano-Leadbetter ureteroneocystostomy was successful in 93.6% of all 814 renal units surgically treated. The operation is safe, but can be associated with late development of hypertension despite correction of the reflux.