bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Posthemorrhagic Hydrocephalus in the Preterm Infant with a Ventricular Access Device
Authors: Hudgins Roger J. , Boydston William R. , Gilreath Carita L.
Published: April 2003

Intraventricular hemorrhage (IVH) and subsequent posthemorrhagic hydrocephalus (PHH) commonly complicate the course of extremely preterm infants. Many methods for treating the hydrocephalus have been used, none of which are ideal. We present the largest series of infants with PHH treated with one modality, the ventricular access device (VAD). One hundred and forty-nine preterm infants with PHH were treated by placement of a VAD and serial taps to control intracranial pressure and ventricular size. Variables recorded include gender, race, gestational age, weight at birth, IVH grade, incidence of VAD infection, malfunction or local wound problems and indwelling time to either shunt placement or VAD removal. Of the 149 preterm infants, 91 were males and 58 females. The average birth weight was 994 g and the average gestational age at birth was 26.3 weeks. Three infants were IVH grade 1, 8 were grade 2, 62 were grade 3 and 76 were grade 4. VAD occlusion occurred in 15 infants (10%). Nine infants required contralateral VAD placement for a trapped ventricle. VAD infection occurred in 12 infants (8%), 5 of whom were treated successfully with a combination of systemic and intra-VAD antibiotics without removal of the VAD. The total rate of revision was thus 20% (15 for occlusion, 9 for trapped ventricle, 7 for infection). Wound problems were minimal and consisted of 4 cerebrospinal fluid leaks and 14 subgaleal fluid collections. For the 133 survivors, the rate of shunt placement was 88%. The VAD, while not ideal, is an excellent treatment at this time for PHH. It can be utilized for several months with acceptable rates of infection, blockage and wound complications. The VAD tap is simple to perform, not disruptive to minimal stimulation protocols, and can be done by physician extenders. In addition, medications can be administered via the access device, thus allowing treatment of some infections without VAD removal as well as instillation of thrombolytic agents such as urokinase.
Sinus pericranii
Authors: Buxton N. , Vloeberghs M.
Published: April 2003

Sinus pericranii is an unusual anomaly of venous drainage from intracranial to extracranial systems via the diploë of the skull. A case and its management are presented. The aetiology, various options regarding treatment and their indications are discussed, including various surgical techniques and interventional radiology.
Unique Clinical Presentation of Pediatric Shunt Malfunction
Authors: Lee Thomas T. , Uribe Juan , Ragheb John , Morrison Glen , Jagid Jonathan R.
Published: April 2003

Introduction: A cerebrospinal fluid (CSF) shunt is the primary treatment for most etiologies of hydrocephalus in the pediatric population. Malfunction of the shunt may present with unique symptoms and signs. This retrospective review investigates the presenting signs and symptoms of pediatric patients with shunt malfunction. Clinical Material and Method: One-hundred-and-thirty CSF diversion procedures were performed at two affiliated pediatric hospitals over a 2-year period. Seventy consecutive cases of CSF shunt revision were reviewed. These 70 operations were performed on 65 patients. Their medical records and radiographic studies were reviewed, and supplemented with a telephone interview to obtain a minimum of 3 months follow-up. Results: The 65 patients’ age ranged from 3 months to 16 years. The original etiology of the hydrocephalus was Chiari II malformation in 17, idiopathic in 15 and intraventricular hemorrhage in 10, neoplasm in 8 patients and meningitis in 5 patients. The most frequent presenting symptoms were headache (39 admissions), nausea/vomiting (28) and drowsiness (21). Seven Chiari patients (41%) presented with neck pain, 2 (12%) presented with lower cranial nerve palsy, and 2 (12%) presented with symptomatic syrinx, complaints not reported by non-Chiari patients (p < 0.01, χ2 analysis). Four myelodysplastic patients presented with a new-onset or recurrent seizure episode, which was significantly more frequent than in nonmyelodysplastic patients (p < 0.05, χ2 analysis). On examination, increased head circumference was noted in 17 patients. Parinaud’s syndrome was noted more prominently in patients with a history of intracranial neoplasm (4 of 8 cases) than in patients with nonneoplastic diseases (2 of 62 cases; p < 0.05, χ2 analysis). Other interesting presenting signs were pseudocyst (2), syringomyelia (2), hemiparesis (2) and Parkinson-like rigidity (2). Conclusion: Pediatric shunt malfunction generally presents with headache, nausea/vomiting, altered mental status, increased head circumference and bulging fontanelle. Other less frequent but unique presenting signs and symptoms, such as neck pain, syringomyelia and lower cranial nerve palsy in the myelodysplastic population, and Parinaud’s syndrome in patients with a history of intracranial neoplasm are frequently associated with shunt malfunction and should prompt a radiographic workup.
Successful Use of Intracavitary Bleomycin for Low-Grade Astrocytoma Tumor Cyst
Authors: Disabato Jennifer A. , Handler Michael H. , Strain John D. , Fleitz Julie M. , Foreman Nicholas K.
Published: April 2003

We report successful use of bleomycin in a low-grade astrocytoma tumor cyst of the tectal plate. A 6-year-old male underwent subtotal resection of a low-grade astrocytoma of the tectal plate followed by chemotherapy and proton beam radiation at age 2 and a half. Despite resolution of the solid portion of the tumor, serial MRI showed enlargement of a bilobar tumor cyst 3 years after the original diagnosis. The patient developed progressive ataxia, short-term memory loss and dysconjugate gaze. Following stereotactic placement of an Ommaya reservoir into the cyst, Isovue contrast and CT scan were used to confirm the integrity of the cyst. Five consecutive daily doses of 3.0 mg of bleomycin were instilled into the cyst after removal of cyst fluid. The therapy was well tolerated in the outpatient setting, and the clinical findings resolved. Subsequent CT and MRI at 4 months and 2 years after bleomycin confirmed no recurrence of the tumor or cyst.
The Delta Valve: How Does Its Clinical Performance Compare with Two other Pressure Differential Valves without Antisiphon Control?
Authors: Davis Steven E. , Levy Michael L. , McComb J. Gordon , Sposto Richard
Published: April 2003

Objective: The Delta valve is a pressure differential valve with a siphon control device. The valve mechanism is normally closed, but is designed to open in response to positive ventricular pressure, thereby avoiding overdrainage of cerebrospinal fluid (CSF). As a result, the incidence of subdural fluid collections as well as postural symptoms is purportedly reduced. In addition, the valve might reduce the number of obstructions as there would be no negative pressure sucking tissue and debris into the shunt system. In order to assess whether use of the Delta valve reduced the number of shunt-related problems as compared with two other pressure differential valves without an antisiphon component, we performed a retrospective review of all children undergoing CSF diversion procedures at our institution. Methods: We reviewed the charts of 1,193 patients. Cases included 2,325 ventriculoperitoneal (V-P) shunt insertions or revisions from January 1, 1985, to December 31, 1994, performed at our institution. The Delta valve and two pressure differential valves without antisiphon function were exclusively inserted during the following time periods: Holter-Hausner (H-H): January 1, 1985, to August, 1987; Heyer-Schulte (H-S): August, 1987, to June, 1991, and Delta: June, 1991, to December 31, 1994. Results: Of the cases reviewed, 475 patients underwent insertion of a V-P shunt at the Childrens Hospital of Los Angeles and had a total of 686 shunt operations. Median follow-up was 3 years and ranged up to 10 years. Kaplan-Meier analysis documented that 67% of H-H, 71% of H-S and 70% of the Delta valves were functioning at 1-year follow-up. At 2-year follow-up, 66% of H-H, 64% of H-S and 65% of the Delta valves were functioning. The difference was not statistically significant. The occurrence rate for symptomatic subdural fluid collections was 0.7% (1/130) for H-H, 2.2% (3/139) for H-S and 1.0% (2/206) for the Delta valve (p = 0.52). The combined breakage/obstruction rate for the series was 7.7% (10/130) for H-H, 2.9% (4/139) for H-S and 4.9% (10/206) for the Delta valve (p = 0.19). No Delta valves malfunctioned secondary to fibrous capsule affecting the antisiphon device. Conclusions: In conclusion, it appears that performance of the Delta valve was not significantly different from the H-H and H-S valves, two valves without an antisiphon device. There was no significant difference in the occurrence of symptomatic subdural fluid collections based upon valve type, or in the combined valve breakage/obstruction rates based upon valve type.
The Modern Assessment of Personality Disorders
Authors: Mombour W. , Bronisch T.
Published: April 2003

The general definition of personality disorders (PD) has found agreement in many classification systems and has remained relatively stable over many decades. However, a closer look at the history of the classification of various PD reveals that there are changes from generation to generation: a continuous variation in our cultural norms means that some types are ‘renormalised’ from time to time and that others are added. On the other hand, a comparison of the descriptions and classifications of PD by Schneider, the DSM and ICD systems shows substantial agreement on many types of PD.
Valproic Acid and Carbamazepine:A Successful Antipsychotic M edication? The Problem of Diagnosis and Its Relevance for Therapy
Authors: Gutiérrez Karin , Walter Henriette , Bankier Bettina
Published: April 2003

This single-case study deals with a 24-year-old woman who suffered after a severe depressive episode from paranoid-psychotic symptoms, which did not respond to antipsychotic medication, but to antiepileptics. In this case report, it is elaborated why psychotic symptoms may not respond to antipsychotic medications and the utility of a polydiagnostic approach is shown. Psychotic symptoms based on dynamic instability may occur simultaneously in the pathogenesis of affective disorders and schizophrenia. It is demonstrated that the use of a polydiagnostic approach will lead to a more refined etiopathogenetic attribution.
Schizoid and Narcissistic Features in Personality Structure Diagnosis
Authors: Geiser Franziska , Lieberz Klaus
Published: April 2003

Objective: This study examines the relationship between schizoid and narcissistic personality features. While the schizoid personality disorder seems widely accepted as a diagnostic category, the utility of the narcissistic personality disorder construct is under discussion. We regard schizoidism as a primary, structural disturbance of interaction with the world, whereas narcissism appears as a secondary phenomenon of self-organization and self-regulation. This study focuses on the question, whether these features are correlated or interact with each other in personality structure. Method: A standardized narcissism inventory is being applied to a group of schizoid and nonschizoid patients. Results: Only 1 of 18 narcissism scales differentiates significantly between these patient groups. By cluster analysis, the group of schizoid patients is divided into two subgroups characterized by their higher or lower narcissism scores. These are contiguous to existing descriptions of an active/fighting and a passive/evading schizoid subtype. Conclusion: ‘Schizoid’ and ‘narcissistic’ personality features can be regarded as distinct, but complementary personality conditions.
Unknown People Believed to Be Known: The ‘assoziierende Erinnerungs- fälschungen’ by Kraepelin
Authors: Murai Toshiya , Kubota Yasutaka , Sengoku Akira
Published: April 2003

A male patient with epilepsy, who developed a unique form of paramnesia after an episode of zonisamide-induced psychosis is reported. The patient consistently mistook people who were quite new to him, such as staff of the hospital, for persons whom he had met long ago. However, he did not misidentify their names or other attributes, such as their occupations. This extraordinary form of misidentification does not fall into any known subcategory of misidentification syndromes. Rather, this paramnesia falls into the classical description of ‘assoziierende Erinnerungsfälschungen’ by Kraepelin. The neuropsychological interpretation of the reported patient is difficult. However, loss of familiarity with environmental objects due to his long sustained epileptic history is supposed to be a possible mechanism of paramnesia.
Coping Styles and Psychosomatic Problems: Are They Related?
Authors: Ruchkin Vladislav V. , Eisemann Martin , Hägglöf Bruno
Published: April 2003

A number of recent studies have shown avoidant coping to be related with diverse types of somatic and mental pathology. In order to investigate the relevance of coping for both psychological and somatic problems in delinquent subjects, 185 boys from juvenile correction and 96 boys from secondary schools in Arkhangelsk, Northern Russia, were assessed by means of the Coping Scale for Children and Youth, the Youth Self-Report and the Giessen Subjective Complaints List – youth form. The results from the delinquent subjects partly confirmed previous findings on the dominant role of behavioural avoidance in the relationships between coping styles and both behavior/emotional problems and somatic complaints. Further implications of the results are discussed.
Correlates of Symptom Dimensions in Schizophrenia Obtained with the Spanish Version of the Manchester Scale
Authors: Tabarés Rafael , Sanjuán Julio , Gómez-Beneyto Manuel , Leal Carmen
Published: April 2003

In the last decade, a significant number of studies have been published which suggest a multifactorial psychopathological structure in schizophrenia. Seventy-eight acute and chronic schizophrenic patients diagnosed in accordance with DSM-III-R criteria were studied with the Manchester Scale, Premorbid Adjustment Scale, Family History-RDC Interview, Digit Span, Mini-Mental State and computerized tomography (CT). A factorial analysis of the symptoms as recorded with the Spanish version of the Manchester Scale was carried out. Three factors (‘positive’, ‘negative’ and ‘disorganization’) accounted for 79% of the total variance. Poor premorbid adjustment was associated with high scores for the ‘positive’ dimension. The ‘disorganization’ dimension was significantly associated with lower scores in the Mini-Mental and attention test than the rest. However, CT did not differentiate between these symptom dimensions. This study of a sample of mostly outpatients corroborates the hypothesis of three clinical dimensions in schizophrenia.
Adverse Reactions to Peak Flow Monitoring
Authors: Schoch Otto Dagobert , Nierhoff Norbert , Knoblauch Andreas
Published: April 2003

Five patients with adverse reactions to peak flow monitoring are presented: 2 patients had herniation of abdominal content, while the others presented with vasovagal syncope, minor depression and neurotic preoccupation with peak flow values, respectively. As a result, 3 of the 5 patients became noncompliant. For nonpsychological somatic adverse reactions, we calculated an incidence of 1.1 cases/1,000 patients started on peak flow monitoring. Adverse reactions with a psychological background may be more frequent. Clinicians should bear in mind that patients noncompliant with peak flow monitoring may have discontinued because of adverse reactions.
Relationship between Inflammatory Cells in Bronchoalveolar Lavage Fluid and Pathologic Changes in the Lung Interstitium
Authors: Yoshii Chiharu , Nagata Nobuhiko , Tao Yoshiaki , Suematsu Rika , Nikaido Yoshihiko , Kido Masamitsu
Published: April 2003

Bronchoalveolar lavage (BAL) is recognized as an important research tool for various lung diseases, but it is still uncertain whether inflammatory cells in BAL fluid (BALF) accurately reflect pathologic changes in the lung interstitium. We used a morphometric method to quantify the density of inflammatory cells in the lung interstitium by utilizing a computer-aided graphic analyzer and compared those findings with BALF results. Two types of animal models were studied, i.e., endotoxemia (Escherichia coli endotoxin) and hypersensitivity pneumonitis (inhaled ovalbumin). Male Wistar rats were used; the right lungs were lavaged and the left lungs were prepared for morphometric study. In the endotoxemia model, the neutrophil fraction in BALF and the neutrophil density in the lung interstitium correlated significantly at 18 h (r = 0.81, p < 0.05) and 24 h (r = 0.81, p < 0.05) but not at any other time points after injection. In the hypersensitivity pneumonitis model, the neutrophil fraction in BALF and the neutrophil density in the lung interstitium correlated significantly (r = 0.80, p < 0.05) only at 3 h after inhalation. The lymphocyte fraction in BALF and the lymphocyte density in the lung interstitium were correlated positively at 3 h (r = 0.83, p < 0.05), 1 day (r = 0.82, p < 0.05), 2 days (r = 0.67, p = NS), and 4 days (r = 0.87, p < 0.05), but not at 6 days after inhalation. Our data suggest that neutrophil fraction in BALF does not reflect neutrophil populations in the lung interstitium except at the time of maximal neutrophil count in lung lavage. For lymphocytes in the hypersensitivity pneumonitis model, those in BALF and in the lung interstitium roughly correlate in the majority of measurements.
Treatment of Respiratory Failure with Inhaled Nitric Oxide and High- Frequency Ventilation in an Infant with Respiratory Syncytial Virus Pneumonia and Bronchopulmonary Dysplasia
Authors: Hoehn T. , Krause M. , Krueger M. , Hentschel R.
Published: April 2003

In a 7-month-old infant with bronchopulmonary dysplasia and respiratory syncytial virus (RSV) pneumonia, we have shown an additive effect of high-frequency ventilation (HFV) and inhaled nitric oxide (iNO) in terms of improved oxygenation and the avoidance of extracorporeal membrane oxygenation. Apparently, the combined therapy of HFV and iNO is superior to either therapeutic modality alone in the treatment of hypoxemic respiratory failure due to RSV pneumonia. The mechanism of increased lung expansion and alveolar recruitment appears to be responsible for a favorable clinical outcome. We conclude that the combined therapy of HFV and iNO should be considered in hypoxemic respiratory failure in pediatric patients.
Clearance in Small Ciliated Airways in Allergic Asthmatics after Bronchial Allergen Provocation
Authors: Svartengren Katharina , Svartengren Magnus , Philipson Klas , Barck Charlotte , Bylin Gunnar , Camner Per
Published: April 2003

Background: Asthma tends to affect mucociliary clearance, as assessed from measurements in large airways. However, there is no knowledge about clearance in the smallest airways of the tracheobronchial region in acute exacerbation of asthma. Objective: The aim of the study was to investigate clearance from the bronchiolar region in patients with allergic asthma in a situation resembling a mild acute exacerbation of the disease. We also aimed to compare clearance data with corresponding data found for healthy subjects and asthmatics on therapy. Methods: Tracheobronchial clearance was studied twice in 9 patients with mild asthma of the allergic type after inhalation of 6 μm (aerodynamic diameter) monodisperse Teflon particles labelled with 111In. At one exposure, inhalation was performed 4 h after bronchial provocation with an allergen the patients were allergic to. The second exposure was a control measurement. The particles were inhaled at an extremely slow flow, 0.05 liter/s, which gives deposition mainly in the small ciliated airways (bronchioles). Lung retention was measured at 0, 24, 48 and 72 h. Results: All patients demonstrated an early asthmatic reaction of varying degree after bronchial provocation. There was significant clearance of radioaerosol in each 24-hour period for both exposures, with the possible exception of the period between 24 and 48 h for the provocation exposure, with similar fractions of retained particles at all points of time. The retained fractions were significantly larger compared to a group of healthy subjects and asthmatics on regular treatment with anti-inflammatory drugs. Conclusions: Our results indicate that in allergic asthmatics a bronchial allergen provocation with an early asthmatic reaction does not significantly influence overall clearance from the bronchiolar region. However, in the present group of patients, retention in small ciliated airways was significantly higher compared to healthy subjects and asthmatics on regular treatment.
Forced Expiratory Wheezes in a Patientwith Dynamic Expiratory Narrowing ofCentral Airways and an Oscillating Patternof the Flow-Volume Curve
Authors: Bauer Torsten T. , Merget R. , Kollmeier J. , Schultze-Werninghaus G.
Published: April 2003

Forced expiratory wheezes (FEW) are common and the pathogenesis of this phenomenon might involve fluttering of the airways, but this theory has not been confirmed in patients. We report a case of a patient with FEW and a normal FEV1 that showed a bronchoscopically confirmed collapse of the trachea and main stem bronchi during forced expiration. Superimposed to the flow-volume curve was an oscillating pattern with a frequency that corresponded well with the wheeze generated during forced expiration. The oscillating pattern in the flow-volume curve and the collapse of the major airways supports the theory of wheezes generated by fluttering airways during forced expiration. Although FEW may be found also in healthy subjects, flow limitation is essential for the generation of FEW. The inclusion of a forced expiratory maneuver in the clinical examination might therefore be helpful in guiding the diagnosis towards airways obstruction.
Plasma Endothelin-1 Level in Chronic Obstructive Pulmonary Disease: Relationship with Natriuretic Peptide
Authors: Fujii Tatsuo , Otsuka Toshihiro , Tanaka Shigehiro , Kanazawa Hiroshi , Hirata Kazuto , Kohno Masakazu , Kurihara Naotsugu , Yoshikawa Junichi
Published: April 2003

Background and Objective: Endothelin-1 (ET-1) is a potent vasoconstrictor peptide produced by the vascular endothelium. The purpose of this study was to elucidate the pathophysiological role of ET-1 in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease (COPD). Method: We measured plasma ET-1 levels during right heart catheterization both at rest and during exercise on room air and while breathing oxygen in patients with COPD. In addition, we simultaneously measured plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). Results: Plasma ET-1 levels at rest were significantly higher in 21 patients with COPD than in 16 control subjects (p < 0.001). For COPD patients, there was no correlation between the plasma ET-1 level and pulmonary arterial pressure or pulmonary vascular resistance at rest. On the other hand, there was a significant negative correlation between plasma ET-1 level and mixed venous oxygen tension (r = –0.503, p < 0.05). Also, the plasma ET-1 level was positively correlated with those of ANP (r = 0.540, p < 0.05) and BNP (r = 0.533, p < 0.05) at baseline. Oxygen administration significantly decreased plasma ET-1 levels at rest (p < 0.05). Plasma ET-1 levels did not change significantly with exercise despite the progression of pulmonary hypertension and hypoxemia. In contrast, plasma ANP and BNP levels both increased markedly with exercise (p < 0.01). Conclusion: We conclude that in patients with COPD, the plasma ET-1 level is not affected by acute progression of pulmonary hypertension and hypoxemia during exercise, and persistent hypoxemia may be associated with an increase in the plasma ET-1 level. In addition, our findings suggest that ANP and BNP may modulate the pulmonary vascular tone by interacting with ET-1 in these patients.
Reproterol – A Monomolecular Combination of Orciprenaline and Theophylline: Novel Aspects of Its Mode of Action in Asthma
Authors: Juergens Uwe R. , Stöber Meinolf , Vetter Hans
Published: April 2003

Background and Objective: Reproterol is a monomolecular combination of orciprenaline and theophylline used as β-adrenergic agonist to induce bronchodilation in bronchial asthma. Since the mechanism of action of reproterol has not been investigated so far, its potential anti-inflammatory activity in asthma remains still unknown. Therefore, we have studied in vitro whether the theophylline component of the reproterol molecule might enhance the stimulatory effect of the β-adrenoceptor on cAMP production resulting in suppression of inflammatory mediator production. Methods: The effects of reproterol, orciprenaline and theophylline (10–9–10–5 M) on spontaneous cAMP (5 × 104 cells/30 min)- and on LPS (10 μg/ml)-stimulated LTB4 production (105 cells/4 h) were determined in normal monocytes in vitro. Results: Production of cAMP (n = 9) was significantly augmented in a dose-dependent manner by orciprenaline (30 ± 8%) and theophylline (28 ± 10%), but mostly by reproterol (127 ± 8%) at 10–5 M. Despite incubation with propranolol, significant stimulation of cAMP production was notable following reproterol therapy. Production of LTB4 was significantly inhibited by reproterol (–48 ± 14%) and less by theophylline (–28 ± 10%), but was stimulated by orciprenaline (+20 ± 8%) at 10–5 M. Conclusion: We conclude that reproterol exerts a strong stimulatory effect on monocyte cAMP production and a suppressive effect on LTB4 production possibly due to a synergistic mode of action on adenylate cyclase activity and inhibition of phosphodiesterases. More clinical studies in bronchial asthma will be needed to determine whether these results may translate into clinically relevant effects.
Congenital Broncho-Oesophageal Fistula Associated with Bronchiectasis in Adults
Authors: Dogan Rıza , Farsak Bora , Yilmaz Mustafa , Tok Mustafa , Güngen Yücel
Published: April 2003

Congenital broncho-oesophageal fistula is a rare entity in adult patients. This anomaly may cause various symptoms such as respiratory infections, coughing bouts when eating or drinking and even haemoptysis. Even rarer than its occurrence with the above-mentioned symptoms is its presentation with bronchiectasis. A congenital broncho-oesophageal fistula presenting with bronchiectasis in a 28-year-old male and 36-year-old female are described. In reported cases, symptoms of chronic recurrent pulmonary suppuration were initially attributed to alternative aetiologies. In both cases, with such an unusual presentation, the observation of the fistulous tract was coincidental. Surgical division of the fistula associated with lobectomy resulted in complete resolution of symptoms.
Expression of CA125 in Thoracic Endometriosis in a Patient with Catamenial Pneumothorax
Authors: Tsunezuka Yoshio , Sato Hideo , Kodama Takamitsu , Shimizu Hiroshi , Kurumaya Hiroshi
Published: April 2003

A 40-year-old woman had experienced monthly right thoracic pain and productive cough occurring at the beginning of her menstrual period. X-ray findings indicated a diagnosis of catamenial pneumothorax. The serum CA125 level was very high at 159.6 U/ml. Thoracoscopy showed multiple dark cherry-colored nodules with neovascularization on the diaphragm. Following partial resection of the diaphragm thoracic endometriosis was diagnosed. Immunohistochemical staining of these endometrial cells showed antibodies to CA125. She has been well without recurrence for 15 months, and her serum CA125 level was within the normal range after operation.
Co-Expression of Vascular Endothelial Growth Factor and Its Receptor flt-1 in Malignant Pleural Mesothelioma
Authors: König Jens-Ekkehard , Tolnay Edina , Wiethege Thorsten , Müller Klaus-Michael
Published: April 2003

Background: Vascular endothelial growth factor (VEGF) is a potent angiogenic protein with a selective mitogenic effect on endothelial cells known to be involved in many normal and pathological processes. Coexpression of VEGF and its receptor flt-1 has been reported in different types of malignant tumors. Objective: In the present study we investigated the expression of VEGF and flt-1 in 90 cases of diffuse malignant pleural mesotheliomas. Methods: VEGF and flt-1 expression was analyzed by immunohistochemistry and non-radioactive in situ hybridization. Results: VEGF expression was visualized immunohistochemically in tumor cells. flt-1 expression correlated with histological differentiation (p < 0.013). Furthermore, expression of flt-1 was detected in tumor cells, macrophages and microvessels adjacent to tumor cells. VEGF and flt-1 expression were confirmed by in situ hybridization. Conclusion: There was a statistically significant correlation between VEGF and flt-1 expression (p < 0.001). The observed coexpression of VEGF and flt-1 possibly suggests a potential autocrine loop for malignant pleural mesothelioma cells.
Therapeutic Equivalence and Acceptability of Two Multidose Powder Inhalers in the Treatment of Asthma
Authors: Wettengel Ralf , Laurikainen Kari , Silvasti Matti , Toivanen Petri , Sauter Karin
Published: April 2003

Background: Problems in using conventional inhalation aerosols, in addition to environmental reasons, have driven development of the dry powder inhalers. Objective: To compare therapeutic equivalence and acceptability of two dry powder inhalers, Easyhaler (EH) and Diskhaler (DH), in the delivery of beclomethasone dipropionate (BDP) in the treatment of asthma. Methods: Adult asthmatics (n = 185), previously treated with inhaled steroids, were recruited in this open parallel-group study. After a run-in period of 2 weeks during which the patients inhaled 800 μg/day of BDP via DH, the patients were randomly allocated into three groups: EH 200 group (62 patients) using EH 200 μg/dose inhaler (1 inhalation q.i.d.), EH 400 group (62 patients) using EH 400 μg/dose inhaler (1 inhalation b.i.d.), and DH group (61 patients) using DH 200 μg/dose inhaler (1 inhalation q.i.d.) for 12 weeks. The primary outcome variables were PEF and FEV1. Results: The 95% CI for treatment difference in morning PEF between the EH 200 and DH groups was –16 to 23 litres/min and between the EH 400 and DH groups –18 to 21 litres/min. There was an increase in the morning PEF of 13 litres/min (p < 0.05) in the EH 200 group, and 9 and 11 litres/min in the DH and EH 400 groups. No differences between the groups were seen in the lung function parameters, in the symptom scores, in the use of rescue medication or in the incidence of adverse events. The treatments had no effects on morning cortisol levels. The patients in the EH groups compared the inhalers by using an 11-item questionnaire. In 8 questions the majority of the patients rated EH superior to DH. Conclusion: The tested inhalers were therapeutically equal. However, based on the acceptability data, the EH was better accepted by the patients than DH.
Spontaneous Coughing up of a Polyp
Authors: Terashima Masahiro , Nishimura Yoshihiro , Nakata Hiroyuki , Iwai Yasuhiro , Yokoyama Mitsuhiro
Published: April 2003

We report the case of an 18-year old female with right lower lobe atelectasis, who was admitted to our hospital because of a nonproductive cough. She underwent fiberoptic bronchoscopy that revealed a peduncular polyp in the right truncus intermedius or middle bronchus. Before admission for laser polypectomy, she spontaneously coughed up the tissue mass, and the right lower lobe atelectasis disappeared. We report a rare case of ‘autopolypectomy’ of a bronchial adenoma.
Sarcoidosis and Common Variable Immunodeficiency
Authors: Sutor Gerd-Christian , Fabel Helmut
Published: April 2003

The occurrence of sarcoidosis in combination with common variable immunodeficiency (CVID) has been described in a small number of patients. In these patients, sarcoidosis consisted of lymphadenopathy, mild to moderate pulmonary involvement and hepatosplenomegaly. However, severe and rapidly progressive pulmonary fibrosis in combination with a severe defect of the cellular and humoral immune system has not been described yet. In our patient, defects of the T and B cell system resulted in severe immunodeficiency. The defect of the humoral immune system was characterized by the impairment of specific antibody production in vivo. In addition, hypogammaglobulinemia with missing IgA and IgE along with a marked defect in IgM and IgG production was noted. There was a progressively reduced lymphocyte proliferation in response to T cell mitogens, while proliferation after specific IL-2 stimulation was normal. A Th1 lymphocyte-subset-like profile might thus play a role in the pathogenesis and might form the connecting link between sarcoidosis and CVID. This is the report of a so far new and unique combination of severe immunodeficiency and sarcoidosis also associated with a congenital dysmorphia consisting of a palatal cleft. The findings of the 40 patients with CVID and sarcoidosis reported so far are discussed in order to point out the typical features of patients with this uncommon syndrome.
Role of Carbohydrate Antigens Sialyl Lewis (a) (CA19-9) in Bronchoalveolar Lavage in Patients with Pulmonary Fibrosis
Authors: Obayashi Yuka , Fujita Jiro , Nishiyama Takehiko , Yoshinouchi Takeo , Kamei Tadashi , Yamadori Ichiro , Hojo Satoko , Ohtsuki Yuji , Hirashima Mitsuomi , Takahara Jiro
Published: April 2003

Background: It has been reported that carbohydrate antigen sialyl Lewis (a) (CA19-9) levels are elevated in serum as well as in bronchoalveolar lavage fluid (BALF) of patients with pulmonary fibrosis. However, the biological significance of CA19-9 is unclear. Objective: The purpose of the present study was to evaluate correlations between CA19-9 levels in BALF and several biochemical as well as clinical parameters in patients with pulmonary fibrosis. In addition, biological functions of CA19-9 were also examined. Methods: We studied 24 patients with a diagnosis of pulmonary fibrosis: 16 with idiopathic pulmonary fibrosis (IPF) and 8 with pulmonary fibrosis associated with a collagen vascular disorder (PF-CVD). In BALF, carbohydrate antigens sialyl Lewis (a) (CA19-9), elastase: α1-proteinase inhibitor complex (E-PI), hepatocyte growth factor (HGF), LDH, IgG, IgA, albumin, and cell differentiation were measured. We also evaluated the effects of CA19-9 on neutrophil functions. Results: CA19-9/albumin levels in BALF significantly correlated with HGF/albumin, elastase/albumin, LDH/albumin, total number of alveolar macrophages, and total number of neutrophils. Purified CA19-9 had a chemotactic activity for neutrophils. In addition, neutrophil chemotactic activity to C5a, fMLP, and interleukin 8 was significantly stimulated after incubation with purified CA19-9. Furthermore, CA19-9 increased the expression of CD15s on neutrophils. Conclusions: Our data demonstrated (i) CA19-9 in BALF correlated with other markers of inflammation in pulmonary fibrosis, and (ii) CA19-9 can modify neutrophil functions. These results suggest that CA19-9 may play a role in the process of lung injury in patients with pulmonary fibrosis.
Decline in FEV1 in Community-Based Older Volunteers with Higher Levels of Neutrophil Elastase in Bronchoalveolar Lavage Fluid
Authors: Betsuyaku Tomoko , Nishimura Masaharu , Takeyabu Kimihiro , Tanino Mishie , Miyamoto Kenji , Kawakami Yoshikazu
Published: April 2003

Background: Neutrophil elastase (NE) is thought to be one of the key proteinases in the development of chronic obstructive pulmonary disease (COPD). Previously, we have shown that the NE-α1-proteinase inhibitor (NE-α1PI) complex in bronchoalveolar lavage (BAL) fluid was markedly elevated in asymptomatic smokers who had subclinical emphysema on CT scans. We proposed that excessive NE-α1PI complex in BAL fluid was a factor which might differentiate smokers who were developing emphysema from others. Objective: In this study, we addressed the question of whether elevated levels of the NE-α1PI complex in BAL fluid are linked to the accelerated decline in pulmonary functions in those subjects. Methods: We conducted a follow-up study to analyze the decline in FEV1 for 4.3 years on average for 26 community-based volunteers who had received pulmonary function tests, CT scans and BAL. The levels of the NE-α1PI complex in BAL fluid and in plasma was measured. Results: Neither pulmonary function measurements nor the presence of emphysema on CT scans could predict the decline in FEV1. The number of inflammatory cells in BAL fluid was also not an indicator of progression. By contrast, subjects with higher levels of the NE-α1PI complex in BAL fluid had a significantly accelerated decline in FEV1 compared to those with lower levels. Conclusion: These data seem to support the hypothesis that NE in the lung is related to the onset and/or progression of COPD.
Cystic Schwannoma Presenting as Massive Hemoptysis in an Adult
Authors: Ondo Kaoru , Sugio Kenji , Yano Tokujiro , Kase Shinichiro , Yamazaki Koji , Yamaguchi Masafumi , Sugimachi Keizo
Published: April 2003

A 62-year-old man who presented with the chief complaint of hemoptysis is reported. A chest radiograph obtained on admission showed a huge cystic mass located at the posterior mediastinum. Prior to surgery, transarterial embolization was done because of continuous massive hemoptysis. An uneventful removal of the tumor was performed, and the pathological diagnosis was schwannoma. The hemoptysis was thought to have been caused by changes in the cystic formation in combination with inflammation which extended to the lung.
Airflow Limitation in Japanese Smokers: Significance of Serum Neutrophil Elastase/α1-Proteinase Inhibitor Ratio and FEV1 (%pred) Adjusted by Pack-Years
Authors: Hoshino Yuma , Nagai Sonoko , Koyama Hiroshi , Okuda Kaoru , Nishimura Koichi , Miki Hiroyuki , Hamada Kunio , Izumi Takateru
Published: April 2003

Background: In spite of the known role of cigarette smoking in the development of airflow limitation (AL), fewer than 20% of smokers actually develop chronic obstructive pulmonary disease (COPD). Objectives: We examined how smoking histories and indices in blood are related to the degree of AL in asymptomatic smokers in order to determine whether they can predict the development of AL. Methods: Spirometry and peripheral blood tests were examined in 433 Japanese asymptomatic current smokers at the initial examination. Forced expiratory volume in 1 s (FEV1) was measured periodically for 2 or more years (2–13 years) in 66 of the subjects. Results: AL defined as an FEV1/vital capacity of less than 0.7, was found in 11.3% (49 of 433) of the smokers. Pack-years of smoking, serum amounts of α1-proteinase inhibitor, and serum procollagen III peptide activities were correlated with the degree of AL. Fifteen percent (10 of 66) of subjects underwent rapid declines in FEV1 that were found to be related not with smoking amounts or initial FEV1, but with low FEV1 (%pred) adjusted by pack-years and an elevated serum neutrophil elastase/α1-proteinase inhibitor ratio. These results suggest that smokers with a low FEV1 out of proportion to pack-years are susceptible smokers at a high risk of developing COPD, and further, that increased proteinase burden relative to antiproteinase activity may contribute to the development of COPD. Conclusions: We conclude that the serum neutrophil elastase/α1-proteinase inhibitor ratio and FEV1 (%pred) adjusted by pack-years can be reliable predictors of the development of COPD.
Prognosis of Bronchial Artery Embolization in the Management of Hemoptysis
Authors: Osaki Shin-ichi , Nakanishi Yoichi , Wataya Hiroshi , Takayama Koichi , Inoue Koji , Takaki Youichi , Murayama Sadayuki , Hara Nobuyuki
Published: April 2003

Background: Bronchial artery embolization (BAE) is a well-accepted and widely used treatment modality for the management of massive and recurrent hemoptysis. However, few reports have previously investigated the long-term results. Objectives: To investigate the prognosis of patients with hemoptysis who had undergone BAE. Methods: Twenty-two patients with hemoptysis underwent BAE. The underlying diseases included bronchiectasis in 9, aspergillosis in 3, chronic bronchitis in 2, idiopathic bronchial bleeding in 4, and other diseases in 4. The follow-up period ranged from 25 to 88 months (median 47 months). Results: After the initial BAE, 11 of 22 (50%) patients had re-bleeding (5 patients with hemoptysis and 6 patients with minor hemosputa). Among them, 1 patient suffered from recurrent massive hemoptysis and died from airway obstruction within 1 month after BAE. In addition, 10 of these 11 (90.9%) patients experienced recurrent airway bleeding within 3 years after BAE. Recurrent cases of hemoptysis were seen in 6 of 22 patients (27.3%) within 3 years and no case recurred later than 3 years after BAE. A recurrence of hemoptysis was frequently seen in patients with either bronchiectasis or pulmonary-bronchial artery (P-B) shunt. Although BAE is an effective treatment for the immediate control of hemoptysis, 5 of the patients experienced recurrent bleeding in the long-term follow-up. Conclusions: It is important to follow-up such patients until 3 years after initial BAE, especially when either ectatic changes of the bronchi on a CT scan or a P-B shunt on angiographic findings are detected.
Pulmonary Migratory Infiltrates and Pachypleuritis in a Patient with Crohn’s Disease
Authors: Faller Michèle , Gasser Bernard , Massard Gilbert , Pauli Gabrielle , Quoix Elisabeth
Published: April 2003

Crohn’s disease can be associated with several respiratory manifestations. We report here a case of pulmonary migratory infiltrates associated with bilateral pleural thickening and peripheral eosinophilia. The histopathological findings show an association of necrotizing nodules, eosinophilic infiltration in the non-abscessed lung tissue, areas of non-caseating epithelioid granulomas, and an extensive pleural fibrosis. The different histopathological findings are detailed and the responsibility of either Crohn’s disease or treatment by mesalazine is discussed.
Different Manifestations of Langerhans Cell Histiocytosis Affecting Two Members of a Family
Authors: Balikó Z. , Schreiner M. , Kishindy K.K. , Hegedüs G. , Kosztolányi Gy.
Published: April 2003

Two different manifestations of Langerhans cell histiocytosis (histiocytosis X) are presented, the first occurring as a solitary rib eosinophil granuloma in an 11-year-old girl, and the second as an eosinophil granuloma of the lung of her mother, a 41-year-old heavy smoker, appearing 8 years after the onset of her daughter’s disease. Familial clustering of two different manifestations of histiocytosis X disease is very rare and raises the possibility of inherited mutations that promote emergence of clonal Langerhans cells.
Use of Posteroventral Pallidotomy for Treatment of Parkinson’s Disease: Is Pallidotomy Still an Experimental Procedure?
Authors: Jacques, D.S. , Eagle, K.S. , Kopyov O.V.
Published: April 2003

Surgical interventions have been employed to alleviate symptoms of Parkinson’s disease (PD) for decades, with improving success. One such treatment has been pallidotomy, the lesioning of a portion of the globus pallidus. Early pallidotomy procedures have paved the way for more accurately targeted methods. Technological advancements in imaging and targeting have made modern pallidotomy a safe and well-tested means of treating PD patients that has reliably positive results. Numerous group studies in recent years have demonstrated effective relief of PD symptoms, and the neuroanatomical and physiological aspects which underlie its effects are being elucidated as well. Recent descriptions of pallidotomy as an experimental procedure must therefore be considered in light of these reports. This review will examine the development of the pallidotomy procedure and the neuroanatomical rationale which underlies it, and discuss recent studies of its efficacy in PD patients.
Posterior Occipital Approach in Deep Brain Stimulation for Both Pain and Involuntary Movement
Authors: Taira, Takaomi , Kawamura, Hirotsune , Takakura Kintomo
Published: April 2003

We report a patient with intractable left facial pain and severe hyperkinesia of the left arm who was successfully treated with deep brain stimulation. The stimulation lead was positioned to pierce both the sensory relay nucleus and the nucleus ventrointermedius of the thalamus in a single stereotactic trajectory through an occipital burr hole.
Stereotactic Biopsy of Intracranial Brain Lesions
Authors: Fritsch, Michael J. , Leber, Mark  J. , Gossett, Lynne , Lulu, Bruce A. , Hamilton Allan J.
Published: April 2003

Diagnostic yield and complication rate were analyzed for a series of 65 consecutive stereotactic biopsies of intra-axial brain lesions. The diagnostic yield was 98.5 ± 1.5% and the complication rate was 1.5%. A median number of 14 biopsies (range 1–48) were taken per lesion. The biopsy sites followed a clockwise pattern, going from the superficial margin to the center and the deep margin of the lesion with respect to the inner table of the skull. A side window cannula biopsy needle was used. All patients underwent immediate postoperative CT scans within 4 h of biopsy to rule out intracranial complications. All patients were discharged within 24 h after biopsy, unless medical reasons unrelated to the biopsy required further hospitalization. We attribute the high diagnostic yield in our series to the high number of systematically taken biopsies per lesion. The higher number of biopsies did not lead to an increase in complications. From our experience, it appears safe to discharge patients the same day or within 24 h after a stereotactic biopsy if the postoperative CT shows no complication. Stereotactic biopsy could often safely be performed on an outpatient basis.
Frameless Laser-Guided Stereotaxis: A System for CT-Monitored Neurosurgical Interventions
Authors: Hussman Karl L. , Chaloupka John C. , Berger Scott B. , Chon Kenneth S. , Broderick Maggie
Published: April 2003

Objective: Since a simple, rapid and accurate stereotactic system allowing CT monitoring would offer the neurosurgeon several advantages, the feasibility and application accuracy of frameless laser-guided freehand point stereotaxis for neurosurgical interventions was studied. Methods: A Cartesian coordinate grid mounted upon the far wall of a CT scan room defined a plane. The scanner isocenter defined the origin of a three-dimensional coordinate system. Phantom entry point and target point coordinates were determined by the positional CT cursor. These coordinates were entered into a computer which determined the coordinates of the grid intersection point with a line passing through the entry and target points. A tripod-mounted laser assembly comprising two encased lasers oriented retrograde and antegrade along opposite vectors, was positioned near the grid. The retrograde laser was positioned to illuminate the marked grid intersection point while the antegrade laser simultaneously illuminated the entry point; the beams were thereby aligned along the line of trajectory. The tip of a probe was placed on the entry point; the hub was then moved into the path of the antegrade laser, thereby aligning the probe with the line of trajectory. The probe was then inserted to the target at a trigonometrically calculated distance. Results: Ten consecutive phantom tests averaged 17.5 min. Phantom test application accuracy averaged ±2 mm at an average insertion distance of 7.1 cm. Conclusion: Phantom tests indicate that simple, rapid and accurate CT-monitored frameless laser-guided freehand point stereotaxis is feasible. Clinical investigation is warranted.