bluuebunny/crossref_metadata_2025 huggingface dataset:
Unexpected Pulseless Disease Associated With Recurrent Venous Thromboembolisms
Authors: Morelle Johann , Tintillier Michel , Martinot Jean-Benoit , Moortgat Stephanie , Hermans Cedric
Published: December 2007

Venous thromboembolic disease is a well-documented complication of Klinefelter’s syndrome, even if mechanisms underlying this prothrombotic state have not been conclusively established. On the contrary, arterial thrombosis is far less frequent, and a case of a patient with Klinefelter’s syndrome presenting with simultaneous venous thrombtoembolic disease and a complete thrombosis of the left subclavian artery is presented. Elevated levels of type 1 plasminogen activator inhibitor, in the absence of other usual thrombophilic abnormalities, raise the question of the role played by this inhibitor of the fibrinolysis in the arterial and venous thromboses presented by this patient.
Successful Pregnancy Outcome in Women With Bad Obstetric History and Recurrent Fetal Loss Due to Thrombophilia: Effect of Unfractionated Heparin and Low—Molecular Weight Heparin
Authors: Ghosh Kanjaksha , Shetty Shrimati , Vora Sonal , Salvi Vinita
Published: December 2007

Acquired and inherited thrombophilias are known to be associated with unfavorable pregnancy outcome including recurrent fetal loss. There are differences of opinion whether these patients need to be treated with aspirin, unfractionated heparin, low—molecular weight heparin, corticosteroids, or intravenous immunoglobulins. In all, 25 consecutive patients with a history of fetal loss and 7 patients who presented in early pregnancy with deep-vein thrombosis were treated, and their pregnancy outcome was noted. All the women were positive either for a solitary or for a combination of acquired and heritable thrombophilia markers. In all, 23 patients were treated with unfractionated heparin and 9 with low—molecular weight heparin. In all, 16 out of 23 patients (69.6%) treated with unfractionated heparin and 9 out of 9 (100%) treated with low—molecular weight heparin had successful pregnancy outcome. There was a complete resolution of thrombus in all the cases. None of the patients had any adverse reactions such as heparin-induced thrombocytopenia, thrombosis, or fracture. Both unfractionated heparin and low—molecular weight heparin were effective in cases of bad obstetric history and recurrent pregnancy loss due to thrombophilia. However, low—molecular weight heparin was found to be more effective than unfractionated heparin along with other advantages of not requiring laboratory monitoring and easy administration. None of the patients in either group had to interrupt the therapy for any adverse treatment-related complications.
MEF2A Sequence Variants in Turkish Population
Authors: Gulec Sukru , Ruchan Akar Ahmet , Akar Nejat
Published: December 2007

Myocyte enhancer factor 2 (MEF2) is present in skeletal, cardiac, and smooth muscles and in neurons. MEF2A gene encodes a transcription factor which was on 15q26. The objective was to study the MEF2A gene in patients with premature MI. The control group consisted of 87 subjects who were older than 45 years with no history of cardiovascular disease or MI and no family history of CAD. The premature MI group consisted of 69 patients with documented MI younger than 45 years. No abnormal bands with single strand conformation polymorphism were detected after screening exon 1 through exon 8. This is the first study that detected 145408: T>C polymorphism in intron 10. In both study groups, the rare polymorphism P279L in exon 7, T>C polymorphism in intron 10, and 21-bp deletion in exon 11 of the gene were not found. The data supported the previous studies indicating no association between MEF2A gene and premature MI.
The Fibrinogen Functional Turbidimetric Assay
Authors: Stief Thomas W.
Published: December 2007

Hitherto, clinical fibrinogen methods were based on coagulation seconds, with assay conditions not similar to a plasma milieu. The fibrinogen functional turbidimetric assay included 50 µL citrated plasma + 100 µL 300 mIU/mL thrombin, 400 µg/mL polybrene, and 6% albumin—phosphate-buffered saline; an increase in absorbance at 405 nm/5 min at room temperature (or 2 minutes at 37°C) was observed. In all, 6% albumin in the fibrinogen functional turbidimetric assay reagent abolishes falsely elevated fibrinogen to fibrin turbidity in hypoproteinemic plasma samples. This assay can detect fibrinogen activity of 250% to 300% of normal, the lower detection limit being 7% of normal (0.2 g/L). The normal range of this assay is 100% ± 20% (mean value ± 1 SD; coefficient of variations <4%). This assay imitates fibrinogen to fibrin conversion in clotting blood plasma; it is independent of plasmatic albumin or heparin and can be performed everywhere. This assay has a diagnostic value in pathology-disseminated intravascular coagulation and in assessing risk for atherothrombosis.
In Vitro Simulation of Extremely Activated Thrombolysis
Authors: Stief Thomas W.
Published: December 2007

A life-threatening thrombus in massive pulmonary embolism has to be eliminated within minutes. Extremely activated plasmatic fibrinolysis destroys such thrombi in time: 50 µL plasma clots were incubated with urokinase or tissue-type plasminogen activator and 50 µL pooled normal plasma. The microtiter plate clot lysis assay was performed. The time point at which 50% of the clot has been lysed is 4 minutes for 8333 IU/mL urokinase or an equimolar concentration of tissue-type plasminogen activator (52498 IU/mL = 105 µg/mL). The effective dose 50% at 5 minutes lysis time is about 800 nM (4320 IU/mL) urokinase or (27220 IU/mL = 54 µg/mL) tissue-type plasminogen activator. Addition of plasminogen to the plasmatic clot supernatant improves thrombolysis if 65 IU/mL of urokinase acts for 10 minutes. The risk for severe intracranial hemorrhage in massive thrombolysis might be much lower than the lethality of a massive pulmonary embolism. Extremely activated plasmatic thrombolysis could be clinically indicated.
Homocysteine Activates Platelets In Vitro
Authors: Mohan Irwin V. , Jagroop I. Anita , Mikhailidis Dimitri P. , Stansby Gerard P.
Published: December 2007

The mechanism of thrombogenicity in hyperhomocysteinemia remains controversial. The authors investigated the association between elevated plasma homocysteine levels, platelet function, and blood coagulation. Blood was collected from healthy subjects and patients with critical limb ischemia. Basal platelet counts and platelet aggregation as well as flow cytometry were performed to assess spontaneous- and agonist-induced platelet aggregation as well as P-selectin and Glycoprotein IIb/IIIa expression at different homocysteine concentrations. Thromboelastography was performed, and platelet shape change was assessed, using a channelyzer, by measuring median platelet volume. Lactate dehydrogenase was measured, to indirectly assess red blood cell membrane integrity, after homocysteine exposure. The study results suggest that platelet activation and hypercoagulability occur after exposure to homocysteine, especially in patients with critical limb ischemia. Homocysteine concentrations of approximately 50 µmol/L appear to be the level at which these changes occur in vitro, and this effect on platelets appears to be indirect.
Oxidative Stress in Young Subjects With Acute Myocardial Infarction: Evaluation at the Initial Stage and After 12 Months
Authors: LoPresti Rosalia , Catania Anna , D'Amico Teresa , Montana Maria , Caruso Marco , Caimi Gregorio
Published: December 2007

In 105 subjects (97 men and 8 women) aged <46 years (mean age 39.6 ± 5.5 years), with recent acute myocardial infarction (T1), thiobarbituric acid reactive substances and total antioxidant status were determined; NO production was evaluated by measuring the nitrite and nitrate (NOx) concentration. The patients with acute myocardial infarction were subdivided according to the main risk factors, number of risk factors, and extent of coronary lesions. The evaluation was repeated after 12 months (T2). In these subjects, thiobarbituric acid reactive substances and NOx were significantly increased and total antioxidant status was significantly decreased at T1. In single risk factor, only NO metabolites were significantly lower in acute myocardial infarction subjects who smoke than in subjects who do not. Subdividing the subjects according to the number of risk factors and number of stenosed coronary vessels, there were no significant differences between the subgroups. At T2, thiobarbituric acid reactive substances and NOx were decreased and total antioxidant status was increased, but all parameters were still altered.
Bilateral Subdural Hematomas in an Adult With Hereditary Factor VII Deficiency: A Complication of Sit-ups and Inversion?
Authors: Barton James C. , Bertoli Luigi F. , O'Malley Sean
Published: December 2007

A 57-year-old man of northern Italian and Polish descent with a late-onset, mild form of hereditary factor VII deficiency developed bilateral intracranial subdural hematomas after performing sit-ups while he was in a head-down position on an inversion table. The pertinence of the Valsalva maneuver and increased intracranial venous and intraocular pressure associated with sit-ups and other exercises in the causation of subdural hematomas and other types of intracranial and ocular hemorrhage are discussed in this study.
Pericardial Hemorrhage Due to Acetylsalicylic Acid in a Patient With Essential Thrombocythemia
Authors: Kayrak Mehmet , Acar Kadir , Yazici Mehmet , Kaya Coskun , Selim Ayhan S. , Gok Hasan
Published: December 2007

Essential thrombocythemia is a clonal myeloproliferative disorder that causes thrombocytosis. Essential thrombocythemia is characterized by increased incidence of thrombosis with arterial event more than venous events and hemorrhagic complications. Acetylsalicylic acid enhances both minor and major bleedings. The authors describe pericardial hemorrhage, which is related to the use of low-dose acetylsalicylic acid in a patient with essential thrombocythemia. The patient was successfully managed with clopidogrel therapy during the 16 months follow-up without recurrent thrombotic or hemorrhagic events.
Fatal Bleeding Due to a Heparin-Like Anticoagulant in a 37-Year-Old Woman Suffering From Systemic Mastocytosis
Authors: Sucker Christoph , Mansmann Georg , Steiner Stefan , Gattermann Norbert , Schmitt-Graeff Anette , Loncar Robert , Scharf Rudiger E. , Stockschlader Marcus
Published: December 2007

A 37-year-old female patient with systemic mastocytosis who was admitted with severe unexplained bleeding symptoms is studied. Laboratory procedures established the diagnosis of a patient-derived—heparin-like anticoagulant as a very rare hemostatic abnormality predisposing to bleeding. The patient died from refractory disease despite therapy with protamine, initiation of chemotherapy, and supportive measures. The case illustrates the clinical presentation and diagnosis of heparin-like anticoagulants. Etiology, pathophysiology, and therapeutic options are discussed.
The Recalcified Coagulation Activity
Authors: Stief Thomas W.
Published: December 2007

Thrombin activity generated after plasma recalcification is of analytical and clinical interest. Fifty microliters of citrated plasma was recalcified with 5 µL of 250 mM CaCl 2. After 0 to 90 minutes (37°C) 50 µl 2.5 M arginine, pH 8.6, was added. After 20 minutes, thrombin was chromogenically quantified. In normal recalcified plasma, the generated thrombin activity is about 0.1-0.2 IU/ml (37°C) when fibrin generation starts. Pooling of normal plasmas increases the generated thrombin activity about 3-fold. Plasmas of patients on heparin or coumarin generate about 10-fold less thrombin activity. Freezing of pooled plasma at −20°C and thawing at room temperature or 37°C increases thrombin generation approximately 1.5- or 2-fold, respectively. Only thrombin activities in the ascending part of the thrombin generation curve (RECA-t2/RECAt 1>1) are valid. So a prothrombotic state in blood or plasma can be diagnosed.
Coagulation Activation by Lipopolysaccharides
Authors: Stief Thomas W.
Published: December 2007

Lipopolysaccharides at approximate plasma reactivities >3 ng/mL or β-glucans at >0.5-1 μg/mL are toxic for human blood; lipopolysaccharide interacts with membrane components of susceptible cells (eg, monocytes) activating phospholipase A2 that destroys the cell membrane. Cell fragments (microparticles or DNA) possess polynegative niches that activate intrinsic hemostasis. Pathologic disseminated intravascular coagulation arises. Blood vessels are obstructed by disseminated thrombi, and vital organ areas become ischemic. Multiorgan failure threatens life of the patient. Diagnosis and therapy of pathologic disseminated intravascular coagulation is of extreme clinical importance. For early diagnosis of pathologic disseminated intravascular coagulation, specific activation markers of coagulation (eg, plasmatic amidolytic thrombin activity) or the plasmatic lipopolysaccharide or glucan reactivity can be measured. A new treatment target might be kallikrein or factor XIIa; 10 to 20 mM arginine is the approximate 50% inhibitory concentration against the contact phase of coagulation. The complex interaction between cell fragments and hemostasis causes pathologic disseminated intravascular coagulation in sepsis.
Finding Success in Medication Management
Authors: McDonald Margaret V. , Peterson Laura E.
Published: December 2007

This article outlines the incidence and risk of medication errors in older home health care patients and reasons why improving medication management has become a national priority. The article also describes an initiative that was developed to improve geriatric medication management. The Visiting Nurse Associations of America (VNAA) Curricula for Homecare Advances in Management and Practice (CHAMP) program offers a multimodal, geriatric care, quality improvement educational approach that includes an online course, coaching calls, in-person workshops, and a faculty-moderated peer-to-peer support listserv. The target audience is home care frontline nurse and therapy managers. Course topics include mastering medication assessment and reconciliation, monitoring for complications, and improving patient adherence. In addition, the course includes strategies to help embed the capacity for continuous practice improvement within agencies.
Communicating With Physicians: How Agencies Can Be Heard
Authors: Markley Jennifer , Winbery Stephen
Published: December 2007

Communication failure plays an important role in medical errors. Clinical communication is highly complex and prone to error especially during transitions of patient care and emergent situations. Standardized approaches and tools may provide potential solutions to improve the quality of communication and prevent subsequent patient harm. Maximizing nurse—physician collaboration holds promise for improving patient care and creating satisfying work roles. The purpose of this article is to describe strategies that will facilitate effective nurse—physician collaboration. First discussed is the clinician perspective with an emphasis on a model, situation, background, assessment, recommendation (SBAR). This shared mental model is for improving communication between clinicians. This introduction is integrated with actual experiences encountered by a Texas home health agency in implementing the SBAR technique. Finally, the physician perspective is presented with discussion of communication development strategies to enhance nurse-physician collaboration and communication in a home care setting.
Pandemic Economics: Financial Survival for Home Care Agencies in a Bird Flu Outbreak
Authors: Martin Sharon Dezzani
Published: December 2007

Flu pandemics have occurred regularly throughout recorded history. Preparation now will determine which home care agencies survive the next flu pandemic financially. This article discusses six cost areas that will affect the home care agency bottom line. These areas include supplies, staff shortages, reimbursement issues, vaccine and antiviral medication, unusual costs associated with a pandemic, and planning. Many suggestions for financial survival are offered. Major suggestions include financial planning in advance of a pandemic, stockpiling six essential supplies to last at least a 6- to 8-week period, and vigorous political action to pass a federal home care pandemic insurance plan and a federal home care paperwork modification plan to be implemented when the government declares a pandemic emergency regionally or nationally.
Ethics at the End of Life
Authors: Childress Sue
Published: December 2007

Patients, families, and health care providers all face ethical issues at the end of life. Related to increased technology, decreased resources, and immense cultural diversity, these controversies are a common concern to providers in home care. Increased knowledge and skills related to ethical discussions are crucial tools for providers in home care. Providers'abilities to facilitate these discussions with families and patients at the end of life can ease the transition from aggressive care to hospice care. This article describes basic principles of an ethical discussion and discusses the common ethical dilemmas faced at the end of life.
Collecting Health Data With Youth at Faith-Based Institutions: Lessons Learned
Authors: Reinert Bonita , Carver Vivien , Range Lillian M. , Pike Chris
Published: December 2007

Faith-based organizations (FBOs) are ideal for health promotion but can present unique challenges in data collection. The present initiative included 6 years of awards to mostly small, rural, predominantly African American FBOs to conduct tobacco prevention lessons for youth in Grades 4—6 while they were attending summer Vacation Bible School. In 2005, these awards included $1,500 disbursed to 64 geographically diverse FBOs who had never before received this funding. Lessons learned include the following: Plan for evaluation in every aspect of the project; pilot-test everything; use reminders judiciously; make backup plans at every step; personally collect data in a nonthreatening way; and safeguard data entry. Evaluation requires extensive time, money, and effort; so, in both the intermediate and the long run, this extra work is worth it.
BART to HIVEd: Adapting an HIV Education Prevention Program
Authors: Polacek Georgia N. L. J. , Coker Jennifer , Lewis Kayan L. , Minter Monica , Villela-Perez Verónica , Scott Anthony A.
Published: December 2007

One of the fastest growing segments of the population infected with HIV is the nation's youths. Thus, prevention in this high-risk population is vital. The authors detail the process of adapting an evidence-based HIV/AIDS educational program (HIVEd) to the unique needs of high-risk youths in adjudicated and detained facilities and alternative high schools. The HIVEd program derives from St. Lawrence's Becoming A Responsible Teen (BART) curriculum. This article describes the modification of BART into HIVEd, identifies the challenges encountered and lessons learned, and suggests future directions for HIVEd as a useful tool for prevention of HIV/AIDS and sexually transmitted infection in high-risk youths.
Using a Delphi Technique to Determine the Needs of African American Breast Cancer Survivors
Authors: Shaw Mary D. , Coggin Claudia
Published: December 2007

A qualitative study was designed in collaboration with the Sisters Network, Inc., the only nonprofit national Black breast cancer support group, to identify the needs of Black breast cancer survivors. This article describes the use of the Delphi technique as a methodological tool for listening to culturally different speakers and building consensus among members of a racial minority group regarding their most important needs as breast cancer survivors. The specific objective of the study was to determine if the seldom-used Delphi technique could serve as a tool for deriving consensus on a significant health care concern among members of a racial minority group. Sixty-two survivors from different geographical regions of the United States participated in the study. The Delphi technique proved to be a useful qualitative method for encouraging discussion among a group of women with a vested interest in a specific health issue.
Fetal Alcohol Syndrome Prevention Using Community-Based Narrowcasting Campaigns
Authors: Glik Deborah , Prelip Michael , Myerson Amy , Eilers Katie
Published: December 2007

Preventing fetal alcohol syndrome (FAS) by encouraging pregnant women to abstain from drinking alcohol competes with commercial alcohol marketing. Two FAS-prevention campaigns using a narrowcast approach among young women of childbearing age in two disadvantaged Southern California communities are compared. The design, implementation process, and degree to which campaigns reached the priority populations are the focus of this article. Formative research shows that young women in disadvantaged communities receive mixed messages about dangers of drinking during pregnancy. A social norms approach using positive role models was the most acceptable message strategy based on materials pretesting. Differences in campaign implementation and distribution strategies between communities were documented through program monitoring. Survey research indicated the more viable messaging and implementation strategies. Findings show that low-cost community campaigns are feasible; however, variations in messaging, distribution strategies, and saturation levels determine whether such campaigns succeed or fail to reach priority populations.
Ethics and Patient—Provider Communication
Authors: Marks Ray , Shive Steven E.
Published: December 2007

Effective health educator—client communication processes are a prerequisite to the acquisition and appropriate application of new knowledge, to discussions that focus on treatment risks and options, and to the mediation of (a) optimal self-management practices, (b) adherence to health recommendations, (c) client satisfaction, (d) autonomous, responsible decision making, and (e) provision of supportive and helpful advice. But is there room for improvement? To provide more uniform high-quality communications to all citizens and to support the practice principles embedded in the Health Education Code of Ethics, this article outlines results of the related literature, the authors' research, and a specific post hoc analysis of a national sample that strongly suggests that much more needs to be done to ensure health providers effectively communicate health promotion messages without bias in at least five related communication domains.
Evidence for Grief as the Major Barrier Faced by Alzheimer Caregivers: A Qualitative Analysis
Authors: Frank Jacquelyn B.
Published: December 2007

Feelings of loss and grief are frequent companions for current Alzheimer's family caregivers. Increased acknowledgment and understanding of caregiver grief among researchers has led to more comprehensive explorations of the multifaceted nature of caregiver grief and loss. Absent from the literature, however, is an exploration of anticipatory grief as an actual barrier to the task of caregiving. Through an analysis of 353 open-ended survey responses, the present article explores links between anticipatory grief, ambiguous loss, and principal barriers that family members face as dementia caregivers across the state of Indiana. By drawing parallels between caregiver responses and the Marwit-Meuser Caregiver Grief Inventory subscales, this article illustrates that the fundamental barrier experienced by current Alzheimer's caregivers appears to be a combination of anticipatory grief and ambiguous loss rather than hands-on care issues. The implications of this finding for future caregiver research and interventions are discussed.
Distinct MRI Atrophy Patterns in Autopsy-Proven Alzheimer's Disease and Frontotemporal Lobar Degeneration
Authors: Rabinovici G.D. , Seeley W.W. , Kim E.J. , Gorno-Tempini M.L. , Rascovsky K. , Pagliaro T.A. , Allison S.C. , Halabi C. , Kramer J.H. , Johnson J.K. , Weiner M.W. , Forman M.S. , Trojanowski J.Q. , DeArmond S.J. , Miller B.L. , Rosen H.J.
Published: December 2007

To better define the anatomic distinctions between Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD), we retrospectively applied voxel-based morphometry to the earliest magnetic resonance imaging scans of autopsy-proven AD (N = 11), FTLD (N = 18), and controls (N = 40). Compared with controls, AD patients showed gray matter reductions in posterior temporoparietal and occipital cortex; FTLD patients showed atrophy in medial prefrontal and medial temporal cortex, insula, hippocampus, and amygdala; and patients with both disorders showed atrophy in dorsolateral and orbital prefrontal cortex and lateral temporal cortex ( PFWE-corr < .05). Compared with FTLD, AD patients had decreased gray matter in posterior parietal and occipital cortex, whereas FTLD patients had selective atrophy in anterior cingulate, frontal insula, subcallosal gyrus, and striatum ( P < .001, uncorrected). These findings suggest that AD and FTLD are anatomically distinct, with degeneration of a posterior parietal network in AD and degeneration of a paralimbic fronto-insular-striatal network in FTLD.
Clinical Presentation of Prodromal Frontotemporal Dementia
Authors: Hallam Bradley J. , Silverberg Noah D. , LaMarre Amanda K. , Mackenzie Ian R. A. , Feldman Howard H.
Published: December 2007

Background. Misrecognition of symptoms in the early stages of frontotemporal dementia (FTD) frequently contributes to diagnostic delay. Three frameworks have been proposed for the clinical identification of prodromal FTD: (1) cognitive profiling, (2) the presence of behavioral/psychiatric symptoms in the absence of memory complaints, and (3) a combined approach of cognitive, behavioral, and neuroimaging features. Objective. To evaluate current conceptual frameworks for the clinical recognition of prodromal FTD with current empirical evidence. Method. We performed a comprehensive PsychINFO and MEDLINE database search to identify articles investigating the prodromal symptoms of FTD. Conclusions. The 3 frameworks capture important aspects of the clinical picture of prodromal FTD but require further refinement. The prodromal stage of FTD is characterized by both cognitive and behavioral features. Diagnostic accuracy will likely be improved by considering a combination of cognitive and behavioral features, because some features overlap with prodromes for Alzheimer's disease and vascular dementia.
Resurrecting the Motivation-Hygiene Theory: Herzberg and the Positive Psychology Movement
Authors: Sachau Daniel A.
Published: December 2007

Herzberg's motivation-hygiene theory is a popular but controversial theory of employee satisfaction. The theory was at the center of a long debate that focused on conceptual and methodological problems with the theory. Now, more than 30 years after the debate and despite multiple claims that Herzberg's theory is dead, emerging research from the field of positive psychology is surprisingly consistent with basic tenets of the motivation-hygiene theory. It may be time to resurrect Herzberg's theory. This article includes a summary of the motivation-hygiene theory, a clarification of long-standing misinterpretations of the theory, and an examination of the fit between Herzberg's theory and contemporary research on happiness, intrinsic motivation, and materialism. The benefits of returning to Herzberg's model are discussed.
Endograft Malapposition in the Distal Aortic Arch Resulting in Functional Coarctation
Authors: Riesenman Paul J. , Farber Mark A. , Fulton Jospeh J.
Published: December 2007

The application of thoracic endografts to thoracic aortic injuries is often limited by the available diameters of these devices. Abdominal aortic endografts have been successfully used in the thoracic aorta to overcome sizing limitations. A case is presented of a patient who underwent endovascular exclusion of a thoracic aortic transection with an abdominal aortic endograft iliac limb. The repair was complicated by endograft malapposition to the lesser curvature of the aortic arch and the development of a functional coarctation. The endovascular repair was successfully salvaged through the use of a balloon-expandable stent to improve endograft apposition to the vessel wall.
Endovascular Repair of Traumatic Superior Mesenteric Artery to Splenic Vein Fistula
Authors: Al-Khayat Haitham , Haider Hani H. , Al-Haddad Abdullah , Al-Khayat Hisham , Ginzburg Enrique
Published: December 2007

Traumatic mesenteric arterioportal fistulas (APF) are rare but serious and life-threatening. This article reports the case of a 24-year-old female who suffered a gunshot wound to the abdomen and subsequently developed a superior mesenteric artery (SMA) pseudoaneurysm and APF, which caused secondary right heart failure and pulmonary hypertension. The patient underwent a successful endovascular stent-graft exclusion of the pseudoaneurysm/APF. The patient was asymptomatic 18 months post procedure and leading an active life with a normal arterial flow in the SMA confirmed by duplex ultrasonography.
Popliteal Vein Aneurysm: A Case Report and Review of Literature
Authors: Nasr Wael , Babbitt Russell , Eslami Mohammad H.
Published: December 2007

The authors report a case of popliteal vein aneurysm (PVA) in a healthy patient who presented with symptoms and review the literature. A 40-year-old healthy male presented with hypoxia secondary to pulmonary emboli. He underwent diagnostic tests revealing a suprageniculate saccular PVA, which was treated by aneurysmectomy and lateral venorrhaphy. A follow-up duplex scan after 18 months showed patent popliteal vein in an asymptomatic patient. A review of 120 cases identified revealed that the most common presentation of PVA is because of thromboembolic complications, often having saccular morphology. Patients were at risk of thromboembolic complications whether intraluminal thrombi were present (63% of the cases) or not. Patients treated with anticoagulation alone had a failure rate of 43%, with thromboembolic complications. Surgical repair of PVA—regardless of the aneurysm size—should be considered in all patients to decrease the risk of thromboembolization.
Successful Coil Embolization of a Ruptured Gastroduodenal Artery Aneurysm
Authors: Kueper Markus Alexander , Ludescher Burkhard , Koenigsrainer Ingmar , Kirschniak Andreas , Mueller Kasimir , Wiskirchen Jakub , Koenigsrainer Alfred
Published: December 2007

Aneurysms of the gastroduodenal artery are rare. Reported here is the case of a 60-year-old woman suffering from the covered rupturing of a twin aneurysm of the gastroduodenal artery. The patient presented herself in the surgical emergency unit with abdominal discomfort. Diagnostics showed free fluid in the abdominal cavity together with anemia of 9.9 g/dL. A computed tomography scan and an angiography revealed the covered rupturing of a twin aneurysm of the gastroduodenal artery, which was treated by endovascular coiling of the gastroduodenal and pancreaticoduodenal arteries. The patient's hemoglobin level remained stable after treatment, and she was released from the hospital after 18 days. Visceral artery aneurysms are rare. Although endovascular therapy is preferred in cases involving active bleeding, surgery remains the primary therapy in those cases in which bleeding becomes uncontrollable.
Ratio of mutant JAK2-V617F to wild-type Jak2 determines the MPD phenotypes in transgenic mice
Authors: Tiedt Ralph , Hao-Shen Hui , Sobas Marta A. , Looser Renate , Dirnhofer Stephan , Schwaller Jürg , Skoda Radek C.
Published: December 2007

An acquired somatic mutation in the JAK2 gene (JAK2-V617F) is present in the majority of patients with myeloproliferative disorders (MPDs). Several phenotypic manifestations (polycythemia vera [PV], essential thrombocythemia [ET], and primary myelofibrosis) can be associated with the same mutation. We generated JAK2-V617F transgenic mice using a human JAK2 gene with the sequences encoding the kinase domain placed in the inverse orientation and flanked by antiparallel loxP sites. Crossing mice of one transgenic line (FF1) with transgenic mice expressing Cre-recombinase under the control of the hematopoiesis specific Vav promoter led to expression of JAK2-V617F that was lower than the endogenous wild-type Jak2. These mice developed a phenotype resembling ET with strongly elevated platelet counts and moderate neutrophilia. Induction of the JAK2-V617F transgene with the interferon-inducible MxCre resulted in expression of JAK2-V617F approximately equal to wild-type Jak2 and a PV-like phenotype with increased hemoglobin, thrombocytosis, and neutrophilia. Higher levels of JAK2-V617F in mouse bone marrow by retroviral transduction caused a PV-like phenotype without thrombocytosis. These data are consistent with the hypothesis that the ratio of mutant to wild-type JAK2 is critical for the phenotypic manifestation. A similar correlation was also found in patients with MPD.
Cooperative signaling through the signal transducer and activator of transcription 3 and nuclear factor-κB pathways in subtypes of diffuse large B-cell lymphoma
Authors: Lam Lloyd T. , Wright George , Davis R. Eric , Lenz Georg , Farinha Pedro , Dang Lenny , Chan John W. , Rosenwald Andreas , Gascoyne Randy D. , Staudt Louis M.
Published: December 2007

The activated B cell–like (ABC) subgroup of diffuse large B-cell lymphoma (DLBCL) is characterized by constitutive activation of the nuclear factor-κB (NF-κB) pathway. In this study, we showed that the NF-κB pathway induced the expression of the cytokines interleukin (IL)-6 and IL-10 in ABC DLBCL cell lines, which also have high levels of total and phosphorylated signal transducer and activator of transcription (STAT) 3 protein, suggesting autocrine signaling. Using RNA interference for STAT3, we defined a gene expression signature of IL-6 and IL-10 signaling through STAT3. Based on this signature, we constructed a molecular predictor of STAT3 signaling that defined a subset of ABC DLBCL tumors with high expression of STAT3, IL-6, and/or IL-10 and their downstream targets. Although the STAT3-high and STAT3-low subsets had equivalent expression of genes that distinguish ABC DLBCL from germinal center B cell–like DLBCL, STAT3-high ABC DLBCLs had higher expression of signatures that reflected NF-κB activity, proliferation, and glycolysis. A small-molecule inhibitor of Janus kinase signaling, which blocked STAT3 signature expression, was toxic only for ABC DLBCL lines and synergized with an inhibitor of NF-κB signaling. These findings suggest that the biological interplay between the STAT3 and NF-κB pathways may be exploited for the treatments of a subset of ABC DLBCLs.
Increased proteasomal degradation of Bax is a common feature of poor prognosis chronic lymphocytic leukemia
Authors: Agrawal Samir G. , Liu Feng-Ting , Wiseman Catherine , Shirali Sima , Liu Hongxiang , Lillington Debra , Du Ming-Qing , Syndercombe-Court Denise , Newland Adrian C. , Gribben John G. , Jia Li
Published: December 2007

Many biologic markers are associated with poor prognosis in chronic lymphocytic leukemia (CLL), but their mechanistic role remains unclear. Bax is an essential proapoptotic protein and decreased levels in malignant cells lead to resistance to apoptosis. Using a Bax degradation activity (BDA) assay, CLL cells were found to show variable Bax instability. However, BDA did not correlate with Bax protein levels: BDA positive and negative cases had high and low baseline Bax levels. BDA positive cases showed a marked accumulation of poor prognostic markers—unmutated immunoglobulin heavy chain variable genes, ZAP-70/CD38 positivity, 11q22/17p13 deletion, and short lymphocyte doubling time. Patients with BDA positive cells had a shorter median overall survival (OS; 126 months vs not reached, P = .011) and time to first treatment (16 vs 156 months, P = .029) than BDA negative cases. Dual BDA and ZAP-70 positivity had a median OS of 84 months (P = .012). The BDA assay measures the intrinsic ubiquitin/proteasome activity of CLL cells and dynamic changes in Bax protein levels over time. Mechanistically, Bax instability may represent a final common pathway for disparate prognostic markers, as well as being itself an indicator of poor prognosis.
Occult connective tissue diseases mimicking idiopathic interstitial pneumonias
Authors: Tzelepis G. E. , Toya S. P. , Moutsopoulos H. M.
Published: December 2007

In patients with interstitial lung disease (ILD), the diagnosis of idiopathic interstitial pneumonia is usually made after excluding, among other conditions, connective tissue diseases (CTDs). Although in most patients with a CTD and respiratory symptoms, the systemic nature of the disease is obvious, the ILD-related manifestations in CTDs may often dominate the clinical picture or precede systemic findings and thus mimic idiopathic interstitial pneumonia.

With the exception of systemic lupus erythematosus, all CTDs may imitate chronic idiopathic interstitial pneumonias. In this setting, clues to an underlying CTD may be entirely absent or include subtle findings from various systems, including skin, vascular and musculoskeletal system or internal organs. Since nonspecific interstitial pneumonia is a relatively frequent histological pattern in CTDs, biopsy reports of nonspecific interstitial pneumonia should also prompt a search for an underlying CTD.

Ultimately, diagnosis of a CTD requires confirmation with immunological testing; interpretation of the various laboratory tests should always be carried out in conjunction with clinical findings.

The present article reviews specific clinical aspects of connective tissue disease-related interstitial lung disease that may help differentiate it from idiopathic interstitial pneumonia, especially when interstitial lung disease is the predominant or sole manifestation of an occult connective tissue disease.
Primary care spirometry*
Authors: Derom E. , van Weel C. , Liistro G. , Buffels J. , Schermer T. , Lammers E. , Wouters E. , Decramer M.
Published: December 2007

Primary care spirometry is a uniquely valuable tool in the evaluation of patients with respiratory symptoms, allowing the general practitioner to diagnose or exclude chronic obstructive pulmonary disease (COPD), sometimes to confirm asthma, to determine the efficacy of asthma treatment and to correctly stage patients with COPD. The use of spirometry for case finding in asymptomatic COPD patients might become an option, once early intervention studies have shown it to be beneficial in these patients.

The diagnosis of airway obstruction requires accurate and reproducible spirometric measurements, which should comply with the American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines. Low acceptability of spirometric manoeuvres has been reported in primary care practices. This may hamper the validity of the results and affect clinical decision making. Training and refresher courses may produce and maintain good-quality testing, promote the use of spirometric results in clinical practice and enhance the quality of interpretation.

Softening the stringent ATS/ERS criteria could enhance the acceptability rates of spirometry when used in a general practice. However, the implications of potential simplifications on the quality of the data and clinical decision making remain to be investigated.

Hand-held office spirometers have been developed in recent years, with a global quality and user-friendliness that makes them acceptable for use in general practices. The precision of the forced vital capacity measurements could be improved in some of the available models.
Global strategy for asthma management and prevention: GINA executive summary
Authors: Bateman E. D. , Hurd S. S. , Barnes P. J. , Bousquet J. , Drazen J. M. , FitzGerald M. , Gibson P. , Ohta K. , O'Byrne P. , Pedersen S. E. , Pizzichini E. , Sullivan S. D. , Wenzel S. E. , Zar H. J.
Published: December 2007

Asthma is a serious health problem throughout the world. During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services. Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations. A comprehensive workshop report entitled “A Global Strategy for Asthma Management and Prevention”, first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines. The 2006 report contains important new themes. First, it asserts that “it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained,” and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions. The importance of the patient–care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised.
Serum diagnosis of diffuse large B-cell lymphomas and further identification of response to therapy using SELDI-TOF-MS and tree analysis patterning
Authors: Zhang Xing , Wang Bo , Zhang Xiao-shi , Li Zhi-ming , Guan Zhong-zhen , Jiang Wen-qi
Published: December 2007

Background

Currently, there are no satisfactory biomarkers available to screen for diffuse large B cell lymphoma (DLBCL) or to identify patients who do not benefit from standard anti-cancer therapies. In this study, we used serum proteomic mass spectra to identify potential serum biomarkers and biomarker patterns for detecting DLBCL and patient responses to therapy.

Methods

The proteomic spectra of crude sera from 132 patients with DLBCL and 75 controls were performed by SELDI-TOF-MS and analyzed by Biomarker Patterns Software.

Results

Nine peaks were considered as potential DLBCL discriminatory biomarkers. Four peaks were considered as biomarkers for predicting the patient response to standard therapy. The proteomic patterns achieved a sensitivity of 94% and a specificity of 94% for detecting DLBCL samples in the test set of 85 samples, and achieved a sensitivity of 94% and a specificity of 92% for detecting poor prognosis patients in the test set of 66 samples.

Conclusion

These proteomic patterns and potential biomarkers are hoped to be useful in clinical applications for detecting DLBCL patients and predicting the response to therapy.
Expression of genes for bone morphogenetic proteins BMP-2, BMP-4 and BMP-6 in various parts of the human skeleton
Authors: Kochanowska Iwona , Chaberek Slawomir , Wojtowicz Andrzej , Marczyński Bartosz , Włodarski Krzysztof , Dytko Maria , Ostrowski Kazimierz
Published: December 2007

Background

Differences in duration of bone healing in various parts of the human skeleton are common experience for orthopaedic surgeons. The reason for these differences is not obvious and not clear.

Methods

In this paper we decided to measure by the use of real-time RT-PCR technique the level of expression of genes for some isoforms of bone morphogenetic proteins (BMPs), whose role is proven in bone formation, bone induction and bone turnover. Seven bone samples recovered from various parts of skeletons from six cadavers of young healthy men who died in traffic accidents were collected. Activity of genes for BMP-2, -4 and -6 was measured by the use of fluorescent SYBR Green I.

Results

It was found that expression of m-RNA for BMP-2 and BMP-4 is higher in trabecular bone in epiphyses of long bones, cranial flat bones and corpus mandibulae then in the compact bone of diaphyses of long bones. In all samples examined the expression of m-RNA for BMP-4 was higher than for BMP-2.

Conclusion

It was shown that m-RNA for BMP-6 is not expressed in the collected samples at all. It is postulated that differences in the level of activation of genes for BMPs is one of the important factors which determine the differences in duration of bone healing of various parts of the human skeleton.
Scope of FNAC in the diagnosis of soft tissue tumors-A study from a tertiary cancer referral center in India
Authors: Rekhi Bharat , Gorad Biru D , Kakade Anagha C , Chinoy RF
Published: December 2007

Background

Fine needle aspiration cytology (FNAC) forms one of the first diagnostic tools in the evaluation of tumors. Its role in diagnosing soft tissue tumors (STT) has been fairly documented, as well as debated. Present study was aimed at evaluating its scope in diagnosing 127 cases of soft tissue tumors.

Methods

Conventional Pap and MGG staining was available in all the cases. Immunocytochemistry (ICC) was performed in 15 cases. Histopathological details were available in 115 cases.

Results

50% cases were referred for a primary diagnosis, while 26.8% & 22.8% cases were evaluated for recurrent and metastatic lesions, respectively. Extremities were the commonest sites. On FNAC, 101 cases (79.5%) were labeled as malignant, whereas 10 cases (7.9%) were labeled as benign. The remaining 16 cases (11%) were not categorized and were labeled as ‘unsure/not specified’. Histopathological confirmation in 115 cases, gave a diagnostic accuracy of 98%, with a positive predictive value of 98% in malignant cases and a negative predictive value of 100% in benign cases. Two cases were false positive. Among the various cytological categories, 60 cases (47.2%) were of spindle cell type, followed by 32 (25.2%) of round cell type and 14 cases (11%) of lipomatous type. Other 12 cases (9.4%) were of pleomorphic type; 7 (5.5%) cases of epithelioid type and remaining 2 cases were of myxoid type. All the round cell, pleomorphic and myxoid type of tumors were sarcomas, whereas 73.3% cases of spindle cell type were labeled as ‘malignant’. Exact cytological sub typing was offered in 58 cases, with rhabdomyosarcoma (RMS) as the most frequently sub typed tumor. The two false positive malignant cases were of fibromatosis and a pigmented schwannoma, on biopsy. Out of 28 metastatic lesions, lymph nodes were the commonest site for metastasis, with epithelioid tumors that formed highest percentage of metastatic cases.

Conclusion

FNAC is fairly specific and sensitive in STT diagnoses for primary, recurrent and metastatic lesions. The cytological types, especially round cell and pleomorphic sarcomas, can be quickly identified. Clinicopathological correlation with ICC as an adjunct, are valuable in exact sub typing.