bluuebunny/crossref_metadata_2025 huggingface dataset:
Haematuria Presenting Six Years after a Pelvic Fracture
Authors: Ivil K.D. , Zafirakis H. , Cahill D.J. , Cetti N.E.
Published: April 2003

Pelvic fractures are frequently associated with injuries to the lower genitourinary tract. However, most described injuries are noted at the time the fracture is sustained. We describe the case of a 63-year-old man who presented with haematuria 6 years after sustaining an ‘open-book’-type pelvic fracture.
Prognostic Value of Renal Cell Carcinoma Nuclear Grading: Multivariate Analysis of 333 Cases
Authors: Ficarra Vincenzo , Righetti Rita , Martignoni Guido , D’Amico Antonio , Pilloni Stefania , Rubilotta Emanuele , Malossini Gianni , Mobilio Gaetano
Published: April 2003

Objective: To evaluate the independent predictive value of the nuclear grading system according to Fuhrman in relation to the disease-specific survival of patients with renal clear cell carcinoma. Material and Methods: 333 patients who underwent radical nephrectomy for renal clear cell carcinoma between 1983 and 1999 were evaluated. In all patients we retrospectively studied nuclear grading, average tumor size, multifocality, pathologic stage of primary tumor, vein invasion, lymph node involvement and distant metastases. The Kaplan-Meier method was applied to evaluate disease-specific survival rates. The log rank test was used to compare survival curves and for univariate analysis. The Cox proportional hazards model was used for the multivariate analysis. Results: Histologic grade was G1 in 83 cases (25%), G2 in 117 cases (35%), G3 in 110 cases (33%) and G4 in 23 cases (7%). Our data showed that nuclear grading according to Fuhrman is related to medium tumor size (p < 0.0001), pathologic stage of cancer (p < 0.001), venous system invasion (p < 0.001), lymph node involvement (p < 0.001) and distant metastases (p < 0.001). The disease-specific survival after 5 and 10 years was 94 and 88%, respectively, in patients with G1, 86 and 75% in patients with G2, 59 and 40% in patients with G3 and 31% in patients with G4 (log rank p value < 0.0001). Multivariate analysis showed that nuclear grading by Fuhrman has a prognostic independent predictive value (hazard ratio = 1.8461, p = 0.002). Conclusions: Nuclear grading is an important independent predictive factor of disease-specific survival in patients with renal cell carcinoma.
Objective Penile Vascular Response to Intraurethral Prostaglandin E2 (Dinoprostone)
Authors: Karabulut Ayhan , Peskircioglu Levent , Özkardeş Hakan , Altuǧ Uǧur , Erol Demokan
Published: April 2003

Purpose: Intraurethral prostaglandin E2 (PGE2) administration is a noninvasive treatment modality for erectile dysfunction. The purpose of this study was to evaluate the objective effects of this agent by measuring peak systolic velocities of cavernosal arteries after intraurethral PGE2 administration and comparing with the results obtained with an intraurethral placebo gel and intracavernous papaverine injection. Materials and Methods: The study group consisted of 22 consecutive impotent volunteers with a mean age of 46 years who had normal penile arterial responses as determined by penile arterial responses on papaverine-stimulated penile duplex ultrasonography. The peak systolic velocity in cavernosal arteries was recorded after intracavernous injection of 60 mg of papaverine. All patients received 1 mg of intraurethral PGE2 gel and placebo at 15-day intervals. The peak systolic velocities were recorded after each treatment. Results: Mean peak systolic velocity achieved by intraurethral administration of PGE2 gel (25 ± 8 cm/s) was less than that achieved by intracavernous papaverine (40 ± 6 cm/s) but higher than that obtained by placebo (15 ± 4 cm/s). Twelve patients had erections, while 9 had partial and 1 had no erection with intraurethral PGE2. Placebo did not cause any erections. No serious side effects were observed. Conclusion: Intraurethral administration of PGE2 appears to be an effective and simple method for increasing penile arterial flow and can be used during penile Doppler ultrasonography to stimulate the penile arterial system.
Alpha-Fetoprotein-Producing Renal Cell Carcinoma
Authors: Poulakis V. , Witzsch U. , de Vries R. , Becht E. , Altmannsberger H.-M. , Störkel S.
Published: April 2003

Alpha-fetoprotein (AFP) is recognized as a tumor marker of yolk sac tumors, liver cancer and some other cancers of the digestive organs. Renal cell carcinoma (RCC) producing AFP is a rare entity. A case of AFP-producing RCC with solitary bone metastasis, but without liver involvement, is reported. The stain specific to AFP proved the presence of AFP in the cytoplasms of more cells of the renal tumors. Additionally, the other published cases are reviewed. These cases indicate that mesoderm-originating malignant tumors such as RCCs can produce AFP in some situations. So, AFP is probably more universal than believed, although it is generally a popular and useful tumor marker for hepatocellular carcinomas and yolk sac tumors.
Excessive Verumontanum Hyperplasia Causing Infertility
Authors: Perimenis P. , Gyftopoulos K. , Ravazoula P. , Athanassopoulos A. , Barbalias G.
Published: April 2003

Retrograde ejaculation is an uncommon cause of infertility in otherwise healthy men. We hereby report a previously undescribed verumontanum hyperplasia as a cause of retrograde ejaculation in a 32-year-old male that was successfully treated by transurethral resection.
Oat-Cell Carcinoma of the Prostate
Authors: López Cubillana P. , Martínez Barba E. , Prieto A. , Server Pastor G. , Sola J. , Nicolás J.A. , García Hernández J.A. , Gómez G. , Martínez Pertusa P. , Pérez Albacete M. , Bañón V. , Valdelvira P. , Guardiola A. , Castillo D. , Cao E. , Alonso J.D.
Published: April 2003

Background: Any carcinoma of prostatic origin which is not an acinary adenocarcinoma of the prostate is considered to be an atypical carcinoma. One member of this group of atypical prostatic tumors is the oat-cell carcinoma, or small cell carcinoma (SCC) of the prostate. This variety of carcinoma constitutes the histologic basis of <1% of all prostatic neoplasms. Methods: Between 1992 and 1997, four patients were diagnosed with SCC of the prostate at our hospital. In 3 of the 4 cases, the histopathological diagnosis was pure SCC, and in the 4th case there was a component of prostatic adenocarcinoma associated with the SCC. At the time of diagnosis, extracapsular extension of the tumor was present in all 4 cases, with T3 or higher stages in all of them (T3AN₀M1, T3AN₀M₀, T3BN₀M1, and T4N₀M₀). Because of the presence of extracapsular extension, radiotherapy and radical surgery were ruled out for all 4 patients. They were all offered systemic chemotherapy with cyclophosphamide (1 g/m2), doxorubicin (50 mg/m2) and vincristine (1.2 mg/m2). This therapeutic protocol was carried out in only 2 cases. Results: Survival was <1 year in the 3 patients with pure SCC, and the patient with a mixed tumor is alive with detectable disease 9 months after diagnosis. Conclusions: This poor vital prognosis in SCC stresses the need for early diagnosis a timely and appropriate therapeutic intervention in this condition.
Electromyography of Male Rat Perineal Musculature during Copulatory Behavior
Authors: Miura Takafumi , Kondo Yasuhiko , Akimoto Masao , Sakuma Yasuo
Published: April 2003

Electromyogram (EMG) recordings were made from the bulbospongiosus (BS) and ischiocavernosus (IC) muscles of the awake male rat in order to evaluate the roles played by these muscles in the implementation of penile intromission during a copulatory encounter. Male rats with bipolar wire electrodes implanted chronically in the BS and IC muscles were mated with sexually receptive females. Concurrent videotape recordings established a relationship between EMG and components of male rat copulatory behavior, i.e. mount, intromission and ejaculation. On EMGs recorded from the IC muscle, the initial low-amplitude phase at the initiation of each behavioral component was distinguished from the late high-amplitude phase whenever the male accomplished mounting or intromission. In the BS muscle, the late high-amplitude phase was observed only when the male accomplished intromission. Power spectrum analysis by fast Fourier transformation revealed that in the IC muscle the two phases differed at an overall range of 100–1,000 Hz. In the BS muscle, however, the spectra of the two phases differed at a specific range of 400–600 Hz. Recruitment of additional motor units would culminate in such a characteristic rise in the power spectrum. The results suggest that somatosensory inputs contingent on the intromission cause such recruitment in the BS to regulate penile cups and other movements.
Perineal Ectopic Testis: A Rare Cause of Empty Scrotum
Authors: Nounla J. , Tröbs R.B. , Rolle U.
Published: April 2003

Perineal ectopic testis is a rare congenital anomaly and remains a urologic curiosity. We report the course of 2 recurrent cases after hormonal therapy and a third case associated with inguinal hernia. During the surgical exploration, the gubernaculum testis was found fixed to the perineum. The testes were placed in the scrotum. The evaluation of differential diagnosis of empty scrotum is recommended.
Effects of Tamm-Horsfall Protein and Albumin on the Inhibition of Free Radicals
Authors: Chen Wen-Chi , Lin Her-Sheng , Tsai Fuu-Jen , Li Chia-Wei
Published: April 2003

Introduction: Oxalate in urine can cause tubular cellular damage by the production of free radicals. Then, cell death and cellular debris may promote the retention of calcium oxalate crystals and finally the formation of stones. The two most abundant urinary proteins, Tamm-Horsfall protein (THP) and albumin, were tested for the effects of antioxidants. Materials and Methods: By using xanthine-xanthine oxidase reaction, purified THP and albumin were tested for the inhibitory effect. OD295 was used as a spectrophotometric method to measure the production of uric acid during the reaction. Results and Conclusions: Both proteins can inhibit the reaction of xanthine oxidase on xanthine, although the effect was decreased after enzymatic deglycosylation of sialic acid. Albumin has an IC50 of 10.7 nM in native condition and 11.9 nM after deglycosylation, whereas THP has 69.6 nM in native condition and 102.0 nM in deglycosylated condition. The data indicates that THP and albumin have an antioxidant effect. Sialic acid in THP has partly an inhibitory effect and is associated with calcium oxalate formation. Studies have indicated that further investigation of the role of free radicals in the formation of urolithiasis and of sialic acid in protein function is needed.
Genetic Counselling: Evolution or Involution?
Authors: Frontali Marina , Jacopini Anna Gioia
Published: April 2003

The need for genetic counselling derives from the peculiarities of genetic information, as compared to other biomedical tests, with particular reference to (a) its predictive character; (b) the existing gap between the ability to diagnose and to treat an inherited disorder, and (c) the psychological, social and ethical problems that genetic testing can raise. Counselling is traditionally performed by healthcare professionals, specifically trained to help individuals to develop ways of dealing with genetic information and gain a better understanding of the problems related with it. The growing number of genetic tests (for rare Mendelian as well as for common disorders), the development of easier and cheaper molecular techniques, the increasing tendency of physicians to have recourse to genetic tests, by-passing alternative diagnostic procedures, are all factors that contribute to the vast increase in the demand for genetic tests, a demand which is significantly out of step with the available numbers of trained counsellors. This paper discusses possible solutions, including the institution of committees with regulatory powers on genetic testing, the promotion of studies on models of genetic services, on programmes to monitor the services currently offered by test providers, and the expansion of training programmes and of employment opportunities for genetic counsellors.
Public Attitudes regarding the Donation and Storage of Blood Specimens for Genetic Research
Authors: Wang Sophia S. , Fridinger Fred , Sheedy Kris M. , Khoury Muin J.
Published: April 2003

Objective: As sequencing of the human genome is completed, there is a need for population-based research to assess frequencies of genetic variants and their associations with human diseases. The authors therefore assessed the current climate regarding the donation and storage of blood for genetic research. Methods: Data from the American Healthstyles Survey of health attitudes and behavior were examined. In the 1998 survey, four questions regarding blood donation and storage for genetic research were posed to the participants. Results: Of 3,130 participants, 2,621 (84%) completed these questions. Of the respondents, 42% were in favor of both blood donation and long-term storage for genetic research, 37% were in favor of either blood donation or storage but not both and 21% were not willing to donate blood or have it stored for genetic research under any circumstances. Loglinear analysis demonstrated that the characteristics of respondents who favored both blood donation and long-term storage for genetic research were attitudinal; specifically, those believing that genetic research will prevent disease [odds ratio (OD) 2.9; p < 0.001]; those believing in genetic determinism (OR 1.5; p = 0.004) and those agreeing they would participate in government research (OR 2.9; p < 0.001). The model also demonstrated that characteristics indirectly associated with attitudes towards blood donation/storage for genetic research were demographic and included higher education, white race, living in the Mountain/Pacific or mid-Atlantic regions of the United States and positive family history of a genetic disorder (p < 0.05). Conclusion: Understanding the various factors contributing to knowledge, attitudes and behavior regarding the donation and storage of blood specimens for genetic research will contribute to future actions in communicating genetic research goals to the public and recruitment for population-based genetic studies.
Finnish Physicians’ Interest in Genetic Screening
Authors: Toiviainen Hanna , Hemminki Elina
Published: April 2003

Objectives: To report on Finnish physicians’ opinions on the possible future use of genetic screening and their interest in knowing their own risk for diseases. Methods: A questionnaire survey mailed to gynaecologists, paediatricians, general practitioners and clinical geneticists. Both leading physicians and a sample of other practitioners were included (response rate 74%, n = 571). Results: Physicians preferred genetic testing of people at risk over population-wide screening. Breast and colon cancer, familial hypercholesterolaemia and juvenile diabetes were diseases for which screening was most often considered useful. The most popular target group was the whole population. Opinions on the suitability of genetic screening were not uniform, and physicians did not take a stand on genetic screening as a whole but differentiated by disease and target group. Those wanting to know their own risk for diseases supported screening procedures in general more than did other physicians. Conclusions: Physicians were not enthusiastic about genetic screening. Nevertheless, testing of individuals with a family history of certain diseases is likely to become more widespread.
Creating Needs?
Authors: Caulfield Timothy , Wertz Dorothy
Published: April 2003

An increasing number of genetic tests are moving from the laboratory to the clinical setting. It seems an appropriate time to assess the interest and receptivity of the public toward genetic testing services. This is particularly so given the concerns that have been expressed about the commercialization of genetic testing technologies. To this end, the paper begins with an overview of the concerns and benefits associated with commercialization. This is followed by a review of a selection of survey data relevant to the potential ‘genetic testing market’ (i.e., the attitudes, perceptions and knowledge of the public, patients and professionals). We conclude that although emerging data and past experience suggest that the actual uptake of genetic tests may fall short of expectations, the strong public interest and perceived right of access disclosed in the survey research indicate a future potential for a large testing market. As such, the concerns associated with the commercialization process warrant careful consideration.
Perspectives in the Management of Alzheimer’s Disease: Clinical Profile of Donepezil
Authors: Rogers S.L.
Published: April 2003

Donepezil HCl is a piperidine-based reversible acetylcholinesterase (AChE) inhibitor, chemically distinct from other cholinesterase (ChE) inhibitors and rationally designed to treat the symptoms of Alzheimer’s disease (AD). It is highly selective for AChE in the central nervous system (CNS), with little or no affinity for butyrylcholinesterase (BuChE). In preclinical studies in animals, donepezil produced increased CNS acetylcholine. The resultant enhancement of cholinergic activity gave rise to improved performance by rats on tests of learning and memory, with no evidence of hepatic or renal toxicity. In subsequent phase I clinical evaluations in healthy volunteers, donepezil demonstrated favorable pharmacokinetic, pharmacodynamic and safety profiles. Its long terminal disposition half-life supported once-daily administration, with no requirement for dose modification in the elderly or in patients with renal or hepatic impairment. A 14-week, phase II dose-finding study in patients with mild to moderate AD (Clinical Dementia Rating [CDR], 1–2; Mini-Mental State Examination [MMSE], 10–26) showed that donepezil at a dose of 5 mg/day produced highly significant improvements in cognition (as measured by the Alzheimer’s Disease Assessment Scale, cognitive subscale [ADAS-cog]). Subsequently, two pivotal parallel-group, placebo-controlled phase III trials (of 15 and 30 weeks’ duration) showed highly statistically significant improvements in ADAS-cog, MMSE, Clinician’s Interview-Based Impression of Change with caregiver input (CIBIC plus) and CDR-SB (Sum of the Boxes) scores, compared with placebo, in mild to moderate AD patients treated with either 5 or 10 mg/day donepezil. Adverse events in the phase II and III trials were mild and transient and resolved with continued donepezil administration. The donepezil clinical trials program has shown that this drug is a clinically effective and well-tolerated once-daily treatment for the symptoms of mild to moderate AD.
Neuroimaging in the Diagnosis of Frontotemporal Dementia
Authors: Miller Bruce L. , Gearhart Rosalie
Published: April 2003

The role of neuroimaging for the diagnosis of frontotemporal dementia (FTD) remains controversial. The modern history of imaging in the study of FTD is outlined. Also, the findings on MRI and SPECT in 15 consecutive FTD patients is noted. Both MRI and SPECT detected focal frontal involvement in nearly every single case (MRI 14/15 and SPECT 15/15). Also, the majority of patients showed asymmetry on MRI (8/15) and SPECT (12/15). This study confirms that neuroimaging is sensitive to the frontotemporal degeneration associated with FTD. Additionally, it suggests that this is often asymmetric in the relative involvement of these brain regions.
Molecular Genetic Characterisation of Frontotemporal Dementia on Chromosome 3
Authors: Ashworth Anthony , Lloyd Sarah , Brown Jeremy , Gydesen Susanne , Sorensen S. Asger , Brun Arne , Englund Elisabet , Humphreys Christine , Housman David , Badura Mary , Stanton Jr. Vincent , Taylor Kay , Cameron Jessica , Munroe David , Johansson Jenni , Rossor Martin , Fisher Elizabeth M.C. , Collinge John
Published: April 2003

We have previously localized a locus causing familial nonspecific dementia to the centromeric region of chromosome 3 in a pedigree from the Jutland area of Denmark. This pedigree shows anticipation. Here we present further analysis of these anticipation data which are suggestive of trinucleotide repeat expansion involvement. We also outline our strategies to clone the mutant gene via its putative associated trinucleotide repeat sequence.
Alzheimer’s Disease and the Cerebellum: A Morphologic Study on Neuronal and Glial Changes
Authors: Sjöbeck Martin , Englund Elisabet
Published: April 2003

Structural manifestations of Alzheimer’s disease (AD) including neuronal loss were investigated in 12 cases of AD and in 10 healthy age-matched controls, with focus on the cerebellum. Linear Purkinje cell (PC) density was measured in the vermis and cerebellar hemispheres. Neurons were also counted in the inferior olivary nucleus. In vermis of the AD cases, the mean PC number was significantly lower (p = 0.019) than in the controls. The neurons in the inferior olive were similarly fewer, though not significantly (p = 0.13). Molecular layer gliosis and atrophy in the vermis was clearly severer in AD than in the controls. Features typical of cerebral Alzheimer encephalopathy (plaques, tangles and microvacuolization) were inconspicious. The structural cerebellar changes in the AD cases were thus neuronal loss, atrophy and gliosis, judged to represent the disease process, and with a main involvement in the vermis. This may be reflected in some of the symptoms and signs seen in AD, signs that are generally overlooked or judged to be of noncerebellar origin.
Association Analysis of the Partially Duplicated α7 Nicotinic Acetylcholine Receptor Genetic Variant and Alzheimer’s Disease
Authors: Liou Ying-Jay , Lai I-Ching , Hong Chen-Jee , Liu Hsiu-Chih , Liu Tsung-Yun , Tsai Shih-Jen
Published: April 2003

Changes in the nicotinic acetylcholine receptors (nAChRs) have been demonstrated for Alzheimer’s disease (AD). Of these receptors, the α7 nAChRs, which are abundant on hippocampal interneurons, have been implicated in the cytotoxic role of the β-amyloid. Increased mRNA levels of α7 nAChR in the peripheral lymphocytes and hippocampus of AD patients have been reported. We tested the hypothesis that the allelic variant, 2bp deletion, of the partially duplicated α7 nAChR gene confers susceptibility to Alzheimer’s disease. The –2bp polymorphism was examined in 120 patients with AD and 98 normal controls. The distribution of the partially duplicated α7 nAChR genotypes (p = 0.372) and alleles (p = 0.465) did not differ significantly for AD patients and controls. This negative finding suggests that the partially duplicated α7 nAChR genetic polymorphism contributes no major effect to the development of AD. However, we suggest that the other genetic variation of the α7 nAChR gene, related to AD or the associated symptomatology, merits further investigation.
Genetic Analysis in Patients with Familial and Sporadic Frontotemporal Dementia: Two Tau Mutations in Only Familial Cases and No Association with Apolipoprotein ε4
Authors: Kowalska Anna , Asada Takashi , Arima Kunimasa , Kumakiri Chikara , Kozubski Wojciech , Takahashi Keikichi , Tabira Takeshi
Published: April 2003

We screened for tau gene mutations among 24 Japanese (6 familial and 18 sporadic cases) and 4 Polish patients with frontotemporal dementia (FTD) using PCR-SSCP analysis followed by DNA sequencing. We identified 2 missense mutations in exon 10: N279K and P301L in 2 Japanese patients with familial FTD. Additionally 3 DNA polymorphisms: 2 known (3′ exon 3 + 9, A → G and exon 7, codon 176, G → A) and 1 new (exon 8, codon 185, T → C) were identified in 1 Polish patient. Tau mutations were not found in subjects with a negative family history suggesting that tau mutations do not account for most sporadic cases of FTD. We also found no association of apolipoprotein E4 allele with FTD.
Antibacterial Activity of Retinaldehyde against Propionibacterium acnes
Authors: Pechère M. , Pechèreb J.-C. , Siegenthalera G. , Germaniera L. , Saurat J.-H.
Published: April 2003

Background: Retinaldehyde has been shown to exert antibacterial activity in vitro. Aim: This study evaluates the effect of retinaldehyde on Propionibacterium acnes both in vivo and in vitro. Methods: Microbial minimal inhibitory concentrations (MICs) of retinaldehyde and retinoic acid were determined on reference strains of P. acnes. In vivo activity of daily topical application of 0.05% retinaldehyde on the P. acnes density was evaluated after application in a single-blind randomised study. Results: MICs of retinaldehyde were 4 mg/l for P. acnes No. CIP179 and CIP53119 and 8 mg/l for P. acnes No. CIP53117. In contrast, the MICs of retinoic acid were superior to 128 mg/l for these three strains. In vivo, retinaldehyde-treated areas displayed a significant decrease in counts of viable P. acnes as compared with the untreated areas with a median decrease of 102 log P. acnes/cm2 after 2 weeks of daily application. Vehicle alone had no effect. Conclusion: The MIC of retinaldehyde against P. acnes suggests a direct antibacterial activity. Daily topical application of 0.05% retinaldehyde is associated with a clear reduction of the P. acnes density.
Comedolytic Effect of Topical Retinaldehyde in the Rhino Mouse Model
Authors: Fort-Lacoste L. , Verscheure Y. , Tisne-Versailles J. , Navarro R.
Published: April 2003

Background: Retinaldehyde is a key molecule in the metabolism of vitamin A by keratinocytes. In order to evaluate its range of topical activity in acne, its comedolytic effect was compared to that of retinoic acid in the same vehicle, in the rhino mouse model. Methods: The animals were treated on the back daily for 5 consecutive days per week for 3 weeks. At the end of this period, histological slides were analyzed in order to quantify the features of comedones and epidermal thickness. Results: Topical treatment with a retinaldehyde (0.05% w/w) and a retinoic acid formulation (0.025% w/w) induced comedolysis and increased the epidermal thickness with the same intensity. Conclusion: These data indicate that retinaldehyde exerts a significant comedolytic activity.
Prevalence of Gastroesophageal Reflux Disease in Patients with Extraesophageal Symptoms Referred from Otolaryngology, Allergy, and Cardiology Practices: A Prospective Study
Authors: García-Compeán Diego , González Mario , Galindo Gabriela , Mar David , Treviño José , Martínez Rodolfo , Bosques Francisco , Maldonado Héctor
Published: April 2003

Aim: To investigate the prevalence of gastroesophageal reflux disease (GERD) as well as the clinical, endoscopic, and manometric characteristics in 57 adult patients with otolaryngeal symptoms, asthma, or noncardiac chest pain referred from specialized services. Methods: The following evaluations were performed: (1) upper endoscopy, (2) 24-hour ambulatory esophageal pH monitoring, and (3) esophageal manometry. The prevalence of GERD was determined, and demographic, clinical, endoscopic, and manometric characteristics of patients with or without GERD were evaluated. Results: Thirty-four out of 57 patients (60%) had GERD. The 95% confidence interval ranged from 48 to 72%. There was no statistical difference between patients with or without GERD regarding gender, age, or time of evolution of symptoms. Cough was more frequent in the subjects with GERD (75 vs. 25%, p<0.05). Nevertheless, cough was observed in only 53% of the patients with GERD. Patients suffering from laryngitis had a greater proximal and distal esophageal acid exposure time than those without. Conclusions: The prevalence of GERD was 60%. There is not a definite demographic or clinical profile that permits us to distinguish between patients with and without GERD among those with ear, nose, and throat and pulmonary symptoms or chest pain.
Gastric Metaplasia of the Proximal Esophagus Associated with Esophageal Adenocarcinoma and Barrett’s Esophagus: What Is the Connection?
Authors: Malhi-Chowla Navreet , Ringley Robin , Wolfsen Herbert
Published: April 2003

Background/Aim: The inlet patch is an area of heterotopic gastric mucosa found in the proximal esophagus at the level of the upper esophageal sphincter. Limited data are available regarding this form of gastric metaplasia and its incidence, significance, and possible association with other esophageal diseases. We report our observations of such gastric metaplasias in patients with esophageal adenocarcinoma or Barrett’s esophagus and high-grade dysplasia. Methods: All patients having Barrett’s esophagus and adenocarcinoma referred for photodynamic therapy were included in this study. The patients were prospectively evaluated endoscopically for the presence of gastric metaplasia of the proximal esophagus (salmon-colored area of a least 5 mm in diameter with cardia-type gastric metaplasia on biopsy). Results: A total of 36 patients were included in this study: 11 patients with dysplastic Barrett’s esophagus (8 males, mean age 79 years) and 25 adenocarcinoma patients (18 males, mean age 71 years). At endoscopy prior to photodynamic therapy, 11 patients (31%; 8 adenocarcinoma, 3 dysplastic Barrett’s esophagus) were noted to have an area of gastric mucosa in the proximal esophagus. In each patient, there was at least 5 cm of normal squamous mucosa between gastric metaplasia and distal esophageal pathology. Conclusions: In this selected group of patients with high-grade dysplastic Barrett’s esophagus or adenocarcinoma referred for photodynamic therapy, gastric metaplasia of the proximal esophagus was found in nearly one third. Prospective studies are under way to test more widely for this association and to determine whether this is a marker of disease severity and the result of similar pathogenetic mechanisms.
Nitric Oxide and Hemodynamic Impairment
Authors: Groszmann Roberto
Published: April 2003

Recently, increasing evidence has pointed towards a major role for the endothelium in the maintenance of basal vascular tone and the development of local and generalized vasodilatation in chronic liver diseases. The endothelium produces at least two substances that are known to contribute to the development of systemic and splanchnic vasodilatation in portal hypertension: nitric oxide (NO) and prostaglandins [1].
Transjugular Intrahepatic Portosystemic Stent Shunt for Hepatorenal Syndrome and Ascites
Authors: Wong Florence
Published: April 2003

Refractory ascites is defined as ascites that cannot be mobilized, or the early recurrence of which cannot be prevented despite maximal diuretic therapy of 400 mg of spironolactone or 30 mg of amiloride plus up to 120 mg of furosemide daily for at least 1 week despite being on dietary sodium restriction of 50 mEq or less per day. Patients who cannot tolerate diuretic therapy because of complications are also regarded as having refractory ascites [1]. Approximately 5% of all patients with ascites are refractory to conventional medical therapy of sodium restriction, diuretics and large volume paracentesis, and the management of these patients has been unsatisfactory. The recent development of a transjugular intrahepatic portosystemic stent shunt (TIPS) as a treatment for refractory variceal hemorrhage [2–4] led to the observation that after TIPS placement, concomitant ascites in these patients seemed to disappear or became easier to control [5–7]. There followed a flurry of enthusiasm on the use of TIPS as a treatment for refractory ascites.
Apoptosis and Hepatocarcinogenesis
Authors: Schulte-Hermann R. , Hufnagl K. , Löw-Baselli A. , Rossmanith W. , Wagner A. , Ruttkay-Nedecky B. , Bursch W. , Müllauer L. , Parzefall W. , Grasl-Kraupp B.
Published: April 2003

Cells may die by active mechanisms (cellular suicide). The concept of active cell death goes back to the 19th and early 20th century [1]. Active or programmed cell death serves to eliminate excessive cells, e.g. from hyperplastic organs, or cells damaged by moderate injury. Morphologically and biochemically, mechanisms of active cell death may be diVerent in diVerent organs and in different physiological states. Apoptosis (type I) is characterized by cytoplasmic and nuclear condensation, fragmentation, and heterophagy [2]; in type II cell death autophagic/lysosomal processes are prominent which produce cytoplasmic degradation well before nuclear alterations [3, 4].
Percutaneous Ethanol Injection in Hepatocellular Carcinoma
Authors: Livraghi Tito
Published: April 2003

Percutaneous ethanol injection (PEI) was presented in 1986 [1]. Since long-term results of this therapy are now available, some considerations and conclusions can be drawn.
Laser-Induced and Microwave Thermotherapy of Hepatocellular Carcinoma
Authors: Vogl Thomas , Mack Martin , Müller Petra , Straub Ralf , Eichler Katrin , Felix Roland
Published: April 2003

Small and unifocal hepatocellular nodules are currently treated best via hepatic resection of liver transplantation. Alternatively some studies present also excellent survival rates for local ethanol injection (percutaneous ethanol injection – PEI). In more advanced stages of hepatocellular carcinoma, transarterial chemoembolization (TAE) has proven in some studies to be effective in reducing tumor volume and increasing survival. MR-guided laser-induced thermotherapy presents a new alternative therapeutic approach in malignant liver lesions [1–3]. Additionally, microwave thermotherapy has proven to be therapeutically effective in some limited studies; recently developed cooled application systems might further expand the clinical use of that technique [4, 5].
Pancreatitis in Soweto, South Africa
Authors: Segal Isidor
Published: April 2003

Both acute pancreatitis and chronic pancreatitis now appear to be endemic at Soweto, South Africa, and they carry a substantial toll in terms of morbidity and mortality. Case-control studies identified the same three environmental factors in each disease, namely, heavy alcohol consumption, marked exposure to occupational chemicals and low intake of fruit (a major source of vitamin C). This congruity, and parallel trends on blood biochemical analysis indicating heightened free radical activity coupled with poor antioxidant status, suggest that the two diseases may be part of a pathobiological spectrum that is linked by pancreatic oxidant stress. Further, asymptomatic chronic alcoholics had plasma glutathione concentrations that were midway between the values in non-alcoholic controls and patients with chronic pancreatitis, being significantly different from each. And, finally, apparently healthy Sowetans were actually in a state of oxidant stress that was tied in with their very poor vitamin C status, and lower serum selenium concentrations than in the UK. These data, and evidence that both antioxidants mitigate against alcoholic toxicity in experimental studies, may offer scope for disease prophylaxis in this unprivileged community.
Surgery for Carcinoma of the Pancreas in Japan
Authors: Takada Tadahiro
Published: April 2003

Pancreatic cancer surgery was first performed in Japan in the 1940s, although it was not until the 1970s that pancreatic resectional surgery became widely available. In the late 1970s, influenced by the application of regional pancreatectomy by Fortner and colleagues, several institutions in Japan introduced radical pancreatic cancer surgery. Aggressive strategies in pancreatic cancer surgery were approved in Japan in the 1980s. Japanese surgeons introduced additional modifications to pancreatic cancer surgery, including radical pancreatoduodenectomy with extended lymph node and connective tissue dissection and portal vein resection. However, it became clear that such extended operations impair the quality of life of the patient, even though the resectability of cancer increased to up to about 50%. Improvements to radical pancreatoduodenectomy were therefore introduced. Pylorus-preserving pancreatoduodenectomy with extended lymphadenectomy, connective tissue dissection, and portal vein resection is a Japanese modification to radical pancreatectomy that improves the quality of life of the patient and does not reduce the survival rate. Another modification applicable to low-grade malignancies is organ-preserving pancreatectomy, such as duodenum-preserving total pancreatic head resection, ventral pancreatectomy, and medial or segmental pancreatectomy. Although aggressive Japanese surgical strategies have provided important data, most studies have been retrospective. In the near future, Japanese surgeons will need to reevaluate their strategies in term of the importance of extended lymphadenectomy with connective tissue dissection and its influence on long-term survival of patients. Such reevaluation will require randomized controlled trials performed according to a detailed and strict protocol.
Rationale of the So-Called Extended Resection for Pancreatic Invasive Ductal Carcinoma
Authors: Imamura Masayuki , Hosotani Ryo , Kogire Masafumi
Published: April 2003

It has generally been recognized that for adenocarcinoma of the pancreas, surgical resection provides the only chance for cure. In this study, we have analyzed the long-term survival of 141 patients with invasive ductal adenocarcinoma of the pancreas who received macroscopically curative resection. Multivariate analysis demonstrated that comprehensive stage of the tumor, curability of the resection, and adjuvant radiation therapy were independent prognostic factors. Pancreatectomy in this study was done with an extensive retroperitoneal clearance of para-aortic lymph node and nerve tissues, so-called extended resection. Survival curves of these patients revealed that the R0 resection is essentially necessary for long-term survival. Survival curve without microscopic lymph node metastasis was significantly better than that with node metastasis; however, 3 patients with node metastasis have been alive for more than 3 years. The survival curve of the patients who received adjuvant radiation therapy was better than of those who underwent surgery alone, and postoperative regional chemotherapy with continuous 5-FU infusion decreased hepatic metastases within 6 months. The results suggest that local recurrence of pancreatic cancer might possibly be controlled by extended resection and adjuvant irradiation, and early development of hepatic metastases might be controlled with regional chemotherapy.
Intra-Oral Administration of Sweet-Tasting Substances and Infants’ Crying Response to Immunization: A Randomized, Placebo-Controlled Trial
Authors: Ramenghi Luca A. , Webb A. Vivian , Shevlin Patricia M. , Green Martine , Evans David J. , Levene Malcolm I.
Published: April 2003

The analgesic effects of four solutions administered intra-orally (25 and 50% sucrose solutions, hydrogenated glucose, and a sterile water placebo) were tested in groups of babies receiving routine DTP (diphtheria, tetanus, and pertussis) and HIB (Haemophilus influenzae type B) injections at the first, second, or third immunization. The duration of the baby’s cry during 3 min following DTP and HIB injections was measured as main outcome. For all three immunization groups, the babies receiving the placebo generally spent most time crying. For both the DTP and HIB injections, the difference between 50% sucrose and placebo was most evident in the group receiving the 3rd immunization. Intra-oral administration of the 50% sucrose solution, compared to placebo, appeared to reduce the cry response to painful experiences in babies beyond the neonatal period.
Estimation of Neonatal Body Composition: Isotope Dilution versus Total-Body Electrical Conductivity
Authors: Hashimoto Kazumasa , Wong William W. , Thomas Alicia J. , Uvena-Celebrezze Jennifer , Huston-Pressley Larraine , Amini Saeid B. , Catalano Patrick M.
Published: April 2003

The objective of the study is to evaluate neonatal body composition determined by the isotope dilution method compared with the total-body electrical conductivity (TOBEC) method. An oral dose of 18O- and 2H-labeled water was given to 40 healthy term newborns, and 26 infants successfully completed the protocol. The isotope concentrations in urine samples were measured by gas-isotope ratio mass spectrometry. Fat and percent body fat (%F) estimated by isotope dilution were correlated with fat and %F estimated. Total body water measured by isotope dilution of 18O and 2H was 2.44 ± 0.36 and 2.49 ± 0.35 kg, respectively (p < 0.001). Fat and %F estimated by 18O, 2H, and TOBEC were 0.48 ± 0.20 kg and 13.7 ± 5.1%, 0.48 ± 0.19 kg and 13.7 ± 4.6%, and 0.38 ± 0.21 kg and 10.9 ± 5.0%, respectively. Neither fat nor %F estimates by isotope dilution showed good correlation with the TOBEC estimates (r = 0.22–0.57). Because of the wide variation of water content in individuals, the isotope dilution method may not be the optimal way of assessing body composition, and specifically body fat, in newborns.
Infantile Perineal Protrusion: A Statistical, Clinical, and Histopathologic Study
Authors: Konta Ritsuko , Hashimoto Isao , Takahashi Masaaki , Tamai Katsuto
Published: April 2003

Background: Review of the literature of the peculiar nodule in the perineum of female infants disclosed that the analysis of incidence by gender, observation of the course, histopathologic assessment, and the pathogenesis of the abnormality was suboptimal. Objective: We therefore planned to study a large number of children to analyze the incidence by gender, the course, and the pathogenesis of the peculiar perineal nodules. Methods: Of 500 children (224 boys and 276 girls) who ranged from newborn to 11 years of age, occurrence of the perineal nodules was checked. When nodules were found, the site, shape, size, number, and the onset were examined. Histopathologic examination and observation of the course were carried out in some cases. Results: None of the boys in our population had nodules, but 13% of the girls did. These lesions always occurred as a single peanut-, hen’s crest-, or tongue tip-shaped nodule on the perineal midline, and 93% of the lesions had been present since birth. Histologically, the nodule was an outward projection of essentially normal, redundant skin, showing no evidence of lichen sclerosus et atrophicus. Conclusion: In view of these findings, we conclude that perineal nodules are a kind of developmental anomaly occurring mostly in girls.
Prevalence and Awareness of Tinea pedis in Italian Sailors
Authors: Ingordo Vito , Fracchiolla Stefania , Figliola Francesco , D’Andria Giuliano , Colecchia Bruno , Naldi L.
Published: April 2003

Background: It is difficult to carry out studies on the prevalence of tinea pedis in the community. Some studies are performed on selected groups of subjects, exposed to the same risk factors, i.e. schoolchildren, public bathers, athletes and military men. Objective: The aim of this work was to detect in a sample of military men the prevalence of tinea pedis and the awareness of their condition, and to relate the infection to risk factors of the group as well. Methods: 410 male Italian navy cadets in an Italian navy petty officers school were clinically examined and mycological cultures were performed, employing the skin scrapings obtained from suspected lesions. Results: Dermatophytes were isolated from toe clefts in 10 subjects, giving a point prevalence of 2.4% (95% confidence interval 1.3–4.4%). The isolated dermatophytes were Trichophyton mentagrophytes (70%), Trichophyton rubrum (20%) and Epidermophyton floccosum (10%). None of the subjects was aware of his disease. No significant association was observed between tinea pedis and risk factors (i.e. hyperhidrosis and habits). Conclusion: The prevalence in our sample was lower than that observed in previous studies on military men. That can be attributed to the general amelioration of hygienic conditions and strengthening of preventive habits. Therefore the prevalence of tinea pedis in Italian sailors seems to be reduced but still rather relevant. That is important because these subjects are a reservoir of ringworm infection.
Exploring the Causes of Cutaneous B-Cell Lymphoma: We Should Learn from the Lyme Disease Experience
Authors: Naldi Luigi , Minelli Cosetta
Published: April 2003

Epidemiological studies rely on the uneven distribution of disease within and between populations and represent a simple but efficient way of studying disease causation. The incidence of non-Hodgkin’s lymphomas (NHLs) has increased dramatically over the past few decades and the epidemic calls for epidemiological studies. The study of Munksgaard and colleagues, in this issue of Dermatology, is a good example of an epidemiological study based on the so-called ecological correlation. It focuses on cutaneous B-cell lymphoma (CBCL) and fails to document a correlation between CBCL incidence and Lyme disease as a surrogate indicator for the exposure to tick bites. Although ecological studies neither inform about the time relationship between exposure and disease nor usually allow control for confounding variables, they can provide important information that would guide the direction of further research. There is a number of analytical studies focusing on risk factors for NHLs. One drawback of these studies is that they consider NHLs as a single category. One merit of the paper of Munksgaard et al. is that it focused on a rather specific disease, i.e. CBCL.
Nevi and Melanoma: Lessons from Turner’s Syndrome
Authors: Gibbs Peter , Brady Benjamin M.R. , Gonzalez René , Robinson William Allen
Published: April 2003

Females with Turner’s syndrome (TS) have a markedly increased number of cutaneous nevi. While this is a well-recognized risk factor for cutaneous melanoma (CM), the incidence of this tumor in TS and the implications for our understanding of nevi and melanoma have not previously been considered. Here we report a case of an anorectal melanoma in a woman with TS and a review of the literature. Overall, there appears to be a lower than expected incidence of CM. Possible explanations are discussed and in particular the possible relationship between sex hormones and melanoma development as these girls fail to undergo normal pubertal development. Further study of this syndrome may provide important insights into the genetic factors involved in normal melanocyte and nevus development, the potential influence of sex hormones on melanoma development and the relationship between the presence of nevi and the risk of developing CM.
Pentoxifylline Attenuates UVB-Induced Cutaneous Erythema
Authors: Lowitt Mark H.
Published: April 2003

Background: The mechanism for ultraviolet-B (UVB)-associated cutaneous erythema may involve production of tumor necrosis factor α (TNF-α). Pentoxifylline inhibits TNF-α production. Objective: To assess the effect of oral pentoxifylline on UVB-induced erythema in humans. Methods: Baseline minimum erythema doses (MEDs) for UVB were measured. Subjects received pentoxifylline 400 mg orally every 8 h for 4 doses. MED assays were repeated 2 h after the last dose of pentoxifylline. Pre- and posttreatment MED results were assessed by the paired t test. Results: Oral administration of pentoxifylline to 7 normal adults elevated the MED for UVB in all 7 individuals. Conclusion: Pentoxifylline may diminish the cutaneous sunburn response to UVB radiation when it is administered prior to ultraviolet exposure.
Cutaneous Plasmacytosis: An Unusual Presentation Sharing Features with POEMS Syndrome?
Authors: Cerottini Jean-Philippe , Guillod Joël , Vion Brigitte , Panizzon Renato G.
Published: April 2003

Cutaneous plasmacytosis is a recently described skin disorder consisting of brown to red papules and nodules containing polyclonal plasmacytes. In this particular case, leg ulcers developed but also a diffuse patchy hyperpigmentation coexisting with a primary hypothyrodisim. The last two signs have only been described to date in POEMS syndrome, which is linked to monoclonal plasmacytic proliferation, and might suggest an overlap between these two entities.