bluuebunny/crossref_metadata_2025 huggingface dataset:
Distal Urethral Polypropylene Sling Surgical Management for Urodynamic Stress Incontinence in Korean Women
Authors: Lee Jung Hun , Kim Khae Hawn , Lee Hyo Won , Kim Kye Hyun , Choi Joong Sub , Yoon Sang Jin , Han Jong Sul , Lee Kyo Won
Published: March 2009

Introduction: The purpose of the present study was to assess the objective and subjective efficacy of the distal urethral polypropylene sling (DUPS) for urodynamic stress incontinence (USI) in Korean women. Patients and Methods: We performed DUPS in 89 consecutive patients with USI. The Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6) were used to evaluate the surgical outcomes. Results: The mean operative time was 29.4 min (range 25–40). Concomitant procedures were performed including rectocele repair (n = 48), laparoscopically assisted vaginal hysterectomy (n = 12) and laparoscopic myomectomy (n = 1). There were no intraoperative complications or major postoperative complications. The average follow-up was 15 months (range 12–18). Both mean IIQ-7 and UDI-6 scores decreased significantly after DUPS. In addition, 87% of the patients reported no symptoms of USI under any circumstances and 95% of the patients reported never or rarely being bothered by USI. Conclusions: DUPS is a safe, inexpensive, simple, and effective surgical method for USI. The procedure provides a high cure rate in Korean women.
Construction of Urothelium-Specific Recombinant Adenovirus and Its Inhibition in Bladder Cancer Cell
Authors: He Xiang-Dong , Wang Zhi-Ping , Wei Hai-Yan , Zhou Qin , Wang De-Gui , Tian Jun-Qiang , Fu Sheng-Jun , Rodriguez Ronald
Published: March 2009

Aim: To construct urothelium-specific recombinant adenovirus and investigate its inhibition in bladder cancer cell. Methods: RT-PCR analysis was used to determine expression patterns of hUPII and coxsackie adenovirus receptor on multiple cell lines. Transient transfection and luciferase detecting assay were used to detect tissue specificity of the hUPII promoter. Recombinant adenovirus Ad-UPII-E1A and Ad-UPII-Null were constructed. Restrictive enzyme digestion assay and PCR confirmed the correct construction. The adenovirus E1A protein expressed in BIU-87 was tested by Western blot after cells were infected with recombinant adenovirus. Recombinant adenovirus Ad-UPII-E1A was tested for its inhibition in bladder cancer cell line BIU-87. Results: HUPII and CAR were expressed and the hUPII promoter is highly active in bladder cancer cell line BIU-87. Using homologous recombination in bacteria technology, the hUPII promoter and E1A gene were inserted into the genome of type 5 recombinant adenovirus. The E1A protein was markedly positive in the samples of BIU-87 cells infected with recombinant adenovirus Ad-UPII-E1A. MTT assay demonstrated recombinant adenovirus Ad-UPII-E1A inhibited bladder cancer cell BIU-87 growth. Conclusion: The hUPII promoter shows high tissue specificity. Recombinant adenovirus Ad-UPII-E1A and Ad-UPII-Null were constructed and confirmed. Recombinant adenovirus Ad-UPII-E1A is effective in inhibition in bladder cancer cell line BIU-87.
A Twelve-Year Experience with Adrenal Cortical Carcinoma in a Single Institution: Long-Term Survival after Surgical Treatment and Transcatheter Arterial Embolization
Authors: Soga Hideo , Takenaka Atsushi , Ooba Takeshi , Nakano Yuzo , Miyake Hideaki , Takeda Masashi , Tanaka Kazushi , Hara Isao , Fujisawa Masato
Published: March 2009

Introduction: We retrospectively analyzed 6 cases of adrenal cortical carcinoma (ACC) treated during a 12-year period at a single institution. Patients and Methods: We reviewed the clinical and pathological records and updated the follow-up of the patients treated and observed in our institution between 1995 and 2006. Results: All 6 patients underwent surgery for ACC. The mean age at diagnosis was 53.3 years (range 36–72). The median follow-up was 50.7 months (range 13–132). Three patients were clinically classified as stage II, 2 as stage III and 1 as stage IV with bone metastasis. The 5-year overall survival was 62.5%. Recurrences or metastases occurred in 4 patients. Two patients without reoperation for metastases died, and others with radical treatments such as surgery, chemotherapy, transcatheter arterial embolization and/or radiation remain alive. Conclusions: In our experience, transcatheter arterial embolization was effective against liver metastasis.
Arsenic Methylation Capability, Myeloperoxidase and Sulfotransferase Genetic Polymorphisms, and the Stage and Grade of Urothelial Carcinoma
Authors: Huang Steven K. , Chiu Allen Wen-Hsiang , Pu Yeong-Shiau , Huang Yung-Kai , Chung Chi-Jung , Tsai Hui-Ju , Yang Mo-Hsiung , Chen Chien-Jen , Hsueh Yu-Mei
Published: March 2009

Arsenic exposure is associated with an increased risk of bladder cancer. To explore the distribution of the arsenic methylation capability and myeloperoxidase (MPO) and sulfotransferase (SULT) 1A1 genotypes in patients at different stages and grades of urothelial carcinoma (UC), 112 UC cases were recruited between September 2002 and May 2004 for this study. Urinary arsenic species, including inorganic arsenic (AsIII + AsV), monomethylarsonic acid, and dimethylarsinic acid, were determined with a high-performance liquid chromatography-linked hydride generator and atomic absorption spectrometry. The MPO and SULT1A1 genotypes were examined with polymerase chain reaction and restriction fragment length polymorphism. Differential effects of the arsenic methylation capability were found among patients with different stages of UC; however, urinary arsenic concentrations were borderline significantly increased with the progress of UC patients regardless of whether or not they had been exposed to arsenic from drinking water. The MPO and SULT genetic polymorphisms might modify the arsenic methylation profile and UC progression, and thus are worthy of further investigation.
Retroperitoneal Laparoscopic Uretero-Pyelostomy for Symptomatic Yo-Yo Reflux
Authors: Khan Muneer , Qadri Syed Javid Farooq , Bhat Arshad Hussain , Khan Naveed
Published: March 2009

Incomplete ureteric duplication is usually an incidental finding. However, this condition may occasionally be symptomatic and warrant surgical correction. Various surgical procedures are used to treat this condition with varying degrees of success. We present the case report of a 21-year-old female who had right-sided symptomatic incomplete ureteric duplication and was managed by retroperitoneal laparoscopic ureteropyelostomy. To our knowledge, this is the first reported case of such a procedure.
Urinary Retention, Erectile Dysfunction and Meningitis due to Sacral Herpes Zoster: A Case Report and Review of the Literature
Authors: Erol B. , Avci A. , Eken C. , Ozgok Y.
Published: March 2009

Zona zoster infection is often associated with painful erythematous vesicular eruptions of the skin or mucous membranes. Varicella zoster virus which stays latent in the sensorial root ganglia causes zona zoster infection. The most recognized feature of zona zoster is the dermatomal distribution of vesicular rashes. In the present case report, we state an unusual presentation of sacral zona zoster with urinary retention, erectile dysfunction and meningitis.
Toxic Dermatolysis, Tissue Necrosis and Impaired Wound Healing due to Sunitinib Treatment Leading to Forefoot Amputation
Authors: Feyerabend S. , Schilling D. , Wicke C. , Stenzl A.
Published: March 2009

Innovative treatment strategies in urologic oncology confront the treating physician with a new spectrum of adverse events. With growing understanding of underlying pathomechanisms, we need to identify contraindications against the use of certain antiproliferative drugs. The management of toxicities involves a multidisciplinary approach and thus, the exchange of experience across medical specialties is mandatory. We report a case of fulminant toxic dermatolysis, tissue necrosis and impaired wound healing resulting in the amputation of one forefoot after 6 days of treatment with sunitinib.
Development of the Human Retroperitoneal Fasciae
Authors: Matsubara Akio , Murakami Gen , Niikura Hitoshi , Kinugasa Yusuke , Fujimiya Mineko , Usui Tsuguru
Published: March 2009

Introduction: Although the renal fascia (RF), ureteral sheath, lateroconal fascia (LF) and hypogastric nerve are critical landmarks for retroperitoneal surgery, their laminar relationships require clarification. Materials and Methods: Horizontal sections (hematoxylin-eosin staining) of human fetuses at two different developmental stages [9–12 (3 fetuses, crown-rump length, CRL 40–65 mm) and 20–25 weeks of gestation (9 fetuses, CRL 152–220 mm)] were compared. Results: In the early-stage group, the pararenal space had already formed between the posterior RF and the transversalis fascia (TF). The anterior RF extended along the peritoneum and often fused with the latter. In the late-stage group, the posterior RF extended inferomedially toward the anterior aspect of the aorta and inferior vena cava. However, at the level of the renal hilus, the posterior RF was connected with vascular sheaths of the great vessels. The LF was seen developing as a fasciculation of the multilaminar structure in the pararenal space. However, on the posterolateral side of the colon after retroperitoneal fixation, the fusion fascia of the peritoneum could also be identified as LF. Conclusions: A common sheath for ureters and hypogastric nerves appeared to be likely on the inferior side of the kidney. The LF did not appear to be a primary structure such as the RF, but a result of secondary mechanical stress due to fatty tissue developing earlier along the TF than in the perirenal space. However, the suggested similarity between LF and fusion fascia in the plane occupied was a likely cause for misinterpreting the laminar configurations during surgery.
Fibronectin Gene Expression in Aortic Regurgitation: Relative Roles of Mitogen-Activated Protein Kinases
Authors: Truter Sharada L. , Catanzaro Daniel F. , Supino Phyllis G. , Gupta Anuj , Carter John , Ene Ada R. , Herrold Edmund M. , Dumlao Themy F. , Beltran Frans , Borer Jeffrey S.
Published: March 2009

Objectives: In aortic regurgitation (AR), fibronectin (FN) expression is upregulated. This study sought to determine signal transduction pathways involved in upregulation of FN expression in AR. Methods: Cardiac fibroblasts (CF) from rabbits with surgically induced AR and matched controls (NL) were cultured and assayed for FN expression and kinase activity with and without inhibitors of kinases JNK, p38 mitogen-activated protein kinase (MAPK) and extracellular response kinase (ERK). NL CF also were subjected to cyclic strain mimicking AR for 24 h in culture with and without inhibitors. Results: AR CF exhibited 2.9-fold greater c-Jun phosphorylation (p < 0.01) and 1.5- to 2-fold greater ATF2 phosphorylation (p < 0.05–0.01) than NL. JNK and p38MAPK inhibition reduced c-Jun and ATF2 phosphorylation to NL; ERK inhibition had no effect. FN mRNA expression was similar in pattern to kinase activities. Cyclic strain in NL CF increased c-Jun phosphorylation 2-fold versus unstrained controls (p < 0.005). This was suppressed by inhibition of JNK but not p38MAPK. Conclusion: FN expression in response to the acute mechanical strain resembling AR is upregulated primarily via JNK. However, in chronic AR both JNK and p38MAPK are involved. These signaling pathways represent potential therapeutic targets for normalizing extracellular matrix (ECM) composition and contractile force transmission, believed to be related to ECM composition/organization, in AR.
Atrial Na,K-ATPase Increase and Potassium Dysregulation Accentuate the Risk of Postoperative Atrial Fibrillation
Authors: Tran Cao Thach , Schmidt Thomas Andersen , Christensen John Brochorst , Kjeldsen Keld
Published: March 2009

Background: Postoperative atrial fibrillation is a common complication to cardiac surgery. Na,K-ATPase is of major importance for the resting membrane potential and action potential. The purpose of the present study was to evaluate the importance of Na,K-ATPase concentrations in human atrial biopsies and plasma potassium concentrations for the development of atrial fibrillation. Methods: Atrial myocardial biopsies were obtained from 67 patients undergoing open chest cardiac surgery. Na,K-ATPase was quantified using vanadate-facilitated 3H-ouabain binding. Plasma potassium concentration was measured with ion-selective electrode. Results: In patients with preoperative sinus rhythm, 3H-ouabain-binding site concentration was 16% higher in patients developing postoperative atrial fibrillation compared to patients maintaining sinus rhythm [302 ± 15 pmol/g wet weight (n = 20) vs. 261 ± 11 mmol/g wet weight (n = 33), p = 0.03]. Also with multivariable analysis, 3H-ouabain-binding site concentration was significantly associated with the development of atrial fibrillation. High increase in plasma potassium concentration during the perioperative period and surgery was associated with postoperative atrial fibrillation. Conclusions: The present study supports the increasing evidence of dysregulation of the potassium homeostasis as an important factor in the development of cardiac arrhythmias. High atrial Na,K-ATPase and sudden plasma potassium concentration increase may contribute to precipitate atrial fibrillation.
A Screening Instrument to Measure the Prevalence of Neurological Disability in Resource-Poor Settings
Authors: Bower James H. , Howlett William , Maro Venance P. , Wangai Hannah , Sirima Neema , Reyburn Hugh
Published: March 2009

Background: Very little is known about the prevalence of neurological morbidity in Africa. Much of this is due to the difficulty in performing epidemiological surveys in these settings. A screening instrument to measure neurological disease in resource-poor settings was designed by the World Health Organization in 1981, but several problems with it have subsequently been recognized. Methods: We created a new screening instrument that addressed problems with the original instrument identified by prior investigators, and that included questions to identify diseases of public health significance and broad neurological syndromes. This new instrument was tested in an outpatient setting in Moshi, Tanzania. We compared the sensitivity and specificity of the new instrument to the original 1981 WHO instrument. Results: We tested the survey on 128 participants. Of these, 63 had neurological diagnoses, 21 had pain-only diagnoses and 44 had no neurological diagnoses. The survey was well received by all the participants. A nonmedical interviewer was trained to administer and interpret a simple neurological examination without difficulty. The median time to administer the instrument was 13 min (interquartile range 10–17 min). The sensitivity of the new instrument improved that of the WHO instrument from 98.4 to 100%, but the difference was not statistically significant (p = 0.44). However, the specificity significantly improved from 29.2 to 61.0% (p = 0.001). Conclusions: We have developed a screening instrument to measure the prevalence of neurological morbidity in resource-poor settings. It was shown to be highly feasible, highly sensitive, and more specific than the existing WHO instrument.
Dietary Intake of Individual Glucosinolates in Participants of the EPIC-Heidelberg Cohort Study
Authors: Steinbrecher Astrid , Linseisen Jakob
Published: March 2009

Background/Aims: To compile a database on content of individual glucosinolates in food and to describe the dietary intake of individual glucosinolates in a German population. Methods: Studies analysing the content of individual glucosinolates in food were aggregated to form a database of 26 individual glucosinolates in 18 vegetables and condiments consumed in Germany. This database was linked to food intake data derived from 24-hour diet recalls of 2,121 participants of the EPIC-Heidelberg cohort study. Results: Mean total glucosinolate intake (±standard error) was 14.2 (±1.1) mg/day for men and 14.8 (±1.3) mg/day for women. The intake increased with age and education; smokers ingested less glucosinolates than never or former smokers. The quantitatively most important individual glucosinolates were glucobrassicin and sinigrin with mean daily intakes of 3.5 (±0.3) and 1.7 (±0.2) mg/day for men, and 4.2 (±0.4) and 2.5 (±0.4) mg/day for women, respectively. Broccoli, Brussels sprouts and cauliflower contributed most to the total glucosinolate intake in this population. Conclusions: The established database allowed for the first time the estimation of dietary intake of individual glucosinolates. The database can be used for epidemiological research on the role of glucosinolates in health and disease.
The Impact of Nutritional Fatty Acids during Pregnancy and Lactation on Early Human Adipose Tissue Development
Authors: Hauner H. , Vollhardt C. , Schneider K.T.M. , Zimmermann A. , Schuster T. , Amann-Gassner U.
Published: March 2009

Recent observational studies suggest that mean birth weight and body fat growth in the first year of life have increased continuously over the last decades. Both elevated birth weight and early fat mass are potential risk factors for childhood obesity. Experimental and limited clinical data suggest that the dietary ratio of n–6 to n–3 fatty acids (FAs) during pregnancy is critical for early adipose tissue growth. The aim of this randomized controlled study is to examine the effect of the supplementation with n–3 long-chain polyunsaturated FAs and reduction in the n–6/n–3 ratio in the diet of pregnant women/breast-feeding mothers on adipose tissue growth in their newborns using various methods for the assessment of body fat mass. Measurement of skinfold thickness in the newborn is the primary outcome parameter. Two hundred and four pregnant women will be recruited before the 15th week of gestation and randomly assigned to either active intervention or an isocaloric control diet. This upcoming study will explore the potential of this dietary approach to limit early adipose tissue growth and may contribute to the development of a new strategy for the primary prevention of childhood obesity.
Influence of Trp64Arg Polymorphism of Beta 3-Adrenoreceptor Gene on Insulin Resistance, Adipocytokines and Weight Loss Secondary to Two Hypocaloric Diets
Authors: de Luis D.A. , González Sagrado M. , Aller R. , Izaola O. , Conde R.
Published: March 2009

Objective: To investigate the influence of the Trp64Arg polymorphism in the beta 3-adrenoreceptor gene on adipocytokines, insulin resistance and weight loss secondary to a low fat versus a low carbohydrate diet. Methods: A population of 193 obese patients was analyzed. A nutritional evaluation was performed at the beginning and at the end of a 2-month period in which subjects received 1 of 2 hypocaloric diets. Results: 172 (89.1%; 44 males, 128 females) subjects had the genotype Trp64/Trp64 (wild-type group) and 21 subjects (10.9%; 4 males, 17 females) had Trp64/Arg64 (mutant-type group). In the wild-type group BMI, weight, fat mass, waist circumference, systolic blood pressure, glucose, triglycerides, insulin, homeostasis model assessment (HOMA) and leptin decreased significantly regardless of the diet. In the mutant-type group, this was the case for BMI, weight, waist circumference, fat mass and leptin levels. Only leptin levels have a significant decrease in the wild-type group (diet I 13.7%, diet II 26.3%, p < 0.05 for both). In the mutant group, leptin decreased as well (diet I 22.5%, diet II 30.1%, p < 0.05 for both). Conclusion: The metabolic effect of mild weight reduction by 2 hypocaloric diets is greatest in subjects homozygous for the normal beta 3-adrenoreceptor gene. Improvement in glucose, insulin and HOMA is better than in the mutant-type group.
Validation of the Danish Addenbrooke’s Cognitive Examination as a Screening Test in a Memory Clinic
Authors: Stokholm Jette , Vogel Asmus , Johannsen Peter , Waldemar Gunhild
Published: March 2009

Background: Addenbrooke’s Cognitive Examination (ACE) is a cognitive screening test developed to detect dementia. It has been validated in several countries. Validation studies have predominantly included patients with various degrees of dementia and healthy controls. Objective: The aim of this study was to evaluate the Danish version of ACE as a screening test for early dementia in an outpatient memory clinic. Further, we wanted to investigate the ability of the ACE to discriminate patients with early Alzheimer’s disease (AD) from patients with depression. Method: 78 patients with mild AD (MMSE ≥20), 30 non-demented patients diagnosed with depression (originally referred for evaluation of cognitive symptoms), and 63 healthy volunteers, all between 60 and 85 years of age, were included. All patients were given the ACE as a supplement to the standard diagnostic work-up. Results: The cut-off points for optimal trade-off between sensitivity and specificity for ACE were 85/86 (sensitivity 0.99, specificity 0.94). When these cut-off points were applied to the group of depressive patients, the specificity dropped to 0.64, indicating a great overlap in individual test scores for demented and depressed patients. Conclusion: The optimal cut-off points for ACE found in this Danish study were close to what is reported in most other European studies. The great overlap in ACE scores for demented and depressed patients emphasize that test scores must be interpreted with great caution when used in diagnostic work-up.
An Acoustical and Perceptual Study of Vowels Produced by Alaryngeal Speakers of Cantonese
Authors: Ng Manwa L. , Chu Rhoda
Published: March 2009

Objective:The present study determines the acoustical and perceptual differences between alaryngeal and laryngeal speakers of Cantonese in the production of Cantonese vowels. Subjects and Methods:Formant frequencies (F1 and F2) associated with eight Cantonese vowels (/i, y, 3, a, q, $, œ, u/) produced by 40 alaryngeal (10 esophageal, 10 tracheoesophageal, 10 with pneumatic artificial larynx, 10 electrolaryngeal) and 10 laryngeal speakers were obtained. To assess how formants affect vowel perception, the vowels were identified by 20 naïve listeners, based on which confusion matrices were established. Results: Spectral analysis revealed that F1 and F2 values of Cantonese vowels produced by the alaryngeal speakers were significantly higher than those produced by laryngeal speakers, with the exception of F2 of /3/, /i/ and /y/ produced by alaryngeal speakers using pneumatic artificial larynx, and /3/ produced by electrolaryngeal speakers. Conclusion: The acoustic findings suggest a general shortening of the effective vocal tract length for resonance in alaryngeal speakers after laryngectomy. Percent correct identification of vowels from the perceptual experiment indicated similar error patterns in vowel identification between alaryngeal and laryngeal speaker groups. Among the different alaryngeal speaker groups, naïve listeners tended to perceive the vowels produced by electrolaryngeal speakers more accurately.
Effect of Psychological Stress on Female Vocal Quality
Authors: van Lierde K. , van Heule S. , De Ley S. , Mertens E. , Claeys S.
Published: March 2009

Psychological stress can influence vocal quality. The purpose of the present study was to determine the effect of stress on female vocal quality. In this experimental study 54 female voices were studied in a stress-inducing and a relaxed condition. In the stress-inducing condition the subjects were asked to read a passage while instructions were used to evoke stress. In the relaxed condition the same reading task but without specific instructions was used. Identical subjective and objective assessment techniques were used to determine vocal quality in the stressed and the relaxed conditions. In stress-inducing and challenging conditions the female voice is more breathy, strained and of a lower objective vocal quality characterized by lower fundamental frequency, lower frequency, intensity and aerodynamic capacity. This study indicates that stress-inducing and challenging conditions change vocal quality and vocal performance. Understanding of the effect of stress on voice production is relevant for clinical diagnostic situations, particularly in patients who present with a functional (nonorganic) voice disorder, as well as those patients who have some organic pathology but who also report exacerbation of symptoms during periods of increased life stress.
Evaluation of Posterior Pole with Echography and Optical Coherence Tomography in Patients with Behçet’s Disease
Authors: Iaccarino Gennarfrancesco , Cennamo Gilda , Forte Raimondo , Cennamo Giovanni
Published: March 2009

Background: In Behçet’s disease posterior segment involvement is very frequent (about 80%). Macular edema is the most commonly observed complication and is related to reduction of visual acuity. The purpose of the study was to evaluate choroidal involvement during posterior vasculitis due to Behçet’s disease. Methods: Thirty eyes (15 patients) presenting with posterior vasculitis due to Behçet’s disease were studied. All patients had been evaluated with optical coherence tomography (Stratus OCT, Zeiss) to evaluate the retinal thickness (RT) and with standardized 8-MHz A scan echography to determine the retinochoroidal thickness (RCT). Echographic evaluation with 10- and 20-MHz probes was performed in all cases. Results: In 7 eyes (23.3%), both RT and RCT were normal. In 5 eyes (16.6%), they were both increased. In the other 18 eyes (60%), the RCT was increased while the RT was normal, thus indicating a thickening of the choroid alone. No significant correlation was found between choroidal thickness and the presence of vitreal abnormalities. Neither increases in RT nor those in RCT were significantly related to visual acuity. No correlation was found between RT or RCT and pharmacological treatment. Conclusion: Choroidal inflammation could often play a primary eti- ological role during posterior vasculitis in Behçet’s disease. Echographic detection of choroidal thickening in patients with Behçet’s disease not presenting with retinal alterations or visual symptoms could represent a useful way to detect an early inflammation, in order to start a proper therapy and to influence the final visual prognosis.
Phase I Pharmacokinetic Study of Weekly Intravenous and Intraperitoneal Paclitaxel Combined with S-1 for Advanced Gastric Cancer
Authors: Ishigami Hironori , Kitayama Joji , Otani Kensuke , Kamei Takao , Soma Daisuke , Miyato Hideyo , Yamashita Hiroharu , Hidemura Akio , Kaisaki Shoichi , Nagawa Hirokazu
Published: March 2009

Objectives: A dose-escalation study of weekly intraperitoneal paclitaxel (PTX) combined with S-1 and intravenous PTX was performed to determine the maximum-tolerated dose (MTD) and recommended dose (RD) in gastric cancer patients. Patients and Methods: Nine gastric cancer patients with peritoneal dissemination and/or cancer cells on peritoneal cytology were enrolled. PTX was administered intravenously on days 1 and 8 at a fixed dose of 50 mg/m2, and intraperitoneally with an initial dose of 20 mg/m2, stepped up to 30 or 40 mg/m2. S-1 was administered at a fixed dose of 80 mg/m2/day for 14 consecutive days, followed by 7 days of rest. A pharmacokinetic study of PTX was also performed. Results: The MTD was determined to be 30 mg/m2, as 2 of 3 patients developed dose-limiting toxicities, grade 3 febrile neutropenia and diarrhea. Therefore, the RD was determined to be 20 mg/m2. The intraperitoneal and serum PTX concentration remained effective for over 72 and 48 h, respectively. Conclusions: Combined chemotherapy of S-1 plus weekly intravenous and intraperitoneal PTX was shown to be a safe regimen that should be further explored in clinical trials.
Risk Factors for Posterior Compared to Anterior Ischemic Stroke: An Observational Study of the Registry of the Canadian Stroke Network
Authors: Subramanian G. , Silva J. , Silver F.L. , Fang J. , Kapral M.K. , Oczkowski W. , Gould L. , O’Donnell M.J.
Published: March 2009

Background: Traditional vascular risk factors appear to exert varying magnitudes of risk for different major vascular events. For example, hypercholesterolemia is a much stronger risk factor for myocardial infarction than ischemic stroke. Limited evidence also suggests that vascular risk factors may exert differing magnitudes of risk for ischemic stroke within different cerebral arterial territories. We sought to determine the association between traditional vascular risk factors and the location of ischemic stroke (posterior versus anterior). Methods: Consecutive patients with acute ischemic stroke who were admitted to 11 regional stroke centers within the Registry of the Canadian Stroke Network were included in the study sample. The Oxfordshire Community Stroke Project classification was used to distinguish posterior from anterior circulation ischemic stroke. Multivariable logistic regression was applied to determine the association between risk factors (age, gender, diabetes mellitus, hypercholesterolemia, hypertension, atrial fibrillation and smoking history) and posterior (compared to anterior) circulation ischemic stroke. Results: In total, 8,489 patients with acute ischemic stroke were included. On multivariable analysis, diabetes mellitus (OR = 1.14; 95% CI = 1.02–1.27) was associated with an increased odds of posterior circulation ischemic stroke, whereas age (OR = 0.86; 95% CI = 0.83–0.90), female sex (OR = 0.84; 95% CI = 0.76–0.93), atrial fibrillation (OR = 0.83; 95% CI = 0.74–0.94) and pulmonary edema (OR = 0.74; 95% CI = 0.62–0.88) were related to a reduced odds of posterior compared with anterior circulation ischemic stroke. Conclusions: Some traditional vascular risk factors for ischemic stroke appear to exert different magnitudes of risk for posterior compared to anterior circulation ischemic stroke.
Cavernous Malformations of the Central Nervous System in the Pediatric Age Group
Authors: Acciarri Nicola , Galassi Ercole , Giulioni Marco , Pozzati Eugenio , Grasso Vincenzo , Palandri Giorgio , Badaloni Filippo , Zucchelli Mino , Calbucci Fabio
Published: March 2009

Objective: The main clinico-diagnostic features, risk factors and associated diseases of cavernous malformations (CMs), also called cavernous angiomas or cavernomas, of the central nervous system (CNS) in children are described, and the most relevant differences compared to the affected adult population are pointed out, focusing on the management of pediatric patients harboring cranial and spinal CMs. Materials: This was a retrospective study of a series of 42 children symptomatic for CMs of the cranial and spinal compartments (35 supratentorial brain lesions, 5 infratentorial and 2 in the spinal region) operated on between 1975 and 2005, with a clinical follow-up ranging from 12 to 192 months. The results were compared with those found in the most recent literature dealing with pediatric CMs of the CNS. Results: Surgical treatment produced excellent or good results in 69% of our 42 children. Unchanged neurological deficits were observed in 23.8% of cases, while morbidity from surgical procedures was 7.14%. Mortality was absent in this series. These surgical results are comparable with those found in the literature, where morbidity and mortality rates from surgery are 8.8 and 1.13%, respectively, and are mostly associated with procedures for the excision of deep, critically located cavernomas. Conclusion: CMs represent the most common CNS vascular lesion in children, although their incidence is 4 times lower than that of the adult population. The natural history of pediatric CMs throughout the neuraxis seems to be more aggressive than in adult patients; these lesions have higher rates of growth and hemorrhage, larger dimensions and often atypical radiological pictures at diagnosis. Beside the familial form of the disease, which is more often associated with multiple lesions and an earlier age of clinical presentation, the major risk factor for CMs in children seems to be radiotherapy for CNS tumors. Furthermore, a greater number of CMs coexistent with mixed angiomatous lesions have been reported in children than in adults. Surgical results are related to the preoperative neurological status of the children; symptomatic patients who are operated on early, before they develop severe neurological deficits or long-standing seizures, may achieve the best clinical outcome. Radiosurgery does not seem to be advisable in children as an alternative treatment for deep CMs or those causing epilepsy.
Treatment of Posthemorrhagic Hydrocephalus in Premature Infants with Subcutaneous Reservoir Drainage
Authors: Yu Bo , Li Shasha , Lin Zhenlang , Zhang Nu
Published: March 2009

Aims: To investigate the effectiveness of subcutaneous reservoir drainage as a treatment for the different types of posthemorrhagic hydrocephalus in premature infants. Methods: 11 premature infants with posthemorrhagic hydrocephalus underwent subcutaneous reservoir embedment surgery, and cerebrospinal fluid (CSF) was drained via the reservoir intermittently for 8 weeks. During the period of drainage, ultrasound and computerized tomography were used to measure ventricle size. CSF examinations were performed routinely to assess the presence of intraventricular hemorrhage (IVH) and/or infection. Results: (1) Five infants were diagnosed as having obstructive hydrocephalus; 2 had nearly normal ventricle sizes with treatment and drainage was stopped after 8 weeks, 2 had nearly normal ventricle sizes after 4 more weeks of drainage, and 1 underwent ventriculoperitoneal shunt (V-P shunt) surgery due to failure of ventricle size reduction. (2) Six infants were diagnosed as having communicating hydrocephalus; 4 had further enlarged ventricle size after 8 weeks and underwent V-P shunt surgery, 1 had treatment aborted at week 8 of drainage, and only 1 had moderate reduction of ventricle size after 8 weeks. (3) None of the 11 infants had progressive IVH and/or intracranial infection during drainage. Conclusions: Subcutaneous reservoir drainage is a suitable and safe treatment for posthemorrhagic hydrocephalus in premature infants. It is more effective for obstructive hydrocephalus than for communicating hydrocephalus.
Germinal Matrix Hemorrhage of Prematurity: Treatment Approaches and Outcomes in a Single Institutional Review in the Ukraine
Authors: Lim Lee Wei , Volkodav O.V.
Published: March 2009

Objective: To review the treatment outcome of germinal matrix hemorrhage (GMH) in premature infants in a single Ukrainian institution in an effort to determine optimal diagnostic and therapeutic approaches. Materials and Methods: Eight hundred and thirty-five premature newborns (gestational age 33.0 ± 2.50 weeks, birth weight 2,124.81 ± 282.54 g; mean ± SD) were examined for the development of perinatal hypoxic-ischemia injury and asphyxia condition. This research focuses on various types of massive intracranial hemorrhage (ICH) and posthemorrhagic hydrocephalus (PHH). The diagnostic methods were based on intracranial imaging studies and clinical features that are present at birth. The therapeutic and preventive strategies consist of parental counseling, supportive and rehabilitative care for affected infants. Surgical intervention was indicated for the prevention and treatment of severe PHH. Thirty-four preterm infants were treated by ventricular-peritoneal/subgaleal shunting with close monitoring of intracerebral pressure. Results: Massive GMH took place at 32–35 gestational weeks as a result of increased periventricular anastomosis. GMH was unusual in full-term newborns, whereas cerebral hypoxic-ischemic injuries were more common in full-term neonates. Approximately 98% of premature infants with low birth weight survived and 2% died due to respiratory distress syndrome and other complications. ICH which occurs in neonates at 24–28 gestational weeks was mainly due to immature vascular walls and insufficiency of vascular anastomosis at the germinal matrix. Conclusions: ICH occurring in the germinal matrix of premature newborns is closely related to the development of the brain vasculature. Evacuation of the hematoma is more detrimental than beneficial, despite the rapid strides being taken to keep low-birth weight premature infants alive. Therefore, the treatment of ICH and PHH requires a fundamental understanding of pathogenetic changes, which is necessary for the neurorehabilitation and immediate elimination of cerebral compression and its complications.
Experimental Analysis of Radiation Dose Distribution in Radiosurgery II. Dose Fall-Off outside the Target Volume
Authors: Massager Nicolas , Maris Calliope , Nissim Ouzi , Devriendt Daniel , Salmon Isabelle , Levivier Marc
Published: March 2009

Introduction: The role of radiation dose delivered to surrounding tissues outside target is often minimized in radiosurgery. We study histopathological effects of dose fall-offs outside the target using an experimental model of trigeminal nerve irradiation in the rat. Material and Methods: Sixteen rats were irradiated with a Gamma Knife at the right trigeminal nerve using a 90-Gy dose and 4 different gradients of dose fall-off; the brainstem at the trigeminal nerve root entry was histologically analyzed 3 months after irradiation. Results: Four specific histopathogical reactions were found as a consequence of the irradiation. All these reactions were significantly related to the gradient of dose fall-off. Conclusions: Different dose distributions outside the target could produce various histological effects in the irradiated tissue that could influence the outcome of radiosurgical treatment. A more rapid fall-off of dose (higher selectivity) is associated with less risk of histological changes in tissues surrounding the target.
Bilateral Anterior Thalamic Nucleus Lesions Are Not Protective against Seizures in Chronic Pilocarpine Epileptic Rats
Authors: Hamani Clement , Ewerton Flavio I.S. , Marcolin de Almeida Flávia , Bonilha Saulo M. , Covolan Luciene , Fantin Cavarsan Clarissa , Ballester Gerson , Mello Luiz E. , Lozano Andres M.
Published: March 2009

Aims: To investigate whether anterior thalamic nucleus (AN) lesions are protective against spontaneous recurrent seizures in the chronic phase of the pilocarpine model of epilepsy. Methods: Two groups of rats were treated with bilateral AN radiofrequency thalamotomies or sham surgery 2 weeks after pilocarpine-induced status epilepticus. After the lesions, animals were videotaped from the 2nd to the 8th week after status epilepticus (total 180 h). Results: During the 6 weeks of observation, no differences in the frequency of spontaneous seizures were found between animals that had bilateral AN lesions (n = 26; 3.1 ± 0.6 seizures per animal) and controls (n = 25; 3.0 ± 0.6 seizures per animal; p = 0.8). Conclusions: We conclude that AN thalamotomies were not effective in reducing the frequency of seizures during the chronic phase of the pilocarpine model of epilepsy.
Prevalence of Urinary Incontinence among Women and Its Impact on Quality of Life in a Semirural Area of Western Turkey
Authors: Tozun Mustafa , Ayranci Unal , Unsal Alaaddin
Published: March 2009

Background/Aims: Urinary incontinence (UI) is a very common and bothersome condition among women, affecting up to 50% of women during their lifetime. Older women are disproportionately affected and often view UI as a normal part of aging, thus precluding contact with medical professionals. The aim of this study was to determine the frequency and risk factors of UI in women aged 20 years or older, as well as to examine its effects on women’s quality of life (QOL). Methods: The study was conducted on 1,585 women aged 20 years and over between January and March 2007. Data were obtained by a face-to-face interview, using a questionnaire consisting of questions pertaining to the women’s demographic characteristics, medical and obstetric history and UI. The Short Form-36 (SF-36) scale was used to assess the QOL of the women. Results: The prevalence of UI in this group of women was 49.5%. UI was significantly associated with advanced age (p < 0.05), lower education level (p ≤ 0.001), recurrent urinary tract infection (p < 0.001), chronic obstructive pulmonary disease (p < 0.001), diabetes mellitus (p ≤ 0.001), a history of nocturnal enuresis in childhood (p < 0.001), taking diuretics (p < 0.05) and body mass index (p < 0.001). When the QOL of the women with and without UI were evaluated, the scores for women without UI were higher than those with mild, moderate or severe UI (p < 0.001 for each). Women with UI of varying severity had lower mean domain scores on the SF-36 than women without UI (p < 0.001 for each). As the severity of UI increased, it was seen that the mean domain scores according to the scale showed a decrease (p < 0.001). Conclusion: It is concluded that UI is a common disorder among women in this region of Turkey and that it also negatively affects these women’s QOL, suggesting the need for more social and medical study in this area.
Clinical Significance of UDP-Glucuronosyltransferase 1A1*6 for Toxicities of Combination Chemotherapy with Irinotecan and Cisplatin in Gynecologic Cancers
Authors: Takano Masashi , Kato Masafumi , Yoshikawa Tomoyuki , Sasaki Naoki , Hirata Junko , Furuya Kenichi , Takahashi Michiko , Yokota Harushige , Kino Nao , Horie Koji , Goto Tomoko , Fujiwara Keiichi , Ishii Kenji , Kikuchi Yoshihiro , Kita Tsunekazu
Published: March 2009

Background: To investigate the effects of UDP-glucuronosyltransferase 1A1 (UGT1A1) *28, *6 and *27 in patients with gynecologic cancer who received chemotherapy with irinotecan and cisplatin. Methods: Patients eligible for this study had cervical or ovarian cancer treated with chemotherapy; a course of the regimen consisted of 60 mg/m2 of irinotecan on days 1, 8 and 15, and 60 mg/m2 of cisplatin on day 1 every 4 weeks. UGT1A1 polymorphisms and toxicities were analyzed. Results: From March 2007 to December 2007, 30 Japanese patients were enrolled; 24 ovarian carcinoma patients and 6 cervical cancer patients. The following genotypes of UGT1A1 were found: wild type in 17 patients (57%), *28 in 4 patients (13%), *6 in 8 patients (27%), *28*6 in 1 case (3%) and no case of *27 (0%). Grade 3/4 neutropenia, thrombocytopenia and diarrhea were significantly more frequent in *6 patients compared with wild-type patients. Also, in *6 patients irinotecan administration on days 8 or 15 was significantly more often omitted due to toxicities. In patients with *28 or *28*6, side effects were similar to those in patients with *6. Conclusion: In addition to UGT1A1*28, UGT1A1*6 might also be a key candidate to determine the dose of combination chemotherapy with irinotecan and cisplatin.
Automatic Evaluation of Tracheoesophageal Substitute Voice: Sustained Vowel versus Standard Text
Authors: Bocklet Tobias , Toy Hikmet , Nöth Elmar , Schuster Maria , Eysholdt Ulrich , Rosanowski Frank , Gottwald Frank , Haderlein Tino
Published: March 2009

Objective: The Hoarseness Diagram, a program for voice quality analysis used in German-speaking countries, was compared with an automatic speech recognition system with a module for prosodic analysis. The latter computed prosodic features on the basis of a text recording. We examined whether voice analysis of sustained vowels and text analysis correlate in tracheoesophageal speakers. Patients and Methods: Test speakers were 24 male laryngectomees with tracheoesophageal substitute speech, age 60.6 ± 8.9 years. Each person read the German version of the text ‘The North Wind and the Sun’. Additionally, five sustained vowels were recorded from each patient. The fundamental frequency (F₀) detected by both programs was compared for all vowels. The correlation between the measures obtained by the Hoarseness Diagram and the features from the prosody module was computed. Results: Both programs have problems in determining the F₀ of highly pathologic voices. Parameters like jitter, shimmer, F₀, and irregularity as computed by the Hoarseness Diagram from vowels show correlations of about –0.8 with prosodic features obtained from the text recordings. Conclusion: Voice properties can reliably be evaluated both on the basis of vowel and text recordings. Text analysis, however, also offers possibilities for the automatic evaluation of running speech since it realistically represents everyday speech.
Relationship between Mothers’ Sense of Coherence and Oral Health Status of Preschool Children
Authors: Bonanato K. , Paiva S.M. , Pordeus I.A. , Ramos-Jorge M.L. , Barbabela D. , Allison P.J.
Published: March 2009

Objective: The aim of the present study was to investigate the relationship between mothers’ sense of coherence (SOC) and oral health status in a representative sample of 5-year-old preschool children. Methods: A cross-sectional study was conducted in Belo Horizonte (Brazil) on a sample of 546 mothers and their 5-year-old children, randomly selected from preschools. Data were collected through questionnaires (mothers), the short version of Antonovsky’s SOC scale (SOC-13) and clinical dental examinations (children). Simple and multiple logistic regression analyses were performed on the data. The following 8 outcome variables were selected: dental caries, filled and missing teeth, dental pulp exposure due to caries, dental root fragment, visible plaque, gingivitis and supragingival calculus. The examination was carried out by 2 trained, calibrated examiners. Results: Mothers with a lower SOC were more likely to have children with decayed teeth (OR = 1.59, 95% CI = 1.01–2.29), dental pulp exposure (OR = 1.99, 95% CI = 1.06–3.77) or filled teeth (OR = 1.85, 95% CI = 1.12–3.06) regardless of the child’s social class and gender. Conclusion: The data indicate that mothers’ SOC is an important psychosocial determinant of the oral health status among preschool children.
A Cluster Randomised Trial of Effectiveness of Educational Intervention in Primary Health Care on Early Childhood Caries
Authors: Mohebbi S.Z. , Virtanen J.I. , Vahid-Golpayegani M. , Vehkalahti M.M.
Published: March 2009

Early childhood caries (ECC) remains a serious problem in several developing and developed countries. This cluster randomised trial evaluated the impact of a 6-month educational intervention on ECC. The trial targeted 12- to 15-month-old children (n = 242) and their mothers in Tehran, Iran, visiting 18 public health centres, randomly selected and assigned to two intervention groups and one control group. At baseline, each mother was interviewed and each child underwent a dental examination of all teeth for the number of decayed teeth (dt) and of upper central incisors for the number of teeth with enamel caries (de). All mothers in the two intervention groups (A and B) received oral health instructions from the vaccination staff. In addition, group A received extra reminders. The outcome was defined as increments in the number of teeth with dt or de, as percentages of children developing new dt or de, and as the number needed to treat (NNT). No new de appeared in group A, the mean de increment in group B was 0.2 (SD = 0.6), and in the controls, it was 0.4 (SD = 0.7) (p < 0.05). The percentages of children developing new de were 0, 14, and 26%, respectively. No differences in dt increments were found. Regarding de, NNT for group A was 4 and for B 9; the figures for dt were 13 and 17, respectively. In conclusion, oral health education given to mothers by general health staff is a valuable tool to prevent caries in infants and toddlers.