bluuebunny/crossref_metadata_2025 huggingface dataset:
Iron Status and Iron Deficiency Anaemia in Adolescents in a Tanzanian Suburban Area
Authors: Massawe S.N. , Ronquist G. , Nyström L. , Lindmark G.
Published: April 2003

Objectives: To assess the extent and degree of anaemia in adolescents in a Tanzanian suburban area, to estimate the contribution of iron deficiency, using serum (S)-ferritin and soluble transferrin receptor (sTfR) as markers of iron deficiency. Materials: Consecutive primigravidae at booking for antenatal care (n = 76), primary school boys (n = 101) and postmenarchal girls (n = 130) age ≧12 years were investigated. Methods: Weight and height were measured; venous blood was drawn for haematological analyses, malaria screening, S-ferritin, sTfR, and C-reactive protein. Stool specimens were analysed for intestinal parasites. Results: Anaemia (Hb <105 g/l) was highly prevalent in adolescent primigravidae (75.5%). Adolescent girls were more anaemic (Hb <120 g/l) than boys (14.5 vs. 7.9%). Iron deficiency and hookworm infestation were predominant in both groups of adolescents, however, malaria contributed more to anaemia in the primigravidae. Nearly 40% of the anaemic primigravidae had indication of infection, and S-ferritin was less useful as a marker of iron deficiency in this group. sTfR identified iron deficiency in both pregnant and non-pregnant adolescents.
Plasma 5′-Nucleotidase Activities and Uric Acid Levels in Women with Pre-Eclampsia
Authors: Yoneyama Yoshio , Suzuki Shunji , Sawa Rintaro , Otsubo Yasuo , Miura Atsushi , Kuwabara Yoshimitsu , Ishino Hiroshi , Kiyokawa Yasuko , Doi Daisuke , Yoneyama Koichi , Kobayashi Hajime , Araki Tsutomu
Published: April 2003

The present study investigated plasma activity of 5′-nucleotidase, a key enzyme in the production of adenosine, in pre-eclampsia, and evaluated the relationship between changes in 5′-nucleotidase activity, and levels of uric acid, endproduct of the purine metabolism, and the severity of pre-eclampsia. We measured plasma 5′-nucleotidase activities and uric acid levels in women with 18 normal pregnancies, mild and severe pre-eclampsia. In mild and severe pre-eclampsia, plasma 5′-nucleotidase activities and uric acid levels were significantly increased compared with those in normal pregnancy (p < 0.05). Plasma 5′-nucleotidase activity increased according to increases in uric acid levels and the severity of pre-eclampsia. These results suggest that increased plasma 5′-nucleotidase activity may, at least in part, be related to changes in purine metabolism in pre-eclampsia.
Molecular Epidemiology and Immunology of Hepatitis B Virus Infection – An Update
Authors: Pumpens Paul , Grens Elmars , Nassal Michael
Published: April 2003

Hepatitis B virus (HBV) continues to be one of the most important viral pathogens in humans. This review provides an update on the molecular epidemiology and immunology of HBV infection. DNA sequencing has allowed replacement of the initial serotypic classification of HBV strains by a more systematic genotype system that currently consists of 7 members (genotypes A–G). More recently, sequence analysis of virus isolates from many individual patients has revealed the occurrence of certain mutational hot spots in the genome, some of which appear to correlate with the patient’s immunological and/or disease status; however, cause and effect are not always easily discernible. This holds particularly for the issue of whether virus variants exist that have, per se, an increased pathogenic potential; due to the scarcity of appropriate experimental in vivo models, such hypotheses are difficult to prove. Similarly, because of the compact organization of the HBV genome, almost every single mutation may have pleiotropic phenotypic effects. Nonetheless, there is accumulating evidence that at least some frequently observed mutations are causally related to viral escape from selective pressures, such as the presence of antibodies against dominant B cell epitopes, or drugs that inhibit the viral reverse transcriptase; possibly, this is also true for the cellular immune response. Therefore, despite the availability of an effective prophylactic vaccine, further extensive efforts are required to monitor the emergence of vaccination- and therapy-resistant HBV variants and to prevent their spread in the general population.
Cowpea Mosaic Virus: From the Presentation of Antigenic Peptides to the Display of Active Biomaterials
Authors: Chatterji A. , Burns L.L. , Taylor S.S. , Lomonossoff G.P. , Johnson J.E. , Lin T. , Porta C.
Published: April 2003

The potential of cowpea mosaic virus (CPMV), a plant icosahedral virus, for the presentation of foreign peptides and proteins is reported. The most prominent feature at the virus surface is a region of the smaller of the two coat proteins (S) which has been extensively used for the insertion of foreign peptides. Given the availability of the three-dimensional structure of the native virus and the amenability of foreign peptide-expressing CPMV chimeras to crystallisation, immunological data can be correlated with the conformational state of the foreign insert. The latter is influenced by proteolysis which occurs within the foreign inserts. In an effort to offer an alternative context for peptide expression, extensive exploration of a second region of the S protein is reported with respect to tolerance to small insertions. Moreover, to make CPMV suitable for a wider spectrum of presentation, a technique was developed to allow surface coupling of a peptide which can serve as the anchoring point for a range of proteins. This new approach is also widely applicable for the direct chemical cross-linking of peptides and full-length protein domains to the viral capsid.
Short-Term Effects of Improved Glycemic Control on Cognitive Function in Patients with Type 2 Diabetes
Authors: Hewer W. , Mussell M. , Rist F. , Kulzer B. , Bergis K.
Published: April 2003

Background: According to numerous studies, type 2 diabetes is associated with mild cognitive dysfunction, and there is some evidence suggesting favorable effects of improved metabolic control on the mental capability of elderly diabetic patients. Objective: To compare patients with type 2 diabetes to normal controls with respect to cognitive performance and to investigate the consequences of glycemic adjustment. Methods: 53 patients with type 2 diabetes, most of them in secondary failure on oral antidiabetic drugs, but free from conditions which may cause brain dysfunction, were included (mean age 58.8 ± 6.1 years, duration of disease 12.0 ± 6.4 years). They were examined prior to (t1), and following (t2) glycemic adjustment with a time interval of approximately 2 weeks. 29 non-diabetic controls, comparable with regard to age, gender, education and verbal intelligence were examined twice with a corresponding time interval. Cognitive performance was assessed by well-standardized tests with a focus on attention/concentration, psychomotor speed, verbal fluency and verbal memory; mood status by two self-rating scales. Restoration of glycemic control included insulin treatment in the majority of patients (46/53). Results: Diabetic subjects scored significantly lower in all cognitive tests used, while they did not differ from controls in mood status. From t1 to t2 they improved in those tests measuring attention/concentration, and psychomotor speed. With regard to similar changes in controls, we interpret these improvements as practice effects rather than the consequence of altered metabolic control. Conclusion: In a sample of patients with long-standing type 2 diabetes we could not confirm previous reports of improved cognitive capacity with restoration of glycemic control. Further studies on the effects of changes in control of blood glucose on cognitive performance in type 2 diabetes should be conducted with special regard to drugs used to lower blood glucose.
Cerebrovascular Disease in Italy and Europe: It Is Necessary to Prevent a ‘Pandemia’
Authors: Gaddi Antonio , Cicero Arrigo F.G. , Nascetti Simona , Poli Andrea , Inzitari Domenico
Published: April 2003

In Italy and Europe, strokes are the third most common cause of death and resulting invalidity. In the ever-increasing 80-years-old-and-over population, strokes become more serious due to the clinical presentation during the acute phase and the ten times higher mortality, but also in relation to the twice as high resulting disability as for younger subjects. With the growing number of ailing and not-self-sufficient elderly, other resources will have to be relocated to this field of public health. Then, the dependence index and the ensuing equivalence based on estimates for the first decades of 2000 will create more difficulties in retrieving the funds for social policies. However, stroke prevention is possible both through correct behavioural habits and pharmacological means. Besides the well-known preventive effects of an adequate antihypertensive, antidiabetic and/or antiaggregant/anticoagulant therapy, there is increasing evidence of the effectiveness of statin therapy in stroke prevention. Subjects with a personal history of cerebrovascular events have an increased coronary risk and vice versa. The greatest part of the risk factors for the cerebrovascular disease coincides with those for cardiovascular disease, for which the correction of the former automatically involves a reduction in incidence of both pathologies. In this context, a statin’s rational use can therefore represent an important tool for the combined prevention of the two pathologies. Finally, different hypotheses link the origin of Alzheimer’s disease to that of progressive cerebrovascular dementia caused by cerebral microcirculation damage. The aim of this review is to resume the actual knowledge about the epidemiology of cerebrovascular disease in Italy and Europe, and about the means available to prevent this phenomenon.
Increased Respiratory Burst and Increased Expression of Complement Receptor-3 (CD11b/CD18) and of IL-8 Receptor-A in Neutrophil Granulocytes from Newborns after Vaginal Delivery
Authors: Gessler Peter , Dahinden Clemens
Published: April 2003

To study neutrophil activation in cord blood as a function of the mode of delivery, we performed analysis of the function of neutrophil granulocytes by assessing their ability to produce reactive oxygen products (ROP) as well as neutrophil cell surface expression of CD11b/CD18 and interleukin (IL)-8 receptors quantified with flow cytometry. Plasma levels of granulocyte colony-stimulating factor (G-CSF) were measured using an immunoassay. Neutrophil granulocytes were derived from cord blood of term newborns delivered vaginally (n = 20) and by cesarean section (n = 10), and, for comparison, from adult peripheral blood (n = 15). Blood neutrophil counts and the capacity of neutrophil granulocytes to produce ROP in response to stimulation with Escherichia coli was increased in newborns after vaginal delivery as compared to newborns delivered by cesarean section. The level of expression of the adhesion molecule/complement receptor CD11b/CD18 and the chemokine receptor IL-8 RA was also higher after vaginal delivery. Plasma concentrations of G-CSF in cord blood of newborns were higher than those of adults with no difference detectable between vaginal delivery and cesarean section. The data demonstrate a higher functional responsiveness and a higher expression level of functionally important receptors in neutrophils after vaginal delivery possibly due to activation of neutrophil granulocytes during labor.
Synapse Loss May Be a Minor Contributor to Decreased Regional Cerebral Blood Flow in Alzheimer Disease
Authors: Bigio Eileen H. , Reisch Joan S. , White 3rd Charles L. , Satumtira Sivapong , Sontag Estelle , Bonte Frederick J.
Published: April 2003

In this study we tested the hypothesis that synapse loss contributes to decreased regional cerebral blood flow (rCBF) in Alzheimer disease (AD). We compared antemortem rCBF and postmortem analysis of synaptophysin, as a measure of synapse loss, in 13 cases of AD. rCBF studies were performed using inhaled xenon gas (Xe-133), which yields quantitative results. Synapse loss was evaluated in postmortem brain samples using an enzyme-linked immunosorbant assay (ELISA) that measures synaptophysin, with results expressed as picomoles synaptophysin/10 mg brain. Synaptophysin was expressed either as concentration (QS method) or as the ratio of the concentration to the combined results in frontal, temporal and parietal lobe (RS method). There was no correlation between synapse loss and rCBF using the QS method and only borderline significance between right SPECT and right temporal synaptophysin using the RS method. The results of this study suggest that synapse loss may be a minor contributor to the decreased rCBF observed in AD.
Neuropsychological Performance in Depressed and Euthymic Bipolar Patients
Authors: Martinez-Aran A. , Vieta E. , Colom F. , Reinares M. , Benabarre A. , Torrent C. , Goikolea J.M. , Corbella B. , Sánchez-Moreno J. , Salamero M.
Published: April 2003

Introduction: Recent studies have suggested that the presence of persistent cognitive dysfunctions in bipolar patients is not restricted to acute episodes, but they persist even during remission states. Nevertheless, there are several methodological pitfalls in most studies, such as unclear remission criteria, diagnostic heterogeneity or small sample sizes. Patients and Methods: Several domains of cognitive function were examined in 30 depressed bipolar patients [DSM-IV criteria for major depression, Hamilton Depression Scale (HDRS) ≧17] and 30 euthymic bipolar patients (at least 6 months of remission, HDRS ≤8 and Young Mania Rating Scale, YMRS ≤6). Psychosocial functioning was assessed through General Assessment of Functioning. Results: The two groups showed a similar pattern of neuropsychological performance. However, the depressed group was significantly impaired on the Controlled Oral Word Association Test, FAS (COWAT), a measure of verbal fluency, compared with the euthymic group. On the other hand, functional outcome in euthymic patients was related to verbal fluency, even after controlling for residual depressive symptoms. Conclusions: Neuropsychological performance was similar in both groups, except for verbal fluency, which was lower in the depressed group. Poor verbal fluency was related to a poor social outcome in euthymic patients. Further research including longitudinal designs aimed at evaluating changes in cognition in these patients is warranted.
The Seldinger Technique for Insertion of Difficult to Place Ventricular Catheters
Authors: Lam Cornelius H. , Horrigan Medina , Lovick Darren S.
Published: April 2003

Background: Multiloculated ventricular hydrocephalus is a difficult pathology for neurosurgeons to treat. Not only are the shunts for this condition prone to malfunction, but they are also difficult to place. Methods: The Seldinger technique is used in combination with a rigid scope with a working channel. A soft filiform wire or a thick suture is inserted through the channel. The scope is withdrawn and a ventricular catheter is slid down the wire. The remainder of the shunt is inserted in the usual fashion. Results: We have not encountered any neurologic compromise from this technique. No bleeding was encountered with the described technique. Conclusion: The Seldinger technique with appropriate types of guide wires and in combination with an endoscope is a useful technique for difficult to place shunts.
The Role of Surgical Placement and Pump Orientation in Intrathecal Pump System Failure: A Technical Report
Authors: Dickerman Rob D. , Stevens Q.E. , Schneider Steven J.
Published: April 2003

Intrathecal pump catheter complications are the most common cause of failure in drug delivery. A previous report has documented that intra-abdominal positioning of the intrathecal pump may predispose the pump-catheter neck to premature catheter breakdown and leakage. Based on this report, we reviewed over 100 intrathecal pump cases to determine the frequency of malpositioning and its role in the pathogenesis of catheter failure. We found three specific cases where a ‘fulcrum effect’ occurred due to intra-abdominal positioning of the pump predisposing the catheter to breakdown. This study demonstrates that intra-abdominal placement of the pump can predispose the catheter to failure/breakdown and that surgeons should attempt to place the pump catheter neck in a superiomedial position, distant from any bony prominences, to prevent the ‘fulcrum effect’ on the pump-catheter neck junction and reducing the likelihood of either internal or external compressive forces.
Long-Term Follow-Up of Direct Heart Shunts in the Management of Hydrocephalus
Authors: Martin Jonathan E. , Keating Robert F. , Cogen Phillip H. , Midgley Frank M.
Published: April 2003

The authors performed a retrospective review of clinical data on 60 patients treated with direct heart shunts (DHSs) for hydrocephalus at the Children’s National Medical Center from 1976 to 1979. Mean shunt survival was 79 months. Rates of proximal revision and infection were comparable to those in previous shunt series. Distal revision rates were lower than those reported in previous ventriculoatrial shunt series. The DHS is an effective self-lengthening cerebrospinal fluid shunt that may be considered as a salvage technique in the challenging shunt-dependent patient.
Circulating Intercellular Adhesion Molecule-1 in Chronic Hepatitis C Patients with Normal or Elevated Aminotransferase before and after Alpha-Interferon Treatment
Authors: Montalto Giuseppe , Giannitrapani Lydia , Soresi Maurizio , Florena Ada , Di Martino Daniela , Franco Vito , Carroccio Antonio , Cervello Melchiorre
Published: April 2003

Objectives: Intercellular adhesion molecule-1 (ICAM-1) plays a fundamental role during liver inflammation. In fact, weak ICAM-1 expression is physiologically restricted to the endothelium of portal vessels and to sinusoidal lining cells, but it becomes markedly evident on sinusoidal lining cells and at the surface of hepatocytes during inflammatory liver diseases. The aim of this study was to evaluate the behaviour of soluble ICAM-1 (sICAM-1) in chronic hepatitis C (CH-C) patients with persistently normal aminotransferase in comparison with patients with CH-C and elevated aminotransferase, and its changes during α-interferon (IFN) therapy. Immunohistochemical localization of ICAM-1 was also performed on liver tissue specimens of both groups. Methods: Sixty subjects were divided into 3 groups: group A included 19 patients with CH-C and persistently normal aminotransferase; group B included 21 patients with CH-C and persistently elevated aminotransferase levels, and group C included 20 healthy subjects representing the control group. The first two groups were treated with recombinant α-IFN 2b at a dose of 6 MU 3 times a week for 3 months and followed up with 3 MU 3 times a week for another 3 months. Results: Baseline values of serum ICAM-1 in groups A and B were significantly higher than those in group C (p < 0.0001). The median baseline value of sICAM-1 in group A (525.0 ng/ml) was lower than that of group B (561.0 ng/ml), but the difference was not statistically significant. Furthermore, there was a trend toward higher ICAM-1 values as histological severity increased (Mantel-Haenszel χ2 8.8, p < 0.003). Post-treatment sICAM-1 serum values showed a marked decrease in both groups, but only among responder patients, while ICAM-1 levels were unchanged in non-responders. Immunohistochemical localization showed no staining for ICAM-1 in normal liver specimens, while there was a quite similar staining for ICAM-1 in the two groups of patients, consistent with an inflammatory process. Conclusions: This study shows that circulating ICAM-1 levels in most patients with CH-C and persistently normal aminotransferase are higher than those in a control group and the fact that ICAM-1 molecules are also expressed on the hepatocyte membrane suggests that they could play an important role, in association with other molecules, in the intercellular adhesion processes during the induction and maintenance phases of the immune response. In both groups, only patients responding to α-IFN therapy showed a marked decrease in serum ICAM-1 below baseline values.
A New Model of Chronic Colitis in SCID Mice Induced by Adoptive Transfer of CD62L+ CD4+ T Cells: Insights into the Regulatory Role of Interleukin-6 on Apoptosis
Authors: Mudter Jonas , Wirtz Stefan , Galle Peter R. , Neurath Markus F.
Published: April 2003

Objective: The proinflammatory cytokine interleukin (IL)-6 is involved in various chronic inflammatory processes. IL-6 is a predominant cytokine produced by lamina propria T cells in Crohn’s disease and experimental colitis. This study was designed to examine the effect of a neutralizing IL-6-receptor (IL-6R) antibody on the programmed cell death of mucosal T cells in the CD62L+ CD4+ SCID transfer model of chronic experimental colitis in mice and to gain more insight into the pathogenesis of this transfer colitis model. Methods: For adoptive transfer, we isolated CD62L+ CD4+ double-positive T cells from wild-type BALB/c mice followed by intraperitoneal application of 1 million cells in CB17 SCID mice. The purity of the transferred T-cell population was tested by FACS analysis. Cytokine secretion was measured by ELISA. Western blot analysis was performed to detect phospho-STAT-3 in protein extracts of splenic cells. Cryo- and paraffin colon cross-sections were used to perform immunochemical or fluorescence TUNEL stainings. Results: We isolated CD62L+ CD4+ and CD62L– CD4+ T cells. In vitro studies showed an increased production of IL-4 by CD62L– CD4+ T cells compared to CD62L+ T cells. 8–10 weeks after transfer of CD62L+ CD4+ T cells in SCID mice, reconstituted mice developed wasting disease, anal prolapse and diarrhea, whereas mice reconstituted with CD62L– CD4+ did not, similar to anti-IL-6R-treated CD62L+ CD4+-reconstituted SCID mice. Anti-IL-6R-treated reconstituted SCID mice showed decreased levels of activated STAT-3. The previously described efficacy of anti-IL-6R antibody treatment on colitis activity appeared to be due to the induction of apoptosis, as many TUNEL-positive cells were detected in the lamina propria. Conclusions: These results suggest that the activation of the IL-6/STAT-3-signaling pathway plays a pivotal role in the pathogenesis of CD62L+ CD4+ transfer colitis. Moreover, the application of a neutralizing antibody to IL-6R induces apoptosis in transferred T cells. These data implicate the importance of anti-apoptotic pathways in chronic disease and might contribute to future therapies.
Mutations of the BRCA1 Gene in Hereditary Breast and Ovarian Cancer in the Czech Republic
Authors: Pohlreich P. , Stříbrná J. , Kleibl Z. , Zikán M. , Kalbáčová R. , Petruželka L. , Konopásek B.
Published: April 2003

Objective: Mutations in the BRCA1 gene confer a high risk for the development of breast or ovarian cancer. The aim of this study was to establish the frequency and spectrum of BRCA1 mutations in Czech breast or ovarian cancer families. Subjects and Methods: We have screened 28 patients with early-onset cancer and 54 patients from risk families for germ-line mutations in BRCA1. All coding exons were analyzed by the protein truncation test (PTT) and the reverse transcription polymerase chain reaction (RT-PCR). Detected variants were characterized by direct sequencing of PCR products. Results: Five distinct deleterious mutations have been identified in six families. All the mutations led to the premature termination of translation. One mutation was detected in a group of 11 (9.1%) patients with early-onset breast cancer. Two mutations were observed in 32 (6.3%) families with a history of breast cancer only. Three mutations were found in 22 (13.6%) families with both breast and ovarian cancer. The 5382insC mutation was the only abnormality detected twice. In addition, two variant transcripts, the loss of exon 5 and in-frame 3-bp deletion at the beginning of exon 8, were identified only at the cDNA level. Their biological significance remains unknown. Conclusion: PTT analysis enables examination of long PCR products. The technique is useful for rapid detection of mutations in hereditary breast cancer.
Riks-Stroke – A Swedish National Quality Register for Stroke Care
Authors: Asplund Kjell , Hulter Åsberg Kerstin , Norrving Bo , Stegmayr Birgitta , Terént Andreas
Published: April 2003

Background: Riks-Stroke, the Swedish national quality register on stroke care, provides unique opportunities to evaluate stroke units in routine clinical care. Methods: Basic patient characteristics, process indicators and outcome variables are recorded in all 85 hospitals admitting acute stroke patients. A 3-month follow-up is included. Results: There are wide variations between hospitals in the proportion of patients admitted to a stroke unit, in secondary prevention and in the proportion of patients in institutional care at 3 months. Even after adjustment for available prognostic indicators, case fatality is lower and functional outcome is better in patients treated in stroke units than in patients treated in general wards. Conclusion: Riks-Stroke shows that outcome is consistently better in patients treated in a stroke unit than in general wards, not only in randomised trials but also in routine stroke care.
The French Stroke Program
Authors: Hommel Marc , Deblasi Alain , Garambois Katia , Jaillard Assia
Published: April 2003

The French healthcare system is organised according to a political, geographical and demographic framework. In France today, less than 20 hospitals have dedicated intensive care units for acute stroke patients. In the 1999 national survey, 94% of stroke patients were admitted to public hospitals, 35% were treated in neurological wards and 4% had access to an intensive care stroke unit. To improve the quality of care and resource utilisation, a national plan for stroke will be implemented at regional level during the next five-year plan. After a long period of status quo, many positive actions for stroke care have been initiated within a couple of years, based on the evidence of more effective stroke treatments, such as thrombolysis and the specialist care provided by stroke units.
Detection of CMV DNA in the Aqueous Humor of AIDS Patients with CMV Retinitis by AMPLICOR CMV Test
Authors: Yamamoto Narumichi , Wakabayashi Taketoshi , Murakami Kimio , Hommura Sachiko
Published: April 2003

The present study was performed to detect the cytomegalovirus (CMV) DNA in the aqueous humor from the eyes of acquired immunodeficiency syndrome (AIDS) patients with CMV retinitis. Detection of CMV DNA in the aqueous humor in the eyes with active CMV retinitis was compared with detection of CMV DNA in inactive retinitis. CMV DNA in the aqueous humor was evaluated before and after treatment with intravitreal injection of ganciclovir. CMV DNA in the aqueous humor was measured by AMPLICOR CMV test. Forty-two eyes of 35 AIDS patients were diagnosed ophthalmoscopically as having CMV retinitis that was subclassified as either active or inactive. The active and inactive CMV retinitis cases were distinguished based on clinical evaluations and fundus photographs. The results showed that 37 of the 42 eyes (88.1%) were positive for CMV DNA prior to treatment, while in 29 of these 37 eyes (78.4%), the aqueous humor became CMV DNA-negative after the treatment. Successful treatment with the intravitreal injection of ganciclovir was associated with a reduction in the detection of CMV DNA in the aqueous humor. CMV DNA was not detected in the aqueous humor of patients with quies cent CMV retinitis. In conclusion, the AMPLICOR CMV test was found to be a reliable tool for differentiating active and inactive CMV retinitis, and is useful for helping to select the optimal treatment regimen. The intravitreal injection of ganciclovir is highly effective in reducing detectable CMV DNA in the aqueous humor.
Ultrasound Biomicroscopy of Eyelid Lesions
Authors: Kikkawa Don O. , Ochabski Renata , Weinreb Robert N.
Published: April 2003

This study compared ultrasound biomicroscopy with histopathology in discerning depth of eyelid lesions and tissue characteristics. Ultrasound biomicroscopy (50 MHz) was used to analyze lesion depth and tissue characteristics of eight patients with eyelid lesions referred to a university-based referral practice prior to excisional biopsy. This data was then compared to histopathologic findings. Lesion depth measured by ultrasound biomicroscopy was correlated with histopathologic depth with a linear regression. Ultrasound biomicroscopy correlated highly to histopathology with regards to tissue characteristics and lesion depth (R2 = 0.87). Ultrasound biomicroscopy accurately measures depth of eyelid lesions and accurately determines tissue characteristics.
The External Opening of the Cochlear Aqueduct in Infants and Adults
Authors: Marques Sergio Ricardo , Bonaldi Laís Vieira , De Angelis Marco Antonio , Isotani Sadao , Smith Ricardo Luiz
Published: April 2003

Objective: The purpose of the present study is the description of the shape and area of the cochlear aqueduct (CA) opening by means of molds obtained from infant and adult temporal bones. Material and Methods: Through molding techniques the evaluation was performed in 118 temporal bones of infants (5–60 months) and of adults (19–89 years), dimensions and shapes being evaluated through computerized image processing. Results and Conclusions: The data shows that the area of the opening is significantly smaller in children than in adults (7.32 ± 3.32 versus 18.48 ± 6.42 mm2). In infants, in 56% the shape of the opening was triangular; in adults triangularity was 100%. The variability in the shape and size of the CA opening in infants suggests adaptations of the CA opening during cranial growth.
Abscess Formation and Perichondritis of the Ear following Acupuncture Treatment
Authors: Ellies Maik , Laskawi Rainer
Published: April 2003

In this patient an auricular abscess formation and perichondritis of the right ear developed following ear acupuncture treatment. Despite initially performed oral antibiotic treatment a surgical intervention and intravenous therapy with ciprofloxacin were necessary. There was only a moderate cosmetic deformity of the right ear. Because of the increasing use of ear acupuncture treatment for chronic pain states in recent years, one must be aware of the possible side-effects, which can include abscess formation and perichondritis leading to deformities of the ear. In conclusion, an absolutely aseptic treatment in ear acupuncture is recommended.
Neuroimmunomodulation and Immune Privilege: The Role of Neuropeptides in Ocular Immunosuppression
Authors: Taylor Andrew W.
Published: April 2003

Regional immunoregulatory mechanisms insure that the most effective immune defense mounted is in proportion with preserving unique tissue functionalities. Immune-privileged tissues, such as the eye, are tissue sites of extreme regional immunoregulation. They have evolutionarily adapted several mechanisms to prevent the induction of inflammation within their tissue microenvironment. With over half a century of experimental examinations of ocular immune privilege, only recently have we come to understand that neuropeptides constitutively present in ocular tissues are part of the mechanisms of immune privilege.
Tamoxifen, a Selective Estrogen Receptor Modulator, Reduces Ischemic Damage Caused by Middle Cerebral Artery Occlusion in the Ovariectomized Female Rat
Authors: Mehta Shyamal H. , Dhandapani Krishnan M. , De Sevilla Liesl M. , Webb R. Clinton , Mahesh Virendra B. , Brann Darrell W.
Published: April 2003

Previous work has demonstrated that physiological concentrations of 17β-estradiol can protect the female rat brain against middle cerebral artery occlusion (MCAO)-induced ischemic damage. The present study examined whether therapeutic doses of the clinically relevant selective estrogen receptor modulator (SERM), tamoxifen, can similarly protect the female rat brain against ischemic stroke damage. Adult female rats were bilaterally ovariectomized and implanted subcutaneously with either a placebo or tamoxifen time-release pellet (0.1, 0.8 or 2.4 mg/kg/day). One week later, the animals underwent permanent MCAO to assess the protective ability of the different tamoxifen doses on brain infarct size. As expected, MCAO produced a large infarct (∼53%) of the affected cerebral hemisphere in placebo (control) animals. The 0.1 mg/kg/day dose of tamoxifen did not exhibit any significant protective effects, however; the 0.8 and 2.4 mg/kg/day doses of tamoxifen, which are in the therapeutic range, dramatically reduced infarct of the affected cerebral hemisphere (∼70% reduction) as compared to the controls. The reduction of infarct size was primarily due to protection of two major structures, the cerebral cortex and striatum. Laser Doppler analysis further revealed that tamoxifen had no significant effect on cerebral blood flow either before or after MCAO, suggesting that tamoxifen protection is independent of cerebral blood flow changes. Further studies showed that tamoxifen pellets implanted at the time of MCAO did not reduce infarct size, suggesting that pretreatment with tamoxifen is necessary to observe a protective effect. These studies suggest that clinically important SERMs may have an additional unrecognized beneficial effect of protection of the female brain.
Induction of IκB-Kinase by Cholecystokinin Is Mediated by Trypsinogen Activation in Rat Pancreatic Lobules
Authors: Tando Yusuke , Algül Hana , Schneider Günter , Weber Christoph K. , Weidenbach Hans , Adler Guido , Schmid Roland M.
Published: April 2003

Background and Aims: Supramaximal concentrations of cholecystokinin (CCK) or cerulein induce the intracellular activation of trypsinogen and the transcription factor NF-ĸB, a key regulator of inflammatory gene expression. Both events occur early in the development of an acute pancreatitis. The aim of this study was to examine the relationship between intracellular trypsinogen and NF-ĸB activation. Methods: We detected NF-ĸB-binding activity in electromobility shift assays, IĸB proteolysis in Western analysis and endogenous IĸB-kinase (IKKα and β) activation using immune complex kinase assays following treatment with CCK in rat pancreatic lobules. To block intrapancreatic trypsinogen activation, a potent and cell-permeable serine-protease inhibitor, Pefabloc, was used. Results: CCK-induced IĸBα degradation and subsequent NF-ĸB activation correlated closely with the catalytic activity of IKKs to phosphorylate IĸBα in vitro. Activation is dose-dependent and peaked at 30 min. Doses of Pefabloc sufficient to inhibit trypsin activation reduced CCK-induced activation of NF-ĸB whereas TNF-α-induced NF-ĸB activation was not blocked but slightly increased. Moreover, treatment with Pefabloc as well as another serine protease inhibitor, FUT175, inhibited CCK-induced IKK activation. Conclusion: These results suggest that intrapancreatic activation of trypsinogen may contribute to NF-ĸB signaling via IKK activation in cerulein pancreatitis. This also explains the fact that only doses of CCK which activate trypsinogen induce NF-ĸB activation in pancreatic acinar cells. Thus, trypsinogen activation is likely to modulate signaling events in acinar cells in the initial phase of acute pancreatitis.
Dose-Dependent and Preterm- Accentuated Diaplacental Transport of Nutritive Allergens in vitro
Authors: Edelbauer Monika , Loibichler Christine , Witt Armin , Gerstmayr Marianne , Putschögl Bettina , Urbanek Radvan , Szépfalusi Zsolt
Published: April 2003

Objective: The mechanisms by which nutritive allergens are transported from mother to fetus and the ensuing immunological response are incompletely understood. We investigated the role of different allergen concentrations in influencing the diaplacental allergen transport in preterm and term placentas. Method: Twenty-seven human term placentas and 12 preterm placentas were dually perfused in vitrofor up to 4 h by adding alternately two different nutritive allergens, β-lactoglobulin (BLG) or ovalbumin (OVA), at four different allergen concentrations (0.02, 0.2, 2 and 20 mg/ml) to the maternal perfusate medium. Allergen concentrations in fetal venous outflow samples collected during perfusion were measured by using specific ELISAs. Results: Perfusion of increasing allergen concentrations via the maternal circulation resulted in a concentration-dependent increase of fetal allergen uptake in all term and preterm placentas. A mean maternal-to-fetal ratio of 20,000/1 and 3,000/1 for BLG, and 40,000/1 and 5,000/1 for OVA was found in term and preterm placentas, respectively. Preterm placentas (27–36 weeks of gestation) were found to favor the diaplacental passage of nutritive allergens compared with placentas at term (>36 weeks of gestation). Conclusion: Maternal-to-fetal allergen transport occurs in a dose-dependent and molecular weight-dependent manner with clear accentuation in preterm placentas.
Impaired Mixed Lymphocyte Reaction in Intrahepatic Cholestasis of Pregnancy
Authors: Dong Minyue , Xie Xing , Wang Zhengping , He Jing , Zhou Jianhong , Cheng Qi
Published: April 2003

Objective: To clarify the alteration of maternal-fetal mixed lymphocyte reaction (MLR) in intrahepatic cholestasis of pregnancy (ICP). Methods: Twenty-two patients with intrahepatic cholestasis of pregnancy and 21 normal pregnant women were recruited into the present study. Of patients with ICP, 5 also experienced pregnancy-induced hypertension (PIH). Maternal-fetal mixed lymphocyte reaction was conducted by using a morphologic transformation method, and the transformation rates of lymphocytes were compared either between ICP patients with and without pregnancy-induced hypertension, or between control and ICP group. Results: In the ICP group, the transformation rates of lymphocytes were not significantly different between pregnancies with and without pregnancy-induced hypertension (p > 0.5). Compared with control, the transformation rate of lymphocytes in intrahepatic cholestasis of pregnancy decreased significantly (p < 0.001). Conclusion: Suppressed mixed lymphocyte reaction was observed in intrahepatic cholestasis of pregnancy and its mechanism behind and role in the disease need to be further explored.
Body Composition Modulates the Effects of Hormone Replacement Therapy on Growth Hormone and Insulin-Like Growth Factor-I Levels in Postmenopausal Women
Authors: Figueroa Arturo , Going Scott B. , Milliken Laura A. , Blew Robert , Sharp Sarah , Lohman Timothy G.
Published: April 2003

Objective: To examine the relationships of body composition with basal serum estrone, estradiol, androstenedione, cortisol, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels in 73 postmenopausal women. Design: Cross-sectional study of hormone levels and body composition determined by dual-energy X-ray absorptiometry and anthropometry in women who were not taking oral hormone replacement therapy (HRT) and women taking HRT. Because high adiposity may modify hormone levels, subjects were grouped by fatness into obese (BMI >25 kg/m2 and waist circumference >80 cm) and lean groups, as well as by HRT use. Results: Total levels of estrone, estradiol, GH and cortisol were significantly higher and IGF-1 was lower in HRT users. In HRT users, estradiol levels were higher and GH levels were lower in obese than lean women. IGF-1 levels were lower in obese HRT users than lean nonusers. Total cortisol levels were significantly higher in lean HRT users than lean nonusers and obese users. GH and IGF-1 were significantly inversely correlated with trunk fat and percent body fat. Multiple regression revealed that only trunk fat was a significant (negative) determinant of GH and IGF-1 levels, whereas HRT use positively and negatively predicted GH and IGF-1, respectively. Percent body fat significantly predicted estradiol levels. Body composition did not differ by HRT use. Conclusions: Our results suggest that trunk fat attenuates the HRT-induced increase on GH levels. In addition, trunk fat is a significant determinant of low IGF-1 levels in postmenopausal women, and IGF-1 levels decline more with HRT use.
Axillary Lymphadenopathy as the Primary Presentation of Primary Peritoneal Carcinoma
Authors: Berker Bulent , Ortac Firat , Ataoglu Omur
Published: April 2003

The finding of isolated distant metastatic axillary lymphadenopathy without remarkable intra-abdominal disease is very unusual. We report on a patient with primary peritoneal serous carcinoma who initially presented with axillary lymphadenopathy, and was misdiagnosed as having primary breast cancer. In the case of an isolated axillary adenocarcinoma various kinds of immunohistochemical tests should be performed in order to elucidate the origin of the malignancy.
Bronchial Hyperreactivity and Allergic Status in Inflammatory Bowel Disease
Authors: Ceyhan Berrin Bagcı , Karakurt Sait , Cevik Hikmet , Sungur Murat
Published: April 2003

Background: Despite the known systemic manifestations of inflammatory bowel disease (IBD) and a large number of reports associating lung disease and IBD, the frequency of atopy and bronchial hyperreactivity (BHR) in IBD remains obscure. Objectives: The aim of this study was to investigate the prevalence of abnormal pulmonary function tests, BHR and the atopic status in patients with IBD. Methods: Thirty patients with IBD (19 with ulcerative colitis and 11 with Crohn’s disease; 19 male, 11 female) and 16 controls without any gastrointestinal disease (9 female, 7 male) were included. Patients were questioned with respect to pulmonary and allergic symptoms; subsequently, lung function tests, BHR, skin prick test positivity, peripheral eosinophilia and serum IgE levels were evaluated and compared with those of control subjects. Results: The mean duration of IBD was 5.3 ± 4.8 years. IBD patients had significantly more often respiratory symptoms in comparison with controls (odds ratio, OR: 9.0, p < 0.04). A previous diagnosis of asthma and antiasthmatic drug treatment were noted in 3/30 (10%) IBD patients. Allergic symptoms were more prevalent in IBD patients in comparison with the controls (OR: 13, p < 0.007), particularly in patients with ulcerative colitis (OR: 16, p < 0.004). The mean FEV1 was 3.1 ± 0.9 liters (96 ± 18% predicted), mean methacholine PD20: 14.7 ± 3.6 mg/ml, mean IgE: 190.5 ± 305.6 IU/ml (normal value <94 IU/ml) and the percentage of peripheral eosinophils was 3.1 ± 3.3% in the IBD patients. These values did not result in statistically significant differences in comparison with controls. Furthermore, abnormal lung function and BHR were observed in 8/30 (27%) and 5/30 (17%) IBD patients, respectively. Abnormal lung function tests were more prevalent in the IBD patients than in the controls (OR: 12, p < 0.04). Skin prick tests were positive in 15/30 (50%) IBD patients. The risk of a positive skin prick test increased in the IBD patients in comparison with the controls (OR: 7.0, p < 0.02). Duration and activity of IBD did not influence the prevalence of BHR, allergic and respiratory symptoms, abnormal lung function, high serum IgE levels and skin test positivity. Conclusions: Allergic symptoms, respiratory symptoms, abnormal lung function tests and skin prick test positivity were more common among the IBD patients in comparison with the controls.
Newly Diagnosed Chronic Obstructive Pulmonary Disease
Authors: Kornmann O. , Beeh K.M. , Beier J. , Geis U.P. , Ksoll M. , Buhl R.
Published: April 2003

Background: The new guidelines of the Global Initiative for Obstructive Lung Disease (GOLD) propose a novel staging system for COPD. This study describes the frequency distribution of GOLD stages in newly diagnosed COPD patients in a large city pulmonary practice. Methods: All patients newly admitted between 1995 and 1996 were analyzed retrospectively. Incident COPD cases were classified according to GOLD criteria. Results: Among 1,434 patients, 210 were diagnosed with chronic obstructive pulmonary disease (COPD) (60% males, age 55 years, range 20–82 years). 67.5% of the patients were current smokers, 27% ex-smokers, and 5.5% nonsmokers. Based on GOLD criteria, 37% had stage 0, 5% stage I, 46% stage II, and 12% stage III COPD. Symptoms leading patients to seek medical advice were cough (84%), exertional dyspnea (70%), and sputum (45%), with a median symptom duration of 12 months (range 1–240 months). Compared with patients with GOLD stages 0–1, those with stages 2–3 were older (60 vs. 47 years, p < 0.001), heavier smokers (40 vs. 20 pack-years, p < 0.001), had a longer duration of symptoms (24 vs. 6 months, p < 0.001), and elevated IgE (stage 3 only, p < 0.04 vs. stages 0–2). Interestingly, stage 0 COPD patients did not have ‘normal’ spirometry, as indicated by significantly lower FEV1 (% predicted) and FEF25–75 (% predicted), compared with age-matched nonsmoking controls (93.1 ± 1.8 vs. 99 ± 1.6, p = 0.004; and 76.2 ± 2.8 vs. 91.2 ± 2.9, p = 0.0003, respectively). Conclusions: The majority of COPD patients seek medical advice at advanced disease stages, and smoke actively despite severe symptoms and functional impairment. However, nearly every second patient presents at stages 0–1, thus opening a window for therapeutic or behavioral intervention. GOLD guidelines are a useful basis to reinforce screening programs aimed at early detection and prevention of progressive COPD in individuals at risk and smoking cessation.
Obstructive Sleep Apnea Syndrome as First Manifestation of Pharyngeal Non-Hodgkin’s Lymphoma
Authors: Gómez-Merino Elia , Arriero Juan Manuel , Chiner Eusebi , Signes-Costa Jaime , Marco Juan
Published: April 2003

Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive episodes of upper airway obstruction during sleep that provoke an abnormal number of apneas and hypopneas, leading to arousals and, as a result, to an altered sleep architecture. Here we present a patient with clinical symptoms characteristic of OSAS. During follow-up, pharyngeal non-Hodgkin’s lymphoma was diagnosed and treated, with a nearly complete normalization of polysomnography.
Pleural Effusion with Splenic Rupture as Manifestations of Recurrence of Sarcoidosis following Prolonged Remission
Authors: Nusair Samir , Kramer Mordechai R. , Berkman Neville
Published: April 2003

A 55-year-old man presented with a 3-week history of dry cough and left pleuritic chest pain with a new exudative pleural effusion. Sixteen years earlier, he was diagnosed with sarcoidosis presenting with hilar lymphadenopathy, erythema nodosum, mildly disturbed liver function tests and noncaseating granulomata on liver biopsy, with no evidence of pulmonary parenchymal disease. He was treated with prednisone and in recent years maintained at a low daily dose, until it was eventually discontinued two years prior to his present illness. There was no evidence of infection or malignancy, and the fluid resolved following treatment with naproxen. Three weeks later the patient presented with sudden onset of dyspnea and left chest pain. After starting intravenous heparin for suspected pulmonary emboli, the patient developed hemodynamic instability which was accompanied by abdominal tenderness and decreasing hematocrit. Splenic rupture was diagnosed, and the patient underwent splenectomy. Pathology specimens revealed a hemorrhagic infarct with subcapsular hematoma, and numerous noncaseating granulomata within the splenic tissue. This patient had recurrent sarcoidosis with two rare manifestations of the disease, 2 years after withdrawing low dose prednisone, given for a prolonged time. The possibility of reemergence of the disease in organs other than the organs involved in the initial presentation should always be considered in sarcoidosis.