bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Long-Term Administration of Prostaglandin I2 in Incipient Diabetic Nephropathy
Authors: Owada Akira , Suda Shin , Hata Toshihiko
Published: April 2003

Background/Aims: Diabetic nephropathy is one of the primary diseases of refractory renal failure and heads the list of patients undergoing dialysis. Therefore, it is very important to get treatment in incipient nephropathy. Methods: Twenty-seven patients in incipient diabetic nephropathy of type 2 diabetes mellitus who showed signs of microalbuminuria were randomly, but not blindly, assigned to two groups, either the beraprost sodium (PGI2) group or the control group, and effects of the preparation on urinary albumin excretion or other parameters were examined for 24 months. Results: Urinary albumin excretion was significantly decreased after 18 months in beraprost sodium group; however, there was no change in the control group. Difference was observed between the two groups after month 12; however, it was not significant (p = 0.0673 at month 24). Three factors that affect urinary albumin excretion, e.g. blood pressure, blood sugar and protein intake, were almost constant during the study period. The level of creatinine clearance was significantly decreased in beraprost sodium group after 24 months as compared with the control group. Conclusion: In this study, we found that the long-term 24-month administration of PGI2 preparation, beraprost sodium, decreased albuminuria in patients of incipient diabetic nephropathy. The possible mechanisms are that the PGI2 may have alleviated constriction effect of angiotensin II on efferent glomerular arteriole and attenuated glomerular hyperfiltration, and inhibited growth of mesangial cells by platelet-derived growth factor as well.
No Effect of Transfusion Transmitted Virus Viremia on the Distribution and Activation of Peripheral Lymphocytes in Hemodialyzed Patients
Authors: Fodor Bertalan , Ladányi Erzsébet , Aleksza Magdolna , Takács Mária , Lakos Gabriella , Árkossy Ottó , Koós Aranka , Nagy Attila , Széll Júlia , Klenk Nora , Sárváry Enikő , Sipka Sándor
Published: April 2003

Aim: We aimed to examine the distribution and activation of peripheral T cells in TTV positive (n = 32) and negative (n = 17) hemodialyzed patients. The control group (n = 20) consisted of healthy blood donors. Method: TTV-DNA was detected by seminested PCR. CD3, CD4, CD8, CD19, CD56, CD3/HLA-DR, CD3/CD69 and the Th1/Th2 ratio of T cells were analyzed by flow cytometry. Circulating IFN-γ, IL-2, IL-4, IL-6, IL-10, IL-13, TNF-α, TGF-β levels were measured by ELISA in the sera. Results: There was no difference between the CD3, CD4, CD8 and CD19 values of HD subjects. In addition, the expression of both activation markers, HLA-DR and CD69, was significantly elevated in the TTV-positive and -negative HD groups compared to the controls, but not showing any difference from each other. The measurements of intracellular cytokines showed the enhanced occurrence of INF-γ + CD4 T cells, and decreased appearance of IL-4 + CD4 lymphocytes in the HD groups without any significant difference between the TTV virus positive and negative patients. In addition, HD also elevated the expression of IL-10 in CD4 and CD8 (Th2) cells. There were only two significant changes in the levels of circulating cytokines: (a) IL-2 increased; (b) IL-13 decreased in both groups of HD patients compared to the controls, independently of TTV positvity or negativity. Conclusions: We assume that transfusion-transmitted virus does not cause any specific change in the distribution and activation of lymphocytes in the peripheral blood of hemodialyzed patients. Hemodialysis itself, however, results in a significant activation of peripheral T cells with the domination of increased production of Th1 type cytokines, IFN-γ, IL-2, in contrast to the decreased synthesis of Th2 type cytokines, IL-4 and IL-13. Furthermore, the increased expression of IL-10 in the CD4 and CD8 cells of HD patients can be the sign of a contraregulatory Th2 activation as an answer on the Th1 effect.
Serum Matrix Metalloproteinases MMP-2 and MMP-3 Levels in Dialysis Patients Vary Independently of CRP and IL-6 Levels
Authors: Preston Gloria A. , Barrett Cheri V. , Alcorta David A. , Hogan Susan L. , Dinwiddie Lesley , Jennette J. Charles , Falk Ronald J.
Published: April 2003

Background: Patients on chronic hemodialysis or peritoneal dialysis often develop an inflammatory state that causes morbidity and mortality. Cross-sectional studies of dialysis patients have determined that C-reactive protein (CRP) is a predictor of morbidity. Little is known as to whether CRP, cytokines, such as IL-6 and IL-1β that stimulate the synthesis of CRP, or matrix metalloproteinases (MMPs) are markers of inflammation in patients on dialysis. Methods: We assayed by ELISA serum levels of MMP-2, MMP-3, IL-6 and CRP in healthy individuals and in patients with pre-end-stage renal disease (pESRD, n = 10), peritoneal dialysis (PD, n = 11), hemodialysis (HD, n = 17) and renal transplant (TX, n = 10). Results: MMP-2 was significantly elevated before dialysis, perhaps indicative of progressive chronic renal sclerosis. MMP-3 was markedly elevated in hemodialysis patients but not in pESRD or PD patients, and may be related to the hemodialysis process and/or accelerated atherogenesis in these patients. IL-6 was significantly elevated in all patient groups, including pESRD patients. There were no statistically significant differences in CRP levels among the study groups. CRP correlated with IL-6, but not with MMP-2 or MMP-3. Conclusions: The data indicate that there are measurable differences in the expression of MMPs within the dialysis patient population. Because dialysis can be associated with local and systemic inflammation, increased levels of MMP-3 in the hemodialyis group may be a reflection of gene stimulation induced by inflammatory cytokines and should be considered as a marker of chronic, local inflammation.
Vasovagal Syncope in Emergency Room Patients: Analysis of a Metropolitan Area Registry
Authors: Casini-Raggi Vincenzo , Bandinelli Gabriele , Lagi Alfonso
Published: April 2003

The aim of this study was to assess the epidemiology of syncope in unselected patients referred to an emergency room and eventually admitted to the clinical wards to perform a complete work-up, and to analyze the costs of hospitalization. The clinical charts of all patients referred for all causes to the emergency rooms of three hospitals in the Florence area during the year 2000 and of all patients admitted from the emergency rooms to the clinical wards with a diagnosis of lone-related (vasovagal) or disease-related syncope were revised. A total of 1,290 (3.36%) cases of syncope out of 38,330 presentations were registered; among these, 702 cases (1.83% of all presentations, 54% of all syncopes) were directly discharged, and 443 cases (1.14% of all presentations, 34% of all syncopes) were hospitalized. The remaining 149 cases (12% of all syncopes) refused admission. Following admission, 500 patients were discharged with the diagnosis of syncope: 115 lone-related (23%) and 385 disease-related syncopes (77%). A cost-benefit analysis of the hospitalized patients showed that admitting patients with lone syncope leads to an economical loss to the hospital.
Different Aetiology of Familial Low-Grade and High-Grade Glioma? A Nationwide Cohort Study of Familial Glioma
Authors: Malmer Beatrice , Henriksson Roger , Grönberg Henrik
Published: April 2003

An increased risk for first-degree relatives (FDR) of glioma patients has previously been observed. The novel objective of this study was to investigate differences in familial risk among FDR of low-grade glioma (LGG) and high-grade glioma (HGG) cases, respectively. Two cohorts were constructed, one from 15,321 FDR of LGG cases and the other from 26,635 FDR of HGG cases calculating standardised incidence ratios (SIR). The risk for LGG among FDR of LGG cases was significantly increased, SIR 3.65 (95% CI 2.31–5.47). The risk was even higher in the cohort of siblings, SIR 7.00 (95% CI 3.35–12.87), and especially in the younger siblings (<40 years), SIR 9.01 (95% CI 4.31–16.57). When calculating the risk for HGG in the LGG cohort and the risk for HGG in the HGG cohort, there was a generally twofold increased risk, but no trends of increased risk in relatives of younger probands. Two different methods calculating familial risk displayed similar results. LGG families apparently have features manifesting a distinct pedigree pattern with sibpairs affected at a young age. These families could provide new insights into the aetiology of glioma.
Differential Expression of Genes from Nitrate-Tolerant Rat Aorta
Authors: Pi Xinchun , Yan Chen , Kim Dongsoo , Chen Jiyuan , Berk Bradford C.
Published: April 2003

Organic nitrates act as vasodilators and have long been used for treatment of cardiovascular diseases. However, the therapeutic effect of nitrates is limited by induction of nitrate tolerance which is associated with endothelial dysfunction and enhanced vasoconstriction. Multiple mechanisms cause nitrate tolerance including alterations in gene expression. To identify genes whose expression is altered due to chronic treatment with nitroglycerin (NTG), nitrate-tolerant rats were made by infusion of NTG for 3 days (10 µg/kg/min) using an osmotic minipump. We constructed a PCR-selected cDNA subtracted library from NTG-treated and vehicle-treated rat aortas. Screening of ∼500 clones in the subtracted library showed that four genes were regulated by NTG treatment. Specifically, mRNA levels of β-globin, tropoelastin, gelsolin and a small G protein were confirmed to be upregulated consistently by NTG treatment. These identified genes may play important roles in the development of nitrate tolerance and represent promising candidates to understand the mechanisms of nitrate tolerance and endothelial dysfunction in the vasculature.
External Collar Inhibits Balloon-Induced Intimal Hyperplasia in Rabbits
Authors: Fogelstrand Per , Risberg Bo , Mattsson Erney
Published: April 2003

Intimal hyperplasia is a common complication following vascular interventions. To understand the underlying pathophysiology, the focus has mainly been on the intima and media. The adventitia has been less investigated, although adventitial hyperplasia is seen together with intimal hyperplasia. If the adventitial response is an important part of the process, the adventitia might be a target to inhibit intimal hyperplasia. In the present study we investigated whether an external collar attenuating the adventitial thickness could inhibit a balloon-induced intimal hyperplasia. The common carotid artery was injured in rabbits (n = 6) with a 3-french balloon catheter. The mid portion of the injured artery was encircled with a silicone collar (diameter = 2.0 mm). After 14 days the balloon-induced neointima was reduced by 54 ± 6.3% underneath the collar. The adventitial and medial thickenings were also attenuated (36 ± 8.7 and 44 ± 4.3%, respectively). This study demonstrates that intimal hyperplasia following balloon injury can be inhibited with an external collar. This supports the idea of the adventitia as a potential target to inhibit intimal hyperplasia.
Trimethoprim versus Gentamicin for the Prevention of Bacteriuria following Transrectal Biopsy of the Prostate – Do Patients Need Additional Anaerobic Cover?
Authors: Shivde S.R. , Cooke R.P.D. , O’Neill W.A. , Cowie A.G.A. , Lawrence W.T. , Watson G.M.
Published: April 2003

Objectives: To study the incidence of aerobic and anaerobic bacteriuria in patients undergoing transrectal ultrasound-guided biopsies of the prostate. A comparative assessment of efficacy of trimethoprim with gentamicin for the prevention of bacteriuria following the transrectal biopsy of the prostate. To assess the need for additional prophylaxis against anaerobes for patients undergoing transrectal biopsies of the prostate gland. Patients and Methods: In a pilot study during 1995–1997, all the patients undergoing transrectal ultrasound-guided biopsy of the prostate were randomised to receive either trimethoprim or gentamicin prophylaxis prior to the procedure. Midstream urine (MSU) samples were taken just prior to biopsy and 72 h later. A patient questionnaire to determine the symptoms of urinary tract infection (UTI) accompanied the 72-hour MSU request form. Urine samples were cultured aerobically, using a semiquantitative technique if dipstick analysis revealed the presence of blood, pus cell or nitrite. In addition to the routine aerobic culture, post-biopsy samples were also cultured for anaerobes by direct and enrichment methods. Bacteriuria was defined as a pure or mixed growth of 105 colony-forming units/ml. Fisher’s test of exact probability was used for statistical analysis. Results: 115 patients were available for final analysis. 53 had received gentamicin and 62 trimethoprim. Four patients had pre-existing bacteriuria (3.5%), 3 in the trimethoprim group and 1 in the gentamicin group. Post-operative bacteriuria developed in 5 patients given gentamicin (9.4%) and 1 given trimethoprim (1.6%). This difference was not statistically significant (p = 0.085). Post-procedure bacteriuria was asymptomatic in all but 1 case. Anaerobes were detected in only 5 MSUs (4.3%) post-biopsy. Conclusion: Though there was no statistical significant difference in the rates of bacteriuria following administration of trimethoprim and gentamicin, data appear to favour trimethoprim prophylaxis. Further studies are warranted. Transrectal biopsy of the prostate is associated with a low incidence of anaerobic UTI. In view of the very low incidence of anaerobic bacteriuria, routine antibacterial prophylaxis against anaerobes does not appear to be justified.
Protective Effect of Trimetazidine in a Model of Ischemia-Reperfusion in the Rat Retina
Authors: Mohand-Said S. , Jacquet A. , Lucien A. , Espinasse-Berrod M.A. , Frasson Correa De Silva M. , Sahel J.
Published: April 2003

Trimetazidine is an anti-ischemic agent which is frequently prescribed as a prophylactic treatment of episodes of angina pectoris and as a symptomatic treatment of vertigo and tinnitus. It has also shown beneficial effects in models of visual dysfunction, but the mechanism(s) by which this occurs is as yet undefined. The present study was intended to evaluate the influence of trimetazidine on retinal damage induced by ischemia-reperfusion in a rat model. Retinal ischemia was induced by increasing intraocular pressure to 160 mm Hg for 60 min. Trimetazidine or buffer controls were administered 3 days before the ischemia or in the postischemic period. The degree of retinal damage was assessed after 15 and 30 days of reperfusion after the ischemic insult by histopathologic study according to Hughes’ quantification of ischemic damage. Retinal ischemia led to significant reductions in thickness and cell number, mainly in the inner retinal layers. The results from the study demonstrate that treatment with intraperitoneally injected trimetazidine conferred significant protection against retinal ischemic damage. Better results were obtained in the pretreatment group after 15 days of reperfusion. Trimetazidine protects the rat retina from pressure-induced ischemic injury and might be considered a potential therapeutic modality for combating retinal ischemia.
Prevalence of Disorders of Executive Cognitive Functioning among the Elderly: Findings from the San Luis Valley Health and Aging Study
Authors: Grigsby Jim , Kaye Kathryn , Shetterly Susan M. , Baxter Judith , Morgenstern Nora E. , Hamman Richard F.
Published: April 2003

The San Luis Valley Health and Aging Study is a population-based epidemiologic study of chronic illness and disability among Hispanic and non-Hispanic white persons over the age of 60 in two counties in rural southern Colorado, USA. Between 1993 and 1995, we examined the prevalence of impaired executive cognitive functioning in a sample of 1,313 individuals living both in the community and in nursing homes. Overall, 1 person in 3 was found to have at least mild impairment, while 1 in 6 had moderate to severe deficits. Increasing levels of executive functioning impairment were associated with lower education, advancing age, and Hispanic ethnicity. After controlling for education and acculturation, the differences by ethnic group were no longer significant.
Cytogenetic and Molecular Genetic Aspects of Childhood Myeloproliferative/Myelodysplastic Disorders
Authors: Hall Georgina W.
Published: April 2003

Of the myeloproliferative/myelodysplastic disorders (MPD/MDS) that occur in childhood most, regarding the cytogenetic and molecular genetic basis, is known about the two purely paediatric disorders: juvenile myelomonocytic leukaemia (JMML) and transient myeloproliferative disorder (TMD). Although much has been published about these two disorders, their aetiology is by no means fully established. It would appear, however, that in this paediatric subset of MPDs a stage/developmentally specific vulnerability for proliferation and transformation exists. The study of the molecular basis of many other MPD-like syndromes that also occur in childhood, has been greatly accelerated by the identification of rare, but recurring, cytogenetic abnormalities involving 8p11 and 5q31–33. Good collaborative studies could result in similar progress being made in the understanding of JMML and TMD.
Management and Outcome of Non-Traumatic Cerebellar Haemorrhage
Authors: Cohen Zvi R. , Ram Zvi , Knoller Nachshon , Peles Einat , Hadani Moshe
Published: April 2003

Thirty-seven patients with non-traumatic cerebellar haemorrhage were treated in our department between 1984 and 1999. The outcome was retrospectively analysed according to the neurological status, CT findings and the selected treatment modality (conservative therapy vs. surgery). Our data indicate that in that sample size, the size of the haematoma was the only significant predictor of the outcome (p = 0.04). The prediction of the outcome by a logistic regression model includes both the size of the haematoma and the treatment modality (surgery or conservative) as variables. The data suggest that patients in a good neurological status on admission (Glasgow Coma Scale 13–15) with a small haematoma (<3 cm) should be treated conservatively. In all patients with large haematomas (>3 cm), including those in a good neurological status, and in all comatose patients, surgical evacuation is indicated. A different haematoma size as a cut-off point for choosing surgery as the preferred therapeutic modality, as well as the indication for ventriculostomy as a temporizing measure or a substitute for surgery are yet undetermined and need further investigation in a randomized trial.
Dynamic Single-Section CT Demonstrates Reduced Cerebral Blood Flow in Acute Intracerebral Hemorrhage
Authors: Rosand Jonathan , Eskey Clifford , Chang Yuchiao , Gonzalez R. Gilberto , Greenberg Steven M. , Koroshetz Walter J.
Published: April 2003

Optimum blood pressure (BP) management in acute intracerebral hemorrhage (ICH) remains controversial. BP reduction may limit hematoma expansion, but may also exacerbate ischemia. Reduced regional cerebral blood flow (rCBF) has been reported in ICH. Its extent and precise pattern, however, remain uncertain. Dynamic single-section CT perfusion (CTP) is rapid, easily performed and offers superior spatial resolution to PET, SPECT and MRI. It may be the most applicable method for assessing the effects of BP management on rCBF in ICH. We sought to assess whether CTP can identify rCBF abnormalities in acute ICH in 5 patients with ICH who underwent CTP within 24 h of symptom onset. rCBF was measured in serially expanded 2-mm rings around the hematoma and compared with rCBF in the uninvolved hemisphere. Mean time to CTP was 9 h (range 3–23). Mean ICH volume was 25 ml (range 9–64). Perihematoma perfusion was reduced in all patients compared with contralateral hemisphere rCBF. rCBF reduction was most pronounced immediately adjacent to the hematoma (p < 0.05 at 2 mm, p = 0.084 at 4 mm, p > 0.2 at 6 and 8 mm). Perihematoma rCBF increased as a function of the distance from hematoma perimeter. Rate of rCBF increase over distance correlated with time from onset (p = 0.006). We conclude that CTP identifies a rim of reduced rCBF in ICH. A gradient of hypoperfusion appears to extend at least 4 mm beyond the hematoma edge and may be time dependent. Whether reduced CBF is associated with perihematoma ischemia requires additional study.
Heme Oxygenase-1 Induction and Dependent Increase in Ferritin
Authors: Gonzales Soledad , Erario María A. , Tomaro María L.
Published: April 2003

The in vivo effect of hemin on both brain oxidative stress and heme oxygenase-1 (HO-1) induction was studied. A marked increase in lipid peroxidation was observed 1 h after hemin administration and antioxidant enzymes significantly decreased 3 h after hemin injection. HO-1 activity appeared 6 h after treatment, peaking 9 h after hemin administration. Such induction was preceded by a decrease in GSH pool and an increase in hydrogen peroxide concentration. Iron ferritin levels and ferritin content began to increase 6 h after HO-1 induction, and these increases remained high for at least 24 h after hemin injection. Administration of bilirubin entirely prevented HO-1 induction as well as the generation of oxidative stress parameters. These results indicate that the induction of heme oxygenase by hemin may be a general response to oxidant stress, by increasing bilirubin and ferritin levels and could therefore provide a major cellular defense mechanism against oxidative damage.
Thyroid Function in Kuwaiti Subjects with Down’s Syndrome
Authors: Ali Fawzi E. , Bayoumy Hossam A. , Mohammad Abdul Salam R. , Al-Busairi Waleed A. , Al-Othman Abdul Naser A.
Published: April 2003

Objective: To investigate the thyroid function of individuals with Down’s syndrome (DS). Methods: Thyroid function and antithyroid antibodies were measured in 58 Kuwaitis with DS who resided at a residential facility or attended rehabilitation centers. Results: Twenty-six subjects (45%) were euthyroid and 32 (55%) had thyroid dysfunction. One patient had previously been diagnosed with thyroid failure whereas the other 31 patients had newly discovered disease: 9 patients had primary hypothyroidism (T4 9.95 ± 1.1 pmol/l and TSH 15.15 ± 11.93 mU/l), 19 subclinical hypothyroidism (TSH 6.47 ± 2.57 mU/l), 1 secondary hypothyroidism, 1 hyperthyroidism, and the remaining 1 subclinical hyperthyroidism. Antithyroid antibodies were found in 52% of the total subjects and in 59% of those with thyroid dysfunction. Conclusions: Thyroid dysfunction is common in Kuwaiti subjects with DS and is presumably the consequence of autoimmune thyroid disease. Periodic thyroid function testing is recommended in individuals with DS, which is best done through a national program.
Patient Characteristics and Practice Patterns in the Treatment of Acute Myocardial Infarction in Kuwait: A Pilot Study
Authors: Rashed Wafa , Zubaid Mohammad , David Thomas , Mohammad Bader , Basharuthulla Mahmoud S. , Smid Jaroslav , Khan Hassan , Memon Anjum
Published: April 2003

Objectives: To determine the characteristics, management and outcomes of patients with acute myocardial infarction (AMI) admitted to the general hospitals and to assess the feasibility of establishing a registry for AMI in Kuwait. Subjects and Methods: We prospectively included 111 consecutive patients (94 males and 17 females, mean age 55 years) admitted to the coronary care units of the five participating hospitals during May 2000. The subjects all had a final diagnosis of AMI. A structured data collection form that included biochemical measurements was filled out for each patient. Results: The prevalence of hypercholesterolemia, diabetes, hypertension and current smoking was 46, 45, 30 and 49%, respectively. Fifty-four of 57 patients who were eligible for thrombolytic therapy received treatment. The median time from symptom onset to thrombolytic therapy was 180 min. At discharge 93% were prescribed aspirin, 81% beta-blockers, 40% angiotensin-converting enzyme inhibitors, and 32% lipid-lowering drugs. The in-hospital mortality was 10%. Conclusions: The incidence of smoking, diabetes and hypercholesterolemia is high among our patients. Thrombolytic therapy is used regularly but insufficiently early. Based on this pilot study, it is feasible to establish an AMI registry in Kuwait.
Cardiac Tests in Asymptomatic Type 2 Diabetics
Authors: Al-Attar Abdulnabi T. , Mahussain Suad A. , Sadanandan S.
Published: April 2003

Objective: To evaluate the use of noninvasive procedures for the detection of myocardial ischemia and its relation with other coexistent clinical factors in patients with asymptomatic type 2 diabetes mellitus. Subjects and Methods: A total of 42 patients with type 2 diabetes mellitus, aged 41–72 years with no clinical history suggestive of coronary heart disease, were evaluated for silent myocardial ischemia by stress cardiac exercise tolerance test (ETT), 12-lead electrocardiography (ECG), transthoracic echocardiography and stress myocardial perfusion scan using technetium-99m tetrofosmin. Results: Eleven patients (26.2%) showed an ischemic pattern on ETT, the resting ECG was suggestive of ischemia in only 2 (4.8%), echocardiography showed diastolic dysfunction in 9 (21.4%), and the stress myocardial perfusion scan was ischemic in 3 (7.3%). For subjects over the age of 57, a significant difference was found between age and ischemic ETT (p = 0.026) and diastolic dysfunction by echocardiography (p = 0.044). Patients with microalbuminuria and/or diastolic dysfunction were more likely than others to have ischemic ETT (p = 0.036 and 0.024, respectively) and patients with diastolic dysfunction had a higher prevalence of ischemic ETT. There was no relation between ischemic ETT and other major cardiac risk factors (hypertension, dyslipidemia, smoking, sex, duration of diabetes, BMI, and glycated hemoglobin levels). Conclusion: The cardiac ETT was most helpful for detecting myocardial ischemia in asymptomic type 2 diabetics. For equivocal ETT findings, echocardiography is recommended. The prevalence of myocardial ischemia was high in patients with type 2 diabetes mellitus.
Transverse Colon Diverticulitis Simulating Inguinal Hernia Strangulation: A First Report
Authors: Yahchouchy-Chouillard Elie K. , Aura Tamer R. , Lopez Yves N. , Limot Olivier V. , Fingerhut Abe L.
Published: April 2003

Background: Strangulation is the most serious complication of inguinal hernia. Diverticulitis, a common condition, is usually localized in the left colon. The association of complicated inguinal hernia and diverticulitis is rare. Methods: We report the case of a 73-year-old male patient who presented with a suspicion of strangulated inguinal hernia. Results: CT and operative findings showed transverse colon diverticulitis lodged in an incarcerated inguinal hernia without signs of strangulation. Surgical hernia repair was undertaken while the treatment of diverticulitis was conservative. Follow-up was uneventful. Conclusion: This is a first report of documented transverse colon diverticulitis simulating inguinal hernia strangulation.
Jejunal Intussusception of a Gastric Lipoma: A Review of Literature
Authors: Mouës C.M. , Steenvoorde P. , Viersma J.H. , van Groningen K. , de Bruïne J.F.
Published: April 2003

Gastrointestinal intussusception is an uncommon condition caused by a pendunculated, gastric tumor being forced through the pyloric sphincter and into the duodenum. An extremely rare case of gastrojejunal intussusception caused by a giant gastric lipoma is described in this article. The patient presented with anemia and weight loss. Initial gastroduodenal endoscopy failed to establish the diagnosis but abdominal ultrasound and computed tomography revealed signs of intussusception possibly associated with a lipoma of the small bowel. At laparotomy a pendunculated, submucosal, gastric lipoma, measuring 10 × 5 cm was found to have been intussuscepted into the jejunum. It was reduced and removed through a gastrotomy. Recovery was uneventful.
Modern Treatment of Early Gastric Cancer: Review of the Japanese Experience
Authors: Adachi Yosuke , Shiraishi Norio , Kitano Seigo
Published: April 2003

Background: Recently, detections of early gastric cancer (EGC) have been increasing, and the treatment strategies for gastric cancer have been changing. To demonstrate recent clinical experience of EGC in Japan and to assess modern strategies for the treatment of EGC, we investigated the English-language literature of the past 10 years through computer searches. Methods: This article intends to provide gastric surgeons with recent Japanese experience of the treatment for EGC. In a search for modern treatments of EGC, we selected 100 papers published in well-known medical journals, and focused on the following items of EGC: (1) prognostic factors, (2) endoscopic treatment, (3) surgical procedures, and (4) Japanese guidelines. Results: The most important factor influencing the survival of patients with EGC is the status of lymph node metastasis. The incidence of lymph node metastasis is 1–3% for mucosal cancers and 11–20% for submucosal cancers. Endoscopic mucosal resection (EMR) is a technique for the treatment of EGC, and the recent indication includes the tumors confined to the mucosa up to 3 cm in size or those invading the superficial submucosa. Surgical procedures include conventional Billroth I gastrectomy, limited resections, and laparoscopic surgery. Laparoscopic wedge resection using the lesion-lifting method and laparoscopy-assisted distal gastrectomy provide less pain, faster recovery and shorter hospital stay. Guidelines for the treatment of gastric cancer proposed by the Japanese Gastric Cancer Association show that patients with mucosal cancer can be managed by EMR or distal gastrectomy, whereas patients with submucosal cancer are candidates for distal gastrectomy with lymph node dissection. Conclusion: Although the prognosis of patients with EGC depends on the presence or absence of lymph node metastasis, most are successfully treated by modern endoscopic or surgical techniques. Laparoscopic surgery and limited resections will contribute to the better quality of life of patients with EGC.
Power Doppler Ultrasonographic Diagnosis of Small Hepatocellular Carcinomas
Authors: Morimoto Yoshihiko , Kubo Shoji , Shuto Taichi , Tanaka Hiromu , Hirohashi Kazuhiro , Yamamoto Takatsugu , Yamada Ryusaku , Kinoshita Hiroaki
Published: April 2003

Background/Aims: Power Doppler ultrasonography can evaluate the hemodynamics of intrahepatic tumors. The ability of power Doppler ultrasonography to detect small hepatocellular carcinomas and estimate the differentiation of the tumor by the patterns of intranodular waves was assessed. Methods: We used conventional B-mode ultrasonography, power Doppler ultrasonography, and dynamic computed tomography to examine 71 hepatocellular carcinomas (≤3 cm) before liver resection. Results: The sensitivity of conventional ultrasonography, power Doppler ultrasonography, and computed tomography increased as tumor diameter increased, with little difference between modalities. Nodules up to 5 mm in diameter as well as some nodules in the lateral segment or the subphrenic area of the liver were not detected by power Doppler ultrasonography, although two nodules not detected by computed tomography were apparent from power Doppler ultrasonography. With the latter modality, the proportion of nodules with afferent pulsatile waves was higher in moderately or poorly differentiated hepatocellular carcinomas than in well-differentiated hepatocellular carcinomas. Afferent continuous waves were detectable only in well-differentiated hepatocellular carcinomas. Conclusion: Although the sensitivity of power Doppler ultrasonography remains unsatisfactory for minute lesions (≤5 mm) and for laterally or subphrenically situated lesions, this method can usually distinguish moderately or poorly differentiated from well-differentiated hepatocellular carcinomas, which is useful in planning treatment and predicting outcome.
Human Rhinovirus 87 Identified as Human Enterovirus 68 by VP4-Based Molecular Diagnosis
Authors: Ishiko Hiroaki , Miura Rika , Shimada Yasushi , Hayashi Akio , Nakajima Haruhiko , Yamazaki Shudo , Takeda Naokazu
Published: April 2003

Human rhinoviruses (HRVs) are the major cause of respiratory infections. We developed a diagnostic method for HRVs based on the reverse-transcription polymerase chain reaction (RT-PCR) and VP4-based phylogenetic analysis. A set of primers used in the RT-PCR of human enteroviruses (EVs) appeared to be capable of amplifying all prototype strains of HRVs, each of which generated a 530-bp fragment. The single exception was HRV-87, which generated a 650-bp fragment, as observed in human EVs. The VP4 nucleotide sequence of HRV-87 showed more than 97% nucleotide identity with human EV-68, and formed a monophyletic cluster along with the prototype strain of EV-68 in the human EV-D cluster. HRV-87 showed the second highest homology (76.8%) with EV-70, another member of the human EV-D, in a sample of 66 human EVs and 12 HRVs. Therefore, HRV-87 should be reclassified into the cluster containing human EV-68.
Effects of 17β-Estradiol and Xenoestrogens on the Neuronal Survival in an Organotypic Hippocampal Culture
Authors: Sato Kaoru , Matsuki Norio , Ohno Yasuo , Nakazawa Ken
Published: April 2003

Xenoestrogens are man-made compounds that mimic the actions of estrogens through interactions with estrogen receptors (ERs). Although xenoestrogens have received a great deal of attention as possible causes of brain disfunctions, little information concerning the effects of xenoestrogens on the central nervous system is available. In this study, we investigated the effects of 17β-estradiol (E2) and four xenoestrogens (17α-ethynylestradiol, diethylstilbestrol, p-nonylphenol and bisphenol A (BPA)) on the neuronal survival using organotypic hippocampal slice cultures. When the cultured hippocampal slices were exposed to glutamate (1 mM, 15 min), the CA1-selective neuronal damage was induced. Pretreatment with E2 and the xenoestrogens (24 h) selectively exacerbated the CA3 neuronal damage caused by glutamate. In spite of the marked difference of binding affinities to ERs, all compounds revealed maximal effects at 1 nM. ER antagonists, tamoxifen and ICI 182,780, did not affect responses to E2 and the xenoestrogens, indicating that these effects are mediated through mechanisms other than ERs. In spite of the fact that BPA has little interaction with ERs at 1 nM, E2 and BPA equally increased the expression of N-methyl-D-aspartate receptor in CA3 and upregulated the spine density of the apical portion of CA3 dendrites at 1 nM. These compounds also enhanced the sprouting of mossy fibers to CA3 neurons. These results suggest that exposure to E2 and xenoestrogens during the developmental stage results in a marked influence on synaptogenesis and neuronal vulnerability through mechanisms other than ERs.
Evaluation of Barrier Creams against Sulphur Mustard
Authors: Chilcott Robert P. , Jenner John , Hotchkiss Sharon A.M. , Rice Paul
Published: April 2003

The purpose of this study was to assess the effectiveness of a range of passive and reactive barrier cream formulations against the chemical warfare agent sulphur mustard (SM) using an in vitro diffusion cell system containing human skin. In general, proprietary formulations were relatively effective under occluded conditions, but ineffective under unoccluded conditions. For example, SM skin absorption rates through occluded control and Stokoderm® pre-treated skin were 538 ± 193 and 200 ± 51 µg·cm–2·h–1, respectively (p < 0.05). Under unoccluded conditions, control and Stokoderm pre-treated skin absorption rates were 4.41 ± 1.90 and 36.84 ± 15.19 µg·cm–2·h–1 (p < 0.05). Novel (perfluorinated) barrier creams were generally more effective under unoccluded conditions; pre-treatment with one formulation led to an 18-fold reduction in skin absorption rate and reduced the total amount of SM penetrated by 95% of the applied dose. Several proprietary formulations also had adverse effects on the effectiveness of the skin decontaminant fuller’s earth. The rate (Jss) and total amount (percentage of dose) of SM absorbed through the skin were deemed to be independent parameters of barrier cream performance. These data indicate that (1) perceived conditions of use, (2) compatibility with existing protective equipment and (3) the rate and extent of SM skin absorption must all be taken into account when evaluating barrier creams in vitro.
A Distal Protruding Ureteral Polyp Looking Like a Bladder Mass
Authors: Isikay Levent , Ozdemir Gurhan , Altan S. Ali , Akgul Turgay , Gonenc Faruk
Published: April 2003

A 34-year-old female patient with a right lumbar and back pain during micturition is presented. Ultrasonography and intravenous urogram both supported a possible bladder mass. Finally, a ureteral polyp was diagnosed on cystoscopy and resected by the ureteroscopic approach.
Conservative Management of Spontaneous Rupture of a Sigmoid Colon Neobladder
Authors: Gupta N.P. , Nabi G. , Ansari M.S.
Published: April 2003

A case of successful management of spontaneous perforation of an orthotopic sigmoid colon neobladder 18 months following radical cystectomy for muscle-invasive transitional cell carcinoma is described. Conservative management of such perforations has rarely been described in the literature; however, this is the first case report of sigmoid colon neobladder perforation and of its successful conservative management, to the best of our knowledge.
Phase II Study of Repeated Single 24-Hour Infusion of Low-Dose 5-Fluorouracil for Palliation in Symptomatic Hormone-Refractory Prostate Cancer
Authors: Bex A. , Otto T. , Lümmen G. , Rübben H.
Published: April 2003

Background: To assess the efficacy and toxicity of repeated single 24-hour infusion of low-dose 5-fluorouracil for symptomatic hormone-refractory prostate cancer using relevant endpoints of palliation and biological response. Patients and Methods: 25 patients with histologically confirmed prostatic adenocarcinoma and symptomatic progressive disease despite one or several hormonal treatments and chemotherapy were included in the study. Treatment consisted of a single 24-hour infusion of 500 mg/m2 5-fluorouracil (5-FU) to be repeated on day 21. This regimen was continued until either progression or serious toxicity occurred. Response was assessed by serial measurements of serum prostate-specific antigen (PSA) as well as by health-related quality-of-life instruments (EORTC QLQ-C30 and McGill-Melzack Present Pain Intensity Scale) every 3 weeks. In 10 patients with bidimensionally measurable metastases, objective responses were assessed every 3 months. Results: A mean number of four courses of repeated single 24-hour infusion of 5-FU was administered (range 2–6). Toxicity was absent or mild, and no patient had to be withdrawn from therapy. All patients required analgesics prior to treatment and only 3 patients experienced a significant reduction in pain for 9 weeks, the remaining patients experienced no deterioration for a mean duration of 12 weeks (6–18 weeks). Five patients (20%) demonstrated a biological response of a 50% or greater decrease in PSA from baseline, including 2 (12%) with a 75% or greater decline for 10 weeks (range 6–16 weeks). One partial remission was observed among 10 patients with measurable lesions lasting 12 weeks; 4 patients had stable disease with a mean duration of 12 weeks. Mean survival time from the onset of treatment with 5-FU was 7 months (2–12 months). Conclusions: Though less toxic than other 5-FU regimens, repeated single low-dose 24-hour infusion is of no significant benefit in patients with symptomatic hormone-refractory prostate cancer.
Strong Stromal Hyaluronan Expression Is Associated with PSA Recurrence in Local Prostate Cancer
Authors: Aaltomaa S. , Lipponen P. , Tammi R. , Tammi M. , Viitanen J. , Kankkunen J.-P. , Kosma V.-M.
Published: April 2003

Objective: HA (hyaluronan) is involved in cell migration, differentiation and cell proliferation, which all are essential to tumour growth. In addition, the cell surface receptor of HA, CD44, is important in cancer cell adhesion, cell migration and tumour neovascularisation. We studied the expression of HA and CD44 and their relationship with other prognostic factors and prostate-specific antigen (PSA) recurrence in local prostate cancer (PC). Material and Methods: 77 PC patients treated with radical prostatectomy were followed-up for a mean of 4 years. HA was detected by using a HA specific probe and CD44 expression was analysed by conventional immunohistochemistry. Results: All specimens expressed HA in tumour stroma and 78% (60/77) of the tumours showed strong stromal expression of HA. The fraction of positively stained specimens for CD44 was 66% (51/77). The strong stromal HA expression was related to perineural infiltration (p = 0.001) and capsule invasion (p = 0.05). No correlation was demonstrated between the stromal HA expression and CD44 expression, preoperative PSA, clinical or pathological T classification, pN status, Gleason grade, seminal vesicle invasion or surgical margin invasion. Reduced CD44 expression was related only to preoperative PSA level (p = 0.008). The PSA recurrence was predicted by strong stromal HA expression, pT classification, seminal vesicle invasion, capsule invasion and surgical margin invasion (p ≤ 0.02 for all). pT classification and seminal vesicle infiltration predicted PSA recurrence free survival (RFS). In the multivariate analysis only the seminal vesicle infiltration was an independent predictor of PSA RFS (p = 0.009). Conclusion: The strong stromal HA expression was related to PSA recurrence, perineural infiltration and seminal vesicle invasion. Those are the factors related to unfavourable prognosis, but the follow-up period of this series is too short to make definitive prognostic conclusions.
Role of Tissue Polypeptide Specific Antigen in the Detection of Prostate Cancer
Authors: Onur Rahmi , Orhan İrfan , İlhan Necip , Semercioz Atilla
Published: April 2003

Objective: The aim of the present study was to evaluate the role of tissue polypeptide specific antigen (TPS) in the diagnosis of different stages of prostatic cancer (CaP) and to compare the diagnostic efficacy of serum TPS in respect to total prostate-specific antigen (tPSA) and free/total (f/t) PSA ratio. Patients and Methods: Patients with BPH (n = 58), localized CaP (n = 37) and metastatic CaP (n = 16) were compared by measuring serum TPS, tPSA and f/t PSA ratio. Results: Serum TPS was significantly increased only in patients with metastatic CaP (p < 0.05) and TPS levels was not significantly different between patients with BPH and localized CaP. Both f/tPSA and tPSA showed better sensitivity, specificity and receiver operating curve analysis in the differential diagnosis of BPH and localized CaP. Conclusion: In conclusion, serum TPS measurement was found to be significantly increased in metastatic prostatic carcinoma cases but was not useful in the early detection of prostatic carcinoma. Although there are several studies demonstrating the usefulness of TPS in the differential diagnosis of prostate cancer, there is increasing evidence for the use of this molecule in the late period of the disease or as an adjunct to other molecules in the detection of recurrences.
Incidence and Management of Dialysis Patients with Renal Calculi
Authors: Viterbo Rosalia , Mydlo Jack H.
Published: April 2003

Objective: The incidence of renal stones in patients on dialysis, while lower in number compared to the general population because of decreased renal function, is nonetheless a clinical dilemma. We wanted to evaluate the incidence and management of stone disease in patients on hemodialysis. Methods: We reviewed the literature from 1966 to the present using Medline. Study inclusion criteria were detection and treatment of stone disease in both hemodialysis and peritoneal dialysis patients. Results: It is estimated that between 5 and 13% of all dialysis patients will develop symptomatic renal calculi and many more asymptomatic calculi. Many of the stone-forming dialysis patients will have recurring stone disease with one study finding an 83.3% recurrence rate. Conclusions: Since dialysis patients have a wide range of urine output, the clinician should be alert to the possibility of stone formation. We recommend yearly ultrasound examinations on all dialysis patients as well as citrate and magnesium supplements with careful follow-up of laboratory results and urine electrolytes. We also recommend careful follow-up of all patients on aluminum-hydroxide phosphate binders as they are predisposed to form Al-Mg-urate stones. For those dialysis patients that form renal calculi, watchful waiting and symptomatic treatment is recommended since almost all patients will spontaneously pass their stones. However, ESWL and other current modalities may be used with no greater morbidity compared to nondialysis cohorts. We also suggest that patients with severe recurring intractable stone disease who are candidates for renal transplantation should be offered bilateral nephrectomies.
Voiding Dysfunction in Children: Role of Urodynamic Studies
Authors: Schewe Jörg , Brands Frank H. , Pannek Jürgen
Published: April 2003

Introduction: Urodynamic examination is said to be the most reliable, but also a rather invasive tool for the diagnosis of dysfunctional voiding in children. We compared the usefulness of baseline diagnostics to urodynamics. Materials and Methods: 60 children, mean age 9 years, admitted for further evaluation of voiding dysfunctions (monosymptomatic nocturnal enuresis, 17; recurrent urinary tract infection, 12; reflux, 2; urgency, incontinence or residual urine, 29) underwent clinical examination, ultrasound, uroflowmetry, endoscopy and urodynamics. Results: Urodynamic evaluation revealed pathologic findings in 37 patients. Detrusor instability was found in 26 children, 11 children (18%) demonstrated signs of pelvic floor overactivity. Treatment decision was based on baseline diagnostics exclusively in 14 children, mainly on baseline diagnostics in 56 patients, and on urodynamics exclusively in 4 children (7%). Conclusion: In children with idiopathic dysfunction, urodynamics did not have a significant additional value compared to baseline diagnostics. Therefore, noninvasive methods should be the first-line diagnostic tools. Only in patients with unsuccessful initial treatment should a urodynamic examination be performed to rule out severe bladder dysfunction.
The Use of a Symptom Checklist (SCL-90-R) as an Easy Method to Estimate the Relapse Risk after Alcoholism Detoxification
Authors: Lucht M. , Jahn U. , Barnow S. , Freyberger H.J.
Published: April 2003

We tested the use of some subscales of the psychiatric symptom checklist SCL-90-R in predicting relapse within a 1-year follow-up period after a combined detoxification- and abstinence-focused day patient psychotherapy program in 20 men and 13 women with alcohol dependence. Scores of the SCL-90-R subscales interpersonal sensitivity (p = 0.008), anxiety (p = 0.022), phobic anxiety (p = 0.019) and Global Severity Index (GSI; p = 0.040) on admission were higher in the subgroup with relapse within the first year after therapy. A decrease in depression (p = 0.004), anxiety (p = 0.006) and GSI (p = 0.006) scores during therapy was associated with a longer abstinence duration (shorter vs. longer than 24 weeks). Therefore we propose to further investigate the capacity of the SCL-90-R to identify subgroups at higher risk for relapse after detoxification and abstinence therapy in patients with alcohol dependence.