bluuebunny/crossref_metadata_2025 huggingface dataset:
RT-PCR Suggests Human Skeletal Muscle Origin of Alveolar Soft-Part Sarcoma
Authors: Nakano Hirotaka , Tateishi Akio , Imamura Tetsuo , Miki Hiroshi , Ohno Tohgo , Moue Toshiko , Sekiguchi Mayumi , Unno Kazutoshi , Abe Satoshi , Matsushita Takashi , Katoh Yoshiharu , Itoh Tatsuo
Published: April 2003

In 1952, Christopherson et al. proposed that alveolar soft-part sarcoma (ASPS) was a distinct entity with unique clinical and pathological features. Since their report, its histogenesis has not been determined. In order to clarify the histogenesis of ASPS, a study using reverse transcription polymerase chain reaction using cDNAs from MyoD1 and myogenin, and the actin filament from human-skeletal-muscle-related mRNAs has been performed in 5 cases of ASPS. The expression of MyoD1 and myogenin was determined in 5 and 2 cases of the 5 cases, respectively. Moreover, expression of the many mRNAs from the actin filament of skeletal muscle was also found in ASPS. According to these findings, it is now postulated that ASPS is of skeletal muscle origin.
Canadian Oncologists and Clinical Practice Guidelines: A National Survey of Attitudes and Reported Use
Authors: Graham I.D. , Evans W.K. , Logan D. , O’Connor A. , Palda V. , McAuley L. , Brouwers M. , Harrison M.B.
Published: April 2003

Purpose: To determine (1) Canadian oncologists’ attitudes toward practice guidelines, (2) oncologists’ self-reported use of practice guidelines and, (3) physicians’ characteristics and attitudes associated with self-reported use of practice guidelines. Participants and Methods: A cross-sectional, self-administered postal survey was administered to Canadian oncologists. Main outcome measures were level of agreement with 8 descriptive statements about guidelines, score on the attitudinal scale of the guideline of Tunis et al., and physicians’ stated use of guideline. χ2 and logistic regression procedures were used to explore the relationship between physician characteristics and use of guidelines. Results: Over 80% of respondents agreed that they were good educational tools, convenient sources of advice, intended to improve quality of care; over 40% agreed that they were unbiased syntheses of expert opinion. Conversely, 42, 26, 20 and 16% felt they were intended to cut costs, were oversimplified cookbook medicine, were too rigid to apply to individual patients, and a challenge to physicians’ authority, respectively. Forty-one percent reported using practice guidelines routinely or most of the time. Use was associated with positive attitudes about guidelines, receiving medical school training abroad and being a radiation oncologist. Conclusion: Canadian oncologists were quite positive about practice guidelines and reported using them frequently. Our results suggest that use of guidelines by oncologists may be related to attitudes about guidelines in general, specialty within oncology and country of medical school training.
Cisplatin Induces Fas Expression in Esophageal Cancer Cell Lines and Enhanced Cytotoxicity in Combination with LAK Cells
Authors: Matsuzaki Ikuo , Suzuki Hiroyuki , Kitamura Michihiko , Minamiya Yoshihiro , Kawai Hideki , Ogawa Junichi
Published: April 2003

Objective: To establish a new therapeutic approach for the treatment of esophageal cancer, we investigated an alternative mechanism of immunotherapy for sensitizing target cells to effector cells. Methods: Six human esophageal cancer cell lines were used. The expression of Fas antigen on tumor cells was determined by flow cytometry. The cytotoxic effect of cis-dichlorodiammineplatinum (CDDP) and anti-Fas antibody was evaluated using an MTT assay. The cytotoxic activity of LAK cells was measured by a 51Cr release assay. Results: Five out of six esophageal cancer cell lines expressed Fas antigen at various levels (26.2–61.5%), and Fas expression increased after CDDP treatment. The antitumor effect of anti-Fas antibody on the esophageal cancer cell line and the antitumor effect of LAK cells activated by IL-2 were enhanced by pretreatment with CDDP. After concanamycin A treatment to specifically evaluate Fas-dependent cytotoxicity, LAK cells expressing Fas ligand killed only Fas-positive cells, but not Fas-negative cells. An anti-Fas neutralizing antibody inhibited this cytotoxicity. DNA fragmentation was shown in a cell line that was treated with CDDP and anti-Fas antibody, and also in the targeted esophageal cancer cell line cocultured with LAK cells. Conclusion: Our results suggest a potential clinical application of CDDP as a Fas inducer to make esophageal tumors susceptible to Fas antigen and LAK cytotoxicity.
Psychosomatic Aspects of Cushing’s Disease
Authors: Sonino Nicoletta , Fava Giovanni
Published: April 2003

The past decades have witnessed an increasing understanding of the psychosomatic aspects of Cushing’s disease. Stressful life events were found to precede its onset in controlled studies. Major depression is a common, life-threatening complication of Cushing’s syndrome, regardless of its etiology. The presence of depression connotes severity of clinical presentation and entails prognostic value (patients with hypothalamic-pituitary forms are more likely to relapse after successful treatment if they presented with depression). Quality of life of patients with Cushing’s disease is seriously compromised. Recovery has a natural course to run and may be considerably influenced by affective responses based on highly individualized psychological assets and liabilities. The psychobiological correlates of Cushing’s disease have considerable etiological, clinical and therapeutic implications. Such implications also extend over the nonendocrine forms of major depression.
Stereotypical Relationship Patterns and Psychopathology
Authors: Cierpka M. , Strack M. , Benninghoven D. , Staats H. , Dahlbender R. , Pokorny D. , Frevert G. , Blaser G. , Kächele H. , Geyer M. , Körner A. , Albani C.
Published: April 2003

Background: We explored the relationship between the consistency of relationship patterns and the severity of psychopathology. Method: Relationship patterns were assessed by means of Relationship Anecdote Paradigm interviews rated according to the Core Conflictual Relationship Theme (CCRT) method. The repetition of the same type of CCRT components across relationship narratives indicated stereotypical patterns. Results: Subjects treated in an inpatient setting (n = 25) told narratives with more consistent patterns than subjects in an outpatient setting (n = 32). Relationship episodes of normal adults (n = 23) were more flexible compared with the two clinical groups. Especially repetitions of the wish component were closely associated with the severity of psychopathology assessed by SCL-90R. Conclusions: The consistency of relationship patterns seems to be connected with the severity of psychopathology.
Chronic Pelvic Pain as a Somatoform Disorder
Authors: Ehlert U. , Heim C. , Hellhammer D.H.
Published: April 2003

Background: The purpose of this study was to determine whether psychiatric disturbances, particularly somatization, and an increased number of traumatic and critical life events, which have been found in women with idiopathic chronic pelvic pain (ICPP), can also be observed in women with chronic pelvic pain and abdominal adhesions (ACPP). Methods: Forty women who underwent diagnostic laparoscopy were subdivided into three groups according to blind rated somatic pathologies: ICPP patients (n = 16), ACPP patients (n = 10), infertile controls without pain (n = 14). Besides the standardized assessment of DSM-III-R diagnosis, questionnaires and semistandardized interviews were used to estimate depression, somatization, pain, the prevalence of sexual and physical abuse, and the number of critical life events. Results: Diagnostic criteria for somatoform pain disorder were fullfilled in 73.3% of the ICPP patients, 60% of the ACPP patients and none of the controls. With respect to the somatization symptom checklist the two pain groups scored significantly higher than the controls (p < 0.05). Referring to perceived pain, ACPP patients differed from the ICPP patients by one out of seven subscales (higher persistence of pain; p < 0.05). No correlation was found between the intensity of pain and the severity of classified adhesions. The two groups of pain patients significantly differed from controls by a higher prevalence of sexual abuse (p < 0.05). Depression was found neither in the pain groups nor in the controls. Conclusions: Because high somatization and high prevalence rates of abuse were not only found in patients suffering from ICPP but also in ACPP patients, it seems to be doubtful that the somatic pathology may fully explain the psychopathology in patients with ACPP.
A Pilot Study of Hypnosis in the Treatment of Patients with Psoriasis
Authors: Tausk Francisco , Whitmore S. Elizabeth
Published: April 2003

Background: The use of psychological therapies for patients with psoriasis has been proposed based on observations that the severity of their disease may correlate with emotional stress. The aim of this pilot study was to evaluate the effect of hypnosis as a treatment modality for patients with psoriasis. Methods: We performed a 3-month randomized, single-blind, controlled trial of the use of hypnosis in adults with stable, chronic, plaque-type psoriasis. Highly or moderately hypnotizable subjects were randomized to receive either hypnosis with active suggestions of improvement (5 patients) or neutral hypnosis with no mention of their disease process (6 patients). After this period, the study was unblinded, and all the patients were treated for an additional 3 months with hypnosis with active suggestions of improvement. Results: Highly hypnotizable subjects showed significantly greater improvement than did moderately hypnotizable subjects, independent of treatment group assignment (active suggestion or neutral hypnosis). Conclusion: Although this study included a very limited number of patients, the results suggest that hypnosis may be a useful therapeutic modality for highly hypnotizable subjects with psoriasis, and merits further testing in a larger patient population.
The Influence of Alexithymic Characteristics on the Self-Perception and Facial Expression of a Physiological Stress State
Authors: Näätänen Petri , Ryynänen Arto , Keltikangas-Järvinen Liisa
Published: April 2003

Background: In spite of the connection of alexithymic characteristics to many stress-related disorders, little is known about the effects of these characteristics on the self-perception of stress, which may have functional value in the regulation of daily behavior. The present study assessed the influence of alexithymic characteristics on the self-perception of stress in relation to the corresponding physiological/expressive responses during and while recovering from a phasic stressor. Methods: A median split of the scores on the Toronto Alexithymia Scale was used to divide 32 healthy middle-aged men into two groups, a high alexithymia (HA) and a low alexithymia (LA) group. Both groups participated in a 3-min hand-grip task, followed by a 3-min recovery period. During these periods, subjects’ heart rate (HR) and facial electromyographical (EMG) activity on the corrugator supercilii and frontalis lateralis areas were measured and perceptions of exertion, unpleasantness and tension were self-rated. The perceptual style was assessed with the discrepancy scores: standardized scores of the physiological measures were subtracted from the corresponding standardized scores of the perceptions. Thus, positive scores indicated that self-reported perceptions exceeded the corresponding physiological or expressive activity (overestimation) and negative scores indicated the opposite (underestimation). Results: The HA group decreasingly underestimated exertion in relation to HR during the task and increasingly overestimated it during the recovery period. The HA group also overestimated unpleasantness in relation to the corrugator EMG response during the recovery period. Conclusions: High alexithymic characteristics seem to predispose to the delayed self-perception of physiological stress state so that the beginning of this state may remain subjectively unnoticed and the subjective recovery from it prolonged relative to the physical recovery. During this prolonged subjective recovery the feelings of unpleasantness are not facially expressed. The consequences of this style for health-related behavior are discussed.
Coping with Unfair Treatment at Work – What Is the Relationship between Coping and Hypertension in Middle-Aged Men and Women?
Authors: Theorell Töres , Alfredsson Lars , Westerholm Peter , Falck Bengt
Published: April 2003

Background: An important hypothesis in psychosomatic medicine is that exposure to psychosocial factors that arouse anger may accelerate the onset of hypertension, particularly if the subject is not allowed to show anger or to deal constructively with the factor that evoked it. For working men and women, being treated in an unfair way at work may be crucial. The present study was designed to answer the question whether the pattern of coping – primarily directed towards the aggressor (open) or directed inwards or towards others (covert) – is associated with hypertension among working men and women. Study group: Five thousand seven hundred and twenty working men and women aged 15–64 participated in the study. The participation rate was 76%. Methods: The coping pattern was studied by means of a Swedish version of a self-administered questionnaire that was originally introduced by Harburg et al. Results: Significant results were confined to the age group 45–54. All analyses were adjusted for age and body mass index. Smoking habits and social class had no effect on the relationships. Low scores (lowest quartile) for open coping tended to be associated with an elevated prevalence ratio (PR) of hypertension both among men (PR 1.3, 95% confidence interval, CI, 0.9–1.7) and women (PR 1.4, 95% CI 1.0–2.0). High scores for covert coping (highest quartile) were associated with an elevated PR of hypertension among men (PR 1.6, 95% CI 1.2–2.2) but not in women. If the analysis was confined to cases without medication, the relationship between a high level of covert coping and high blood pressure was still significant for men. For women, however, no significant findings were made after this operation. Accordingly, the relationship between a low level of open coping and hypertension in women was confined to women with medication. Coping patterns were correlated with psychosocial work environment factors, in particular decision latitude. Conclusion: In men, covert coping was associated with prevalence of hypertension. In women, there tended to be a relationship between low scores for open coping and hypertension.
Social Support and Psychological Distress in Primary Care Attenders
Authors: Grassi L. , Rasconi G. , Pedriali A. , Corridoni A. , Bevilacqua M.
Published: April 2003

Background: Growing evidence has been collected about the high prevalence of psychological distress in primary care. The role of psychosocial variables, namely the role of support from the patients’ interpersonal ties, has not been extensively explored. Methods: The study investigated the relationship between perceived social support, as evaluated by the Multidimensional Scale of Perceived Social Support, and psychological distress, as measured by the Brief Symptom Inventory, in 1,341 primary care attenders. Results: In comparison with highly supported patients, lowly supported subjects showed higher scores on distress dimensions (e.g. depression, anxiety, phobia) and a higher prevalence of psychological morbidity (‘caseness’ = 37.3 vs. 11%). Conclusion: The findings suggest that, in the setting of primary care, the GPs’ assessment of their patients’ social support system may be useful in identifying those more vulnerable to psychological stress.
Exploring the Benefits of Group Psychotherapy in Reducing Alexithymia in Coronary Heart Disease Patients: A Preliminary Study
Authors: Beresnevaite Margarita
Published: April 2003

Background: Although there is preliminary evidence that alexithymia may influence the course of coronary heart disease (CHD), there are no studies exploring attempts to modify alexithymic characteristics in cardiac patients. Method: Twenty post-myocardial infarction (MI) patients (19 men and 1 woman) were placed in a treatment group, which received weekly group psychotherapy for 4 months. Seventeen post-MI patients (16 men and 1 woman) were placed in a comparison group which received two educational sessions over a period of 1 month. All subjects completed the Toronto Alexithymia Scale (TAS) before the start of group therapy, at the end of the 4-month period, and in follow-up assessment after 6-month, 1-year, and 2-year intervals. Results: In the psychotherapy treatment group, there was a significant reduction in the mean TAS score following group therapy, which was maintained over the 2-year follow-up period. In the educational group, there were no significant changes in mean TAS scores between the initial testing and any of the follow-up intervals. On an individual basis, a decrease to a lower level of TAS scores occurred in a higher percentage of patients in the treatment group than in the educational group. Over the 2-year follow-up period, patients with decreased alexithymia following group therapy experienced fewer cardiac events (reinfarction, sudden cardiac death, or rehospitalization for rhythm disorder or severe angina) than patients whose alexithymia remained unchanged. Conclusions: The results indicate that group psychotherapy is able to decrease alexithymia and that for many patients this change can be maintained for at least 2 years. A reduction in the degree of alexithymia seems to influence favorably the clinical course of CHD.
The Relationship between Dimensions of Alexithymia and Dissociation
Authors: Grabe H.-J. , Rainermann S. , Spitzer C. , Gänsicke M. , Freyberger H.J.
Published: April 2003

Background: The study investigated the following hypotheses: (1) Alexithymia is significantly associated with dissociation. (2) Pathological versus nonpathological dissociation is associated with alexithymic traits. Methods: Psychiatric in- and outpatients (n = 173) and nonclinical subjects (n = 38) were investigated with the Toronto Alexithymia Scale (TAS-20), the FDS (German version of Dissociation Experience Scale) and the Symptom Check List (SCL-90-R; GSI). Correlation analyses followed by MANOVA and logistic regression were performed. Results: Significant correlations and partial correlations, controlling for GSI, were observed between dissociation and alexithymia. The MANOVA demonstrated significantly higher scores for the two TAS-20 dimensions ‘difficulty identifying feelings’ and ‘difficulty expressing feelings’ in the group with pathological dissociation. On the basis of the TAS-20 subscores, logistic regression analysis correctly classified 72.5% of the cases into the pathological and the nonpathological dissociation group. Conclusions: These results support our hypothesis that pathological traits of dissociation are highly associated with alexithymia. A model is discussed in which alexithymic characteristics may contribute to the development of pathological dissociation and stress-related disorders such as posttraumatic stress disorder.
Are Premorbid Personality Traits Linked to the Risk of Alzheimer’s Disease?
Authors: Balestrieri M. , Nacmias B. , Sorbi S. , Marcon G.
Published: April 2003

Background: The identification of the premorbid manifestation of Alzheimer’s disease (AD) usually is carried out retrospectively by eliciting information from caregivers. However, the study of subjects with familial Alzheimer’s disease (FAD) not yet affected by AD allows the direct identification of premorbid characteristics of the disease. Methods: This is a psychometric assessment of 3 mutated and 5 control subjects, belonging to an Italian family associated with a missense mutation linked to the presenilin 2 gene. The assessment included an evaluation of personality traits, cognitive and affective condition, social disabilities, experiential and familial context. Results: According to the MMPI, the mutated subjects did not show consistent personality traits. Also other questionnaires (HADS, WAIS, BDQ) were negative for definite cognitive or behavioural patterns. ApoE genotypes did not differentiate mutated from control subjects. Conclusions: Our results may be considered important for a better understanding of the pathogenesis of AD. The heuristic and practical importance of longitudinal prospective studies is emphasised.
EPIC-Germany – A Source for Studies into Diet and Risk of Chronic Diseases
Authors: Boeing H. , Wahrendorf J. , Becker N.
Published: April 2003

The ‘European Investigation into Cancer and Nutrition (EPIC)’ represents one of the main scientific activities of the EU program ‘Europe against Cancer’ and is a large-scale cohort study on diet and chronic diseases, especially cancer, with approximately 475,000 study participants. The German contribution amounted to 53,000 study participants recruited between 1994 and 1998. The study instruments of the baseline examination included self-administered questionnaires for optical reading, PC-guided interviews, and physical examinations. These instruments covered different aspects of lifestyle, with a particular focus on diet. In addition, about 95% of the participants provided 30 ml of blood. The blood was stored in liquid nitrogen for further use, preferentially in nested case-control studies. All interviews and examinations were conducted by trained interviewers in examination centers established for this study in local health offices. Every 2 years, a follow-up questionnaire is mailed to the study participants. The follow-up questionnaires will be used as the major source of outcome information and to update exposure information. The self-reported diseases are verified by medical data. In the future, record linkage with local cancer registries will help to support the identification and collection of incident cancer cases. Only an outline of hypotheses was formulated at the very beginning of EPIC in 1992. In the future, each etiological study will be based on detailed research hypotheses according to the existing knowledge and identified research gaps. These studies will be conducted on cancer at the international level and on non-cancer diseases at the national or local level.
Tumor Necrosis Factor, Interleukin-6,and Epinephrine Are Associated with Hypermet abolism in AIDS Patients with Acute Opportunistic Infections
Authors: Süttmann Ulrich , Holtmannspötter Markus , Ockenga Johann , Gallati Harald , Deicher Helmuth , Selberg Oliver
Published: April 2003

During a 9-day period we investigated body composition, resting energy expenditure (REE), IL-6, TNF, and sTNFR-55 and sTNFR-75 plasma concentrations during infectious complications in 12 patients with HIV disease. At study entry, IL-6 was detectable in 5 and TNF in 10 patients. TNF was closely correlated with sTNFR-75 concentration (r = 0.84, p < 0.001) whereas sTNFR/sTNFR-55 ratio increased throughout the study. TNF concentrations were significantly correlated with the 24-hour excretion of epinephrine and norepinephrine (r = 0.64 and 0.69; each p < 0.01). Compared to expected values REE was increased by 34%. Body cell mass was the single best predictor of REE and explained 72% of its variance. In contrast, the deviation of measured from predicted REE was correlated with TNF and IL-6 concentrations (r = 0.9). We conclude that increased plasma concentrations of cytokines in complicated HIV disease display little biologic variability and relate to hypermetabolism in these patients.
IGF-1 and Its Binding Proteins IGFBP-1 and 3 as Nutritional Markers in Prepubertal Children
Authors: Martínez de Icaya Purificación , Fernández Concepción , Vázquez Clotilde , del Olmo Dolores , Alcázar Victoria , Hernández* Manuel
Published: April 2003

Objective: To assess the validity of the use of IGF-1, IGFBP-1 and IGFBP-3 as biochemical markers of nutritional status in prepubertal healthy children. Design: Cross-sectional survey. Setting: Healthy children from the Madrid area. Participants: Prepubertal children (aged 7–10 years) with a body mass index (BMI) above the 90th percentile (n = 25) and below the 10th percentile (n = 31) were selected from 2,559 included in the CAENPE study (Food Intake and Nutritional Status in Schoolchildren from Madrid). Results: Overweight children were found to have higher serum levels of IGF-1 (306 ± 162.2 vs. 209 ± 71.2 ng/ml, p < 0.001) and IGFBP-3 (3.3 ± 1.0 vs. 2.9± 0.5 mg/l, p < 0.01) and lower serum levels of IGFBP-1 (4.3 ± 3.9 vs. 13.8 ± 7.4 μg/l, p < 0.01). There was a positive correlation with BMI, for IGF-1 and IGFBP-3, and negative correlation for IGFBP-1. No differences in albumin and transferrin concentrations were observed between both groups of children. Conclusion: IGF-1, IGFBP-1 and IGFBP-3 clearly classify over- and underweight prepubertal children, showing a good correlation with BMI. They can be used as biochemical markers of caloric nutritional status in this population.
Recombinant Human Erythropoietin Resistance in Iron-Replete Hemodialysis Patients: Role of Aluminum Toxicity
Authors: Tarng Der-Cherng , Huang Tung-Po
Published: April 2003

The present study was designed to investigate the impact of aluminum toxicity on the response to recombinant human erythropoietin (rHuEPO) therapy in hemodialysis patients, when iron deficiency has been corrected or excluded. We studied 39 patients on regular hemodialysis (20 males and 19 females; mean age 58.8 years), who were under maintenance rHuEPO treatment for at least 6 months, and who had stable hematocrit levels for more than 3 months. All patients had adequate iron stores and availability with serum ferritin >100 µg/l and iron saturation >25%. They were classified into two groups: 19 poor responders, who required subcutaneous rHuEPO doses >100 U/kg/week and failed to achieve the target hematocrit level of 30%, and 20 good responders, who needed doses of ≤100 U/kg/week to maintain the target level. Serum aluminum levels including basal (Albasal) and 44 h after desferrioxamine (DFO) infusion (Alpost-DFO), intact parathyroid hormone, and inflammatory and hemolytic indices were examined in both groups. The results showed that the mean weekly rHuEPO doses were significantly lower and the mean hematocrit levels higher in the good responders than in the poor responders. Although the poor responders had markedly higher mean Albasal and Alpost-DFO levels, no differences were observed in the other parameters between the two groups. Furthermore, the poor responders significantly had the greater increment in the serum aluminum levels after DFO infusion (ΔAl =Alpost-DFO – Albasal). The mean corpuscular volume had a strong inverse correlation with ΔAl in the poor response group (r = –0.711, p < 0.001). We concluded that the post-DFO rise of serum aluminum can be used as a means of estimating tissue stores. Subclinical aluminum toxicity may exhibit an inhibitory effect on erythropoietic response to rHuEPO therapy.
Acute Bone Pain following Renal Transplantation: Differentiation between Benign Bone Edema and Avascular Necrosis
Authors: Pilmore Helen , Walker Robert , McMillan Bruce , Paranjpe Dhananjay , Berkeley Barrie
Published: April 2003

Two patients are reported who presented within the first 3 months posttransplantation with acute bone pain where serial magnetic resonance imaging (MRI) allowed differentiation between bone edema, which resolved spontaneously, and avascular necrosis (AVN) requiring core decompression. Case 1 had ill-defined images consistent with bone edema that resolved, whereas case 2 developed well-demarcated lesions in the femoral condyles and tibial epiphyses which were confirmed as AVN at surgery. Alternative explanations for bone edema were not evident. We would suggest that in any transplant recipient who develops acute bone pain, MRI is the initial diagnostic modality of choice. Evidence of development of well-demarcated lesions on serial MR scans indicate early AVN. However, on current evidence it is difficult to predict which lesions will progress and until greater experience becomes available, we would recommend intraosseous plethysmography and venography so that incipient or early AVN can be treated by core decompression of the affected bone.
Recurrent Crescentic Membranous Nephropathy in Two Successive Renal Transplants: Association with Choroidal Effusions and Retinal Detachment
Authors: Lazowski Piortr , Sablay Leonarda B. , Glicklich Daniel
Published: April 2003

We report the case of a 50-year-old man in whom crescentic membranous nephropathy recurred in two succesive renal transplants leading rapidly to renal failure. Deterioration of renal function was associated with choroidal effusions and retinal detachments. Multiple serologic tests were negative. High-dose steroids, cyclophosphamide, cyclosporine, plasmapheresis and OKT3 failed to arrest the deterioration of renal function.
Timing of Initiation of Uremia Therapy and Survival in Patients with Progressive Renal Disease
Authors: Ifudu Onyekachi , Dawood Mohammed , Homel Peter , Friedman Eli A.
Published: April 2003

We conducted a prospective cohort study to detect any relationships between specific clinical features and laboratory indices at initiation of hemodialysis and long-term survival. One hundred and thirty-nine consecutive patients with chronic renal failure hospitalized to start maintenance hemodialysis between January 1990 and December 1994 were enrolled, and follow-up was completed through December 1995. At baseline, subjects were assigned to one of five groups based on their major indication for initiation of hemodialysis. The indications were: (a) nausea and vomiting; (b) severe weakness; (c) no major symptom (dialysis started because of ‘high’ serum creatinine and blood urea nitrogen concentrations); (d) volume overload, and (e) miscellaneous (angina, pericarditis, seizure, pruritus, and hyperkalemia). Blood urea nitrogen, serum creatinine and serum albumin concentrations were measured once before the first dialysis. The main outcome measure was death. The 139 study subjects included 77 women and 62 men comprising 116 Blacks (83%), 15 Hispanics (11%), and 8 Whites (6%) of mean age 54 ± 15 years. Mean length of follow-up was 39 months. At baseline, mean blood urea nitrogen concentration was 121 ± 38 mg/dl, mean serum creatinine concentration was 12.6 ± 5.2 mg/dl, and mean serum albumin concentration was 3.5 ± 0.62 g/dl. Forty-two subjects (30%) died during follow-up. Cox regression analysis showed that there was no significant association between mortality and any of the indicators evaluated (indication for initiation of dialysis (p = 0.2), serum creatinine concentration (<10 vs. ≥10 mg/dl) (p = 0.8), blood ure nitrogen concentration (<100 vs. ≥100 mg/dl) (p = 0.68) and serum albumin concentration (<4 vs. ≥4 g/dl) (p = 0.62). All analyses included adjustment for age and diabetes.We conclude that in patients with chronic renal failure, the clinical features and laboratory indices used as guidelines for initiation of renal replacement therapy do not correlate with survival. Objective parameters that will permit initiation of dialysis at a time that will maximize survival in patients with chronic renal failure are needed.
Immunoallergic Granulomatous Interstitial Nephritis following Treatment with Omeprazole
Authors: Montseny Jean-Jacques , Meyrier Alain
Published: April 2003

A 69-year-old male who had a long history of ocular myasthenia was treated with omeprazole for 3 months. Progressive renal insufficiency was discovered fortuitously. There were no clinical or laboratory manifestations of immunoallergy. Renal biopsy revealed severe granulomatous interstitial nephritis, tubular injury and fibrosis. Histology of a liver nodule disclosed hepatic granulomatous involvement. Withdrawal of omeprazole and a short course of corticosteroids were followed by improvement but not normalization of renal function. This is the eighth report of omeprazole-induced interstitial nephritis. In the present case as in 2 others in the literature, the patients had been followed up for an autoimmune disease previously, which suggests that in patients with such a background, patients should be examined regularly for renal functional impairment during treatment with omeprazole.
Determinants of Ventricular Arrhythmias in Hemodialysis Patients
Authors: Tamura Koji , Tsuji Hisako , Nishiue Takashi , Tokunaga Satoshi , Yajima Ibuki , Higashi Tokio , Iwasaka Toshiji
Published: April 2003

Background/Aims: In chronic hemodialysis patients, we evaluated determinants of repetitive ventricular tachyarrhythmias which included late potentials and heart rate variability. Methods: We compared the presence of late potentials and heart rate variability obtained by ambulatory electrocardiogram (ECG), findings of echocardiography, and laboratory data between patients with and those without ventricular arrhythmias of Lown class 4A or 4B. Ambulatory ECG was recorded for 24 h from the beginning of hemodialysis. Heart rate variability was evaluated by the standard deviation of the normal RR interval (SDNN). Results: Thirty patients (17%) had ventricular arrhythmias of Lown class 4A or 4B. They were older than patients without such arrhythmias (p = 0.0021). Left-ventricular wall motion score (2.0 ± 3.9 and 0.3 ± 1.2, respectively, p < 0.0001) and left-ventricular mass index (167 ± 59 and 140 ± 44 g/m2, respectively, p = 0.0053) were larger in patients with ventricular arrhythmias of Lown class 4A or 4B than in those without. Stepwise logistic regression analysis was performed to select variables related to ventricular arrhythmias of Lown class 4A or 4B from the following 8 candidate variables; age, sex, presence of ischemic heart disease, diabetic nephropathy as the primary renal disease, presence of late potentials, SDNN, left-ventricular wall motion score and left-ventricular mass index. Higher left-ventricular wall motion score (p < 0.0001), older age (p = 0.0022) and male sex (p = 0.0235) were the variables associated with ventricular arrhythmias of Lown class 4A or 4B. Conclusion: In patients receiving hemodialysis, predominantly with chronic glomerulonephritis, ventricular arrhythmias of Lown class 4A or 4B were not associated with arrhythmogenic substrate revealed by late potentials or autonomic dysfunction assessed by heart rate variability. Left-ventricular wall motion abnormalities, age and sex were significant factors.
Mesangial Proliferative Nephritis in Man Is Associated with Increased Expression of the Cell Survival Factor, Bcl-2
Authors: Uda Susumu , Yoshimura Ashio , Sugenoya Youichi , Inui Kiyoko , Taira Takayasu , Ideura Terukuni
Published: April 2003

Although most studies suggest that the hypercellularity in mesangial proliferative nephritis is due to increased cell proliferation, we hypothesized that it may also be due to increased expression of survival factors that may block their removal (apoptosis). We therefore studied the expression of apoptosis preventing/delaying the bcl-2 gene product in the glomerulus with various human glomerulonephritides. Immunohistochemistry for Bcl-2, proliferating cell associated protein (Ki-67) and α-smooth muscle actin (α-SMA) was performed on 55 biopsied kidney tissues: 6 cases of orthostatic proteinuria as a control (OP); 6 cases of diffuse proliferative lupus nephritis (WHO type IV, LN-MPGN); 24 cases of IgA nephropathy (IgA); 9 cases of minimal change nephrosis and 10 cases of idiopathic membranous nephropathy. The number of Ki-67-positive cells and the expression of α-SMA in the glomerulus were significantly higher in LN-MPGN and IgA. There was a significant positive correlation between glomerular Bcl-2 expression and glomerular cell proliferation evaluated by the number of Ki-67-positive cells (r = 0.605, p < 0.01) or glomerular α-SMA expression (r = 0.674, p < 0.01). Glomerular expression of Bcl-2 in IgA or LN-MPGN was significantly higher than that in OP (p < 0.01 and p < 0.05 vs. OP, respectively). The Bcl-2-positive cells were present in mesangial locations and demonstrated a perinuclear pattern. These results suggest that maintenance of glomerular hypercellularity in human glomerular diseases is partly due to the prevention of mesangial cell death via Bcl-2 expression.
Treatment of Pulmonary Embolism by Subcutaneous Low-Molecular- Weight Heparin in a Hemodialysis Patient
Authors: Szeto C.C. , Wang Angela Y.M. , Lui S.F. , Lai K.N. , Yu Alex W.
Published: April 2003

Low-molecular-weight heparin (LMWH) has been used in the prophylaxis and treatment of deep vein thrombosis. Data regarding the efficacy of this drug without subsequent use of oral anticoagulant in the treatment of pulmonary embolism is limited. Pulmonary embolism may complicate the use of central venous catheter in hemodialysis. We report a case of acute submassive pulmonary embolism complicating a central venous hemodialysis catheter in a dialysis patient. After the catheter was removed, the patient was treated successfully with subcutaneous injection of LMWH for three months. We conclude that LMWH is safe and effective for treatment of pulmonary embolism in patient on hemodialysis.
Acute Oliguric Renal Failure Associated with Unilateral Renal Embolism: A Successful Treatment with Iloprost
Authors: Levin Moshe , Nakhoul Farid , Keidar Zohar , Green Jacob
Published: April 2003

A 66-year-old woman presented with acute-onset rapid atrial fibrillation and right upper quadrant pain which had appeared 24 h prior to admission. The patient also manifested acute oliguric renal failure (serum creatinine 6.9 mg/dl). Selective renal angiography revealed total occlusion of the right renal artery with normal visualization of the left kidney vasculature. The patient was treated with intra-arterial urokinase and intravenous heparin, with no response. Intravenous administration of the prostacyclin analogue, iloprost, resulted in rapid resolution (within hours) of the oliguric acute renal failure, in spite of the continuing presence of a nonfunctioning right kidney. We conclude that the etiology of the acute renal insult in this patient is probably related to unilateral renal arterial embolization accompanied by arterial spasm of the unaffected kidney. The contralateral vasospasm can be reversed by iloprost, which then leads to a rapid recovery from acute renal failure. We are unaware of prior reports documenting the beneficial effect of iloprost in a clinical setting as described here.
Peritoneal Dialysis-Associated Peritonitis Caused by Alcaligenes xylosoxidans
Authors: El-Shahawy Mohamed A. , Kim David , Gadallah Merit F.
Published: April 2003

Despite significant progress to decrease its incidence, peritonitis remains the main source of morbidity and treatment failure in patients on continuous ambulatory peritoneal dialysis (CAPD). The majority of cases of peritonitis result from infection with aerobic gram-positive (Staphylococcus epidermidis and Staphylococcus aureus), or gram-negative organisms. Less common organisms that are also reported include anaerobic bacteria, fungi, and mycobacteria, which collectively account for less than 10% of isolates cultured. We report a case of peritoneal dialysis-associated peritonitis, and review the literature on peritonitis caused by Alcaligenes species. Alcaligenes xylosoxidans is a nonfermenting gram-negative rod and opportunistic pathogen that is motile with peritrichous flagella. The clinical features and microbiological data of our case, as well as the other previously reported cases of peritonitis caused by Alcaligenes species show no particular pattern of peritoneal dialysate cell count. However, the rate of recurrence of peritonitis is characteristically high. The cause of such a high rate of recurrence of peritonitis is probably a reflection of the predilection of Alcaligenes species to cause infection in the ‘sicker’ patients, and the almost universal resistance of this species to most antimicrobial agents. We, therefore, recommend that catheter removal be undertaken as early as the identification of the organism is made. Whether patients should be allowed to return to CAPD after recovery is a more difficult question. We suggest that a reevaluation of the patient’s overall status be undertaken, including personal hygiene, exchange technique, presence of diabetes mellitus, malnutrition, and/or other factors that may render the patient more prone to infection with opportunistic pathogens.
Aldosterone-Producing Adrenocortical Adenoma Complicated by Chronic Renal Failure
Authors: Ito Hiroyuki , Sasaoka Atsushi , Takao Toshihiro , Nishiya Koji , Nanamiya Wakako , Chikazawa Hiroaki , Matsumoto Takafumi , Kitagawa Shiroshi , Hishimoto Kozo
Published: April 2003

A 61-year-old Japanese woman was hospitalized because of general malaise. The patient demonstrated hypertension, hypokalemia and chronic renal failure (CRF). Plasma aldosterone concentration and urinary excretion of aldosterone were elevated. Abdominal computed tomographic scan revealed right adrenal tumor and multiple cysts in both kidneys. Adrenal scintigram using 131I-adosterol disclosed uptake of the isotope in the area corresponding to the adrenal tumor. Plasma aldosterone concentration and renin activity (PRA) in an upright posture and daily variations in adrenocorticotropic hormone, cortisol, aldosterone levels and PRA were compatible with aldosterone-producing adrenocortical adenoma. After administration of spironolactone and manidipine hydrochloride, a calcium antagonist, general malaise disappeared, and blood pressure and serum potassium level returned to the normal range without adrenalectomy. Although adrenalectomy is known to be effective for the treatment of aldosterone-producing adrenocortical adenoma, several papers reporting cases of aldosterone-producing adrenocortical adenoma with CRF indicated that surgical therapy was not always optimal in terms of postoperative conditions. Taken together, the conservative therapy may be one of the choices considering the prognoses of hypertension and renal dysfunction in patients with aldosterone-producing adrenocortical adenoma with CRF.
Venous Thoracic Outlet Syndrome Simulating Subclavian Stenosis in a Hemodialysis Patient
Authors: Williams Mark E.
Published: April 2003

Hemodialysis-associated subclavian venous stenosis should be suspected when upper extremity edema occurs after a graft or fistula has been placed there. Alternatively, venous thoracic outlet syndrome could also produce venous congestion, simulating subclavian stenosis. The latter diagnosis was unsuspected until central subclavian vein obstruction on venography became complete, with the arm passively hyperabducted. The patient’s symptoms resolved after surgical decompression. Causes of thoracic outlet obstruction are reviewed.
Combination ACE Inhibitor and Angiotensin II Receptor Antagonist Therapy in Diabetic Nephropathy
Authors: Hebert Lee A. , Falkenhain Michael E. , Nahman Jr N. Stanley , Cosio Fernando G. , O’Dorisio Thomas M.
Published: April 2003

The benefit of angiotensin-converting enzyme (ACE) inhibitor (i) therapy in diabetic glomerulosclerosis is thought to be largely the result of attenuation of angiotensin II (AngII) effects on blood pressure, glomerular hemodynamics and hypertrophy, and tissue fibrosis. The present study was undertaken to determine whether the addition of AngII receptor antagonist therapy to ACEi therapy in diabetic nephropathy results in attenuation of AngII effects beyond that achieved by ACEi therapy alone. Seven patients were studied as inpatients on the General Clinical Research Center each for 3 consecutive weeks as follows: week 1, the patients’ usual regimen which included daily oral moderate to high dose ACEi therapy; week 2, the patients’ usual regimen plus oral losartan (an antagonist (a) of the angiotensin type 1 receptor, AT1) 50 mg (n = 3) or 100 mg (n = 4) daily; week 3, return to the patients’ usual regimen. Diet, physical activity, and blood glucose were held as constant as possible during the three weeks of daily testing. We found that plasma renin levels increased significantly during combination therapy and then returned to baseline values with discontinuation of AT1a therapy: mean baseline renin values (week 1) 3.0 ng/ml/min ± 1.1 SE, mean renin values during combination therapy (week 2) 7.0 ng/ml/min ± 3.2 (p = 0.0078 by Wilcoxon rank sum test), mean renin values after discontinuation of AT1a therapy (week 3) 3.9 ng/ml/min ± 2.0 (NS compared to baseline values). In addition, 2 patients developed transient hypotension when losartan therapy was initiated. During this short-term study, 24-hour proteinuria, serum creatinine, serum potassium, and plasma aldosterone were not changed significantly by combination therapy. We conclude that in patients with diabetic nephropathy addition of AT1a therapy to ACEi therapy attenuates AngII effects better than ACEi therapy alone. We suggest that combination therapy for the management of diabetic glomerulosclerosis merits further investigation.
Nephrotic Mice (ICGN Strain): A Model of Diffuse Mesangial Sclerosis in Infantile Nephrotic Syndrome
Authors: Mizuno Shinya , Mizuno-Horikawa Yoko , Yue Bing-Fei , Okamoto Munehiro , Kurosawa Tsutomu
Published: April 2003

The ICGN mouse strain is a unique model for naturally occurring nephrotic syndrome. In the present study, we examined the onset of the clinical manifestation of nephrotic syndrome and determined the sequence of intraglomerular events associated with progression of nephrotic conditions. Laboratory analysis revealed that homozygous (nep/nep) mice showed urinary albumin excretion during the suckling stage, rapidly leading to hypoalbuminemia accompanied by body growth failure. Renal pathology demonstrated that an initial intraglomerular event in the nephrotic mice was observed 3 weeks after birth in the form of mesangiolytic lesions, characterized by microaneurysm, platelet accumulation and capillary ballooning. In 6-week-old homozygous mice, mesangial sclerosis, characterized by mesangial expansion and glomerular hypertrophy, was observed in a diffuse fashion. Immunohistochemistry revealed that the glomerular cells in the 3-week-old homozygous suckling mice were positive for α-smooth muscle actin, suggesting a phenotypic change in the mesangial cells. Mesangial expansion, confirmed by the over-deposition of type I collagen, was evident until 6 weeks after weaning, while it was of interest that fibrogenic cytokines such as platelet-derived growth factor and transforming growth factor-β were not detected in the sclerotic glomeruli throughout the observations. Furthermore, the nephrotic features were shown to be resistant to steroid therapy with a high dose of prednisolone. Our results suggest that diffuse mesangial sclerosis, a hereditary glomerular disease, may be genetically generated through early myofibroblast formation, which occurs and develops probably independently of up-regulation of these fibrogenic cytokines. In conclusion, the homozygous nephrotic mouse (ICGN strain) is believed to be a good model for investigating not only nephrotic conditions but also cellular and molecular pathogenesis of diffuse mesangial sclerosis in steroid-resistant infantile nephrotic syndrome.
Treatment of Renal Stones in Bulgaria in Ancient Times (‘Hissarya’ Baths)
Authors: Nenov D. , Nenov V. , Lazarov G. , Tchepilev A.
Published: April 2003

Well-known mineral baths in Bulgaria, ‘Hissarya’, are described. Their existence dates back more than 25 centuries. ‘Hissarya’ is an Arabic word meaning ‘siege of a castle’. Remains of castle walls are the symbol of ‘Hissarya’ today. Every year more than 100,000 patients from Bulgaria and other countries visit ‘Hissarya’. From the time of the Thracians and the Roman Empire until now renal stones have been successfully treated by drinking the mineral water and by taking baths. The Roman Emperor Septimius Severus (193–211) visited ‘Hissarya’ every spring to treat his renal disease.