bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Re-Challenge in Patients with Suspected Lidocaine Allergy
Authors: Amsler E. , Flahault A. , Mathelier-Fusade P. , Aractingi S.
Published: April 2004

Background: Lidocaine is an anaesthetic agent used worldwide in various clinical specialties. Although lidocaine hypersensitivity is very rare, clinicians frequently encounter patients with such an alleged diagnosis. Using a questionnaire, we evaluated the results of re-challenge with lidocaine, the gold standard for assessing hypersensitivity reactions in patients who claim to be allergic to this drug. Methods: A detailed questionnaire was sent to members of the French Dermatological Society, targeting the management of patients claiming lidocaine intolerance. After analysis and recall of doubtful episodes, 199 re-challenges were made. True lidocaine hypersensitivity was finally demonstrated in only 1 patient. Conclusions: The results of this study demonstrate that patients claiming to be allergic to lidocaine are usually not, their symptoms corresponding in most cases to a vasovagal episode. Re-challenge is safe and may constitute an easy and cheap alternative to skin testing. This should be performed in specialized centres except in case of a vasovagal episode.
Punch Grafting for Lip Leucoderma
Authors: Malakar Subrata , Lahiri Koushik
Published: April 2004

Background: Lip leucoderma (LL) is a common concern of great psychological scarring. The condition is often resistant to medical management due mainly to the absence of hair follicles. Melanocyte transfer, therefore, by any surgical procedure may repigment this condition. Objective: To repigment LL by punch graft (PG) and to estimate and evaluate the degree of repigmentation and its complications. Methods: One hundred and eight cases of stable and resistant LL of various causes were studied. They were followed up to a maximum of 5 years. Results: Graft take was achieved in 98 cases (91%) whereas all the grafts were rejected in 8 cases of herpes-labialis-induced LL (HlLL). Two cases (1.5%) showed depigmentation of grafts. Cobblestoning was the most common complication and was observed in 32 cases (30%). Complete repigmentation was achieved in 78 cases (72%). Conclusion: PG is a simple office procedure to treat LL. The procedure should exclude HILL.
Topical Effectiveness of Molgramostim (GM-CSF) in Sickle Cell Leg Ulcers
Authors: Méry Laure , Girot Robert , Aractingi Sélim
Published: April 2004

Background: Leg ulcers are a frequently neglected, severe complication of sickle cell disease (SCD), responsible for significant altering quality of life. The management of leg ulcers remains disappointing. Local application of recombinant human granulocyte-macrophage colony-stimulating factor has been shown to be effective in several types of chronic wound healing. Methods: We report 5 homozygous sickle cell patients with 14 leg ulcers lasting from 1 month to 6 years, treated with topical dripping of molgramostim solution. Results: Healing was obtained for 9/14 ulcers, with no local or systemic adverse reactions. Comments: Molgramostim solution appears to be an adequate therapy for SCD leg ulcers but a more conclusive evaluation will depend on larger series of patients and other types of formulations for topical applications could be even more effective in the future.
Skin Disorders with Prominent Eosinophilic Infiltration Treated Successfully with Nicotine
Authors: Kanekura Takuro , Usuki Kazunari , Kanzaki Tamotsu
Published: April 2004

Background: Nicotine was effective in the treatment of skin disorders attributable to neutrophils such as pyoderma gangrenosum and orogenital ulcerations due to Behçet’s disease. Objective: We assessed the efficacy of nicotine for treating skin disorders with prominent eosinophilic infiltration. Patients and Methods: A 67-year-old man with Kimura’s disease was treated for 2 weeks with nicotine chewing gum (6 mg/day). A 50-year-old woman with erythema nodosum with eosinophilic infiltration was treated for 4 weeks with transdermal nicotine patches (5 mg/day). Results: Both patients showed a dramatic clinical and histopathological improvement. Conclusion: Our results suggest that nicotine may be useful for treating skin disorders with eosinophilic infiltration as well as neutrophilic dermatoses.
Cutaneous Intravascular Lymphoma following Extravascular Lymphoma of the Lung
Authors: Tomasini Carlo , Novelli Mauro , Ponti Renata , Pippione Mario , Bernengo Maria Grazia
Published: April 2004

Intravascular lymphoma (IL) is a rare aggressive disease characterized by exclusive or predominant accumulation of malignant lymphoid cells within the lumina of small arteries, veins and capillaries. We describe a 74-year-old woman with IL presenting in the skin as asymptomatic teleangiectatic plaques on the thighs. The cutaneous neoplasm developed 18 months after an extravascular large B cell lymphoma of the lung and heralded its relapse. No neurologic symptoms were present during the course of the fatal disease. Immunophenotypic and immunogenotypic studies confirmed a unique B cell subtype. This case of IL is unusual for the association with an extravascular B cell lymphoma suggesting a link between the two diseases.
In utero Stem Cell Transplantation:A European Overview
Authors: Jones D.R.E.
Published: April 2004

In utero stem cell transplantation (IUTx) is a therapeutic option for some lymphohaematopoietic disorders which can be diagnosed early in pregnancy. However, the promise of effective treatment before potentially life-threatening pathology becomes manifested has not been realised in all cases. This has prompted investigators to reassess their understanding of fetal haematopoiesis and of developmental pathways in the fetal immune system, to unravel the problem of failure to engraft after IUTx. The European Network for Fetal Transplantation (ENFET) was established to address these issues and to develop a concerted approach to IUTx. In this way, ENFET aims to study the basic biology of stem cell development and to put the findings into the context of engraftment potential following IUTx. One issue which has gained currency since ENFET was established, is the concept of stem cell ‘plasticity’, which has changed our view of the utility of IUTx so that there is now a real prospect for using this therapy in a larger range of disorders than was initially envisaged. Paradoxically, our current knowledge of stem cell plasticity must also change our views on the utility of IUTx for haematopoietic disorders, since it might offer some insights into the reasons for lack of engraftment observed in some of these conditions. The issue of in utero gene therapy is also being addressed by members of the ENFET consortium. Recent setbacks in postnatal gene therapy trials have put this therapeutic modality under intense scrutiny and there is much work still to be done before such therapy can realistically be offered in utero.
Human Embryonic Stem Cells Form Embryoid Bodies Containing Visceral Endoderm-Like Derivatives
Authors: Conley Brock J. , Trounson Alan O. , Mollard Richard
Published: April 2004

Objective: The objective of this study was to determine the potential of human embryonic stem (hES) cells to provide an in vitro model of human extraembryonic endoderm development. Methods: The hES cell line HES-2 was propagated in Dulbecco’s modification of Eagle’s medium (DMEM) in the presence of 20% fetal calf serum (FCS) on a mouse embryonic fibroblast feeder layer. Clumps of approximately 50–100 cells were transferred to fresh DMEM and FCS and grown as embryoid bodies (EBs) in suspension culture. EBs were subjected to immunohistochemistry for endodermal, ectodermal and mesodermal specific markers and immunoreactivity analysed by confocal microscopy and on cryosections. Results: HES-2 cells reproducibly formed spherical EBs after 2–3 days in suspension culture as clumps. EBs continued to expand and by 7 days had commenced cavitation in a highly reproducible and organised fashion. Culture periods longer than 10 days led to cystic structures displaying inconsistent morphological organisation. Immunolocalisation of anti-α-fetoprotein-, anti-neurofilament- and anti-CD31-specific antibodies at 7 days of culture provided evidence of regional differentiation of endodermal, ectodermal and mesodermal derivatives in cavitating EBs. Further, of 10 cavitating EBs analysed at 7 days of culture, all displayed immunolocalisation of anti-pan-keratin-, anti-CK8- and anti-α-fetoprotein-specific antibodies to a peripheral cellular layer, suggestive of yolk sac visceral endoderm (VE) formation. Conclusion: Cavitation, the presence of regionalised cell lineage-specific immunoreactivity and the development of a VE-like peripheral cell layer demonstrate that the HES-2 hES cell line can be induced to undergo EB formation and provide scope to study early human primitive endoderm and yolk sac VE development.
Oligohydramnios and Fetal Renal Sonographic Appearances Related to Prostaglandin Synthetase Inhibitors
Authors: Fieni S. , Gramellini D. , Vadora E.
Published: April 2004

A case of acute neonatal renal failure in twins following tocolytic treatment with ketoprotene is described. The twins had visible signs in utero of developed anhydramniosis associated with morphological renal abnormalities on ultrasound. At birth both twins had acute renal failure with reduced creatinine and urea levels, which could only be normalized after 3 and 18 months, respectively.
Framing the Decision: Determinants of How Women Considering Multifetal Pregnancy Reduction as a Pregnancy-Management Strategy Frame Their Moral Dilemma
Authors: Britt David W. , Evans Wendy J. , Mehta Shilpi S. , Evans Mark I.
Published: April 2004

Objective: How people make decisions regarding medical technologies and procedures are affected by how they ‘frame’ those decisions. Medical frames are characterized by a reliance on statistics regarding outcomes and risk to mother and surviving embryos, emphasize the influence of medical authorities, and are driven by a desire to minimize medical risks. Moral frames, on the other hand, are driven more by a desire to minimize the disruption to antiabortion and antireduction moral precepts, and weight heavily the advice of religious leaders. These frames contest with one another. Our objective is to examine the biographical determinants of frame dominance in this contest as it applies to multigestation pregnancies where selective reduction is being considered as a pregnancy-management strategy. Methods: For a sample of 55 multigestation women considering multifetal reduction as a pregnancy-management strategy, we develop a distinction between medical and moral frames. Semistructured interviews generated qualitative data that were independently coded by two researchers. These variables were then analyzed using dummy variable regression analysis. Results: Conceptualizing these frames as anchoring opposite ends of a continuum, we show that 40% of the variance in frame dominance can be accounted for by three factors: how involved patients are in religious institutions that have antiabortion norms, whether they have medico-scientific careers, and how pro-reduction their advice has been from fertility specialists and obstetricians prior to coming to the clinic. Conclusions: The implication of these results for practice include recognizing the wide variation in patient’s perceptions of their situations and how these perceptual frames alter how women confront risk-benefit statistics and being flexible in one’s approach to counseling patients. This approach can further serve as a model for similar reproductive-health dilemmas.
Nuchal Translucency and Ductus venosus Blood Flow as Early Sonographic Markers of Thanatophoric Dysplasia
Authors: Ferreira Anabela , Matias Alexandra , Brandão Otília , Montenegro Nuno
Published: April 2004

Thanatophoric dysplasia (TD) is the most frequent form of lethal osteochondrodysplasias. Prenatal diagnosis is commonly accomplished in the second-trimester scan, but occasionally TD may not be clearly distinguished from the other osteochondrodysplasias, with consequent important prognostic implications. However, in order to confirm the diagnosis, complementary radiological, pathological and molecular studies are mandatory. We present a case of TD diagnosed in the late first trimester with the contribution of nuchal translucency combined with ductus venosus blood flow assessment.
Diprosopus Associated with Neural Tube Defect and Facial Cleft in theFirst Trimester
Authors: Bulbul Y. , Drummond C.L. , Hillion Y. , Bidat L. , Ville Y.
Published: April 2004

We report a case of diprosopus presenting with increased nuchal translucency of 5.3 mm at 14 weeks of gestation. Ultrasonographically, the fetus presented with micrognathia, anterior indentation of the cephalic pole, abnormal cerebral hemispheres with a cystic 4th ventricle and angulation of the spine. The fetal karyotype was normal (46,XX). Following termination of pregnancy, postmortem examination established the diagnosis of diprosopus tetraophthalmus with facial cleft of the 2 faces.
Use of Aspirin and Low-Molecular-Weight Heparin to Prevent Recurrence of Maternal Floor Infarction in Women without Evidence of Antiphospholipid Antibody Syndrome
Authors: Makino Aiko , Suzuki Yoshikatu , Yamamoto Tamao , Sato Takeshi , Kojima Kazuhisa , Suzumori Kaoru
Published: April 2004

During pregnancy, maternal floor infarction (MFI) and massive perivillous fibrin deposition (MFD) often cause fetal growth restriction and death, both being markedly increased by occlusion of the maternal intravenous circulation. Incident rates have been reported to be in the range of 0.09–0.5% and recurrent MFI/MFD might be more frequent in early-onset cases. Thus, prevention measures are necessary for high-risk women who have had MFI/MFD as complications in a previous pregnancy. In this report, the use of oral low-dose aspirin at the early trimester and low-molecular-weight heparin drip infusion from the mid-second trimester was examined for this purpose.
Monopolar Thermocoagulation in the Management of Acardiac Twins
Authors: Chang Ping-Jian , Liou Jui-Der , Hsieh Ching-Chang , Chao An-Shine , Soong Yung-Kuei
Published: April 2004

Objective: To demonstrate the equipment setup and the application of monopolar thermocoagulation in the management of acardiac twins. Methods: We described 2 cases of acardiac acephalus twins who developed congestive heart failure and polyhydramnios at 20 weeks of gestation. A monopolar wire electrode was inserted through a 14-gauge trocar under ultrasound guidance. The inter-twin circulation was interrupted and confirmed by color Doppler flow examination. Results: Case 1 was detected at 20 weeks of gestation with progression to early signs of fetal congestive heart failure at 22 weeks. This case had smooth operative procedure and delivered a healthy infant at 32 weeks. Case 2 was referred at 24 weeks of gestation with marked fetal congestive heart failure. Although thermocoagulation cessed the inter-twin perfusion, the fetus died in utero 12 h later with persistent irreversible circulatory compensation. Conclusion: Monopolar thermocoagulation was an effective and generally available alternative technique to fetal endoscopic surgery for the interruption of vascular communication between acardiac twins.
Leiden Mutation, Bed Rest and Infection: Simultaneous Triggers for Maternal Deep-Vein Thrombosis and Neonatal Intracranial Hemorrhage?
Authors: Sikovanyecz János , Orvos Hajnalka , Pál Attila , Katona Márta , Endreffy Emõke , Horváth Emese , Szabó János
Published: April 2004

The possible etiologic roles of infection and bed rest are discussed in connection with a case of maternal homozygous Leiden mutation leading to prematurity, maternal deep-vein thrombosis and neonatal intracranial hemorrhage in a heterozygous premature baby. Maternal bacterial infection and bed rest may trigger deep-vein femoral thrombosis in women with a homozygous Leiden mutation on tocolytic therapy for the treatment of premature labor. The neonate carrying at least one mutated allele of factor V Leiden might be at risk for the development of intracranial hemorrhage.
Clinical Evaluation of the Risk of Twin-to-Twin Transfusion Syndrome Using the Relative Power Contribution of Fetal Heart Rate Fluctuations
Authors: Kimura Yoshitaka , Suzuki Nobuaki , Sugawara Jun-Ichi , Murakami Takashi , Terada Yukihiro , Chisaka Hiroshi , Okamura Kunihiro
Published: April 2004

Objectives: In twin pregnancies, it has been suggested that fluctuations of the two fetal heart rates should be considered as two variates that affect each other. We therefore investigated whether the relative power contribution (RPC) of heart rate fluctuation between twins reflects the clinical severity of twin-to-twin transfusion syndrome. Study Design: Sixty-three cases of twin pregnancy including 43 monochorionic twins and 20 dichorionic twins were studied. Thirteen monochorionic twins with polyhydramnios in one twin were regarded as twin-to-twin transfusion syndrome (TTTS). Of the 13 TTTS cases, 8 cases with polyhydramnios in one twin and oligohydramnios in the other were deemed to be a ‘stuck’ twin. The RPC of the very low frequency domain (VL; 0.0125–0.0625 Hz) of fetal heart rate fluctuation in the twin fetuses of monochorionic and dichorionic pregnancies was obtained within a week of delivery. The relationship between the value of the RPC and the outcome of these twins was examined. Results: For both monochorionic and dichorionic twins the RPC of twin fetuses was significantly higher in TTTS twins than in twins without TTTS. In particular, in pregnancies that resulted in fetal death, early neonatal death, or hydrops of one of the twins, this twin had a higher RPC than the other twin. No significant difference was observed in the RPC value between twins of either monochorionic or dichorionic pregnancies that did not develop TTTS. Serial changes in RPC values were followed in 7 cases of TTTS. The RPC value rose rapidly just before delivery in three cases with resultant poor outcome. Conclusion: A rapid change in the RPC of twin fetuses measured using the VL frequency domain of fetal heart rate fluctuations may predict poor outcome in twin pregnancies.
Five Months of Physical Exercise in Hemodialysis Patients: Effects on Aerobic Capacity, Physical Function and Self-Rated Health
Authors: Molsted Stig , Eidemak Inge , Sorensen Helle Tauby , Kristensen Jens Halkjaer
Published: April 2004

Background: The number of chronic renal failure patients treated by hemodialysis (HD) is continuously increasing. Most patients have reduced physical capacity and have a high risk of cardiac and vascular diseases. The aim of this study was to determine the effects of 5 months physical exercise of HD patients’ physical capacity, self-rated health and risk factors for cardiovascular disease. Methods: 33 HD patients were included in the study. Inclusion criteria: HD for more than 3 months, age >18 years. Exclusion criteria: Diabetes mellitus, symptomatic cardiovascular disease, musculoskeletal limitations, severe peripheral polyneuropathy, inability to speak Danish or English, dementia or other mental disorders. The patients were randomly assigned to an exercise group (EG, n = 22) or a control group (CG, n = 11). Prior to randomization, baseline testing was performed. The effects were measured by aerobic capacity, ‘2-min stair climbing’, ‘squat test’, self-rated health (SF36), blood pressure and lipids. All tests were carried out by blinded testers. The intervention consisted of 1 h of physical exercise twice a week for 5 months. Results: 20 patients completed the intervention. Attendance was 74% of all sessions. There were no dropouts caused by complications related to the intervention. The EG had a significant increase in aerobic capacity, ‘squat test’ and Physical Function and Physical Component Scale (SF36). No significant changes were observed in any of the parameters in the CG. Conclusion: Physical exercise twice a week for 5 months increases physical function and aerobic capacity in HD patients. An exercise program with only two exercise sessions per week seems easy to implement in clinical practice with high attendance among participants. Further investigation is needed to determine the effects on blood pressure and lipids. There were no medical complications related to the exercise program.
Blood Pressure Response to Uncomplicated Hemodialysis: The Importance of Changes in Stroke Volume
Authors: Boon Diederik , van Montfrans Gert A. , Koopman Marion G. , Krediet Raymond T. , Bos Willem Jan W.
Published: April 2004

Background: The cause of blood pressure (BP) changes during uncomplicated hemodialysis (HD) has not been fully investigated. Controversy exists whether changes in BP result from changes in stroke volume (SV) or total peripheral resistance (TPR). Methods: We investigated 19 patients using continuous BP monitoring (Portapres®) and subsequent Modelflow® analysis, yielding continuous SV, cardiac output (CO) and TPR values. Blood volume (BV) monitoring was also performed. For each patient, the sensitivity index (SI) was calculated. The SI is the slope of the curve depicting the relationship between the systolic BP (SBP) response and the BV response. The patients were divided into two groups: group A had an SI >1 which means a decrease in SBP in response to BV change, and group B had an SI <1. In these patients, SBP remained stable despite a BV change. Results: Baseline characteristics and baseline values of all parameters were similar between the groups. In group A, SBP decreased by 25 ± 19 mm Hg and in group B the SBP increased by 5.0 ± 29 mm Hg (p < 0.05), while BV change was similar (10.6 ± 4.9 and 11.2 ± 4.2%, respectively). The difference in SBP response was caused by a different SV response (group A –44 ± 16% and group B –26 ± 18%, p = 0.04), while the TPR response was similar (71 ± 27% in group A vs. 59 ± 58% in group B). Conclusion: Patients responding with a BP decrease to BV reduction during uncomplicated HD differ in their SV response from patients with a stable BP.
Analysis of Glomerular Anionic Charge Status in Children with IgA Nephropathy Using Confocal Laser Scanning Microscopy
Authors: Sakagami Yoshitsugu , Nakajima Mitsuru , Takagawa Ken , Ueda Taku , Akazawa Hideki , Maruhashi Yoshiyuki , Shimoyama Hironobu , Kamitsuji Hidekazu , Yoshioka Akira
Published: April 2004

Background: The proteinuria resulting from IgA nephropathy is secondary to altered charge-selective and/or size-selective properties of the glomerular capillary walls. However, the functional changes occurring within the glomerular capillary network which lead to proteinuria are still poorly understood. In this study, we analyzed the participation of charged components in the glomerular capillary and their role with respect to proteinuria in childhood IgA nephropathy. Methods: We examined glomerular anionic charge in renal biopsy specimens with confocal laser scanning microscopy using FITC-conjugated poly-L-lysine as a cationic tracer. The renal specimens investigated were from 9 children with IgA nephropathy (IgAN(+)) associated with detectable proteinuria in a morning urine specimen, 8 children with IgA nephropathy (IgAN(–)) and 11 children with thin basement membrane disease (TBMD) with no detectable proteinuria. Results: The labeling intensity of glomerular fixed anionic sites from IgAN(+) was significantly lower than that of IgAN(–) and TBMD. Staining the serial sections following methylation treatment revealed that the labeling intensity for fixed anionic sites in TBMD was significantly higher than that of both IgAN(+) and IgAN(–). On the other hand, saponification treatment resulted in significantly more intensive fluorescence in TBMD and IgAN(–) than in IgAN(+). Furthermore, statistical analysis demonstrated a significant correlation between 24-hour protein excretion and the intensity of fixed anionic sites in all patients with IgA nephropathy at pH 7.0 and following staining with saponification treatment. Conclusions: These findings suggest that a reduction of glomerular anionic charge might be causally associated with the development of proteinuria in childhood IgA nephropathy. Furthermore, sulfate components such as heparan sulfate proteoglycan might be involved initially followed by carboxyl components such as sialoglycoproteins in the glomeruli of patients with IgA nephropathy contributing to the occurrence of proteinuria. We suggest that this method represents a straightforward approach to dissect the participation of charged components in the pathogenesis of childhood IgA nephropathy and their relationship to the development of glomerular proteinuria.
P2Y Receptors Present in the Native and Isolated Rat Glomerulus
Authors: Bailey M.A. , Turner C.M. , Hus-Citharel A. , Marchetti J. , Imbert-Teboul M. , Milner P. , Burnstock G. , Unwin R.J.
Published: April 2004

Extracellular ATP can mobilize intracellular calcium in rat glomeruli by interacting with P2Y receptors. However, the identity of the receptor subtypes involved is not known. In the present study, we have used RT-PCR to identify mRNAs for specific P2Y receptor subtypes expressed in the rat glomerulus: mRNA for P2Y1, P2Y2, P2Y4 and P2Y6 receptors was detected. Functional expression of P2Y1 and P2Y2/P2Y4, but not P2Y6, receptors in intact glomeruli was confirmed by measuring the relative stimulation of the inositol phosphate pathway induced by selective agonists of a particular receptor subtype. Finally, we have used available polyclonal antibodies to confirm the expression of P2Y1 and P2Y2 in the glomerulus, in mesangial cells and glomerular epithelial cells (podocytes), respectively; but we could not demonstrate P2Y4 or P2Y6 receptor expression by this means. In a separate series of experiments, we have examined the possibility that intra-renal sympathetic nerve terminals are a source of extracellular ATP and that this would be supported, though not excluded, by supersensitivity to ATP following denervation. Nucleotide-induced stimulation of the inositol phosphate pathway was measured in both control rats and rats that had been sympathectomized by intraperitoneal injection of 6-hydroxydopamine. The response to norepinephrine was measured as a positive control. In the sympathectomized rats, the effect of norepinephrine was significantly enhanced, whereas ATP-induced inositol phosphate production was unaffected, being similar in both groups of animals.
Effect of Angiotensin II Type 1 Receptor Blockade on Conduit Artery Tone in Subtotally Nephrectomized Rats
Authors: Kööbi Peeter , Jolma Pasi , Kalliovalkama Jarkko , Tikkanen Ilkka , Fan Meng , Kähönen Mika , Moilanen Eeva , Pörsti Ilkka
Published: April 2004

Background: Angiotensin II type 1 (AT1) receptor antagonists provide end-organ protection and enhance resistance artery relaxation in uremia. The effect of AT1 blockade on conduit artery function in renal failure is unknown. Methods: The influence of 8-week losartan therapy (20 mg/kg/day) on tone of isolated main branch mesenteric arterial rings was studied in 5/6 nephrectomized (NX) rats. Blood and urine chemistry were examined, and AT1 receptors quantified using autoradiography. Results: NX rats showed decreased creatinine clearance without change in blood pressure. Losartan did not influence these variables, although [125I]-Sar1,Ile8-angiotensin II binding to renal AT1 receptors was significantly prevented. Vasoconstriction to endothelin-1 was reduced by losartan in NX and Sham rats. Vasorelaxation to acetylcholine was attenuated in untreated but not in losartan-treated NX rats, and experiments with Ca2+-activated K+ channel blockers suggested that impaired endothelium-mediated response after NX was due to deficient relaxation via K+ channels. Endothelium-independent relaxation to levcromakalim, adenosine triphosphate-sensitive K+ channel agonist, was impaired in untreated but not in losartan-treated NX rats. Conclusion: Losartan reduced conduit artery vasoconstriction to endothelin-1 and augmented vasorelaxation via K+ channels in NX rats, although blood pressure and renal function were unchanged. Therefore, AT1 blockade confers functional benefits to large arteries in renal failure.
Ex vivo Reactivity of the Ovarian Vascular Bed to Noradrenaline and Carbachol during Ovarian Hyperstimulation Syndrome
Authors: Oriowo M.A.
Published: April 2004

Objective: To study reactivity of the ovarian vascular bed to noradrenaline and carbachol during an experimentally induced ovarian hyperstimulation syndrome (OHSS) in rabbits. Materials and Methods: Rabbits were treated with human menopausal gonadotropin (75 IU) daily for 6 days, followed by human chorionic gonadotropin (2,500 IU) to induce OHSS. The ovarian vascular bed was isolated and perfused with physiological solution and its reactivity to injected noradrenaline and acetylcholine was examined. Results: The mean weight of the hyperstimulated ovary was 2.85 ± 0.5 g compared to 0.25 ± 0.1 g for the control rabbits. There was no significant difference in (a) the basal perfusion pressure of the ovarian vascular bed ex vivo; (b) the potency of, or maximum response to, noradrenaline, and (c) agonist dissociation constant or receptor density. Carbachol induced significantly greater vasodilation in ovarian vascular beds from hormone-treated rabbits, indicating a greater role for nitric oxide in this syndrome, as further supported by the observation that NW-nitro-L-arginine methyl ester hydrochloride (L-NAME) was more effective against carbachol-induced response in hormone-treated rabbits. Conclusion: In the rabbit model of OHSS, carbachol produced an increased ex vivo vascular response but noradrenaline did not.
Pulmonary Function Tests and Thyroid Hormone Concentrations in Patients with Chronic Obstructive Pulmonary Disease
Authors: Okutan Oguzhan , Kartaloglu Zafer , Onde Mehmet Emin , Bozkanat Erkan , Kunter Erdogan
Published: April 2004

Objective: To evaluate the relationship between pulmonary function tests, arterial blood gases, and thyroid gland functions in patients with chronic obstructive pulmonary disease (COPD). Subjects and Methods: Thirty-two patients (mean age 64.1 ± 7.3 years, range 53–84 years) with stable COPD (mean duration of disease 11.1 ± 9.1 years, range 1–30 years) and 15 healthy control cases participated in the study. Pulmonary function, arterial blood gas, and thyroid hormone concentration were measured, and thyroid ultrasonography and scintigraphy were also performed. Results: The values of the pulmonary function tests (vital capacity, forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow) and PaO2 were lower in the study than control group (p < 0.001), but the values of PaCO2 and concentration of free 3,5,3′-triiodothyronine (fT3) were higher in the study than control group (p < 0.01) although thyroid hormone concentrations were within normal limits in all cases. However, there was no difference between the values of thyroid-stimulating hormone and free thyroxine in both the study and control groups and therefore association could not be established between them on the one hand and pulmonary function test and arterial blood gases on the other hand. Only the values of PaCO2 and fT3 were positively associated; all other values were negatively associated with fT3. Conclusion: Changes in pulmonary function tests and arterial blood gases seem to be associated with fT3 concentrations in patients with COPD. Increased respiratory workload could affect thyroid functions.
Molecular Characterization of Nitroimidazole Resistance in Metronidazole-Resistant Bacteroides Species Isolated from Hospital Patients in Kuwait
Authors: Jamal Wafaa Y. , Rotimi V.O. , Brazier J.S. , Johny Molly , Wetieh Wafaa M. , Duerden B.I.
Published: April 2004

Objectives: The aim of this study was to screen for infections caused by metronidazole (MTZ)-resistant Bacteroides spp., and to characterize the genes that encode the MTZ resistance. Materials and Methods: A total of 7 MTZ-resistant Bacteroides spp. were isolated from 5 patients with MTZ-resistant infections. These organisms were investigated for carriage of genes that encode MTZ resistance. The presence of these genes was investigated by PCR and the PCR products were subjected to PCR-RFLP analysis. Results: The strains were MTZ-resistant with minimum inhibitory concentrations of >32 µg/ml. The presence of nim genes was indicated by PCR in all 7 strains. PCR-RFLP analysis of the nim gene products demonstrated two of the five reported resistance genes, nimA–nimE. These two resistance genes were nimE in 5 of the 7 isolates and nimA in 2 strains. Conclusion: MTZ-resistant Bacteroides spp. have been isolated from patients in Kuwait. Nim genes, specifically nimE and nimA, mediate the drug resistance in these isolates. The methods used in detecting these genes are rapid, accurate and relatively inexpensive and could be adopted easily to help in monitoring emergence of MTZ resistance determinants in Kuwait.
The Recurrence Risk of Ischemic Stroke in Childhood
Authors: Brankovic-Sreckovic Vesna , Milic-Rasic Vedrana , Jovic Nebojsa , Milic Natasa , Todorovic Slobodanka
Published: April 2004

Objective: To determine the risk of recurrence of ischemic stroke in children and to evaluate the influence of etiological factors and underlying mechanisms on recurrence rate. Subjects and Methods: Thirty-six children (21 boys and 15 girls) with clinically and radiographically proven ischemic cerebral infarction were prospectively followed up over a period of 1–9 years (median 5 years 5 months). The median age of onset of stroke was 8.4 years (1–16 years). Patients with hemorrhagic stroke, neonatal infarction and sinovenous thrombosis were not included. The patients were analyzed according to the mechanisms and etiology of the initial and recurrent stroke event. Results: For the initial stroke, cardioembolic (33.3%) and arteriopathic processes (36.1%) were identified as the most probable mechanisms of arterial ischemic stroke. Prothrombotic abnormalities were found in 4 children (11.1%). Underlying pathology in the remaining 7 (19.4%) was not known. Recurrent ischemic infarction was diagnosed in 5 children (13.9%) within 5 days to 18 months (median 6 months) after the first stroke manifestation. In 3 of them stroke recurrence was due to cardiac or transcardiac embolism. Cardiac abnormality prior to the first stroke was detected in 1 child. Clinically silent multiple cerebral infarcts disclosed by MRI preceded the overt stroke episode in 2 patients. Conclusion: Congenital and acquired heart diseases were the most common cause of repeated stroke in our study. The risk of recurrence appeared to be fivefold higher in children with cardiac disease irrespective of the coexistence of other risk factors. The risk factors of stroke in children were multiple and overlapping. Consequently, recognition of the major one and its underlying mechanism is crucial for both effective therapeutic approach and the prevention of recurrence.
Sacrocervicopexy and Combined Operations Involving Cases of Total Uterine Prolapse
Authors: Karateke Ates , Gurbuz Ayse , Kabaca Canan , Mengulluoglu Murat
Published: April 2004

Objective: To determine the outcome of sacrocervicopexy and combined operations in the treatment of uterovaginal prolapse in women with desire to preserving both uterus and fertility. Clinical Presentation and Intervention: Sacrocervicopexy with Prolene mesh and combined operations were performed in 3 women with total uterine prolapse because of the patient’s desire to retain fertility in 2 cases and refusal of hysterectomy in the 3rd patient. The 1st case was a 38-year-old woman, gravida 2, parity 1; the 2nd case a 42-year-old woman, gravida 3, parity 2, and the 3rd a 39-year-old woman, gravida 1, parity 1. Douglas pouch was obliterated with Moschcowitz operation. All of the women underwent sacrocervicopexy with Prolene mesh. The repair of a paravaginal defect and prophylactic Burch urethropexy were accomplished through entering Retzius’ space. Genital hiatus was narrowed via approximating levator muscles transvaginally. No serious intraoperative complications occurred and no recurrence was detected during the follow-up period. There was no postoperative complication except for some degree of pain in the 1st postoperative month in 1 case. Conclusion: The results indicate that sacrocervicopexy and repair of all concomitant defects in the pelvic floor are effective procedures in the treatment of uterovaginal prolapse in cases where there is a desire to retain fertility and uterus.
Fever of Unknown Origin in Carcinoma of the Colon
Authors: Karachalios George N. , Karachaliou Iris G. , Bablekos George , Charalabopoulos Konstantinos
Published: April 2004

Objective: To report a case of fever of unknown origin in a patient with carcinoma of the colon but without gastrointestinal symptoms. Clinical Presentation and Intervention: A 65-year-old man presented with a long-standing fever (of 38°C, about two months’ duration), night sweats, fatigue, malaise and anxiety. General physical examination including rectum, radiographic examinations of the chest, abdomen and bones (including ultrasonography and CT scanning) was normal. Biochemistry profile as well as other laboratory studies including blood, urine and stool cultures were normal except for erythrocyte sedimentation rate, which was 105 mm/h. A barium enema showed a rectosigmoid carcinoma. A left sigmoidal colectomy was performed. The patient recovered quickly and remained well for eight years postoperatively. Conclusion: This case shows that carcinoma of the colon should be included in the differential diagnosis of patients with fever of unknown origin.
The Distribution and Morphological Characteristics of Catecholaminergic Cells in the Diencephalon and Midbrain of the Bottlenose Dolphin (Tursiops truncatus)
Authors: Manger Paul R. , Fuxe Kjell , Ridgway Sam H. , Siegel Jerome M.
Published: April 2004

The present study describes the distribution and cellular morphology of catecholaminergic neurons in the diencephalon and midbrain of the bottlenose dolphin (Tursiops truncatus). Tyrosine hydroxylase immunohistochemistry was used to visualize these putatively dopaminergic neurons. The standard A1-A17, C1-C3, nomenclature is used for expediency; however, the neuroanatomical names of the various nuclei have also been given. Dolphins exhibit certain tyrosine hydroxylase immunoreactive (TH-ir) catecholaminergic neuronal groups in the midbrain (A8, A9, A10) and diencephalon (A11, A12, A14), however, no neuronal clusters clearly corresponding to the A13 and A15 groups could be identified. The subdivisions of these neuronal groups are in general agreement with those of other mammals, but there is a high degree of species specificity. First, three TH-ir neuronal groups not identified in other species were found: in the ventral lateral peri-aqueductal gray matter, posterior dorsal hypothalamus, and rostral mesencephalic raphe. Second, the normal components of the substantia nigra (A9 or pars compacta, A9 lateral or pars lateralis, A9 ventral or pars reticulata) were extremely cell sparse, but there was a substantial expansion of the A9 medial and A10 lateral subdivisions forming an impressive ‘ventral wing’ in the posterior substantia nigra. The findings of this and previous studies suggest a distinct evolutionary trend occurring in the neuromodulatory systems in mammals. The results are discussed in relation to motor control, thermoregulation, unihemispheric sleep, and dolphin cognition.
Exogenous Nitric Oxide Upregulates p21waf1/cip1 in Pulmonary Microvascular Smooth Muscle Cells
Authors: Stotz William H. , Li Dechun , Johns Roger A.
Published: April 2004

The histopathology of chronic pulmonary hypertension includes microvascular proliferation and neointimal formation. Nitric oxide (NO) has been implicated in the regulation of these mechanisms, but how NO controls microvascular proliferation and its effect on pulmonary microvascular cells is still unclear. In this study, we characterized the in vitro effects of NO on rat pulmonary microvascular smooth muscle cell (PMVSMC) proliferation and investigated the contribution of the p42/44 mitogen-activated protein kinase (MAPK) pathway and p21waf1/cip1 induction to this response. NO donors inhibited PMVSMC proliferation in a dose-dependent manner. In the presence of hypoxia, the degree of inhibition was significantly enhanced. This inhibition was reversible and independent of apoptosis. The soluble guanylyl cyclase inhibitor 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) had no impact on proliferation rates, suggesting a cyclic guanosine monophosphate-independent process. Administration of MEK1/2 inhibitors failed to abrogate the antimitotic effect of NO. There was a two- fold induction of the cyclin-dependent kinase inhibitor p21 in PMVSMC treated with NO donors. Under hypoxic conditions, NO caused a three-fold increase in p21 levels. These results demonstrate that NO inhibits PMVSMC proliferation and that this inhibition is not the result of p42/44 MAPK activation. The ability of NO to induce p21 upregulation may be a mechanism by which it exerts antiproliferative effects in PMVSMC.
Kleptomania: Comorbid Psychiatric Diagnosis in Patients and Their Families
Authors: Dannon Pinhas N. , Lowengrub Katherine M. , Iancu Iulian , Kotler Moshe
Published: April 2004

Objectives: Kleptomania, defined by DSM-IV as the inability to resist the impulse to steal objects which are not needed for personal use or for their monetary value, may reflect a form of obsessive-compulsive spectrum disorder and/or affective spectrum disorder. Methods: Twenty-one kleptomanic patients and 57 first-degree relatives completed a semistructured DSM-IV-based interview and questionnaires. Questionnaires are: the HDRS-17 (the Hamilton Rating Scale for Depression), the HARS (Hamilton Rating Scale for Anxiety), the Y-BOCS (Yale-Brown Obsessive Compulsive Scale), the YMRS (Young Mania Rating Scale). The two groups were compared to demographically matched normal controls (n = 64). Results: We found a high prevalence of affective and anxiety disorders in our sample of kleptomanic patients and their first-degree relatives. In addition, the scores on the HDRS, HARS, and Y-BOCS were significantly higher in the study group than in the control group. Conclusions: Our finding of a high prevalence of psychiatric comorbidity in kleptomanic patients could lead to the development of new treatment strategies for this disorder. Furthermore, the pattern of psychiatric disorders seen in the first-degree relatives can lead to new insights about the nosology and etiopathology of kleptomania.
Being a Webcam
Authors: Schmid-Siegel B. , Stompe T. , Ortwein-Swoboda G.
Published: April 2004

Searching through studies of schizophrenic delusions with a view to the new media, we came across the case of a young woman who integrated the Internet in her delusional system. Analysing the story she told, we recognised a psychotic symptom, which we preliminarily called ‘perception broadcast’. Perception broadcast shows a more complex structure than the related first rank symptom ‘thought broadcast’ described by Kurt Schneider. In our view the existence of a structure like perception broadcast depends on the existence of new technologies, such as the World Wide Web and ‘virtual reality’, creating new cultural patterns which themselves are associated with collective perceptions of derealisation.
Multi-Minicore Disease with Susceptibility to Malignant Hyperthermia in Pregnancy
Authors: Osada Hisao , Masuda Kentaro , Seki Katsuyoshi , Sekiya Souei
Published: April 2004

Multi-minicore disease (MmD) is a congenital non-progressive or slowly progressive myopathy associated with multifocal degeneration of muscle fibers. Obstetric management for patients with MmD has not been described previously. A 25-year-old primigravida with a history of muscular weakness from birth was diagnosed with MmD and found to be susceptible to malignant hyperthermia (MH) by muscle biopsy at 28 weeks of gestation. Pregnancy proceeded uneventfully and she had a successful vaginal delivery under sufficient preparation for the possible occurrence of MH. Pregnant women who exhibit myopathic symptoms from childhood should consult an anesthesiologist prior to delivery.
Radiosurgery as Primary Management for Meningiomas Extending into the Internal Auditory Canal
Authors: Pollock Bruce E. , Pollock Bruce E. , Link Michael J. , Link Michael J. , Foote Robert L. , Foote Robert L. , Stafford Scott L. , Stafford Scott L. , Brown Paul D. , Brown Paul D. , Schomberg Paula J. , Schomberg Paula J.
Published: April 2004

Stereotactic radiosurgery is increasingly utilized as primary management for patients with skull base meningiomas. This study reviews the results of stereotactic radiosurgery for patients with meningiomas extending into the internal auditory canal (IAC) to determine the risk of facial weakness or hearing loss. From 1990 to 2002, 16 patients had radiosurgery for meningiomas extending into the IAC. The median patient age was 63 years. Ten patients had symptoms of vestibulocochlear nerve dysfunction before radiosurgery. The median tumor volume was 5.1 cm3; the median tumor extension into the IAC was 7 mm (range, 3–12). The median tumor margin dose was 15 Gy. The median follow-up was 36 months. Ten meningiomas (63%) decreased in size, and 6 tumors were unchanged. No patient developed facial weakness. One patient (6%) had worsened facial sensation. Three of 14 patients (21%) with either normal hearing clinically (n = 5) or documented Gardner-Robertson class 1–2 before radiosurgery (n = 9) had decreased hearing after radiosurgery. The 1-, 2- and 5-year actuarial incidences of hearing preservation were 93, 84 and 42%, respectively. Three patients (19%) had improved hearing after radiosurgery. One patient with class 2 hearing improved to class 1; 2 patients with no speech discrimination before radiosurgery (class 5) improved to a class 3 status following the procedure. The risk of facial weakness or hearing loss is low after radiosurgery for patients with meningiomas extending into the IAC. Radiosurgery is an excellent alternative to surgical excision for meningiomas in this location, especially if a subtotal resection is likely or a hearing-sacrificing operation such as a translabyrinthine approach is contemplated.
Antioxidant Status in Acute Stroke Patients and Patients at Stroke Risk
Authors: Zimmermann C. , Winnefeld K. , Streck S. , Roskos M. , Haberl R.L.
Published: April 2004

Background and Purpose: Antioxidant enzymes like copper/zinc superoxide dismutase (SOD), catalase and gluthatione peroxidase (GSHPx) are part of intracellular protection mechanisms to overcome oxidative stress and are known to be activated in vascular diseases and acute stroke. We investigated the differences of antioxidant capacity in acute stroke and stroke risk patients to elucidate whether the differences are a result of chronic low availability in arteriosclerosis and stroke risk or due to changes during acute infarction. Methods: Antioxidant enzymes were examined in 11 patients within the first hours and days after acute ischemic stroke and compared to risk- and age-matched patients with a history of stroke in the past 12 months (n = 17). Antioxidant profile was determined by measurement of glutathione (GSH), malondialdehyde (MDA), SOD, GSHPx and minerals known to be involved in antioxidant enzyme activation like selenium, iron, copper and zinc. Results: In comparison to stroke risk patients, patients with acute ischemic stroke had significant changes of the GSH system during the first hours and days after the event: GSH was significantly elevated in the first hours (p < 0.01) and GSHPx was elevated 1 day after the acute stroke (p < 0.05). Selenium, a cofactor of GSHPx, was decreased (p < 0.01). GSHPx levels were negatively correlated with National Institutes of Health Stroke Scale (NIHSS) scores on admission (r = –0.84, p < 0.001) and NIHSS scores after 7 days (r = –0.63, p < 0.05). MDA levels showed a trend for elevation in the first 6 h after the acute stroke (p = 0.07). No significant differences of SOD, iron, copper nor zinc levels could be identified. Conclusions: Differences of antioxidant capacity were found for the GSH system with elevation of GSH and GSHPx after acute stroke, but not for other markers. The findings support the hypothesis that changes of antioxidant capacity are part of acute adaptive mechanisms during acute stroke.