bluuebunny/crossref_metadata_2025 huggingface dataset:
Distribution of Primary Afferent Neurons Innervating the Porcine Oviduct and Their Immunohistochemical Characterization
Authors: Czaja Krzysztof
Published: April 2003

Previous studies have revealed that some nerve fibres supplying the porcine oviduct may be of sensory origin. Therefore, the present study was aimed at disclosing the distribution of porcine ‘oviductal’ primary afferent neurons and the pattern(s) of putative coincidence of substance P (SP), calcitonin gene-related peptide (CGRP), vasoactive intestinal peptide (VIP) and nitric oxide synthase (NOS) within these nerve cell bodies using combined retrograde tracing and double-labelling immunohistochemistry. We also investigated the existence and coexistence of immunoreactivities to tyrosine hydroxylase (TH) and dopamine β-hydroxylase within the neurons because in some mammals, dorsal root ganglia (DRG) were previously found to contain perikarya immunoreactive (IR) to TH. Retrograde labelling revealed a population of large sensory neurons located in the Th10–L3 DRG. There were no significant differences in the number or distribution between the ampulla- and isthmus-projecting neurons. Double-labelling immunoflourescence allowed several subpopulations of the studied perikarya to be distinguished. The largest one consisted of SP/CGRP-IR nerve cells, while the smallest subpopulation comprised NOS/VIP-IR neurons. Either SP/NOS, solely SP- or solely NOS-IR neurons were also found. Because identically coded nerve fibres have been observed within the wall of the porcine oviduct, based on their association with particular organ structures, it can be assumed that SP/CGRP-, SP/NOS- or solely NOS-IR neurons are involved in the antidromic relaxation of the oviductal vessels, SP-, NOS- or SP/CGRP-IR nerve cells control the oviductal tonus and that some neurons project beneath the epithelium and are involved in the transmission of sensory modalities from the oviduct to the spinal cord.
Response of Zygomaticomaxillary Suture to Experimental Malocclusion in Rats
Authors: Kasahara Takehiro
Published: April 2003

The purpose of this study was to examine the response of the zygomaticomaxillary suture (ZMS) to experimental malocclusion in rats. Thirty-two male Wistar rats were divided into two groups. Malocclusion was produced in the experimental group (n = 20) by gluing a wire, 1 mm in diameter, on the upper left first molar. Duration of the procedure was 20 min. In the control group (n = 12), rats were forced to open their mouths for the same time as in the experimental group. Histomorphological changes of the ZMS were examined at intervals of 1, 2, 4 and 8 weeks. The specimens were stained with hematoxylin-eosin and Mallory’s azan. The suture in the control group showed a regular functional arrangement of component fibers, and osteoblasts lined the periphery of new bone at the inner half of the suture. On the untreated side in the experimental group, osteoclasts were most abundant after 2 weeks. Histomorphometric quantification of the sutural width revealed that, at the inner half of the suture, the width of the sutural space on the treated side in the experimental group was greater than that in the control group after 4 weeks (p < 0.05). The argyrophilic nucleolar organizer region (AgNOR) technique was used to investigate the transcriptional activity of fibroblasts in the suture. At the inner half of the suture, the number of AgNORs on the untreated side in the experimental group was greater than that on the treated side and that in the control group after 2 weeks (p < 0.05). Around the tip of the suture and at the outer half of the suture, there was no appreciable difference in the AgNOR number between the experimental and control groups. It was concluded that unilateral changes in occlusion had different effects on the treated and untreated sides of the ZMS. Moreover, the inner and outer halves of the suture showed different histological changes in response to experimental malocclusion.
Muscle Spindle Reinnervation following Phenol Block
Authors: Wolf Joshua H. , English Arthur W.
Published: April 2003

Infusion of phenol into peripheral nerves is used clinically to manage spasticity. It produces relief of symptoms by chemical denervation. We simulated the clinical procedure by bathing the lateral plantar nerve of rats in 7% phenol solution for 20 min. We studied the innervation of muscle spindles in the plantar lumbrical muscles of untreated rats and in rats 4 and 6 weeks after a single phenol block. Spindles were identified by the immunoreactivity of nuclear bag1 fibers to slow tonic myosin (antibody ALD 19). The integrity of the sensory and motor reinnervation of spindles was evaluated using a monoclonal antibody specific for a high molecular weight neurofilament protein. Four weeks after phenol block, muscle spindles were difficult to find, as their immunoreactivity to antibody ALD 19 was reduced. In those spindles studied, most (>80%) were completely denervated. The remainder of which were innervated by afferents only. None received efferent (gamma) innervation. After 6 weeks, spindles were readily identified and nearly all (>90%) received recognizable afferent innervation. A much smaller number (38%) received gamma innervation. Phenol block thus results in a complete denervation of muscle spindles, followed by a fairly rapid sensory reinnervation. Reinnervation by gamma motor neurons is either incomplete or significantly delayed.
The Lumbosacral Ligament
Authors: Hanson Patrick , Sørensen Henrik
Published: April 2003

The lumbosacral ligament (LSL), situated between the L5-vertebra and the sacrum, was studied in autopsy material. Twenty-eight cadaveric specimens from 12 black and 16 white persons aged 17–30 years were studied during routine forensic autopsies. The ligaments were measured and determined in situ. Thereafter, the ligaments were removed for histologic preparation. The ligament in the black subjects was thicker compared with the white (7.5 ± 1.4 vs. 5.7 ± 1.2 mm), and wider (11.7 ± 1.6 mm in the black vs. 9.2 ± 0.5 mm in the white), yielding a greater cross-sectional area in the black group (70.7 ± 22.8 vs. 34.5 ± 11.4 mm2, p < 0.001). However, no histological differences were noted. The previously described fibro-osseus tunnel could not be detected in any of the subjects. In all instances, the ligament was situated medial to the L5 nerve. Compression of the L5 nerve under the previously presented fibro-osseus tunnel could not be confirmed.
Geometrical Analysis of the Femoral Neck Torsion
Authors: Fabeck L. , Parewyck S. , Rooze M. , Burny F.
Published: April 2003

By the geometrical analysis of three cross sections the surface along the femoral neck, the second moments of area and the major axes of symmetry are obtained. The surface passing through these axes determined in each section, from the lateral to the medial third of the neck, is one of the two anatomical surfaces of symmetry of the neck. The geometric structure defined by this surface is a helicoid. No plane, in the ordinary sense of the word, has to be defined in the femoral neck. At the trochanteric junction, the major axis is inclined about 17° on the anteversion plane, twists anteriorly and becomes more horizontal to finish with a mean inclination of 60° at the cephalic junction. Surprisingly, this twist and then the neck torsion are in opposite directions to that suggested by the bony markers, often taken as a reference and reported in the anatomical descriptions.
Enhancement of Toluidine Blue Staining by Transforming Growth Factor-β, Insulin-Like Growth Factor and Growth Hormone in the Temporomandibular Joint of Aged Mice
Authors: Blumenfeld I. , Gaspar R. , Laufer D. , Livne E.
Published: April 2003

Osteoarthritic lesions appear in the articular cartilage of the temporomandibular joint of mice aged 7 months and older. Reduced rate of proteoglycan (PG) synthesis leading to destruction of the articular cartilage was observed in this joint. The purpose of the present study was to test the ability of transforming growth factor-β1 (TGF-β1), insulin-like growth factor-1 (IGF-1) and growth hormone (GH) to induce PG synthesis in joint cartilage of aged animals and to compare it with the effect of interleukin-1α (IL-1α). Mandibular condyle explants from 18-month-old mice were cultured up to 72 h in serum-free medium, supplemented with IL-1α (TGF-β1 (0.1–5.0 ng/ml), TGF-β1 (1.0 ng/ml) + IGF-1 (2 ng/ml) or GH (10 ng/ml). The incorporation of 35S-SO4 into sulfated PG was tested. Cartilage samples were processed for histomorphometry using sections stained with 0.1% toluidine blue (TB), pH 1.8. Results indicated that in cultures supplemented (48 h) with either TGF-β, TGF-β + IGF-1 or with GH, an increased height and area of TB-positive staining as well as increased incorporation of 35S-SO4 into sulfated PG were observed. In contrast, the cytokine IL-1α exerted an inhibitory effect on TB staining and on 35S-SO4 incorporation. The present study demonstrated that in vitro supplementation of IL-1α to mandibular condyle cartilage reduced the height and area of TB staining and incorporation of 35S-SO4, whereas TGF-β1, TGF-β1 + IGF-1 or GH increased the height and area of TB staining and increased incorporation of 35S-SO4. The two parameters used to identify increased PG synthesis were shown to reveal similar results and were useful for studying the dynamic events taking place in cartilage destruction and repair in osteoarthritis.
Distinct Myosin Heavy Chain Isoform Transitions in Developing Slow and Fast Cat Hindlimb Muscles
Authors: Unguez Graciela A. , Talmadge Robert J. , Roy Roland R. , Dalponte Donny , Edgerton V. Reggie
Published: April 2003

The expression of myosin heavy chain (MHC) isoforms leading to adult fiber phenotypes in the tibialis anterior (TA) and soleus muscles of the cat were investigated from embryonic day 35 to 1 year after birth. Electrophoresis and immunoblotting of myofibrils demonstrated the expression of 5 different MHC isoforms, i.e. I, IIa, IIx, embryonic, and neonatal, during development. Based on electrophoresis, the adult-like MHC composition of the soleus and TA were not observed until postnatal day 40 (P40) and 120 (P120), respectively. In contrast, immunohistochemical analyses revealed that the adult-like fiber phenotype composition was attained much later (P120) in the soleus. The existence of multiple MHC isoforms in individual fibers suggested that transitions occurred until P120 in both muscles. Adult type I fibers were first observed at P1. Adult IIA fibers were first observed at P30 in the TA and P40 in the soleus. IIX fibers were not identified until P40 in the TA. The transition to the predominantly slow phenotype of the soleus involved a gradual loss of embryonic and fast isoforms accompanied by an accumulation of slow MHC. In contrast, the expression of slow and fast MHC in the fast TA muscle was relatively unchanged throughout development. These results show that the establishment of a given MHC-based fiber phenotype varies significantly between slow and fast muscles in the kitten.
Chaperones in the Parotid Gland: Localization of Heat Shock Proteins in Human Adult Salivary Glands
Authors: Vanmuylder Nathalie , Evrard Laurence , Daelemans Philippe , Dourov Nicolas
Published: April 2003

Heat shock proteins (HSPs) are expressed or increased in response to various biological stresses. Moreover, these ‘stress proteins’ seem to be expressed by some cells living in physiological conditions. From then on, they could play an important physiological role in normal cell functioning. The best-known physiological role of these HSP proteins is to act as ‘molecular chaperones’. In this context, we have investigated the immunohistochemical expression of HSP27, HSP70, HSP90 and HSP110 in 10 human adult salivary glands. To highlight the presence of RNAm encoding HSP70, an in situ hybridization was performed. In our material, HSP27 was strongly expressed in the cytoplasm of striated duct cells and in some myoepithelial cells. The same localization was less stained for HSP70 and HSP90. The immunocytochemical reaction was weak or negative for HSP110 in striated ducts. HSPs were not expressed in acinic cells. In situ hybridization gave a positive signal in striated ducts with a probe encoding HSP70. Epithelial cells of the striated ducts and myoepithelial cells expressed HSP27, HSP70 and HSP90. These HSPs probably act in part as molecular chaperones for protein synthesis, transport and for several interactions between HSPs and different proteins.
Changes in the Structure of Dentine from Cheek Teeth of Deer Chronically Exposed to High Levels of Environmental Fluoride
Authors: Appleton J. , Chesters J. , Kierdorf U. , Kierdorf H.
Published: April 2003

The purpose of this study was to examine, using backscattered electron imaging, the changes occurring in the structure of the dentine including giant tubules in the teeth of deer chronically exposed to fluoride. The primary and secondary dentine was characterised by the presence of interglobular dentine and regular bands of hypo- and hypermineralised dentine. Giant tubules in the unworn teeth of animals exposed to low and high levels of fluoride were characterised by a large lumen and hypermineralised rim in which there were calcospherites. With the occlusal wear of the teeth tubules beneath the immediate surface of the exposed dentine in teeth from fluorotic animals became occluded with mineral, but in low fluoride animals some tubules at the surface were not occluded with mineral. It is suggested that mineral which occludes the tubules may come from both intrinsic and extrinsic sources. The presence of some open tubules at the immediate surface in the worn teeth of animals exposed to low fluoride suggests an extrinsic source for this mineral.
Structure of the Middle Ear and Auditory Tube in the House Musk Shrew, Suncus murinus
Authors: Yoshida Mitsuharu , Kitoh Junzoh , Yanagita Noriyuki
Published: April 2003

Anatomical features of the middle ear and auditory tube (AT) in the house musk shrew, Suncus murinus, were examined by dissection and light microscopy. The tensor veli palatini (TVP) and tensor tympani (TT) have no connections with the wall or cartilage of the AT although they are connected by the intermediate tendon. None of the levator veli palatini (LVP) muscle bundles are attached to the AT. The salpingopharyngeus (SA) alone has its origin on the caudal edge of the tubal cartilage. The origin extends to the pharyngeal two thirds of the cartilage. The SA originates perpendicular to the AT and runs caudomedialward. Some SA muscle bundles intermingle with those of the palatopharyngeus to end on the dorsal wall of the pharynx. The observations provide no evidence that the TVP, LVP and TT have any role in AT function. The only muscle affecting the AT function in S. murinus is the SA, and it would be the AT dilator.
Galactosyltransferase Function during Mammalian Fertilization
Authors: Nixon Brett , Lu Qingxian , Wassler Michael J. , Foote Cynthia I. , Ensslin Michael A. , Shur Barry D.
Published: April 2003

Gamete recognition has been studied extensively in the mouse. In this system, it is generally believed that sperm bind to a class of O-linked oligosaccharides on the zona pellucida glycoprotein, ZP3. The best characterized sperm receptor for ZP3 is β1,4-galactosyltransferase (GalT), which functions in a lectin-like capacity by binding to N-terminal N-acetylglucosamine residues on ZP3 oligosaccharides. Multivalent oligosaccharides on ZP3, as well as synthetic polymers terminating in N-acetylglucosamine aggregate GalT, leading to activation of a heterotrimeric G protein cascade and culminating in the acrosome reaction. Following fertilization, cortical granules release N-acetylglucosaminidase, which removes the binding site for sperm GalT and facilitates the zona block to polyspermic binding. Genetic manipulation of GalT expression has confirmed its function as a ZP3 receptor. Overexpressing GalT on sperm leads to increased binding of ZP3, increased G protein activation, and precocious acrosome reactions. In contrast, sperm from mice made null for GalT by homologous recombination are refractory to ZP3, in that they are unable to bind soluble ZP3 and fail to undergo the acrosome reaction in response to zona glycoproteins. Surprisingly, GalT null sperm still bind to the zona and achieve low rates of fertilization in vitro. This then suggests that sperm-egg binding involves receptor-ligand interactions independent of GalT and ZP3. The current model suggests that GalT functions as the ZP3 receptor that is responsible for inducing the acrosome reaction, whereas initial sperm-zona binding is dictated by other sperm surface receptors. Consistent with this, at least three other zona pellucida monosaccharides have been implicated in sperm binding, and novel sperm surface glycoproteins have been suggested to function in gamete binding. A large scaffolding protein has been identified that associates with the GalT cytoplasmic domain and may be responsible for orchestrating its signal transduction capacities that lead to the acrosome reaction.
A Prokinetic Approach to Treatment of Gastroesophageal Reflux Disease
Authors: Achem Sami R. , Robinson Malcolm
Published: April 2003

Currently available medications for gastroesophageal reflux disease (GERD) vary in mechanisms of action from neutralization or suppression of gastric acid to improving underlying upper gastrointestinal dysmotility. This article reviews the clinical efficacy of pharmacological agents used to treat GERD and provides a rationale for considering a primary prokinetic approach to antireflux treatment which will be applicable to many patients. Treatment trials in acute GERD have demonstrated unexpectedly prolonged maintenance of high esophageal pH with tablet and liquid antacid formulations. However, there are no well-designed placebo-controlled trials of antacids for esophageal mucosal healing. H2 receptor antagonists (H2RAs) at conventional doses relieve reflux symptoms in at least 50% of reported series of GERD patients, and they can also provide endoscopic healing in 27–45% of the cases. Therapy with more potent acid-suppressive agents such as proton pump inhibitors (PPIs) may lead to improved symptomatic relief and to superior healing compared with H2RA therapy, especially in those patients with more advanced erosive esophagitis. Promotility agents, particularly cisapride, offer symptom relief and healing rates which are quite similar to standard H2RA treatment. GERD tends to be a chronic and relapsing condition. Cisapride has been shown to be quite effective in maintaining remission in GERD patients, including endoscopic remission in the lesser degrees of esophagitis. This may be accomplished with relatively low and cost-effective dosing in many individuals. For the small proportion of patients who manifest severe grades of esophagitis, PPI therapy is associated with lower relapse rates than either H2RA or prokinetic treatment. Overall, a strong case can be made for the empirical selection of promotility therapy for the large numbers of GERD patients who do not have documented severe erosive disease.
Zenker’s Diverticulum
Authors: Achkar Edgar
Published: April 2003

Zenker’s diverticulum is a pouch protruding posteriorly above the upper esophageal sphincter, in the Killian’s triangle, an area of relative weakness. Zenker’s diverticulum was thought, for many years, to occur as a result of cricopharyngeal incoordination but more recent evidence points to poor upper sphincter compliance with diminished sphincter opening and increased hypopharyngeal pressures. Small Zenker’s diverticula may be asymptomatic. As they become larger, symptoms include dysphagia, food regurgitation, and a sensation of globus. The best diagnostic method is a barium swallow with attention to the cricopharyngeal area. Although gastroesophageal reflux may be responsible for many throat symptoms, the relationship of reflux to the pathogenesis of Zenker’s diverticulum is speculative. The treatment of Zenker’s diverticulum is surgical. There have been many variations in technique over the years. Diverticulectomy with cricopharyngeal myotomy remains the most frequently performed operation. Endoscopic treatment with or without laser stapling has been reported but is not popular in the United States.
Gastric Stump Cancer: What Is the Risk?
Authors: Safatle-Ribeiro Adriana V. , Ribeiro Jr. Ulysses , Reynolds James C.
Published: April 2003

Patients who have undergone partial gastric resections are at an increased risk for the development of cancer in the gastric remnant. The overall risk increases over time and is higher in patients with an initial diagnosis of gastric rather than duodenal ulcer, in men and following partial gastrectomy with Billroth II reconstruction. The site of tumor growth is predominantly in the anastomotic area, but may occur anywhere in the stump. Enterogastric reflux, achlorhydria, bacteria overgrowth, and Helicobacter pylori appear to be the major factors involved in the etiopathogenesis of the gastric stump cancer. Surveillance of these patients with endoscopy and multiple biopsies may provide the means to diagnose tumors at an early stage, but the cost-benefit ratio of surveillance requires further study. Despite the magnitude of alterations in gastric stump mucosa, unfortunately, at this time we do not have good predictors of patients who will develop a cancer.
Gastrointestinal and Hepatic Manifestations of Hereditary Hemorrhagic Telangiectasia
Authors: Sharma Virender K. , Howden Colin W.
Published: April 2003

Hereditary hemorrhagic telangiectasia (HHT) or Osler-Rendu-Weber (ORW) disease is an autosomal-dominant disorder that frequently presents with gastrointestinal bleeding which may be a diagnostic and therapeutic challenge. Hepatic involvement in this disease is increasingly recognized and poses another therapeutic challenge. With advances in genetic screening and diagnostic procedures, and the increasing awareness of the condition by physicians and patients, this disease is being diagnosed more often. This article reviews the available literature on gastrointestinal and hepatic manifestations of HHT, and the various diagnostic and therapeutic modalities available for its management.
Risks of Intra-Abdominal Nonshunt Surgery in Cirrhotics
Authors: Gopalswamy N. , Mehta Vivek , Barde Christopher J.
Published: April 2003

We have reviewed the risks of various nonshunt intra-abdominal operations in cirrhotic patients. Most of these studies are retrospective reviews with limitations. Among various risk stratifications in cirrhosis, Child-Pugh classification is sufficiently informative. Elective surgery can be done safely in patients with Child’s A or B class. Operations in Child’s C patients and emergent surgery carry formidably high mortality. Limiting the extent of surgery, controlling ascites, correcting coagulation abnormality and malnutrition and aggressively treating infection, might reduce mortality. Laparoscopic cholecystectomy and endoscopic sphincterotomy in cirrhotics seem to be promising in reducing mortality and morbidity.
Pathophysiology and Therapy of Chronic Radiation-Induced Injury to the Colon
Authors: Donner Charles S.
Published: April 2003

Radiotherapy of pelvic malignancies causes chronic radiation damage to the gut in approximately 5% of patients. The injury can lead to local ischemia and fibrosis with the development of ulcers, strictures and lower gastrointestinal bleeding. The clinical presentation varies from mild disease to debilitating rectal bleeding, diarrhea, obstruction and fistula formation. Therapy should be directed toward the dominant symptom. Formalin instillation and endoscopic obliterative therapy can be used for bleeding due to telangiectasis. Nutritional intervention, e.g. total parenteral nutrition or elemental diets, is useful as adjunctive therapy to maintain hydration and nutritional status. Surgery should be reserved for severe refractory bleeding, fistulas or obstruction. Due to the recurrent character of the disease and the high complication rate, surgery should be viewed as an effort of last resort.
Health-Related Quality of Life Outcomes of Omeprazole versus Ranitidine in Poorly Responsive Symptomatic Gastroesophageal Reflux Disease
Authors: Revicki Dennis , Sorensen Sonja , Maton Paul , Orlando Roy
Published: April 2003

Objective: This study evaluated changes in health-related quality of life (HRQL) outcomes of once-daily omeprazole compared with ranitidine for the short-term treatment of patients with poorly responsive symptomatic gastroesophageal reflux disease (GERD). Methods: A double-blind, randomized clinical trial, compared omeprazole versus ranitidine for the treatment of poorly responsive GERD. Eligible patients had a history of predominant heartburn symptoms with symptomatic heartburn after 6 weeks of ranitidine treatment. Patients were randomized to omeprazole 20 mg once daily (n = 156) or ranitidine 150 mg twice daily (n = 161) and followed for 8 weeks. Assessments were completed at baseline and after 8 weeks with physician-rated symptoms: Gastrointestinal Symptom Rating Scale (GSRS); Psychological General Well-Being (PGWB) Index; Sleep Scale; Impact on Daily Activities Scale, and Overall Treatment Effect. Primary HRQL endpoints were the GSRS reflux scale and PGWB total score. Results: No differences between the 2 treatment groups were observed in baseline demographic, clinical or HRQL measures. After 8 weeks, omeprazole-treated patients had greater improvement in GSRS reflux scale scores (p<0.0001) and PGWB total scores (p = 0.019) compared with ranitidine-treated patients. Significant between group differences favoring omeprazole were also observed in GSRS total scores (p<0.0001), abdominal pain scale scores (p = 0.003), and indigestion scale scores (p = 0.003), Impact on Daily Activities (p = 0.001), PGWB positive well-being (p = 0.015), anxiety (p = 0.030), and general health scale scores (p = 0.010). Patient ratings of overall treatment effect demonstrated the significantly (p<0.0001) greater benefits of omeprazole (mean = 5.26) compared with ranitidine treatment (mean = 3.83). Conclusions: Omeprazole treatment significantly reduced persistent reflux-related symptoms and normalized psychological well-being compared with ranitidine in poorly responsive symptomatic patients with GERD.
Changes in Gastrointestinal Permeability in Celiac Disease
Authors: Vogelsang Harald , Schwarzenhofer Maria , Oberhuber Georg
Published: April 2003

Increased gastrointestinal permeability was found in celiac disease already 20 years ago. Originally a genetical defect was supposed leading to elevated permeability and later to celiac disease. However, patients under long-term gluten-free diet normalized their permeability tests. On the other side, unaffected relatives of patients with celiac disease showed high permeability but not different from patients with irritable bowel syndrome and with a tendency for normalization during follow-up. In active symptomatic celiac disease, permeability is elevated in the gastroduodenum – measured by sucrose test – as well as in the small intestine – measured by lactulose/mannitol ratio. The sensitivity in active celiac disease is high (near 100%), the specificity is low due to high permeability in many intestinal diseases as in acute infectious gastroenteritis, Crohn’s disease, nonsteroidal anti-inflammatory drug treatment, etc. In contrast, lactulose/mannitol test permeability is much less sensitive in silent celiac disease without diarrhea (74%). The real importance of permeability disease is established by its use for follow-up of celiac patients under gluten-free diet whereas it is correlated to the degree of mucosal atrophy. In vitro tests also show increased lactulose mucosal to serosal flux in celiac disease, but not correlated to oral permeability test. In conclusion, lactulose/mannitol test is the only noninvasive functional test in celiac disease which has essential importance in active celiac disease and in follow-up under diet.
Genetics of Inflammatory Bowel Disease. A Personal View on Progress and Prospects
Authors: Satsangi Jack , Jewell Derek , Parkes Miles , Bell John
Published: April 2003

Clinical, epidemiological and molecular data reported in the last 5 years have provided strong evidence that genetic factors are important in susceptibility to both Crohn’s disease and ulcerative colitis. The model of disease inheritance which best fits the epidemiological data is that Crohn’s disease and ulcerative colitis are related polygenic diseases. However, genetic heterogeneity is likely to be extensive, and may well underlie the variability in clinical presentation associated with inflammatory bowel disease. Considerable progress has already been made in identifying potential disease susceptibility loci using the technique of genome-wide scanning. There is optimism that international collaborative studies will allow fine mapping of the loci implicated on chromosomes 16 and 12. The identification of novel susceptibility genes has become a realistic goal for investigators. Once this has been achieved, there are likely to be immediate clinical benefits, both in understanding disease pathophysiology, and in disease management.
Mirizzi Syndrome: A Rare Cause of Obstructive Jaundice
Authors: Freeman Mark , Rose Jeffrey , Forsmark Christopher , Vauthey Jean-Nicolas
Published: April 2003

Mirizzi syndrome is a rare cause of bile duct obstruction secondary to extrinsic compression of the hepatic duct by stones impacted in the cystic duct or infundibulum of the gallbladder. The suspicion of Mirizzi syndrome primarily relies on radiographic means such as ultrasound, computed tomography and cholangiography. The recognition of this rare syndrome is crucial in developing the proper treatment approach. We present 3 cases of Mirizzi syndrome and a review of the literature pertaining to the diagnosis and treatment of this rare cause of obstructive jaundice.
Evaluation and Endoscopic Palliation of Cholangiocarcinoma. Management of Cholangiocarcinoma
Authors: Rumalla Ashwin , Baron Todd
Published: April 2003

Patients with a cholangiocarcinoma usually develop symptoms of biliary obstruction which dominate the course of their illness. At presentation, the diagnosis may be difficult to establish due to the desmoplastic nature of this tumor. Location and extent of the tumor, however, are more effectively evaluated by current radiologic techniques. Following these staging procedures, most patients are found to be unsuitable for curative resection. Therefore, establishing effective biliary drainage to relieve symptoms of obstruction becomes the most critical therapeutic goal in these patients. In the past, surgical biliary bypass procedures were advocated, but were associated with high perioperative morbidity and mortality rates. Endoscopic biliary stenting produces quick and effective relief of symptoms from biliary obstruction due to cholangiocarcinoma. Initially, successful biliary drainage is possible in most patients. However, subsequent stent occlusion or spread of tumor into nonstentable intrahepatic ducts leads to recurrent jaundice. Local therapies including 192Ir brachytherapy and photodynamic therapy may prevent or postpone these problems.
Inflammatory Bowel Disease and Pregnancy: A Review
Authors: Jospe Erin , Peppercorn Mark
Published: April 2003

Inflammatory bowel disease often occurs during peak reproductive years. Rates of conception, pregnancy outcome and disease course during pregnancy should be discussed prior to attempted conception. The majority of patients whose disease is well controlled prior to pregnancy should expect a fertility rate comparable to the general population, and an uncomplicated pregnancy with a favorable outcome. The disease should continue to be pharmacologically or surgically controlled as necesssary during pregnancy; the majority of drug options available to pregnant patients being without detriment to the fetus. No predictable inheritance pattern has been established and, at this time, there is no ability to screen prenatally.
Alpha-1-Antichymotrypsin Is Not Associated with the Increased Frequency of Apolipoprotein-E- Epsilon-4 Allele in Elderly Non-Demented Leprosy Patients
Authors: Endoh Masumi , Ueki Akira , Takahashi Keikichi , Yamanaka Hideki , Izumi Shinzo , Tabira Takeshi
Published: April 2003

In our previous study, elderly leprosy patients showed a low prevalence of senile dementia of the Alzheimer type, but the frequency of apolipoprotein E (APO-E) σ4 was elevated in non-demented elderly leprosy patients. Recent study has shown that Alzheimer’s disease risk associated with APO-E σ4 is significantly increased by the α1-antichymotrypsin (ACT) genotype AA. Therefore we examined an association between ACT polymorphism and the APO-E σ4 allele in 350 leprosy patients. None of our data showed an association of ACT genotype and APO-E σ4 allele in leprosy patients. The allelic frequencies of the ACT gene did not differ even between demented patients with leprosy and age-matched controls. Our present data suggest that ACT polymorphism is not associated with the increased frequency of APO-E σ4 in leprosy patients.
The Validity of Informant Reports in Assessing the Severity of Dementia: Evidence from the CAMDEX Interview
Authors: Neri Mirco , Roth Martin , de Vreese Luc Pieter , Rubichi Sandro , Finelli Chiara , Bolzani Roberto , Cipolli Carlo
Published: April 2003

The evaluation of a patient’s mental state, overall clinical profile and behavioural disturbance in the process of diagnosing dementia requires at least two sources of information: the patient and the informant. Since the severity of the dementia may interfere with the subjective perception of these disorders, it is important to evaluate the consistency between these two sources of information and the clinical and psychometric evaluation made by the physician. Accordingly, in this study five behavioural areas, derived from the semi-structured interview schedule provided by the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX, i.e., Sleep, Depressed Mood, Everyday Activity, Memory and Global Mental Functioning) have been tested on the patient and his/her informant. Eighty dementia patients (mean age = 74 years) and their informants participated in the study. The dementia group was subdivided into two levels of severity according to DSM-IIIR criteria: 41 with mild dementia and 39 with moderate dementia, respectively, matched for age and schooling. The rating of impairment was found to increase along with the severity of dementia in all the above-mentioned areas, except for sleep. However, the source of information per se significantly influenced the evaluation of memory functioning. Moreover, the significant interaction between the two factors considered indicates that memory functioning is evaluated quite differently by the patients and the informants, as only in the assessment made by the latter group did the impairment increase in parallel with severity of dementia. Finally, whereas none of the subjective measures recorded in the patients were significantly correlated with their test scores, the correlations between the informant memory appraisals and patient test results proved to be significant. The present findings confirm the validity of informant reports in assessing cognitive and memory disorders in early-stage dementia, as well as in distinguishing patients with mild from those with moderate dementia.
Further Evidence of Cholinergic Impairment of the Neuroendocrine Control of the GH Secretion in Down’s Syndrome
Authors: Beccaria L. , Marziani E. , Manzoni P. , Arvat E. , Valetto M.R. , Gianotti L. , Ghigo E. , Chiumello G.
Published: April 2003

There are data indicating that cholinergic activity is precociously impaired in Down’s syndrome (DS). On the other hand, acetylcholine as well as arginine (ARG) play a major stimulatory role in the neural control of growth hormone (GH) secretion in humans, likely acting via the inhibition of hypothalamic somatostatin release. The aim of the present study was to verify the effects of pyridostigmine (PD, 120 mg p.o.), a cholinesterase inhibitor, and ARG (0.5 g/kg i.v.) on the growth hormone-releasing hormone (GHRH) (1 µg/kg i.v.)-induced GH rise in 15 adult patients with DS (M/F: 8/7; age 26.5 ± 2.2 years; body mass index, BMI: 25.7 ± 1.0 kg/m2) in which the potentiating effect of PD on GH secretion has been reported to be reduced. The results in DS were compared to those in 15 normal subjects (NS) (M/F: 8/7; age: 30.0 ± 1.3 years; BMI: 21.4 ± 0.4 kg/m2). Basal GH and insulin growth factor I (IGF-1) levels in DS (1.8 ± 0.7 and 206.5 ± 21.0 µg/l) were similar to those in NS (1.4 ± 0.3 and 179.4 ± 11.0 µg/l). The GH response to GHRH alone in DS (526.5 ± 120.1 µg/l/h) was lower (p < 0.05) than that recorded in NS (895.4 ± 153.7 µg/l/h). The GHRH-induced GH rise was potentiated by PD both in DS (1,138 ± 184.2 µg/l/h; p < 0.02 vs. GHRH alone) and in NS (2,213.8 ± 212.8 µg/l/h; p < 0.005 vs. GHRH alone); however, as the percent potentiating effect of PD was similar in both groups (215 and 247%, respectively) the GH response to GHRH+PD in DS was lower (p < 0.005) than that in NS. The GHRH-induced GH rise was also potentiated by ARG in both DS (2,243 ± 362.4 µg/h; p < 0.001 vs. GHRH alone) and NS (2,764.3 ± 325.7 µg/l/h; p < 0.005 vs. GHRH alone). As the percent potentiating effect of ARG in DS was more marked than in NS (425 vs. 308%, respectively), the GH response to GHRH+ARG became similar in both groups. No sex-related difference was found in the GH response to various stimuli both in DS and NS. In conclusion, these data demonstrate that the potentiating effect of PD but not that of ARG is impaired in adults with DS in whom a reduced somatotrope responsiveness to GHRH is present. These findings indicate that in DS the pituitary GH releasable pool is fully preserved while an impairment of the tuberoinfundibular cholinergic pathways could lead to somatostatinergic hyperactivity and low somatotrope responsiveness to GHRH.
Explicit Memory in Frontotemporal Dementia: The Role of Medial Temporal Atrophy
Authors: Lavenu I. , Pasquier F. , Lebert F. , Pruvo J.P. , Petit H.
Published: April 2003

In our memory clinic experience, memory impairment differs widely in patients with frontotemporal dementia (FTD). We searched for a correlation between explicit memory disturbance assessed with the Grober and Buschke test and medial temporal atrophy on CT scan in 22 consecutive patients with FTD. Five of the 22 patients had a medial temporal lobe (MTL) atrophy. There was no significant difference between the two groups for the demographic characteristics. Free recall, cued recall and the learning curve were significantly better in patients without MTL atrophy. The patients with MTL atrophy made more intrusions. We found a positive correlation between total recall and cued recall and the mean of medial temporal lobe measurement. These results are in agreement with the role of the hippocampal formation in the memory process. In our group, the ratio of patients with MTL atrophy is similar to the ratio of Pick’s disease in frontotemporal dementia. In histological series more severe hippocampal atrophy are reported in Pick’s disease. Therefore MTL atrophy on CT scan could be a marker of Pick’s disease in FTD.
Apolipoprotein E Polymorphism in Patients with Alzheimer’s Disease, Vascular Dementia and Ischemic Cerebrovascular Disease
Authors: Ji, Y. , Urakami K. , Adachi, Y. , Maeda M. , Isoe, K. , Nakashima K.
Published: April 2003

Apolipoprotein E σ4 allele (ApoE σ4) is associated with Alzheimer’s disease (AD) in familial and sporadic cases, but the associations of ApoE σ4 allele and vascular dementia (VD) and/or ischemic cerebrovascular disease (ICVD) are still controversial. To clarify the associations of ApoE polymorphism with AD, VD and ICVD in Japanese, we examined ApoE polymorphism in samples of 255 patients with AD, 87 patients with VD, and 123 patients with ICVD, as compared with 117 age-matched healthy control subjects (CTL). The frequency of the ApoE σ4 allele was significantly higher in the VD group (0.21), the ICVD group (0.15) as well as in the AD group (0.26) than in the CTL subjects (0.08). These findings suggest that the genotype of ApoE σ4 is associated with not only AD but also VD and ICVD, and that ApoE σ4 plays an important role in the development of dementia and ICVD.
Degenerative Dementia of the Frontal Type
Authors: Galante Emanuela , Muggia Silvia , Spinnler Hans , Zuffi Marta
Published: April 2003

The retrospective neurological, neuroradiological and neuropsychological observation of 9 cases of dementia with frontal symptoms is reported. Aim of this paper is to contribute to the clinical corpus of data related to the frontal features of the frontotemporal dementia (FTD) syndrome, so as to support clinicians’ awareness and widen the information available for the diagnostic approach to the dementias. FTD is a clinical diagnosis which does not imply a single underlying pathology, since more than one condition can induce the syndrome. Inertia and behavioural symptoms were the traits characterizing both the onset and the progression of the disease in our patients. Progression brought to the surface behavioural and neuropsychological patterns generically traced back to frontal dysfunction. Social inadequacy was the most salient trait. From a clinical point of view frontal dementias may be regarded as a conceptually different type of dementia with respect to Alzheimer’s disease, i.e., a ‘behavioural’ as opposed to a ‘cognitive’ progressive disorder.
Immunohistochemistry and in situ Hybridization of T-Cell Acute Lymphoblastic Leukemia-Associated Antigen 1 in Human Brain Tissues
Authors: Yamada T. , Tsujioka Y. , Takahashi M. , Tsuboi Y. , Taguchi J. , Yoshie O.
Published: April 2003

One of the proteins belonging to the transmembrane 4 superfamily, T-cell acute lymphoblastic leukemia-associated antigen 1 (TALLA1), behaves like a potential tumor-associated antigen. Furthermore, its mRNA is expressed in normal brain. We examined here the histochemical localization of the protein and its mRNA in human brain tissues. Both nonneurological and Alzheimer disease (AD) brains showed astroglial staining for the TALLA1 molecule. In AD brain tissues, globular dystrophic neurites were positively stained. In damaged white matter showing leukoaraiosis by CT scan there was varicose axonal staining with the anti-TALLA1 antibody. In situ hybridization histochemistry using a RNA probe demonstrated neuronal expression of the mRNA. These results suggest that TALLA1, like amyloid precursor protein or chromogranin A, is produced in neurons and transported by axonal flow.
Progression of Alzheimer-Related Neuritic Plaque Pathology in the Entorhinal Region, Perirhinal Cortex and Hippocampal Formation
Authors: Yilmazer-Hanke Deniz M. , Hanke Joachim
Published: April 2003

Extracellular deposits of the β-amyloid protein and intraneuronal neurofibrillary changes are hallmarks of Alzheimer’s disease. Neurofibrillary changes in the cell body of neurons are the neurofibrillary tangles, while β-amyloid deposits containing dystrophic neurites with neurofibrillary changes are called neuritic plaques. β-Amyloid deposits and neurofibrillary tangles display a sequential accumulation in the cerebral cortex. In the present study, the topographical distribution of β-amyloid deposits and neuritic plaques in the entorhinal region, perirhinal cortex and hippocampal formation was investigated in relationship to the amyloid and neurofibrillary staging proposed by Braak. The number of subregions displaying β-amyloid deposits and neuritic plaques continuously increases in correlation with the amyloid stage (for β-amyloid deposits r = 0.90, p < 0.0001, for neuritic plaques r = 0.74, p < 0.0001) and neurofibrillary stage (for β-amyloid deposits r = 0.53, p < 0.0001, for neuritic plaques r = 0.68, p < 0.0001). Parallel to the advancement in the neurofibrillary stage, early and late predilection sites of β-amyloid deposits and neuritic plaques can be distinguished. The early predilection sites correspond to projection areas of regions which exhibit incipient neurofibrillary tangles. Furthermore, neuritic plaques only occur in the presence of neurofibrillary tangles in the areas investigated. The findings indicate that neuritic plaques gradually develop in the projection areas of tangle-bearing neurons.
The Prevalence, Assessment and Associations of Falls in Dementia with Lewy Bodies and Alzheimer’s Disease
Authors: Ballard Clive G. , Shaw Fiona , Lowery Kathleen , McKeith Ian , Kenny Roseanne
Published: April 2003

Falls were assessed for 3 months using a daily fall diary in 65 (30 dementia with Lewy bodies, DLB; 35 Alzheimer’s disease, AD) dementia patients from a case register, diagnosed using operationalised clinical criteria, with established accuracy against post-mortem. Multiple falls (>5) occurred in 37% of DLB patients and 6% of those with AD, often resulting in injury. None of the standard risk assessment tools identified fallers, but they did identify multiple fallers. More detailed evaluation methods examining gait patterns, sway and neurovascular instability were not helpful. Multiple falls were associated with DLB, parkinsonism, previous falls, greater impairment of activities of daily living and older age. Falls are particularly common in DLB sufferers and may aid diagnosis. Treatment studies evaluating fall reduction strategies are a priority.
Clinical Diagnosis of Dementia with Lewy Bodies in a Japanese Dementia Registry
Authors: Imamura Toru , Hirono Nobutsugu , Hashimoto Mamoru , Shimomura Tatsuo , Tanimukai Satoshi , Kazui Hiroaki , Hanihara Tokiji , Mori Etsuro
Published: April 2003

We found 15 patients with dementia with Lewy bodies (DLB) and 232 patients with Alzheimer’s disease (AD) among 327 consecutive patients with mild to moderate dementia in a Japanese dementia registry, using the clinical criteria of the Consortium on DLB International Workshop. The percentage of females was significantly lower in DLB than in AD (p < 0.01), while age at examination, Mini-Mental State Examination score and duration of cognitive symptoms were comparable between the two diseases. Eight of the 15 DLB patients (53%) had spontaneous parkinsonism, which was observed in 6 of the 232 AD patients (2.6%). Visual hallucinations were reported by 11 of the 15 DLB patients (73%) and 8 of the 232 AD patients (3.4%). Cognitive fluctuation was positive in 13 of the 15 DLB patients (87%). We found two types of episodic cognitive deterioration: one was characterized by pronounced disturbances of attention and alertness (inattention type), and the other was characterized by marked and bizarre disturbances of orientation in time and places, and misidentification of persons (disorientation type). Systematized delusion was observed in 8 DLB patients, and 5 patients showed neuroleptic sensitivity. Patients with DLB have a unique dementia syndrome even in the stage of mild to moderate cognitive impairments. Further studies are recommended to establish diagnosis, treatment and management.
Frontotemporal Dementia: An Attempt at Clinical Characteristics
Authors: Pfeffer A. , Łuczywek E. , Gołębiowski M. , Czyżewski K. , Barcikowska M.
Published: April 2003

The clinical recognition of frontotemporal dementia (FTD) depends on its differentiation from Alzheimer’s disease (AD). From 212 patients primarily diagnosed as probable AD, 24 cases with mild dementia, absence of disturbances the presence of which would have prevented a full neuropsychological assessment, and brain CT with detailed visualization of hippocampus atrophy were chosen. On the basis of neuropsychological examination the patients were divided into two groups: 11 cases with predominant deficit in frontal system tasks (FTD group) and 13 cases with changes in cognitive functions typical of AD (AD group). Age at onset, duration, behavioral changes, psychotic symptoms, depression, speech disorders, neurologic deficit and hippocampal atrophy were analyzed in both groups. Statistically significant differences for behavioral disturbances and hippocampal atrophy were found. Early behavioral changes and lack of early hippocampal atrophy on CT may be useful features for differentiating between FTD and AD, especially when SPECT is not available.