bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective study on the management of patients with complicated diverticular disease
Authors: Salem T. A. , Molloy R. G. , O'Dwyer P. J. 
Published: November 2005

AbstractIntroduction  Diverticular disease is a common condition with high morbidity and mortality related to its complications. The aim of this study was to assess the predictive role of acute diverticulitis in the development of further complications from diverticular disease.Patients and methods  Prospective assessment of all patients with complicated diverticular disease over a 1‐year period in a large teaching hospital was undertaken. All patients had documented evidence of their diagnosis by radiological, endoscopic or histopathological techniques when feasible.Results  Seventy‐seven patients with complicated diverticular disease were identified. There were 53 females and 24 males with a median age of 74 years (range 30–97 years). Complications included: acute diverticulitis (37), fistula (12), perforation (8), bleeding (7), abscess (7) and stricture (6). Only 8 had two or more previous documented episodes of diverticulitis. Twenty‐five underwent surgery, 3 died (peritonitis 2, abscess1) and 5 had a complication (anastomotic dehiscence 1, adhesive obstruction 1, incisional hernia 2 and pneumonia 1). Three (5%) of 37 patients with acute diverticulitis had two or more admissions but none underwent surgery or developed further complications. CT was performed during acute admission in 14/37 patients with acute diverticulitis. The majority of patients with fistula (9/12), perforation 7/8, bleeding 6/7 and abscess 5/7 had no previous episode of diverticulitis while most patients with stricture (4/6) had previous documented episodes.Conclusion  In our patient population acute diverticulitis is not a good predictor of the development of further complications from diverticular disease as only a minority of patients with perforation, fistula, abscess and bleeding had previous documented episodes of diverticulitis.
A prospective study of outcome from rubber band ligation of piles
Authors: Longman R. J. , Thomson W. H. F. 
Published: November 2005

AbstractObjective  With the recent introduction of stapled anopexy it is timely to review the benefits of existing treatment options for piles. This study investigates the effectiveness and safety of rubber band ligation (RBL) of piles in the outpatient setting.Patients and methods  Two hundred and fifty‐two consecutive patients referred with piles in an 18‐month period were studied prospectively. In those patients deemed suitable for banding of piles, data were collected on symptoms, proctoscopic appearance and degree of piles. Short and long‐term outcome data were recorded for success of treatment and complications.Results  Of 203 patients considered suitable and who attended for RBL, 176 kept their follow‐up appointment. One hundred and forty‐eight (84%) had been rendered symptom‐free. A third of patients, however, had proctoscopic evidence of persistent piles, whilst in half of those patients with continuing symptoms the anal cushions appeared normal. Six (3%) patients had suffered a complication. Long‐term follow‐up by questionnaire found that 44% of respondents remained asymptomatic at a median of 46 months from banding. Six (5%) of 117 responders to the questionnaire had, though previously normal, suffered a postbanding impairment of continence.Conclusion  Most patients with piles of any degree can be safely managed by rubber band ligation, but return of symptoms in the long term affects more than half of patients treated.
Cave adaptation in the spider genus Anthrobia (Araneae, Linyphiidae, Erigoninae)
Authors: Miller Jeremy A. 
Published: November 2005

The genus AnthrobiaTellkampf, 1844 is revised and expanded to include two epigean species, Anthrobia acuminata (Emerton, 1913) comb. nov., and A. whiteleyae sp. nov., and two troglobites, the type species A. monmouthiaTellkampf, 1844, and A. coylei sp. nov. The female of A. acuminata is described for the first time. All four Anthrobia species were added to a phylogenetic analysis of erigonine genera. Analysis of this matrix results in a single most parsimonious tree (length = 915, CI = 0.23, RI = 0.58; uninformative characters excluded: length = 911, CI = 0.23), which places Anthrobia sister to Diplocentria Hull, 1911. Troglobitic Anthrobia and epigean Anthrobia are both monophyletic. In comparison to the epigean species, troglobitic Anthrobia exhibit the following putative adaptations to cave life: loss of eyes, elongation of the legs, and reduction of the tracheal system. The reliability of phylogenetic results indicating monophyly of cave Anthrobia are discussed in light of the fact that potentially cave adaptive synapomorphies support this relationship.
Cognitive‐behaviour formulation for three men with learning disabilities who experience psychosis: how do we make it make sense?
Authors: Kirkland Jamie 
Published: November 2005

SummaryCognitive‐behaviour therapy (CBT) is increasingly being used with people with learning disabilities. One of the challenges in working this way is effectively sharing and understanding the formulation of the client's problem. One could argue that only with a shared understanding can there be collaboration between the therapist and the client. By utilizing current theory around CBT for psychosis and CBT for people with learning disabilities a diagram that was understandable to the client was developed to illustrate each formulation. The aim of the paper is to describe a method for engaging in a collaborative approach with three men with psychosis utilizing current thinking in CBT for people with learning disabilities and CBT for psychosis.
A comparison of challenging behaviour in an adult group with Down's syndrome and dementia compared with an adult Down's syndrome group without dementia
Authors: Huxley Adam , Van‐Schaik Paul , Witts Paul 
Published: November 2005

SummaryThis study investigated the frequency and severity of challenging behaviour in adults with Down's syndrome with and without signs of dementia. Care staff were interviewed using the Aberrant Behaviour Checklist‐Community version (M.G. Aman & N.N. Singh, Slosson, East Aurora, NY, 1994), to investigate the frequency and severity of challenging behaviour. Individuals’‘dementia status’ was assessed by using the Dementia Scale for Down's syndrome (Gedye Research and Consulting, Vancouver, 1995). The results showed that the dementia group displayed more frequent and severe forms of challenging behaviour than the nondementia group. The difference in reported levels of challenging behaviour of both groups with the general learning disabilities population was not considered to be clinically significant and levels fell predominantly within the ‘normal range’. The findings of this study suggest that frequent and severe forms of challenging behaviour in adults with Down's syndrome is more likely to be a behavioural symptom associated with the onset of a dementing illness and not due to normal ageing alone.
Microbially driven acidity generation in a tailings lake
Authors: BERNIER L. , WARREN L. A. 
Published: November 2005

ABSTRACT In situ characterization and geochemical modelling of acid generation in a mine tailings lake (Moose Lake, ON, Canada) over a 2‐year period (2001–2002; surficial lake pyrrhotite slurry disposal initiated in 2002) show that bacteria significantly impact acidity behaviour through particle‐associated S oxidation and that they do so under conditions that differ from those controlling abiotic pathways. Seasonal epilimnetic pH decreases occurred in both years, decreasing from approximately 3.5 in May to 2.8 by September (2001) or July (2002). Epilimnetic acid generation rates were depth‐dependent, with maximal rates observed not at the surface of lake where O2 concentrations were highest, but rather within a geochemically reactive zone (approximately 1 m thick) of steep, decreasing O2 gradients and dynamic Fe and S geochemistry in the lower epilimnetic region of the lake. Acid generation occurred dominantly through particle rather than aqueous pathways, but model predictions of acid generation via abiotic pyrrhotite oxidation involving either O2 or ferric iron (Fe3+) predicted neither the observed rates nor the depths at which maximal rates occurred. In contrast, model predictions based on microbial pathways involving both O2 and ferric iron (Fe3+) agreed extremely well with both the observed depth profile of H+ generation and the observed rates at any given depth. Imaging showed extensive microbial colonization of epilimnetic‐associated pyrrhotite particles commonly with significant biofilm formation. FISH (fluorescence in situ hybridization) probing of the community in both pelagic and particle compartments indicated mixed communities occurred in both, and that Acidithiobacillus spp. accounted for 2–46% of the total community in either compartment. Initiation of pyrrhotite slurry discharge at the lake surface in 2002 was accompanied by a relative increase in the number of particle‐associated microbes, as well as a relative proportional decrease of Acidithiobacillus spp. in the total microbial community. Given the widespread occurrence of bacteria across mining environments, the implications of our results extend beyond this specific site and provide new insight into bacterially driven processes contributing to bulk system characteristics which are not currently well constrained.
Childhood Absence Epilepsy: Evolution and Prognostic Factors
Authors: Grosso Salvatore , Galimberti Daniela , Vezzosi Piero , Farnetani Mariangela , Di Bartolo Rosanna Maria , Bazzotti Simone , Morgese Guido , Balestri Paolo 
Published: November 2005

Summary:  Purpose: To evaluate how diagnostic criteria influence remission rates for patients with childhood absence epilepsy (CAE) and to assess clinical and EEG parameters as predictors of outcome. Methods: One hundred nineteen patients were diagnosed with CAE, according to International League Against Epilepsy (ILAE) classification criteria. They were subsequently evaluated according to stricter diagnostic criteria. Sixty‐two subjects fulfilled these criteria as group 2; 57 did not and constituted group 1. Diagnostic parameters that prevented patients of group 1 from entering group 2, and variables such as sex, familial history of generalized epilepsy, and personal history of febrile convulsions also were tested as prognostic factors for terminal remission. Results: Compared with those in group 1, patients of group 2 had significantly higher rates of seizure control (95% vs. 77%), higher rates of terminal remission (82% vs. 51%), fewer generalized tonic–clonic seizures (8% vs. 30%), and shorter mean periods of treatment (2.2 vs. 3.8 years). Significantly fewer patients were receiving polytherapy in group 2 than in group 1 (11% vs. 47%), and fewer patients had seizure relapses at antiepileptic drug discontinuation (0 vs. 22%). Conclusions: Remission rates of patients with CAE are greatly influenced by the classification criteria used for selection. Stricter diagnostic criteria allow the definition of a homogeneous group of patients with excellent prognosis. Factors predicting unfavorable prognosis were generalized tonic–clonic seizures in the active stage of absences, myoclonic jerks, eyelid myoclonia or perioral myoclonia, and EEG features atypical for CAE.
Cognitive Decline in Severe Intractable Epilepsy
Authors: Thompson Pamela J. , Duncan John S. 
Published: November 2005

Summary:  Purpose: To explore the relation between seizure‐related variables and cognitive change in patients with severe intractable epilepsy. Methods: A retrospective analysis of data from 136 patients who had undergone a cognitive assessment on two occasions at an interval of ≥10 years. Cognitive measures included tests of memory and executive skills in addition to intelligence quotients (IQ). Details were available regarding seizure type and frequency in the intertest interval. Results: Cognitive decline was severe and occurred across a wide range of cognitive functions. The frequency of generalised tonic–clonic seizures was the strongest predictor of decline. Complex partial seizure frequency was associated with a decline in memory and executive skills but not in IQ. Seizure‐related head injuries and advancing age carried a poor cognitive prognosis, whereas periods of remission were associated with a better cognitive outcome. Early age at onset was not implicated, and duration of epilepsy was a much less potent predictor of cognitive decline than has been reported in cross‐sectional studies. No evidence indicated that a higher level of cognitive function protected against cognitive decline. Conclusions: Our findings, together with those from animal studies and surgically treated patients, suggest that seizures can have a direct adverse effect on cognition and that good seizure control even after years of intractability can have a beneficial impact on cognitive prognosis. This study was based on individuals who merited two cognitive assessments ≥10 years apart and hence is biased in favor of those with the most severe forms of refractory epilepsy and those with decline.
Measuring Outcome in Psychogenic Nonepileptic Seizures: How Relevant Is Seizure Remission?
Authors: Reuber Markus , Mitchell Alex J. , Howlett Stephanie , Elger Christian E. 
Published: November 2005

Summary:  Purpose: To examine whether seizure remission is a comprehensive marker of outcome in psychogenic nonepileptic seizures (PNESs). Methods: A postal questionnaire was returned by 147 patients with PNESs a mean of 4.2 years after diagnosis (mean age at follow‐up, 38.1 years). The proportion of patients who were “unproductive” (receiving health‐related state benefits) at follow‐up was determined, with a comparison of markers of ongoing psychopathology (Global Severity Index, anxiety and depression scores of the Symptom Checklist 90, Somatization Index DSM of the SOMS‐2) in three outcome groups: group 1, continuing seizures; group 2, seizures stopped but patients “unproductive;” and group 3, seizures stopped, patients “productive.” Results: Of the patients, 71.4% continued to have seizures, and 28.6% had achieved seizure remission; 60.0% of patients with continuing seizures and 42.7% of patients in remission were “unproductive” (difference, NS). Ongoing psychopathology was related to the factor “group membership” with higher values in groups 2 and 3 than in group 1 (GSI, p < 0.001; anxiety, p = 0.01; depression, p = 0.02; Somatization Index DSM, p < 0.001). Across all patients and in the subgroup with PNESs and additional epilepsy, differences were significant only between groups 2 and 3, not between groups 1 and 2. In patients with PNESs alone, differences were significant only between groups 1 and 2. Conclusions: Seizure remission is not a comprehensive measure of good medical or psychosocial outcome in PNESs. Nearly half the patients who become seizure free remain unproductive. Many of these patients continue to report symptoms of psychopathology. Seizure control should not be the only focus of treatment in clinical practice or outcome observation in research studies.
In Situ–Produced 7‐Chlorokynurenate Has Different Effects on Evoked Responses in Rats with Limbic Epilepsy in Comparison to Naive Controls
Authors: Zhang De Xing , Williamson John M. , Wu Hu‐Qui , Schwarcz Robert , Bertram Edward H. 
Published: November 2005

Summary: Purpose:Uncontrolled epilepsy remains a significant health concern and requires new approaches to therapy.N‐methyl‐d‐aspartate (NMDA) receptor blockade has been considered, but the adverse cognitive and behavioral effects of conventional NMDA‐receptor antagonists have prevented the development of clinically useful compounds. An alternative approach may be the blockade of the glycine coagonist (“glycineB”) site of the NMDA receptor.Methods:As a first step in the exploration of this approach, we examined the effect of 4‐chloro‐kynurenine (4‐Cl‐KYN), which is converted by astrocytes to the potent NMDA glycine‐site antagonist 7‐chloro‐kynurenic acid (7‐Cl‐KYNA), on the in vivo epileptiform evoked potentials in the CA1 region of rats with chronic limbic epilepsy (CLE). 4‐Cl‐KYN (100 mg/kg) was administered intraperitoneally to naive and epileptic rats. Evoked potentials were induced in area CA1 of the hippocampus by electrical stimulation of the midline region of the thalamus. Simultaneous microdialysis was performed in the contralateral hippocampus to determine the extracellular levels of 7‐Cl‐KYNA over the course of the experiment.Results:Administration of 4‐Cl‐KYN caused a significant reduction in the amplitude of the population spike and in the number of population spikes in epileptic animals (p < 0.01) but had no effect on the evoked response in naive rats. In contrast, 4‐Cl‐KYN significantly altered the paired response in naive animals (p < 0.01), but had no significant effect on this parameter in epileptic animals. The levels of 7‐Cl‐KYNA measured achieved known pharmacologically effective concentrations and paralleled the observed physiological effects.Conclusions:The use of glial cells for the neosynthesis and local delivery of neuroactive compounds may be a viable strategy for the treatment of limbic epilepsy. These results also underscore the unique pharmacology of neurons in epilepsy.
Fasting versus Gradual Initiation of the Ketogenic Diet: A Prospective, Randomized Clinical Trial of Efficacy
Authors: Bergqvist A. G. Christina , Schall Joan I. , Gallagher Paul R. , Cnaan Avital , Stallings Virginia A. 
Published: November 2005

Summary: Purpose:The ketogenic diet (KD) is a 90% fat diet that is an effective treatment for intractable epilepsy. Rapid initiation of the KD requires hospital admission because of the complexity of the protocol and frequent mild and moderate adverse events. The purpose of the study was to compare the efficacy of a gradual KD initiation with the standard KD initiation preceded by a 24‐ to 48‐h fast.Methods:Children ages 1 to 14 years with intractable epilepsy were randomized to a fasting initiation (FAST‐KD) or gradual initiation (GRAD‐KD). Baseline seizure activity was recorded daily for 28 days before admission and continued for the 3‐month duration of the study. Effectiveness was measured in two ways: (a) the proportion of subjects with >50% reduction in target seizure type from baseline to 3‐month evaluation, and (b) percentage reduction in the frequency of the target seizure type from baseline to 3‐month evaluation. Blood glucose was assessed q4 to 6h, and weights, electrolytes, hydration status, vomiting, acid balance, need for interventions (citric acid and sodium citrates (Bicitra) and IV fluids) were assessed daily. Fisher's exact tests were used to examine the association between protocol and occurrence of adverse events, and longitudinal mixed‐effects models were used to look for trends in tolerability data over time.Results:Forty‐eight subjects, 24 in each arm, were randomized. In the FAST‐KD protocol, 58% of the children had >50% reduction in the target seizure type at 3 months, and 21% were seizure free. In the GRAD‐KD protocol, 67% had a >50% reduction at 3 months, and 21% were seizure free. The two protocols were equivalent in efficacy (p = 0.033). At 3 months, the FAST‐KD median percentage seizure reduction rate was 78% (ranging from 100% reduction to 73% increase in seizures per week) and was 94% (ranging from 100% reduction to 161% increase in seizures per week) for the GRAD‐KD protocol. By using a logarithmic transformed percentage reduction rate and an equivalence limit difference of 20%, the efficacy of the two protocols was equivalent (p = 0.0002). Children in the GRAD protocol lost significantly less weight (p = 0.006), and had fewer and less‐severe episodes of hypoglycemia (p < 0.001), fewer treatments for acidosis (citric acid and sodium citrates) (p < 0.04) and dehydration (IV fluids) (p < 0.04), but no difference in vomiting was noted.Conclusions:These data suggest that in children with intractable epilepsy, a gradual initiation results in fewer adverse events and is tolerated better overall while maintaining the efficacy of the KD.
Vagus Nerve Stimulation Induces Concomitant Respiratory Alterations and a Decrease in SaO2 in Children
Authors: Zaaimi Boubker , Héberlé Claire , Berquin Patrick , Pruvost Mickael , Grebe Reinhard , Wallois Fabrice 
Published: November 2005

Summary:  Purpose: To analyze respiratory alterations and effects on SaO2 caused by vagus nerve stimulation (VNS) in children with epilepsy. Methods: Polysomnographic recordings, including electroencephalography, thoracoabdominal distention, nasal airflow, SaO2, and VNS artifact were evaluated in 10 children with pharmacoresistant epilepsy treated with VNS. Results: Each VNS caused a significant increase in respiratory frequency (p < 0.05) throughout the stimulation period and a decrease in thoracoabdominal‐distention amplitude (p < 0.05), especially at the beginning of the stimulation. These respiratory alterations induced a decrease in SaO2 from 1 to 5%. The effects of VNS on respiration differed significantly between rapid‐eye‐movement (REM) and non‐REM (NREM) sleep states. Conclusions: VNS caused a pronounced change in respiration in children with epilepsy, and this induced a decrease in SaO2. It is possible that VNS has a neuroprotective effect, and this possibility calls for further investigation.
In Vivo Epileptogenicity of Focal Cortical Dysplasia: A Direct Cortical Paired Stimulation Study
Authors: Matsumoto Riki , Kinoshita Masako , Taki Junya , Hitomi Takefumi , Mikuni Nobuhiro , Shibasaki Hiroshi , Fukuyama Hidenao , Hashimoto Nobuo , Ikeda Akio 
Published: November 2005

Summary:  Purpose: Alternation of the intracortical inhibitory and excitatory mechanisms in focal cortical dysplasia (FCD) has not been well elucidated in vivo in humans. We investigated in vivo alternation of these mechanisms in epileptogenesis of FCD by means of paired‐pulse direct cortical electrical stimulation. Methods: A 31‐year‐old man with FCD at the left foot primary somatosensory (SI) and motor areas who underwent invasive monitoring with subdural electrodes was studied. By means of subdural electrodes, paired‐pulse electrical stimulation was performed at the epileptic focus (foot SI) and control cortex (hand SI) with interstimulus interval (ISI) of 1–100 ms. Instead of using motor evoked potentials to investigate the degree of cortical excitability in response to motor cortex stimulation, we evaluated the size change of corticocortical evoked potentials (CCEPs), which are elicited at the adjacent cortex by direct cortical stimulation via fiber projection and thus reflect direct and indirect excitation of corticocortical projection neurons at the site of stimulation. Results: During the interictal state, paired‐pulse stimulation of the focus revealed abnormally enhanced intracortical inhibition at ISI of 1–10 ms (maximum, 22%) compared with control stimulation of the hand SI (ISI of 1–2 ms; maximum, 18%) (p < 0.01). While the patient was having the somatosensory aura that later evolved into the left‐leg clonic seizure, single and paired stimulation at the focus showed increased cortical excitability (enlarged CCEP) and decreased intracortical inhibition, respectively. Conclusions: During the aura, interictally enhanced intracortical inhibition at the focus was replaced by increased cortical excitability and decreased intracortical inhibition, suggesting increased net intrinsic epileptogenicity during seizure generation in this patient with FCD.