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  • 1995 - 1999  (501,642)
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  • 1
    ISSN: 1435-165X
    Keywords: Key words Child ; adolescent ; psychopathology ; epidemiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Social competence and emotional/behavioural problems as reported by parents on a Swedish version of the Child Behaviour Checklist (CBCL) were examined in 1308 Swedish school-aged children/adolescents recruited from a stratified, random sample of schools in urban, semirural, and rural areas in Uppsala County, Sweden, and from Stockholm, the capital city of Sweden. The overall response rate was 80.6%. Few gender differences were found, but adolescents received higher problem scores and higher social competence scores than the younger children. Children from the middle SES groups were regarded as having higher social competence levels, and children from the lower SES groups had higher emotional/behaviour problem scores. Children from the larger cities consistently obtained higher problem scores. Those who had received help during the previous year because of psychological problems (2%) had much higher problems scores than those who had not received help. The levels of emotional/behavioural problems in children and adolescents in the present sample seem to be comparable to those reported in similar Scandinavian studies where the CBCL has been used. However, they were considerably lower than those commonly reported in epidemiological studies of children/adolescents from other countries and cultures.
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  • 2
    ISSN: 1435-165X
    Keywords: Keywords Non-retarded autism ; script ; theory-of-mind ; verbal IQ
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The primary purpose of this study was to investigate autistic children's scripts for social routines. Scripts specify familiar events in terms of who does what, when, to whom, and why. Scripts are verbalizations of mental event representations, containing and organizing generalized knowledge of how the world works. Scripts are presumed to be of vital importance for the development of shared meaning, communication, and social behaviour. In this study, children with autism were asked to explain well-known social routines, such as how you shop in a supermarket, make a cake or celebrate a birthday. The scripts of the 12 children with non-retarded autism were compared to scripts of matched normal control children. Despite the fact that all of the participating children with autism had an IQ above 90 and a mental age between 8 and 14, a significant difference in autistic and normal control children's ability to generate scripts for familiar social routines was found. The results are discussed in relation to the same children's ability to pass theory-of-mind tests and their verbal intelligence.
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  • 3
    ISSN: 1435-165X
    Keywords: Keywords children ; mental health ; psychometrics ; screening ; strengths and difficulties
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A new English instrument for screening mental health in children and adolescents, the Strengths and Difficulties Questionnaire (SDQ), was translated into Swedish and used for parental ratings of 900 children aged 6–10 years from the general population. The SDQ which comprises 25 items, divided into 5 subscales (prosocial, hyperactivity, emotional symptoms, conduct problems, and peer problems) was developed from the Rutter scales. An earlier English validation study has shown the two instruments to have equal ability to identify child psychiatric cases, but the SDQ also provides screening on empathy and prosocial behaviour which are aspects of child development emphasized in current child psychiatry. The design of the SDQ with both strengths` and difficulties` items supposedly increases acceptability of the instrument on behalf of informants and makes the questionnaire especially suitable for studies of general population where the majority of children are healthy. Our results, which are novel findings on the instrument, confirmed the postulated factor structure and showed significant gender-differences in results on the total scale, prosocial and hyperactivity subscales and on some of the single items. Moreover, our investigation showed that a Swedish translation of the parental version of the SDQ worked well.
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  • 4
    ISSN: 1435-165X
    Keywords: Key words Adolescence ; anorectal anomalies ; chronic illness ; juvenile chronic arthritis ; self-esteem
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To explore the Harter Self-Perception Profile for Adolescents (SPPA) as an indicator of psychosocial outcome in adolescents with chronic physical disorders, we administered the questionnaire along with other well-established measures of psychosocial outcome (the semistructured Child Assessment Schedule (CAS) interview and the Youth Self Report (YSR) and Child Behavior Checklist (CBCL) questionnaires) to one group of diseased adolescents with good psychosocial adjustment (juvenile chronic arthritis, JCA) and one with a high level of psychosocial maladjustment (anorectal anomalies, ARA). The adolescents with ARA had significantly lower scores of global self-worth, school competence, and social acceptance as compared to the adolescents with JCA. However, global self-worth in neither group was impaired as compared with that of the general Norwegian adolescent population. Perceived physical appearance was the single self-concept domain accounting for the variance in global self-worth (R2 = 0.71, p < 0.001). Among the other measures of psychosocial outcome, global self-worth was most strongly related to mood according to the CAS interview (r = −0.53, p < 0.001) and to the YSR internalizing score (r = −0.53, p < 0.001). Our findings indicate that the SPPA has limited ability to identify chronically diseased adolescents with adverse psychosocial outcome.
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  • 5
    ISSN: 1435-165X
    Keywords: Key words Child behaviour problems ; maternal psychiatric disturbance prevalence ; log-linear models
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Prevalence estimates for psychiatric disturbance in mothers and their 2 1/2 year old children and the variations in prevalence associated with marriage quality, social class and the child's developmental level are presented. It was found that both the mother's psychiatric disturbance, and more specifically, depression were associated most strongly with child disturbance, poor marriage quality and low child developmental level. For toddler disturbance, the strong associations were with type and severity of disturbance in mother, social class, marriage quality and low developmental quotient.
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  • 6
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    ISSN: 1435-165X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 7
    ISSN: 1435-165X
    Keywords: Key words Moyamoya disease ; psychosis ; adolescent ; temporal lobe pathology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This paper reports the case of a 12-year-old boy who presented with an acute transient psychosis. Investigations revealed Moyamoya disease with occlusion of the left middle cerebral artery. There was no previous history of transient ischaemic attacks, no history of psychiatric disease, no family history of psychosis and no history of illicit drug use. Although no previous cases of Moyamoya disease with psychosis as the sole presenting feature have been described, we suggest the possibility of a causal link.
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  • 8
    ISSN: 1435-165X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 9
    ISSN: 1435-165X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 10
    ISSN: 1435-1803
    Keywords: Key words Myocardial ischemia – myocardial infarction – signal transduction – second messengers – calcium
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The mechanisms responsible for infarct size reduction with preconditioning remain controversial. Our aim was to determine whether release of the second messenger inositol (1,4,5)-trisphosphate (Ins(1,4,5)P3) during the preconditioning stimulus may play a role. To test this concept, Langendorff-perfused rabbit hearts underwent sham perfusion, 5 min of coronary artery occlusion (CO), or 5 min of CO+infusion of neomycin, an agent which inhibits formation of Ins(1,4,5)P3. Direct quantitation (by competitive binding assay) revealed a 2-fold increase in Ins(1,4,5)P3 content with brief ischemia vs shams (0.69±0.14 vs 0.34±0.05 pmol/mg tissue; p<.05) that was blocked by neomycin (0.15±0.04 pmol/mg). Infarct size (by tetrazolium staining) was assessed in additional hearts that underwent 30 min of sustained CO and 2 h of reperfusion. As expected, two 5-min episodes of preconditioning ischemia reduced infarct size versus controls (30±6% versus 63±3% of the myocardium at risk; p<.01). In contrast, infarct size was comparable (54–56% of the risk region) in neomycin-treated control and preconditioned hearts. These results demonstrate that myocardial Ins(1,4,5)P3 content is increased in response to brief preconditioning ischemia and are consistent with the concept that Ins(1,4,5)P3 may be a potential mediator of infarct size reduction with preconditioning in isolated rabbit heart.
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  • 11
    ISSN: 1435-1803
    Keywords: Key words Isovolumic relaxation – dog – diastole – intraventricular pressure gradients
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Tau (τ), the time constant for isovolumic relaxation, is often used as a measure of cardiac diastolic function. However, several methods of calculating τ have been published which may produce different results and, thereby, different conclusions. The purpose of this study was to determine if the method of τ calculation effects the results when left ventricular pressure (LVP) is measured at different positions along the base-to-apex axis. In 16 dogs, we measured LVP at 6 positions along the base-to-apex axis. We calculated τ using three different methods: 1) a monoexponential model (P(t)=[P0–Pasym]eAt+Pasym, where t=time, P0=LVP at t=0, Pasym is asymptotic pressure as t→∞, A is –1/τ) with a zero asymptote 2) a monoexponential model with a variable asymptote in which the monoexponential decay equation is differentiated with respect to time and substituted into the original equation so that dP/dt vs. LVP is a (–/τ), and 3) a monoexponential decay model with variable asymptote in which Pasym and A are varied until the best fit line is reached by minimizing the residual sum of squares. When τ is calculated using method 1, τ measured at the LV base is 98.01%±8.85% of the τ at the apex. If calculated using method 2, τ measured at the LV base was 75.46±39.4% of τ measured at the apex. When method 3 is used for τ calculations, base τ increases to 117.76±4.91% of the apical τ. We conclude: 1) the method used to calculate τ will effect the results and, thus, conclusions drawn from τ data. 2) When using Method 3, which appears to be the best method for τ calculation, τ increases at the LV base compared to the apex.
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  • 12
    ISSN: 1435-1803
    Keywords: Key words Positron emission tomography – hypertrophic cardiomyopathy – transmural blood flow – calcium channel blockers
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Verapamil alleviates symptoms in patients with hypertrophic cardiomyopathy (HCM), but the underlying mechanism of improvement remains speculative. Baseline and dipyridamole myocardial blood flow (MBF) were measured in 15 HCM patients (14 men, 42±10 years), before and after 4 weeks of verapamil SR 480 mg daily, using 15O labelled water and positron emission tomography (PET). Subendocardial (endo) and subpericardial (epi) MBF was measured in the septum (thickness 25.4±5.8 mm). Pre-treatment baseline whole heart MBF was 1.02±0.28 ml/min/g and 1.01±0.30 ml/min/g on treatment (p=ns). Dipyridamole MBF was 1.39±0.31 ml/min/g off treatment and 1.23±0.34 ml/min/g on treatment (p=ns). Coronary flow reserve (dipyridamole/resting MBF) was 1.45±0.52 and 1.30±0.51, respectively (p=ns). At baseline, the septal endo/epi MBF ratio was uniform off and on treatment (1.13±0.18 vs 1.18±0.21, p=ns). Before treatment, the endo/epi ratio following dipyridamole decreased to 0.93±0.24 (p<0.01 vs baseline) and 5/15 (33%) patients had a ratio <0.8 which would suggest subendocardial underperfusion. During treatment, the endo/epi ratio following dipyridamole was no more different from baseline (1.06±0.24, p=ns vs baseline) and 2/14 (14%) patients had an endo/epi <0.8. PET can be successfully used to determine transmural MBF in vivo in patients with hypertrophied ventricles. Despite symptomatic improvement, high dose verapamil therapy does not increase total MBF in patients with HCM but may improve septal transmural MBF distribution during dipyridamole in some patients.
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  • 13
    ISSN: 1435-1803
    Keywords: Key words Bowditch-effect – hypertrophic cardiomyopathy – myocardial contraction – human myocardium – calcium
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The present study was designed to test the hypothesis that in hypertrophied myocardium of patients with hypertrophic obstructive cardiomyopathy (HOCM) a reduced contractile reserve provided by frequency dependent potentiation of force of contraction contributes to the myocardial dysfunction. Myectomy was performed in 8 HOCM patients with normal systolic left ventricular function at rest. Nonfailing myocardium from the hearts of three multiorgan donors was investigated for comparison. In thin myocardial strips we measured the inotropic effects of different stimulation frequencies (0,5–3.0Hz) at different extracellular Ca2+ concentrations (1.8–16.2 mmol/l). At 1.8 mmol/l extracellular Ca2+ concentration, increasing stimulation rates had no positive inotropic effect in HOCM myocardium, whereas in nonfailing myocardium force of contraction increased up to 3 Hz. Increasing extracellular Ca2+ concentrations induced a positive force-frequency relation in HOCM with a maximum at 5.4 mmol/l Ca2+. A further increase to 16.2 mmol/l Ca2+ resulted in a negative force-frequency relation in these specimens. The time to peak tension and the time to relaxation decreased at increasing stimulation frequencies at all Ca2+ concentrations investigated. In conclusion, in hypertrophied myocardium of HOCM patients increasing stimulation frequencies failed to have a positive inotropic effect at physiological extracellular Ca2+ concentrations. The induction of a positive force-frequency relation by higher Ca2+ concentrations suggests that an abnormal cellular Ca2+ handling may play an important pathophysiological role.
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  • 14
    ISSN: 1435-1803
    Keywords: Key words Myocardial infarction – ischemic preconditioning – naloxone – rabbits
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective The hypothesis that naloxone blockade of ischemic preconditioning (IP)-induced infarct limitation does not require central nervous system participation was evaluated using quaternary naloxone in anesthetized rabbits (Study I) and naloxone hydrochloride in isolated rabbit hearts (Study II). Methods In Study I, rabbits underwent 30 min coronary artery occlusion and 180 min reperfusion. IP was elicited with a 5 min coronary artery occlusion beginning 15 min before the 30 min occlusion. Intravenous naloxone methiodide, 12.9 mg/kg, was bolused 10 or 1 min before IP. In Study II, rabbit hearts underwent 45 min coronary artery occlusion and 120 min reperfusion. IP was elicited with 2 cycles of 5 min coronary artery occlusion plus 5 min reperfusion, beginning 20 min before the 45 min occlusion. Naloxone hydrochloride, 1µmol/L, was added to the buffer perfusate for 25 min preceding the long coronary artery occlusion. In both studies, infarct size was assessed with tetrazolium, normalized to risk volume, and analyzed using ANOVA. Results In both studies, IP reduced infarct size compared to control (6.3 ± 2,3 vs. 29.5 ± 4,4, P = 0.007, Study I; 11.8 ± 4.7 vs. 47.7 ± 6.7, P = 0.03, Study II). In Study I, IP was not blocked when naloxone methiodide was given 10 min before IP (13.8 ± 4.8 vs. 42.3 ± 5.4, P = 0.004) but was blocked when given 1 min before IP (25.3 ± 7.2 vs. 28.4 ± 5.0, P = ns). In Study II, infarct size was intermediate in the 1µmol/L naloxone hydrochloride+IP group (19.0 ± 6.5 vs. 48.9 ± 8.4, P = ns) but IP was blocked by 100 µmol/L naloxone hydrochloride (62.6 ± 4.5 vs. 56.2 ± 6.7, P = ns). Conclusion Naloxone blockade of IP-induced infarct limitation involves a cardiac mechanism.
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  • 15
    ISSN: 1435-1803
    Keywords: Key words Congestive heart failure – conscious dog – angiotensin II receptor antagonist – angiotensin converting enzyme inhibitor – vascular tone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study was designed to assess the influence of the activation status of the renin angiotensin system (RAS) on the hemodynamic effects of EXP 3174 (an angiotensin AT1 receptor antagonist) and enalaprilat (an angiotensin converting enzyme inhibitor) in tachycardia-induced heart failure. Thirteen dogs were chronically instrumented to measure left ventricular (LV) pressure, its first time derivative (LV dP/dt), atrial and aortic pressures, and cardiac output. EXP 3174 (0.1 mg/kg, iv) or enalaprilat (1 mg/kg, iv) were administered in conscious dogs with heart failure induced by right ventricular pacing (250 beats/min, 3 weeks). EXP 3174 and enalaprilat produced significant vasodilation but the effects of EXP 3174 on mean aortic pressure (MAP), cardiac output, and total peripheral resistance (TPR) were only 50% of those produced by enalaprilat. When dogs were grouped according to their baseline plasma renin activity (PRA) values, in dogs with normal PRA (0.5 ± 0.1 ng/ml/h) EXP 3174 did not produce significant change in MAP and TPR, while enalaprilat decreased significantly MAP and TPR. In contrast, in dogs with high PRA (6.7 ± 3.2 ng/ml/h), EXP 3174 produced significant reductions in MAP and TPR, which were similar to those produced by enalaprilat. Thus, in conscious dogs with heart failure, enalaprilat is effective whether the RAS is activated or not. In contrast, EXP 3174 is effective only when the RAS is activated. These results may help in the choice of inhibitors of the RAS in heart failure.
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  • 16
    ISSN: 1435-1803
    Keywords: Key words Ischemic cardiomyopathy – dilated cardiomyopathy – calcium – SR Ca2+ release channel – human myocardium
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Altered Ca2+ metabolism of the sarcoplasmic reticulum results in changes of the contractile behavior in failing human myocardium. The ryanodine-sensitive Ca2+ release channel of the sarcoplasmic reticulum plays a key role in the intracellular Ca2+ handling in cardiac myocytes. Recently, we showed that the density of 3H-ryanodine binding sites which correspond to the SR Ca2+ release channel in human myocardial homogenates is unchanged in failing human myocardium. However, the sensitivity of the channel towards Ca2+, which acts as the trigger signal of channel activation and thereby initiates contraction, has not yet been investigated in failing and nonfailing myocardium. Methods: Homogenates (100 μg protein) from hearts with dilated (DCM, n = 10) or ischemic (ICM, n = 9) cardiomyopathy were incubated with a saturating concentration of 3H-ryanodine (12 nM) in the presence of different Ca2+ concentrations ranging from 1 nM to 10 mM. For comparison, myocardium of 8 nonfailing hearts which could not be transplanted for technical reasons was investigated. Nonspecific binding was determined in the presence of a high concentration (10 μM) of unlabeled ryanodine. Results: 3H-ryanodine binding to the Ca2+ release channel showed a bell-shaped pattern with an increase in specific binding at submicromolar Ca2+ concentrations and a decrease at higher Ca2+ concentrations than 0.5 mM, whereas nonspecific binding was not influenced by different Ca2+ concentrations. In nonfailing myocardium, maximal 3H-ryanodine binding (Bmax) was 85.2 ± 3.1 fmol/mg protein and half-maximal binding was reached at a free Ca2+ concentration of 0.25 (0.22 – 0.30)μM (EC50). Neither EC50 values nor maximal specific 3H-ryanodine binding differed between nonfailing and failing myocardium of both etiologies. EC50 values were 0.24 (0.23 – 0.26)μM (DCM, n = 10) or 0.28 (0.25 – 0.31)μM (ICM, n = 9), respectively. Caffeine (2 mM) and the ATP-analogon AMP-PCP (1 mM) led to a shift towards lower Ca2+ concentrations consistent with an activation of the channel by these compounds, whereas Mg2+ (0.7 mM) shifted the Ca2+-dependence of 3H-ryanodine binding towards higher Ca2+ concentrations indicating inhibition of channel opening. After activation of the Ca2+ release channel by caffeine or AMP-PCP as well as after the inhibition with MG2+ EC50 values were the same in failing and nonfailing myocardium. Conclusion: Caffeine and AMP-PCP sensitize, whereas Mg2+ desensitizes the myocardial Ca2+ release channel to Ca2+. The determination of Ca2+-dependent 3H-ryanodine binding to the human myocardial Ca2+ release channel is a useful tool to investigate its open probability. Furthermore, the Ca2+-sensitivity and the pharmacological behavior of the human SR Ca2+ release channel are similar in failing and nonfailing myocardium.
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  • 17
    ISSN: 1435-1803
    Keywords: Key words Fura-2 – atrium – force-frequency relationship – calcium – human
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The present study invesitgates the effect of stimulation frequency and external Ca2+-concentration on intracellular systolic and diastolic Ca2+ as well as on the force-frequency relationship (FFR, 0.5 to 3.0 Hz, 1.0 mmol/l extracellular Ca2+) in human myocardium using fura-2 AM loaded electrically stimulated right atrial muscle strips (coronary bypass surgery, n = 15, age: 60.0 ± 1.9 years). The FFR was positive (3.0 vs. 0.5 Hz: 184 ± 43 % of basal value) and linked to an increase in peak systolic (R340/380 sys, 119 ± 7 %) as well as diastolic Ca2+ (R340/380ED, Δ fura-2 ratio +0.20 ± 0.02). After elevating the extracellular Ca2+ concentration from 1.0 to 2.4 mmol/l, force of contraction (FOC) increased from 0.5 up to 1.0 Hz (128 ± 8 %) and declined after further augmentation of stimulation frequency (3.0 Hz: 87 ± 15 %). However, this decrease in FOC was accompanied by an increase in diastolic Ca2+ (Δ fura-2 ratio +0.45 ± 0.08), while systolic Ca2+ declined at high stimulation frequencies. In conclusion, the frequency-dependent force generation is accompanied by an increase in both systolic and diastolic Ca2+ levels. Thus, especially at high stimulation frequencies the Ca2+-lowering mechanisms may become crucial and may be responsible for the blunted force-frequency relationship in failing human myocardium.
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  • 18
    ISSN: 1435-1803
    Keywords: Key words Bay K 8644 – nifedipine – ryanodine – force-frequency relation – tetanic contraction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The present study investigated the influence of Bay K 8644 and nifedipine (Nif) on the force-frequency relationship and on tetanic tension and force of contraction of failing human myocardium (PAP, n = 12). In addition, ryanodine (Rya) was studied on the force-frequency relationship. Bay K 8644 (0.1 μM) increased, but Nif (0.01 μM) reduced isometric force of contraction significantly. However, both, Bay K 8644 (2 Hz vs. 0.5 Hz: Control: −31.6 ± 7.8 %; +Bay K 8644: +103 ± 30 % (% basal); p < 0.005) as well as Nif (2 Hz vs. 0.5 Hz: Control: −8.8 ± 9.7 %; +Nif: +90.9 ± 31.5 %) (% basal); p < 0.05), were able to restore a positive FFR in PAP. By measurement of tetanic tension and posttetanic potentiation in the presence of the 1,4-dihydropyridines, we support the hypothesis of the existence and functional relevance of a dihydropyridin-ryanodine receptor junctional complex. In skinned fiber preparations, Bay K 8644 showed no effect on Ca2+-sensitivity or caffeine induced Ca2+-release. Rya (10 μM) decreased force of contraction in PAP and was effective in restoring a postive FFR (2 Hz vs. 0.5 Hz: Control: −7.3 ± 5.1 %; +Rya: +98.0 ± 31.9 % (% basal); p < 0.05). Thus, the altered FFR and Ca2+-homeostasis in failing human myocardium may result from changes in sarcolemmal Ca2+-influx and/or from altered SR-Ca2+-load.
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  • 19
    ISSN: 1435-1803
    Keywords: Key words Free radicals – N-2-mercaptopropionyl glycine – myocardial infarction – preconditioning – triphenyltetrazolium chloride
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Recent studies have repoarted that prolonged infusion of N-2-mercaptopropionyl glycine (MPG), a diffusible antioxidant, could limit infarct size in dogs. However, there are no comparable studies testing this agent in other species. We examined the efficacy of MPG in a rabbit model of infarction. Rabbit hearts were subjected to a 30-min coronary artery occlusion. Infarct size expressed as a percentage of risk zone was determined by either triphenyltetrazolium chloride (TTC) staining after 3 h of reperfusion (study 1) or by histology after 72 h of reperfusion (study 2). In study 1, 37 ± 2.6 % of the risk zone infarcted in the control group. Intravenous MPG at a rate of 100 mg/kg/h starting 15 min after the onset of ischemia and continuing until 1 h after reperfusion had no effect on infarct size (35.4 ± 3.4 % infarction). However, infusion of MPG until the end of reperfusion significantly reduced infarct size as measured with TTC to 17.2 ± 2.5 % (p < 0.01 vs. control group). In study 2, 48.6 ± 4.0 % of the risk zone infarcted in the control group. In the treatment group MPG was started as above and was continued for 4 h of reperfusion followed by an intramuscular injection at the termination of the intravenous infusion. No protection was seen after 72 h of reperfusion (43.8 ± 2.1 % infarction). These findings reveal that MPG at a dose and schedule that appeared to protect the dog heart could not effect sustained protection in the rabbit heart. TTC staining revealed that MPG appeared to have preserved viability for up to 3 h of reperfusion suggesting that failure may have been due to early withdrawal of the drug. Alternatively, early TTC staining may yield spurious results under conditions in which protection is dependent upon antioxidant or free radical scavenger treatment as has previously been suggested. It is concluded that MPG as administered in the previous canine studies does not limit infarct size in all species, thus raising a concern about MPG's potential efficacy in man.
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  • 20
    ISSN: 1435-1803
    Keywords: Key words Cell death – rat ventricular myocytes – TUNEL – annexin V – phospholipids
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In many cell types, DNA fragmentation is a late event of apoptosis which may be lacking. This contrasts with the early translocation of phosphatidylserine (PS) from the internal to the external leaflet of the cell membrane. We examined whether an early PS translocation also occurs during apoptosis induced in adult rat ventricular myocytes grown in the presence of 10 % fetal calf serum (FCS), by the protein kinase inhibitor staurosporine. Apoptosis was assessed by the observation of: (i) typical alterations in cell morphology; (ii) nuclear alterations visualized using the permeant intercalating agent Hoechst 33258; (iii) DNA fragmentation detected by the TUNEL method. PS translocation was detected using annexin V binding. Data are expressed as means ± SEM. Prolonged exposure of myocytes to 10 μM staurosporine from day 3 to day 7 of culture resulted in cell shrinkage, typical nuclear alterations, membrane protrusions and fragmentation of the sarcomeric apparatus in the vast majority of myocytes. At this time, 52.4 ± 5.7 % of staurosporine-treated myocytes were TUNEL positive (vs 6.1 ± 2.0 % in control cultures (CC), p < 0.001) and 69.7 ± 1.7 % were annexin V positive (vs 21.1 ± 1.0 % in CC, p < 0.001). Importantly, PS translocation was detected as early as 35 minutes following staurosporine addition, the percentage of annexin V positive myocytes reaching 10 times the control value (19.2 ± 2.7 vs. 1.8 ± 0.8 %, p < 0.001) after 3 hours. A 18-hour staurosporine exposure of freshly isolated myocytes resulted, at the end of exposure, in 24.3 ± 1.7 % annexin V positive myocytes (vs 9.6 ± 0.5 % in CC, p < 0.05), whereas a marked increase in the percentage of TUNEL positive myocytes was observed only from day 5. Finally, myocyte exposure to the membrane-permeant ceramide analog, C2-ceramide (50 μM), resulted in 63.2 ± 3.5 % annexin V positive myocytes 4 hours later (vs 17.8 ± 4,4 % in CC, p < 0.001), whereas a significant increase in the percentage of TUNEL positive myocytes was detected only the next day (43.7 ± 3.4 vs 9.9 ± 1.3 %, p < 0.001). Taken together, these results strongly suggest that the loss of PS asymmetry is an early event of cardiac myocyte apoptosis which precedes DNA fragmentation.
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  • 21
    ISSN: 1435-1803
    Keywords: Key words Insulin – tyrosine kinase – protein kinase C – KATP channels – phosphatidylinositol 3-kinase – ischemic preconditioning
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Because tyrosine kinase blockade prevents protection by ischemic preconditioning (PC) in several species, activation of tyrosine kinase appears to be critical for cardioprotection. The tyrosine kinase's identity, however, is unknown. The present study tested whether activation of a receptor tyrosine kinase, the insulin receptor, could mimic PC and if the mechanism of protection was similar to that of PC. Isolated rabbit hearts were subjected to 30 min of regional ischemia and 2 h of reperfusion. Infarct size was determined by triphenyltetrazolium staining and expressed as a percentage of the area at risk. Infarct size in control hearts was 32.6 ± 2.3 %. A 5-min infusion of insulin (5 mU/ml) followed by a 10-min washout period prior to ischemia significantly reduced infarction to 14.7 ± 2.1 % (P < 0.05). The tyrosine kinase inhibitor genistein (50 μM) given around the insulin infusion blocked protection (28.9 ± 2.8 %). However, when present during the onset of ischemia, genistein had no effect on protection triggered by insulin (14.0 ± 2.4 %; P < 0.05). Inhibition of either PKC by polymyxin B (50 μM) or KATP channels by 5-hydroxydecanoate (100 μM) also failed to prevent protection by insulin (17.5 ± 3.2 % and 17.6 ± 3.0 %, respectively). However, the reduction in infarct size by insulin was significantly attenuated by wortmannin (100 nM), a selective inhibitor of phosphatidylinositol 3-kinase (P13K, 28.3 ± 2.2 %). Insulin was still able to protect the heart when given only during the reperfusion period (13.2 ± 3.4 %). PC reduced infarction to 12.8 ± 2.0 % (P < 0.05). In conclusion, activation of the insulin receptor reduces infarct size in the rabbit heart even when instituted upon reperfusion. However, the mechanism of protection is quite different from that of PC and involves activation of P13K but not PKC or KATP channels.
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  • 22
    ISSN: 1435-2451
    Keywords: Key words Oncogene ; Tumor-suppressor gene ; Thyroid carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Introduction and discussion: Molecular genetic investigations relating to thyroid cancer have started to gain clinical importance, with discovery of the tumor-specific oncogenes PTC 1–3 in papillary thyroid cancer and the syndrome-specific mutations of the RET protooncogene in MEN-2a, MEN-2b and familial MTC patients. Furthermore, the thyroid-specific sodium-iodine symporter, causing iodine accumulation in thyroid tissue, has been cloned and now offers studies to enhance iodine and radioiodine uptake in thyroid cancer, which could soon prove to be clinically applicable.
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  • 23
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract There is considerable controversy surrounding the appropriate treatment of papillary thyroid carcinoma (PTC), most of which centers around the extent of thyroidectomy. Despite the advocation of less than total thyroidectomy by many surgeons, there is a renewed interest by others, mainly in Europe and Japan, in the performance of routine total thyroidectomy and extensive lymph-node dissection for PTC. This has been shown to be an effective strategy for medullary thyroid carcinoma, which is not responsive to thyroid suppression or radioactive iodine treatment. PTC, however, is well treated by these adjuvant modalities and, in general, has an excellent prognosis. The benefit of extensive operations for routine cases of PTC has not been proven, and this practice is not employed by most surgeons in the United States. Node dissection is reserved for those patients with palpable adenopathy.
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  • 24
    ISSN: 1435-2451
    Keywords: Key words C-cell cancer ; Medullary thyroid carcinoma ; Prevention ; Treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Introduction: C-cell cancer of the thyroid or medullary thyroid carcinoma (MTC) exists in a sporadic and a hereditary form, the latter of which is part of the multiple endocrine neoplasia type-2 (MEN-2) syndromes. Discussion: MTC metastasises early to local (lymph nodes) and distant sites (liver, lung, bone). Therefore, early detection is mandatory to enable a chance of cure. In sporadic MTC, the sensitive tumour marker calcitonin enables detection of the disease at an early stage. In hereditary MTC, more than 95% of the patients have germline RET mutations. Thus, MEN-2 has become the paradigm for the practice of molecular medicine, and gene carriers can be identified before MTC even occurs. Surgery is the only chance of cure and recently developed surgical techniques provide the therapeutic prerequisite to achieve calcitonin normalisation in both sporadic and hereditary MTC.
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  • 25
    ISSN: 1435-2451
    Keywords: Key words Intraabdominal infection ; Prognosis ; Prospective study ; Risk factor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Introduction and methods: A prospective observational multicenter study with 18 hospitals was performed to assess preoperative risk, therapeutic management and outcome of patients with peritonitis. Data collection was carried out according to standardized and recommended definitions. Included in the study were 355 patients with macroscopically confirmed peritonitis. Results: In the univariate analysis, the following factors influenced both the mortality and the incidence of postoperative complications: age, presence of certain concomitant disease, site of origin of peritonitis, type of admission and the ability of the surgeon to eliminate the source of infection. In addition, postoperative infective complications were related to the etiology of peritonitis and the exudate. In the multivariate analysis, APACHE II (P<0.001), successful operation (P<0.001), age (P<0.001), liver disease (P<0.03), malignant disease (P<0.04) and renal disease (P<0.05) turned out to be significant with respect to death. Escherichia coli was the predominant organism (51%), following by enterococci (30%) and bacteroides (25%). There was a significantly higher postoperative infection rate in patients with no adequate treatment of enterococci than patients with adequate treatment or no enterococci (P<0.05). Conclusion: The study demonstrated the important role of the physiological reserve of the patient and of the surgeon, which is not adequately reflected in existing scoring systems. Further investigations are needed to study the impact of enterococci on the outcome.
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  • 26
    ISSN: 1435-2451
    Keywords: Key words Peritonitis ; Sepsis ; Tonometry ; Pneumoperitoneum ; Laparoscopic surgery ; Conventional surgery ; Mortality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: Tonometry is widely used in the diagnosis of sepsis and splanchnic ischemia. This study was devised to analyze the predictive value of gastric tonometry for outcome of experimental viscus perforation-induced peritonitis. The impact of conventional and laparoscopic intervention on tonometric measurements was the main scope. Methods: This randomized controlled intervention trial was performed in a University experimental laboratory, using 24 female Duroc pigs. Pigs were subjected to gastric perforation followed by a 12 h interval of peritonitis, and then to either laparoscopic or conventional surgical repair of the defect with peritoneal lavage. Gastric tonometry and cardiocirculatory monitoring were performed. Results: Septic shock associated with peritonitis and subsequent lethal outcome was accurately predicted with gastric tonometry. Changes of gastric mucosal pH correlated significantly with decreases of MAP (r 2 = 0.880; P < 0.001) and SVR (r 2 = 0.678; P < 0.001), increase of QT (r 2 = 0.486; P = 0.013), and mortality (r = 0.752; P < 0.001). Mortality was significantly higher in laparoscopically treated animals compared to those subjected to the open procedure (78% vs 22%; P < 0.045). Conclusions: Gastric tonometry accurately predicted mortality in experimental peritonitis. The decline of gastric mucosal pH in the laparoscopic group was more than double that of to conventionally treated animals. This finding not only reflected the increase of systemic CO2 due to higher absorption during CO2-pneumoperitoneum, but probably also indicated a more severe form of splanchnic ischemia during laparoscopic surgery. Even though tonometry can be used to accurately predict mortality and separate the high risk group, extreme caution should be applied under conditions associated with severe peritonitis.
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  • 27
    ISSN: 1435-2451
    Keywords: Key words Xenograft ; Transplantation ; Allograft
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Background: The prospect of xenotransplantation has stimulated considerable hopes as well as major concerns. The question of whether or not patients accept xenografts is influenced not only by scientific facts but also by psychological factors. It was the aim of this study to analyze the attitudes of patients toward transplantation of xenogeneic organs and evaluate factors influencing these attitudes. Methods: To this end, attitudes toward xenogeneic compared with allogeneic organ grafts were evaluated by means of detailed questionnaires in 1049 patients in Germany, who either had received transplants (n=722) or were on the waiting list for various organ grafts (n=327). Answers were correlated to demographic data as well as to the physical and mental conditions of the patients. Results: The survey indicates that 77% of patients would accept xenografts while 7% would refuse them if results of xenotransplantation were comparable with those of allotransplantation. If xenotransplantation were associated with increased risks due to more intensive medication 58% would still basically accept xenografts. Acceptance of xenografts was significantly higher in patients who had received transplants and among males. Age, religion, waiting time, and type of organ were not found to influence acceptance rates. Xenografts were thought to be associated with considerable or severe emotional stress by 23% of patients, versus 3% for allografts. The pig was the preferred donor animal, and gene therapeutic manipulation for improvement of results would be accepted by 84%. Inadequate graft function/increased risk of rejection and risk of disease transmission were the major concerns for 60% and 52% of patients, respectively; emotional concerns were the major concerns for 24% and animal-rights concerns for 15%. Conclusions: These findings show that the potential acceptance rate of xenografts would be quite high, with a more positive attitude in transplanted patients than in waiting-list patients; there was no major difference in acceptance rate for various types of organs. Major concerns about xenotransplantation currently are functional inferiority and transmission of diseases.
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  • 28
    ISSN: 1435-2451
    Keywords: Key words Liver tumours ; Ultrasound ; PEI ; Radio-frequency ablation ; Review
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Background: Percutaneous ethanol injection (PEI) and radio-frequency (RF) ablation are possible palliative treatment modalities for patients with non-resectable liver metastases of colorectal carcinomas. The different techniques are explained and reviewed. Results: PEI did not show promising results for the treatment of liver metastases. RF results were more encouraging; some studies showed improved mean survival times for patients when a complete necrosis of the metastases could be achieved. The maximum diameter of the necrotic area possible in a single session is about 5 cm. Conclusion: PEI and RF are palliative last-line treatment strategies for patients with non-resectable liver metastases and should only be applied if chemotherapy is not sufficient or not possible. The long-term efficacy of RF ablation in this group of patients has to be evaluated.
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  • 29
    ISSN: 1435-2451
    Keywords: Key words Evidence-based medicine ; Doctor ; patient relationship ; Conflict
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The doctor–patient relationship is characterised by clinical situations that reflect different degrees of impairment of the patient’s quality of life on the one hand and different degrees of threat to the patient’s life on the other. Typical patterns of these situations from absent or minimal to severe impairment of well being or threat to life are described. With regard to this, the doctor–patient communication is still suffering from considerable deficits. For the latter, a possible philosophical framework and reason is given. The potential of evidence-based medicine to ease this conflict by bringing into the game the current best-available scientific evidence is discussed, and some inherent serious limitations of evidence-based medicine are shown. Besides these drawbacks, doctors are usually very reluctant and lazy to integrate evidence-based results into their daily practice. In the author’s view, evidence-based medicine is a reasonably new tool. However, it should not yet be overestimated in its potential to influence and improve daily clinical practice.
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  • 30
    ISSN: 1435-2451
    Keywords: Key words Evidence-based medicine ; Surgical research ; Rationing ; Clinical practice guidelines ; Health economics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Introduction: Evidence-based medicine (EBM) has been proposed as a new paradigm of practising medicine. However, an unproductive polarisation between supporters and opponents can make its unbiased assessment difficult. This review gives an overview of the arguments and discusses their surgeon-specific importance. Discussion: As EBM claims a position in the centre of medicine, it borders with other highly debated topics as, for instance, rationing and equity of care, doctor–patient interaction, medical research and education. Most arguments against EBM relate to its role in reducing health expenses by rationing healthcare. We think that the principles of EBM can be applied to make the inevitable process of rationing fair and reproducible. In addition, evidence-based surgery is criticised for interfering with patient individuality and physician autonomy, although this is a misunderstanding. Furthermore, the evidence-basis of EBM, in particular the randomised controlled trial (RCT) and systematic review, has been subject of discussion. Additionally, surgical research has its own inherent difficulties and, ultimately, some clinicians have doubted the practical feasibility of applying EBM at the bedside, because searching and critically appraising the literature is too difficult and time consuming. Conclusions: We believe that most critics consider EBM to be a potentially dangerous tool, because they fear it will be used against themselves. Thus, these conflicts only prove that EBM as a methodology may have a strong impact on solving them. As EBM has already made discernible progress, surgeons should not stand aside from these activities, which are bound to strongly influence healthcare in the next century.
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  • 31
    ISSN: 1435-2451
    Keywords: Key words Acute appendicitis ; Appendectomy ; CRP ; Fertile-aged women ; Leukocyte count
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Background and aims: An uninflamed appendix at appendectomy represents a misdiagnosis. In fertile-aged women, the diagnostic accuracy in acute appendicitis is usually lower than 60%. We studied the role of preoperative leukocyte count and C-reactive protein (CRP) measurements in the diagnosis of acute appendicitis in fertile-aged women with a clinical suspicion of acute appendicitis. In particular, what is the clinical value of unelevated leukocyte count and CRP in excluding acute appendicitis in these patients? Methods: We calculated the mean leukocyte count and CRP values in (1) 100 consecutive fertile-aged women operated on for a clinical suspicion of acute appendicitis but with an uninflamed appendix found at appendectomy, and (2) 100 consecutive fertile-aged women operated on for a clinical suspicion of acute appendicitis and acute appendicitis found at appendectomy. The percentages of patients with (1) both values unelevated, (2) only leukocyte count elevated, (3) only CRP value elevated, or (4) both values elevated were calculated within the groups A (uninflamed appendix) and B (acute appendicitis). Results: The mean leukocyte value was significantly (P<0.001) higher in patients with acute appendicitis (13.7×109/l) than in those with an uninflamed appendix (10.6×109/l). Similarly, the mean CRP value was significantly (P<0.05) higher in patients with acute appendicitis (42 mg/l) than in those with an uninflamed appendix(29 mg/l). Taken together, 24 patients were operated on for a clinical suspicion of acute appendicitis, although preoperative leukocyte count and CRP values were unelevated. An uninflamed appendix was found in all these patients at appendectomy. Conclusion: Although clinical symptoms and signs indicated acute appendicitis, unelevated leukocyte count and CRP values excluded it, with a 100% predictive value in the current study of fertile-aged women. In our patients, 24% (24 of 100) of unnecessary appendectomies could have been avoided by trusting in this finding.
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  • 32
    ISSN: 1435-2451
    Keywords: Key words Late-onset form ; Malignant schwannoma ; Neurofibromatosis ; Skeletal manifestation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Introduction: Von Recklinghausen’s neurofibromatosis is known to occur with markedly variable expressivity. Nevertheless, cases that do not feature characteristic findings are uncommon. Case: We report an extremely rare, sporadic case of neurofibromatosis, exclusively represented in the skeleton of a 49-year-old woman. The late onset of the disease and the absence of common diagnostic criteria permit us to classify it as neurofibromatosis type VII. Additionally, the disease was complicated by early malignant transformation of a thoracic neurinoma, which was removed by a wide local resection. Two years after surgery, the patient developed local recurrence and liver metastases. She died a few months later despite aggressive chemotherapy.
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  • 33
    ISSN: 1435-2451
    Keywords: Key words Fibrin glue ; Stent ; Anastomosis ; Gastrointestinal tract ; Sutureless
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Introduction and methodology: To develop a practical gastrointestinal sutureless anastomosis technique, 164 end-to-end and end-to-side anastomoses were performed on the small intestine (SI), large intestine (LI), rectum, esophagus and gallbladder in 109 female Landrace pigs weighing 25 kg and 35 kg. There were 116 fibrin glue (FG) and 48 sutured anastomoses. The end-to-end SI and LI anastomoses were divided into five groups: sliding absorbable intraluminal nontoxic stent (SAINT); SAINT placement device (SAINT-PD); nonsliding SAINT (nST); sutureless stapler (SS); and sutured controls. The SAINT had a sucrose base, with some having reinforcing fibers. Results: No deaths from dehiscence occurred in any group except one FG-cylinder attempt in the colon (technique abandoned). Statistical analysis of gross pathology indices showed no significant group differences. However, trends favored the SAINT in many indices, including grade-0 intraluminal tissue ridge formation (70.8% SI, 84.4% LI) and grade-0 adhesion rates (45.8% SI, 73.1% LI). Histologic examination showed fewer giant cells, less inflammation, less scar tissue formation and faster healing in the SAINT and nST anastomoses than controls. Follow-up of 300–540 days demonstrated no signs of necrosis or stenosis in the SAINT anastomoses. The nST had excellent results; however, it seems impractical in SI anastomoses and unsuitable for LI. Conclusions: The SAINT-PD has potential for all gastrointestinal sites, but needs larger experimental trials. The SS technique is impractical and had high tissue ridge formation and adhesion rates. These preliminary trials suggest the simplicity, versatility and safety of the SAINT technique; however, the small groups limit result interpretation. The results present a starting point for sutureless FG gastrointestinal anastomosis, and future experimental evaluation with more extensive statistical analyses in larger studies are needed.
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  • 34
    ISSN: 1435-2451
    Keywords: Key words Hormonal control ; Lower-oesophageal-sphincter pressure ; Neurotensin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Background: Ingestion of food has been shown to modulate the lower-oesophageal-sphincter pressure (LESP). Fat is especially effective in decreasing the postprandial LESP. As there is good evidence that neurotensin (NT) is able to decrease the LESP, we conducted the present trial to determine whether NT could possibly be a mediator of the fat-induced decrease of the LESP. Methods: Six half-breed dogs were fitted for cervical side-to-side oesophagostomy to allow repeated oesophageal intubation; plasma NT immunoactivity was recorded during infusion of NT and after intragastric instillation of 200 ml of a fat solution. Experiments were repeated, with the specific NT antibody GN25 administered intravenously. Results: The optimal dose of NT required to simulate a postprandial situation was 50 pmol/kg/h. Infusion of this NT dose led to a statistically significant decrease of the LESP. Simultaneous administration of the NT antibody (immunoneutralisation) significantly inhibited this effect. Intragastric fat decreased the LESP and increased plasma NT. Immunoneutralisation of endogenously released NT led to an earlier restoration of baseline LESP, but this effect was not statistically significant. Conclusions: NT and intragastric fat modulate the LESP. NT appears to mediate the postprandial, fat-induced decrease of the LESP. Research with specific NT-receptor antagonists is necessary to determine the exact role of NT and other regulatory peptides in this context.
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  • 35
    ISSN: 1435-3725
    Keywords: 23.20.Nx ; 29.30.Dn ; 23.20.Lv ; 21.10.Re ; 25.70.Jj ; 27.70.+q
    Source: Springer Online Journal Archives 1860-2000
    Topics: Physics
    Notes: Abstract Using conversion electron and γ-ray spectroscopy combined with a recoil gating method, excited states in 188Pb have been investigated. Further evidence for two excited low-lying 0+ states has been found leading to an interpretation as a multiple shape coexistence in 188Pb.
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  • 36
    ISSN: 1435-3725
    Keywords: 21:60.Cs ; 23.20.Lv ; 27.40.+z
    Source: Springer Online Journal Archives 1860-2000
    Topics: Physics
    Notes: Abstract Shell model calculations in the lower fp shell region, (for 44,45Ca and 47Sc nuclei) have been performed, with different model spaces, to probe the effect of configuration mixing from the p3/2, p1/2 and f5/2 orbitals on the predominantly (f7/2)n states and the contribution arising from the excitation of the N = Z = 16 core. Our calculations indicate that excitation of nucleons across the N = Z = 16 magic shell closure do contribute significantly towards the wavefunctions of the observed level structures of 44,45Ca nuclei. However the inclusion of these configurations did not result in a better agreement for the observed level structure of 47Sc nulcei. A plaussible explaination for this phenomena could be attributed to the two-body matrix elements used and calls for a detailed micro-scopic calculations involving fundamental interactions substantiated by additional spectroscopic data such as lifetime measurements to have an unambigious understanding of the intrinsic configurations of nuclei in this region.
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  • 37
    ISSN: 1435-3725
    Keywords: 25.70.Ef ; 21.60.Gx ; 27.30.+t
    Source: Springer Online Journal Archives 1860-2000
    Topics: Physics
    Notes: Abstract Results on measurements of the proton structure function from the two HERA experiments H1 and ZEUS in 1994 show that perturbative QCD (pQCD) allows to describe the observed rapid rise of with decreasing x down to Q2 = 1.5GeV2. Whereas the pQCD region exhibits a strong rise of σγ*ptot with increasing W2, the total cross-section for real photon-proton scattering σγptot shows only a modest rise with W2. The proton structure function F2 and the total virtual photon-proton (γ*p) cross-section σγ*ptot have been measured in inelastic neutral current scattering, e+p → e+X, at HERA in the previously unexplored transition region of non-perturbative to perturbative QCD at low Q2. To study this kinematic region, a small electromagnetic Beam Pipe Calorimeter (BPC) has been designed, constructed and installed in the ZEUS experiment in 1995. The accuracy of the measurement of F2 in this kinematic region relies mainly on a precise energy calibration and detector alignment. An energy calibration with a precision of 0.5% and a detector alignment of 0.5mm have been achieved. Results on a measurement of F2 and σγptot are obtained for 0.11 ≤ Q2≤ 0.65 GeV2 and 1.7 ċ 10−6 ≤ x ≤ 6.0 ċ 10−5, corresponding to a range in the γ*p center-of-mass energy of 104 ≤ W ≤ 251 GeV. The results on F2 and σγptot indicate a smooth transition between the pQCD region and the photoproduction region. A detailed phenomenological analysis as well as a QCD analysis has been carried out to investigate the limitations of a non-perturbative as well as a perturbative QCD description.
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  • 38
    ISSN: 1435-3725
    Keywords: 12.38.Cy ; 12.38.Lg
    Source: Springer Online Journal Archives 1860-2000
    Topics: Physics
    Notes: Abstract We show that taking into account the interplay between perturbative and non-perturbative effects, the power-suppressed shift to the broadening distributions becomes B dependent, and the non-perturbative contribution to the mean values becomes proportional to $$1/(Q\sqrt{\alpha_s(Q)})$$ . The new theoretical treatment greatly improves the consistency of the phenomenology with the notion of the universality of confinement effects in jet shapes.
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  • 39
    ISSN: 1435-3725
    Keywords: 75.80.+q ; 75.30.Gw
    Source: Springer Online Journal Archives 1860-2000
    Topics: Physics
    Notes: Abstract A quantitative model describing large magnetostrain effect observed in several ferromagnetic shape memory alloys such as Ni2MnGa is briefly reported. The paper contains an exact thermodynamic consideration of the mechanical and magnetic properties of similar type materials. As a result, the basic mechanical state equation including magnetic field effect is directly derived from a general Maxwell relation. It is shown that the magnetic field induced deformation effect is directly connected with the strain dependence of magnetisation. A simple model of magnetisation and its dependence on the strain is considered and applied to explain the results of experimental study of large magnetostrain effects in Ni2MnGa.
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  • 40
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Decision analysis methods were used to compare four mycobacteriology laboratory strategies with respect to time to confirmation and exclusion of smear-positive and smear-negative cases of pulmonary tuberculosis. Strategies assessed included the following: (i) polymerase chain reaction (PCR) on all respiratory specimens; (ii) PCR on smear-positive specimens and on the broth of vials for other specimens attaining a growth index >10 in a radiometric culture detection system; (iii) PCR on smear-positive specimens only; and (iv) radiometric culture detection, with DNA probe for species identification of vials attaining a growth index >999. Strategies i and ii had predicted average times to confirm cases of 5 and 7.6 days, respectively, and remained within 3 days of each other over a broad range of PCR performance with smear-negative specimens. In contrast, case confirmation times using strategies iii and iv were 10.4 and 15.3 days, respectively. Only 10% of specimens were processed by PCR in strategy ii. Times to confirm smear-negative cases were comparable for strategies i and ii when PCR sensitivity was <40% with these specimens. Times to exclude pulmonary tuberculosis were similar for all strategies. Given the current suboptimal performance of PCR with smear-negative specimens, strategy ii offers accelerated case confirmation with limited PCR usage.
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  • 41
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 42
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Following a study in Senegal (1990–1995) in which the relative efficacy of a diphtheria-tetanus-acellular pertussis vaccine (DTaP) was compared with that of a diphtheria-tetanus-whole-cell pertussis vaccine in children given a simultaneous injection of Bacille Calmette-Guérin (BCG) vaccine, this subsequent study was conducted to evaluate the possible adjuvant effect of the BCG vaccine on acellular pertussis vaccine components. A second objective was to compare the immunogenicity of these components when administered in accordance with a 2–4–6-month (spaced) schedule or an accelerated 2–3–4-month schedule. In all, 390 healthy Senegalese infants were randomly divided into three groups of 130 infants. Antibodies to acellular pertussis components were measured in serum samples obtained within 2 days of the first DTaP dose and 1 month after the third dose. BCG vaccine, given simultaneously with the DTaP vaccine, did not influence the immunogenicity of the acellular pertussis vaccine components when compared with separate administration of the two vaccines. Infants immunised according to a 2–4–6-month schedule had a significantly higher immune response than those immunised according to a 2–3–4-month schedule with respect to the response to pertussis toxoid assessed by seroneutralisation on Chinese hamster ovary cells (P<0.0001). These results suggest that BCG and DTaP vaccines can be given simultaneously without interference or enhancement and that more optimal immunogenicity is achieved with an extended than with an accelerated schedule.
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  • 43
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The minimum inhibitory concentrations (MICs) of mupirocin were determined by the E test (AB Biodisk, Sweden) and the agar dilution method for 107 staphylococci. The organisms consisted of 34 coagulase-negative staphylococci and 73 methicillin-resistant Staphylococcus aureus. Polymerase chain reaction (PCR) primers designed to amplify a 456 bp region of the plasmid-borne isoleucyl tRNA synthetase gene (ileS–2), responsible for high-level mupirocin resistance in staphylococci, were used on DNA preparations from these isolates. Isolates with high-level mupirocin resistance due to the ileS–2 gene should be PCR positive. There was close correlation between the E test and agar dilution MIC values, with only two strains differing by more than two serial dilutions. Most (51 of 54 strains) of the high-level resistant strains (MIC>256 μg/ml) were resistant to the highest concentration of mupirocin tested (1024 μg/ml). PCR correctly classified all but four (96%) of the isolates in accordance with the results of agar dilution. All four isolates that gave discrepant results were methicillin-resistant Staphylococcus aureus. Two of these were PCR positive, yet the MIC of mupirocin for these strains was <0.06 μg/ml; on prolonged incubation they produced halos within the inhibition zone on agar diffusion testing, suggesting that the phenotypic results may have been erroneous. One of 54 isolates for which the MIC exceeded 256 μg/ml was PCR negative when tested by the original methodology, but a 456 bp product was produced when retested using a lowered annealing temperature. One isolate for which the MIC of mupirocin was 16 μg/ml by agar dilution and 8 μg/ml by the E test was positive by PCR. PCR of the ileS–2 gene is a useful, rapid method for detecting high-level mupirocin resistance in staphylococci.
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  • 44
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  This study compared the efficacies of clarithromycin-ethambutol and clarithromycin-ethambutol-clofazimine for the treatment of Mycobacterium avium complex (MAC) in AIDS patients. Thirty-four patients were randomized into two groups to receive clarithromycin 2 g/day and ethambutol 20 mg/kg/day, with or without clofazimine 200 mg/day. The evaluation was based primarily on blood cultures becoming negative after 2 months of therapy, but survival at 12 months and clinical evolution were also assessed. Inclusions were prematurely stopped because of a communication reporting increased mortality associated with clofazimine. At 2 months, the blood cultures of 55% of the clarithromycin-ethambutol group patients versus 81% of the clarithromycin-ethambutol-clofazimine group were negative; this difference is not significant (P=0.42). Only one relapse was observed during the study. No clarithromycin-resistant strain was isolated. No apparent difference in either survival or clinical evolution was observed in this small number of patients (median survival, 144 days in the clarithromycin-ethambutol group and 236 days in the clarithromycin-ethambutol-clofazimine group, P=0.44). The clarithromycin-ethambutol combination appears to be an effective and well-tolerated first-line therapy against MAC infections in AIDS patients.
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  • 45
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  To investigate the incidence, underlying diseases, and macropathological and microbiological features of invasive aspergillosis in a university hospital, the protocols of 1187 autopsies performed during the 4-year period 1993–1996 were reviewed. Invasive aspergillosis was diagnosed as the cause of death in 48 (4%) cases, four (8%) of which did not involve severe primary immunosuppression. In seven (15%) cases no pulmonary involvement was found; in six of these cases the portal of infection could not be established, whereas in one case invasive aspergillosis originated from Aspergillus peritonitis. Aspergillus grew in 42% of the samples obtained from the respiratory tracts of 32 patients with pulmonary aspergillosis and submitted within 10 days antemortem; at least one positive culture was obtained from 20 (63%) of these patients. It is concluded that the diagnosis of aspergillosis by means of culture has an appreciable sensitivity. Fatal invasive aspergillosis was rare among patients without severe immunosuppression, whereas invasive aspergillosis without pulmonary involvement was unexpectedly frequent.
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  • 46
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The aim of this work was to analyze the effects of highly active antiretroviral therapy on the chronically activated immune system of 26 antiretroviral-naive HIV-1-infected patients. Samples from baseline to week 24 or 36 of treatment were tested for serum levels of β2-microglobulin, tumor necrosis factor α and soluble tumor necrosis factor α receptor type II, as well as for human leukocyte antigen-DR expression on T cells. After starting therapy, the mean HIV-1 RNA serum levels decreased and the mean CD4+ cell counts increased from baseline to week 36 (P<0.001). Mean levels of tumor necrosis factor α receptor type II, tumor necrosis factor α and β2-microglobulin as well as expression of human leukocyte antigen-DR were significantly reduced at the end of follow-up (P<0.01). Deactivation kinetics of these parameters was similar in patients with CD4+ counts>200 cells/μl at baseline versus those with CD4+ counts <200 cells/μl at baseline, despite higher activation at baseline in the group with <200 cells/μl. In summary, this study shows that highly active antiretroviral therapy is able to induce a strong deactivation of the immune system of HIV-1-infected patients.
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  • 47
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Cutaneous mucormycosis is a rare but serious infection in trauma patients. Reported here is the case of a young patient with cutaneous mucormycosis due to Absidia corymbifera probably caused by a soil-contaminated wound. Despite daily surgical debridement and amphotericin B therapy, cure could be achieved only by amputation of the lower limb.
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  • 48
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In a study designed to evaluate the efficacy of penicillin in HIV-infected patients with syphilis and to determine the clinical and laboratory responses after treatment, 13 patients with HIV infection and syphilis were assessed at enrollment and at the last follow-up examination (median time of 21 months). The Venereal Diseases Research Laboratory (VDRL) test, the Treponema pallidum hemaglutination test, and leukocyte counts in cerebrospinal fluid were evaluated both at enrollment and at the last follow-up visit, and the polymerase chain reaction for Treponema pallidum DNA and the rabbit infectivity test were performed on cerebrospinal fluid samples at the last follow-up visit. Primary syphilis was confirmed in four patients, latent syphilis in five, and neurosyphilis in four. After penicillin treatment, all patients were asymptomatic. The serum rapid plasma reagin test became negative in five patients, and titers declined in eight. The VDRL test, Treponema pallidum DNA, and the rabbit infectivity test were negative in all 13 patients. Except for one patient whose serological titer was slow to decline, all patients had good clinical and serological responses to penicillin. In certain settings, factors other than penicillin treatment failure should be considered in HIV-infected patients with suspected relapse of syphilis.
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  • 49
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The frequency of enterobacterial isolates with high resistance to expanded-spectrum β-lactam antibiotics (mainly cefotaxime or ceftriaxone) has increased notoriously in Argentina, mainly because of the spread of extended-spectrum β-lactamases. The aim of this work was the study of extended-spectrum β-lactamases in several Morganella morganii isolates with unusually high resistance to ceftriaxone. These strains produced at least two β-lactamases, of apparent pIs of 5.4 and 8.2, molecular weight 23 000, well inhibited by clavulanate, compatible with a broad-spectrum β-lactamase – perhaps TEM-1 – and an extended-spectrum β-lactamase, respectively. The extended-spectrum β-lactamase was identified as a CTX-M-type β-lactamase – probably CTX-M-2 – by polymerase chain reaction, restriction profile analysis and DNA-DNA hybridisation. The remaining isolates studied produced either the broad-spectrum β-lactamase plus the ubiquitous AmpC β-lactamase (13 strains), or the AmpC β-lactamase only (10 strains).
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  • 50
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The two most commonly used targets for diagnosis of pertussis by the polymerase chain reaction have been the pertussis toxin promoter and the repeated insertion sequence IS481. A comparative assessment of these primers was performed on routinely collected nasopharyngeal swabs, stored at –20  °C, using novel semiquantitative enzyme immunoassays. Both sets of primers behaved similarly with bacterial suspensions, and the 17 culture-positive nasopharyngeal swabs were also positive with the pertussis toxin promoter primers, with one exception, which had been subject to prolonged storage. Significantly more of the 69 culture-negative swabs were positive with the pertussis toxin promoter primers (n=36) than with the IS481 primers (n=18). To determine the effect of inhibitors, a comparative assessment of three primer pairs against human DNA (β-globin and glyceraldehyde-3-phosphate dehydrogenase) was also performed.
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  • 51
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A novel immunochromatographic membrane-based assay for the detection of specific IgG antibodies to Mycobacterium tuberculosis was evaluated in patients with active tuberculosis in a low-prevalence population. The sensitivity of the test for detecting active tuberculosis was 41.5% (17/41 patients positive); its specificity in a group of patients with other lung diseases was 91.4% (3/35 false positive), while in a group of 47 healthy controls it was 100%. The sensitivity of the immunochromatographic test equaled that of auramine staining, but different subsets of tuberculosis patients were detected by the two tests. The suboptimal sensitivity of this immunochromatographic test implies that, even though it could be a useful adjunct, it cannot be a replacement for the diagnosis of tuberculosis by other microbiological methods along with clinical and radiological data.
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  • 52
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  • 53
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 54
    ISSN: 1435-4373
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  • 55
    ISSN: 1435-4373
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  • 56
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    Springer
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 57
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The aim of this study was to analyze the results of the tuberculosis contact tracing carried out in an outpatient pneumology settingand to assess its performance with regard to the detection of new cases of tuberculosis and infected contacts. One thousand two hundred and twenty-eight contacts of 302 tuberculosis patients were evaluated in the Tuberculosis Unit of the Dr. Fleming Specialities Center between 1992 and 1996. Contacts were categorized into groups with regard to bacteriological status of the index case (Group A, smear-positive; Group B, culture-positive only; Group C, smear- and culture-negative) and intimacy of exposure to the index case (close or casual). The possible association between the existence of infection or disease and the bacteriological status of the index case and degree of intimacy of exposure was analyzed. There were 582 infected contacts (47.4%) and 42 new cases of tuberculosis (3.4%), six of which were smear-positive. The proportion of infected and diseased contacts was significantly higher for those who had contact with smear-positive patients and those who had close contact with the index case. Chemoprophylaxis was completed in 431 (35.1%) of the contacts evaluated. Systematic investigation of contacts represents an efficient means of discovering new cases of tuberculosis and infection, especially among contacts of smear-positive index cases and among those who are closer to the index case. The administration of appropriate treatment to these contacts will contribute to controlling the transmission of tuberculosis within the community.
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  • 58
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Integrons are genetic elements that, although unable to move themselves, contain gene cassettes that can be mobilized to other integrons or to secondary sites in the bacterial genome. The majority of approximately 60 known gene cassettes encode resistance to antibiotics. Recently, a number of gene cassettes encoding extended-spectrum β-lactamases or carbapenemases have been described. Up to at least five cassettes may be present in an integron, which leads to multiresistance. Frequently, more than one integron is observed within the same bacterial cell. Integrons are widespread in their species distribution. Although integrons are normally reported from Enterobacteriaceae and other gram-negative bacteria, an integron has been described in Corynebacterium glutamicum, a gram-positive species. The gene cassette in this integron showed even higher expression when compared to the expression in Escherichia coli. Integrons have been reported from all continents and are found frequently. The widespread occurrence of integrons is thought to be due to their association with transposon plasmids, conjugative plasmids, or both. Integrons form an important source for the spread of antibiotic resistance, at least in gram-negative bacteria but also potentially in gram-positive bacteria. The aim of this review is to describe the versatility of integrons, especially their mobility and their ability to collect resistance genes.
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  • 59
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Twelve healthy volunteers participated in a randomized crossover study to compare urinary concentrations, serum parameters, and urinary bactericidal activity of ciprofloxacin after single intravenous (i.v.) doses of 200 mg and 400 mg and an oral (p.o.) dose of 500 mg. The median serum concentrations at 1 h after administration were 1 μg/ml, 4.3 μg/ml, and 2.2 μg/ml, respectively. Between the first collection period (0–2 h) and the last collection period (38–48 h), the median urinary concentrations decreased from 394 μg/ml, 675 μg/ml, and 585 μg/ml, respectively, to 0.3 μg/ml, 0.6 μg/ml, and 1 μg/ml, respectively. The urinary concentrations after the 400 mg i.v. and the 500 mg p.o. doses were not statistically different but were significantly higher than those after the 200 mg i.v. dose. The urinary bactericidal titers (UBTs), defined as the highest urinary dilution bactericidal for the organism tested, were determined against Escherichia coli (ATCC 25922) and eight uropathogens up to 48 h after administration of ciprofloxacin. The UBTs after the 400 mg i.v. and the 500 mg p.o. doses were similar and were significantly higher (P<0.05) than those following the 200 mg i.v. dose. After 400 mg i.v. and 500 mg p.o., median UBTs of ≥1 : 4 were present up to 48 h for all strains for which the MIC was ≤0.5 μg/ml, except for one nalidixic-acid resistant Escherichia coli strain for which the MIC was 0.25 μg/ml. Species for which the MIC is ≥1 μg/ml showed median UBTs of ≥1 : 4 for 8–16 h. Median UBTs of ≥1 : 4 were present up to 8 and 12 h for both Pseudomonas strains tested. A once-daily dosage of 400 mg i.v. or 500 mg p.o. might be sufficient for treatment of urinary tract infections caused by highly susceptible pathogens. A twice-daily dosing scheme seems to be preferable for complicated infections caused by pathogens with intermediate susceptibilty (MIC≥1 μg/ml) or for empiric therapy.
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  • 60
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In a 3-month prospective study among 203 Austrian outpatients with diarrhea, the role of pathogenic Escherichia coli and the use of the polymerase chain reaction in screening Escherichia coli isolates from clinical stool specimens were evaluated. Enteroaggregative Escherichia coli and enterotoxigenic Escherichia coli combined were identified as the second most frequent cause of diarrhea. Of a total of 85 bacterial pathogens isolated from 80 patients, 15 were pathogenic Escherichia coli, 13 enteroaggregative Escherichia coli and two enterotoxigenic Escherichia coli. Enteropathogenic, enteroinvasive, and enterohemorrhagic Escherichia coli isolates were not detected.
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  • 61
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  To contribute to the discussion of whether or not human granulocytic ehrlichiosis (HGE) occurs in midwestern Germany, sera from individuals with different risk categories for tick exposure were retrospectively examined by means of an immunofluorescence assay. The seroreprevalence for the HGE agent accounted for 5.5% of the 270 patients tested. Specific antibodies were detected more often in patients with early Lyme infection than in patients with stage III disease or in asymptomatic individuals seropositive for Lyme disease. Investigation of 50 patients with an active or recent syphilis infection revealed no cross-reactivity between Treponema pallidum antibodies and the HGE agent. The prevalence of HGE antibodies (13.1%) among 76 Lyme borreliosis patients from this urban area was significantly higher (P<0.05) than that in the control groups (2.6%). The findings indicate that concomitant or serial infections with Borrelia burgdorferi and the HGE agent or closely related organisms may be a common occurrence in tick-exposed patients from Germany.
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  • 62
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  To determine to what extent methodological differences affect susceptibility testing parameters for linezolid, MICs and disk inhibition zones were compared using the methods described by the National Committee for Clinical Laboratory Standards and the British Society for Antimicrobial Chemotherapy for 198 strains of gram-positive cocci. Zones were 4–5 mm larger by the British Society for Antimicrobial Chemotherapy method, but MICs did not differ, except for pneumococci, which were more sensitive when the British Society for Antimicrobial Chemotherapy method was used. This is because incubation in CO2 depresses the activity of linezolid against this species only. Breakpoints for linezolid may need adjusting when testing is by other than National Committee for Clinical Laboratory Standards methods.
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  • 63
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In a study to determine the prevalence and antimicrobial susceptibility of bacterial pathogens in the oropharynx of healthy children, throat swabs obtained from 1765 children were cultured and the organisms recovered tested by the disk diffusion method and the E test. Six hundred ninety-one children (39.1%) harbored Haemophilus influenzae, 112 (6.3%) Streptococcus pyogenes, 73 (4.1%) Moraxella catarrhalis, 52 (2.9%) Streptococcus pneumoniae, and 50 (2.8%) Neisseria meningitidis in their oropharynx. The rate of penicillin resistance was 2%, 0%, and 12%, respectively, for Streptococcus pneumoniae, Streptococcus pyogenes, and Neisseria meningitidis. Ampicillin resistance was observed in 8.6% of Haemophilus influenzae strains and 78% of Moraxella catarrhalis strains and was associated with the presence of β-lactamase, except in one strain of Haemophilus influenzae. Five (4.4%) isolates of Streptococcus pyogenes were resistant to macrolides. The low level of resistance observed in this area contrasts with the high rates reported in the literature.
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  • 64
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  • 65
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  • 66
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  • 67
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