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Heidelberg retina tomograph in ocular Behçet's disease.

PURPOSE: To compare the optic disc topography of patients with ocular Behçet's disease (BD) with age-matched controls, using Heidelberg retina tomograph (HRT). METHODS: This study included 32 patients (51 eyes) with ocular BD (active and/or inactive), 38 patients (74 eyes) with nonocular BD, and 62 normal subjects (62 eyes). All patients and control group underwent complete ophthalmologic evaluation. Intraocular pressure was less than 22 mmHg in patients and in the control group. The optic nerve heads of all subjects were imaged with the HRT (software 2.01a-M). The following stereometric parameters were calculated for each patient: disc area, cup area, cup/disc area ratio, rim area, height variation contour, cup volume, rim volume, mean cup depth, cup shape measure, mean RNFL thickness, and RNFL cross-sectional area. Differences among the groups were evaluated by Kruskal-Wallis variance analysis. When the Kruskal-Wallis test revealed a significant difference between groups, multiple comparison tests were used to find out which groups differed from which others. RESULTS: The mean disc area was significantly smaller (P<0.05) in patients with ocular and nonocular BD. The mean cup area, mean cup depth, and mean cup volume were significantly smaller (P<0.05) in patients with ocular BD. No significant differences were found between the groups in terms of the other stereometric parameters (P>0.05). CONCLUSION: A small disc and cup may be an additional risk factor for retinal vaso-occlusion in ocular Behçet's disease.

Adolescent↗

Postglacial distribution area expansion of Polyommatus coridon (Lepidoptera: Lycaenidae) from its Ponto-Mediterranean glacial refugium.

The genetic population structure of Polyommatus coridon (Poda, 1761) (Chalk-hill blue) was studied by means of allozyme electrophoresis in north-eastern Germany, the Czech Republic, Slovakia and Hungary. All analysed parameters showed high genetic diversity within populations (number of alleles: 2.61; observed and expected heterozygosity: 18.6% and 19.7%, respectively; percentage of polymorphic loci: total: 73.6%, on 95% level: 56.1%), whereas genetic differentiation between populations was comparatively low (F(ST) = 0.028 +/- 0.005 s.d.). Hierarchical variance analysis revealed significant structuring among five regional population clusters. A significant isolation-by-distance structure exists (r = 0.39; P < 0.05). The mean number of alleles per locus declined significantly from south to north and showed a strong correlation with the geographical latitude (r = -0.88, P < 0.0001). We suggest that this reflects the loss of alleles during the postglacial colonisation of eastern Central Europe from an ice-age refugium in the Balkans. A possible scenario for the postglacial expansion process in eastern Central Europe is discussed using these data: coming from the north-western part of the Balkans, P. coridon may have reached the western tip of Hungary, and consecutively colonised eastern Central Europe using two alternative expansion routes.

Animals↗

Clonal diversity and genetic differentiation in Ilex leucoclada M. patches in an old-growth beech forest.

We investigated clonal diversity within patches of Ilex leucoclada and genetic variation within and among patches using random amplified polymorphic DNA (RAPD) markers in a 1-ha plot within an old-growth beech forest. We found 38 patches that exhibited a clumped distribution in the middle of the plot. We identified a total of 166 RAPD phenotypes among the 215 stems sampled from 27 patches that were completely within the plot. The population showed high clonal diversity within patches (mean number of genets relative to number of stems = 0.79; mean Simpson's D = 0.89). Variation in RAPD phenotypes among patches was highly significant (PhiST in the molecular variance analysis = 0.316, P < 0.001), indicating genetic differentiation among patches. Pairwise genetic distances, PhiST, among patches did not correlate with geographical distances among patches. The cluster analysis based on the genetic distances showed few clear clusters of patches, indicating no spatial genetic structure among patches. High levels of clonal diversity both within patches and within the population may be explained by multiple founders, seedling recruitment during patch-formation, and somatic mutation. The significant genetic differentiation among patches may be caused by separate founding events and/or kin structuring within patches.

Cluster Analysis↗

Peritoneal urea and creatinine clearances in continuous peritoneal dialysis patients with different types of peritoneal solute transport.

We studied whether anuric subjects on continuous ambulatory peritoneal dialysis (CAPD) who achieve the target Kt/V urea of 2.0 weekly will also achieve the target normalized creatinine clearance (NCCr) of 60 liter/1.73 m2 weekly, and the reasons of discrepancy between the two clearances in anuric subjects, by analyzing 476 clearance studies performed in 309 CAPD patients within 12 months of the performance of a peritoneal equilibration test (PET). On the basis of the PET, peritoneal solute transport was classified as low (37 clearance studies), low-average (199 studies), high-average (186 studies) and high (54 studies). We found that weekly values of Kt/V urea in the low transport group (LTG) was 1.74 +/- 0.51, in the low-average transport group (LATG) was 1.66 +/- 0.41, in the high-average transport group (HATG) 1.68 +/- 0.41, and in the high transport group (HTG) 1.73 +/- 0.46 (NS, variance analysis). Weekly values for NCCr, liter/1.73 m2 were: LTG, 37.8 +/- 9.0; LATG, 44.0 +/- 9.2; HATG, 49.2 +/- 10.0; HTG 56.8 +/- 13.3 (P < 0.0001). The ratios of raw (not-normalized) peritoneal creatinine clearance to peritoneal urea clearance were: LTG, 0.65 +/- 0.14; LATG, 0.76 +/- 0.09; HATG, 0.84 +/- 0.09; HTG, 0.91 +/- 0.12 (P < 0.0001). Linear regression with Kt/V urea as x and NCcr as y revealed the following results: LTG, y = 19.486 + 10.500x, r = 0.591 [if x = 2.0, y = 15.004 + confidence interval (95% CI) of y 25.3 to 55.7]; LATG, y = 15.0004 + 17.482x, r = 0.774 (if x = 2.0, y = 50.0, 95% CI of y 38.4 to 61.6); HATG, y = 15.285 + 20.162x, r = 0.829 (if x = 2.0, y = 55.6, 95% CI of y 44.4 to 66.8); HTG, y = 14.945 + 24.134x, r = 0.839 (if x = 2.0, y = 63.2, 95% CI of y 48.4 to 78.1). Peritoneal solute transport type has a major effect on peritoneal creatinine clearance, but an insignificant effect on peritoneal urea clearance. Consequently, the majority of anuric patients who achieve a weekly Kt/V urea of 2.0 will have a weekly NC cr lower than 60 liter/1.73 m2 and will require a Kt/V urea much higher than 2.0 to achieve the target NCcr of 60 liter/1.73 m2 weekly. The current targets of urea and creatinine clearance are not compatible in anuric patients on CAPD.

Adult↗

Pitfalls of irritant patch testing using different test chamber sizes.

BACKGROUND: Test chambers for irritant patch testing are usually larger than those used in allergic patch testing. In general, larger areas show stronger skin reactions than smaller areas. OBJECTIVE: This study investigated whether this difference is of practical relevance, when a model irritant is applied in small and large Finn chambers and evaluated by measurement of transepidermal water loss (TEWL). METHODS: Patch testing was performed with 2 concentrations of sodium lauryl sulfate (SLS) (0.25% and 0.5%) on forearms of healthy volunteers. Large (inner diameter, 12 mm) and small (inner diameter, 8 mm) chambers were used. RESULTS: A variance analysis (3 factors, 2-tailed) showed that the test outcome, as assessed by TEWL, was strongly dependent on SLS test concentration and test chamber size. The larger chambers gave approximately 30% to 50% higher values than the smaller. CONCLUSIONS: This may be explained by the fact that with the small chambers, the adjacent small area of nontreated skin was also assessed by the evaporimeter, biasing the results. A formula estimating TEWL value of the large chamber from values of the small chambers has been proposed.

Adolescent↗

[Traumatic hämolysis of verious heart-lung-machines on oxygenators (author's transl)].

1250 protocols of heart-lung-machines, taken between 1962-1974, underwent a variance analysis. The results show that rollerpumps with high pumpvolumes (80 ccm) are not significantly lower hemolytic than rollerpumps with a pumpvolume of 40 ccm. The hemolysis stands in direct proportion to the blood flow. Membranoxygenators effect a less traumatisation than screen- and bubbleoxygenators. Furthermore the use of fresh ACD-blood shows a lower hemolysis than hemodilution and older ACD stored blood. Type and age of the vitium have no influence on the traumatic hemolysis. The use of the orthograde perfusion is significantly better than the retrograde perfusion; the use of blood-filters is no cause for traumatic hemolysis. The above mentioned results are in accordance to literature, but the facts cannot be objectivated that easily than in invitro experiments.

Adolescent↗

[Comparative hospital tours: visiting the oasis of psychiatry].

AIM: Currently, financial sponsors and Government officials of the relevant ministries responsible for the German health care system request comparative length-of-stay figures in hospitals as indicators of efficacy of inpatient treatment. In psychiatry such comparisons are considered doubtful because of the heterogeneity of patients in different hospitals. This study compares the length of stay in eight German psychiatric hospitals accounting for individual as well as organisational characteristics. METHODS SAMPLE: 27,792 patient records according to the DGPPN-BADO (the standardized psychiatric assessment and discharge battery in Germany) from eight hospitals with a total of 135 wards. STATISTICAL ANALYSIS: Variance components modelling with random effects using three levels (patients, wards, hospitals). RESULTS: After adjustment for patient and organisational characteristics, there were no significant differences in the average length of stay between the eight hospitals. CONCLUSIONS: Hospital comparisons of quality of care require a multilevel approach. Based on our results further comparisons and implementation of quality improvements in inpatient psychiatry should focus on the ward level.

Germany↗

[Prevalence estimation of overweight and obesity based on subjective data of body-mass-index (BMI)].

OBJECTIVES AND METHODS: In connection with the increasing importance of chronic diseases the estimation of the prevalence of overweight and obesity becomes more and more important. Today these estimations are usually done via the Body-Mass-Index (BMI). For economic reasons BMI is often obtained by means of questionnaires or interviews. These (subjective) BMI-data show great differences to measured (objective) data. The differences between subjective and objective data and their dependence on age, gender and residence were investigated. RESULTS: Subjective and objective data show significant differences. On the basis of subjective data too many persons classify themselves as underweight or normal weighted and fewer persons classify themselves as overweight and obese. Variance analysis shows significant influences of gender and age. Women underestimate their BMI more than men. With increasing age the differences also increase. CONCLUSIONS: The estimation of BMI based on subjective data is inaccurate. In this way the prevalence of obesity and overweight are underestimated. That is why subjective data are not useful for clinical and epidemiological research, but it is interesting against the background of health psychology.

Adolescent↗

[Importance of the therapeutic alliance experience for the differential psychotherapeutic indication].

The influence of the therapeutic alliance experience on the recommendation for psychotherapy and prognosis was examined in a retrospective study. Three hundred seventy-four of 3270 patients who presented at the psychosomatic-psychotherapeutic outpatient service at the Benjamin Franklin Hospital of the Free University of Berlin between July 1994 and December 1999 were selected based on the fact that they had been examined only by a psychoanalyst and recommended for individual psychoanalytical outpatient therapy, nondirective therapy (according to Rogers) or behavioral therapy. Results of the unifactorial variance analysis: The better the alliance is assessed, the sooner procedures for psychoanalytical therapy are recommended (F = 35.85; p < 0.000) and the better the assessment of the prognosis (r = 0.68; p < 0.000). The results confirm the importance of the therapeutic working relationship and correct the assumption that the indication and prognosis are exclusively diagnosis or patient-related, clearly showing that they are the result of an interactive process.

Adult↗

[Variations of pain in the treatment of one classical acupuncture-point versus one point of Yamamoto's new scalp acupuncture].

INTRODUCTION: In an experimental design the pain reduction effect of acupuncture is studied and compared to the treatment of a classical acupuncture point and a point of the Yamamoto New Scalp Acupuncture (YNSA). METHODS: Experimental pain stimuli (32 per test person) were set in 42 test persons at the upper calcaneus edge and pain reduction was checked intra-individually by using the following variations of treatment: Acupuncture YNSA basis-point D, Acupuncture at the classical point Xiao Chang Shu = Bl 27, Acupuncture at a placebo point of the head, Acupuncture at a placebo point of the gluteal region. RESULTS: Evaluation of the data as well as a statistical investigation using a bi-factoral variance analysis with repeated measurements of 2 respectively 1 factor yielded following results: There are highly significant differences concerning pain reduction through the stimulation of the YNSA basis-point D and the acupuncture at the classical point Bl 27 (p < 0,0007). There are also highly significant differences concerning the verum and the placebo treatment (p < 0,00006). Further hypothesis of controlling the experimental design were tested. CONCLUSIONS: On the whole, the investigation shows that there is a marked difference between the verum and placebo treatment as well as a difference between the acupuncture of the YNSA basis-point D and the classical acupuncture point Xiao Chang Shu (Bl 27) with regard to pain reduction induced by experimental stimuli at the calcaneus. These differences are significant.

Acupuncture Analgesia↗

[Electrical impedance scanning in the differentiation of suspicious breast lesions: comparison with mammography, ultrasound and histopathology].

PURPOSE: To assess the value of Electrical Impedance Scanning (EIS) in the differentiation of suspicious breast lesions in comparison to mammography (MG) and ultrasound (US). METHODS: In 95 female patients (median 53.1 ys) 95 suspicious breast lesions (BI-RADS TM III - V) in MG or US underwent targeted EIS (TransScan TS 2000(R); TransScan Medical, Israel; Siemens Elema, Sweden). Histopathologic proof (vacuum-assisted biopsy or surgical biopsy) was obtained in all cases. MG, US and EIS were independently assessed by two radiologists in consensus. Chi-square tests as well as variance-analysis for ROC-statistics were performed. RESULTS: Of 95 lesions, 44 were benign, 51 malignant. Sensitivity, specificity, positive and negative predictive values were, respectively for MG 95.3 %, 23.5 %, 51.3 % and 85.7 %, for US 86.5 %, 44.2 %, 57.1 % and 79.1 %, for EIS 77.3 %, 82.3 %, 79.1 % and 80.8 %. The ROC-analysis revealed a significant greater area under the curve for EIS than for MG and US. The sensitivity for EIS was higher in lesions < 10 mm (n = 26; 100 %) and in invasive cancers (n = 31; 80.6 %). The negative predictive value of EIS was higher in BI-RADS TM-IV-lesions (83.9 %) as well as in dense breast parenchyma on the mammogram (86.7 %). CONCLUSION: EIS shows potential adjunctive value to MG and US in the differentiation of suspicious breast lesions.

Adult↗

Olanzapine plasma concentration, average daily dose, and interaction with co-medication in schizophrenic patients.

BACKGROUND: Olanzapine, a thienobenzodiazepine, is one of the relatively new atypical antipsychotic drugs. The lowest threshold of effective olanzapine plasma levels in inpatient treatment is assumed to be 9 ng/ml. Very little is known about the plasma concentration in patients at various oral doses of olanzapine or about the clinically relevant interactions with co-medications. METHODS: In 71 schizophrenic patients (age 32.6 +/- 12.1, range 18-63 years; 31 women, 40 men), plasma olanzapine levels were assessed in 377 tests by high-performance liquid chromatography (HPLC) with electrochemical detection. Fifty-six of these plasma levels were assessed while patients were receiving olanzapine as monotherapy; otherwise, the plasma levels were assessed with the patients receiving various co-medications. RESULTS: The mean daily oral dose of olanzapine was 17.5 mg (SD = 7.0, range 5-40 mg), and the mean olanzapine plasma concentration was 54.2 ng/ml (SD 37.8 ng/ml, range 1.2-208 ng/ml). The plasma concentration of olanzapine increased linearly with the daily oral dose (r = 0.64, p < 0.001). A multiple variance analysis considering age and sex as covariables showed a significant difference in the dose-corrected plasma levels of olanzapine among 40 smokers and 31 non-smokers; age and sex did not affect the dose-corrected plasma levels. However, women received a significantly lower daily dose of olanzapine under routine clinical study conditions. No differences could be detected among the dose-corrected plasma concentration of those patients who were taken off olanzapine because they did not respond (n = 14) or because of side effects (n = 5) and those who were discharged while still on olanzapine. Under the co-medication with fluvoxamine, significantly higher dose-corrected olanzapine plasma concentrations were found than with olanzapine monotherapy, whereas significantly lower dose-corrected olanzapine plasma concentrations were detected under lithium and trimipramine co-medication. Under co-medication with amitriptyline, benperidol, carbamazepine, flupentixol, and lorazepam, the dose-corrected olanzapine plasma concentrations were no different than the plasma levels under olanzapine monotherapy. CONCLUSIONS: The relevance of therapeutic drug monitoring is emphasized with respect to the data presented and to the literature. Future studies should examine, in particular, the effects of a wider range of co-medications in a larger patient sample.

Adolescent↗

Is 1-hour glucose screening test reliable after a short-term administration of antenatal betamethasone?

This study was designed to determine whether betamethasone has any effect on 1-hour (50-g) glucose screening test in nongestational diabetic pregnancy, and if any exists, to determine if this effect is transient or permanent. If the effect is temporary, the study was designed to determine the duration of this glucose intolerance effect and to determine the timing of 1-hour glucose screening test after betamethasone usage. One hundred fourteen pregnant women with a diagnosis of preterm labor at 24 to 34 weeks gestation were enrolled into the prospective study. One-hour glucose screening test was performed before initiation of hydration treatment. Forty pregnant women with normal 1-hour glucose results, who also had responded to hydration therapy, made up our study group. Twenty-four hours, 72 hours, and 1 week after administration of betamethasone, 50-g glucose challenge tests were again performed. A 3-hour glucose tolerance test was performed in pregnant women, whose 1-hour screening test had been positive 1 week after corticosteroid administration. In the evaluation of data, one-way, variance analysis and Tukey's multiple comparison test were used. The mean value of 1-hour glucose results of 50-g challenge test at the 24 hours was significantly higher than the mean value of 1-hour glucose results of the test done initially before betamethasone administration and than those of the tests done at 72 hours and 1 week (p < 0.001 for these three groups). There was no statistically significant difference between the mean values of 1-hour glucose results of the test done before betamethasone administration and both the results of the tests done at 72 hours (p = 0.96) and 1 week (p = 0.99), separately. There was no significant difference between the mean 1-hour glucose results of the tests at 72 hours and 1 week (p = 0.99). The test results were positive in 42.5%, 10%, and 5% of the patients, respectively at 24 hours, 72 hours, and 1 week. The betamethasone administration significantly deteriorates 1-hour glucose screening test results in the nongestational diabetic patients but this effect of betamethasone is transient. Because of its high false-positivity at 24 hours (42.5%) and at 72 hours (10%) in women with initial negative 1-hour glucose screening test, we suggest that 1-hour glucose screening test in pregnant women be postponed at least 1 week after betamethasone administration or perform the test before administration of betamethasone.

Adolescent↗

[MRI with supermagnetic iron particles versus double-spiral CT in identification of malignant liver lesions].

PURPOSE: The purpose of this study was to evaluate the efficacy of MRI with superparamagnetic iron oxide (SPIO) and double-spiral CT in the detection of liver metastases and hepatocellular carcinoma. METHODS: 38 patients with a total of 144 malignant hepatic lesions underwent CT and MRI. A panel of experts defined the gold standard. Five experienced judges performed independently blinded evaluation of the number of detectable lesions. Multifactorial variance analysis was used to determine the statistical significance. RESULTS: SPIO-MRI shows the highest rate of detection and is significantly superior to native MRI and native CT. The highest rate of detection by CT is shown in the portal-venous phase of contrast; nevertheless, the rate is significantly inferior to SPIO-MRI. In general, the native phases of CT and MRI are significantly inferior to the contrast phases of both. SPIO-MRI shows a higher rate of false positive findings. CONCLUSION: The time-consuming and cost-intensive SPIO-MRI significantly increases the rate of detectability for malignant liver lesions compared with double-spiral CT but it also increases the rate of false positive findings.

Adult↗

Doppler flow measurement in coronary artery bypass grafts and early postoperative clinical outcome.

The present investigation attempts to correlate flow measurements made intraoperatively in coronary bypass grafts with clinical outcome. A total of 352 consecutive patients undergoing isolated coronary artery surgery underwent hemodynamic assessment of their bypass grafts (328 internal thoracic artery and 582 saphenous vein grafts) at the end of cardiopulmonary bypass (CPB) by using a 8 MHz pulsed Doppler ultrasound flowmeter. The total patient population was divided into three groups of distinct outcome (A: normal, 228 patients; B: complicated, 106 patients; C: poor, 18 patients) on the basis of a combination of the following parameters: difficult weaning from bypass, use of inotropic drugs, reduced left-ventricular stroke work index, myocardial infarction, intraaortic balloon counterpulsation, and death of cardiac origin. Univariate analysis has shown clinical outcome to be influenced by preoperative clinical condition and not by flow in bypass grafts (average flow per graft [ml/min] was 60 +/- 2 [mean +/- SEM] in group A, 58 +/- 3 in group B and 43 +/- 6 in group C: NS by analysis of variance). Multivariate analysis (Fisher linear discriminant analysis) selected only the two following factors leading to normal (group A) or adverse (groups B and C) outcome: unstable angina (p = 0.026) and duration of additional CPB after unclamping the aorta (p < 10(-5). To conclude, clinical outcome was not influenced by flow as measured in well-functioning bypass grafts by pulsed Doppler technique.

Blood Flow Velocity↗

[Effect of dexamethasone and spironolactone therapy in calcium and phosphate homeostasis in premature infants with a birth weight under 1,500 g].

BACKGROUND: Dexamethasone and spironolactone are widely used in the management of bronchopulmonary dysplasia in premature infants. There are few data available about adverse effects of this drugs on the urinary excretion of calcium and phosphate in this group of patients. PATIENTS: 24 h-urine samples could be collected in 85 infants between 8 and 40 days. 31 infants received dexamethasone and 32 spironolactone. METHODS: Multivariate variance analysis was performed to study the influence of dexamethasone and spironolactone on the measured excretion of calcium and phosphate. The influence of gestational and postnatal age, calcium and phosphate intake and theophylline treatment were excluded by use as covariates. RESULTS: Spironolactone showed no significant influence on the urinary excretion of calcium or phosphate. Dexamethasone treatment increased the daily excretion of phosphate in the urine and decreased the phosphate concentration in serum. CONCLUSION: None of the examined drugs showed a significant increase of the renal excretion of calcium in preterm infants. Thus a higher risk of nephrocalcinosis development due to these drugs has not been confirmed. Dexamethasone treatment might increase the risk of osteopenia by enhancing phosphate excretion.

Bronchopulmonary Dysplasia↗

EEG background activity in childhood epilepsy: valid parameterisation by the partial autocorrelation function.

The relationship between EEG background activity and the clinical course is studied in a group of 42 patients with a primary myoclonic-astatic epilepsy. According to the occurrence of seizures the probands are divided into two groups. One group is comprised of patients with an unfavourable course of the disease and the other group is comprised of probands with a favourable one. It is shown by a combined approach of variance analysis, linear discriminant analysis and factor analysis that the EEG background activity parameterized by the partial autocorrelation function is significantly different in the two clinically defined groups. The error rate for assigning a proband, only from the proband's parameterized EEG, to the correct clinical class is estimated to be 0.24. A factor analysis of EEG parameters yields a discriminant factor interpreted as rhythm-power-factor. The group with an unfavourable course is characterized by rhythms in the theta-band and a greater total power than in the favourable group which shows rhythms in the alpha-band. Hypersynchronous potentials in the EEG of this study are not related to the clinical course of the epilepsy. This study confirms that the EEG background activity contains important information about the convulsibility in primary myoclonic-astatic epilepsy.

Adolescent↗

Normal urinary flow for girls aged 3-14 years.

103 healthy girls aged 3-14 in whom urological illness or chronic urinary tract infection could be ruled out were examined uroflowmetrically with a "Mictiograph" operating on the rotation-dynamic principle. The 103 girls were subdivided into 2 groups: 3-7 years (N:53) and 8-14 years (N:50). For both age groups we could establish uroflowmetric results (volume, micturition time, average flow, maximum flow, time required for attaining maximum flow) and subject them to statistical scrutiny. For all 5 uroflow parameters we figured the mean, variance, and standard deviation for both age groups. In a variance analysis we were able to document significant group differences for volume, average flow and maximum flow. Basing on these results it was possible to represent the correlation of average and maximum flow with volume for both age groups using lines of regression. Moreover, in the group aged 8-14 there existed a linear relation of volume, average flow and maximum flow to age. Naturally, some girls will continue to require a combined urodynamic examination. But by means of the statistically validated uroflow norms presented here, better differentiation from pathological results can be attained, and uroflow measurements in girls can now be regarded as reliable indicators.

Adolescent↗