J Int Med Res 2005;33 (1)

Contents

Review Article

Cell Wall-deficient Bacteria as a Cause of Infections: a Review of the Clinical Significance
Page: 1-20
ME Onwuamaegbu, RA Belcher, C Soare
 

Efficacy of Lumiracoxib in Osteoarthritis: a Review of Nine Studies
Page: 21-41
F Berenbaum, J Grifka, JP Brown, J Zacher, A Moore, G Krammer, D Dutta, VS Sloan
 

Research Report

Effects of Sevoflurane, Isoflurane and Propofol Infusions on Post-operative Recovery Criteria in Geriatric Patients
Page: 55-60
C Arar, G Kaya, B Karamanlioglu, Z Pamukçu, N Turan
 

Clinical Features Associated with Circulating Concentration of Soluble Leptin Receptor in Patients with Diabetes
Page: 61-67
N Kotajima, T Takahashi, H Ito, H Sumino, Y Fukumura, M Kurabayashi, M Murakami, T Kanda
 

Preparation and Evaluation of a Hyaluronate-collagen Film for Preventing Post-surgical Adhesion
Page: 68-76
S-W Tsai, J-F Fang, C-L Yang, J-H Chen, L-T Su, S-H Jan
 

An Alternative, Less Invasive Approach to Median Sternotomy for Cardiac Operations in Adults: Right Infra-axillary Minithoracotomy
Page: 77-83
B Tünerir , R Aslan
 

Therapeutic Effect of Vitamin D3 in a Rat Diffuse Axonal Injury Model
Page: 90-95
UA Malcok, G Sengul, HH Kadioglu , IH Aydin
 

Research Note

Effect of Carboxylesterase Inhibition on the Anti-tumour Effects of Irinotecan
Page: 84-89
Y Morishita, M Fujii, Y Kasakura, T Takayama
 

Incidence of the Type and Calcification Patterns in Patients with Elongated Styloid Process
Page: 96-102
M Ilgüy, D Ilgüy, N Güler, G Bayirli
 

Clinical Report

Ulcerative Colitis Activity Index: a Useful Prognostic Factor for Predicting Ulcerative Colitis Outcome
Page: 103-110
S Gürel, M Kiyici
 

Effect of Anti-hypertensive Drug Dose Frequency on the Clinic–Home Blood Pressure Difference in Patients with Stage 1 Treated Hypertension
Page: 111-118
H-C Huang, M-S Lin, K Kudo, N-C Chang, T-M Lee
 

Enlargement of Post-traumatic Intracerebral Haematoma: Incidence and Time Course
Page: 119-122
WG Liu, Y Yao, JY Zhou, XF Yang
 

Fresh Homografts Obtained Through a National Organ-sharing Programme for Repair of Congenital Heart Disease
Page: 123-131
SK Metin, BS Ugurlu, Ö Oto, ON Sariosmanoglu, E Hazan, N Ünal, GS Saylam, A Akçoral, Ç Dontlu
 

Articles

Antioxidant and Cardioprotective Properties of the Sulphydryl Angiotensin-converting Enzyme Inhibitor Zofenopril
Page: 42-54
S Evangelista , S Manzini
 

Review Article

Cell Wall-deficient Bacteria as a Cause of Infections: a Review of the Clinical Significance
ME Onwuamaegbu¹, RA Belcher², C Soare^3
1Department of Clinical Cardiology, Royal Brompton Hospital, London, UK; ²The Education Centre, University Hospital of North Durham, Durham, UK; ³Accident and Emergency Department, University Hospital of North Staffordshire NHS Trust, Stoke on Trent, UK
 

Cell wall-deficient bacteria (CWDB) are pleomorphic bacterial forms. These atypical organisms may occur naturally or they can be induced in the laboratory. Their presence has been known about for over a century, but a definite link to clinical disease outcomes has not been demonstrated. A number of case reports and laboratory studies suggest some disease associations, however. Considerable controversy surrounds the true relevance of CWDB to disease; there is a widespread belief that they may represent a response by the walled organism to adverse extra­cellular conditions like antibiotic pressure. This review looks at studies published between 1934 and 2003, which were identified by Dialog Datastar using the key words ‘cell wall deficient bacteria and clinical significance and infections’ and by further scanning the reference list at the end of the papers retrieved. We conclude that the evidence for the clinical signific­ance of CWDB in disease is not compelling.

Efficacy of Lumiracoxib in Osteoarthritis: a Review of Nine Studies
F Berenbaum¹, J Grifka², JP Brown³, J Zacher⁴, A Moore⁵, G Krammer⁶, D Dutta⁷, VS Sloan^8
1Pierre and Marie Curie University-Saint-Antoine Hospital, Paris, France; ²Orthopaedische Klinik, Universität Regensburg, Bad Abbach, Germany; ³Centre de l’ostéoporose et de rhumatologie de Québec, Ste-Foy, Canada; ⁴Orthopädische Klinik, HELIOS Klinikum, Berlin, Germany; ^5,6Novartis Pharma AG, Basel, Switzerland; ^7,8Novartis Pharmaceuticals Corporation, East Hanover, USA
 
Lumiracoxib is a cyclooxygenase-2 selective inhibitor in development for the treatment of osteoarthritis (OA), rheumatoid arthritis and acute pain. We reviewed nine clinical studies of 1 – 52 weeks’ duration demon­strating the efficacy of lumiracoxib in OA. Male and female patients aged more than or equal to 18 years with primary OA of the hand, hip or knee received lumiracoxib, placebo or active comparators (diclofenac, celecoxib or rofecoxib). Lumiracoxib provided consistent reductions in OA pain intensity and improvements in the patient’s global assessment of disease activity and functional status (assessed using the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire or the Australian/Canadian OA Hand Index). These results were superior to placebo and similar to the active comparators tested. In addition, lumiracoxib was consistently superior to placebo and generally similar to active compara­tors in terms of the new Outcome Measures in Clinical Trials and Osteoarthritis Research Society International criteria. These were used to provide a single measure of response to treatment, taking into account pain, the patient’s global assessment of disease activity and functional status.

Research Report

Effects of Sevoflurane, Isoflurane and Propofol Infusions on Post-operative Recovery Criteria in Geriatric Patients
C Arar¹, G Kaya², B Karamanlioglu³, Z Pamukçu⁴, N Turan^5
1,2,3,4Department of Anaesthesiology and ⁵Department of Biostatistics, Trakya University Medical Faculty, Edirne, Turkey
 

We compared the effects of sevoflurane, isoflurane and propofol infusions on post-operative recovery criteria in geriatric patients. Sixty patients aged > 65 years, classified as American Society of Anesthesiologists (ASA) group 1 or 2 and undergoing gynaecological or urological procedures were randomized equally into three groups. Group 1 received 1 minimum alveolar concentration (MAC) sevoflurane in a 50% O₂/N₂O mixture and group 2 received 1 MAC isoflurane in a 50% O₂/N₂O mixture. Group 3 received a 50% O₂/N₂O mixture plus propofol total intravenous anaesthesia (8 mg/kg for the first 30 min, followed by 6 mg/kg for maintenance). Recovery criteria comprising the times to spontaneous eye opening, extubation, response to verbal stimuli and orientation were recorded following the discontinuation of anaesthesia. Recovery times were significantly shorter in groups 1 and 3 compared with group 2. We conclude that sevoflurane and propofol had similar effects on recovery criteria and were associated with a faster recovery than isoflurane.

Clinical Features Associated with Circulating Concentration of Soluble Leptin Receptor in Patients with Diabetes
N Kotajima¹, T Takahashi², H Ito³, H Sumino⁴, Y Fukumura⁵, M Kurabayashi⁶, M Murakami⁷, T Kanda^8
1,5,7Department of Laboratory Medicine and Medical Laboratory Centre, and ^3,4,6Second Department of Internal Medicine, Gunma University School of Medicine, Gunma, Japan; ^2,8Department of General Medicine, Kanazawa Medical University, Ishikawa, Japan
 

We aimed to determine if there were any clinical features that were significantly associated with the circulating concen­tration of soluble leptin receptor (OB-Re) in 67 Japanese subjects with diabetes mellitus. The characteristics evaluated included age, height, body weight, body mass index (BMI), systolic and diastolic blood pressure, duration of diabetes, haemoglobin A_1C and blood lipid concentrations, urinary albumin excretion rate, circulating concentrations of leptin, tumour necrosis factor-a (TNF-a), TNF-a receptor 1 and genotypes of the angiotensin-converting enzyme (ACE) gene. We found statistically significant negative correlations between circulating OB-Re concentration and body weight, BMI, diastolic blood pressure, concentrations of leptin and TNF-a receptor 1. Serum OB-Re concentration was not associated with any of the other clinical characteristics that were measured, or with the different ACE genotypes. Our results suggest that OB-Re might have an important influence on the biological activity of leptin in diabetic subjects.

Preparation and Evaluation of a Hyaluronate-collagen Film for Preventing Post-surgical Adhesion
S-W Tsai¹, J-F Fang², C-L Yang³, J-H Chen⁴, L-T Su⁵, S-H Jan^6
1,3,4,5,6Biomedical Engineering Centre, Industrial Technology Research Centre, Hsin-Chu, Taiwan; ²Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
 

Post-surgical adhesion occurs when fibrous strands of scar tissue form, leading to the abnormal joining of anatomical structures. Patients undergoing abdominal surgery are at risk of the complications associated with intraperitoneal adhesions. Hyaluronic acid (HA) is a biocompatible, biodegradable and non-toxic natural polymer, which is gain­ing popularity as a barrier agent for preventing post-surgical adhesions. As HA is water-soluble and rapidly degraded in vivo, chemical modification is required to pro­duce a non-soluble sheet that might be used to prevent tissue adhesion. We develop­ed a range of biocompatible cross-linked HA-collagen composites and then evalu­ated them in a rat model of post-surgical adhesion. The results showed that cross-linked HA-collagen was almost totally resistant to hyaluronidase digestion. HA-collagen membranes induced minimal tissue reactions and were bioresorbed with­in 14 days post-surgery. These results suggest that cross-linked HA-collagen mem­brane may be a valuable anti-adhesion material to prevent post-surgical intra­peritoneal adhesion.

An Alternative, Less Invasive Approach to Median Sternotomy for Cardiac Operations in Adults: Right Infra-axillary Minithoracotomy
B Tünerir ¹, R Aslan^2
1,2Department of Cardiovascular Surgery, Osmangazi University Medical School and Research Hospital, Eskis¸ehir, Turkey
 
We compared the use of right infra-axillary minithoracotomy and conven­tional median sternotomy in direct open-heart surgery in 59 adults undergoing elective surgery for mitral valve stenosis, mitral valve disease, atrial septal defect repair, left atrial myxoma excision or mitral and tricuspid valve disease. Patients were randomized to the infra-axillary minithoracotomy group (Group A; n = 29) or the median sterno­tomy group (Group B; n = 30). Post-oper­ative outcomes (post-operative bleed­ing; cross-clamp time; length of hospital and intensive care unit stays; and post-operative blood transfusion and analgesic requirements) were recorded and compared; they were found to be significantly lower in Group A than Group B. We concluded that right infra-axillary minithoracotomy is less invasive and can be used safely in adults as an alternative approach to conventional median sterno­tomy for some cardiac operations. Further multicentre studies in adults are now needed.

Therapeutic Effect of Vitamin D3 in a Rat Diffuse Axonal Injury Model
UA Malcok¹, G Sengul², HH Kadioglu ³, IH Aydin^4
1,2,3,4Department of Neurosurgery, Medical School, Ataturk University, Erzurum, Turkey
 

We investigated the therapeutic effect of vitamin D₃ in a rat diffuse axonal injury model. A total of 60 male Sprague–Dawley rats weighing 175 – 200 g were anaesthetized and subjected to head trauma using Marmarou’s impact-acceleration model. The rats were then separated into two groups; one group was treated with vitamin D₃ and the other with saline for up to 4 days after the head trauma. Rats from both groups were killed 1, 3 or 8 days post-injury. The brains were examined histopathologically and scored according to the level of neuronal, vascular and axonal damage. There were no significant differences between the groups after 1 or 3 days, but evaluation after 8 days revealed a significant improvement in the group treated with vitamin D₃. Our data indicate that vitamin D₃ has a beneficial effect in diffuse axonal injury and may be useful in the management of this condition.

Research Note

Effect of Carboxylesterase Inhibition on the Anti-tumour Effects of Irinotecan
Y Morishita¹, M Fujii², Y Kasakura³, T Takayama^4
1,2,3,4Department of Digestive Surgery, Nihon University School of Medicine, Itabashi-Ku, Tokyo, Japan
 
Irinotecan (CPT-11) is an important anti-cancer agent activated by carboxylesterase (CE). Treatment with CPT-11 may be associated with severe adverse effects, however, so determining the optimal dose would greatly benefit patients. We investigated the relationship between the anti-tumour effects of CPT-11 and CE con­centration using bis-p-nitrophenylphosphate (BNPP), a specific inhibitor of CE, in nude mice with xenograft tumours. Initial experi­ments showed that the optimal dose of CPT-11 was 100 mg/kg. This dose was then used to study the anti-tumour effects of CPT-11 with and without BNPP. A direct correlation was found between the dose of administered BNPP and the growth rate of the tumour, demonstrating that the anti-tumour effects of CPT-11 were related to the CE con­centration. Measuring the con­centration of CE may allow the optimum dose of CPT-11 to be determined, opening up the possibility of individualized chemo­therapy programmes.

Incidence of the Type and Calcification Patterns in Patients with Elongated Styloid Process
M Ilgüy¹, D Ilgüy², N Güler³, G Bayirli^4
1,2,4Department of Oral Diagnosis and Radiology and ³Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
 

We investigated the incidence of elongated styloid process (Eagle’s syndrome) using panoramic radiographs taken of 860 patients referred to our clinic. Any styloid process identified was classified according to its length, type and the pattern of calcification. Fifty-nine elongated styloid processes were identified in 32 patients (3.7%), most being bilateral; 24 patients were female and eight were male (female/male ratio: 3:1). The mean age of these patients was 43 ± 14 years (range: 18 – 78 years). Type I (elongated) was the most frequent type on both sides (42/59); and the most frequent patterns of calcification were partially calcified on the left side (18/59) and completely calcified on the right side (16/59). Only two patients were symptomatic. A corrected differential diagnosis is important to distinguish elongated styloid process from other pathologies with partially overlapping symptoms. We would recommend that clinicians consider the possibility of Eagle’s syndrome when both the clinical and radiographic evidence support this diagnosis.

Clinical Report

Ulcerative Colitis Activity Index: a Useful Prognostic Factor for Predicting Ulcerative Colitis Outcome
S Gürel¹, M Kiyici^2
1Department of Gastroenterology and ²Department of Internal Medicine, Medical Faculty, Uludag University, 16059 Bursa, Turkey
 

We evaluated the usefulness of various parameters in predicting the prognosis of ulcerative colitis. The records of 73 patients with ulcerative colitis were examined retrospectively. Patients were divided into two groups according to whether they had received only 5-aminosalicylic acid (5-ASA; n = 26) or glucocorticoids and/or azathioprine with or without 5-ASA (n = 47). The disease extent, endoscopic activity and ulcerative colitis activity index (UCAI) before therapy were recorded, together with the disease outcome. No statistically significant differences in outcome were observed in relation to therapy group, disease extent or endoscopic activity. UCAI had a significant effect on outcome, however: patients with lower UCAI values were more likely to remain in remission and less likely to require urgent surgery or experience a fatal outcome than those with higher UCAI values. This difference was apparent in both treatment groups. Thus a high pre-treatment UCAI may indicate a worse outcome.

Effect of Anti-hypertensive Drug Dose Frequency on the Clinic–Home Blood Pressure Difference in Patients with Stage 1 Treated Hypertension
H-C Huang¹, M-S Lin², K Kudo³, N-C Chang⁴, T-M Lee^5
1Division of Cardiology, Department of Internal Medicine, Taipei Municipal Yang-Ming Hospital, Taipei, Taiwan; ²Graduate Institute of Epidemiology, College of Public Health, National Taiwan University and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; ³Department of Cardiology, New Tokyo Hospital, Tokyo, Japan; ⁴Division of Cardiology, Department of Internal Medicine, Taipei Medical University and Hospital, Taipei, Taiwan; ⁵Division of Cardiology, Department of Internal Medicine, Taipei Medical University and Chi-Mei Medical Centre, Tainan, Taiwan
 

Clinic blood pressure (CBP) is generally used for diagnosis and treatment monitoring in hypertension, but target organ damage correlates more closely with home blood pressure (HBP). Eliminating the clinic–home blood pressure difference (CHBPD) would make conventional CBP a more accurate alternative to HBP. This prospective, randomized, open trial compared the effect of a once-daily versus a twice-daily regimen of anti-hypertensive therapy on CHBPD. After a 2-week wash-out period, 85 confirmed stage 1 hypertensive patients were randomized to receive 2 mg tri­chlormethiazide daily in one (40 subjects) or two (45 subjects) daily doses for 3 weeks. CBP and HBP measurements were taken during the third week of treatment and the CHBPD calculated. After treatment, the systolic and diastolic CHBPD values were significantly greater in the once-daily regimen than in the twice-daily regimen. Conventional CBP should not be used as an alternative to HBP for evaluating prognosis and monitoring anti-hypertensive therapy when using a once-daily regimen.

Enlargement of Post-traumatic Intracerebral Haematoma: Incidence and Time Course
WG Liu¹, Y Yao², JY Zhou³, XF Yang^4
1,2,4Department of Neurosurgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, China; ³Biomedical Engineering Research Centre, Nanyang Technological University, Singapore
 
We retrospectively assessed the incidence and time course of enlargement in post-traumatic intracerebral haematoma (PTICH). Computed tomography (CT) scans from 165 patients who underwent a scan within 72 h and a repeat scan within 120 h of the onset of trauma were examined. A semi-automated method using region deformation-based segmentation was used to calculate the haematoma volume. The presence of haematoma enlargement was also determined based on a consensus by five observers. Seventy cases (42%) showed enlargement of the haematoma. The frequency of haematoma enlargement decreased as the interval between the onset of trauma and the initial scan increased. The discriminant value of the ratio of the haematoma volume in the second scan to that in the initial scan was ascertained, and the cut-off value for haematoma enlargement was determined to be 1.45. The radiographic criterion for enlargement in PTICH on CT scan was, therefore, defined as a more than or equal to 1.45 times increase in haematoma volume.

Fresh Homografts Obtained Through a National Organ-sharing Programme for Repair of Congenital Heart Disease
SK Metin¹, BS Ugurlu², Ö Oto³, ON Sariosmanoglu⁴, E Hazan⁵, N Ünal⁶, GS Saylam⁷, A Akçoral⁸, Ç Dontlu^9
1Ege Saglik Hospital, Izmir, Turkey; ^2,3,4,5Department of Cardiovascular Surgery,^6,7,8Department of Paediatric Cardiology and ⁹Institutional Transplant Coordinator, Dokuz Eylül University Medical School, Izmir, Turkey
 
Homografts have been used in congenital cardiac surgery for over 30 years. We utilized the resources of a national organ-sharing programme to obtain fresh homografts and report their use in correct­ing cardiac pathologies in 20 children between March 2001 and May 2003. In 16 patients, a valved conduit was used to form a connection between the pulmonary ventricle and the pulmonary artery. In three patients, a non-valved aortic conduit was used to form an extra-cardiac Fontan circulation and in one patient, non-valved pulmonary and aortic conduits were used to repair an infected aortic aneurysm. Three patients died following surgery. Survivors were followed up using echo­cardiography between 2 and 24 months post-surgery. Results demonstrate that, with the help of a national organ-sharing programme, the use of fresh homograft conduits is feasible in a paediatric patient population with reasonable waiting times.

Articles

Antioxidant and Cardioprotective Properties of the Sulphydryl Angiotensin-converting Enzyme Inhibitor Zofenopril
S Evangelista ¹, S Manzini^2
1,2Department of Preclinical Development, Menarini Ricerche SpA, Florence, Italy
 
Zofenopril, a new potent sulphydryl angiotensin-converting enzyme (ACE) inhibitor, is characterized by high lipophilicity, selective cardiac ACE inhibition, and antioxidant and tissue protective activities. In vitro and in vivo experiments suggest that zofenopril exerts antioxidant properties at clinically achievable tissue concentrations. In endothelial cells, zofenopril enhances nitric oxide production, attenuates atherosclerotic lesion development and inhibits adhesion molecule expression by reducing reactive oxygen species. These peculiar characteristics are reflected in the drug’s cardioprotective activity, which has been shown to be greater than that of non-sulphydryl ACE inhibitors. Cardiac hypertrophy was also reduced by chronic zofenopril administration, independently of its blood pressure-reducing effect. ACE inhibitors with a sulphydryl group could have an advantage in improving vas­­cular function and reducing cardiac impairment compared with non-sulphydryl-containing ACE inhibitors. This could explain zofenopril’s remarkable clinical efficacy post-infarction, and potentially beneficial use in prevention and therapy of cardiovascular diseases, such as atherosclerosis, thrombosis and heart failure.