bluuebunny/crossref_metadata_2025 huggingface dataset:
Supraspinal control of external anal sphincter motility: effects of vesical distension in humans and cats
Authors: Vitton V. , Grimaud J.‐c. , Bouvier M. , Abysique A.
Published: September 2006

Abstract  A pontine centre located near the micturition centre controlling external anal sphincter (EAS) motility via noradrenergic neurones has been described in cats. The aim of this study was to determine (i) whether a similar centre controls EAS motility in humans and (ii) whether this centre is involved in vesico‐sphincteric reflexes in cats and humans. The effects of an alpha‐1‐adrenoceptor antagonist (nicergoline) and those of vesical distension on the electrical activity of the EAS were studied in paraplegic and non‐paraplegic volunteers. The effects of vesical distension by injecting saline at physiological levels on the responses of the EAS to pudendal nerve stimulation were investigated in intact cats and cats with nerve sections. In non‐paraplegic subjects, nicergoline and vesical distension abolished the activity of the EAS. These effects were no longer observed in paraplegic patients. In cats, vesical distension inhibited the reflex response of the EAS to pudendal nerve stimulation. This vesico‐sphincteric reflex, which was no longer observed in spinal animals, persisted after nicergoline injection. These findings indicate that in humans, there exists a supra‐spinal centre facilitating the tonic activity of the EAS via noradrenergic neurones not involved in the inhibitory vesico‐sphincteric reflex.
Contrasting interactions between ethylene and abscisic acid in Rumex species differing in submergence tolerance
Authors: Benschop Joris J. , Jackson Michael B. , Gühl Kerstin , Vreeburg Robert A. M. , Croker Stephen J. , Peeters Anton J. M. , Voesenek Laurentius A. C. J.
Published: September 2006

Complete submergence of flooding‐tolerant Rumex palustris plants strongly stimulates petiole elongation. This escape response is initiated by the accumulation of ethylene inside the submerged tissue. In contrast, petioles of flooding‐intolerant Rumex acetosa do not increase their elongation rate under water even though ethylene also accumulates when they are submerged. Abscisic acid (ABA) was found to be a negative regulator of enhanced petiole growth in both species. In R. palustris, accumulated ethylene stimulated elongation by inhibiting biosynthesis of ABA via a reduction of RpNCED expression and enhancing degradation of ABA to phaseic acid. Externally applied ABA inhibited petiole elongation and prevented the upregulation of gibberellin A1 normally found in submerged R. palustris. In R. acetosa submergence did not stimulate petiole elongation nor did it depress levels of ABA. However, if ABA concentrations in R. acetosa were first artificially reduced, submergence (but not ethylene) was then able to enhance petiole elongation strongly. This result suggests that in Rumex a decrease in ABA is a prerequisite for ethylene and other stimuli to promote elongation.
Extended coagulation profiles of healthy baboons and of baboons rejecting GT‐KO pig heart grafts
Authors: Ezzelarab Mohamed , Cortese‐Hassett Andrea , Cooper David K. C. , Yazer Mark H.
Published: October 2006

Abstract:  Introduction:  Derangements of coagulation, e.g. thrombotic microangiopathy (TM) and disseminated intravascular coagulation (DIC), limit the success of pig‐to‐baboon organ transplantation. Studies have investigated the coagulation profile in baboons post‐xenotransplantation (XTx), but an extended coagulation profile of healthy baboons pre‐XTx has not been reported.

Methods:  Blood was drawn from nine healthy male baboons (approximate age 5 yr, mean weight 15 kg) that had not undergone any prior surgical or therapeutic procedures. An extended coagulation profile, consisting of markers of thrombin activation, fibrinolysis, endothelial activation, the protein C pathway, and overall reactive state, was investigated by a reference coagulation laboratory, using tests for human plasma. The mean value ± SD was calculated for 18 parameters (analytes); values outside of the mean ± 2 SD were excluded. Three baboons subsequently underwent transplantation with hearts from GT‐KO pigs, and received either no therapy (B24603), CVF (B25003), or CVF + leflunomide (B24903), and their extended coagulation parameters were followed.

Results:  For 14 of the 18 analytes, the human reference range reflected the coagulation status of healthy baboons. Exceptions included thrombin/antithrombin complex and fibrinopeptide A, which were elevated compared with the human reference range, while plasminogen activity was lower. The human assay failed to detect baboon plasminogen activator inhibitor‐1. Immediately after GT‐KO pig heart transplantation, the untreated B24603 demonstrated a coagulation profile consistent with its postoperative clinical status; DIC was not apparent, and the heart was electively excised within 2.5 h. In B25003 and B24903, that rejected their grafts on days 8 and 12, respectively, the coagulation profile showed evidence of DIC, particularly in B24903, which was clinically coagulopathic by this time.

Conclusions:  (i) The human reference range of extended coagulation parameters forms a basis for studies in baboons, with a few exceptions. (ii) Antibody‐mediated rejection of GT‐KO pig hearts in baboons can be associated with laboratory and clinical evidence of DIC.
Yield improvement for manufacture of α1‐proteinase inhibitor
Authors: Zimmerman T. P.
Published: September 2006

Background and Objectives  The aim of this study was to increase the yield of active α1‐proteinase inhibitor (α1‐PI) from Cohn fraction IV‐1 paste during the manufacture of this therapeutic protein and to investigate the molecular mechanism for this yield increase.

Materials and Methods  Dissolution experiments with IV‐1 paste investigated the impact of different variables on the yield of α1‐PI activity. Solutions of IV‐1 paste prepared under different conditions were assayed for evidence of protease activity by Western blots of α1‐PI following SDS‐PAGE, by azocaseinolytic and amidolytic (S‐2288) assays, and by zymography, and for the extent of α1‐PI oligomerization by Western blots following nondenaturing PAGE.

Results  Minor modification of the manufacturing process by combining dissolution of IV‐1 paste with the subsequent pH adjustment (to 9·25–9·50 with NaOH), achieved by addition of a standard concentration of NaOH to the 10‐mm Tris base dissolvent for IV‐1 paste, was found to give a highly reproducible 9·4 ± 0·9% increase in yield of active α1‐PI. Solutions of IV‐1 paste prepared with this combined dissolvent contained reduced amounts of low molecular weight fragments of α1‐PI, reduced protease activity, and reduced amounts of oligomers of α1‐PI. Addition of the protease inhibitor leupeptin to the 10‐mm Tris base dissolvent for IV‐1 paste also caused an increase in the yield of α1‐PI activity.

Conclusions  Dissolution of IV‐1 paste in a more alkaline medium gave a significant increase in the yield of active α1‐PI. This yield increase was attributed to a reduction both in protease activity and in the extent of oligomerization of α1‐PI.
Diagnostik von Mykosen des Auges und seiner Adnexe
Authors: Behrens‐Baumann W. , Müller J.
Published: September 2006

Das Spektrum der Mykosen des Auges und seiner Adnexe wird im klinischen Bild und im labordiagnostischen Vorgehen abgehandelt. Die einzelnen Lokalisationsformen unterscheiden sich in ihrer Symptomatik, in ihren Risikofaktoren und im Erregerspektrum.
Einfluss einer Antimykotika‐Prophylaxe auf die gastrointestinale Besiedlung mit Sprosspilzen bei hämatologischen Patienten
Authors: Rimek Dagmar , Redetzke Kristin , Kappe R.
Published: September 2006

Hämatologische Patienten weisen ein hohes Risiko zur Entwicklung einer invasiven Candidose auf und sind häufig gastrointestinal mit Sprosspilzen besiedelt. Das Infektionsrisiko kann durch eine prophylaktische orale Antimykotikagabe reduziert werden. Oft wird Fluconazol eingesetzt, was zu einer vermehrten Rate von Besiedlungen und Infektionen durch resistente Sprosspilzarten führen kann. Wir untersuchten den Einfluss einer Antimykotika‐Prophylaxe auf die gastrointestinale Sprosspilzbesiedlung bei hämatologischen Patienten im Vergleich zu Gesunden.

In die Studie eingeschlossen wurden 46 hämatologische neutropenische Patienten mit 52 Stuhlproben aus 52 Episoden antimykotischer Prophylaxe und 110 gesunde Kontrollen. Die Patienten erhielten Amphotericin B oral (n = 8), Amphotericin B und Fluconazol (n = 7), Amphotericin B und Itraconazol (n = 5), Fluconazol oral (n = 15) und Itraconazol oral (n = 17) Bei 63,5% der Patienten und 60% der Kontrollen wurden Sprosspilze im Stuhl nachgewiesen mit einer mittleren Keimzahl von 1,6 × 103 bzw. 0,4 × 103 KBE g−1 (P = 0,045). Niedrige Keimzahlen von 103 to 104 KBE g−1 wiesen 19,3% der Patienten und 37,3% der Kontrollen auf (P = 0,021), mehr als 105 KBE g−1 28,9% der Patienten und 10,9% der Kontrollen (P = 0,004). Der Anteil von Candida albicans betrug in der Patientengruppe 32,6%, in der Kontrollgruppe 54,1% (P = 0,021). In der Patientengruppe wurden im Vergleich zu den Kontrollen vermehrt Fluconazol‐resistente Arten nachgewiesen: C. glabrata in 20,9% vs. 11,7% (P = 0,168), C. krusei in 25,6% vs. 4,7% (P = 0,001). Kein Patient unter Antimykotika‐Prophylaxe erkrankte an einer gesicherten oder wahrscheinlichen invasiven Candidose.

Als Schlussfolgerung ergibt sich, dass eine orale Antimykotika‐Prophylaxe bei neutropenischen hämatologischen Patienten zu einer höheren Kolonisationsrate mit Fluconazol‐resistenten Candida Arten führte, invasive Candidosen aber verhindert wurden.
Serum IL‐6 and IL‐1‐ra with sequential organ failure assessment scores in septic patients receiving high‐volume haemofiltration and continuous venovenous haemofiltration
Authors: GHANI ROHANA ABDUL , ZAINUDIN SOEHARDY , CTKONG NORELLA , RAHMAN AHMAD FAUZI ABDUL , WAFA SYED ROZAIDI WAFA SYED HUSSAIN , MOHAMAD MARLYN , MANAF MOHD RIZAL ABDUL , ISMAIL RAHIMAH
Published: September 2006

Aim:  Sepsis is characterized by an uncontrolled release of pro‐inflammatory and anti‐inflammatory mediators leading to immunoparalysis, cellular and humoral dysfunction, multiorgan dysfunction and death. This study evaluated the efficacy of high‐volume haemofiltration (HVHF) compared with continuous venovenous haemofiltration (CVVH) in removing these inflammatory mediators. Clinical responses were assessed with the sequential organ failure assessment (SOFA) score.

Methods:  Septic patients with an end‐organ dysfunction or septic shock were randomized to receive 6 h of CVVH (ultrafiltration dose of 2 L/h equivalent to about 35 mL/kg per hour or HVHF (ultrafiltration dose of 100 mL/kg per hour or 6 L/h, whichever was higher). The sequential organ failures were scored for the 24 hours preceding recruitment; at day 1, day 7, at discharge from the intensive care unit and at hospital discharge.

Results:  Thirty‐three patients were enrolled. Fifteen received HVHF and 18 received CVVH. The serum IL‐6 levels (pg/mL) at baseline were similarly elevated in both groups (P = 0.745). The HVHF group showed a significant reduction after 6 h of treatment with a median interquartile range (IQR) of 20.62 (49.21) pg/mL (P = 0.025) with no similar result in the CVVH group. Non‐survivors showed a higher baseline serum IL‐6 compared with the survivors (median (IQR) 172.31 (261.34) vs 58.9 (104.21), P = 0.044). In the HVHF group there was a positive association between the IL‐6 levels at 6 h with the SOFA scores at day 1 (r = 0.392, P = 0.001) but not at day 7. After 6 h of treatment in the HVHF group there was a direct correlation between the IL‐6 levels and number of hospital days (r = 0.90, P = 0.040). The maximum SOFA scores were persistently recorded before treatment. The SOFA scores reduced in both groups from baseline to day 7 (HVHF P = 0.048; CVVH P = 0.006). The SOFA scores at day 1 is significantly higher in the non‐survivors compared with the survivors (P = 0.038).

Conclusions:  High‐volume haemofiltration at 6 L/h may seem to successfully remove some inflammatory cytokines in septic patients. The improvement in the SOFA scores at day 7 promises benefit of continuous renal replacement therapy in septic patients, but after 20 days this effect may be lost. In addition, the baseline serum IL‐6 and IL‐1‐ra were independent predictors of a poor outcome as reflected by the higher SOFA scores at day 1.
Proton pump inhibitors and acute interstitial nephritis: Report and analysis of 15 cases
Authors: SIMPSON IAN J , MARSHALL MARK R , PILMORE HELEN , MANLEY PAUL , WILLIAMS LAURIE , THEIN HLA , VOSS DAVID
Published: September 2006

Aim:  Although proton pump inhibitors (PPI) are usually safe and effective therapeutic agents, serious adverse effects can occur. The aim of the present study was to report and analyse the clinical features of 15 patients with acute interstitial nephritis (AIN) and acute renal failure from PPI that were referred to renal services in Auckland over a period of 3 years.

Methods:  The clinical presentation, therapeutic drugs, demographic details and renal outcome of the patients were considered. The population at risk and total PPI exposure were able to be defined. The diagnosis of AIN was made by renal biopsy in 12 cases. In all patients, the time‐course of drug exposure and improvement of renal function on withdrawal suggested PPI were causal.

Results:  The median patient age was 78 years. The mean baseline serum creatinine level was 83 µmol/L, peak level 392 µmol/L, and recovery level 139 µmol/L. The erythrocyte sedimentation rate (ESR) and C‐reactive protein were elevated at the time of diagnosis in the 11 and 12 patients, respectively, where this information was collected (ESR mean 85 mm/h, and C‐reactive protein mean 81 mg/L). AIN occurred at 8 per 100 000 patient years (95% confidence level 2.6–18.7 per 100 000 patient years). Although four patients presented with an acute systemic allergic reaction, 11 were asymptomatic with an insidious development of renal failure.

Conclusion:  PPI are now the most commonly identified cause of AIN in the Auckland area. Recovery occurs after withdrawal of the drug but is often incomplete. Early diagnosis may be facilitated by clinician awareness of the insidious onset of renal failure, and an elevated erythrocyte sedimentation rate and C‐reactive protein.
Comparison of biochemical, haematological and volume parameters in two treatment schedules of nocturnal home haemodialysis
Authors: MAHADEVAN KUMAR , PELLICANO REBECCA , REID ALISTAIR , KERR PETER , POLKINGHORNE KEVAN , AGAR JOHN
Published: September 2006

Background:  The biochemical, haemodynamic, clinical and nutritional benefits of nocturnal home haemodialysis (NHHD) compared with 4 h, three times per week conventional haemodialysis are well known and accrue by increasing dialysis time and frequency either for 8 h alternate night per week (NHHD3.5) or for 8 h six nights per week (NHHD6). However, there are little data comparing NHHD3.5 with NHHD6.

Method and Results:  Thirteen patients on NHHD6 were compared with 21 patients on NHHD3.5, all with similar demographic profiles. Pre‐ and post‐dialysis phosphate (PO4) control was ideal between the groups. However, all NHHD6 needed PO4 supplementation compared with 4/21 (19%) NHHD3.5. In the present study, 8/21 (38%) NHHD3.5 needed PO4 binders whereas none was required with NHHD6. The pre‐haemoglobin (Hb) 122.8 g/L (NHHD6) versus 124.9 g/L (NHHD3.5) and the pre‐albumin 38.31 g/L (NHHD6) versus 37.71 g/L (NHHD3.5) were not significantly different. NHHD6 had significantly lower pre‐blood urea and creatinine (10.16 vs 19.54 mmol/L and 437.0 vs 812.3 µmol/L, respectively). Less interdialytic urea and creatinine fluctuation were also noted in NHHD6. Of major significance was the significantly lower ultra filtration rate and intradialytic weight gains (mean ± SEM) of NHHD6 (249 ± 76 mL/h and 2.0 ± 0.65 kg) versus NHHD3.5 (425 ± 168 mL/h and 2.9 ± 1.2 kg).

Conclusion:  The authors conclude that NHHD6 offers the optimum biochemical, volume and clinical outcome, but NHHD3.5 has additional appeal to providers seeking home‐based therapy cost advantages and consumable expenditure control. A flexible dialysis programme should offer all the time and frequency options of NHHD but in particular, should support NHHD at a frequency sympathetic to the clinical rehabilitation and lifestyle aspirations of individual patients.
Protein kinase C activation and its role in kidney disease (Review Article)
Authors: LI JUN , GOBE GLENDA
Published: September 2006

SUMMARY:  Protein kinase C (PKC) comprises a superfamily of isoenzymes, many of which are activated by cofactors such as diacylglycerol and phosphatidylserine. In order to be capable of activation, PKC must first undergo a series of phosphorylations. In turn, activated PKC phosphorylates a wide variety of intracellular target proteins and has multiple functions in signal transduced cellular regulation. A role for PKC activation had been noted in several renal diseases, but two that have had most investigation are diabetic nephropathy and kidney cancer. In diabetic nephropathy, an elevation in diacylglycerol and/or other cofactor stimulants leads to an increase in activity of certain PKC isoforms, changes that are linked to the development of dysfunctional vasculature. The ability of isoform‐specific PKC inhibitors to antagonize diabetes‐induced vascular disease is a new avenue for treatment of this disorder. In the development and progressive invasiveness of kidney cancer, increased activity of several specific isoforms of PKC has been noted. It is thought that this may promote the kidney cancer’s inherent resistance to apoptosis, in natural regression or after treatments, or it may promote the invasiveness of renal cancers via cellular differentiation pathways. In general, however, a more complete understanding of the functions of individual PKC isoforms in the kidney, and development or recognition of specific inhibitors or promoters of their activation, will be necessary to apply this knowledge for treatment of cellular dysregulation in renal disease.
Tracheal rupture in a child with blunt chest injury
Authors: EIPE NAVEEN , CHOUDHRIE ASHISH
Published: September 2006

A 10‐year‐old boy fell from a tree and sustained blunt injury to his chest. He was brought to the hospital (6 h later) with difficulty in breathing and inability to speak. There was a bruise on the neck and extensive subcutaneous emphysema over the neck and chest and decreased air entry over the right hemithorax. Radiographs revealed a right‐sided pneumothorax, pneumomediastinum and tracheal deviation. An intercostal drain (with underwater seal) was inserted and he was transferred to the operating room for bronchoscopy. Anesthesia was induced with IV midazolam and ketamine. The trachea was intubated orally and anesthesia maintained with spontaneous breathing of halothane in oxygen. Flexible fiberoptic bronchoscopy performed via the tracheal tube revealed no injury to bronchi or carina. Bronchoscopy through the tracheal tube withdrawn to the level of the vocal cords revealed a 1‐cm long posterior longitudinal tear approximately 2–3 cm below the cords. The surgeons planned a definitive tracheostomy distal to the traumatic tracheal opening. This was difficult and initially unsuccessful because of subcutaneous emphysema. A ureteric catheter was introduced through the tracheal tube and a tracheostomy tube mounted on the fiberoptic bronchoscope, which was then inserted through the surgical tracheostome. This followed the ureteric catheter into the distal trachea and the trachea was successfully cannulated. We review the mechanism of tracheal injuries with special reference to its occurrence in children with blunt injury. We discuss the airway management in these potentially life‐threatening injuries.
Steal‐induction after clonidine premedication: a comparison of the oral and nasal route
Authors: ALMENRADER NICOLE , PASSARIELLO MAURIZIO , COCCETTI BRUNO , HAIBERGER ROBERTA , PIETROPAOLI PAOLO
Published: September 2006

Background:  Clonidine premedication in children reliably provides preoperative sedation and anxiolysis, but onset of oral clonidine is known to be slow. Nasal clonidine has been shown to reach peak plasma levels within 10 min in rodents. The aim of the present study was to compare clinical effects and percentage of steal‐induction after clonidine premedication by the oral and nasal route.

Methods:  Forty children, aged 1–6 years, scheduled for minor infraumbilical surgery, were randomly assigned to receive either pure clonidine 4 μg·kg−1 intranasally (group CN, n = 20) or clonidine 4 μg·kg−1 orally in syrup (group CO, n = 20) prior to mask induction. Drug acceptance, preoperative sedation and anxiolysis, quality of mask acceptance, recovery profile and parents’ satisfaction were evaluated.

Results:  Drug acceptance was similar between groups, but quality of taste was significantly better in the oral group. There was no significant difference of preoperative anxiolysis and sedation. The onset of sedative effect was after 38.3 min for oral clonidine and 47.5 min for nasal clonidine. A steal‐induction could be performed in 60% of children in each group. Emergence from anesthesia and parents’ satisfaction were comparable.

Conclusions:  Intranasal clonidine administration has no advantage over the oral route. Clinical effects were similar with both routes; there was a trend towards a faster onset of sedation with oral clonidine. Clonidine premedication causes light sleep, which allows a steal‐induction in 60% of patients.
ON PREDICTION OF TOTAL VALUE IN INCOMPLETELY SPECIFIED DOMAINS
Authors: Ża̧dło Tomasz
Published: September 2006

This paper presents the problem of prediction of a domain total value based on the general linear model. In many methods presented in the survey sampling literature (e.g. Cassel, Särndal & Wretman, 1977[Foundations of inference in survey sampling, New York: John Wiley & Sons]; Valliant, Dorfman & Royall, 2000[Finite population sampling and inference. A prediction approach. New York: John Wiley & Sons]; Rao, 2003[Small area estimation. New York; John Wiley & Sons]) a common assumption is that for each element of a population the domain to which it belongs is known. This assumption is especially important in the situation when a superpopulation model with auxiliary variables is considered. In this paper a method is proposed for prediction of the domain total when it is not known whether a unit belongs to a given domain or not, or when the information is available only for sampled elements of the population.
Continuous Improvement and Collaborative Improvement: Similarities and Differences
Authors: Middel Rick , Boer Harry , Fisscher Olaf
Published: September 2006

A substantial body of theoretical and practical knowledge has been developed on continuous improvement. However, there is still a considerable lack of empirically grounded contributions and theories on collaborative improvement, that is, continuous improvement in an inter‐organizational setting. The CO‐IMPROVE project investigated whether and how the concept of continuous improvement can be extended and transferred to such settings. The objective of this article is to evaluate the CO‐IMPROVE research findings in view of existing theories on continuous innovation. The article investigates the similarities and differences between key components of continuous and collaborative improvement by assessing what is specific for continuous improvement, what for collaborative improvement, and where the two areas of application meet and overlap. The main conclusions are that there are many more similarities between continuous and collaborative improvement. The main differences relate to the role of hierarchy/market, trust, power and commitment to collaboration, all of which are related to differences between the settings in which continuous and collaborative improvement unfold.
Intergenerational Transfer of Human Capital and Optimal Education Policy
Authors: CREMER HELMUTH , PESTIEAU PIERRE
Published: September 2006

We study the design of education policies (subsidies and public education) when parents' investment in education is motivated by warm‐glow altruism and determines the probability that a child has a high ability. The optimal subsidy is not necessarily positive. It is determined by two conflicting terms: a Pigouvian term (warm‐glow altruists do not properly account for the impact of education on future generations) and a “paternalistic” effect (the warm‐glow term may not be fully included in social welfare). Finally, total crowding out of private expenditure (for one of the types) by public education may be desirable.
The Signaling Effect of Tax Policy
Authors: BARIGOZZI FRANCESCA , VILLENEUVE BERTRAND
Published: September 2006

The paper focuses on the signaling value of a tax when agents are less informed than the government on the effect of their consumption. The policy making process is analyzed as a game in which the government wants to influence consumers' behaviors through tax policy, consumers being rational and Bayesian. The marginal cost of public funds induces the government to provide biased information to pursue budgetary objectives. We analyze the tax distortion that is required for credibility.
Advances in the understanding of malignant transformation of keratinocytes: an immunohistochemical study
Authors: Tucci M.G. , Offidani A. , Lucarini G. , Simonelli L. , Amati S. , Cellini A. , Biagini G. , Ricotti G.
Published: September 2006

Aim

We set out to investigate the interactions between malignant transformation of keratinocytes, presence of oncoproteins and immunosurveillance in squamous cell carcinoma (SCC) and in a preneoplastic lesion, actinic keratosis (AK).

Methods

Samples of SCC, AK and normal skin (NS) were subjected to quantitative analysis using the following antibodies: anti‐p53, Ki67, OKT6, OK‐DR, B7/BB1, anti‐CD54, anti‐CD11, OKT3, OKT4, OKT8; positivity for ras‐p21, EGFr and bel‐2 was evaluated by semiquantitative analysis.

Results

Oncoprotein alterations and increased keratinocyte proliferative activity were observed both in AK and SCC. The number of Langerhans cells (CD1a+ cells) was similar in the two lesions but lower in SCC compared to AK. The proportion of CD1a+‐B7/BB1+ cells was slightly higher in AK and SCC than in NS. The Langerhans cells expressed the HLA‐DR antigen in all groups. Values were highest in AK and NS, and quite low in SCC. Cytotoxic T lymphocytes were more numerous in SCC than in AK and NS. Interestingly, the total CD4/CD8 ratio was much lower in SCC than in AK and NS, which indicates an increase in the CD8+ subpopulation in samples of SCC. In the epithelia of SCC samples there were a considerable number of B7/BB1+ keratinocytes.

Conclusions

We suggest that alterations in the immunodefence mechanisms have an important role in the transformation of AK into SCC, and that these changes affect not only lymphocytes, but also professional (i.e., Langerhans cells) and non‐professional (i.e., keratinocytes) antigen presenting cells.
A clinical survey of psoriasis in Italy: 1st AISP report
Authors: Finzi Aldo F. , Benelli Cinzia
Published: September 2006

Background

Psoriasis is present all over the world and its prevalence varies in the different populations and different geographical areas. For example, Northern European countries seem to have rates of incidence which are greater than those known for Southern Europe. However, today there is still a lack of adequate data to allow comparisons at an international level.

Methods

In Italy in 1994 the AISP (Interdisciplinary Association for the Study of Psoriasis) co‐ordinated the recording of monthly case histories and clinical results relating to psoriasis in patients observed in dermatology centres homogeneously distributed throughout Italy. The results were extrapolated from the overall case series.

Results

A sample of nearly 8000 cases was collected, most presenting psoriasis vulgaris. This pathology, prevalent in males, first appears at an age somewhere between the teens and twenties. Numerous factors may be involved, and onset is mainly attributed to stress, viral or bacterial infections and pharmacological therapy. Over 90% of cases lost between 1 and 7 working days in the course of the year. Local anti‐psoriasis treatment in monotherapy was administered more frequently than systemic therapy or combined therapy.

Conclusions

The results of this first Italian epidemiological study confirm that psoriasis is homogeneously distributed throughout the country. About 50% of patients avail themselves of specialist cures, even several times in the course of the year, and use a wide range of therapies which may be more or less demanding. The internal socio‐economic cost of the disease is evident, particularly in terms of working days lost and/or medical expenses.
Comparison of skin atrophy and vasoconstriction due to mometasone furoate, methylprednisolone and hydrocortisone
Authors: Hoffmann K. , Auer T. , Stücker M. , Hoffmann A. , Altmeyer P.
Published: September 2006

Background/aims

Topical glucocorticoids with improved benefit/risk ratio are of great interest in dermatology, but there are very few trials directly comparing the efficacy and side‐effects of these new preparations. In our study the vasoconstrictor effect and side‐effects of two of these new glucocorticoids were evaluated and blanching effect was determined by two‐dimensional laser scanning.

Methods

In a randomised, double blind intra‐individual comparative trial, 10 subjects were treated with various glucocorticoids or drug‐free vehicle. The test drugs were mometasone furoate (MF), methylprednisolone aceponate (MP) and hydrocortisone (OH‐C). The preparations were tested for a period of 3 weeks with occlusion on the flexor side of the forearm. Skin thickness and vasoconstriction were determined using 20 MHz ultrasound scanning, laser Doppler scanning (LDS) and chromometry.

Results

No adverse effects were observed during the observation period. Only partial vasoconstriction occurred in most cases during the observation period. MP and MF produced maximal blanching between days 3 and 5 of treatment, while with OH‐C clinically visible blanching did not occur. Ultrasound evaluation of skin thickness showed similar behaviour for all three steroids tested: there were no signs of skin atrophy in any of the cases. LDS evidenced hypoperfusion of a test area on the perfusion image in only a few patients and there were no significant differences between the steroids tested. On evaluation of vasoconstriction caused by the steroids tested using chromometry there was a significant difference between MF and OH‐C on the L*a*b* scale (P < 0.005). Only at day 3 was a blanching effect caused by MP and MF demonstrable (a‐value, P < 0.05).

Conclusion

In summary, the synthetic steroids MF and MP presented side‐effects similar to those of OH‐C but much greater vasoconstrictor effect; after an application period of over 5 days under occlusion a blanching effect in our model was not demonstrable by means of chromometry. Two‐dimensional laser scanning offers no advantage in the evaluation of the blanching effect in comparison to one‐dimensional laser fluxmetry (LDF). © 1998 Elsevier Science B.V.
Lipodystrophia centrifugalis abdominalis infantilis
Authors: Takeda Hikaru , Mitsuhashi Yoshihiko , Ishizawa Toshiyuki , Kondo Shigeo
Published: September 2006

Aim

To describe the clinical features of lipodystrophia centrifugalis abdominalis infantilis (LCAI) with special attention to the erythema which is seen around the depressed lesion.

Background

LCAI is a rare disorder which occurs mainly in Asian people, particularly in Japanese; it usually begins as an erythematous macule which subsequently expands centrifugally and leaves a central depression. However, the erythema has been seldom documented in detail. We here report a case of LCAI observed from its early stage and review the literature.

Case report

A 2‐year‐old Japanese girl was brought to our out‐patient clinic. Clinical examination revealed a slight depression surrounded by faint erythema that mimicked morphea on her left inguinum, but there was no hardening of the skin. The erythema disappeared 5 months after onset. Thereafter, the lipodystrophy expanded irrespective of the treatment to her right inguinum and lower abdomen.

Conclusions

The depression continues to grow without the erythema in most patients. This suggests that the erythema is not necessary for enlargement of the depression although it precedes the depression in most patients.
Acquired ichthyosis, alopecia and loss of hair pigment associated with leiomyosarcoma
Authors: Farrell A.M. , Ross J.S. , Thomas J.M. , Fisher C. , Bunker C.B.
Published: September 2006

Acquired ichthyosis is an important clinical finding; internal malignancy, systemic disease and medication are recognised associations. We present a 70‐year‐old lady with acquired ichthyosis and leiomyosarcoma, one of the less frequently associated malignancies. An additional unusual finding was generalised thinning and loss of pigment affecting her hair. Scalp biopsy showed histological evidence of ichthyosis. Following resection of the tumour the ichthyosis resolved and there was regrowth of darker hair.
Generalized cutaneous leishmaniasis in acquired immunodeficiency syndrome1
Authors: Rosatelli J.B. , Souza C.S. , Soares F.A. , Foss N.T. , Roselino A.M.F.
Published: September 2006

Background

Leishmaniasis associated with HIV/AIDS has been reported in the last decade.

Case report

A case of generalized cutaneous leishmaniasis in a patient with AIDS is described. The case is paradoxical in that the cutaneous lesions resemble anergic leishmaniasis caused by Leishmania (L.) amazonensis and Jorge Lobo's disease, but the positive Montenegro test and the clinical improvement with antimonial are more commonly observed in leishmaniasis caused by L.(V.) braziliensis.

Comment

The immunosuppression due to HIV/AIDS seen in this patient may explain the dissemination of the lesions, but the positive specific response to leishmanial antigen may explain the good response to the antimonial treatment.
‘Suction split’ as a routine method to differentiate epidermolysis bullosa acquisita from bullous pemphigoid1
Authors: Feliciani Claudio , Di Muzio Marcello , Pour Saman Mohammad , Allegretti Tiziana , Amerio Paolo , Toto Paola , Coscione Giulia , Proietto Gianluca , Amerio Pierluigi
Published: September 2006

Background and Design

Epidermolysis bullosa acquisita (EBA) and bullous pemphigoid (BP) are diseases with similar clinical, histological, and immunofluorescent findings. Diagnosis requires the use of immunoelectron microscopy, immuno‐precipitation or immunoblotting, but in recent years the differential diagnosis has been based on a cheaper technique named salt split skin. This study demonstrates that with a suction blister the fracture is at the same level as that obtained with the sodium split method and that it is also faster and cheaper. Suction blisters on normal skin and autoimmune perilesional bullous lesions, obtained with a hand vacuum pump, were studied by direct immunofluorescence and electron microscopy to evaluate the level of the split on normal suction split skin. Normal human split skin was also used as a substrate for an indirect immunofluorescent study using sera of patients with BP (68 sera), EBA (10 sera) and cicatricial pemphigoid (CP) (16 sera). Direct immunofluorescent examination was also done on perilesional skin after artificial separation obtained with a hand‐vacuum pump in patients with the same diseases listed above (32 BP, 11 CP, 6 EBA).

Results

On normal human skin split by suction or sodium chloride (NaCl; 1 mol/1) direct immunofluorescence and electron microscopy demonstrated that the split is at the lamina lucida level. Indirect immunofluorescent study of both normal human skin and perilesional skin split using suction as a substrate showed IgG deposits localized on the floor of the suction blister in all cases of EBA, whereas in over 88% of cases of BP and in over 62% of CP the IgG were localized on the roof. Similar results were obtained with direct immunofluorescence in perilesional skin.

Conclusions

‘Suction split’ represents a simple technique to differentiate EBA from BP. This method provides final response in a few hours compared to at least 1–2 days with the sodium split method. Furthermore, the suction split method is cheaper and the tissue can be re‐utilized for molecular biology and immunohistochemical studies.
Mycosis fungoides with involvement of the oral cavity
Authors: Harman Mehmet , Akdeniz Sedat , Arslan Adem , Aöyoĝlu Sadik
Published: September 2006

Mycosis fungoides rarely involves the oral cavity. To our knowledge only 29 cases of oral cutaneous T‐cell lymphoma have been described up to 1994. This report presents a case of mycosis fungoides with involvement of the oral cavity in a 57‐year‐old man who died from septicemia 7 months after the onset of oral involvement.
Fatal cytophagic histiocytic panniculitis after a short response to cyclosporine
Authors: Guitart Joan , Sethi Ruchi , Gordon Kenneth
Published: September 2006

Cytophagic histiocytic panniculitis (CHP) is a disorder characterized by a histiocytic infiltrate in the subcutaneous adipose tissue which often extends to involve systemic organs. Fever, pancytopenia, hepatosplenomegaly, mucosal ulcers and serositis are common systemic symptoms. Although remissions have been reported, the disease tends to follow a chronic course often complicated by terminal hemorrhagic diathesis and death. Several reports in the recent literature have suggested that cyclosporine is the treatment of choice in CHP. We report the first case of cyclosporine treatment failure in CPH. Despite an initial response to treatment and persistent resolution of cutaneous lesions, the internal disease progressed resulting in the patient's death. Therefore the evolution of skin lesions and signs of systemic involvement may not be an accurate assessment of disease activity in patients with CHP being treated with cyclosporine.
Medium dose isotretinoin for the treatment of acne
Authors: Hermes B. , Praetel C. , Henz B.M.
Published: September 2006

Background

Although the efficacy of isotretinoin in the treatment of acne is unquestioned, improvement of patient tolerance and acceptance of the drug are desirable. Furthermore, no data on acne‐induced scarring during isotretinoin treatment are available.

Aim

In the present study, we have evaluated the efficacy and tolerability of an initial stepwise incremental (n= 83) or an initial high dose (n= 11) and a subsequent medium maintenance dosing of isotretinoin in outpatients treated for acne over a 7 year period.

Methods

Ninety‐four patients with moderate to severe acne were treated for a mean duration of 8.3 months, at a mean daily dose of 31.4 mg. Follow‐up and final evaluation were done during outpatient visits and with a standardized patient questionnaire.

Results

Response to treatment was very good in 62.8% and good in 31.9% of patients, with only one treatment failure. Of the patients, 21.3% required retreatment after a mean interval of 7.7 months. Four patients refused or dropped out from treatment, 27% noted initial mild worsening of their acne, and none experienced severe adverse effects. Scars were present in 89.4% of patients, with improvement occurring in 67.9% during treatment.

Conclusion

The altogether good to excellent clinical response of acne lesions and acne scars, with a low side effect profile, warrants further study of this simple, modified treatment regimen in patients with acne and acne‐induced scarring.
Disseminated skin infection due to Mycobacterium fortuitum in an immunocompetent patient
Authors: Salvador J.F. Silvestre , Betlloch M.I. , Alfonso R. , Ramón R.L. , Morell A.M. , Navas J.
Published: September 2006

Skin infections caused by atypical rapid‐growing mycobacteria, which used considered to be unusual, have become more frequent, especially in immunodepressed patients. Clinical cutaneous disease with these pathogens seems to follow two patterns: in the immunocompetent host, a traumatic injury is followed by the development of localized abscess formation; but in the immunocompromised individual there is no history of trauma and the patient presents with multiple subcutaneous nodular lesions. We describe a rare case of an immunocompetent young woman with disseminated skin infection due to Mycobacterium fortuitum. We emphasize the diagnostic and therapeutic problems associated with such infections.
Depot sulfonamid associated linear IgA bullous dermatosis with erythema multiforme‐like clinical features
Authors: Tonev S. , Vasileva S. , Kadurina M.
Published: September 2006

A case of erythema multiforme‐like reaction, following therapy with sulfadimethoxynum is reported in a 19‐year‐old male patient. Histological examination demonstrated a subepidermal bulla and direct immunofluorescence revealed linear deposition of IgA at the dermoepidermal junction. These observations illustrate that linear IgA bullous dermatosis can mimic the clinical features of erythema multiforme and suggest the possibility of drug‐induced pathogenesis.
Efficacy of cyclosporine plus etretinate in the treatment of erythrodermie psoriasis (three case reports)
Authors: Kokelj Franco , Plozzer Carmela , Torsello Pierpaolo , Trevisan Giusto
Published: September 2006

Background

Association of different treatments are often used in erythrodermic psoriasis in order to increase the effectiveness and decrease the incidence of side effects due to single drugs.

Materials and methods

Three in‐patients affected by erythrodermic psoriasis, not responding to cyclosporine, (two patients) and etretinate, (one patient), were treated with the association cyclosporine plus etretinate.

Results

Clinical response was prompt to the combined therapy. The two drugs were tapering off gradually over 6 months; the patients maintained the remission for prolonged period.

Conclusions

Combined cyclosporine‐etretinate therapy may be considered as an effective and well tolerated treatment of erythrodermic psoriasis in patients not responding to monotherapy regimen.
Transdermal absorption of topical anti‐acne agents in man; review of clinical pharmacokinetic data
Authors: van Hoogdalem E.J.
Published: September 2006

Background

Apart from oral drug treatment, drug therapy in acne vulgaris comprises topical treatment with agents with a primarily keratolytic action (e.g. tretinoin and benzoylperoxide), and with antibiotics (clindamycin, erythromycin, and erythromycin‐zinc complex). The acne grade in the particular patient usually determines the selection of the preferred route of administration, viz. topical or oral, or a combination of both, and topical treatment is usually preferred in mild to moderate acne. The fact that a topically applied compound may also become systemically available to a quantifiable extent, is not generally considered.

Aim

The present paper reviews the clinical data on transdermal uptake of anti‐acne agents in man, also with respect to their relevance for daily clinical practice.

Outcome

The majority of published data on transdermal penetration of topical anti‐acne agents focuses on the retinoid tretinoin, and on the antimicrobial agent clindamycin. This interest emerges from the fact that these agents have been associated with embryotoxicity/teratogenicity, and pseudomembranous colitis, respectively. For both compounds the extent of systemic availability after topical application is low, viz. 5–7% and 8%, respectively, at its highest. The height and variability in endogenous retinoid levels is very likely to outweigh any contribution of exogenously applied tretinoin, but a full consensus on the safe use of topical tretinoin in pregnancy is still lacking. With respect to clindamycin, the suggested association between its topical use and the occurrence of pseudomembranous colitis appears not to be of clinical relevance. In order to reduce systemic exposure to clindamycin as much as possible, topical application of clindamycin phosphate is to be preferred over clindamycin hydrochloride salt. Regarding other topical anti‐acne agents, it has been suggested that topical zinc‐erythromycin is to be preferred over erythromycin, both from clinical efficacy and safety viewpoints. With respect to the currently used compounds like benzoylperoxide, azelaic acid, and adapalene, available clinical pharmacokinetic data are scarce, and significant safety concerns did not emerge as yet.

Conclusion

The limited transdermal uptake of topical anti‐acne agents underpins their safe use in daily clinical practice. With respect to topical retinoids, formal consensus is lacking regarding their use in pregnancy.
Clinical efficacy of Velac®, a new tretinoin and clindamycin phosphate gel in acne vulgaris
Authors: Cambazard F.
Published: September 2006

Velac®, a new gel formulation containing both tretinoin (0.025%) and clindamycin phosphate (1.2%), is effective in acne vulgaris using a once daily application. The single formulation enhances compliance in young patients and improves the therapeutic results. Treatment with Velac was found to be more effective than tretinoin alone in inflamed lesions and at least comparable in open and closed comedones. In two of the three studies the overall acne severity grade was significantly more reduced when compared with tretinoin. Velac is also more effective than clindamycin alone in the treatment of the non‐inflamed lesions. In the two multicentre studies the reduction of the overall acne severity grade was also more favourable for the new gel formulation. A more rapid response occurred with Velac than with either component used (clindamycin or tretinoin) alone.
Skin diseases associated with hepatitis C virus infection
Authors: Hadziyannis Stephanos J.
Published: September 2006

Hepatitis C virus (HCV) is a bloodborne agent transmitted by apparent and inapparent parenteral procedures representing a frequent cause of liver disease world‐wide. Both acute and chronic HCV infection may affect the liver as well as various non‐hepatic tissues. Numerous extrahepatic disorders have been recognised in association with HCV infection among which dermatological diseases occupy a central part. Cutaneous necrotising vasculitis, mixed cryoglobulinemia, porphyria cutanea tarda and lichen planus are the major skin diseases frequently associated with HCV infection, but other skin disorders, such as Adamantiadis‐BehQet syndrome, erythema multiforme and nodosum, malacoplakia, urticaria and pruritus, may also be linked to hepatitis C. Further studies are necessary to establish or refute an aetiopathogenetic role of HCV in these conditions. Skin manifestations are also part of the clinical picture of other extrahepatic disorders associated with HCV infection, such as thyroid dysfunction and HCV‐related thrombocytopenia. The response to interferon alpha (a‐IFN) therapy in skin diseases is unpredictable with some patients ameliorating, others remaining stationary and others deteriorating.
Low‐dose retinoid therapy for chemoprophylaxis of skin cancer in renal transplant recipients
Authors: Gibson G.E. , O'Grady A. , Kay E.W. , Murphy G.M.
Published: September 2006

Background Renal transplant recipients have an increased incidence of skin cancers, which may be multiple and aggressive.

Objectives The purpose of this study was to examine the chemoprophylactic effects of low‐dose etretinate (0.3 mg/kg/day) on skin cancer development in renal transplant recipients and to monitor retinoid toxic effects at this dose.

Methods All skin lesions were counted and photographed prior to therapy with etretinate. Patients were assessed at monthly intervals for new skin lesions and for retinoid toxicity.

Results Eleven renal transplant recipients participated. There was a significant reduction in the number of skin cancers which occurred during etretinate therapy compared with pre‐treatment for 3 and 6 months of treatment, and a trend towards fewer skin cancers in the 12 and 18 month treatment periods. Side‐effects were well‐tolerated and no significant biochemical effects were observed.

Conclusion Low dose etretinate is safe, well‐tolerated and partially effective in chemoprophylaxis of skin cancer in renal transplant recipients.