bluuebunny/crossref_metadata_2025 huggingface dataset:
The profile and outcome of pustular psoriasis in Singapore: a report of 28 cases
Authors: Tay Yong‐Kwang , Tham Siew‐Nee
Published: November 2003

Background Pustular psoriasis is a rare form of psoriasis that can be divided into generalized and localized forms. The aim of this study is to describe the patient profile and outcome of pustular psoriasis seen at a tertiary referral skin center in a tropical country.

Methods The records of all patients with pustular psoriasis during the 4 years from 1989 to 1993 were reviewed. Diagnostic criteria for selection included at least one episode of either generalized or localized macroscopic noninfective pustulation.

Results There were 28 patients with pustular psoriasis, with an age range of 4–77 years. Nineteen patients had generalized pustular psoriasis: Von Zumbusch (seven), annular form (two), juvenile form (six), pustular psoriasis of pregnancy (one), and the localized form of generalized pustular psoriasis (three). Nine patients had localized pustular psoriasis: palmoplantar pustulosis (five) and acrodermatitis continua (four).

Patients with the acute Von Zumbusch pattern had recalcitrant disease with multiple flares and significant morbidity and mortality. Patients with the annular form had a subacute onset and a chronic course. In patients with the juvenile form of generalized pustular psoriasis, two patterns could be recognized: Zumbusch form (four) and annular form (two). Despite significant morbidity, each of our young patients had a relatively benign course with no deaths and an excellent response to etretinate therapy. Our nine patients with localized pustular psoriasis all had a chronic course: the average duration of disease was 6 years for patients with palmoplantar pustulosis and 12 years for patients with acrodermatitis continua.

ConclusionsThe pattern of pustular psoriasis seen in Singapore is similar to that reported in the Western literature. Using these categories we can provide guidelines for treatment and prognosis.
Coal tar therapy in paimoplantar psoriasis: old wine in an old bottle?
Authors: Kumar Bhushan , Kumar Ravi , Kaur Inderjeet
Published: November 2003

Background Paimoplantar psoriasis (PPP) is a disabling condition which is usually resistant to most of the available therapeutic modalities. Coal tar is an accepted therapy for psoriasis which has not been well studied for PPP.

Methods Thirty patients with a plaque type of PPP were allocated into two groups: Group A (19 patients) were treated with 6% crude coal tar (CCT) ointment and Group B (11 patients) were treated with white petrolatum and salicylic acid. In both groups, ointment was applied and left on overnight. Wearing of gloves and socks during the night and application of emollients in the day was routinely advised The lesions were assessed for erythema, scaling, and induration (ESI) every 2 weeks for a total of 8 weeks. Patients with greater than 50% improvement were considered to have good improvement. Side‐effects, if any, were also monitored.

Results In Group A, 76.5% of patients (13/17) showed good improvement, whereas only 45.5% of patients (5/11) in Group B showed the same magnitude of improvement (P < 0.05). No side‐effects were reported by any patient in either of the groups.

Conclusions Crude coal tar is a safe, effective, and inexpensive modality for the treatment of PPP. We recommend coal tar under occlusion, along with the liberal use of emollients, as the first line of therapy for all cases of PPP.
Khite: a non‐Western technique for temporary hair removal
Authors: Abdel‐Gawad Mamdouh M. , Abdel‐Hamid Ibrahim A. , Wagner Richard F.
Published: November 2003

Background Khite (also known as fatlah in Egypt) is a manual technique of temporary vellus hair removal that is widely performed In the Middle East.

Methods The technique of khite is reviewed as illustrated.

Results Khite is an effective method of removing unwanted vellus hairs.

Conclusions Dermatologists in all parts of the world should be familiar with khite, because the ease of international travel may bring patients to their attention who have khite‐association complications such as erythema, folliculitis, and secondary pigmentary changes.
Plasmapheresis in toxic epidermal necrolysis
Authors: Chaidemenos George Ch. , Chrysomallis Fotis , Sombolos Kostas , Mourellou Olga , Loannides Dimitris , Papakonstantinou Mary
Published: November 2003

Background The treatment of toxic epidermal necrolysis (TEN) is usually based on the removal of the offending drug(s), fluid replacement, nutritional support, and local management. The mortality and morbidity, however, remain high and the death rate may be reduced to 10% only in special centers that use biologic dressings. Plasma exchange (PE) was proven efficacious in small series of patients and of no particular value in others.

Methods Seven patients suffering from severe TEN covering 30%–80% of body surface area and having two or four mucous membranes involved, were included in this open study. Malignancy (Hodgkin's disease, brain tumor) and a variety of medicaments (carbamazepine, allopurinol, diphenylhydantoin, cefaclor, amoxicyllin with clavullanic acid) were considered as causally implicated. One to four PEs of 2.5 L were given on alternate days in six patients and on a daily basis in the seventh.

Results All patients recovered successfully from their disease. No new lesions appeared after the first PE in four patients. Neither adverse reactions from this therapy nor sequelae from TEN were observed after a long follow‐up lasting up to 8 years.

Conclusions Although PE is expensive and requires easy venous access to be performed, it could be listed in the first line of TEN therapy. The method is safe and efficacious, providing prompt relief from pain and rapid cessation of necrolysis. The alternate day PEs are considered preferable to the everyday regimen.
Topical calcipotriene in combination with UVB phototherapy for psoriasis
Authors: Hecker David , Lebwohl Mark
Published: November 2003

A total of 20 patients with symmetric plaque‐type psoriasis were recruited for a controlled, investigator‐blinded, right–left study. None of the patients had used any therapy other than emollients for 2 months prior to starting in the trial. All patients had a negative antinuclear antibody. By history, all patients had previously improved upon exposure to sunlight or ultraviolet light. Two symmetrical sites of equal severity were selected as target areas. Each patient was treated on one side with mineral oil twice daily and on the opposite side with calcipotriene 0.005% ointment twice daily. The investigator was blinded as to which site received which topical treatment. Both sides were treated with equal doses of ultraviolet B (UVB) three times weekly in graduated suberythemogenic doses. Ultraviolet B radiation was emitted by a group of 6‐ft fluorescent bulbs (Light Sources FS72 T12 UVB HO) in a standard phototherapy unit.

The above regimen was continued for a total of 12 weeks. The severity of psoriasis in the target sites was rated by the examiner at baseline and at weekly intervals for the 12 weeks of study. Target sites were rated by severity of erythema, scaling, plaque elevation, and pruritus, with each of these parameters being assigned a score on a four‐point scale: 0, clear; 1, mild; 2, moderate; 3, severe. The four scores were added together to arrive at a total severity score for each of the target sites.

Statistical analysis was performed using the paired t test, P values less than 0.05 were considered statistically significant.

Eleven of the 20 patients (55%) showed a greater decrease in the severity of their psoriasis with UVB plus calcipotriene compared with UVB plus mineral oil. The difference in severity scores between the two groups was statistically significant as early as week 1 (P < 0.05). The difference between the UVB and calcipotriene group versus the UVB and mineral oil group peaked between weeks 3 and 6. The differences then decreased but remained statistically significant through to week 12 (Fig. 1). There were no instances of local cutaneous irritation, but mild photosensitivity occurred symmetrically on both sides in three patients.
Demographic evaluation of successful antipsoriatic climatotherapy at the Dead Sea (Israel) DMZ Clinic
Authors: Harari Marco , Shani Jashovam
Published: November 2003

Background Natural balneologic properties, thermomineral springs and unequivocal success in improving psoriasis, attract an ever‐growing number of psoriatlcs to the DMZ Clinic on the shores of the Dead Sea in Israel.

MethodsThis paper analyses the rate of success of this balneotherapy in 740 psoriatics who flew in from Germany specifically for this treatment, during 1995, as a function of sex, family history of the disease, number of previous treatments at the Dead Sea, skin type, skin involvement, joint involvement, duration of treatment, sun‐exposure schedule, remission length, and psychologic supervision.

ResultsAfter 4 weeks, 70% of the patients were completely cleared, this improvement being about the same across both sexes. Family history of the disease, skin type, and psychologic support did not affect the rate of success. On the other hand, previous treatments at the Dead Sea, moderate to severe skin surface involvement, and participation of arthritis, improved the chance of better clearing of the psoriatic condition. Similar improvement was obtained by a longer sun‐exposure schedule and a complete 4‐week treatment.

Conclusion These results indicate that the medical improvement in the psoriatic condition after a 4‐week stay at the Dead Sea can be better enhanced and its remission prolonged if additional demographic and anamnestic factors are carefully taken into account.
Fluconazole in the treatment of tinea versicolor
Authors: Amer Mohamed A. ,   Egyptian Fluconazole Study Group
Published: November 2003

Patients with tinea versicolor (TV, n= 603) aged 18–65 years entered into an open, randomized, multicenter study to investigate the efficacy and toleration of three dosage regimens of fluconazole. The study was conducted in 10 different centers in six cities in Egypt.

The patients were randomly assigned to one of three groups:

Group I: received single 150 mg fluconazole capsule repeated weekly for 4 weeks;

Group II: received two 150 mg capsules of fluconazole in a single dose repeated weekly for 4 weeks;

Group III: received two 150 mg capsules of fluconazole in a single dose that could be repeated 2 weeks later.

Five visits were scheduled for each group and the last follow‐up visit was always 28 days after the last fluconazole dose. Response to treatment was assessed clinically and by microscopic examination of KOH mounts of skin scrapings, weekly and 28 days after the last fluconazole dose. The number of fluconazole doses administered was guided by clinical and mycologic response, and the dose was repeated only if the patient showed residual clinical lesions or positive microscopy for skin scrapings.

Final evaluation was rated as cure (disappearance of lesions with no or slight color changes), improvement (no scales while color changes were much less but still obvious), and failure (no or slight changes from baseline). Mycologic assessment was rated as eradication, persistence or relapse. All adverse events were recorded during the treatment period.
Testosterone concentrations and oligomenorrhea in women with acne
Authors: Hasinski Stefan , Telang Gladys H. , Rose Leslie I. , Pollock Jeffrey L. , Spielvogel Richard L. , Miller Jeffrey L.
Published: November 2003

Background Androgen excess is frequently associated with oligomenorrhea as well as acne. Oligomenorrhea in hirsute women has been demonstrated to be associated with higher active testosterone levels than found in eumenorrheic hirsute women. This study was designed to evaluate whether similar findings are present in women with acne. Forty‐four consecutive women with acne were evaluated by measuring their levels of total testosterone, biologically active testosterone, and free testosterone. The women with oligomenorrhea and acne had significantly higher levels of biologically active testosterone than those with eumenorrhea and acne. This implies that biological active testosterone should be measured in oligomenorrheic women with acne and, if elevated, consideration should be given to antiandrogen therapy.

Methods Data were collected from 44 consecutive Caucasian women aged 14 to 38 years. The patients were separated into two groups based on menstrual history. Group 1 had regular menses, and group 2 had oligomenorrhea, defined as menstrual intervals of greater than 36 days. All patients had blood samples drawn on their initial office visit, regardless of the phase of the menstrual cycle, and the levels of total testosterone (TT), biologically active testosterone (BT), and free testosterone (FT) were obtained.

Results The serum TT level was 87±41.3 ng/dL (range, 31–150 ng/dL) in oligomenorrheic women and 56±27.5 ng/dL (range 8–107 ng/dL) in eumenorrheic women. There was no statistically significant difference. The serum BT level in oligomenorrheic women was 33±16.9 ng/dL (range, 11–51 ng/dL) and In eumenorrheic women 19±13.6 ng/dL (range, 11–51 ng/dL). This difference was statistically significant (p <0.05). The serum FT level in oligomenorrheic women was 18±9.4 pg/mL (range, 1–29 pg/mL) and in eumenorrheic women 10±7.1 pg/mL (range, 1–32 pg/mL). This difference was not statistically significant (Table 1).

Conclusions Women with acne and oligomenorrhea, similar to women with hirsutism and oligomenorrhea, have higher levels of biologically active testosterone than those with normal menses.
The variable incidence of psoriasis in sub‐Saharan Africa
Authors: Leder Richard O. , Farber Mugene M.
Published: November 2003

abstract

background surveys of skin disorders have previously provided information about the prevalence and incidence of psoriasis in sub‐saharan africa; however, the geographic and ethnic trends which may be drawn from these surveys have not been fully described in previous studies, which considered only a fraction of the available data.

methods a critical review of clinic‐based surveys of psoriasis incidence and population‐based studies of psoriasis prevalence is presented. the incidence of psoriasis is adjusted, wherever possible, to factor out the widely variable incidence of infectious skin conditions seen in african skin clinics. to distinguish between genetic and environmental factors that may be responsible for the variability of psoriasis incidence, attention is drawn to climate, human leukocyte antigen (hla) frequencies, and language groups across the regions surveyed in sub‐saharan africa.

results higher psoriasis incidence rates are consistently observed in eastern africa than in western africa, consistent with more limited data on the prevalence of psoriasis in western africa. neither rainfall/humidity levels nor hla frequencies can simply account for these differences; however, the ethnicities of sub‐saharan african peoples may be observed to parallel roughly the trend in psoriasis incidence. western african countries, such as nigeria, mali, senegal, and sierra leone, where lower rates of psoriasis incidence have been reported (less than 1.0% of skin disorders), are populated mainly by non‐bantu‐speaking ethnic groups. bantu‐speaking peoples constitute a majority in the populations of most countries in eastern and southern sub‐saharan africa, where the incidence of psoriasis varies widely. african americans, whose largely non‐bantu‐speaking african ancestry is shared with modern western africans, also have relatively low psoriasis incidence rates by comparison with north american caucasians.

conclusions ethnic correlations both within africa and between north america and africa suggest that unidentified genetic factors, which differ between eastern and western sub‐saharan africans, may govern the differential incidence of psoriasis.
Pigmented skin lesions in tyrosinase‐positive oculocutaneous albinos: a study in black South Africans
Authors: Bothwell Janet E.
Published: November 2003

Background The aim of this study was to document the nature, prevalence, and distribution of pigmented skin lesions in tyrosinase‐positive oculocutaneous albinism (typos OCA), the most common recessive disorder in South Africa (overall prevalence, 1 in 3900).

Methods Sixty‐one black subjects with ty‐pos OCA (mean age, 23 years) and 65 normally pigmented black control subjects (mean age, 29 years) were studied.

Results Pigmented skin lesions not directly related to sun exposure included nevi and pigmented macules on the palms and soles. Melanocytic nevi, mostly on the trunk, were present in 82% of subjects with ty‐pos OCA and in 71% of controls. The mean numbers were, however, greater in the ty‐pos OCA subjects than in the controls (12 and 7, respectively), being closer to those reported in whites. Palmoplantar pigmentation was present in 75% of the control subjects, but in none of those with ty‐pos OCA. The most striking sun‐related lesions were dendritic freckles, which were present in 43% of ty‐pos OCA subjects, and were characterized by an irregular branched shape, light to dark brown color, and large size (0.5–3.0 cm). Clinically, they resembled solar lentigines, but histologically the rete ridges were often flattened and there was no increase in the number of melanocytes. Solar keratoses occurred less frequently in ty‐pos OCA subjects with dendritic freckles (50% vs. 73%), which confirmed the sun‐protective role of the increased ability to form pigment.

Conclusions There were two major conclusions. Firstly pigmented nevi occur much more commonly in ty‐pos OCA subjects than was previously thought, being similar in number to those found in white subjects. Secondly, dendritic freckles appear to represent a unique clinical and histologic entity found only on sun‐exposed areas in ty‐pos OCA subjects.
Albendazole: a new therapeutic regimen in cutaneous larva migrans
Authors: Rizzitelli Gaetano , Scarabelli Gabriele , Veraldi Stefano
Published: November 2003

Background Various therapeutic modalities have been used to treat cutaneous larva migrans, including physical treatments (cryotherapy), topical drugs (tiabendazole), and systemic drugs (tiabendazole, albendazole, and ivermectin). Physical treatments are often ineffective and not devoid of side‐effects. Topical tiabendazole is difficult to find in many countries; it is effective orally but frequently causes side‐effects. Ivermectin has been used in a small number of patients.

Methods Eleven (six men and five women) adult patients with cutaneous larva migrans characterized by multiple and/or diffuse lesions were treated with oral albendazole (400 mg daily for 7 days). No other topical or systemic drugs were used and no physical treatment was given.

Results All patients were cured at the end of treatment. No side‐effects were complained of or observed, and no laboratory abnormalities were recorded. No recurrences were observed.

Conclusions Albendazole is effective in the treatment of cutaneous larva migrans characterized by multiple and/or diffuse lesions. This new therapeutic regimen can reduce the number of no responses and recurrences, sometimes observed following shorter (e.g. 3–5 days) treatments with albendazole. The longer duration of treatment is not accompanied by the appearance of new and/or more severe side‐effects.
Classic Kaposi's sarcoma in Greece: a clinico‐epidemiological profile
Authors: Stratigos John D. , Potouridou Irene , Katoulis Alexander C. , Hatziolou Eftichia , Christofidou Eleftheria , Stratigos Alexander , Hatzakis Angelos , Stavrianeas Nicholas G.
Published: November 2003

Background Classic Kaposi's sarcoma (CKS) is not uncommon in Greece with a reported incidence of 0.20 per 100,000 per year.

Methods Epidemiological, clinical and histological features of all CKS cases, diagnosed in‘A. Sygros’ hospital, Athens, Greece during the years 1989–1994, have been recorded and studied prospectively.

Results During the five‐year period studied, 66 CKS patients have been diagnosed in our hospital. Incidence among dermatologic patients was 2.11 per 10,000 patients examined, representing 1.35% of total skin malignancies. Patients' age at diagnosis ranged from 53 to 94 years (mean 72±8.8). The male to female ratio was 2.47:1. A high proportion of the patients were born in Peloponnesos (42.42%) and were residing in Athens (51.51%) or in Peloponnesos (24.24%). Nodules and/or plaques were the most frequent type of lesion, most commonly located on the feet (43.93%) or the hands (28.78%). Accompanying edema was seen in 51.51% of the patients. There were 16 stage I patients (24.24%), 40 stage II (60.60%), 0 stage III and 10 stage IV (15.15%). Involvement of visceral organs was detected in seven patients (10.60%), while 10 had lymph node involvement (15.15%) and three, involvement of the underlying bones (4.54%). Second primary malignancy was diagnosed in 6 cases (9.09%), most often of the reticuloendothelial system (83.33%).

Conclusions CKS in Greece exhibits some special characteristics, including older age of onset; lower male to female ratio; endemic clustering; disseminated skin disease at diagnosis, often accompanied by lymphedema; not unusual visceral or lymph node involvement and association with second malignancies. We suggest that CKS in Greece possibly represents a distinct endemic subtype of CKS.
Skin colonization of Staphylococcus aureus in atopic dermatitis patients seen at the National Skin Centre, Singapore
Authors: Goh Chee‐Leok , Wong Julie S. , Giam Yoke Chin
Published: November 2003

Objective This prospective study sought to determine the bacterial colonization rates on eczematous and non‐eczematous skin and nasal mucosa of patients with atopic dermatitis

Patients Patients, of any age, presenting with atopic dermatitis at the subsidized clinic of the National Skin Centre, Singapore, between 23 August 1996 and 14 September 1996, were included in the study.

Results Thirty‐three patients with atopic dermatitis were seen at the outpatient clinic during the study period. Staphylococcus aureus was isolated in 69.7% of the eczematous lesions and in 42.4% of non‐eczematous skin of patients with atopic dermatitis. S. aureus was isolated in 53% of patients with mild dermatitis, and in 100% with moderate and severe dermatitis. The nasal carriage rate of S. aureus was higher in atopic dermatitis patients (51.5%) than in non‐atopies (35%) (not significant). S. aureus was isolated in 42% of noneczematous skin in atopies compared with only 5% in the control group (p= 0.003). In patients with atopic dermatitis, all S. aureus isolated was sensitive to cloxacillin, cephalexin, clindamycin, and co‐trimoxazole; 92% was sensitive to erythromycin, but only 13% was sensitive to penicillin and ampicillin. In the control group, all S. aureus isolated was sensitive to cloxacillin, cephalexin, erythromycin, clindamycin, and co‐trimoxazole, but only 13% was sensitive to penicillin and ampicillin, and 87% to tetracycline.

Conclusions This study confirmed that the skin of patients with atopic dermatitis was more frequently colonized with S. aureus than that of non‐atopics. The more severe the dermatitis, the higher the rate of colonization. S. aureus is also more often present in non‐eczematous skin of atopics than of non‐atopics. There is also a higher percentage of S. aureus nasal carriage in patient's with atopic dermatitis than in non‐atopics. Hence antibiotics may have a role in the treatment of atopic dermatitis. Because 87% of S. aureus is resistant to penicillin and ampicillin, antibiotics such as cloxacillin and cephalexin should be used to eradicate S. aureus in the skin of atopic dermatitis individuals.
Dermatoses among Brazilian HIV‐positive patients: correlation with the evolutionary phases of AIDS
Authors: Rosatelli Jacy B. , Machado Alcyone A. , Roselino Ana Maria F.
Published: November 2003

Background The presence of dermatoses is very common in Acquired Human Immunodeficiency Syndrome (AIDS). The present study was undertaken to correlate the various dermatoses with the evolutionary phases of AIDS.

Methods We examined 223 HIV‐infected patients older than 13 seen at the University of São Paulo, Faculty of Medicine of Ribeirão Preto, from 1989 to 1993. Patients were divided according to the CDC classification and assigned to groups I, II and III (initial stages of AIDS) and to group IV (fully symptomatic stage of AIDS).

Results The mean frequency of dermatoses detected in patients with AIDS was higher compared to the early phases of HIV infection. The most frequently detected dermatoses were, in decreasing order of occurrence, dermatoses of fungal etiology, and desquamating disorders, such as psoriasis, seborrheic dermatitis, xerosis, and viral dermatoses.

Conclusions A careful examination of skin and mucosae may be highly useful for the diagnosis of HIV infection. The number of dermatoses tended to increase during the more advanced stages of infection.
Clarithromycin versus doxycycline in the treatment of rosacea
Authors: Torresani Claudio , Pavesi Angelo , Manara Gian Carlo
Published: November 2003

Forty patients with rosacea were entered into a study comparing clarithromycin with doxycycline in the systemic treatment of mild and severe rosacea. The patients, 25 women and 15 men, aged from 26 to 62 years, were subdivided into two homogeneous groups with regard to age, sex, and disease seventy. The first group of 23 patients, 14 women and 9 men, was treated with 250 mg of clarithromycin for 4 weeks twice daily, and then with 250 mg once daily for the following 4 weeks. The second group of 17 patients, 11 women and 6 men was treated with 100 mg of doxycycline for 4 weeks twice daily, and then with 100 mg once a day for the following 4 weeks. Both objective and subjective evaluations of the dermatosis were performed prior to therapy and after 4, 6, and 8 weeks of treatment.
Variations in lipid and lipoprotein levels during isotretinoin treatment for acne vulgaris with special emphasis on HDL‐cholesterol
Authors: Lestringant Gilles G. , Frossard Philippe M. , Agarwal Mukesh , Galadari Ibrahim H.
Published: November 2003

Background Many studies have demonstrated an increase in total cholesterol and triglycerides on oral isotretinoin therapy. This has led several investigators to comment on the possibility of increased risk for cardiovascular disease. Yet, the status of high density lipoprotein (HDL) in patients on isotretinoin therapy has not been studied extensively. Patients and methods We studied 104 United Arab Emirates (UAE) nationals (78 women, 26 men) who underwent isotretinoin therapy for acne at doses ranging from 0.2 to 1.6 mg/kg, and determined the lipid and lipoprotein levels before and after an 8–week period of treatment. The risk for cardiovascular disease was evaluated as the ratio of cholesferol/HDL‐cholesterol.

Results Mean cholesterol, triglycerides, and low density lipoprotein‐cholesterol (LDL‐cholesterol) levels rose significantly after treatment (p=0.01) whereas HDL‐cholesterol values decreased significantly (p=0.01). In the entire subject population, the overall risk for cardiovascular disease rose from 3.45 to 3.67, indicating that these subjects remained in the category considered to have “half‐average” to “average” risk of cardiovascular disease.

Conclusions In young and healthy individuals, significant variations in lipid and lipoprotein levels, resulting from isotretinoin treatment for acne, do not influence the overall risk for cardiovascular disease. Isotretinoin is thus a safe and efficient drug for the treatment of acne in these subjects.
Germ plasm in Caenorhabditis elegans, Drosophila and Xenopus
Authors: Ikenishi Kohji
Published: November 2003

Special cytoplasm, called germ plasm, that is essential for the differentiation of germ cells is localized in a particular region of Caenorhabditis elegans, Drosophila and Xenopus eggs. The mode of founder cell formation of germline, the origin and behavior of the germline granules, and the molecules localized in germline cells are compared in these organisms. The common characteristics of the organisms are mainly as follows. First, the founder cells of germline are established before the intiation of gastrulation. Second, the germline granules or their derivatives are always present in germline cells or germ cells throughout the life cycle in embryos, larvae, and adults. Lastly, among the proteins localized in the germ plasm, only Vasa protein or its homolog is detected in the germline cells or germ cells throughout the life cycle. As the protein of vasa homolog has been reported to be also localized in the germline‐specific structure or nuage in some of the organisms without the germ plasm, the possibility that the mechanism for differentiation of primordial germ cells is basically common in all organisms with or without the germ plasm is discussed.
A method for hormonal induction of sperm release in anurans (eight species) and in vitro fertilization in Lepidobatrachus species
Authors: Waggener William L. , Carroll Edward J.
Published: November 2003

Injections of synthetic human gonadotropin releasing hormone (GnRH) into the dorsal pelvic area were used in an attempt to stimulate sperm release in isolated males of eight anuran species including Xenopus laevis, Rana pipiens and Lepidobatrachus laevis. Sperm were obtained within 1–5 h post injection either by mechanical stimulation or by cloacal lavage. Sperm suspensions varied from 8 μL to 7 mL and the cell densities ranged from 4 × 105 to 4 × 107 sperm/mL. The sperm obtained from seven species using GnRH‐induced release were viable based on light microscopic observations of motility. In addition, sperm preparations fertilized eggs in vitro and produced normal tadpoles in the case of L. laevis and L. llanensis. This hormonal method of anuran sperm collection will provide a convenient non‐injurious way to obtain anuran sperm for basic studies of reproduction and development.
The third egg envelope subunit in fish: cDNA cloning and analysis, and gene expression
Authors: Sugiyama Hitoshi , Yasumasu Shigeki , Murata Kenji , Iuchi Ichiro , Yamagami Kenjiro
Published: November 2003

The inner layer of the egg envelope of a teleost fish, the medaka, Oryzias latipes, consists of two major subunit groups, Zl‐1,2 and Zl‐3. On SDS‐PAGE, the Zl‐1,2 group presents three glycoprotein bands that were considered to be composed of a common polypeptide moiety derived from their precursor, choriogenin H (Chg H). Zl‐3 is a single glycoprotein derived from the precursor, choriogenin L (Chg L). In the present study, a fraction of a novel subunit protein was found in the V8 protease digest of Zl‐1,2 that was partially purified from oocyte envelopes. This protein fraction was not present in the purified precursor, Chg H. By RT‐PCR employing the primers based on the amino acid sequence of this fraction, a cDNA for the novel subunit was amplified, and a full‐length clone of the cDNA was obtained by screening a cDNA library constructed from the spawning female liver. The clone consisted of 2025 b.p. and contained an open reading frame encoding the novel protein of 634 amino acids. This protein included Pro‐X‐Y repeat sequences in two‐fifths of the whole length from its N‐terminus. Northern blot analysis revealed that the gene expression for this protein occurred in the liver but not in the ovary of spawning female fish. This protein is considered as the third major subunit of the inner layer of the egg envelope of medaka.
Sonic hedgehog expression in developing chicken digestive organs is regulated by epithelial–mesenchymal interactions
Authors: Narita Tomohiro , Ishii Yasuo , Nohno Tsutomu , Noji Sumihare , Yasugi Sadao
Published: November 2003

Sonic hedgehog (Shh) gene encodes a secreted protein that acts as an important mediator of cell–cell interactions. A detailed analysis of Shh expression in the digestive organs of the chicken embryo was carried out. Shh expression in the endoderm begins at stage 7, when the formation of the foregut commences, and is found as narrow bands in the midgut. Shh expression around the anterior intestinal portal at stage 15 is restricted to the columnar endoderm lined by the thick splanchnic mesoderm, suggesting that the existence of thick splanchnic mesoderm might be necessary for Shh expression in the columnar endoderm. After the gut is closed, Shh expression is found universally in digestive epithelia, including the cecal epithelium. However, its expression ceases in the epithelium of the proventricular glands, the ductus choledochus and ductus pancreaticus that protrude from the main digestive duct. When the gizzard epithelium differentiated into glands under the influence of the proventricular mesenchyme, the glandular epithelium lost the ability to express Shh. These findings suggest that Shh expression in the epithelium may be regulated by surrounding mesenchyme throughout organogenesis of the digestive organs and is closely involved in epithelial–mesenchymal interactions in developing digestive organs.
Body fat estimation in children by magnetic resonance imaging, bioelectrical impedance, skinfold and body mass index: A pilot study
Authors: CHAN YL , LEUNG SSF , LAM WWM , PENG XH , METREWELI C
Published: November 2003

Objective:

The aim of this study was to identify the clinical method to estimate body fat which gave best correlation of total body fat and percentage body fat as measured on MRI.

Methods:

Magnetic resonance imaging (MRI) was used to estimate the total body fat volume and percentage body fat and this was compared with assessment by bioelectrical impedance (BEI), skinfold thickness and body mass index (BMI) in 8‐ to 12‐year‐old children.

Results:

Total body fat measured on magnetic resonance imaging (TBF–MRI) significantly correlated with body mass index, triceps and subscapular skinfolds, and percentage body fat estimations by BEI. Multiple regression analysis showed that BMI and BEI together gave the best prediction of total body fat as measured on MRI from the equation: TBF–MRI=−25277.77+1457.61(BMI)+423.95 (%fat‐BEI), with R2=0.89 .

Percentage body fat measurement from MRI, BEI and skinfold were not significantly different but their results were not interchangeable. Linear regression of %body fat from MRI on those obtained from BEI and skinfold measurements showed a modest fit with R2=0.6973 and 0.5501, respectively.

Conclusions: In children 8–12 years old, BMI gives a good estimation of the total body fat as measured on MRI. The estimation will be improved when both BEI and BMI are used in the prediction. Bioelectrical impedance has a low correlation with total body fat and its use alone in estimating total body fat is not recommended. Skinfold measurement also gives a reasonably good prediction of total body fat and addition of BMI and BEI does not improve the prediction. Both BEI and skinfold measurements give a modest prediction of %body fat measured by MRI method.
Evolution of sleep‐disordered breathing and sleep in infants
Authors: McNAMARA F , SULLIVAN CE
Published: November 2003

Objective:

The evolution of sleep‐disordered breathing and sleeping patterns in a group of high‐risk infants was studied throughout the first year of life.

Methodology:

Eleven infants with documented sleep apnoea underwent overnight polysomnographic studies at monthly intervals to 6 months, then at 9 and 12 months of age.

Results:

All infants had central apnoea and obstructive events recorded on their initial sleep studies. The sleep‐disordered breathing in these infants was associated with disturbed sleeping patterns. The amount of rapid eye movement (REM) sleep recorded in each study was inversely proportional to the amount of apnoea. The amount of apnoea and sleep disturbances were highest at 2 months of age and then progressively improved and obstructive events resolved by 1 year of age.

Conclusions:

The respiratory abnormalities and sleep disturbances peaked in severity at the age reported to have the highest incidence of sudden infant death syndrome (SIDS) and may have implications for its aetiology.
Adenosine in the management of supraventricular tachycardia in children
Authors: SHERWOOD MC , LAU KC , SHOLLER GF
Published: November 2003

Objective:

To assess the efficacy and safety of adenosine in the management of supraventricular tachycardia in children.

Methodology:

A review of 43 children with supraventricular tachycardia who received intravenous adenosine between June 1992 and July 1995.

Results:

Thirty‐five patients had re‐entrant supraventricular tachycardia and eight patients had atrial tachydysrhythmias. Reversion to sinus rhythm occurred in 75% of episodes in all patients treated for supraventricular tachycardia, and in 96% of episodes in patients with re‐entrant supraventricular tachycardia. Early re‐initiation of supraventricular tachycardia after reversion to sinus rhythm occurred in 25% of episodes. Sixteen percent of patients reverted with the recommended 0.05 mg/kg starting dose, and 35% reverted with a dose of 0.1 mg/kg. Four patients were given adenosine as a diagnostic procedure to elicit occult pre‐excitation. The most common side effects were brief feelings of discomfort. No serious side effects occurred.

Conclusion:

Adenosine is safe and effective in the management of supraventricular tachycardia in children. A commencing dose of 0.1 mg/kg is appropriate.
Osteomyelitis and septic arthritis due to Citrobacter freundii and Haemophilus influenzae type b
Authors: STRICKER T , FRÖHLICH S , NADAL D
Published: November 2003

This report describes dual infection with Citrobacter freundii and Haemophilus influenzae type b causing septic arthritis and osteomyelitis of the elbow in a previously healthy 5‐year‐old boy. The patient was treated successfully with intravenous fosfomycin for 4 weeks.

 Infections with Citrobacter beyond the neonatal period are rare in paediatric patients. When Citrobacter spp. is isolated, coinfection with other bacterial pathogens should be considered.
Meningitis due to Haemophilus influenzae type f
Authors: PINCUS DR , ROBSON JMB
Published: November 2003

Objective:

To describe a case of Haemophilus influenzae type f (Hif) meningitis occurring in the H. influenzae type b (Hib) vaccine era.

Results:

Successful treatment of a case of Hif meningitis in a previously vaccinated 3‐year‐old girl is described. The outcome was complicated by deafness. No underlying immunosuppression was demonstrated.

Conclusions:

Despite the great success of Hib vaccines in reducing invasive disease due to H. influenzae, cases of H. influenzae meningitis continue to occur, caused by less common encapsulated serotypes. Whether there will be an increase in the number of these cases in the vaccine era is unknown and infection due to non–b serotypes requires close monitoring.
Symptomatic zinc deficiency in breast‐fed term and premature infants
Authors: STEVENS J , LUBITZ L
Published: November 2003

Two 3‐month‐old exclusively breast‐fed infants, one born at full‐term and the other born prematurely, developed symptomatic zinc deficiency manifested by an acrodermatitis enteropathica‐like eruption. Inadequate breast milk zinc was demonstrated in both cases. A rapid clinical response followed oral zinc supplementation after which their serum zinc levels returned to normal. The infants remained asymptomatic following cessation of zinc therapy. Reports of similar cases suggest that in a group of infants breast milk does not meet their nutritional zinc requirements. Inadequate breast milk zinc is thought to result from a defect in transfer of zinc from maternal serum to breast milk.
A cluster of cases of neonatal coxsackievirus B meningitis and myocarditis
Authors: DALEY AJ , ISAACS D , DWYER DE , GILBERT GL
Published: November 2003

Three babies were referred with enteroviral meningitis and myocarditis during a 4‐month period. During this same period there was an increased frequency of coxsackievirus B type 2 isolates reported to the National Centre for Disease Control. Myocarditis was simultaneous with meningitis in one baby, but delayed by 10 weeks in another, in whom myocarditis mimicked myocardial infarction. Two of the three mothers experienced abdominal pain, one with antepartum haemorrhage, which has been described previously with coxsackievirus infection in pregnancy. Diagnosis was made in two babies by polymerase chain reaction on cerebrospinal fluid.
Neurological deterioration following head injury: The eyes had it
Authors: FLAHERTY MP , O’FLAHERTY SJ
Published: November 2003

A 17‐year‐old male presented with confusion following a mild head injury. Repeated CT scans of the head were normal. There was a 3 year history of decreased vision, associated with a focal pigmentary retinopathy. On assessment he demonstrated visual agnosia and early dementia. An MRI scan showed symmetrical demyelination of the white matter, particularly of the occipital lobes. The diagnosis of subacute sclerosing panencephalitis (SSPE) was confirmed by the typical EEG findings and the presence of measles antibodies in the CSF. The head injury was the precipitating factor which led to a diagnosis of SSPE. This disease should be considered in young patients who have persisting cognitive dysfunction out of keeping with the severity of the initial trauma. A focal pigmentary retinopathy, especially with macular involvement, should also raise the possibility of SSPE, despite the absence of neurological symptoms initially. We report the longest interval to date between the visual symptoms and onset of neurological signs of SSPE.
Lead exposure and cognitive development: Persistence and a dynamic pattern
Authors: TONG S
Published: November 2003

Objectives:

Although enormous effort has been focused over the past two decades on examining the potential adverse effects of exposure to environmental lead on human health, there has been a debate over the persistence and dynamic pattern of these effects.

Methodology:

Articles relevant to this issue which were published between January 1982 and December 1996 were retrieved from Medline and adjunct searching methods (i.e. hand searching of key journals, review of the bibliographies of reports known to be relevant, consulting with experts, and use of Science Citation Index).

Results:

Currently available epidemiological evidence suggests that ‘low’ level exposure to lead in early childhood is likely to cause a moderate but real and detectable effect on cognitive development, and this effect appears to persist into later childhood. The findings from four long‐term prospective studies seem to support the constant decrement model which assumes that cognitive deficits resulting from early lead exposure persist over an extended period of time even when exposure decreases.

Conclusion:

From a public health perspective, it is highly desirable and prudent to reduce the dispersive uses of lead. Since lead is ubiquitous and persistent in the environment and may have a subtle and persistent effect on cognitive development, how to set the environmental standards for lead exposure is an important scientific issue still open for debate.
Symptomatic urinary tract infection in preschool Australian children
Authors: CRAIG JC , IRWIG LM , KNIGHT JF , SURESHKUMAR P , ROY LP
Published: November 2003

Objective:

To describe the demographic and clinical features, short‐term outcomes, microbiology and renal tract abnormalities of a cohort of young Australian children with symptomatic urinary tract infection.

Methodology:

A total of 304 children <5 years with their first documented symptomatic urinary tract infection who presented consecutively to the Emergency Department of a paediatric hospital between March 1993 and December 1994 and without a known predisposing cause were identified and details of their acute illness were recorded. Renal tract sonography, micturating cystourethrography and Tc‐99 m dimercaptosuccinic acid scintigraphy (DMSA) were routinely performed.

Results:

Of those who presented with urinary tract infection, 169 were boys and 135 girls; 64% were less than 1 year of age. For children from the local community, the cumulative incidence of urinary tract infection within the first 5 years of life was estimated to be 1.9% for boys and 1.8% for girls. There were no significant differences in illness characteristics according to mode of referral or geographical locality. Presenting symptoms were generally nonspecific and not referrable to the urinary tract. There were no deaths. One per cent of children required ventilatory support, and bacteraemia occurred in 6%, all of whom were under 6 months of age. E. coli was the causal organism in 84%, and a high in vitro resistance to ampicillin/amoxycillin (54%) was demonstrated by the pathogens isolated. Bacteriuria was eradicated in 99% with antimicrobial treatment. In this setting, the sensitivities of dipstick urinalysis (leucocyte esterase±nitrites) and pyuria on microscopy (>10×106 white cells L−1) were 85%. Abnormal DMSA scintigraphy was detected in 39%, vesicoureteric reflux in 28%, and obstructive uropathy in 1%.

Conclusions:

This study provides current and local data on a large sample of children <5 years with urinary tract infection, which are useful to clinicians who manage children at risk of the condition.
Antibiotic hypersensitivity reactions in cystic fibrosis
Authors: WILLS R , HENRY RL , FRANCIS JL
Published: November 2003

Objectives:

To document the frequency and severity of reactions to antibiotics in children and adolescents with cystic fibrosis (CF), to determine which drugs and routes of administration are most likely to produce reactions and to assess how these reactions limit the choice of antibiotics.

Methodology:

Medical records were reviewed to ascertain the number and routes of courses of antibiotics and all suspected drug reactions. Patients and their parents were interviewed about drug reactions.

Results:

Fifty‐three records were suitable for analysis. Eighteen of 53 subjects had experienced a reaction (34%). The intravenous route was most allergenic, with 33% of treated patients experiencing a reaction and 9.5% of courses provoking a reaction. Piperacillin was the most allergenic antibiotic.

Conclusion:

Drug hypersensitivity reactions are common in CF. Piperacillin is particularly allergenic. Whilst rarely life‐threatening, the reactions are unpleasant and can limit our choices for antibiotic treatment of their bronchopneumonia.
Childhood sleep problems: Association with prenatal factors and maternal distress/depression
Authors: ARMSTRONG KL , O’DONNELL H , McCALLUM R , DADDS M
Published: November 2003

Objective:

To determine whether problems with childhood sleep behaviour are associated with either maternal sleep patterns and emotional status during the pregnancy period, or levels of maternal distress and depression during the postnatal period.

Methodology:

A case/control comparison study. Cases were families presenting for admissions to a mother/baby hospital in Brisbane with the major presenting problem being the child’s sleep behaviour. The control group consisted of families presenting for well child health care to one of four child health centres in suburban Brisbane.

Each participating mother provided information by way of a self‐report questionnaire on social and demographic variables, children’s sleep patterns, maternal emotional adjustment and maternal sleep pattern during the pregnancy, and current problem with child’s sleep behaviour. Current level of maternal distress/depression, was measured using the Edinburgh Postnatal Depression Scale. Cases were compared with controls on all these variables.

Results:

Significant differences were found between groups in childhood sleep parameters, degree of problem related to childhood sleep, maternal sleep variables during the entire pregnancy, and current levels of maternal distress/depression.

Conclusion:

The origins of problematic childhood sleep behaviour may lie in the pregnancy period.

Levels of maternal distress and depression are associated with problematic childhood sleep behaviour.

 The issue of whether childhood sleep problem predisposes to maternal distress/depression needs exploration.

 Assessment of maternal mood disorder or childhood sleep problems should be comprehensive and involve both the maternal infant dyad and the family network.