bluuebunny/crossref_metadata_2025 huggingface dataset:
Clobetasol under Hydrocolloid Occlusion in Psoriasis Results in a Complete Block of Proliferation and in a Rebound of Lesions following Discontinuation
Authors: Mommers J.M. , van Erp P.E.J. , van de Kerkhof P.C.M.
Published: April 2003

Background: It is a well-established fact that very potent corticosteroids are highly effective in the treatment of psoriatic plaques, and that the addition of a hydrocolloid occlusive dressing (HCD) enhances its efficacy. It is known that topical steroids induce normal differentiation and diminish hyperproliferation during treatment of psoriatic plaques. These changes are reflected by an increase in keratin 10 (K10) and a decrease in keratin 6 (K6), respectively. However, the influence of class IV corticosteroids under HCD on K10 and K6 subpopulations has never been studied. Objective: The present study was performed to study quantitatively the influence of a class IV topical steroid under HCD on the dynamics of K10 and K6 subpopulations. Methods: In the present study, we treated moderately severe stable psoriatic plaques with clobetasol-17-propionate under HCD until clearance was achieved. We took biopsies prior to treatment, after clearance and at relapse. Using flow cytometry, we studied the dynamics of K10 and K6 subpopulations. Results: Prior to treatment, 41.8% of all cells expressed K6. After treatment-induced clearance, this proportion decreased to 1.2%, which is below the normal range. At relapse, pre-treatment levels were observed again. A trend to an increasing number of basal cells and an increase in the proliferative activity of these basal cells at relapse compared to the stable situation prior to treatment was observed. Conclusion: We conclude that clobetasol under hydrocolloid occlusion induces virtually a total block of proliferation of the basal cell population and decreases hyperproliferation-associated keratins dramatically. Furthermore, based upon epidermal cell characteristics, we conclude that a rebound phenomenon occurs following discontinuation of therapy with clobetasol under hydrocolloid occlusion.
Paederus Dermatitis: A Report of 46 Cases in Aydın, Turkey
Authors: Şendur Neslihan , Şavk Ekin , Karaman Göksun
Published: April 2003

Paederus dermatitis is a specific form of acute irritant contact dermatitis caused by pederin, a secretion of insects of the genus Paederus. The disease is characterized by vesicles, bullae and sometimes small pustules on an erythematous base with sudden onset of a stinging, burning sensation. The dermatitis is most frequently seen in regions with a hot, tropical climate. We present 46 cases from Aydın, Turkey, a province well known for its long hot summers. These are the first cases reported from this region. We would like to point out the possibility of Paederus dermatitis in regions with a similar climate and suggest that ‘night burn’ be included among other differential diagnoses of a grouped vesicular and/or pustular lesion on an erythematous base.
Atopic Dermatitis and HTLV-1-Associated Myelopathy: Associated or Coincidental Disorders?
Authors: Shohat M. , Ben Amitai D. , Shohat B. , Mosberg R. , Narinski R. , Klein T. , Okon E. , Roizman P. , Cowan E.P. , Alexander R. , David M.
Published: April 2003

Reports from Jamaica have indicated that some patients with infective dermatitis or atopic dermatitis (AD) are seropositive for antibodies to human T-lymphotropic virus type 1 (HTLV-1). We describe a 32-year-old Israeli woman with long-term AD and paresthesia in the distal parts of the extremities. Neurological examination revealed a positive Babinski’s sign. HLA typing demonstrated that this patient has the common HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and infective dermatitis haplotype for DRB1* DQB1*. The presence of HTLV-1 was demonstrated with polymerase chain reaction; HTLV-1-antibodies were detected by the Western blot method and by inoculation of the patient’s peripheral blood mononuclear cells into F344 rats. This study confirms the presence of HTLV-1 antibodies and proviral genome in a patient with AD which later evolved into HAM/TSP. We cannot yet conclude whether these two diseases are associated or coincidental disorders.
Simultaneous Reactivation of Herpes simplex Virus and Varicella-Zoster Virus in a Patient with Idiopathic Thrombocytopenic Purpura
Authors: Nikkels A.F. , Frère P. , Rakic L. , Fassotte M.-F. , Evrard B. , De Mol P. , Piérard G.E.
Published: April 2003

Simultaneous reactivation of distinct Herpesviridae with development of clinical manifestations is exceptional. We report a 48-year-old woman suffering from idiopathic thrombocytopenic purpura. As the disease remained refractory to corticosteroids, immunoglobulins and splenectomy, a cure of vinblastine was administered. An atypical stomatitis developed few days later. Immunohistochemistry on a Tzanck smear and a biopsy evidenced a Herpes simplex virus type 1 (HSV-1) infection. The patient presented simultaneously a single necrotic lesion on the abdomen. Immunohistochemistry on a skin biopsy revealed the presence of the varicella-zoster virus (VZV) gE, gB and IE63 proteins. Intravenous aciclovir was initiated. The present case of simultaneous clinical infections by HSV-I and VZV underlines the importance of complementary viral identification testing in the event of unusual clinical presentations.
Efficacy of Calcipotriol Ointment Applied under Hydrocolloid Occlusion in Psoriasis
Authors: Castelijns F.A.C.M. , Gerritsen M.J.P. , van Erp P.E.J. , van de Kerkhof P.C.M.
Published: April 2003

Background: Hydrocolloid (HCD) dressings enhance the efficacy of topical corticosteroids. Objective: We wanted to evaluate the effect of calcipotriol ointment under an HCD dressing in the treatment of psoriatic plaques. Methods: In 9 psoriatic patients, we cleared one plaque using this approach and took biopsies at start, clearance and relapse. Clinical and immunohistochemical validation was assessed. Results: After an average treatment of 3.6 weeks, each lesion had cleared (apart from some residual erythema). The average remission period was 8 weeks. During this treatment, the number of cycling epidermal cells (Ki-67-positive nuclei) and the expression of keratin 14 and keratin 16 had decreased substantially. In biopsies taken from the skin immediately adjacent to the relapsing lesion, these markers remained reduced which indicated the prolonged effect of calcipotriol on epidermal differentiation. Conclusion: It is speculated that combination therapy of calcipotriol with treatments with a different mode of action such as photo(chemo)therapy, corticosteroids and cyclosporine might be worthwhile.
Postirradiation Morphea of the Breast Presentation of Two Cases and Review of the Literature
Authors: Schaffer Julie V. , Carroll Carolyn , Dvoretsky Israel , Huether Michael J. , Girardi Michael
Published: April 2003

The advent of radiation therapy as a common modality in the treatment and palliation of breast cancer has led to the observation of morphea developing months to years after supervoltage radiation therapy, in and around the site of treatment. We report 2 new cases of morphea at the site of previous supervoltage radiation therapy for breast cancer. The time period between irradiation and onset of morphea in our 2 patients were an atypically long 6.5 years and 32 years, the latter being the longest reported such interval. With conservative treatment, the inflammatory component of the lesions resolved over an approximately 1-year period, leaving residual sclerosis. These patients are compared to those previously reported in the medical literature so as to summarize the range of clinical presentation and course. Recognition of postirradiation morphea is important in distinguishing it from infectious cellulitis, recurrent carcinoma, metastatic carcinoma or development of a second primary carcinoma.
Long-Term Cefuroxime Axetil in Subacute Cutaneous Lupus erythematosus
Authors: Rudnicka Lidia , Szymańska Elżbieta , Walecka Irena , Słowińska Monika
Published: April 2003

Background: Subacute cutaneous lupus erythematosus (SCLE) is a subset of lupus erythematosus characterized mainly by prominent photoaggravated cutaneous manifestations. Standard therapies for SCLE include topical or systemic steroids and antimalarial drugs. Both methods show limited efficacy in clearing cutaneous lesions and occasionally produce serious side effects. Aim: To assess the efficacy of cefuroxime axetil, an oral cephalosporin with antibacterial and immunosuppressive activity, in patients with SCLE. Methods: Three patients with SCLE were treated with cefuroxime axetil at a daily dose of 500 mg for 30–60 days. Results: In all patients complete clearing of skin lesions was achieved and no side effects were observed. Conclusion: We suggest that long-term cefuroxime axetil administration might be an alternative treatment for patients with SCLE skin lesions.
Downward Trend of Sensitization to Glyceryl Monothioglycolate in German Hairdressers1
Authors: Uter Wolfgang , Geier Johannes , Schnuch Axel
Published: April 2003

Background: Due to a high incidence of cases of (occupational) sensitization to glyceryl monothioglycolate (GMT), products containing this compound were withdrawn from the German market some 8 years ago. Methods: We analyzed the data of the Information Network of Departments of Dermatology in Germany which included 1,336 hairdressers who had been tested with GMT (1% in petrolatum) between 1992 and 1998. Results: The proportion of hairdressers reacting positively to GMT fell from initially 45% in 1992 to less than 20% in 1997 and 1998. Conclusion: This most likely reflects the above-mentioned preventive action.
Male-Pattern Baldness in Men with X-Linked Recessive Ichthyosis
Authors: Trüeb R.M. , Meyer J.C.
Published: April 2003

Background: X-linked recessive ichthyosis (XRI) is a genetic disorder of keratinization with extracutaneous manifestations due to deficiency of steroid sulfatase (STS). Because STS plays an important role in androgen metabolism, and elevated levels of dehydroepiandrosterone sulfate have been reported in young men with andogenetic alopecia (AGA), the hypothesis was advanced that men with XRI do not show AGA or develop only mild forms of common baldness. Methods: Patients with a diagnosis of XRI confirmed by analysis of the microsomal sulfatases in our clinic between 1984 and 1998, and in whom study of the case histories depicted the typical clinical presentation of XRI, were sent a questionnaire with the Hamilton-Norwood scale of patterns of hair loss in men, inquiring them to designate the condition of their scalp hair. Results and Conclusions: Of 15 questionnaires returned, 7 indicated Hamilton-Norwood I, 3 Hamilton-Norwood II, 3 Hamilton-Norwood III-vertex, 1 Hamilton-Norwood IV and 1 Hamilton-Norwood VII. The results of this survey do not support the hypothesis that XRI and AGA are mutually exclusive, in as much as advanced AGA was found among these men.
Patient Compliance and Disease Management in the Treatment of Psoriasis in the Netherlands
Authors: van de Kerkhof P.C.M. , de Hoop D. , de Korte J. , Cobelens S.A. , Kuipers M.V.
Published: April 2003

Background: Compliance behaviour and disease management are important issues in chronic skin diseases. Psoriasis patients are ‘experts by experience’ because of many years of treatment. Therefore, it is relevant to gather data from patients on the actual use of antipsoriatic treatments. Objective: The following questions are addressed: (1) What is the present mode of prescription and actual use of antipsoriatic treatments, including topical treatments, photo(chemo)therapy and systemic treatments? (2) What information do patients expect from their doctor, and do they actually receive this information. Methods: To answer these questions, a questionnaire survey was mailed to the subscribers of Psoriasis, the journal of the Dutch Psoriasis Patients’ Organisation. Results: (1) Major issues in the treatment of psoriasis are (a) long-term management, (b) control of mild, moderate but also extensive psoriasis and (c) control of psoriasis on difficult localisations. Patients perceive itch, scaliness and visibility as major criteria for efficacy. (2) Topical treatment is the mainstay in the management of psoriasis. Calcipotriol is the most prescribed drug. Photo(chemo)therapy has an intermediate position between topical and systemic treatments. UVB is prescribed more than twice as frequently as PUVA and 10% of the patients on photo(chemo)therapy proved to be treated with UVB at home. Only 16% of the patients were on a systemic treatment; methotrexate and acitretin were the most frequently used systemic treatments. (3) More than 70% of the patients indicated that they had taken part in the selection of a treatment. In general, the patients were satisfied about the contact with their dermatologist and general practitioner. Compliance with the duration of treatment is limited, especially with regard to topical treatment. Patient compliance with the dose of the treatment is better. Again compliance is the worst in topical treatments. (4) Patients have a strong preference for an effective treatment which is safe for long-term use. Only a minority of patients wants a fast clearing treatment. Conclusion: Itch, scaliness and visibility provide the most relevant information on the severity of psoriasis, as the patients perceive themselves. Treatment duration is often unrestricted, especially with regard to topical treatments, which implies that the cumulative toxicity potential of these treatments may have a serious impact on their safety profile. Patients regard it of importance to have a vote in the selection of the treatment and regard safety as more important than fast clearing.
Intralesional Methotrexate as Effective Treatment in Solitary Giant Keratoacanthoma of the Lower Lip
Authors: Spieth Konstanze , Gille Jens , Kaufmann Roland
Published: April 2003

When size and location of a keratoacanthoma along with patient-related factors argue against surgical treatment, intralesional methotrexate shows to be an effective, easy and inexpensive alternative. The case report presented validates this treatment modality.
Muir-Torre Syndrome – Treatment with Isotretinoin and Interferon Alpha-2a Can Prevent Tumour Development
Authors: Graefe Tim , Wollina Uwe , Schulz Hans-Joachim , Burgdorf Walter
Published: April 2003

Muir-Torre syndrome is a genodermatosis in which multiple internal malignancies are associated with cutaneous sebaceous tumours and kerato-acanthomas. A 57-year-old man presented with multiple sebaceous tumours, kerato-acanthomas, verrucous carcinoma of the nose, renal cell and transitional cell carcinomas of the left kidney, adenoma of the colon and a positive family history of colon carcinoma. He was treated with interferon (IFN-α2a) s.c. 3 × 106 U three times a week along with 50 mg isotretinoin daily as well as topical isotretinoin gel. During a follow-up of 29 months, only 1 sebaceous skin tumour developed and was removed, whereas more than 30 such skin tumours had been surgically removed during the last 3 years. No evidence of internal tumour development or recurrence was found. The combination of IFN with retinoids seems to be of promise to prevent tumour development in Muir-Torre syndrome.
Silicone Granuloma
Authors: Krayenbühl B.H. , Panizzon R.G.
Published: April 2003

Since silicone has rapidly become one of the most commonly used prosthetic materials in the last 30 years in modern medicine, we have consequently been witnessing more silicone-related disease. Especially after silicone breast implantation, defects in the breast implant have led to serious complications, whereas complications of silicone prosthesis implantation in other body parts are less frequent. Here we present an unusual clinical presentation of a silicone granuloma in a patient with a 27-year history of a wide excision of a melanoma of the right lower extremity and subsequent soft-tissue reconstruction using a silicone device.
Parakeratosis variegata: A Possible Role of Environmental Hazards?
Authors: Rogoziński T.T. , Zekanowski C. , Kaldan L. , Blaszczyk M. , Majewski S. , Jabłońska S.
Published: April 2003

We report 2 cases of parakeratosis variegata (PV) evolving from lesions beginning with characteristics of ashy dermatosis. Both patients presented with a reticulated, poikilodermatous and hyperpigmented eruption with bizarre coalescent lichenoid papules. Histology showed lichenoid epidermotropic infiltrates, more pronounced in case No. 1, consistent with early malignancy. The course was chronic: after more than 10 years, systemic symptoms were not present. In patient No. 1, a monoclonal T-cell population was detected 12 years after the onset of the disease. Both patients had close contact with fertilizers and insecticides. In patient No. 2, the lesions spontaneously regressed within 3 years after cessation of exposure. PV may be a prelymphomatous stage of mycosis fungoides or some closely related cutaneous T-cell lymphoma and does not always evolve into overt malignancy. Gene rearrangement detection techniques may be helpful in predicting the course of the disease.
A Case of Antiepiligrin Cicatricial Pemphigoid Successfully Treated by Plasmapheresis
Authors: Hashimoto Yukiko , Suga Yasushi , Yoshiike Takashi , Hashimoto Takashi , Takamori Kenji
Published: April 2003

We report the case of a 73-year-old Japanese woman suffering from antiepiligrin (laminin 5) cicatricial pemphigoid (CP) with typical clinical and immunopathological features. Histologically, the lesional mucous membrane showed a subepidermal blister formation. When indirect immunofluorescence techniques with skin split by 1 M NaCl as the substrate were used, the patient’s serum reacted only to the dermal side. Immunoprecipitation studies demonstrated that the patient’s serum contained IgG autoantibodies directed against a set of polypeptides that corresponded to epiligrin (laminin 5). After corticosteroids and immunosuppressive agents had been administered systemically, the patient’s autoantibody titer decreased and the cutaneous and mucosal blister formations were suppressed. However, the ocular lesions persisted in spite of these therapeutic regimens. After combining these treatments with double-filtration plasmapheresis, the ocular lesions improved and showed almost no progression. Plasmapheresis may thus present a new option for the treatment of CP.
Carpal Tunnel Syndrome with Ulcerous Skin Lesions
Authors: Fritz T.M. , Burg G. , Böni R.
Published: April 2003

We report on a patient suffering from an advanced stage of carpal tunnel syndrome (CTS) with entire loss of cutaneous sensibility and impaired motor function who developed ulcerous skin lesions. In the present case, we would like to focus the attention of the dermatologist on CTS, when skin changes, i.e. atrophy, anhidrosis and ulcerations are found in the sensory zones of the median nerve. The necessity to explore a potential trauma is stressed.
Prolonged Photosensitivity following Contact Photoallergy to Ketoprofen
Authors: Albès B. , Marguery M.C. , Schwarze H.P. , Journé F. , Loche F. , Bazex J.
Published: April 2003

We report the third case of prolonged photosensitivity secondary to contact photoallergy to topical ketoprofen, a 2-arylpropionic acid derivative. The patient suffered from persistent photosensitivity for more than 1 year after the withdrawal of ketoprofen with recurrent eruptions on sun-exposed skin areas. This photosensitivity was associated with a persistent decrease in polychromatic and UVA minimal erythemal doses. Photobiological testing revealed cross-reactivity with fenofibrate and benzophenones. Photoallergy to ketoprofen is due to the benzophenone structure or to the very similar thiophene phenylketone of tiaprofenic acid, but not to the arylpropionic function. Thus, fenofibrate, tiaprofenic acid and benzophenones should be avoided by patients with a positive history of photocontact dermatitis to ketoprofen.
Psoriasis in a Patient with Juvenile Rheumatoid Arthritis
Authors: Kono Takeshi , Ishii Masamitsu , Taniguchi Shoji , Negoro Nobuo
Published: April 2003

A 20-year-old woman had polyarticular-onset type of juvenile rheumatoid arthritis with a chronic and destructive course since 6 years of age. She had developmental retardation, deformity and disability. Asymptomatic erythematous scaly plaques developed on the trunk. A skin biopsy specimen revealed psoriasis. This is the first report of psoriasis developing in a patient with juvenile rheumatoid arthritis.
The Implications and Management of Drug Interactions with Itraconazole, Fluconazole and Terbinafine
Authors: Shear Neil , Drake Lynn , Gupta Aditya K. , Lambert Julien , Yaniv Ron
Published: April 2003

The efficacy and safety of many pharmacological agents can be adversely affected by drug interactions. However, an appreciation of the mechanisms and incidence of these interactions, together with a knowledge of the patient’s medical history, means that the majority are predictable and can be managed successfully. Drug interactions involving oral antifungal agents such as itraconazole, fluconazole and terbinafine have been studied extensively and are well understood. When problems are known to arise, they can often be overcome or minimised by varying the dosage regimens, or by drug monitoring. Where certain drugs are definitely contraindicated with antifungal agents, suitable alternatives can usually be found. Clinical trials and surveillance monitoring have demonstrated that when viewed in a wider context, drug interactions do not represent a particular safety problem for the newer oral antifungal agents. An improved understanding of the drug interaction processes and appropriate control measures mean that the high benefit-to-risk ratio of these medications can be maintained.
Why Do Patients with Atopic Dermatitis Refuse to Apply Topical Corticosteroids?
Authors: Fukaya Mototsugu
Published: April 2003

Background: The number of patients with atopic dermatitis who refuse to use topical corticosteroids because of personal fears seems to be increasing. However, studies on this subject are scarce. Consequently, we have investigated this issue further. Methods: A cross-sectional study based on a questionnaire. Between September 1998 and January 1999, a questionnaire was distributed to patients who responded to an announcement and to those attending 18 hospitals or clinics and 11 self-help groups throughout Japan to identify what makes patients resistant to applying topical corticosteroids. Results: Patients who are reluctant to use topical corticosteroids often experienced: ineffective or short-lasting results, adverse side effects and feelings of distrust towards their physician. These feelings of distrust were found to be significantly stronger among patients who were reluctant to apply topical corticosteroids than among patients who accepted the treatment with little or no feelings of resistance. External influences such as those from family members, acquaintances, mass media (television, newspapers and magazines), alternative ‘nondoctor’ therapists and self-help groups were not found to be a significant factor between both groups. However, the influence of the physician was found to be significant and directly related to the patients’ lack of trust. Conclusions: Patients with atopic dermatitis who refuse to use topical corticosteroids attribute their feelings of resistance to personal experiences rather than to information from external sources. Information or warnings about associated side effects from physicians may help to reduce these fears and ultimately benefit the physician-patient relationship.
Economical Microscope Configuration for Direct Mycological Examination with Fluorescence in Dermatology
Authors: Monod Michel , Jaccoud Sandra , Stirnimann Regina , Anex Romain , Villa Franc , Balmer Stephan , Panizzon Renato
Published: April 2003

Background: The use of fluorochromes such as Blankophor or Calcofluor allows to detect immediately and without ambiguity fungal elements in dermatological preparations. Whereas fluorescence microscopy is widely practised in clinical laboratories, it is not generally used in private practice because of the high price of a epifluorescence microscope. Objective: To propose an economical microscope configuration to visualize fungal elements using fluorescence. Methods: The preparations were examined with a standard microscope for routine observations, equipped with only two supplementary filters. Results: Because the fungal elements produce a particularly bright fluorescence, a 25-watt halogen light is sufficient to visualize them in dermatological preparations: Conclusions: The proposed microscope configuration for direct mycological examination is particularly economical since equipment for epifluorescence and a vapour mercury lamp are not necessary.
Eczema herpeticum during Treatment of Atopic Dermatitis with 0.1% Tacrolimus Ointment
Authors: Lübbe J. , Pournaras C.C. , Saurat J.-H.
Published: April 2003

Recent evidence suggests that 0.1% tacrolimus ointment is an effective treatment of atopic dermatitis. Tacrolimus is an immunosuppressive agent that interferes with cell-mediated immunity. We have observed 2 cases of eczema herpeticum among 36 patients with atopic dermatitis treated with a topical preparation containing 0.1% tacrolimus. A 29-year-old male patient developed generalized herpetic lesions on his face on the 4th day of treatment. His SCORAD was then 73, and the tacrolimus blood level was 7.5 ng/ml. A 23-year-old woman developed disseminated herpetic lesions on her neck, face, shoulders and legs during the 9th week of treatment. Her SCORAD was then 41, tacrolimus blood levels were <3 ng/ml 2 weeks before the infection. Herpes simplex virus type 1 antigens were identified in several lesions by direct immunofluorescence in both patients. Neither patient recalled previous episodes of cold sores. The lesions resolved quickly under intravenous acyclovir treatment but resulted in important facial scarring in the male patient. Conclusions: Eczema herpeticum is a well-known complication of atopic dermatitis. Available data do not allow to link topical tacrolimus with an increased risk for eczema herpeticum, but they are insufficient to exclude an association. Future studies and careful documentation of cases are needed in order to better characterize patients at risk.
Malignant Cylindroma in Brooke-Spiegler Syndrome
Authors: Pizinger K. , Michal M.
Published: April 2003

A 68-year-old female patient presented with a history of gradual appearance of multiple nodules situated predominantly on the scalp and neck, with a few nodules on the trunk. The nodules began to appear at the age of 30. Family history revealed that the patient’s brother, son, father and grandmother had similar cutaneous lesions. The dominant histopathological pattern was that of a cylindroma. Features of both cylindroma and spiradenoma (spiradenocylindroma) were present within the same lesion in some biopsies. Most lesions on the scalp were skin-colored with a smooth surface. The largest tumors located on the neck were tender and ulcerated. Histopathologically, these tumors had the morphology of a high-grade malignant solid neoplasm with epithelioid features.
Bullous Pemphigoid Associated with Silicosis
Authors: Ueki H. , Kohda M. , Hashimoto T. , Komai A. , Nobutoh T. , Yamaguchi M. , Ohmori K. , Miyashita F. , Yoda N.
Published: April 2003

Bullous pemphigoid (BP) has never before been reported to associate with silicosis, although there are numerous reports of silicosis accompanied by different autoimmune diseases, such as systemic sclerosis, systemic lupus erythematosus, dermatomyositis or rheumatoid arthritis. We report on a 63-year-old Japanese patient with silicosis who developed tensed bullae, erosions and macular pigmentation on the trunk and extremities. Indirect immunofluorescence revealed anti-basement-membrane-zone antibodies; immunoblotting analysis demonstrated that the patient’s serum reacted with the 230-kD BP antigen in the epidermal extracts, as well as a recombinant protein of the NC16a domain of 180-kD BP antigen. Clinical symptoms improved after treatment with systemic steroids. To the best of our knowledge, this is the first reported case of BP associated with silicosis.
Pathogenesis and Prevention of Adhesion Formation
Authors: Thompson Jeremy
Published: April 2003

Abdominal and pelvic adhesions are a major cause of morbidity. Appendicitis and appendicectomy are the commonest cause of intra-abdominal adhesion formation. Peritoneal injury, from a variety of causes, leads to peritoneal inflammation and with it the production of plasminogen activator inhibitors. These inhibitors result in the loss of normal mesothelial fibrinolytic activity, and if prolonged, this allows the organisation of fibrinous adhesions into permanent fibrous adhesions. Adhesions may be prevented by minimising injury and there is increasing evidence that laparoscopic surgery is an important method of adhesion prevention. A wide variety of products have been used experimentally to prevent adhesion formation but clinical interest at present is focused on the use of bioresorbable membranes which allow localised adhesion prevention. These products have been proven effective by randomised clinical trials and their use as a routine method of preventing intra-abdominal adhesion formation is likely to increase.
Liver Enzymes Are Commonly Elevated following Laparoscopic Cholecystectomy: Is Elevated Intra-Abdominal Pressure the Cause?
Authors: Andrei Valeriu E. , Schein Moshe , Margolis Marc , Rucinski James C. , Wise Leslie
Published: April 2003

Background: A previous study disclosed ‘unexplained’ disturbances in postoperative liver function tests (LFTs) in up to 80% of 67 patients undergoing laparoscopic cholecystectomy (LC). No cause for these elevations was documented. Our objective was to assess the incidence, cause and clinical significance of ‘unexplained’ disturbances in liver enzymes following LC. Patients and Methods: A retrospective chart review of 270 patients who underwent LC and 64 patients undergoing open cholecystectomy (OC) was conducted. Exclusion criteria: any preoperative abnormality in bilirubin or liver enzyme levels, history of chronic liver disease, gallbladder empyema, gangrene or perforation, any evidence or suggestion of choledocholithiasis or other ductal pathology on preoperative or intraoperative imaging or surgical exploration. Preoperatively and on postoperative day 1, alanine transaminase (ALT), alkaline phosphatase and bilirubin levels were measured. There ‘unexplained’ disturbances were defined as a 50% increase from preoperative values and/or above the normal range. At LC the pneumoperitoneum was maintained at a pressure not exceeding 15 mm Hg. Results: In the groups undergoing OC and LC the respective early elevations in bilirubin occurred in 5 and 9% of patients (NS), and in alkaline phosphatase in 0 and 4% patients (NS). Postoperative ALT was elevated in 15% of patients following OC and in 34% after LC (p = 0.004). ‘Unexplained’ LFT disturbances were not associated with any morbidity. Conclusions: ‘Unexplained’ disturbances in ALT following LC occur in 34% of the patients and appear to be clinically nonsignificant. It is suggested that the reason for this phenomenon is the pneumoperitoneum-related intra-abdominal hypertension; the only variable not present in the OC group.
Extended Radical Whipple Resection for Cancer of the Pancreatic Head: Operative Procedure and Results
Authors: Imaizumi T. , Hanyu F. , Harada N. , Hatori T. , Fukuda A.
Published: April 2003

Pancreatoduodenectomy is now the most fundamental operation for cancer of the pancreatic head. However, with the conventional operative procedure, the resection rate is low and long-term results are extremely poor. We introduced an extended radical Whipple operation in 1978 to improve surgical curability. Systemic dissection of extended lymph nodes and plexuses and en bloc resection of the portal vein was the basic concept. The resection rate for cancer of the pancreatic head has improved from 7–20 to 50%. The curative resection rate has also improved from 10 to 40–50%. The extended procedure did not increase the risk of the Whipple operation. When curative surgery was performed, good long-term survival was expected even in cases of extensive invasion to the portal vein. As a result, 11 patients who underwent curative surgery have survived for a long period of time. At present, however, the majority of patients are in an advanced stage at diagnosis and extended radical operation plays an important role in the curative therapy for this condition.
Anticancer Effects ofPreoperative Chemotherapy onColorectal Carcinoma
Authors: Kumagai Kazuhide , Shimizu Kouji , Masuo Kouki , Yamagata Kennichi , Tanaka Takayuki
Published: April 2003

This study was designed to evaluate the efficacy of preoperative chemotherapy and to investigate the relationship between the histopathologic response and prognosis in patients with colorectal carcinoma. Thirty-six previously untreated patients with advanced colorectal carcinoma were consecutively enrolled in this study and received preoperative N-(2-tetrahydrofuryl-5-fluorouracil (FT-207) by suppository. The histopathologic response was investigated. Histopathologically, 14 patients had no response, 19 responded slightly, 2 moderately and 1 had a complete response to the chemotherapy. The extent of the histopathologic response to chemotherapy was greater in the deeper layers of the invaded tissue. There was no relation between the location of the tumor and the extent of the histopathologic response. Based on clinical cancer staging, the overall 5-year survival rate was 100% in patients with Duke’s A and Duke’s B cancer and 45% in patients with Duke’s C cancer; the 3-year survival rate was 25% in patients with Duke’s D cancer. The 5-year survival rate for those with a positive histopathologic response to chemotherapy was 71%, whereas that for the nonresponders was 79%. Mild chemotherapy in the form of FT-207 suppositories was found to be effective histopathologically. However, no relationship was seen between the histopathologic response and survival rate.
Human Islet Allotransplantation: World Experience and Current Status
Authors: Cretin N. , Bühler L. , Fournier B. , Caulfield A. , Oberholzer J. , Mentha G. , Morel Ph.
Published: April 2003

Currently type-I diabetes mellitus is treated with exogenous insulin administration, but traditional insulin therapy does not prevent long-term systemic complications and therefore alternatives should be sought. Presently the only option is to substitute the insulin-producing β cells in order to obtain a more physiological way to deliver insulin. Simultaneous kidney and pancreas transplantation is an established procedure. Pancreas transplantation, however, is a major surgical procedure with a high rate of complications. Transplantation of the isolated insulin-secreting islets of Langerhans is an alternative approach, which is easier and safer than whole organ transplantation. Since 1990, clinical trials of islet transplantation have begun in a few specialized centers worldwide and the International Islet Registry counting 305 human islet allografts at the end of 1995. Insulin independence at 1 year was achieved in 8% of the patients, but 20% of cases showed a graft function with a normal basal C peptide and improved glycemic regulation. We review here the different aspects of human islets of Langerhans allotransplatation, namely historical aspects, indications, isolation and purification procedures and the results obtained.
Treatment of Perforated Appendicitis: An Analysis of 362 Patients Treated during 8 Years
Authors: Styrud J. , Eriksson S. , Granström L.
Published: April 2003

Background and Method: In a retrospective study 2,351 records from patients who underwent surgery for acute appendicitis during 1986–1993 were analysed. During this period, there were 362 patients with perforated appendicitis. The aim of this study was to analyse the complication rate, the period of antibiotic treatment and whether the complication rate decreased when intravenous treatment was followed by oral antibiotic treatment. Results: The complication frequency was 18% which was significantly higher than that for non-perforated appendicitis of 10%. The complication rate was 15% in the group receiving additional oral antibiotics compared to 19% in the group receiving only intravenous antibiotics. This difference is not significant. Conclusion: Perforated appendicitis is however still associated with increased mortality and morbidity.
Prognostic Value of DNA Ploidy Patterns of Colorectal Adenocarcinoma: Univariate and Multivariate Analysis
Authors: Tonouchi Hitoshi , Matsumoto Koichi , Kinoshita Tsuneki , Itoh Hideki , Suzuki Hiroshi
Published: April 2003

Background/Aim: The prognostic significance of DNA ploidy patterns of colorectal cancer has not yet been settled. The present study was designed to determine the prognostic value of DNA ploidy patterns for colorectal adenocarcinomas after curative resection. Methods: DNA ploidy patterns of 140 colorectal adenocarcinomas were determined by DNA flow cytometry, and the prognostic significance of DNA ploidy patterns was evaluated by univariate as well as multivariate analysis. Results: DNA ploidy patterns were diploid in 75 (53.6%) and aneuploid in 65 patients (46.4%). DNA ploidy patterns did not correlate with any of conventional prognostic variables. Univariate analysis disclosed that Dukes B2, C1, and C2 stages of the disease (p < 0.01), positive nodal metastases (p < 0.01), invasion through the intestinal wall (p < 0.01), and poor tumor differentiation (p < 0.05) were associated with worsened survival, but no correlation was found between DNA patterns and survival of patients. Multivariate analysis disclosed that tumor penetration through the bowel wall was associated with poorer survival of patients but the DNA ploidy pattern had no prognostic significance. Conclusions: A significant prognostic variable for patients after curative resection of colorectal adenocarcinoma was penetration of tumor through the bowel wall but not DNA ploidy patterns.
Laparoscopic Colorectal Surgery:A Five-Year Experience
Authors: Bruch H.-P. , Schiedeck T.H.K. , Schwandner O.
Published: April 2003

Objective: The aim of this study was to assess the feasibility and outcome of 300 laparoscopic colorectal procedures performed within 5 years for both benign and malignant disorders. The specific purpose was to identify the impact of the learning curve on reducing morbidity and on improving the outcome of laparoscopic colorectal surgery. Patients and Methods: All cases were divided into 3 groups: the first 100, the second 100 and the third 100 procedures were analyzed. Statistical analysis was performed by Student’s t test and χ2 test. Results: The laparoscopic procedure had to be converted to open surgery in 22 cases (mean conversion rate 7.3%). Thus, a total of 278 procedures could be performed laparoscopically. The mean major complication rate was 8.6%, minor complications occurred in 9.7%. The overall morbidity rate was 18.3%. In 44 cases, laparoscopic resections were performed for the cure of colorectal malignancy. The mean lymph node harvest was 12.8 nodes, no port-site recurrence was documented at a mean follow-up of 22 months. Analyzing our 5-year experience, the incidence of conversion showed a decline from 8.0% (1st and 2nd 100) to 6.0% in the last 100 procedures (p > 0.05). The major complication rate was significantly decreased from 15 to 6.0% (1st vs. 2nd 100) and was 5.0% in the 3rd group. The minor complication rate, overall morbidity rate and laparotomy rate have also been reduced (p > 0.05). The duration of surgery was shortened from 251.4 to 213.5 min (1st vs. 2nd 100, p < 0.05) and was 196.9 min in the last 100 procedures. Postoperative hospital stay was decreased from 16.3 to 14.3 days (1st 100 vs. 2nd 100, p > 0.05) and could be shortened to 11.2 days (2nd vs. 3rd 100, p < 0.05). Conclusion: With increasing experience, laparoscopic colorectal surgery can be performed with reduced morbidity and improved outcome. To evaluate the role of laparoscopic colorectal procedures, particularly for the cure of malignancy, prospective randomized trials are necessary.
Primary Choledochorrhaphy after Common Bile Duct Exploration
Authors: Tu Zhiyuan , Li Jiadong , Xin Hailin , Zhu Qin , Cai Tongnian
Published: April 2003

Aim: To prove further the safety of primary closure of the common bile duct. Method: Twenty patients among 99 common bile duct explorations underwent primary closure. Pre- and postoperative liver function test, ultrasound and intraoperative cholangiography data, operation time, postoperative complications and the length of postoperative stay were recorded. Results: Nineteen patients did not suffer any biliary complication. One had bile leakage and bile peritonitis, and another had duodenal leakage. One case was complicated by gastric ulcer perforation. The mean postoperative hospital stay except for the 2 patients with complications was 8.72 ± 0.75 days. Preoperative abnormal liver function tests recovered within 2–3 weeks after the operation. Postoperative ultrasound scan of the biliary tract within 2 months revealed no stenosis and residual stone. Conclusion: Primary common bile duct closure is a safe alternative to routine biliary drainage in selected patients.
Bacterial Translocation to the Thoracic Duct in a Setting of Ischemia, Partial Resection and Reperfusion of the Porcine Liver
Authors: Lemaire Lucienne C.J.M. , van Wagensveld Bart A. , van Gulik Thomas M. , Dankert Jacob , van Lanschot J. Jan B. , Gouma Dirk J.
Published: April 2003

Background/Aims: Bacterial translocation is postulated as a risk factor in the development of a systemic inflammatory response syndrome (SIRS). Research on this topic has focused on the detection of bacteria and endotoxin in blood or mesenteric lymph nodes (MLNs). We investigated whether bacterial translocation occurs beyond the MLNs into the thoracic duct in a setting of ischemia, partial resection and reperfusion of the porcine liver. Methods: A porcine model of severe, extra-intestinal tissue injury, consisting of prolonged hepatic ischemia and reperfusion, in combination with hemihepatectomy, was used (experimental group, n = 5 pigs). To prevent venous congestion of the gut during ischemia, a temporary portal-caval shunt was created. In 5 animals (sham group) a sham portal-caval shunt was constructed while liver ischemia, partial resection and reperfusion were not induced. Thoracic duct lymph, portal blood and systemic blood were collected, and analyzed for the presence of bacteria and endotoxin. Results: In the experimental group, the incidence of bacterial translocation to the thoracic duct was significantly higher during early reperfusion compared to the sham group (5/5 animals versus 1/5 animals, p < 0.05). Conclusion: This study demonstrates bacterial translocation into the thoracic duct. Translocation at this level leads to direct discharge of bacteria and endotoxin into the systemic circulation and therefore, may potentially enhance the development of SIRS.
General Aspects of Surgical Treatment of Pancreatic Cancer
Authors: Pedrazzoli Sergio , Pasquali Claudio , Sperti Cosimo
Published: April 2003

Background: Different results and opinions exist concerning the use of a standard or an extended lymphadenectomy, and about the indications for portal vein resection in the surgical treatment of pancreatic cancer. The site of recurrence of pancreatic cancer may help to define the usefulness of different treatments in avoiding local and/or distant recurrences. Methods: From personal experience and a literature review, 841 patients who underwent portal vein resection were collected, and 29 papers reporting the results of extended lymphadenectomy in the surgical treatment of pancreatic cancer were analyzed. A review of the site of relapse according to the surgical treatment, with or without various adjuvant treatments, was performed. Personal experience on survival rate according to the site of relapse (local, distant, local and distant) is also reported. Results: Portal vein resection has been performed without a significant increase in morbidity and mortality rate in a large number of patients. However, its usefulness for increasing the resectability rate and the long-term survival has yet to be established. Extended lymphadenectomy does not increase the morbidity and mortality rate, but conflicting results on long-term survival have been reported. Distant metastases, undetectable by the radiologist and the surgeon, usually kill more than 40% of the resected patients within 12 months. Only lymph node-positive patients with limited undetectable distant metastases seem to benefit from an extended lymphadenectomy. Although many data are lacking, the incidence of the different sites of relapse is the same whatever the surgical and/or adjuvant treatment performed. Overall survival and disease-free survival rate are not affected by the site of relapse. A significantly worse survival rate was observed after the radiological detection of local and distant metastasis than after an only local or only distant metastasis. Conclusion: Portal vein resection and extended lymphadenectomy can be performed without increasing the surgical morbidity and mortality rate. We still have insufficient data to decide which patient can benefit from a more extended procedure. Standardization of operations, terminology, pathological reporting, and follow-up, together with well-designed prospective studies, will help to decide the operation of choice for pancreatic cancer.
New Therapeutic Strategies to Avoid Intra- and Extraperitoneal Metastases during Laparoscopy: Results of a Tumor Model in the Rat
Authors: Jacobi C.A. , Peter F.J. , Wenger F.A. , Ordemann J. , Müller J.M.
Published: April 2003

Background: Therapeutic strategies to prevent port site recurrences in laparoscopy surgery of malignancies have not been investigated until now. Methods: The effects of taurolidine, heparin, and povidone iodine on the growth of rat and human colon adenocarcinoma as well as gallbladder carcinoma were investigated in vitro. Furthermore, cytokine release of growth-stimulating IL-1β by peritoneal macrophages was measured after incubation with carbon dioxide and additional incubation with the different agents. In the third experiment, prevention of intra- and extraperitoneal metastases by intraperitoneal instillation of the different agents during laparoscopy was investigated in a colon carcinoma model in the rat. Tumor cells were administered intraperitoneally in 100 rats, and pneumoperitoneum (8 mm Hg) was established over 30 min with carbon dioxide. Rats received either tumor cells, cells + heparin, cells + povidone iodine, cells + taurolidine, or cells + taurolidine + heparin. Results: In vitro, tumor cell growth decreased after incubation with taurolidine, taurolidine/heparin, and povidone iodine. Cytokine release was stimulated by incubation with carbon dioxide and could only be suppressed by incubation with taurolidine in vitro. In vivo, intraperitoneal tumor weight was lower in rats receiving heparin (251 ± 153 mg) and povidone iodine (134 ± 117 mg) compared to the control group (541 ± 291 mg), but even less when taurolidine (79 ± 82 mg) or taurolidine/heparin (18.3 ± 30 mg) were instilled. Conclusion: Heparin slightly inhibits intraperitoneal tumor growth in vivo, while povidone iodine and taurolidine cause a significant decrease in tumor cell growth in vitro as well as intraperitoneal tumor growth in vivo. Cytokine release of peritoneal macrophages is only suppressed by taurolidine. Total tumor take and trocar metastases are only suppressed by taurolidine and taurolidine/heparin.