bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Fissured Tongue, Geographic Tongue and Median Rhomboid Glossitis among Israeli Adults of Different Ethnic Origins
Authors: Yarom Noam , Cantony Uri , Gorsky Meir
Published: August 2004

Background: Fissured tongue (FT), geographic tongue (GT) and median rhomboid glossitis (MRG) are frequently misdiagnosed and overtreated. FT is a relatively common variant of the tongue that includes numerous grooves or fissures on the dorsum of the tongue, while GT usually appears as areas of atrophy and raised white borders. MRG is an erythematous patch of atrophic papillae located in the central area of the dorsum of the tongue. The prevalence of these lesions varies among different ethnic groups. However, their occurrence among the adult Israeli Jewish population of different ethnic origins is unknown. Objective: To examine the prevalence of benign tongue lesions among adult Israeli Jewish urban, rural and industrial populations of different ethnic origins. Methods: A total of 2,464 healthy Israeli adults were clinically examined and divided into three ethnic groups, Ashkenazi, Sephardic or Eastern, based on place of birth of both parents. The prevalences of FT, GT and MRG were evaluated. FT was subdivided according to four subtypes: mild, moderate, typical and central. Results: The prevalence of FT was 30.5%. The most prevalent, typical FT, grooves over one third of the dorsal tongue, was noted in 11.5% of the study group. GT and MRG were found in 12.7 and 2.4% of the study population, respectively. A strong correlation was found between the occurrence of FT and GT, and a gradual increase in prevalence of FT and GT was noted with age. MRG decreased with age. Conclusions: Although no statistically significant differences were found in the prevalence of FT, GT and MRG among the different ethnic groups, ethnic background probably plays some role in its occurrence.
Effect of Haemodialysis on Acoustic Shear Wave Propagation in the Skin
Authors: Uhoda I. , Petit L. , Krzesinski J.M. , Piérard-Franchimont C. , Piérard G.E.
Published: August 2004

Background: Diverse skin alterations may develop in patients under chronic haemodialysis. Among them, signs of premature photo-ageing have been described. Aim: To assess alterations in the physical properties of skin consistent with ageing effects and with cutaneous fluid exchanges during haemodialysis sessions. Methods: In the first part of the study, 45 haemodialysed patients were compared to 45 age-, sex- and body-mass-index-matched healthy subjects. In the second part of the study, skin of 30 haemodialysed patients was assessed immediately before and after a haemodialysis session. The speed of ultrasound shear wave propagation was measured in each subject. Series of 16 multidirectional resonance running time measurements (RRTM) were performed on the forehead and/or the volar forearm. They were averaged for each subject. The corresponding intra-individual coefficients of variation were calculated as an estimate of the skin mechanical anisotropy. Results: In both haemodialysed patients and their matched controls, RRTM values were significantly higher on the forearms than on the forehead. By contrast, no significant difference was found in RRTM values that could be ascribed to chronic haemodialysis. However, RRTM values were significantly increased as an immediate and probably transient effect of haemodialysis sessions. In healthy subjects, ageing was associated with increased RRTM values. Conclusion: Chronic haemodialysis does not appear to influence significantly the functional expression of the dermal ageing process. Subtle fluid movements occurring in the skin during haemodialysis sessions can be assessed by measuring non-invasively the speed of ultrasound shear wave propagation in the skin.
Clinical and Histological Aspects of Toenail Onychomycosis Caused by Aspergillus spp.: 34 Cases Treated with Weekly Intermittent Terbinafine
Authors: Gianni Claudia , Romano Clara
Published: August 2004

Background: Non-dermatophytic onychomycoses represent 1.45–17.6% of all fungal nail infections. Epidemiological studies have shown that Aspergillus spp. are emerging fungal agents of toenail onychomycosis. Indeed, after Scopulariopsis spp. the genus Aspergillus is the second most common agent of non-dermatophytic onychomycosis. The diagnosis and treatment of toenail onychomycosis caused by non-dermatophyte moulds are not always straightforward. Objectives: The aims of this study were to describe the clinical appearance of toenail onychomycosis due to Aspergillus spp., to investigate the pathogenetic role of these agents and to evaluate the efficacy and safety of weekly intermittent terbinafine (500 mg/day for 1 week each month for 3 months) in the treatment of these patients. Patients and Methods: Mycological study of 2,154 patients with onychodystrophy revealed 1,228 onychomycoses (57%) including 71 cases due to non-dermatophytic fungi (5.6%). Non-dermatophytic onychomycosis caused by Aspergillus spp. represented 2.6% of all onychomycoses. The subjects were 34 patients (22 females, 12 males, age range 30–82 years) observed between September 1999 and December 2001, with toenail onychomycosis caused by Aspergillus spp. confirmed by standard techniques (microscopic examination and culture according to the criteria of English), histological examination of nail clippings and scanning electron microscope examination of the cultures whenever necessary. Results: The clinical features suggesting onychomycosis due to Aspergillus spp. are chalky deep white nail, rapid involvement of lamina and painful perionyxis without pus. Standard mycological tests (direct microscopy and fungal culture) and histological examination confirmed the pathogenetic role of Aspergillus spp. in onychomycoses. In particular, the histological examination was positive in 28 cases (82%) and useful in identifying typical aspects of Aspergillus spp. nail infections. At the follow-up, 12 months after the start of therapy with pulsed terbinafine, clinical and mycological recovery was confirmed in 30 of the 34 patients (88%). Conclusions: Treatment of non-dermatophytic onychomycosis with terbinafine usually requires at least 3 months of continuous systemic therapy. Our study of 34 patients confirms that terbinafine is particularly effective in the treatment of Aspergillus spp. nail infections and that a pulsed regimen is more economical and less demanding.
An Open, Randomized, Comparative Study of Oral Finasteride and 5% Topical Minoxidil in Male Androgenetic Alopecia
Authors: Arca Ercan , Açıkgöz Gürol , Taştan Halis Bülent , Köse Osman , Kurumlu Zafer
Published: August 2004

Background and Aim: Androgenetic alopecia (AGA) is undoubtedly the most common form of hair loss in males. It is a condition which may cause cosmetic and psychosocial problems in androgen-dependent cases. In this open, randomized and comparative study we evaluated the efficacy of oral finasteride and 5% topical minoxidil treatment for 12 months in 65 male patients with mild to severe AGA. Methods: We randomly assigned 40 (61.53%) patients to receive 1 mg/day oral finasteride for 12 months, and 25 (38.47%) patients applied 5% topical minoxidil solution twice daily for 12 months. Results: There were no significant differences between the 2 groups considering age, age of onset of hair loss, family history and type of hair loss (p > 0.05). In the clinical evaluation at the endpoint of treatment, the clinical cure rates (i.e. increased intensity of hair) were 80% (32/40) for the oral finasteride group and 52% (13/25) for the 5% topical minoxidil group. Encountered side effects were all mild, and there was no need to stop the treatment. In the group given oral finasteride, side effects were noted in 7 patients: 6 patients suffered from loss of libido, and 1 patient had an increase in other body hairs; irritation of the scalp was seen in 1 patient in the group administered 5% minoxidil. These adverse events disappeared as soon as the treatment was stopped. The laboratory data on both drug groups did not show any statistically or clinically significant intragroup changes from baseline values to the endpoint (p > 0.05), except the level of serum total testosterone which was increased, and free testosterone and serum prostate-specific antigen in the finasteride group which were statistically decreased from baseline values to the endpoint (p < 0.05). Conclusion: In this comparative study of systemic finasteride and topical minoxidil, it was concluded that both drugs were effective and safe in the treatment of mild to severe AGA, although oral finasteride treatment was more effective (p < 0.05). Adverse events were not considered important either, and these side effects disappeared as soon as the treatment was stopped.
Rapid Clearance of Psoriatic Skin Lesions Induced by Topical Cyclopamine
Authors: Taş Sinan , Avcı Oktay
Published: August 2004

Background: We have earlier found a highly efficient induction of the differentiation of epidermal lineage skin tumors by cyclopamine, a steroidal alkaloid inhibitor of the hedgehog/smoothened signaling, under conditions in which cyclopamine exerted no adverse effect on skin. Objective: We aimed to develop a mechanism-based treatment for psoriasis with cyclopamine. Methods: We subjected psoriatic skin lesions to cyclopamine under conditions similar to those we used for skin tumors and evaluated the responses of lesions clinically and by histopathological/immunohistochemical analyses. Results: All treated lesions in different patients having plaque and guttate forms of psoriasis regressed rapidly. Differentiation of the epidermal cells of lesional skin and disappearances of infiltrating inflammatory cells were evident within a day. Lesions were cleared commonly on days 3–4. Former treatment sites followed up for more than 24 months now show a lack of adverse effects in the long term. Conclusion: An effective treatment for psoriasis is described, consistent with intervention in a proximal/key pathogenic event.
Intravascular Large B-Cell Lymphoma Colonizing Cutaneous Hemangiomas
Authors: Cerroni Lorenzo , Zalaudek Iris , Kerl Helmut
Published: August 2004

Intravascular large B-cell lymphoma is a malignant neoplasm characterized by the proliferation of large B cells (rarely of T lymphocytes) confined within the blood vessels. Although the disease can be limited to the skin, involvement of other organs is common. We report a case of intravascular large B-cell lymphoma colonizing the vessels of preexisting cutaneous cherry hemangiomas.
Senile Angioma-Like Eruption:A Skin Manifestation of In travascular Large B Cell Lymphoma
Authors: Motegi Seiichiro , Tamura Atsushi , Takeuchi Yuko , Ishikawa Osamu
Published: August 2004

Intravascular large B cell lymphoma (IVL) is a rare disease characterized by intravascular proliferation of neoplastic mononuclear cells within the vascular lumina. The diagnosis requires skin, liver, renal, meningeal, or brain biopsy, but is rarely made antemortem. We report a 67-year-old man in whom the histological examination of senile angioma-like eruption enabled us to establish the diagnosis of IVL. In a suspected case of IVL, a skin biopsy of the senile angioma-like eruption may be beneficial for an early diagnosis.
P160L Mutation in the Ca2+ ATPase 2A Domain in a Patient with Severe Darier Disease
Authors: Godic Aleksandar , Glavač Damjan , Korošec Branka , Miljković Jovan , Potočnik Marko , Kansky Aleksej
Published: August 2004

Darier disease (DD) is caused by mutations of the ATP2A2 gene, which encodes the sarco/endoplasmic reticulum Ca2+-ATPase isoform 2 (SERCA2). The mutations affect protein expression, degradation and activity. We report a patient with severe sporadic DD, who did not respond adequately to repeated courses of orally administered acitretin and isotretinoin. He was found to harbor the missense P160L mutation of the ATP2A2 gene in a heterozygous state in the A domain of SERCA2 and polymorphism in intron 18 (2741 + 54 G → A). The A domain plays a key role in translocation of Ca2+ from cytoplasm to endoplasmic reticulum lumen, thus establishing a low intracellular Ca2+ concentration.
A Case of Anti-p200 Pemphigoid with Autoantibodies against both a Novel 200-kD Dermal Antigen and the 290-kD Epidermolysis bullosa acquisita Antigen
Authors: Furukawa Hirotoshi , Miura Takako , Takahashi Masabumi , Nakamura Koichiro , Kaneko Fumio , Ishii Fumito , Komai Reiko , Hashimoto Takashi
Published: August 2004

Background: Anti-p200 pemphigoid with autoantibodies against the 200-kD dermal antigen has recently been identified. Objectives: Our patient showed small and tense blisters on her face and trunk. Methods: Immunoblotting (IB), using extracts of normal human epidermis and dermal skin, and immunoelectron microscopy (IEM), using normal human skin, were performed using the patient’s serum. Results: IB analysis showed that the patient’s serum did not react with 180-kD bullous pemphigoid (BP180) or BP230 antigens; however, IgG autoantibodies in the patient’s serum reacted with a 200-kD dermal antigen as well as the 290-kD epidermolysis bullosa acquisita (EBA) antigen. IEM showed that IgG antibodies in the patient’s serum bound to the lamina lucida, as well as both the lamina densa and sublamina densa. After the treatment with prednisolone, the 290-kD protein reactivity decreased rapidly; however, the 200-kD protein band was still observed. Conclusion: We describe a rare case with immunoreactive autoantibodies against both a novel dermal 200-kD autoantigen and the 290-kD EBA antigen.
Two Cases of Subepidermal Blistering Disease with Anti-p200 or 180-kD Bullous Pemphigoid Antigen Associated with Psoriasis
Authors: Yasuda H. , Tomita Y. , Shibaki A. , Hashimoto T.
Published: August 2004

We describe two patients with psoriasis vulgaris who subsequently developed a subepidermal blistering disease which disclosed IgG and C3 at the basement membrane zone in direct immunofluorescence. The first case was a 75-year-old Japanese man with herpetiform lesions. Histopathology showed neutrophil infiltration. IgG antibodies bound to the dermal side of the salt-split skin. Immunoblot analysis identified a 200-kD antigen in dermal extracts. The second case was a 70-year-old Japanese man. Histopathology showed eosinophil infiltration. IgG antibodies bound to the epidermal side of salt-split skin. Immunoblot analysis identified a 180-kD bullous pemphigoid (BP) antigen in epidermal extracts. We review the clinical and pathological features of psoriatic patients who presented a subepidermal blistering disease in which antigens were detected by immunoblot analysis; i.e., anti-p200 pemphigoid (14 cases) or BP (12 cases). There were few distinct clinical differences between two diseases. However, neutrophils were predominant in anti-p200 pemphigoid, while eosinophils were predominant in BP. After blister formation, ciclosporin was used effectively in addition to systemic steroids in the treatment of anti-p200 pemphigoid. On the other hand, ciclosporin was not used in the treatment of BP with psoriasis.
A Probabilistic Estimation of Fluoride Intake by Infants up to the Age of 4 Months from Infant Formula Reconstituted with Tap Water in the Fluoridated Regions of Ireland
Authors: Anderson W.A. , Pratt I. , Ryan M.R. , Flynn A.
Published: August 2004

Two probabilistic models were developed to estimate the acute and chronic exposure to fluoride of exclusively formula-fed infants aged 0–4 months as a result of the consumption of infant formula reconstituted with fluoridated tap water in Ireland. The estimates were based on calculated infant formula consumption and accepted body weight standards, together with reported concentrations of fluoride in infant formula powder and measured values for the fluoride content of water in Ireland. The mean acute exposure of infants to fluoride on any single day in areas served by 387 fluoridated water supplies was estimated to be between 0.11 and 0.14 mg/kg body weight depending on age group (95th percentiles 0.2 and 0.26 mg/kg b.w., respectively). These predicted intakes were well below the intake of fluoride associated with acute toxic effects, which is considered to be 5 mg fluoride (F–)/kg body weight. The mean chronic exposure of infants to fluoride was estimated to be between 0.106 and 0.170 mg/kg b.w./day depending on body weight (95th percentiles 0.108 and 0.172 mg/kg b.w./day, respectively). This estimate described the average daily fluoride intake of infants during the first 4 months of life residing in the areas served by 226 water supplies that achieved an average yearly fluoride concentration below 1.03 mg/l. Dental fluorosis may be considered to be the only risk at these low doses and from our work it is estimated that there is a very low risk of moderate dental fluorosis of the permanent dentition in infants exposed to fluoride at these levels.
Effects of Mouthrinses with Triclosan, Zinc Ions, Copolymer, and Sodium Lauryl Sulphate Combined with Fluoride on Acid Formation by Dental Plaque in vivo
Authors: Giertsen Elin
Published: August 2004

Bacteriological tests demonstrated a slight synergistic effect of triclosan and sodium lauryl sulphate (SLS) on the growth of Streptococcus mutans NCTC 10449 and Streptococcus sanguis ATCC 10556 in vitro. A single mouthrinse with SLS (17.4 mM) or SLS plus triclosan (3.5 mM) significantly decreased the number of salivary mutans streptococci in a group of 12 subjects up to 90 min after rinsing. The effect on plaque pH of a mouthrinse with either 12.0 mM NaF, NaF plus 10.0 mM zinc acetate, NaF plus 17.4 mM SLS, or NaF plus SLS plus 3.5 mM triclosan with or without the addition of zinc ions or 0.65% w/v of a polyvinylmethyl ether/maleic acid copolymer was investigated. The plaque pH responses to a 10% w/v sucrose mouthrinse were measured in 2-day-old plaque with microtouch pH electrodes in six groups of 10 subjects 90 min after a single mouthrinse with test solution. There was no significant difference in plaque pH between the various mouthrinses. In conclusion, triclosan enhanced the growth-inhibitory activity of SLS against oral streptococci in vitro but not against salivary mutans streptococci in vivo. Neither triclosan incorporated into a mouthrinse containing SLS plus fluoride, nor the addition of zinc ions or copolymer affected acid formation by dental plaque in vivo.
Suppression of Caries-Related Microorganisms in Dentine Lesions after Short-Term Chlorhexidine or Antibiotic Treatment
Authors: Wicht Michael J. , Haak Rainer , Schütt-Gerowitt Heidi , Kneist Susanne , Noack Michael J.
Published: August 2004

This study investigated the efficiency of a chlorhexidine varnish and an antibiotic paste in suppressing the cultivable microflora of deep dentine cavities in a stepwise excavation procedure. Subsequent to enamel preparation and removal of the central biomass, infected dentine was sampled from the cavity floor. Ten cavities each were either covered with the 1% chlorhexidine- and 1% thymol-containing varnish Cervitec (CE), the demeclocycline hydrocortisone-containing ointment Ledermix (LE) or received no treatment as control (CO). A compomer composite was used as intermediate restorative. Cavities were reassessed after 6 weeks and again dentine samples were microbiologically investigated for total viable counts, mutans streptococci and lactobacilli. After 6 weeks a significant reduction of the total viable counts was observed in the LE group (p = 0.011) compared to the control, whereas no differences were found in the CE group (p > 0.05). Mutans streptococci were rarely recovered at baseline and after 6 weeks. Compared to the CO group counts of lactobacilli were significantly reduced in the CE and LE groups (p < 0.05). Lactobacillus species were frequently recovered at baseline and after 6 weeks of observation. Lactobacillus rhamnosus was the predominant species in all samples investigated. Application of CE or LE resulted in reduced counts of lactobacilli after a period of 6 weeks. Although none of the materials completely eliminated the viable microorganisms, the use of LE was more effective than CE in reducing the total anaerobic microorganisms associated with carious dentine.
Toothbrush Abrasion of Surface Softened Enamel Studied with Tapping Mode AFM and AFM Nanoindentation
Authors: Lippert F. , Parker D.M. , Jandt K.D.
Published: August 2004

The aim of the present in vitro study was to investigate the toothbrush abrasion of surface softened enamel using tapping mode atomic force microscopy (TM- AFM) and AFM nanoindentation. TM-AFM investigations showed that the typical prismatic pattern as observed after demineralisation was retained after toothbrushing. The exposure to artificial saliva resulted in the deposition of a ‘sausage-shape’ material with random orientation. Brushing of these samples did not lead to a complete removal of this deposited material. Enamel mineral loss increased with increasing demineralisation time and increased further, although only to a small extent, due to subsequent toothbrushing. Exposure to artificial saliva did not alter the amount of enamel mineral lost due to the brushing treatment. AFM nanoindentation investigations showed that the three different demineralisation treatments caused three statistically different reductions in both surface hardness and reduced elastic modulus values, with the shortest exposure time having the least effect on the nanomechanical properties of the enamel samples. Toothbrushing did result only in a small increase in hardness and reduced elastic modulus. The present study has shown that toothbrushing of surface softened enamel leads to minor changes in the surface morphology and nanomechanical properties. The amount of enamel lost due to toothbrushing was independent of the demineralisation time and was lower compared to the mineral loss caused by the demineralisation treatments. Furthermore, the exposure to artificial saliva offers minimal protective effect to the softened enamel surface against toothbrushing.
Effect of Mucin Alone and in Combination with Various Dentifrices on in vitro Remineralization
Authors: Meyer-Lueckel H. , Umland N. , Hopfenmuller W. , Kielbassa A.M.
Published: August 2004

The aim of this in vitro study was to evaluate the effect of combining various fluoridated dentifrices with mucin on remineralization of bovine enamel. Enamel specimens were embedded in epoxy resin, partly covered with nail varnish, and demineralized in a lactic acid solution (pH 5.0, 14 days). Parts of the demineralized areas of the specimens were then covered with nail varnish. Half of the samples were exposed to a mucin-containing (2.7 g/l) remineralizing solution, the other half to a mucin-free remineralizing solution for 30 days. In each group, the specimens were divided into four subgroups, which were brushed twice a day with a toothpaste containing sodium, stannous/amine, or amine fluoride. The specimens of the fourth subgroup were not brushed, but stored in one of the two solutions. Mineral loss and lesion depth were evaluated from microradiographs. After the remineralization period, specimens that were brushed with one of the dentifrices and stored in the mucin-containing remineralizing solution reacquired more mineral than those brushed and stored in the mucin-free solution (p < 0.05; Bonferroni post hoc test). The results indicate that mucin in combination with various fluorides seems to affect enamel remineralization significantly. Thus, mucin could be considered as an additive to saliva substitutes or mouthwashes in patients with hyposalivation.
The Influence of Drying on Quantitative Laser Fluorescence and Optical Pathlengths in Incipient Natural Caries Lesions
Authors: Mujat C. , van der Veen M.H. , Ruben J.L. , Dogariu A. , ten Bosch J.J.
Published: August 2004

Drying effects in 14 natural lesions were studied with quantitative light-induced fluorescence and optical pathlength spectroscopy. Results were compared with clinical judgments of the lesion surface and microradiographical characterizations of the lesions. Relative fluorescence and average pathlength decreased as a function of drying time with a decay time ranging from 35.5 to <1 min. Depth and mineral loss correlated with average pathlength total changes (r = –0.79/–0.60, respectively) and poorly with total fluorescence changes (r 0.3). The decay time of the drying process for the relative fluorescence correlated well with a theoretical model based on water diffusion in lesion and surface layer, but only for large decay times. Clinical judgments could not be related to the surface layer properties or the changes in the average pathlength, but were weakly related to the changes in the relative fluorescence. We conclude that (i) fluorescence effects are mostly due to the screening by the lesion of the fluorescence from the dentin and enamel-dentin junction; (ii) water evaporation in lesions conforms to the diffusion laws only in large lesions with low surface layer penetrability; (iii) the evaporation process is controlled by the surface layer only for small surface penetrabilities (≈ 0.1 vol% µm–1).
Interstitial Lung Disease Induced by Drugs and Radiation
Authors: Camus Philippe , Fanton Annlyse , Bonniaud Philippe , Camus Clio , Foucher Pascal
Published: August 2004

An ever-increasing number of drugs can reproduce variegated patterns of naturally occurring interstitial lung disease (ILD), including most forms of interstitial pneumonias, alveolar involvement and, rarely, vasculitis. Drugs in one therapeutic class may collectively produce the same pattern of involvement. A few drugs can produce more than one pattern of ILD. The diagnosis of drug-induced ILD (DI-ILD) essentially rests on the temporal association between exposure to the drug and the development of pulmonary infiltrates. The histopathological features of DI-ILD are generally consistent, rather than suggestive or specific to the drug etiology. Thus, the diagnosis of DI-ILD is mainly made by the meticulous exclusion of all other possible causes. Drug dechallenge produces measurable improvement in symptoms and imaging in the majority of patients, whereas corticosteroid therapy is indicated if symptoms are present or drug dechallenge is without an effect. Rechallenge is justified in a minority of patients, and is discouraged for diagnostic purposes only. Pneumotox® (www.pneumotox.com) provides updated information on drug-induced respiratory disease.
Occupational Asthma in the Furniture Industry: Is It Due to Styrene?
Authors: Öner Ferda , Mungan Dilşad , Numanoglu Numan , Demirel Yavuz
Published: August 2004

Background: Styrene, a volatile monomer, has been reported as a cause of occupational asthma in a few case reports. Objective: The aim of this study was to investigate the risk for asthma in relation to exposure to styrene in a large number of workers. Methods: A total of 47 workers with a history of exposure to styrene were included in the study. To establish whether asthma was present, each patient underwent a clinical interview, pulmonary function testing and bronchial challenge with methacholine. Specific bronchial challenges with styrene and serial peak expiratory flow (PEF) measurement at home and at work were carried out in subjects with a diagnosis of asthma to evaluate the relationship between their asthma and exposure to styrene in the workplace. Results: Among the 47 subjects, 5 workers had given a history of work-related symptoms, and 3 of them had a positive methacholine challenge test. Specific bronchial challenges with styrene and serial PEF measurement were subsequently carried out in these 3 subjects. Although provocation tests with styrene were negative in the 3 workers, 1 worker had PEF rate records compatible with occupational asthma. Conclusion: We established one patient with occupational asthma from a group of people who have excessive styrene exposure. This finding may be suggestive but is not conclusive about the causative role of styrene in occupational asthma. Since styrene is a frequently used substance in the furniture industry, it is worth performing further studies to investigate the relationship between styrene and occupational asthma.
Incomplete Forced Expiration – Estimating Vital Capacity by a Mathematical Method
Authors: Steltner Holger , Vogel Michael , Sprung Eva , Timmer Jens , Guttmann Josef , Sorichter Stephan
Published: August 2004

Background: Vital capacity is a key parameter in the determination of lung function, usually assessed by means of a forced expiration maneuver. This maneuver can be exhausting, and patients often cannot complete it. Objectives: This study evaluates a method to estimate forced vital capacity (FVC) based on the extrapolation of volume-time curves from forced expiration. Methods: The algorithm was applied to 2,363 volume-time curves from patients with and without respiratory disease. 416 of these spirograms originated from incomplete maneuvers. For each spirogram, estimated (FVCest) and measured FVC were compared with inspiratory vital capacity. Results: Reliable FVCest were obtained for 82% of all and for 76% of the incomplete maneuvers. Regardless of the category of respiratory disease and acceptability of forced expiration, FVCest were close to inspiratory vital capacities. Conclusions: When assessing the lung function of patients who cannot complete forced expiration, this method could help to reduce the duration of maneuvers required to provide a reliable estimate for vital capacity.
Isolation of Fungi, Especially Exophiala dermatitidis, in Patients Suffering from Cystic Fibrosis
Authors: Horré R. , Schaal K.P. , Siekmeier R. , Sterzik B. , de Hoog G.S. , Schnitzler N.
Published: August 2004

Background: Patients with cystic fibrosis (CF) are at an increased risk of pulmonary colonisation by opportunistic micro-organisms. Using specialised methods, the black yeast Exophiala dermatitidis could consistently be cultured from CF patients. Isolation rates from sputum samples ranged between 1.8 and 15.7%. Occasionally, infection could be recognised. Objectives: This study aimed at investigating the isolation rates of E. dermatitidis in samples taken from CF patients at the University of Bonn, Germany. Methods: Altogether, 439 respiratory specimens taken from 81 CF patients were screened for the occurrence of E. dermatitidis over a period of 18 months. For the selective isolation of this fungus erythritol-chloramphenicol agar (ECA) produced in house was applied. Results: The isolation rate of E. dermatitidis was 1.1% from all specimens, 1.6% from all sputum samples and 6.2% in all patients examined. Conclusions: Prior to the introduction of ECA, E. dermatitidis had never been isolated in our laboratory, either from CF, or from any other patient. During this study, E. dermatitidis was found to colonise the respiratory tract of some CF patients. The use of additional selective culture media is necessary for the recognition of uncommon fungi, e.g. E. dermatitidis, in CF patients.
Clinical, Radiographic and Functional Predictors of Pulmonary Gas Exchange Impairment at Moderate Exercise in Patients with Sarcoidosis
Authors: Barros Walder G.P. , Neder J. Alberto , Pereira Carlos A.C. , Nery Luiz E.
Published: August 2004

Background: Pulmonary gas exchange impairment (GEI) is a common consequence of intrathoracic sarcoidosis presenting with important therapeutic and prognostic implications. Objective: To determine the role of clinical, radiographic and functional variables in predicting GEI during moderate exercise at the estimated lactate threshold (ΘL) in patients with sarcoidosis. Methods: Fifty-four outpatients (29 females) with biopsy-proven sarcoidosis had clinical evaluation (baseline dyspnea index), lung function tests and an incremental cardiopulmonary exercise test with ΘL estimation. On a separate day, patients underwent a constant work rate test at ΘL with assessment of arterial blood gas tensions. Results: There was no evidence of GEI [ΔP (A – a) O2/VO2 >20 mm Hg·l· min–1] in patients with radiographic stages 0–I (n = 13). In the remaining 41 patients, GEI was associated with more extensive radiographic involvement and reduced diffusing capacity of the lung for carbon monoxide (DLCO), forced expiratory volume in 1 s, total lung capacity and forced vital capacity (% predicted;p < 0.05); baseline dyspnea index and resting arterial blood gas tensions, in contrast, were not significantly related to GEI. DLCO correlated best with GEI. The negative predictive value of DLCO >70% predicted (absent-to-mild impairment) was 91.3% (sensitivity = 81.8%) and the positive predictive value of DLCO ≤50% predicted (severe impairment) was 83.3% (specificity = 96.6%, likelihood ratio = 13.35). There was no improvement in diagnostic accuracy when other physiological tests were added to DLCO. These results were consistent with those found in a multiple logistic regression analysis with GEI as the dependent variable (p < 0.01). Conclusions: Conventional chest radiography and DLCO measurements suffice to estimate the individual risk of GEI at moderate exercise in patients with sarcoidosis.
Value of Spirometry in Detecting Volume Restriction in Interstitial Lung Disease Patients
Authors: Boros Piotr W. , Franczuk Monika , Wesolowski Stefan
Published: August 2004

Background: Restriction is a typical functional abnormality in interstitial lung disease (ILD) patients, but is not always present, especially in the early stage of the disease. The greater reduction of vital capacity (VC; %pred.) than total lung capacity (TLC; %pred.) is regarded as a typical pattern of lung function disturbances in ILD patients. Study Objectives: To explore the diagnostic value of spirometry in a detection restrictive pattern the relative volume loss assessed by TLC and VC in large series of patients with a diagnosis of ILD referred for lung function tests was evaluated. Methods: Retrospective, cross-sectional analysis of pulmonary function data was done. The sampleconsisted of 1,173 patients with the diagnosis of different interstitial lung diseases investigated during a period of 5 years. Only patients without airway obstruction (normal FEV1%VC) were included. In all cases spirometry and whole body plethysmography were performed by experienced staff using MasterLab – ‘Jaeger’ equipment according to ERS standards. Reference values according to ERS guidelines were applied. Results: The mean value of TLC expressed as %pred. was significantly (p < 0.001) lower than VC in all patients (93.7 ± 18.6 vs. 98.0 ± 21.4%pred.). The frequency of abnormal (lowered) TLC results was also higher than lowered VC (22.8 vs. 17.8%). Sensitivity of VC reached 69.3% and the positive predictive value was 88.5% in detecting volume restriction as compared to TLC measurement. Conclusion: The relative loss of TLC was greater than VC in our large group of patients. Measurement of TLC should be part of functional assessment of ILD patients, irrespective of whether they present or do not present a restrictive pattern in spirometry.
Clinical Significance of Daytime Plasma Orexin-A-Like Immunoreactivity Concentrations in Patients with Obstructive Sleep Apnea Hypopnea Syndrome
Authors: Sakurai Shigeru , Nishijima Tsuguo , Takahashi Susumu , Yamauchi Kohei , Arihara Zenei , Takahashi Kazuhiro
Published: August 2004

Background: Polysomnography (PSG) tests are very complicated and time consuming, despite their clinical benefits in the diagnosis of patients with obstructive sleep apnea hypopnea syndrome (OSAHS). A plasma marker would be desirable to select patients suspected of OSAHS for further PSG studies. We have recently reported that orexin-A concentrations in plasma collected immediately after waking early in the morning were significantly lower in patients with OSAHS than in controls. Objectives: We conducted the present study to assess the clinical usefulness of the measurement of orexin-A concentrations in plasma obtained in the daytime as a diagnostic predictor to screen patients with OSAHS. Methods: Blood samples were collected in the daytime from 19 male patients with suspected sleep-disordered breathing. Plasma orexin-A concentrations were measured by radioimmunoassay before performing PSG. Results: PSG was conducted in all 19 subjects. PSG showed that 14 subjects had OSAHS and 5 subjects did not. Plasma orexin-A concentrations were significantly lower in patients with OSAHS (4.9 ± 0.8 pmol/l, mean ± SE, n = 14) than in control subjects (12.3 ± 1.9 pmol/l, n = 5) (p = 0.0004). Conclusions: These findings suggest that the orexin-A concentration in plasma obtained even in the daytime may be a useful plasma marker for screening OSAHS.
Cost-Effectiveness of Early Intervention: Comparison between Intraluminal Bronchoscopic Treatment and Surgical Resection for T1N₀ Lung Cancer Patients
Authors: Pasic Arifa , Brokx Hes A.P. , Noordegraaf Anton Vonk , Paul Rick M.A. , Postmus Pieter E. , Sutedja Tom G.
Published: August 2004

Background: For patients with early-stage lung cancer (ESLC) and severe comorbidities, the cost-effectiveness of early intervention may be reduced by screening and treatment-related morbidity and mortality in addition to the risk for non-cancer-related deaths. Objectives: The use of bronchoscopic treatment (BT) for centrally located ESLC as minimally invasive technique has raised questions whether this approach will be more cost-effective than standard surgical resection in the above-mentioned cohort of patients. Methods: The cost-effectiveness of BT of 32 medically inoperable patients with intraluminal tumor has been compared to a matched control group of surgically treated stage IA cancer patients. Results: Median follow-up after BT for ESLC has been 5 years (range 2–10) versus 6.7 years (range 2–10) for the surgical group. Five patients (16%) developed subsequent primaries/local recurrences after BT versus 4 (12.5%) in the surgical group. The respective percentages of actual survival during follow-up have been 50 and 41%, non-lung-cancer-related death 22 and 31% and lung-cancer-related death 28% in both groups, respectively. So far, the average costs per individual for early management by BT have been Euro 22,638 by surgery, and total expenses have been Euro 209,492 and Euro 724,403, respectively. Conclusions: Despite the worse initial health status of patients treated with BT, actual survival rates and costs for early intervention underscore the superior cost-effectiveness of BT as early intervention in properly selected individuals with ESLC in the central airways.
Bronchocentric Granulomatosis Associated with Influenza-A Virus Infection
Authors: van der Klooster J.M. , Nurmohamed L.A.C. , van Kaam N.A.L.
Published: August 2004

Bronchocentric granulomatosis is an unusual pathologic entity that is characterized by a necrotizing granulomatous inflammation surrounding the airways. The diagnosis is usually made retrospectively, after histopathologic examination of an open-lung biopsy or resection of a pulmonary lesion. Although the aetiology has not been fully elucidated, the current pathogenetic mechanism is considered to be an immunologic reaction against endobronchial antigens, since most patients exhibit signs of bronchial asthma, eosinophilia and allergic bronchopulmonary aspergillosis. However, non-asthmatic patients may develop bronchocentric granulomatosis without signs for endobronchial fungal infections, but probably as a consequence of other pulmonary infections. An 80-year-old female patient presented with high fever and bilateral pulmonary infiltrates and nodules. After extensive investigations and open-lung biopsy, the diagnosis bronchocentric granulomatosis was established that was possibly associated with an influenza-A virus infection. Treatment consisted of immunosuppressive drugs (prednisone and cyclophosphamide), which led to complete clinical and radiological recovery.
Primary Malignant Lymphoma in the Posterior Mediastinum
Authors: Takamizawa Akemi , Koizumi Tomonobu , Fujimoto Keisaku , Kubo Keishi , Maruyama Yuichirou , Kawakami Satoshi , Honda Takayuki
Published: August 2004

We present a case of primary malignant lymphoma arising from the posterior mediastinum. A 63-year-old woman was admitted to our hospital for further examination of her chest radiographic findings. She was asymptomatic. Chest computed tomography (CT) and magnetic resonance imaging (MRI) showed a posterior mediastinal mass in the right thoracic paravertebral region. A percutaneous needle biopsy was performed under CT. The histological findings with immunochemical staining revealed a B cell type of diffuse malignant lymphoma. 67Ga scintigraphy revealed accumulation in this area, suggesting the posterior mediastinum as the origin of the disease. Reports of primary malignant lymphoma in the posterior mediastinum are extremely rare. The radiographic characteristics are discussed.
Hypersensitivity Pneumonitis Caused by Esparto Dust in a Young Plaster Worker:A Case R eport and Review of the Literature
Authors: Flandes Javier , Heili Sarah , Gómez Seco Julio , Sabillón Oscar , Fernández Itziar , Ortega Angel
Published: August 2004

We report a case of a 25-year-old, white, male plaster worker who started developing fever, severe dyspnea and cough during the manipulation of esparto fibers. The functional lung study showed restrictive lung disease and decreased single-breath carbon monoxide transfer lung capacity. High-resolution computed tomography revealed a diffuse ‘ground-glass’ pattern. The histopathological findings were interstitial inflammation with a marked predominance of lymphocytes and microgranulomas. Bronchoalveolar lavage showed a significant predominance of lymphocytes, with an increase in the level of CD8. Serum precipitins against fungal antigens confirmed that Aspergillus fumigatus was the cause of the patient’s hypersensitivity pneumonitis.
Radical Perineal Prostatectomy: Development of a New Surgical Technique That Divides the Dorsal Vein Complex
Authors: Hiraoka Yasunori , Shimizu Yuuji , Abe Hiroyuki
Published: August 2004

Standard radical perineal prostatectomy (RPP) was observed by laparoscope through a small suprapubic incision. To increase radicalness, we designed and investigated a new technique of RPP that decreased bleeding and shortened the operation time. Subjects and Methods: Standard RPP was observed by laparoscope through a small suprapubic incision after lymph node dissection in 1 case. In 17 patients with localized prostatic cancer, the dorsal vein complex including the puboprostatic ligament was ligated and divided. The modified RPP was then performed, in which the prostate covered with the prostatic fascia in the anterior region was transected at the bladder neck. Results: The results of the laparoscopic observation in standard RPP confirmed that the prostatic fascia in the prostatic anterior region had been left and the endopelvic fascia could be broken easily and safely by a clamp or finger from the perineum. With modified RPP the dorsal vein complex was easily ligated and divided without bleeding. The prostate could be transected at the bladder neck with the prostatic fascia attached to the anterior prostate as in RRP. The operation time was 140–190 min (mean 160 ± 20.1) and the volume of bleeding was 150–512 ml (mean 224 ± 60.4). Conclusion: This modified technique of RPP that transects the dorsal vein complex may replace the current technique of RPP.
Long-Term Outcomes in Patients with Prostate Cancer Managed with Intermittent Androgen Suppression
Authors: Lane T.M. , Ansell W. , Farrugia D. , Wilson P. , Williams G. , Chinegwundoh F. , Philp T. , Hines J. , Oliver R.T.D.
Published: August 2004

Objectives: To assess the long-term outcomes of patients with prostate cancer managed with intermittent androgen suppression (IAS) following their enrolment in an open, non-randomised feasibility study initiated 10 years ago. Patients and Methods: Patients with prostate cancer who developed marked side effects following androgen deprivation were considered for entry into the study. All patients were required to have been managed with androgen deprivation for a minimum of 9 months and to have achieved PSA remissions to levels <4 ng/ml or falls to greater than 90% of pre-treatment levels. Patients remained off treatment until PSA values rose to >20 ng/ml or individuals became symptomatic – at which stage a 9-month cycle of androgen suppression was repeated. Such on-off cycling continued until hormone-resistant disease developed and patients proceeded (off trial) to second-line therapies. Results: 75 patients were recruited to the study following an initial referral with treatment-related side effects specifically associated with androgen deprivation. 86% of these remain alive at a median of 134 months (11 years) since initial histological diagnosis. Survival times and times to hormone resistance (from first cycle hormone deprivation) have also been calculated. Overall there is a median survival time of 95 months (8 years) from initial (first-cycle) androgen deprivation in those presenting with localised or locally advanced disease and a median survival time of 87 months (7 years) for those presenting with metastatic disease. There exists a median of 83 months to hormone resistance in the localised and locally advanced group and a median of 50 months in those presenting with metastatic disease. We have calculated a 100% 5-year actuarial survival rate for those presenting with localised or locally advanced disease (from time of first cycle hormone ablation) and a 70% 5-year actuarial survival rate for those presenting with metastatic. Conclusions: Long-term outcome figures and actuarial survival rates presented here provide further support for a pulsed or intermittent approach to androgen ablation in patients with prostate cancer. In addition, they serve as valuable extended outcome data for patients managed in this way. Likewise, data presented here suggests that apparent survival advantages appear related, at least in part, to a delay in the onset of androgen resistance and that such a management approach is both safe and effective in those presenting with both metastatic disease as well as those with more localised pathology.
Intravenous Ketorolac Significantly Reduces the Pain of Office Transrectal Ultrasound and Prostate Biopsies
Authors: Mireku-Boateng A.O.
Published: August 2004

Introduction: Campbell’s’ Urology, 8th edition, indicates that office transrectal ultrasound (TRUS) and prostate biopsies require no anesthesia. This is however in contradistinction from the experience of patients who have had the procedure. A study was conducted to evaluate whether 60 mg of intravenous Ketorolac before the procedure makes it more tolerable. Material and Methods: A prospective study was performed involving 24 patients who were randomized into two groups. One group was given 60 mg of Ketorolac intravenously before the procedure and the control group received no analgesia. Results: The two groups were comparable in age and the indications for the TRUS and prostate biopsies. The number of biopsy cores tolerated and taken was significantly less in the control group than in the group that was given intravenous Ketorolac. The degree of pain in the group that had intravenous Ketorolac was significantly less than in the no analgesia group. Conclusion: TRUS with prostate biopsies is a painful procedure. Intravenous Ketorolac significantly reduces the pain involved in the procedure and allows patients to tolerate it better for a more complete procedure.