bluuebunny/crossref_metadata_2025 huggingface dataset:
Promoting Infant Health Through Home Visiting By a Nurse‐Managed Community Worker Team
Authors: Barnes‐Boyd Cynthia , Fordham Norr Kathleen , Nacion Karla W
Published: March 2003

This article describes the Resources, Education and Care in the Home program (REACH‐Futures), an infant mortality reduction initiative in the inner city of Chicago built on the World Health Organization (WHO) primary health care model and over a decade of experience administering programs to reduce infant mortality through home visits. The program uses a nurse‐managed team, which includes community residents selected, trained, and integrated as health advocates. Service participants were predominately African American families. All participants were low‐income and resided in inner‐city neighborhoods with high unemployment, high teen birth rates, violent crime, and deteriorated neighborhoods. Outcomes for the first 666 participants are compared to a previous home‐visiting program that used only nurses. Participant retention rates were equivalent overall and significantly higher in the first months of the REACH‐Futures program. There were two infant deaths during the course of the study, a lower death rate than the previous program or the city. Infant health problems and developmental levels were equivalent to the prior program and significantly more infants were fully immunized at 12 months. The authors conclude that the use of community workers as a part of the home‐visiting team is as effective as the nurse‐only team in meeting the needs of families at high risk of poor infant outcomes. This approach is of national interest because of its potential to achieve the desired outcomes in a cost‐effective manner.
Children and War: Current Understandings and Future Directions
Authors: Berman Helene
Published: March 2003

During the last decade, the number of children whose lives have been disrupted by war, oppression, terror, and other forms of conflict has grown tremendously. When the United Nations High Commission for Refugees was first established during the 1950s to provide international protection to refugees following World War II, it was estimated that there were 1.5 million refugees and displaced persons. Today there are approximately 14 million, about three‐fourths of whom are women and children. Although the experiences of refugee children and adolescents vary considerably, many have witnessed or experienced the death or murder of loved ones. Upon resettlement, they face numerous challenges. Research with this population is a relatively new area of investigation, but there is evidence that many of these young people experience long‐term physical and emotional health problems. In this article, current research findings are reviewed, the widespread emphasis in the literature on post‐traumatic stress disorder (PTSD) is critically examined, future research directions are suggested, and implications for public health nurses are addressed.
Urban Outpost Nursing: The Nature of the Nurses' Work in the AIDS Prevention Street Nurse Program
Authors: Hilton B. Ann , Thompson Ray , Moore‐Dempsey Laura , Hutchinson Kylie
Published: March 2003

The AIDS Prevention Street Nurse Program in Vancouver, Canada focuses on HIV and sexually transmitted diseases (STD) prevention within a context of harm reduction and health promotion targeted at marginalized, hard to reach, high‐risk populations. As part of a large evaluation project that included interviews with street nurses, clients, and other service providers together with document analysis, the nature of the street nurses' work and its fit within the provision of health care were described. The street nurses' work reflected the following themes: reaching the marginalized high‐risk populations for HIV/STDs; building and maintaining trust, respect, and acceptance; doing HIV/AIDS and STD prevention, early detection, and treatment work; helping clients connect with and negotiate the health care system; and influencing the system and colleagues to be responsive. The findings and their implications for community health nursing practice are examined.
Factors Determining the Attitudes of Family Caregivers of Dementia Patients toward Nursing Home Placement in Taiwan: Comparisons between Urban and Semiurban Areas
Authors: Chiu Lian , Shyu Woei‐Cherng , Liu Yu‐Hwa , Wang Shiou‐Ping , Chang Ta‐Pang
Published: March 2003

This study sought to determine the factors that influence the attitudes of family caregivers of dementia patients toward nursing home placement. A telephone survey of primary caregivers was conducted in two metropolitan areas of Taiwan. Caregivers of dementia patients were recruited from the neurology and psychiatry outpatient departments of two medical centers in Taipei (a highly urbanized area, n=144) and two medical centers in Kaohsiung (an area of mixed farm and nonfarm sectors, n=134). Family caregivers were asked if they would place patients in a nursing home if their dementia progressed. The mental status of dementia patients was the most significant variable affecting caregivers attitudes toward nursing home placement. Family manpower available for caregiving at home was especially emphasized as a determining factor affecting the decision to use nursing home care by primary caregivers in highly urbanized areas.
An Interactive Technology Approach to Educate Older Adults About Drug Interactions Arising from Over‐the‐Counter Self‐Medication Practices
Authors: Neafsey Patricia J. , Strickler Zoe , Shellman Juliette , Chartier Virginia
Published: March 2003

An interactive computer program (Personal Education Program [PEP]) designed for the learning styles and psychomotor skills of older adults was used to teach older adults about potential drug interactions that can result from self‐medication with over‐the‐counter (OTC) agents and alcohol. Subjects used the PEP on notebook computers equipped with infrared sensitive touchscreens. Subjects were recruited from senior centers. Those who met age, vision, literacy, independence, and medication use criteria were randomly assigned to one of three groups: (1) PEP plus information booklet; (2) information booklet only; or (3) control. A repeated measures (three time periods 2 weeks apart), three‐group design was used. Users of PEP had significantly greater knowledge and self‐efficacy scores than both the conventional and control groups at all three time points. The PEP group reported fewer adverse self‐medication behaviors over time. Reported self‐medication behaviors did not change over time for either the conventional or control groups. Subjects indicated a high degree of satisfaction with the PEP and reported their intent to make specific changes in self‐medication behaviors.
Key Elements for Church‐Based Health Promotion Programs: Outcome‐Based Literature Review
Authors: Peterson Jane , Atwood Jan R. , Yates Bernice
Published: March 2003

Abstract Although not a new concept, church‐based health promotion programs have yet to be widely researched. Few of the initial studies used randomized and controlled designs. Dissemination of study results has been sporadic, with findings often reported in church periodicals. A renewed interest in church‐based health promotion programs (CBHPP) is emerging. The purpose of this article is to propose seven key elements found in a literature review to be beneficial in establishing church‐based community health promotion programs that demonstrated desired health promotion outcomes. Based on the outcomes of successful CBHPP, the following key elements have been identified: partnerships, positive health values, availability of services, access to church facilities, community‐focused interventions, health behavior change, and supportive social relationships. An example of one program that embodies these elements is presented. The Heart and Soul Program, designed to increase physical activity in midlife women to reduce their risk of cardiovascular disease with advancing age, is discussed within the context of the elements for successful church‐based programs. CBHPP have effectively promoted health behaviors within certain communities. To promote health and wellness in light of our diverse society and health needs, health promotion professionals and churches can be dynamic partners.
Knowledge and Attitudes of High School Students about AIDS: A Turkish Perspective
Authors: Savaser Sevim
Published: March 2003

Abstract    This study was conducted with 705 high school students (360 ninth graders and 345 11th graders; 305 female, 400 male) for the purpose of determining their knowledge and attitudes about HIV/AIDS. Data were obtained using a self‐completed questionnaire. The questionnaire was divided into three sections. Section A included questions about descriptive characteristics of the students. Section B included questions about HIV/AIDS knowledge. Section C included questions about students’ attitudes towards AIDS and their information sources. The percentage, correlation, and one‐way analysis of variance were used for data analysis.

Research findings showed moderate knowledge levels (59.15 ± 14.22 out of 100 points) in a sample group of 705 Turkish high school students on all AIDS‐related questions. Students in private schools had higher scores than those in public schools; boys had higher scores than girls; 11th graders had higher scores than ninth graders, and the methods of transmission were better known than methods of nontransmission. Scores increased in parallel with student age. Knowledge scores of students were also positively correlated with a higher level of parent education and the ease with which sexuality‐related subjects were discussed at home. About half of the students believed that people with HIV/AIDS should be able to attend school and should not have to stop working. Most of the students were informed about HIV/AIDS by media. To prevent the illness, the most important role of the nurses is to focus on education and information for individuals, families, and communities.
Tinea Pedis in Children Presenting as Unilateral Inflammatory Lesions of the Sole
Authors: Geary Rosemary J. , Lucky Anne W.
Published: March 2003

Abstract: Tinea pedis is uncommon in prepubescent children and therefore the diagnosis may be difficult to make. We report tinea pedis in five children presenting as unilateral inflammatory lesions of the sole which was not readily diagnosed. The pathogen in all of our cases was Trichophyton rubrum.
A Study of Cutaneous Tuberculosis in Children
Authors: Ramesh V. , Misra R. S. , Beena K. R. , Mukherjee A.
Published: March 2003

Abstract: Sixty‐three children out of a total of 199 patients seen with cutaneous tuberculosis during a 7‐year period were included in this study. Culture was positive in only four, and the diagnosis was based on clinical examination, tuberculin reaction, histopathology, and response to antitubercular therapy. Forty had lupus vulgaris (LV) and 23 scrofuloderma (SD). The lower half of the body was predominantly affected in those with LV, and keratotic and hypertrophic forms were frequently encountered. LV planus mainly affected the face. Ulcerative and atrophic types of LV were infrequent. Extensive lesions in three children led to disfiguring scars and contractures. Scrofuloderma often involved the cervical group of lymph nodes followed by the inguinal, submandibular, and axillary groups. As compared to skin tuberculosis in adults, regional lymph node involvement in LV was more common, and a combination of both LV and SD was less frequent in children. No difference in clinical presentation could be detected between the BCG vaccinated and unvaccinated children. Tuberculous infection either in the lungs or the bones was present in eight children. An HIV test done in five patients with widespread lesions was negative. Irregular therapy or late diagnosis leading to serious complications, inadequate parental or community support, and lack of awareness among practitioners are the problems to be remedied.
Use of Ultrasonography in the Diagnosis of Childhood Pilomatrixoma
Authors: Hughes Jenny , Lam Albert , Rogers Maureen
Published: March 2003

Abstract: Pilomatrixomas are relatively common childhood tumors that usually occur in the head and neck region. The clinical diagnosis of these lesions may be difficult, especially if the examining physician is unfamiliar with them. Excision is usually recommended, as a foreign body reaction due to calcification of the lesion may occur and cause a vigorous inflammatory response with risk of scarring. A retrospective study was carried out by examining the preoperative ultrasound scans of 28 suspected pilomatrixomas in 25 children. The findings on sonography were correlated with the histologic results in 19 cases (18 pilomatrixomas and one ruptured epidermoid cyst). In the majority of patients, sonography either correctly supported or excluded the clinical diagnosis of pilomatrixoma and contributed to appropriate preoperative assessment and subsequent management of the lesion. We therefore found sonography of suspected pilomatrixomas in children to be a useful and noninvasive procedure, offering a significant improvement in the accurate diagnosis of these lesions.
Phakomatosis Pigmentovascularis Type IIIb Associated with Moyamoya Disease
Authors: Tsuruta Daisuke , Fukai Kazuyoshi , Seto Masumi , Fujitani Ken , Shindo Kisa , Hamada Toshio , Ishii Masamitsu
Published: March 2003

We diagnosed phakomatosis pigmentovascularis type IIIb in an 11‐month‐old baby who had a giant nevus spilus, a nevus flammeus, and moyamoya disease. Development of the patient was normal until 6 months of age when he developed a sudden onset of focal seizures and left hemiparesis. This patient represents the sixth case of phakomatosis pigmentovascularis type IIIb, including three cases in the Japanese literature, reported thus far. However, to our knowledge, this is the first case with an association to moyamoya disease.
Periorbital Edema as the Presenting Sign of Juvenile Dermatomyositis
Authors: Sevigny Gina M. , Mathes Barbara M.
Published: March 2003

We report a case of juvenile dermatomyositis that presented with periorbital edema. Dermatomyositis is an autoimmune disorder with cutaneous manifestations including heliotrope patches, Gottron's papules, periungual telangiectasisas, and subcutaneous calcifications. Periorbital edema may accompany the classic heliotrope rash and, as in this case, may be the only presenting sign of juvenile dermatomyositis.
Congenital Hypertrophy of the Lateral Nail Folds of the Hallux: Clinical Features and Follow‐Up of Seven Cases
Authors: Piraccini Bianca Maria , Parente Gian Luca , Varotti Elisa , Tosti Antonella
Published: March 2003

Abstract: Congenital hypertrophy of the nail folds of the hallux describes an abnormality of the periungual soft tissues of the big toe characterized by hypertrophy of the nail fold which partially covers the nail plate and is frequently associated with inflammation and pain due to an ingrowing nail. We describe the clinical picture and follow‐up of seven patients with this abnormality. In three patients the affected toe showed an asymptomatic, dome‐shaped, hypertrophic lip that partially covered the nail plate. Four patients had acute inflammatory changes due to toenail ingrowth, with considerable swelling and reddening of the hypertrophic lip that was painful on pressure. Topical treatment with steroids was useful to reduce inflammation and produced persistent remission in two patients. Follow‐up showed a spontaneous disappearance of the hypertrophic nail fold in one of the seven patients. In two patients the hypertrophic lip partially regressed, but remained clearly visible, while in two patients it remained unchanged. In two patients surgical correction of the soft tissue abnormality was necessary due to painful nail ingrowth unresponsive to topical treatment.
An Unusual Form of Stevens–Johnson Syndrome with Subcorneal Pustules Associated with Mycoplasma pneumoniae Infection
Authors: Reichert‐Penetrat S. , Barbaud A. , Antunes A. , Borsa‐Dorion A. , Vidailhet M. , Schmutz J. L.
Published: March 2003

Abstract: We report a 10‐year‐old girl in whom Stevens–Johnson syndrome (SJS) (with acute gingivostomatitis and conjunctivitis) was associated with a pustular eruption clinically and histologically similar to Sneddon–Wilkinson subcorneal pustulosis. This is a very rare form of SJS, the true incidence of which is probably underestimated.
Onychomycosis in Children: Treatment with Bifonazole‐Urea
Authors: Bonifaz Alexandro , Ibarra Guadalupe
Published: March 2003

Abstract: We assessed the safety and efficacy of a two‐phase topical treatment with bifonazole‐urea ointment in children with onychomycosis. Twenty‐five children younger than 16 years old with proved onychomycosis were included in the study. Bifonazole‐urea ointment was administered under occlusion until the nontraumatic removal of the nail was achieved. Bifonazole cream was then applied for 4 weeks and a follow‐up visit 4 weeks after cessation of medication was scheduled. During the study, periodic clinical and mycologic evaluations were carried out. Of the 25 patients included, 17 were cured (68%), 6 improved, and 2 failed treatment. The main etiologic agent isolated was Trichophyton rubrum (92%). Two patients had minor side effects, both during the occlusive phase, one each with mild pain and a probable dermatitis from the adhesive strips. Treatment was not discontinued in both of these cases. We concluded that a two‐phase treatment with bifonazole‐urea is effective and safe, and represents a new therapeutic choice for onychomycosis in children.
Characterization of Vernix Caseosa as a Natural Biofilm: Comparison to Standard Oil‐Based Ointments
Authors: Bautista Maria Imelda B. , Wickett R. Randall , Visscher Marty O. , Pickens William L. , Hoath Steven B.
Published: March 2003

Abstract: The application of occlusive films and oil‐in‐oil ointments has been reported to improve epidermal barrier function in very low birthweight, preterm infants. Such infants have a structurally immature stratum corneum and lack a surface coating of vernix caseosa. In this study we examined the short‐term effects of topical application of vernix caseosa to human skin and contrasted these effects with commonly used ointments and water‐in‐oil emulsions. Specifically, vernix, Eucerin®, Aquaphor®, and petrolatum were applied to the volar skin surface of adult volunteers. Surface electrical capacitance (SEC) and transepidermal water loss (TEWL) were measured as indices of surface hydration. Sorption‐desorption profiles were performed to determine skin surface hydrophobicity. Particular attention was given to monitoring the acute (0–120 minutes) changes following vernix treatment in order to compare these effects with earlier reports on the rate of skin surface drying in newborn infants following birth. Immediately after vernix application there was an increase in the rate of water loss from the skin surface. Relative to control skin and skin treated with the ointments and water‐in‐oil emulsions, the application of vernix to freshly bathed human skin resulted in a unique profile of temporal change in baseline surface hydration, moisture accumulation, and water‐holding capacity. These results demonstrate major differences between human vernix and standard oil‐based topical ointments. The results provide a framework for discussing the various properties of topical barriers applied to the very low birthweight infant.
Childhood Lichen Planus: A Report of 23 Cases
Authors: Nanda Arti , Al‐Ajmi Hejab S. , Al‐Sabah Humoud , Al‐Hasawi Fowzia , Alsaleh Qasem A.
Published: March 2003

Abstract: Lichen planus (LP) in children is a rare entity. We report 23 cases of childhood LP seen over a period of 7 years. Ninety‐six percent of the children were of Arab ancestry. There were 52% boys and 48% girls. Classic LP was the most common clinical variant (70%), followed by eruptive generalized LP (13%). A majority of the patients had mild, localized disease. Oral involvement was seen in 39% of patients. Topical steroids were the mainstay of treatment in most of the cases. Children with chronic and recurrent disease responded to dapsone therapy, whereas in those with eruptive and widespread disease, UVB phototherapy was found to be safe and effective. The present report highlights the salient clinical features, treatment, and course of LP in children in Kuwait compared to those reported in children of other countries as well as those of adults.
Incontinentia Pigmenti: A Case Associated with Cardiovascular Anomalies
Authors: Miteva Ljubka , Nikolova Assia
Published: March 2003

Abstract: Various cutaneous and developmental defects of the eyes, teeth, skeleton, and central nervous system have been detected in infants with incontinentia pigmenti. We report an isolated case of incontinentia pigmenti in a 6‐month‐old girl in association with tricuspid insufficiency, an abnormal shunt of the right pulmonary vein into the superior vena cava, and pulmonary hypertension. We believe that our findings will help to confirm the association of cardiovascular anomalies in IP.
Rothmund–Thomson Syndrome with Myelodysplasia
Authors: Narayan S. , Fleming C. , Trainer A. H. , Craig J. A.
Published: March 2003

Abstract: Rothmund–Thomson syndrome (RTS) is a rare autosomal recessive disorder that is caused by a DNA repair defect. It is characterized mainly by skin, eye, and skeletal abnormalities. Cutaneous changes appear at between 3 and 6 months of age and include poikiloderma, photosensitivity, scaling, hyperkeratosis, and disturbance of hair growth. Other abnormalities include cataracts, congenital bone defects, soft tissue contractures, and osteogenesis imperfecta. Various malignancies have been reported in association with RTS, including osteosarcoma, fibrosarcoma, and nonmelanoma skin cancers. The myelodysplastic syndromes are a group of hematologic disorders defined by morphologic abnormalities of the three cell lines. The pathogenesis of myelodysplasia is a multistep process that begins with a somatic mutation in the pluripotential stem cell, which is irreversibly altered and acquires a survival advantage. Myelodysplasia in the young and RTS are both rare conditions. We report a patient with RTS and myelodysplasia. This is the second reported case of an association between these two conditions, which are both likely to be due to a common etiologic cause of nonrepair of stem cell DNA damage. Clinicians should be aware of the potential of this complication arising in patients with RTS.
Low Dose Cyclosporin A Treatment in Generalized Pustular Psoriasis
Authors: Kiliç S. Şebnem , Hacimustafaoğlu Mustafa , Çelebi Solmaz , Karadeniz Aynur , Ildirim Ibrahim
Published: March 2003

Abstract: Generalized pustular psoriasis is a rare form of psoriasis, seldom seen in children. Three patients with generalized pustular psoriasis are presented, two of whom were a sister and brother and whose grandfather also had pustular psoriasis. Lesions consisted of pustular, erythematous, scaly, follicular papules located on the trunk, scalp, and extremities. The pustules in some areas coalesced to form lakes. Histologic examination of several biopsy specimens revealed the changes of pustular psoriasis, which were parakeratosis, elongation of the rete ridges, and deep spongioform pustules and Munro abscesses. All patients were treated with cyclosporin A for periods of 2–12 months. The doses ranged from 1 to 2 mg/kg/day. Clearance of psoriatic lesions occurred after 2–4 weeks of therapy.
Juvenile Hyaline Fibromatosis
Authors: Larralde M. , Santos‐Muñoz A. , Calb I. , Magariños C.
Published: March 2003

Juvenile hyaline fibromatosis (JHF) is a rare autosomal recessive disease with onset in infancy or early childhood. It is characterized by papulonodular skin lesions, soft tissue masses, gingival hypertrophy, and flexion contractures of the large joints. The light and electron microscopic features are very distinctive. Here we report an 8‐month‐old boy with characteristic stiffness of the knees and elbows and pink confluent papules on the paranasal folds, and periauricular and perianal regions. He also had hard nodules all over the scalp and around the mouth, and severe gingival hypertrophy. Histologic and ultrastructural features were typical of JHF. Clinical features, pathology, and physiology are discussed.
Therapeutic Options for the Treatment of Tinea Capitis Caused by Trichophyton Species: Griseofulvin Versus the New Oral Antifungal Agents, Terbinafine, Itraconazole, and Fluconazole
Authors: Gupta Aditya K. , Adam Paul , Dlova Ncoza , Lynde Charles W. , Hofstader Sophie , Morar Nilesh , Aboobaker Jamila , Summerbell Richard C.
Published: March 2003

Tinea capitis is a relatively common fungal infection of childhood. Griseofulvin has been the mainstay of management. However, newer oral antifungal agents are being used more frequently. A multicenter, prospective, randomized, single‐blinded, non‐industry‐sponsored study was conducted in centers in Canada and South Africa to determine the relative efficacy and safety of griseofulvin, terbinafine, itraconazole, and fluconazole in the treatment of tinea capitis caused by Trichophyton species. The regimens for treating tinea capitis were griseofulvin microsize 20 mg/kg/day × 6 weeks, terbinafine [> 40 kg, one 250 mg tablet; 20–40 kg, 125 mg (half of a 250 mg tablet); < 20 kg, 62.5 mg (one‐quarter of a 250 mg tablet)] × 2–3 weeks, itraconazole 5 mg/kg/day × 2–3 weeks, and fluconazole 6 mg/kg/day × 2–3 weeks. Patients were asked to return at weeks 4, 8, and 12 from the start of the study. Griseofulvin was administered for 6 weeks and the final evaluation was at week 12. Terbinafine, itraconazole, and fluconazole were administered for 2 weeks and the patient evaluated 4 weeks from the start of therapy. At this time, if clinically indicated, one extra week of therapy was given. There were 200 patients randomized to four treatment groups (50 in each group). At the final evaluation at week 12, the number of evaluable patients were griseofulvin, 46; terbinafine, 48; itraconazole, 46; and fluconazole, 46. Patients who discontinued therapy or were lost to follow‐up were griseofulvin, 1/3; itraconazole, 0/4; terbinafine, 0/4; and fluconazole, 0/4. The causative organisms were Trichophyton tonsurans and T. violaceum species. Patients were regarded as effectively treated at week 12 if there was mycologic cure and either clinical cure or only a few residual symptoms. Effective treatment was recorded in, intention to treat, griseofulvin (46 of 50, 92.0%), terbinafine (47 of 50, 94.0%), itraconazole (43 of 50, 86.0%), and fluconazole (42 of 50, 84.0%) (p=0.33). Adverse effects were reported only in the griseofulvin group (gastrointestinal effects in six patients). Discontinuation from therapy due to adverse effects occurred only in the griseofulvin group (nausea in one patient). For the treatment of tinea capitis caused by the Trichophyton species, in this study, griseofulvin given for 6 weeks is similar in efficacy to terbinafine, itraconazole, and fluconazole given for 2–3 weeks. Each of the agents has a favorable adverse‐effects profile.
Atrophia Maculosa Varioliformis Cutis: A Pediatric Case
Authors: Paradisi M. , Angelo C. , Conti G. , Palermi G. , Provini A.
Published: March 2003

Atrophia maculosa varioliformis cutis was described in 1918 by Heidingsfeld as a type of idiopathic noninflammatory macular atrophy typically occurring in young individuals. Only 13 cases have been reported since the first description. Considering that atrophia maculosa varioliformis cutis can be mistaken for a scarring and artifact dermatitis, it is important for physicians to distinguish this condition. We report a new case in a 5‐year‐old boy.
Restrictive Dermopathy: A Case Report and a Critical Review of All Hypotheses of its Origin
Authors: Nijsten T. E. C. , De Moor A. , Colpaert C. G. , Robert K. , Mahieu L. M. , Lambert J.
Published: March 2003

Restrictive dermopathy (RD) is a rare, fatal, autosomal recessive genodermatosis in which tautness of a translucent thin skin is the major clinical observation. This causes an intrauterine fetal akinesia deformation sequence (FADS) resulting in polyhydramnios, reduced fetal movements at around 31 weeks gestation, dysmorphic facies, arthrogryposis, and early neonatal death because of respiratory insufficiency. The characteristic histologic abnormalities of the skin are located in a thin dermis, consisting of compactly arranged collagen fibers, scant elastic fibers, and poorly developed skin appendages. The epidermal rete ridges are flattened and the dermal‐hypodermal border is remarkably straight. The etiology of these changes remains unclear. We tested several existing hypotheses and could not confirm them. These included fibroblast dysfunction, abnormal keratin composition, desmosomal changes, and increased proinflammatory cytokines [tumor necrosis factor (TNF)‐α and interleukin (IL)‐6]. We conclude that RD is a relatively easy clinical and pathologic diagnosis, but that the pathogenesis of the disease is not clarified.
Recurring Staphylococcal Scalded Skin Syndrome‐like Bullous Mastocytosis: The Utility of Cytodiagnosis and the Rapid Regression with Steroids
Authors: Has Cristina , Misery Laurent , David Louis , Cambazard Frédéric
Published: March 2003

Abstract: We report a male infant with onset of an extensive bullous eruption at the age of 45 days. Staphylococcal scalded skin syndrome (SSSS) was suspected. Bullous mastocytosis was diagnosed by cytodiagnosis and confirmed by histologic examination. Three serious relapses were noted in a 2‐year follow‐up, and SSSS was again suspected because of high fever and leukocytosis with neutrophilia in an infectious context. Cytodiagnosis revealed the presence of mast cells and permitted rapid diagnosis of recurrences of bullous mastocytosis. Systemic corticotherapy dramatically improved the cutaneous lesions and general symptoms. This case report emphasizes the utility of cytodiagnosis in extensive blistering diseases in infancy and the possibility of obtaining rapid healing by using steroids.
Rofecoxib‐Induced Instant Aquagenic Wrinkling of the Palms
Authors: Carder K. Robin , Weston William L.
Published: March 2003

Abstract: An 18‐year‐old woman presented with a 3‐week complaint of exaggerated palmar wrinkling and swelling following brief exposure (1–2 minutes) of her hands to water. She had a history of mixed connective tissue disease and had been started on rofecoxib therapy 1 month prior to the onset of her skin symptoms. Discontinuation of rofecoxib was followed by resolution of symptoms within a period of 3 weeks. Similar palmar skin changes following water exposure have been reported to occur in cystic fibrosis and are thought to be due to increased salt content of the skin and secondary increased water‐binding capacity. Rofecoxib is a selective COX‐2 inhibitor that has been shown to increase sodium reabsorption in the kidney via effects on prostaglandin E2 and the renal vasculature. The COX‐2 protein is also expressed in keratinocytes and plays a role in keratinocyte differentiation. Prostaglandin E2 also plays a role in keratinocyte proliferation and differentiation. Thus rofecoxib may cause increased sodium reabsorption in the skin, as it does in the kidney. The rofecoxib‐associated elevation in skin sodium may increase keratin water‐binding capacity and cause exaggerated aquagenic wrinkling of the skin, as occurs in cystic fibrosis.
Tufted Angiomas: Variability of the Clinical Morphology
Authors: Herron Mark D. , Coffin Cheryl M. , Vanderhooft Sheryll L.
Published: March 2003

Abstract: In 1989 Wilson Jones and Orkin first described tufted angioma, which has the unifying histologic feature of circumscribed angiomatous tufts and lobules within the dermis. Tufted angioma may take unusual forms clinically. We describe five children less than 3 years of age with tufted angiomas, demonstrating the variability of the morphology of this vascular tumor. Two of the lesions were congenital. Three presented as indurated, vascular‐appearing plaques, one of which had associated hypertrichosis. One lesion appeared clinically compatible with a hemangioma of infancy, but continued to enlarge after the child was 32 months old. The remaining lesion was a nearly circumferential, soft tissue tumor of the left forearm with tortuous vessels and a smaller overlying vascular stain. All of these lesions demonstrated the characteristic histology of tufted angioma. The clinical and histopathologic differential diagnosis as well as treatment options for tufted angioma are reviewed.
Scabies Incognito Presenting as Urticaria Pigmentosa in an Infant
Authors: Kim Kyoung‐Jin , Roh Kyung‐Hyun , Choi Jee‐Ho , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung
Published: March 2003

Abstract: Misdiagnosis is frequent in scabies of infants and children because of a low index of suspicion, secondary eczematous changes, and inappropriate therapy. Topical or systemic corticosteroids may modify the clinical presentation of scabies and that situation is referred to as scabies incognito. We describe a 10‐month‐old infant with scabies incognito mimicking urticaria pigmentosa.
Autosomal Recessive Form of Congenital Cutis Laxa: More Than the Clinical Appearance
Authors: Andiran Nesibe , Sarikayalar Fikriye , Saraçlar Muhsin , Çağlar Melda
Published: March 2003

Abstract: Congenital cutis laxa is an uncommon disorder of generalized elastolysis. The clinical picture is characterized by inelastic, loose, hanging skin that gives the appearance of premature aging. The disease is inherited most commonly in a severe autosomal recessive form, or as a relatively benign, autosomal dominant form. There is often systemic organ involvement in patients with the autosomal recessive form. Cardiopulmonary abnormalities are common and mainly determine the prognosis and life expectancy. Pulmonary emphysema, cor pulmonale, and right‐sided heart failure generally caused by pulmonary disease are often seen in infancy. Various cardiovascular abnormalities including aortic aneurysm, pulmonary artery multiple branch stenosis have been reported in patients with this form of congenital cutis laxa. We report a 10‐month‐old boy with the autosomal recessive form of congenital cutis laxa who had pulmonary valve stenosis. To the best of our knowledge, this is the first case of this association to be reported in the English language literature. We also emphasize the systemic complications that may be associated with congenital cutis laxa.
Antigliadin Antibodies Associated with Chronic Mucocutaneous Candidiasis
Authors: Garcia Yolanda Hidalgo , Díez Santiago Gómez , Aizpún Lourdes Tricas , Oliva Narciso Pérez
Published: March 2003

Abstract:  Chronic mucocutaneous candidiasis (CMC) is a primary immunodeficiency disease clinically characterized by Candida infection of the skin, mucous membranes, or nails that is refractory to traditional treatment. We present a typical case of a 13‐year‐old boy with an onset of illness at 1 month of age in the form of oral thrush. At age 2–3 years the patient began to have external otitis caused by Candida albicans and recurrent upper respiratory tract infections. Analytical studies detected iron deficiency and circulating antigliadin antibodies. Immunologic findings excluded other possible immunodeficiencies. Significant clinical improvement was produced by therapy with orally administered fluconazole. The significance of antigliadin antibodies is discussed.
A Study of Perceptions of Facial Hemangiomas in Professionals Involved in Child Abuse Surveillance
Authors: Greig Aina V. H. , Harris David L.
Published: March 2003

Abstract: Facial hemangiomas are common benign tumors of infancy. They can mimic the appearance of bruises and parents report false accusations of child abuse by strangers. We investigated perceptions of facial hemangiomas in two professional groups involved in child abuse surveillance. Thirty health visitors and 30 primary school teachers were sent a clinical case questionnaire about a child with an involuting facial hemangioma with a color photograph of the lesion. Nineteen health visitors (63%) and 18 primary school teachers (60%) responded. Seventy‐four percent of the health visitors and 11% of the teachers correctly diagnosed a hemangioma. Fifty percent of the teachers were unable to decide on a diagnosis. However, only one health visitor (5%) and one teacher (5%) thought that the lesion was a nonaccidental injury and would involve a child protection advisor. About one‐third of health visitors and one‐third of teachers expressed concerns that the child could suffer psychologically from teasing by peers at school and about one‐third of health visitors were also concerned about the psychological effects of the lesion on the child's parents. Health visitors and teachers were most unlikely to mistake the facial hemangioma in this study for a nonaccidental injury.
Peripheral Blood Progenitor Cell Transplantation
Authors: Jansen Jan , Thompson James M. , Dugan Michael J. , Nolan Pamela , Wiemann Michael C. , Birhiray Ruemu , Henslee‐Downey P. Jean , Akard Luke P.
Published: March 2003

Abstract: Peripheral blood progenitor cells (PBPCs) have become increasingly popular over the last 15 years as the source of hematopoietic stem cells for transplantation. In the early 1990s, PBPCs replaced bone marrow (BM) as the preferred source of autologous stem cells, and recently the same phenomenon is seen in the allogeneic setting. Under steady‐state conditions, the concentration of PBPCs (as defined by CFU‐GM and/or CD34+ cells) is very low, and techniques were developed to increase markedly this concentration. Such mobilization techniques include daily injections of filgrastim (G‐CSF) or a combination of chemotherapy and growth factors. Leukapheresis procedures allow the collection of large numbers of circulating white blood cells (and PBPCs). One or two leukapheresis procedures are often sufficient to obtain the minimum number of CD34+ cells considered necessary for prompt and consistent engraftment (i.e., 2.5–5.0 × 106/kg). As compared to BM, autologous transplants with PBPCs lead to faster hematologic recovery and have few, if any, disadvantages. In the allogeneic arena, PBPCs also result in faster engraftment, but at a somewhat higher cost of chronic graft‐versus‐host disease (GvHD). This may be a double‐edged sword leading to both increased graft‐versus‐tumor effects and increased morbidity. The rapid advances in the study of hematopoietic, and even earlier, stem cells will continue to shape the future of PBPC transplantation.
Influence of Single Low‐Density Lipoprotein Apheresis on the Adhesion Molecules Soluble Vascular Cellular Adhesion Molecule‐1, Soluble Intercellular Adhesion Molecule‐1, and P‐Selectin
Authors: Pulawski Ewa , Mellwig Klaus‐Peter , Brinkmann Thomas , Kleesiek Knut , Horstkotte Dieter
Published: March 2003

Abstract: The aim of our study was to investigate the influence of single low‐density lipoprotein apheresis (heparin extracorporeal low‐density lipoprotein precipitation [HELP]procedure) on plasma concentrations of soluble adhesion molecules (sAMs) such as soluble vascular cellular adhesion molecule‐1 (sVCAM‐1), soluble intercellular adhesion molecule‐1 (sICAM‐1), and P‐selectin in patients with familial heterozygous hypercholesterolemia and documented coronary artery disease enrolled in a chronic weekly HELP apheresis. Before HELP apheresis, the mean plasma concentration of sVCAM‐1 was 515 ± 119 ng/ml, 204 ± 58 ng/ml for sICAM‐1, and 112 ± 45 ng/ml for P‐selectin. After single HELP apheresis, plasma concentrations of sAM declined significantly by 32 ± 7%, 18 ± 15%, and 33 ± 25% for sVCAM‐ 1,sICAM‐1 and P‐selectin, respectively. After a 1 week interval, sAM concentrations rose to approximately the initial values. The concentrations of all sAMs studied were significantly lower in the plasma leaving than entering the filter. Due to filtration, the decline in plasma level of sVCAM‐1, sICAM‐1, and P‐selectin was 62 ± 19%, 51 ± 39%, and 67 ± 22%, respectively. In addition to lipid reduction, single HELP apheresis significantly lowers plasma concentrations of sVCAM‐1, sICAM‐1, and P‐selectin.
Continuous Hemodiafiltration with Polymyxin‐B Immobilized Fiber Is Effective in Patients with Sepsis Syndrome and Acute Renal Failure
Authors: Suzuki Hiromichi , Nemoto Hironori , Nakamoto Hidetomo , Okada Hirokazu , Sugahara Soichi , Kanno Yoshihiko , Moriwaki Kenshi
Published: March 2003

Abstract: The aim of this study was first, to evaluate the effects of continuous hemodiafiltration (CHDF) alone or combined with CHDF and polymyxin‐B immobilized fiber (PMX) on survival rates of patients with sepsis and acute renal failure, and second, to evaluate the changes in plasma levels of inflammatory cytokines before and after treatment with CHDF and PMX and CHDF alone in these patients. Forty‐eight patients with septic shock and acute renal failure were enrolled in this study. The survival rate of all patients at 28 days was 25% for those with CHDF and 75% for those with PMX and CHDF treatment. Combination treatment produced a significant reduction of plasma levels of endotoxin and interleukin‐6 compared to the basal values and to the treatment with CHDF alone. From these data, it is suggested that the combined therapy with PMX and CHDF is effective in improvement of survival rate of patients with septic shock and acute renal failure.
Hemoadsorption in Critical Care
Authors: Ikeda Toshiaki
Published: March 2003

Abstract: This paper concerns the results of endotoxin hemoadsorption therapy using a PMX column in patients with perforative peritonitis complicated by multiple organ failure. The subjects were 31 patients aged 68 ± 12 years. When systolic arterial pressure decreased to less than 90 mm Hg, endotoxin hemoadsorption was initiated and continued for 2 h. At the completion of endotoxin hemoadsorption, systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure were significantly increased. Platelet count decreased to less than 50,000/mm3 in 30% of patients. As for cytokines and vascular endothelial cell function markers, interleukin‐6 and plasminogen activator inhibitor‐1 significantly decreased. These results suggest favorable effects of endotoxin hemoadsorption on the hemodynamic and pathophysiological conditions in patients with septic shock although attention should be given to the decrease in platelet count.
Cytokine Removal by Plasma Exchange with Continuous Hemodiafiltration in Critically Ill Patients
Authors: Nakae Hajime , Asanuma Yoshihiro , Tajimi Kimitaka
Published: March 2003

Abstract: The effectiveness of plasma exchange (PE) with continuous hemodiafiltration (CHDF) in the treatment of critically ill patients was evaluated based on changes in cytokine levels. Twenty‐six patients with acute hepatic failure were treated with PE (PE group) or PE and CHDF (PE+CHDF group), and the levels of cytokines such as tumor necrosis factor (TNF)‐α, interleukin (IL)‐6, and IL‐8 were determined before and after treatment. Bilirubin levels were significantly lower after treatment in both the PE and PE+CHDF groups. There were no significant differences in TNF‐α levels before and after treatment in the PE group, but the TNF‐α level was significantly lower after treatment in the PE+CHDF group. There were no significant differences in the IL‐6 levels before and after treatment in both the PE and PE+CHDF groups. There were no significant differences in IL‐8 levels before and after treatment in the PE group, but the IL‐8 level was significantly lower after treatment in the PE+CHDF group. PE with CHDF therapy was given to 5 patients with acutely aggravated autoimmune diseases, 2 patients with hemorrhagic shock and encephalopathy syndrome, and 3 patients with thrombotic microangiopathy. The results suggested that PE with CHDF therapy are useful in critically ill patients with suspected hypercytokinemia.
Yellow Bush Lupine Invasion in Northern California Coastal Dunes II. Mechanical Restoration Techniques
Authors: Pickart Andrea J. , Theiss Karen C. , Stauffer Howard B. , Olsen Garrett T.
Published: March 2003

Invasion of coastal dunes by Lupinus arboreus (yellow bush lupine) results in soil enrichment and displacement of native plants. Restoration by means of heavy equipment was tested as an alternative to costly manual techniques in a heavily invaded area of relatively flat terrain. Two experiments were conducted in consecutive years at the Eureka Dunes Protected Area in Humboldt County, California. Each experiment consisted of three plots subjected to one of three primary treatments: removal of vegetation with a brush rake, removal of vegetation with a brush rake followed by removal of litter and duff with a plough blade or bucket, and removal of vegetation with tractor‐pulled chokers. Plots were then subdivided into smaller secondary treatment plots subjected to one of two treatments or a control. Secondary treatments consisted of weedmat placed for a 1‐ or 2‐year duration. The goal of the treatments was to remove and prevent reestablishment of nonnative vegetation, including but not limited to bush lupine; success was measured by percent cover of recolonizing vegetation 1.5 years after treatment ended. In the first experiment, primary treatment (vegetation removal) but not secondary (prevention of reestablishment) resulted in significant differences in cover by the end of the experiment. The brush rake and plough blade treatment was most successful at preventing reestablishment of nonnative vegetation. In the second experiment, secondary treatment (prevention of reestablishment) but not primary (removal of vegetation) resulted in significant differences at the end of the experiment. Re‐invasion increased with the amount of time subplots were left uncovered. The difference in the results of the first and second experiments was attributed to variation in rainfall and, to a lesser extent, to localized variation in species composition. Results suggest that mechanical restoration by means of combination of the brush rake and plough blade primary treatment with the 2‐year weedmat secondary treatment would be most successful in meeting the dual goals of removal of nonnative vegetation and prevention of its reestablishment.
Some Suggested Guidelines for Geomorphic Aspects of Anadromous Salmonid Habitat Restoration Proposals
Authors: Kondolf G. Mathias
Published: March 2003

Proposals to improve fish habitat for anadromous salmonids by modifying channel form or substrate must be justified based on geomorphology as well as biology, because geomorphic factors often cause such projects to fail. Proposals should address the geomorphic setting at the watershed scale, by specifying changes in flow regime or sediment yield through tools such as a sediment budget. Proposals should also address geomorphic setting and process at the reach scale, indicating the basis for design channel form and dimensions, calculating the frequency of bed mobilization, and assessing existing gravel quality for spawning habitat enhancement projects. Proposals should include explicit provisions for post‐project performance evaluation, including adequate baseline data to permit project‐induced changes to be quantified. Restoration projects also require clear objectives and adequate funding for long‐term monitoring, and generally would benefit from an adaptive management approach to implementation and evaluation.