bluuebunny/crossref_metadata_2025 huggingface dataset:
Upper extremity arteriovenous fistula does not affect pulse oximetry readings
Authors: AVITSIAN RAFI , ABDELMALAK BASEM , SAAD SAMEH , XU MENG , O’HARA JEROME
Published: September 2006

Aim:  Arteriovenous fistula (AVF) is usually surgically created in a patient’s upper extremity to provide adequate blood flow during haemodialysis. Blood flow distal to an AVF is altered and theoretically could change pulse oximetry (SpO2) reading, systemic blood pressure and skin temperature. The authors conducted a prospective case–control study to measure changes in these parameters in the upper extremity of patients who have had an AVF.

Methods:  In patients with an upper extremity AVF, the authors conducted a prospective case–control study using the patient’s own non‐AVF upper extremity as the control. The authors evaluated other factors that may have influenced blood flow changes distal to an AV fistula like gender, presence of AVF aneurysm, peripheral vascular disease, diabetes mellitus and vasodilator therapy.

Results:  Thirty patients were enrolled, skin temperature and blood pressure were significantly altered in the hand distal to the AVF, but there was no significant change in the SpO2.

Conclusion:  An upper extremity AVF alters blood pressure and temperature measurements when compared with the contralateral non‐AVF side, but there is no difference in SpO2 provided an adequate signal quality is detected.
Regional citrate anticoagulation in continuous venovenous haemofiltration using commercial preparations
Authors: MUNJAL SANDEEP , EJAZ A AHSAN
Published: September 2006

Aim:  The aim of the present study was to test the feasibility of using commercial preparations of replacement and citrate anticoagulation solution in continuous venovenous haemofiltration (CVVH) in a safe, efficient and simple manner.

Methods:  Retrospective review of the database of a large continuous renal replacement therapy programme that uses a standardized prescription of high ultrafiltrate CVVH with commercial solutions for replacement fluid and regional citrate anticoagulation was performed.

Results:  Records of 28 patients who underwent 91 CVVH sessions were analysed. Median circuit survival time was 37 (59.5–15.5) h and the 48 h survival probability was 40%. Bleeding or metabolic complications were not noted, and the procedure was simple to administer.

Conclusion:  Continuous venovenous haemofiltration using commercial preparations of replacement fluid and citrate anticoagulation can be safe, efficient and simple.
Molecular mechanisms mediating vascular calcification: Role of matrix Gla protein (Review Article)
Authors: PROUDFOOT DIANE , SHANAHAN CATHERINE M
Published: September 2006

SUMMARY:  Patients with chronic kidney disease (CKD) have a higher incidence of vascular calcification and a greatly increased risk of cardiovascular death. The mechanisms involved in the accelerated vascular calcification observed in CKD have recently become clearer, leading to the hypothesis that a lack of natural inhibitors of calcification may trigger calcium deposition. One of these inhibitory factors, matrix Gla protein (MGP), is the focus of the present review. MGP, originally isolated from bone, is a vitamin K‐dependent protein that is also highly expressed by vascular smooth muscle cells. MGP has been confirmed as a calcification‐inhibitor in numerous studies; however, its mechanism of action is not completely understood. It potentially acts in several ways to regulate calcium deposition including: (i) binding calcium ions and crystals; (ii) antagonizing bone morphogenetic protein and altering cell differentiation; (iii) binding to extracellular matrix components; and (iv) regulating apoptosis. Its expression is regulated by several factors including retinoic acid, vitamin D and extracellular calcium ions, and a reduced form of vitamin K (KH2) is important in maintaining MGP in an active form. Therefore, strategies aimed at increasing its expression and activity may be beneficial in tipping the balance in favour of inhibition of calcification in CKD.
High glucose and advanced glycosylated end‐products affect the expression of α‐actinin‐4 in glomerular epithelial cells
Authors: HA TAE‐SUN
Published: September 2006

Aim:  To investigate the molecular basis for the phenotypic alterations of glomerular epithelial cells (GEpC, podocytes), involving cytoskeletal changes especially on α‐actinin‐4 as a candidate regulating the barrier to protein filtration and the podocyte actin cytoskeleton.

Methods:  To examine the effects of glucose and advanced glycosylated end‐products (AGE) on α‐actinin‐4, the author cultured rat GEpC on AGE‐ or BSA‐coated plates under normal (5 mmol) and high glucose (30 mmol) conditions and examined the distribution of α‐actinin by confocal microscope and measured the change in α‐actinin‐4 production by western blotting and reverse transcription–polymerase chain reaction.

Results:  Confocal microscopy indicated that α‐actinin‐4 moved from the peripheral cytoplasm to inner actin filament complexes in the presence of AGE and high glucose. These changes might be related to the fusion of microvilli of cell surface examined by electron microscopy. In western blot analysis, AGE significantly decreased the amount of α‐actinin by 28.1%. Furthermore, the combination of high glucose and AGE decreased the amount of α‐actinin more significantly by 53.6% compared with that of the control. The mRNA expression for α‐actinin‐4 was not changed with high glucose or AGE‐coated surfaces; however, when added, the combination of high glucose and AGE significantly decreased the expression of α‐actinin‐4 mRNA by 15.7% compared with that of the control.

Conclusion:  The author suggests that both high glucose and AGE (either individually or in combination) induce the cytoplasmic translocation and the combination suppresses the production of α‐actinin‐4 at the transcriptional level with post‐translational modification and these in vitro changes may explain the cytoskeletal changes of GEpC in diabetic conditions.
Early phase of reperfusion of human kidney allograft does not affect an erythrocyte anti‐oxidative system
Authors: DOMAŃSKI LESZEK , DOŁ GOWSKA BARBARA , SAFRANOW KRZYSZTOF , MYŚLAK MAREK , RÓŻAŃSKI JACEK , ROMANOWSKI MACIEJ , OSTROWSKI MAREK , DOMAŃSKI MACIEJ , PAWLIK ANDRZEJ , CIECHANOWSKI KAZIMIERZ
Published: September 2006

Background: Generation of reactive oxygen specimens is the basic mechanism leading to ischaemia/reperfusion injury of the kidney graft. Oxygen burst is a trigger for sophisticated biochemical changes leading to generation of oxygenated lipids and changes in microcirculation, which recruit recipient’s neutrophils and contribute to delayed graft function. It has been shown that the free radicals generation correlates with the activity of anti‐oxidative system. Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and glutathione (GSH) are involved in protection against free radicals.

Aim: To examine the activity of erythrocyte anti‐oxidative system during reperfusion of the transplanted kidney allograft.

Methods: The study included 40 renal transplant recipients. Blood was taken from the iliac vein before transplantation and from the graft’s renal vein immediately, as well as 2 and 4 min after total reperfusion. The authors assessed the process of reperfusion using ThermaCAM SC500 termovision camera. Spectrophotometric methods were used to measure superoxide dismutase, glutathione peroxidase and catalase activity as well as glutathione concentrations in erythrocytes.

Results: There were no statistically significant differences in the activities of superoxide dismutase, catalase and glutathione peroxidase as well as glutathione concentrations during the first 4 min after total graft reperfusion. Nevertheless, there was a positive correlation between the activity of superoxide dismutase and glutathione peroxidase.

Conclusion: The results suggest that the erythrocyte anti‐oxidative system is stable during the early phase after reperfusion. An association between some anti‐oxidative enzymes was noted.
Role of C‐reactive protein, reticulocyte haemoglobin content and inflammatory markers in iron and erythropoietin administration in dialysis patients
Authors: EL‐KHATIB MAHMOUD , DUNCAN HEATHER J , KANT K SHASHI
Published: September 2006

Aim:  C‐reactive protein (CRP) is an acute phase reactant protein, which becomes elevated in response to inflammation, infections or malignancies. These conditions are well known causes of bone marrow hyporesponsiveness and erythropoietin resistance in dialysis patients. The role of iron‐deficiency as a cause of hyporesponsiveness under these conditions is not clear. Reticulocyte haemoglobin content (CHr) is one of several iron indices used to determine iron deficiency in dialysis patients. The aim of this study is to evaluate the role of CRP and CHr in iron administration and anaemia management in dialysis patients

Methods:  In 47 haemodialysis patients with ferritin levels of >500 ng/mL, CRP, CHr, transferrin saturation (TSAT), other markers and erythropoietin dose were evaluated. Patients with CRP < 5 mg/L (Group A) were compared to patients with CRP > 5 mg/L (Group B).

Results:  Ferritin levels in the two groups were not different. Weekly erythropoietin was significantly different between the two groups. Group B required an average of 121% more erythropoietin than Group A to maintain similar haemoglobin levels of 11–12 g/dL 36% of Group B had CHr < 29 pg versus 7% of patients in Group A. 39% of patients in Group B also had TSAT < 20% versus 0% in Group A. Group A also had more arteriovenous (AV) fistulae as dialysis access than group B.

Conclusion:  Data indicate that low CHr, similar to low TSAT, could be associated with inflammatory process and erythropoietin resistance, but not necessarily with iron‐deficiency. High CRP association with low CHr and low TSAT levels can explain the lack of response to further IV iron therapy. AV grafts, contrary to AV fistulae, are associated with high inflammatory markers and also with a higher erythropoietin requirement.
Postoperative neuroleptic malignant syndrome that occurred repeatedly in a patient with cerebral palsy
Authors: TSUCHIYA NAOHISA , MORIMURA ERI , HANAFUSA TETSUJI , SHINOMURA TETSUTARO
Published: September 2006

A wide variety of neuroleptic agents are associated with neuroleptic malignant syndrome (NMS). However, the association between general anesthesia and NMS is uncertain. We report a case of a patient with cerebral palsy, who showed signs of NMS only after repeated general anesthesia. The patient received general anesthesia three times in a period of 9 months. The first anesthetic passed uneventfully. NMS symptoms were observed only after the second and third anesthetics. The NMS was effectively treated with IV dantrolene and the patient recovered on both occasions. Inhalational anesthetics, muscle relaxants and fentanyl were suspected as possible triggering factors for NMS. After examining the three anesthesia records and previous publications, we surmized that a nondepolarizing muscle relaxant was associated with NMS in this patient.
The Coral Probiotic Hypothesis
Authors: Reshef Leah , Koren Omry , Loya Yossi , Zilber‐Rosenberg Ilana , Rosenberg Eugene
Published: September 2006

Emerging diseases have been responsible for the death of about 30% of corals worldwide during the last 30 years. Coral biologists have predicted that by 2050 most of the world's coral reefs will be destroyed. This prediction is based on the assumption that corals can not adapt rapidly enough to environmental stress‐related conditions and emerging diseases. Our recent studies of the Vibrio shiloi/Oculina patagonica model system of the coral bleaching disease indicate that corals can indeed adapt rapidly to changing environmental conditions by altering their population of symbiotic bacteria. These studies have led us to propose the Coral Probiotic Hypothesis. This hypothesis posits that a dynamic relationship exists between symbiotic microorganisms and environmental conditions which brings about the selection of the most advantageous coral holobiont. Changing their microbial partners would allow the corals to adapt to changing environmental conditions more rapidly (days to weeks) than via mutation and selection (many years). An important outcome of the Probiotic Hypothesis would be development of resistance of the coral holobiont to diseases. The following evidence supports this hypothesis: (i) Corals contain a large and diverse bacterial population associated with their mucus and tissues; (ii) the coral‐associated bacterial population undergoes a rapid change when environmental conditions are altered; and (iii) although lacking an adaptive immune system (no antibodies), corals can develop resistance to pathogens. The Coral Probiotic Hypothesis may help explain the evolutionary success of corals and moderate the predictions of their demise.
A NOTE ON SAMPLING DESIGNS FOR RANDOM PROCESSES WITH NO QUADRATIC MEAN DERIVATIVE
Authors: Mukherjee Bhramar
Published: September 2006

Several authors have previously discussed the problem of obtaining asymptotically optimal design sequences for estimating the path of a stochastic process using intricate analytical techniques. In this note, an alternative treatment is provided for obtaining asymptotically optimal sampling designs for estimating the path of a second order stochastic process with known covariance function. A simple estimator is proposed which is asymptotically equivalent to the full‐fledged best linear unbiased estimator and the entire asymptotics are carried out through studying this estimator. The current approach lends an intuitive statistical perspective to the entire estimation problem.
GIBBS SAMPLERS FOR A SET OF SEEMINGLY UNRELATED REGRESSIONS
Authors: Griffiths William E. , Valenzuela Ma. Rebecca
Published: September 2006

Bayesian estimation of a collection of seemingly unrelated regressions, referred to as a ‘set of seemingly unrelated regressions’ is considered. The collection of seemingly unrelated regressions is linked by common coefficients and/or a common error covariance matrix. Gibbs samplers useful for estimating posterior quantities are described and one of them is applied to a set of linear expenditure functions to estimate household equivalent scales.
Meaningful Regression and Association Models for Clustered Ordinal Data
Authors: Jokinen Jukka , McDonald John W. , Smith Peter W. F.
Published: September 2006

Many proposed methods for analyzing clustered ordinal data focus on the regression model and consider the association structure within a cluster as a nuisance. However, the association structure is often of equal interest—for example, temporal association in longitudinal studies and association between responses to similar questions in a survey. We discuss the use, appropriateness, and interpretability of various latent variable and Markov models for the association structure and propose a new structure that exploits the ordinality of the response. The models are illustrated with a study concerning opinions regarding government spending and an analysis of stability and change in teenage marijuana use over time, where we reveal different behavioral patterns for boys and girls through a comprehensive investigation of individual response profiles.
Getting the Ball Rolling: Voluntary Contributions to a Large‐Scale Public Project
Authors: YILDIRIM HUSEYIN
Published: September 2006

This paper examines dynamic voluntary contributions to a large‐scale project. In equilibrium, contributions are influenced by the interplay of two opposing incentives. While agents prefer to free ride on others for contributions, they also prefer to encourage others to contribute by increasing their own. Main findings of the paper are that (1) agents increase their contributions as the project moves forward; (2) as additional agents join the group, existing agents increase their contributions in the initial stages of the project while reducing them in the stages close to completion; (3) groups that are formed by more patient agents and that undertake larger projects tend to be larger; and (4) groups that rely on voluntary contributions tend to be too small compared to the social optimum. The empirical evidence on contributions to open‐source software projects provides partial support for these findings.
Product Quality and the Optimal Structure of Commodity Taxes
Authors: DELIPALLA SOFIA , KEEN MICHAEL
Published: September 2006

The comparison between ad valorem and specific taxation is among the oldest issues in formal public finance and is important for policy in the European Union (EU) and elsewhere. This paper develops and articulates simple but very general elasticity rules that characterize the optimal balance between the two in a model of endogenous product quality. These rules temper the preference for ad valorem taxation that emerges from homogeneous product models, pointing to relatively heavy reliance on whichever form of taxation has the least effect on product quality.
The Economics of Bipartisan Campaign Reform
Authors: CADIGAN JOHN
Published: September 2006

This essay evaluates two provisions in the Bipartisan Campaign Reform Act (BCRA): raising contribution limits and banning soft money. The model highlights the importance of marginal cost ratios for candidates and their parties. The results suggest that raising contribution limits protects incumbents. Importantly, this generates efficiency gains that come at the expense of electoral competitiveness. When a party has an advantage in a large number of districts, the soft money ban may also reduce rent‐seeking effort while exacerbating existing advantages. Ultimately, the two provisions underscore an “equity‐efficiency” trade‐off. While restricting rent‐seeking effort, they probably lead to less competitive elections.
Passive Industry Interests in a Large Polity
Authors: LEAVER CLARE , MAKRIS MILTIADIS
Published: September 2006

We seek to explain the puzzle of passive industry interests. Taking the formation decision as given, we focus on the ability of a political action committee (PAC) to elicit voluntary donations for campaign giving. We show that, when the number of stakeholders is large and uncertain, PACs behave counteractively. That is, a single PAC that does not oppose the government's prior preference raises resources whenever an opponent poses a credible threat to secure policy favors. By implication money never actually changes hands, prompting the suggestion that counteractive behavior may lie behind the well‐documented, and consistently low, levels of PAC disbursements.
The Optimal Use of Fines and Imprisonment If Governments Do Not Maximize Welfare
Authors: DITTMANN INGOLF
Published: September 2006

We consider a stylized model of crime and punishment in which the prosecution policy is defined by three variables: the size of punishment, the type of punishment, and the detection probability. We derive the optimal type of punishment under the assumption that the detection probability is chosen by a government whose objective function places a higher weight on the government's budget than the social welfare function does. We show that for serious crimes exclusive imprisonment is welfare maximizing. If costs of imprisonment are taken into account, the optimal punishment is a prison term with an additional fine that is smaller or equal to the costs of the prison term. For less serious crimes, fines without imprisonment are welfare maximizing. Therefore, this paper demonstrates that the standard result of the literature that fines should be used whenever feasible need not hold in the presence of a rent‐seeking government. Moreover, it offers a new explanation for the widespread use of mandatory imprisonment for serious crimes.
Optimal Age‐Specific Income Taxation
Authors: LOZACHMEUR JEAN‐MARIE
Published: September 2006

This paper studies optimal earnings taxation in a three‐period life‐cycle model where taxes can be differentiated according to age. Agents choose their level of education when young and their retirement age when old. I study the problem both without and with borrowing constraints. It is shown that, without borrowing constraints, a first‐best optimum can be decentralized by setting a zero tax rate in the third period and a first‐period tax lower than the second‐period one. With borrowing constraints, the first best can no longer be achieved. The gap between the first‐ and second‐period tax rates is larger, while the third‐period tax rate is generally different from zero.
A Class of Antipersistent Processes
Authors: Bondon Pascal , Palma Wilfredo
Published: September 2006

Abstract. We introduce a class of stationary processes characterized by the behaviour of their infinite moving average parameters. We establish the asymptotic behaviour of the covariance function and the behaviour around zero of the spectral density of these processes, showing their antipersistent character. Then, we discuss the existence of an infinite autoregressive representation for this family of processes, and we present some consequences for fractional autoregressive moving average models.
Familial occurrence of pseudoxanthoma‐elasticum‐like papillary dermal elastolysis
Authors: Orlandi Augusto , Bianchi Luca , Nini Gabriele , Spagnoli Luigi Giusto
Published: September 2006

We report the morphological, immmunohistochemical and ultrastructural cutaneous findings of two sisters, aged 72–74, with pseudoxanthoma‐elasticum‐like papillary dermal elastolysis (PDE), recently defined as an age‐related condition. To our knowledge, these are the first familial cases of PDE reported in the literature. The lesions appeared as small, asymptomatic, soft papules around the neck and axillary regions. The affected skin revealed a marked decrease of normal elastic network of papillary dermis without alterations in either the relevant collagen or reticular dermis. Ultrastructural and immunohistochemical examinations showed activated dermal fibroblasts with abundant elongated dendritic cytoplasmic processes and the absence of myofibroblasts. The well documented avoidance of sun exposure (the patients are both nuns), the rare incidence of the disorder (only six cases reported), and the familial occurrence suggest that genetic or inherited predisposition should also be considered in the pathogenesis of PDE.
Erythrokeratoderma variabilis: case report and review of the literature
Authors: Papadavid E. , Koumantaki E. , Dawber R.P.R.
Published: September 2006

We report two patients, mother and daughter, with Erythrokeratoderma variabilis (EV). This rare genodermatosis is characterized by the presence of two components: migratory erythema and fixed hyperkeratosis. Our patients experienced symptomatic relief of pruritus associated with erythema with the use of an oral, low‐sedating H1antihistamine. Revision of the literature in order to allocate the frequency of pruritus in EV and discussion of this association will follow.
Topical therapy in acne
Authors: Gollnick H. , Schramm M.
Published: September 2006

The majority of acne patients will receive a topical treatment either as monotherapy or in combination with a systemic drug therapy depending on the severity of the disease. The currently available topical agents affect at least one of the four main pathogenetic factors responsible for the development of acne, i.e. hyperkeratosis, microbial colonization, immune response and inflammation. Retinoids, azelaic acid, benzoyl peroxide and topical antibiotics represent the spectrum of the established and proven topical agents. Presumably, antiandrogenic agents will soon be available for topical use to treat the important factor of seborrhea. In general, by combining topical agents, their potency can be enhanced and toxicity diminished. Unfortunately, bacterial resistances are beginning to emerge as a significant problem.
Generalized pustular drug eruptions: confirmation by in vitro tests
Authors: Lazarov A. , Livni E. , Halevy S.
Published: September 2006

Background Generalized pustular eruptions are characterized by acute onset of aseptic pustules in febrile patients with leukocytosis after exposure to the offending drug. They have been regarded as uncommon manifestations of adverse drug reactions. Until now few confirmation studies have been carried out.

Objective Our purpose was to describe a series of patients with generalized pustular drug eruption. The diagnosis and etiological role of drugs in these cases was confirmed by two in vitro tests, namely the macrophage migration inhibitory factor (MIF) and the mast cell degranulation (MCD) tests.

Methods The clinical, pathological and laboratory findings in six patients with generalized pustular eruption were studied prospectively. The MIF and MCD tests were performed with the drugs taken by the patients.

Results The dermatological manifestations included numerous pustules on large erythematous areas, papules and erythema multiforme‐like lesions. The pustular eruption developed between 12 h and 5 days after the administration of the provoking drug. The histopathological changes were characterized by subcorneal pustules, papillary edema and mixed cell inflammatory infiltrate. In two biopsies the infiltrate displayed numerous eosinophils. Laboratory investigations revealed leukocytosis with neutrophilia (4 of 6 patients) and eosinophilia and hyperimmunoglobulinemia E (2 of 6 patients).MCD tests with the suspected drugs (Ampicillin, Cefazolin, Tetracycline, Griseofulvin, Enalapril Maleate) were positive in all patients. Positive MIF results were seen in five of the six patients. Withdrawal of the drug led to fast recovery.

Conclusion The diagnosis of pustular drug eruptions depends on circumstantial evidence, some characteristic clinico‐pathological findings and exclusion of alternative diagnoses of other disseminated pustular eruptions. In vitro tests, namely MIF and MCD tests, are a useful diagnostic aid in the identification of the offending drugs.
Leukocytoclastic vasculitis induced by low‐dose methotrexate: in vitro evidence for an immunologic mechanism
Authors: Halevy Sima , Giryes Hani , Avinoach Liana , Livni Ella , Sukenik Shaul
Published: September 2006

The rare occurrence of methotrexate (MTX)‐induced vasculitis has been associated mainly with high or intermediate MTX doses. We report herein a case of cutaneous leukocytoclastic vasculitis (LCV) following treatment with low‐dose oral MTX (7.5 mg/week) for rheumatoid arthritis. The histological findings of a cutaneous lesion were consistent with drug‐induced vasculitis. The clinical and histological findings, including the temporal relationship between MTX intake and the onset of vasculitis, and the results of withdrawal and rechallenge tests, suggest a causal relationship, and indicate a drug‐induced LCV due to MTX. The role of MTX in the induction of the vasculitis was further supported by a positive mast cell degranulation (MCD) test.
Contact allergens in patients with leg ulcers
Authors: Katsarou‐Katsari A. , Armenaka M. , Katsenis K. , Papageorgiou M. , Katsambas A. , Bareltzides A.
Published: September 2006

Background Contact dermatitis can complicate the treatment of leg ulcers and is an acquired phenomenon resulting from the use of topical medications.

Objective To show the incidence of contact dermatitis reactions to topical medications applied to leg ulcers and to evidence changing trends in such reactions through comparison of two case series about 20 years apart.

Subjects and methods We studied two groups of patients with leg ulcers that were patch tested with contact allergens in 1973–1974 and in 1994–1995.

Results One or more positive patch tests was present in 75% and 40% of the patients, respectively. A decrease in the incidence of positive reactions to neomycin, local anesthetics and parabens mix was seen in 1994–1995. The most important contact allergens in 1994–1995 were fragrance mix, colophony and the excipients wool alcohols and amerchol. Other relevant sensitizers were formaldehyde, neomycin and gentamycin.

Conclusion The changing trends in contact allergens over the last 20 years may be explained by changes in the components of topical agents used for treatment.
South American cutaneous leishmaniasis: report of ten cases in Israeli travelers
Authors: Zlotogorski A. , Gilead L. , Jonas F. , Horev L. , Klaus S.N.
Published: September 2006

Background Cutaneous South American leishmaniasis is caused by several species of leishmaniasis. Lack of appropriate treatment may lead to mucocutaneous leishmaniasis, mainly with L. b. braziliensis and L. b. panamensis.

Objective To describe the clinical findings of Israeli travelers infected with cutaneous South American leishmaniasis and to draw attention to this problem.

Subjects Ten patients were interviewed, examined and treated.

Results Twenty‐two lesions of cutaneous leishmaniasis were found, all in exposed areas. Patients were seen by an average three physicians (range 1–6) before the final diagnosis was confirmed by direct smear, after an average period of 125 days (range 88–270 days). Treatment with Pentostam was started after an average period of 134 days (range 94–275 days). All lesions healed completely, but with scarring.

Conclusion Travelers to endemic areas, as well as physicians, should be instructed about the potential risks and the clinical manifestations of cutaneous and mucocutaneous South American leishmaniasis. Such awareness will prevent undue delay in diagnosis and treatment.
Squamous cell carcinoma of the skin ‐ histopathological features and their significance for the clinical outcome
Authors: Petter G. , Haustein U.‐F.
Published: September 2006

Background Owing to the rising incidence of tumours, the question of reliable risk classification is becoming increasingly significant.

Objective Participation in the multicentre carcinoma registry maintained by the Association of Operative and Oncological Dermatology of the German Dermatological Society requires, in addition to the parameters of clinical staging and grading already established by the International Union against Cancer, description of other histopathological criteria related to prognosis, with special attention to microstaging.

Methods One hundred and eighty‐four patients with squamous cell carcinoma of the skin were examined. The histological parameters, carcinoma type, Breslow index, invasion level, growth form, grading and mitotic index were recorded and classified, and clinical staging was performed.

Results It was found that the clinical criterion of tumour diameter (T‐category) determines the further course of the disease. The other parameters taken into account, namely pathohistological microstaging and grading, can increase the accuracy of prognosis evaluation, and in particular enable carcinomas of the T1‐category to be classified as either high malignant or low malignant tumours. The desmoplastic squamous cell carcinoma subtype is a potential risk tumour. Endophytic tumours are more malignant in their development than exophytically‐growing carcinomas, and the probability of recurrence and metastatic tumour spread further increases when ulceration can be detected by microscope. In order to distinguish metastatic and recurring carcinomas, in addition to determining the invasion levels after Clark, measuring the Breslow index proved to be an important criterion. Quoting the mitotic index augmented the grading system, which further improved the reliability of malignancy assessment.

Conclusions The TNM categories currently applied to squamous cell carcinomas of the skin must be supplemented by additional histological parameters which, according to our findings, permit more accurate classification of high and low malignant tumours.
Hereditary multiple fibrofolliculomas, trichodiscomas and acrochordons: syndrome of Birt‐Hogg‐Dubè
Authors: Scalvenzi Massimiliano , Argenziano Giuseppe , Sammarco Elena , Delfino Mario
Published: September 2006

The syndrome of Birt‐Hogg‐Dubè (BHD) is an autosomal dominant syndrome, characterized by a triad of cutaneous lesions including multiple fibrofolliculomas, trichodiscomas, and acrochordons. There are many clinical expressions, solitary and multiple forms, with or without other skin tumors. In the literature BHD syndrome has been associated with internal malignancy. We describe a patient with multiple firm, skin‐colored papules in which the three types of lesion are documented. No signs of systemic disease were present.
Scleromyxoedema and thrombotic thrombocytopaenic purpura: two rare conditions both responding to plasma exchange
Authors: Harman Karen E. , Abbs Ian C. , Mahood John M. , Black Martin M.
Published: September 2006

We report the case of a 66‐year‐old female who over an 18‐month period developed severe, disabling scleromyxoedema with pulmonary fibrosis. Treatment with oral prednisolone and melphalan had failed to prevent disease progression. Treatment with a 5‐day course of plasma exchange, intravenous cyclophosphamide (500 mg) and methyl‐prednisolone (1 g on 3 consecutive days) was unfortunately followed by the development of thrombotic thrombocytopaenic purpura (TTP). After 17 extra plasma exchanges, she recovered and there has been a dramatic improvement in her skin signs. We postulate that the extra plasma exchanges which she received as a consequence of developing TTP have contributed to this result. To our knowledge, TTP has never been associated with scleromyxoedema, but it is likely to be a coincidence in this case.
Benign nodular calcification and calciphylaxis in a haemodialysed patient
Authors: Strumìa Renata , Lombardi Anna Rita , Bedani Pier Luigi , Perini Leonella
Published: September 2006

Several types of soft tissue calcification can be detected from radiographic evaluation of patients with end‐stage renal failure. The factors that predispose to such calcification include an increase in CaxP product in serum, the degree of secondary hyperparathyroidism, the level of blood magnesium, the degree of alkalosis, and the presence of local tissue injury. Three major varieties include calcification of medium‐sized arteries, periarticular or tumoral calcification and visceral calcification. Calciphylaxis is a phenomenon consisting of acute ischemic necrosis in presence of calcification of dermohypodermic arterioles. It occurs mostly in chronic renal failure patients with secondary or tertiary hyperparathyroidism with a persistently elevated calcium‐phosphorus product. There are few options in treating calciphylaxis and the outcome is generally poor. The authors report the case of a haemodialised patient with benign nodular calcification and calciphylaxis. The coexistence of both entities in the same patient has never been described.
Prevalence, epidemiological and clinical correlates of genital Chlamydia trachomatis infection1
Authors: Tchoudomirova K. , Nuhov Ph. , Tchapanova A.
Published: September 2006

Objective To evaluate the prevalence of genital infection with Chlamydia trachomatis in different groups of patients in the region of Plovdiv, Bulgaria, over a period of four years (1992–1995) and to establish epidemiological and clinical correlates of infection.

Material and methods Five groups were enrolled in the study: group A ‐ 990 symptomatic male sexually transmitted disease (STD) patients, group B ‐ 1023 symptomatic female STD patients, group C ‐ 253 gynaecological patients, and asymptomatic groups D ‐ 276 men and group E ‐ 231 women. Urethral samples from men and cervical and urethral samples from women were examined for C. trachomatis antigen by direct immunofluorescence assay (DFA) or enzyme immunoassay (EIA) confirmed by DFA at the STD outpatient clinic of the Medical Institute in Plovdiv.

Results The prevalence rates for genital infection with Chlamydia trachomatis were 25.1% in group A, 21.8% in group B, 15.4% in group C, 4.3% in group D and 6.1% in group E. Infection with C. trachomatis was more common in patients who were ≥ 25 years of age, unmarried, and with risk sexual behaviour, as well as in those who had signs and symptoms suggestive of infection.

Conclusion The study shows a relatively high prevalence of infection with C. trachomatis in STD and gynaecological patients. Symptoms and signs correlated with C. trachomatis infection, but were not specific or reliable indicators of infection. C. trachomatis detection should be included in standard STD and gynaecological examination.
Efficacy and tolerance of oral ivermectin in scabies
Authors: Dourmishev Assen , Serafimova Dimitrina , Dourmishev Lyubomir
Published: September 2006

ObjectiveThe aim of this open‐label study was to investigate the therapeutic effect and adverse reactions of oral ivermectin in scabies patients.

BackgroundThere is much confusion over reports of efficacy, adverse reactions and relapses after oral treatment of scabies with ivermectin.

MethodsNineteen patients, ten otherwise healthy outpatients with scabies, and nine inpatients with scabies and another skin disease (dermatomyositis, 3; pemphigus, 2; bullous pemphigoid, 1; pyoderma, 1; HIV, 1; Behcet's disease, 1) were treated with an oral dose of 0.2 mg/kg ivermectin (1% water solution) on days 1 and 8. The presence of live mites and ova in the patient's skin was investigated before, during and after the treatment.

ResultsNone of the 19 patients with scabies had evidence of scabies after the second dose of ivermectin. In seven patients we noted the enhancement of pruritus 24–72 h after the first administration of ivermectin. In three patients the skin manifestation, vesicle‐pustular rash increased between the second and the fourth day.

ConclusionThe advantages of oral ivermectin treatment in scabies patients are: high therapeutic efficacy againstSarcoptes scabiei, good tolerance and influence of the drug on the whole skin surface and on clinical symptoms. The administration of the drug is easy and quick.
A fibre‐free alginate dressing in the treatment of split thickness skin graft donor sites
Authors: Steenfos H.H. , Agren M.S.
Published: September 2006

Background Alginate dressings are gaining acceptance in wound management although comparative published data with conventional treatment is inconclusive.

Aims The aim of this randomised controlled study was to compare a fibre‐free alginate dressing (Comfeel SeaSorb) with conventional treatment of standardised split‐thickness skin graft donor sites in 17 patients regarding initial absorption of blood and healing.

Results The alginate dressing absorbed 40% (P < 0.05) more blood, measured as total iron content of used dressings, during the first 10 post‐wounding minutes than fine mesh gauze, resulting in less subsequent bleeding. Light microscopic examination of punch biopsies obtained from 10 wounds on post‐operative day 6 demonstrated that nine wounds treated with the alginate dressing compared with seven wounds treated conventionally with paraffin‐impregnated gauze (Jelonet®) were completely epithelialised, a statistically non‐significant difference (P= 0.46).

Conclusions In conclusion, the fibre‐free alginate dressing showed increased initial blood absorption resulting in quicker haemostasis but showed no greater beneficial effect on epithelialisation of split‐thickness skin graft donor sites compared with conventional topical treatment
Increased serum IL‐6, TNF‐alpha and IL‐10 levels in patients with bullous pemphigoid: relationships with disease activity
Authors: D'Auria L. , Mussi A. , Bonifati C. , Mastroianni A. , Giacalone B. , Ameglio F.
Published: September 2006

Aim

The present report analyzes the serum levels of three cytokines, interleukin‐6 (IL‐6), tumor necrosis factor‐alpha (TNF‐alpha) and interleukin‐10 (IL‐10) in 15 patients with bullous pemphigoid (BP) (compared with 20 healthy controls) to evaluate a possible involvement of these biological modulators in the clinical expression of this disease.

Background

BP is a rare, bullous disease of autoimmune origin with evidence of inflammatory processes that cause skin lesions with local increase of various pro‐inflammatory mediators.

Methods

Determination of cytokine concentrations were obtained employing commercially available ELISA kits.

Results

The sera of BP patients showed increased levels of these three cytokines (P < 0.01). When the number of skin lesions (blisters and/or erosion) of each patient, employed as a marker of disease activity, was correlated with the serum levels of IL‐6 and TNF‐alpha, significant correlations were found (IL‐6: P < 0.01 and TNF‐alpha: P < 0.01, respectively), suggesting a possible role of these mediators in the development of BP blisters. The serum levels of IL‐6 also correlated (P= 0.01) with those of serum C reactive protein (CRP), an acute‐phase protein induced by IL‐6 in hepatocytes. In addition, serum TNF‐alpha and sE‐selectin (an adhesion molecule previously reported to be increased by this cytokine) levels were also correlated (P < 0.05).

Conclusions

On the basis of these data, it may be indicated that at least IL‐6 and TNF‐alpha are associated with the clinical expression of BP and that the endothelial activation (possibly induced by the TNF‐alpha activity), seems to be an important phase of this dermatosis.
Penile pyoderma gangrenosum
Authors: Güngör Emel , Karakayali Güliz , Alli Nuran , Artüz Ferda , Lenk Nurdan
Published: September 2006

Pyoderma gangrenosum is a rare ulcerating inflammatory skin disease. Genital involvement has been rarely reported. We report a 24‐year‐old man with penile pyoderma gangrenosum who was treated with systemic corticosteroids.
Peeling agents: toxicological and allergological aspects
Authors: Cassano Nicoletta , Alessandrini Giuseppe , Mastrolonardo Mario , Vena Gino Antonio
Published: September 2006

Background

The use of peeling agents is very common in clinical practice. However, despite the overall good safety profile, it is not without any inherent risk; therefore, clinicians should be adequately informed about potential risk in order to avoid or prevent them.

Objective

This paper reviews toxicological and allergological aspects of peeling agents in general, also beyond their actual use in peeling procedures. Toxic and allergic reactions from peeling agents are rather uncommon and have been rarely reported in association with the medical use of peels.

Methods

Systemic toxic effects may essentially derive from phenol and potentially from two phenol derivatives, resorcinol and salicylic acid. A complete understanding of the toxicological profile of peeling agents, along with a correct execution of the technique and a carefully selection of patients, can help avoid serious side effects.

Results

Allergic contact reactions occur most frequently with resorcinol, while most peeling agents are only rare sensitizers or appear to be free of true sensitizing power. Other types of hypersensitivity response seem to be very rare.
Monocytic aleukemic leukemia cutis
Authors: Török L. , Lueff S. , Garay G. , Tápai M.
Published: September 2006

The authors present a case of monocytic aleukemic leukemia cutis in which skin symptoms were the sole manifestation of the leukemia during the first year and a half of the disease. Diagnostic difficulties, the importance of immunhistochemical markers, and the prognosis and therapy of aleukemic leukemia cutis are discussed.
UV‐B radiation microphototherapy. An elective treatment for segmental vitiligo
Authors: Lotti Torello M. , Menchini Giovanni , Andreassi Lucio
Published: September 2006

Background

Vitiligo is a common disease of unknown cause that produces disfiguring white patches of depigmentation. Previous studies have suggested the effectiveness of UV‐B radiation in generalized vitiligo (GV) therapy, but there was no evidence to support the same role for segmental vitiligo (SV).

Objective

The purpose of this study was to use UV‐B radiation exclusively on vitiligo patches of individuals affected by S V to evaluate the effectiveness of this therapy.

Subjects and methods

Eight individuals with SV were treated for 6 months with a new device called BIOSKIN® that can produce a focused beam of UV‐B (microphoto‐therapy) on vitiligo patches only. Photographs of the subjects were taken at the beginning of the therapy and once a month thereafter for 6 months. The response to treatment was estimated in two comparable photographs using planimetry. A control group of eight individuals matched for sex and age was treated with placebo, using the same device but not releasing any kind of detectable light.

Results

After 6 months of microphototherapy five subjects of the eight studied achieved normal pigmentation on more than 75% of the treated areas. In particular, three of these were totally repigmented. Two individuals achieved 50–75% pigmentation of the treated areas, and only one showed less than 50% repigmentation (Table 3). In the control group only one patient showed moderate repigmentation (less than 50%) (Table 3) (Fig. 3).

Conclusion

UV‐B microphototherapy seems highly effective in restoring pigmentation in patients affected by vitiligo. As no side‐effects have been observed, this could represent the treatment of choice in the limited (segmental) forms of vitiligo.
Malignant fibrous histiocytoma of the scalp. Multidisciplinary treatment
Authors: Camacho Francisco M. , Moreno Jose C. , Murga Manuel , Proaño Jorge , Cantillana Jose , Naranjo Manuel , Martínez‐Sahuquillo Angel , Macher Gustavo , Romero Francisco
Published: September 2006

Background

Malignant fibrous histiocytomas (MFH) are uncommon in the skin, and even less frequent on the scalp. On the scalp they are often very difficult to excise and it is even more difficult to close the resulting wound.

Objective

To review all malignant fibrous histiocytomas diagnosed and treated in our Department during the past 6 years, and to describe the multidisciplinary procedure employed to treat one special case of aggressive malignant fibrous histiocytoma on the scalp that recurred twice.

Result

Malignant fibrous histiocytomas represent 0.01% of malignant cutaneous tumors in our area. The immediate results after a multidisciplinary treatment performed on a recurrent malignant fibrous histiocytoma located on the scalp were excellent, but recurrence was observed 6 months later. Two years later we have also treated another case of MFH on the scalp. The same surgical technique was performed, but the patient received high‐dose‐methotrexate‐based neoadjuvant chemotherapy (HD‐MTX). One year later, this patient is still alive and no signs of recurrence have been detected.

Conclusion

When malignant fibrous histiocytoma occurs on the scalp it must be treated immediately by means of an excision with a large peripheral edge of 2 cm from the visual or CAT limits of the lesion, since the first treatment must be definitive.
Congenital non‐familial unilateral basaloid follicular hamartoma
Authors: Harman Mehmet , Inalöz H. Serhat , Akdeniz Sedat , Inalöz Serap S. , Aslan Adem
Published: September 2006

Basaloid follicular hamartoma is not a well‐recognized clinical entity and has often been diagnosed as trichoepithelioma or basal cell carcinoma. It is a unique benign follicular tumour which comprises a variety of clinical manifestations. We present the case of a 24‐year‐old male with unilateral basaloid follicular hamartoma present at birth and later misdiagnosed as basal cell carcinoma. Histological features of basaloid follicular hamartoma are not always diagnostic and clinico‐pathological correlation is particularly important to distinguish this benign hamartoma from other basaloid tumours including basal cell carcinoma. Continuous follow‐up of our patient did not reveal any clinical or histological malignant transformation.
Nevoid hyperkeratosis of the nipple and areola: treatment with topical retinoic acid
Authors: Okan Gökhan , Baykal Can
Published: September 2006

Nevoid hyperkeratosis of the nipple and areola is a rare dermatosis with unknown etiology, (Perez‐Izquierdo JM, Vilata JJ, Sanchez JL, et al. Retinoic acid treatment of nipple hyperkeratosis. Arch Dermatol 1990;126:687–688). Only 40 cases have been reported until 1997 (Alpsoy E, Yilmaz E, Aykol A. Hyperkeratosis of the nipple: report of two cases. J Dermatol 1997;24:43–45). The disease has a benign course and may only be a cosmetic problem. Different modalities have been used in the treatment of NHNA. In our case treatment with topical retinoic acid induced an acceptable response.