bluuebunny/crossref_metadata_2025 huggingface dataset:
The Dialysis Outcomes and Practice Patterns Study (DOPPS): How Can We Improve the Care of Hemodialysis Patients?
Authors: Goodkin David A. , Mapes Donna L. , Held Philip J.
Published: March 2003

Outcomes among dialysis patients vary considerably internationally and across regions within the United States. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a large, prospective, observational study of representative samples of hemodialysis patients in France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States. The DOPPS collects a wealth of data regarding the patients' demographic characteristics, medical histories, laboratory values, prescriptions, dialysis unit practices, and outcomes. The study seeks to clarify which dialysis practices contribute to improved mortality rates, hospitalization rates, health related quality of life, and vascular access outcomes, after adjusting for the effects of comorbid disease and demographic variables. Over 18,000 patients have been enrolled to date. This paper describes the initial findings and outlines the plans to expand the trial.
Renal Transplantation Update Series Editor: V. Ram Peddi and M. Roy First: Recent Advances in Immunosuppressive Therapy for Renal Transplantation
Authors: Peddi V. Ram , First M. Roy
Published: March 2003

Recent advances in immunosuppression have focused on more effective, safer, and targeted therapies that have resulted in improved short‐ and intermediate‐term renal allograft survival. During the past decade there has been a marked decrease in acute rejection rates following renal transplantation because of the use of newer immunosuppressive agents. Recent data indicate that the average yearly reduction in the relative hazard of graft failure beyond 1 year was 4.2% for all recipients (0.4% for those recipients who had an acute rejection episode and 6.3% for those who did not have an acute rejection). Despite these improvements the currently available immunosuppressive agents are associated with significant cardiovascular risk factors, an increased risk of infection, and the development of malignancies in the long term. Predictive parameters of donor‐specific hyporesponsiveness are needed so as to allow identification of patients in whom immunosuppressive therapy can be safely reduced. Immunosuppressive agents that have recently been approved for use in the United States and those that are in clinical and preclinical studies are discussed.
Evolution of the Single‐Pool Urea Kinetic Model
Authors: Gotch Frank A.
Published: March 2003

Our interest in urea kinetic modeling (UKM) was stimulated some 30 years ago at the time of the advent of hollow fiber kidneys with greatly improved urea transport. This led to examination of the interaction between time and clearance in computing the dialysis dose. In early studies a fixed‐volume single‐pool UKM was used but this frequently gave spurious high volumes and led to the advent of the variable‐volume single‐pool model. The role of volume calculation in assessment of the delivered dialysis dose and the value of normalized protein catabolic rate (nPCR) calculation are reviewed. More recently quantification of double‐pool effects has become simplified and now is widely used for UKM. The National Cooperative Dialysis Study (NCDS) resulted in the concept of dose quantification by Kt/V. This is reviewed, including the controversy surrounding interpretation of the NCDS. Currently there is great interest in more frequent dialysis, 4–6 days/week. The development of a new dose parameter, the standard Kt/V (stdKt/V), to enable quantitative comparison of dose with widely varying dose schedules is discussed.
Dissociation Between Dialysis Adequacy and Kt/V
Authors: Vanholder Raymond , DeSmet Rita , Lesaffer Gerrit
Published: March 2003

Since the initiation of dialysis, nephrologists have sought an index (or indices) for the adequacy of toxic solute removal. This quest has been characterized by a gradual shift in thinking, ending with a preference for dynamic parameters such as clearances normalized for body size (Kt/V). The threshold Kt/V, however, has changed over the years. While present guidelines suggest 1.2 with single‐pool kinetics, higher levels might be proposed in the future. In spite of the known relation between Kt/V and survival, the accuracy of this parameter as a representative of the removal of the whole spectrum of compounds that are responsible for uremia is problematic. Kt/V only assesses the removal of a water‐soluble compound from the body water through mostly hydrophilic membranes to the dialysate water. Furthermore, the small size of urea means that convective and/or diffusive transfer through a given semipermeable membrane is unlikely to be representative of larger molecules, especially if dialyzers with a small pore size are applied. Urea kinetics are also poorly representative of the removal of small protein‐bound molecules and intracellular solutes with cell membrane‐limited clearance. Finally, it should be realized that the Kt/V concept has been developed in a specific population, that is, a group of renal failure patients with few comorbidities, submitted to short intermittent hemodialysis with small‐pore bioincompatible membranes very likely using dialysate of lower quality than that used today. Kt/V might well become less accurate and useful in predicting outcomes as different dialysis conditions are pursued, such as dialysis with biocompatible and/or large‐pore membranes, (ultra) pure dialysate, alternative time frames, high levels of convection, and/or in populations with a different distribution of body mass.
Imaging in the Dialysis Patient: The Pathology of Dialysis
Authors: Freemont A. J.
Published: March 2003

There are a number of pathologies that are associated with the development of renal failure. Once renal function has deteriorated beyond a point where life is not sustainable without dialysis, new sets of pathologic processes develop. These are, in part, related to the continuation of poor renal function and to the process of dialysis itself. This article addresses the processes that are believed to be due to dialysis, among which are disorders of bone, deposition of metals and amyloid within a number of tissues, and local problems such as inflammation and tumors related to the dialysis site.
Biofilms and Infection in Dialysis Patients
Authors: Dasgupta Mrinal K.
Published: March 2003

Biofilm bacterial infections are implicated in most human bacterial infections and are also common in patients undergoing treatment with hemodialysis and peritoneal dialysis. Skin bacteria, which grow into microcolonies with biofilm formation in dialysis environments, are implicated in most of these infections. Dissemination of bacterial biofilms in hemodialysis patients induces bacteremia and endotoxemia. In peritoneal dialysis patients, biofilm causes peritonitis and catheter‐related infections with consequent loss of catheters and technique failure. Effective strategies for the diagnosis, intervention, and prevention of biofilm‐related infections in dialysis patients are described in this review.
Automated Peritoneal Dialysis Symposium: APD in the Developing World: Is There a Future?
Authors: Correa‐Rotter Ricardo
Published: March 2003

Automated peritoneal dialysis (APD) has experienced significant growth in highly developed nations in the last few years, while in developing countries with important social, educational, and financial constraints this treatment modality is, at best, trying to emerge. APD offers advantages that make it popular. Some of these advantages include increased adequacy for some patient groups, enhanced patient well‐being and positive changes in lifestyle, as well as a reduction in peritonitis rates attributed to fewer connect‐disconnect procedures. The development of APD in developing nations has been very poor mainly due to educational and financial constraints. APD growth as a treatment modality in the developing world requires multiple approaches, some of them general and others related to the specific needs of each nation. There is a need to develop APD research projects and pilot programs to demonstrate the benefits for specific subpopulations. In addition, the development of research and industry‐market strategies directed at reducing costs related to this form of treatment are required. The relatively low use of APD in developing nations is primarily influenced by nonmedical factors. Given the financial and educational constraints, APD programs may need to be directed toward specific subpopulations such as young working adults, individuals who require assistance to perform procedures, or patients who require an increased dialysis dose in order to reach adequate clearances.
Automated Peritoneal Dialysis Symposium: The Kinetic Spectrum of APD
Authors: Gotch Frank A.
Published: March 2003

A generalized kinetic model to quantify the efficiency of cycler (CPD) and tidal peritoneal dialysis (TPD) is used to examine the relative efficiency of these techniques over a wide range of tidal volumes, drain profile characteristics, and hourly dialysate flow rates. In the patient with good catheter function, there is little difference in efficiency between CPD and TPD. In patients with long drain times or nonlinear drain profiles, greatly improved efficiency may theoretically be achieved with small tidal volume TPD. A generalized solution of the continuous flow PD (CFPD) kinetic model is used to demonstrate and contrast the kinetics of automated PD (APD) and CFPD.
Automated Peritoneal Dialysis Symposium: The Future of APD
Authors: Diaz‐Buxo Jose A.
Published: March 2003

The future of automated peritoneal dialysis (APD) greatly depends on its ability to provide optimal clearances and volume control, preserve peritoneal transport, maintain adequate peritoneal access, and offer flexibility of prescription at a reasonable and competitive cost. Each of these aspects are discussed in the light of recent technologic advances and clinical experiences in order to project a vision of the potential future of APD.
Intermediate‐Term Outcome with Radical Prostatectomy for Localized Prostate Cancer: The Cleveland Clinic Experience
Authors: Clark Peter E. , Levin Howard S. , Kupelian Patrick A. , Reddy Chandanna , Zippe Craig D. , Klein Eric A.
Published: March 2003

Purpose: We examined the results after radical prostatectomy (RP) for clinically localized prostate cancer to determine the 5‐ and 8‐year disease‐specific and biochemical relapse‐free survival (bRFS), and the clinical and pathologic variables that predict biochemical failure.

Materials and Methods: Nine hundred six patients underwent RP for clinically localized prostate cancer between 1990 and 1999. No patient received neoadjuvant or adjuvant therapy. The mean age was 61.9 years (range 40–77 years). The mean preoperative prostate specific antigen (PSA) level was 8.7 ng/ml (range 0.3–54.0). Seventy‐six percent of patients had a biopsy Gleason score ≤6, and 49% had disease at clinical Stage T1c. Eighteen percent of patients reported a family history of prostate cancer. Actuarial bRFS rates were calculated using Kaplan‐Meier analysis.

Results: Pathologic analysis showed that 43% of patients had extracapsular extension, 44% had pathologic Gleason scores ≤6, 23% had positive margins, 8.9% had seminal vesicle invasion, and 1.9% had lymph node metastases. At a mean follow‐up of 44 months (range 1–114), the 5‐ and 8‐year cancer‐specific survival rates were 97% and 95%, respectively. The actuarial 5‐ and 8‐year bRFS rates were 81% and 76%, respectively. Patients with organ‐confined disease had a 100% cancer‐specific survival rate and a 92% bRFS rate at both 5 and 8 years. On multivariate analysis, a positive family history (p = 0.019), clinical stage (p = 0.014), preoperative PSA level (p < 0.001), pathologic Gleason score (p < 0.001), extracapsular extension (p = 0.03), positive margins (p < 0.0001), and seminal vesicle invasion (p = 0.0003) were all independent predictors of bRFS.

Conclusion: Radical prostatectomy for patients with localized prostate cancer has a high rate of cure for appropriately selected patients.
Sustained Activation of Extracellular Signal‐Regulated Kinase (ERK) Signaling in Human Prostate Cancer LNCaP Cells Depleted of Androgen
Authors: Drew Lisa , Fine Robert L. , Raffo Anthony J. , Petrylak Daniel P.
Published: March 2003

Objectives: The mitogen‐activated protein kinase (MAPK) cascade is involved in the control of cell growth and differentiation. In this study, we have investigated the effect of androgen withdrawal on this pathway and its potential role in the induction of neuroendocrine (NE) differentiation. For this purpose, we used the androgen‐sensitive human prostate cancer LNCaP cells as an in vitro model.

Methods and Results: The incubation of LNCaP cells for 6 days in medium, either free of serum or supplemented with serum depleted of steroids (i.e., charcoal‐stripped serum), resulted in NE differentiation as determined by growth arrest, the formation of neurites, and an increase in neuron‐specific enolase protein expression. Sustained extracellular‐regulated kinase (ERK) phosphorylation/activity and enhanced ERK/MAPK kinase (MEK) activity also were observed on serum or steroid withdrawal. A synthetic androgen, mibolerone, blocked both NE differentiation and ERK phosphorylation induced by the incubation of the cells in steroid‐depleted medium, thus confirming androgen specificity. Furthermore, a culture of LNCaP cells in complete medium supplemented with a 5‐α‐reductase inhibitor, finasteride, also induced NE differentiation and ERK phosphorylation. This implicates depletion of the principal prostatic androgen, dihydrotestosterone, as the specific mediator of these effects. In contrast to ERK, the phosphorylation status of the stress‐activated MAPK members c‐Jun N‐terminal kinase and p38 was not altered by steroid withdrawal. The MEK inhibitor U0126 was used to study the potential role of ERK in regulating NE differentiation. However, U0126 did not reverse NE differentiation associated with steroid depletion, even though ERK phosphorylation was suppressed. The role of erb B tyrosine kinase receptors in mediating ERK phosphorylation during steroid depletion also was investigated. erb B1 protein levels decreased, erb B3 protein levels and phosphorylation remained unaltered, and erb B2 phosphoprotein levels increased after steroid depletion. Stable expression of an intracellular antibody to erb B2, however, did not prevent the up‐regulation of ERK phosphorylation that is associated with steroid depletion.

Conclusions: Androgen depletion induces sustained erb B‐independent ERK signaling in LNCaP cells, however, this pathway is not essential for the associated NE differentiation.
Community Health Workers: Examining the Helper Therapy Principle
Authors: Roman Lee Anne , Lindsay Judith K , Moore Joseph S , Shoemaker Allen L
Published: March 2003

A community approach to the integration of health and social services for low‐income pregnant women is being addressed through Community Integrated Service System (CISS) initiatives of the Maternal Child Health Bureau. This particular CISS program model was designed to enable low‐income mothers to function in a Community Health Worker (CHW) role providing social support for at‐risk pregnant women. Using Riessman's notion of “helper therapy,” the model was also developed to enhance the potential for CHWs to gain helper benefits. The purpose of this exploratory study was to describe perceived helper benefits and stressors associated with the CHW role and to examine the usefulness of an instrument developed to assess benefits and stressors. The study findings revealed that the majority of CHWs perceived helper benefits that included positive feelings about self, a sense of belonging, valuable work experience, and access to health information and skills through training or contact with program staff. Stressors such as feeling inadequate to help, however, were associated with the helper role for some CHWs. Preliminary analysis of the Helper's Perception Measure indicated that it may be an effective measure and should be tested with a larger sample of CHWs.
Public Health Nursing in Japan: New Opportunities for Health Promotion
Authors: Murashima Sachiyo , Hatono Yoko , Whyte Nora , Asahara Kiyomi
Published: March 2003

Major changes are taking place in public health nursing in Japan. These include significant developments in employment, education, and roles of public health nurses (PHNs). Demographic and economic factors have prompted the Japanese government to focus health service delivery on community‐based care, particularly for the growing elderly population. Public health nurses are redefining their roles and are assuming important functions in planning, implementing, and evaluating community health programs for the elderly. Japanese PHNs are using a variety of health promotion strategies to initiate change at the local level. This article presents two case studies to highlight the leadership role of PHNs in creating new services that foster healthy communities.
A Model for Building Collective Capacity in Community‐Based Programs: The Elderly in Need Project
Authors: Moyer Alwyn , Coristine Marjorie , MacLean Lynne , Meyer Mechthild
Published: March 2003

As the focus of health promotion moves from individuals to organizations, communities and broader social policy, the models that guide public health program planning and development need reexamination. Public health nurses are gaining experience in strengthening and supporting the ability of communities to grow and change. This study aimed to illuminate the process. Data, gathered as part of an action research project to develop individual and community‐based strategies to decrease isolation in frail older adults, provided a rich source of qualitative data. Analysis was directed toward identifying the factors and processes of capacity‐building. The emerging model was clarified and partially validated with academics and practitioners from health promotion programs across the age span. Four stages of building collective capacity were identified: identifying common ground, working cooperatively, working in partnership, and working across the community. At each stage, processes of relationship building, project management and capacity‐building resulted in stage specific products. A model of building collective capacity, grounded in community health practice and supported by the literature provides a base for developing practice indicators, and practice guidelines which will strengthen the ability to reach health goals.
Gender Issues and Japanese Family‐Centered Caregiving for Frail Elderly Parents or Parents‐in‐Law in Modern Japan: From the Sociocultural and Historical Perspectives
Authors: Hashizume Yumi
Published: March 2003

This paper presents a sociocultural and historical literature review of gender related issues associated with family‐centered caregiving for frail, elderly relatives in modern Japan. Issues addressed from a Japanese perspective are (a) women and social norms of caregiving, (b) feminine identity and caregiving, (c) women in the workforce, and (d) women and caregiving. Implications for research are also discussed.
Economic Evaluation of a Metropolitan‐Wide, School‐Based Hepatitis B Vaccination Program
Authors: Wilson Thad
Published: March 2003

The results of an evaluation of a large metropolitan‐wide, school‐based hepatitis B vaccination program provide further evidence that such programs are effective and cost‐beneficial. The percentage of 6th grade students fully immunized against hepatitis B rose from approximately 8% to 82% in the program. Administering the vaccine at school was $1.46 per dose less than traditional methods. Over $24 million of potential health care costs have been avoided through the program.
Implementation of the Zuluaga‐Raysmith (Z‐R) Model for Assessment of Perceived Basic Human Needs in Home Health Clients and Caregivers
Authors: Zuluaga Beatrice Harrison
Published: March 2003

The Zuluaga‐Raysmith (Z‐R) model is a conceptual framework that incorporates accepted concepts of universal basic human needs developed by Maslow, yet removes the hierarchical nature of these. The Z‐R model recognizes the existence of a health‐illness continuum and accepts that an entity (individual, family, aggregate, or community) may move freely in the direction of greater health and self‐actualization or towards illness and premature death. The Z‐R model identifies 10 basic needs and recognizes that a perceived deficit in any one of these needs can adversely affect the level of wellness of the entity being considered. This exploratory and descriptive study used 11 nurses as interviewers. Subjects consisted of a convenience sample of homebound clients of a home health agency in a metropolitan city, and selected caregivers (n= 27). A modified functional wellness inventory (developed in 1993 by Louvenia Carter) was used with several open‐ended questions, which together related to the 10 needs of the Z‐R model. Reliability coefficient of the instrument was 0.84. Descriptive statistics were used to analyze the data, using means, percentages, and frequencies. Open‐ended questions were grouped according to content and ranked in order of frequency. The five most pressing needs of this small sample were income; physical health; opportunity to make a contribution; mobility; and mental, emotional, social, and spiritual health (MESSH). Nurses unanimously reported that use of the instrument and the Z‐R model helped them to focus on the total person, identify strengths in their clients, identify perceived needs deficits, and therefore, with the client, facilitate the preparation of a timely and cost‐effective interdisciplinary plan of care to help the entity to move to a higher level of wellness despite the presence of chronic disease, disability, or impending death. These findings suggested that further research is warranted to explore the use of the Z‐R model. A replication study is in progress.
Pregnancy Outcomes of Inmates in a Large County Jail Setting
Authors: Mertens Diana J
Published: March 2003

The purpose of this study was to examine low birthweight (LBW) and fetal death rates for women incarcerated in a large county jail during their pregnancy. Additionally, medical and support services available to these inmates were reviewed. Jail records showed this population to be both medically and socially high risk. Analysis indicated that their LBW rate was statistically higher (p < 0.05) than that of the county or state, but comparable to a matched group residing in high‐risk areas of the city in which many of these women resided. During the course of the study, numerous jail policies were identified which had the potential to negatively impact the health of these women and their pregnancy outcomes.
Promotion of the Good Life by Public Health Nurses
Authors: Uosukainen Leena M.
Published: March 2003

The question of what is the good life has been discussed by philosophers since antiquity. The good of an individual and of a community is complicated. Communities influence an individual's experiences and world views, which are always individual. Public health nurses promoting the good life need multidisciplinary knowledge, as well as other skills such as personal competence and qualifications. The focus of the theoretical framework of promotion of the good life is based on models of health promotion and sustainable development. Working with different clients requires nursing theories, other theories, and multidisciplinary models in practice. Continual quality improvement is needed in order to increase customer satisfaction. This article discusses a doctoral thesis that consists of three empirical studies. The theoretical framework for promotion of the good life as the work of public health nurses is outlined, and the outcomes of the first study, the qualifications concerning health, and the environment are described. In the other parts of the study, curriculum building using future methodology and evaluation with concept maps is reported.
Development of a Structural Equation Model for Causal Relationships Among Arteriosclerosis Risk Factors
Authors: Oh HyunSoo , Seo WhaSook
Published: March 2003

The purpose of this study was to clarify the dynamic causal relationships among arteriosclerotic risk factors, including age, smoking, alcoholic consumption, exercise, hypercholesterolemia, hypertriglyceridemia, and hypertension. Data were collected from the medical records of 400 male clients who visited a university hospital located in Inchon, Korea, from May 1996 to December 1996 for physical examinations. The Lineal Structural Relationships 8 program was used to verify the fitness of the hypothetical model to data.

All of the fit statistics, except the Chi‐square value, showed that the hypothetical model was well fitted to the data. Seven percent of obesity was explained by the variables of age, smoking, alcohol consumption, and exercise. Sixty percent of hyperlipidemia could be explained by the variables of age, smoking, exercise, and obesity. And 22% of hypertension was explained by the variables of age, smoking, alcohol consumption, exercise, and hyperlipidemia. Our results showed that these risk factors were directly and indirectly interrelated, and lifestyle variables (smoking, alcohol consumption, and exercise) influence almost all of arteriosclerotic risk factors.
Effects Of Respite Care for Children with Developmental Disabilities: Evaluation of an Intervention for At Risk Families
Authors: Cowen Perle Slavik , Reed David A.
Published: March 2003

Respite child care programs that provide temporary child care, support, and referral services to families of children with developmental disabilities are thought to be a critical component of formal social support interventions deemed necessary to promote healthy family functioning and prevent child maltreatment. This study describes sociodemographic characteristics, parenting stress levels, foster care placement, and founded child maltreatment rates in families of children with developmental disabilities who were using respite care services in a rural Midwestern state. Comparison of matched pre‐ and post‐test Parenting Stress Index scores indicated significant decreases in Total Stress scores (t=3.27, df=86, p=0.0016), Parent Domain scores (t=3.55, df=86, p=0.0006), and Child Domain scores (t=2.2, df=86, p=0.02) following provision of respite care. Through logistic regression, it was determined that life stress, social support, and service level were significantly related to the occurrence of child maltreatment during enrollment ( p < 0.05). The investigator suggests that public health nurses can enhance their case management strategies when working with the parents of children with developmental disabilities by monitoring for caregiver burnout in addition to ensuring that the child is receiving care appropriate for his or her level of need.
Dropping Out of Maternal and Child Home Visits
Authors: Josten La Vohn E. , Savik Kay , Anderson Melea R. , Benedetto Lisa L. , Chabot Corinne R. , Gifford Melody J. , McEiver Judy , Schorn Mary A. , Frederickson Bonnie
Published: March 2003

The purpose of this study was to examine the relationship between nurse and client characteristics and the reason for client termination from public health nursing maternal and child home visits. The results indicate that clients who dropped out of services received more contacts from the nurses, missed more appointments with the nurses, and were given advice from the nurses on more topics. They also differed from clients who continued with services until the nursing care plan goals were met in reference to marital status, mental illness, source of payment for services, and use of WIC and food stamps. Nurses whose clients were more likely to continue until goals were met were higher in conscientiousness, learned more from experience, and learned less from coworkers or learning on their own. They also worked more hours per week. These findings have implications for practice and research.
Urticarial Eruption Associated with Rheumatic Fever in a Child
Authors: Nousari Hossein C. , Kimyai‐Asadi Arash , Ketabchi Nooshin , Cohen Bernard A.
Published: March 2003

Abstract:The classic description of erythema marginatum is of a few asymptomatic erythematous patches or plaques with a characteristic central clearing which may coalesce and develop a polycyclic configuration. We report a boy with a urticarial eruption without the classic lesions of erythema marginatum in whom the diagnosis of rheumatic fever was subsequently made. Histology of the urticarial lesions revealed a mixed, superficial, perivascular infiltrate with prominent eosinophils. Rheumatic fever should be considered in children with fever and urticaria‐like eruptions even in the absence of the classically described erythema marginatum.
Treatment of Molluscum Contagiosum with Silver Nitrate Paste
Authors: Niizeki Kanji , Hashimoto Ken
Published: March 2003

Abstract: Three hundred eighty‐nine consecutive patients with molluscum contagiosum were treated with 40% silver nitrate paste. The cure rate was 97.7% and no scars resulted.
Proceedings of the 1998 Meeting of the Society for Pediatric Dermatology
Authors: Duarte Ana M. , KORF BRUCE R.
Published: March 2003

The Society for Pediatric Dermatology held its annual meeting in Cambridge, Massachusetts, on July 23–26, 1998. Selected summaries of presentations at the meeting follow.
Proceedings of the 1998 Meeting of the Society for Pediatric Dermatology
Authors: Duarte Ana M. , UNG‐JUURLINK CHANTELLE , FROM LYNN , LASSAM NORMAN
Published: March 2003

The Society for Pediatric Dermatology held its annual meeting in Cambridge, Massachusetts, on July 23–26, 1998. Selected summaries of presentations at the meeting follow.
Febrile Perianal Streptococcal Dermatitis
Authors: Vélez Antonio , Moreno José‐Carlos
Published: March 2003

We describe a child with an unusual presentation of perianal streptococcal dermatitis which included fever, acral scarletiniform desquamation, and extension of erythema to involve the genitalia and proximal thighs, as well as the commonly seen well‐defined erythema of the perianal area. We suggest that isolated group A β‐hemolytic streptococci (GAS) in our patient produced a pyrogenic exotoxin similar to that which appears in scarlet fever.
Cutaneous Markers of Primary Immunodeficiency Diseases in Children
Authors: Berron‐Ruiz Angelica , Berron‐Perez Renato , Ruiz‐Maldonado Ramon
Published: March 2003

Abstract: Primary immunodeficiency diseases (PIDs) are rare but important conditions found predominantly in children. We studied PIDs in a large pediatric hospital, their association with cutaneous alterations, and the importance of cutaneous alterations as diagnostic markers. Among 382,383 pediatric patients, 130 (0.0003%) had a PID: humoral in 27, cellular and combined in 18, phagocytic in 37, and associated with major defects in 45. An average of two cutaneous alterations were present in 90 (69%) patients: infections in 80, eczema‐dermatitis in 38, and miscellaneous in 57. In 71 (79%) patients the cutaneous alterations preceded and were the basis for the clinical immunologic diagnosis. Only two PIDs were not associated with cutaneous lesions.
Partial Lipoatrophy in a Child
Authors: Kuperman‐Beade Marina , Laude Teresita A.
Published: March 2003

Abstract: A 2‐year‐old boy was referred to the pediatric dermatology clinic for evaluation of an idiopathic, hypopigmented, atrophic patch on the right gluteal area. After extensive questioning the patient's parents recalled a penicillin injection several months prior to the appearance of lipoatrophy. There were no associated abnormalities.
Unusual Leukoderma After Erythema Multiforme: A Case Report
Authors: Fustes‐Morales A. J. , Soto‐Romero I. , Estrada Z. , Duran‐Mckinster C. , Orozco‐Covarrubias L. , Tamayo‐Sanchez L. , Ruiz‐Maldonado R.
Published: March 2003

Abstract: Erythema multiforme is an inflammatory disorder of the skin that usually fades without sequelae. It is well known that after inflammatory events, hyper‐ or hypochromic spots can remain, especially in skin types III–VI, but achromia is very rare. We report a case of residual leukoderma after erythema multiforme.
Occurrence of Supernumerary Nipples in Children with Kidney and Urinary Tract Malformations
Authors: Grotto Itamar , Browner‐Elhanan Keren , Mimouni Daniel , Varsano Isaac , Avner Cohen Herman , Mimouni Marc
Published: March 2003

The reported data on the association of kidney and urinary tract malformations with supernumerary nipples are contradictory. We examined 200 children, ages 1 month–16 years, who were being followed because of recurrent urinary tract infection for supernumerary nipples. The patients were divided into two groups: those who were found to have urinary tract malformations on radiographic studies (n=92) and those who were not (n=108). All children were examined for any abnormal pigmentation along the milk line, and the entire body was examined for ectopic supernumerary nipples. Two of the children with proved urinary tract pathology and two of the children with no urinary tract pathology had supernumerary nipples. The odds ratio for having supernumerary nipples among the first group was 1.18 (95% CI: 0.084–16.53, p=0.627). Our results indicate no association between kidney and urinary tract malformations and supernumerary nipples. We believe the message to the practicing physician is that there is no need for radiographic or ultrasonographic investigation of the urinary tract in asymptomatic children found to have supernumerary nipples on routine physical examination.
Cerebral Mass Due to Neurocutaneous Melanosis: Eight Years Later
Authors: Schaffer Julie V. , McNiff Jennifer M. , Bolognia Jean L.
Published: March 2003

Neurocutaneous melanosis (NCM) is associated most commonly with giant congenital melanocytic nevi (CMN), in particular those on the scalp or in a posterior axial location that are accompanied by satellite congenital nevi. It also can occur in patients with multiple medium‐sized CMN. In general, the prognosis of those with symptomatic NCM is poor, even in the absence of malignancy, while the prognosis of those with asymptomatic NCM detected via screening varies and is more difficult to predict. Herein we report an asymptomatic patient with a giant CMN and multiple satellite nevi who had a screening magnetic resonance imaging (MRI) study at age 5 months that showed a rounded area of increased signal in the right temporal lobe on T1‐weighted images, suggestive of parenchymal melanosis. This melanotic mass was resected at age 10 months, and histologic examination of the surgical specimen showed prominent perivascular collections of benign, pigment‐containing melanocytes within cerebral tissue. The patient remains healthy 8 years later. His excellent long‐term outcome and other reports of NCM with localized central nervous system (CNS) involvement apparent on MRI may have implications for management, including early imaging of patients with high‐risk CMN and potential surgical intervention for NCM.
Association of Piebaldism and Neurofibromatosis Type 1 in a Girl
Authors: Angelo Corrado , Cianchini Giuseppe , Grosso Maria Gabriella , Zambruno Giovanna , Cavalieri Rino , Paradisi Mauro
Published: March 2003

We report an 11‐year‐old girl with both piebaldism and neurofibromatosis type 1 (NF1). The patient had large depigmented patches on her lower limbs and a white forelock since birth. In addition, some café au lait spots were present on her trunk at birth and had increased in number and size during childhood in concomitance with the appearance of axillary and inguinal freckling. Neither neurofibromas nor Lisch nodules were detected and the patient was otherwise healthy. Pedigree analysis revealed inheritance for piebaldism on the paternal side. To our knowledge, the association of piebaldism and NF1 has been described previously in only three patients. Awareness of this rare association is relevant to ensure early diagnosis and adequate follow‐up for NF1.
Acquired Leukoderma in Congenital Pigmented Nevus Associated with Vitiligo‐Like Depigmentation
Authors: Itin Peter H. , Lautenschlager Stephan
Published: March 2003

We report a 6‐year‐old boy who developed depigmentation within a congenital melanocytic nevus at the age of 3 years. During the following months a halo phenomenon and vitiligo‐like lesions distant from the nevus appeared. A thorough search for malignant melanoma was negative. A second patient, a 45‐year‐old woman, had a large congenital nevus on the trunk with marked satellitosis. At the age of 20 years, partial regression of the large nevus occurred and, in addition, halos developed around almost all smaller nevi. Repeated searches for associated malignant melanoma were negative. We review the rare cases of halo congenital nevi and emphasize that depigmentation is not necessarily associated with malignant degeneration.
Temporal Triangular Alopecia: Report of an African‐American Child with TTA Misdiagnosed as Refractory Tinea Capitis
Authors: Erickson Quenby , Yanase David , Perry Van
Published: March 2003

Temporal triangular alopecia is an underrecognized form of nonscarring alopecia that appears in children between the ages of 3 and 6 years and is often misdiagnosed. Increased awareness of this entity is needed to prevent ineffective and harmful treatments. We present a case misdiagnosed as tinea capitis in an African‐American girl, review the literature, and elucidate the major differential diagnoses.
Temporal Triangular Alopecia: Report of Five Cases in Asian Children
Authors: Tan Eileen , Ng Mustika , Giam Yoke Chin
Published: March 2003

Temporal triangular alopecia (TTA) is a nonscarring alopecia first described in 1905. We report five cases of TTA in Asian children and review the literature.
A Child with Both Langerhans and Non‐Langerhans Cell Histiocytosis
Authors: Shani‐Adir Ayelet , Chou Pauline , Morgan Elaine , Mancini Anthony J.
Published: March 2003

Abstract: The histiocytic syndromes consist of a group of disorders that share in common the proliferation of cells of the monocytic/macrophage lineage. It has been conventional to divide the histiocytoses into two separate groups: Langerhans cell histiocytosis (LCH) and non‐LCH. We present a 2‐year‐old Hispanic boy who was referred to the dermatology clinic for evaluation of an asymptomatic cutaneous eruption of the head and upper trunk. In addition, he had a 3‐week history of pain in his right leg and difficulty in walking. The patient's physical examination was normal, excluding the skin findings. On plain radiography, multiple lytic lesions in the skull, lumbar spine, and right tibia were seen. Histopathologic examination of a skin biopsy specimen revealed a predominantly histiocytic infiltrate in the dermis which was negative for S‐100 and CD1a stains. A tibial biopsy specimen showed a monomorphous infiltrate of histiocytes that were S‐100 and CD1a positive. This patient's concomitant findings of both LCH and non‐LCH histiocytoses further support a potential overlap within the histiocytic syndromes, as has been suggested by others.
Apheresis Registry in France: Indications, Techniques, and Complications
Authors: Korach J‐M. , Guillevin L. , Petitpas D. , Berger P. , Chillet P. ,   the French Registry Study Group
Published: March 2003

Abstract: The French Registry for Plasma Exchange (PE) was set up in 1985. For 13 years it has allowed for the analysis of the techniques used, along with the indications and complications. After a decrease in the number of participating centers due to the heaviness of the data collection mode, the telematic network created in 1991 led to a new increase in participants from 26 in 1990 to 69 in 1998. Follow‐up shows a slight fall in activity since some protocols ended, while the neurological pathologies remain the most frequent indicators. The important modifications observed over the years are the increase of the centrifugation technique, the development of plasma treatment, and the plasma substitution by an association of albumin‐pentastarch.The French Registry for plasma exchange is the largest data base dealing with therapeutic hemapheresis. The registry set‐up through the internet is the first step toward an international data base.
Microemboli‐Free Blood Detoxification Utilizing Plasma Filtration
Authors: Castino F. , Scheucher K. , Malchesky P.S. , Koshino I. , Nosé Y.
Published: March 2003

Guest Editor's Introduction: This paper was originally presented at the 22nd ASAIO Congress in April 1976 and printed in Volume 22, Trans Am Soc Artif Int Organs, 1976, pages 637–644. It is reprinted with permission in Therapeutic Apheresis Volume 4, Issue 1, as a millennium project of the International Society for Apheresis. This is the first paper describing flat sheet microporous hydrophilic membranes for plasmaseparation. Sixteen membranes of different pore structures and different base polymers were subjected for evaluation. A celanese polypropylene membrane of pore diameters between 0.04–0.2 μ, and a nuclepore polycarbonate membrane of pore diameter between 0.2–0.4 μ were satisfactory as plasma separator flat sheet membranes.
New Principle of Closed System Centrifugation
Authors: Tullis James L. , Surgenor Douglas M. , Tinch Robert , D'hont Maurice , Gilchrist Frederic L. , Driscoll Shirley , Batchelor William H.
Published: March 2003

Guest Editor's Introduction: Much of the early work on continuous flow centrifugation for the separation of blood components was done in the early 1950s in the laboratory of Dr. Cohn. The performance of these instruments and the effects on blood components were studied by teams of investigation under the directions of Tullis and Surgenor. This paper describes the basic components and the instruments developed by these efforts. The instrument was, then, manufactured by Arthur D. Little, Inc. and became known as the Cohn ADL Centrifuge. This paper was printed in Science vol. 124, page 792–797 (1956) and reprinted here with permission.
Resin Hemoperfusion in the Treatment of Drug Intoxication
Authors: Rosenbaum Jerry L. , Winsten Seymour , Kramer Mark S. , Moros Julio , Raja Rasib
Published: March 2003

Guest Editor's Introduction: The effective adsorption of substances by activated charcoal is depressed when such substances are bound to plasma proteins. To remove plasma‐bound substances from blood, synthetic resins were evaluated. This paper is the first report regarding the uncharged resin adsorbent and describes effectiveness in the removal of protein‐bound substances. Encouraged by the report, more effective anion resins have been developed by Asahi Medical Co. and Kuraray Co. and used for the treatment of fulminant hepatitis and postoperative hepatitis. This paper was printed in Trans Am Soc Artif Intern Organs. vol 16, page 134–140 (1970) and reprinted here with permission.
Therapeutic Apheresis in Taiwan
Authors: Yeh Jiann‐Horng , Chiu Hou‐Chang , The  ,   Therapeutic Apheresis Registry Group in Taiwan
Published: March 2003

Abstract: From July 1, 1999, to June 30, 2000, the Formosan Blood Purification Society conducted a survey on the current status of therapeutic apheresis (TA) treatments in Taiwan. There were 13 centers with a total of 437 patients, 498 courses, and 2,086 procedures. The most common indication was for neurological disorders (58.4%), which included mainly myasthenia gravis (34.9%) and Guillain‐Barré syndrome (18.2%). The other indications were hematological disorders (19.3%), hepatic‐pancreatic disorders (12.3%), and rheumatic disorders (7.1%). Seventy‐one percent of TA treatments were reported to be effective. Plasma exchange (PE) performed by either centrifugation or the filtration method constituted 55.4% of TA treatments, the double‐filtration (DF) method constituted 39.3% of treatments, and cytapheresis constituted 5.3% of treatments. The most common machines used for TA were the Plasauto iQ, the KM 8800, the Hemonetics series, and the Fenwal CS‐3000. The overall frequency of complications was 42.2% per course and 12.9% per procedure. Among them, fever, urticaria, and hypotension were the major complications. As compared with the trends of TA treatment in the world, PE still represents the major TA treatment in Taiwan, which should be replaced by DF or more selective adsorptive methods to reduce the PE‐related adverse effects.
Current Topics on Cytapheresis Technologies
Authors: Yamaji Ken , Tsuda Hiroshi , Hashimoto Hiroshi
Published: March 2003

Abstract: Cytapheresis has been investigated recently for the treatment of autoimmune related diseases, such as rheumatoid arthritis (RA), inflammatory bowel disease (IBD), multiple sclerosis, and so on. A large number of physicians have indicated that patients with autoimmune diseases respond to cytapheresis treatment. The effective mechanism of cytapheresis for immune disorders is still controversial. However, the removal of the leukocyte including granulocyte, lymphocyte, and monocyte may play a crucial role in correcting imbalance of the immune system. A session of cytapheresis including leukocytapheresis (LCAP) and granulocytapheresis (GCAP) may not create a sufficient amount of cell removal for the human body. However, the cell removal can be a trigger of the immunomodulation as the treatment for immune disorder. Furthermore, not only cell removal but also reaction by blood contacting with medical device materials may play a role as an immunomodulation for immune disorders. This review introduces current cytapheresis technologies and attempts to elucidate the effective mechanism of cytapheresis for immune disorders, focused on LCAP and/or GCAP for RA or IBD.
Immunomodulation by the Autonomic Nervous System: Therapeutic Approach for Cancer, Collagen Diseases, and Inflammatory Bowel Diseases
Authors: Abo Toru , Kawamura Toshihiko
Published: March 2003

Abstract: The distribution of leukocytes is regulated by the autonomic nervous system in humans and animals. The number and function of granulocytes are stimulated by sympathetic nerves whereas those of lymphocytes are stimulated by parasympathetic nerves. This is because granulocytes bear adrenergic receptors, but lymphocytes bear cholinergic receptors on the surface. These regulations may be beneficial to protect the body of living beings. However, when the autonomic nervous system deviates too much to one direction, we fall victim to certain diseases. For example, severe physical or mental stress → sympathetic nerve activation → granulocytosis → tissue damage, including collagen diseases, inflammatory bowel diseases, and cancer. If we introduce the concept of immunomodulation by the autonomic nervous system, a new approach for collagen diseases, inflammatory bowel diseases, and even cancer is raised. With this approach, we believe that these diseases are no longer incurable.