bluuebunny/crossref_metadata_2025 huggingface dataset:
Ecological interpretation of multiple population size structures in trees: The case of Araucaria angustifolia in South America
Authors: SOUZA ALEXANDRE F.
Published: June 2007

Abstract  In this paper I examined the usefulness of tree population size distributions in evaluating the conservation status of populations of an endangered tree species. I set expectations derived from two complimentary views of the ecology of rainforest trees and examined whether they were met by size distributions of populations of the South American dominant conifer Araucaria angustifolia and its relationship with forest structural characteristics. Specifically, I evaluated the expectations that (i) A. angustifolia trees have larger diameter than average angiosperm trees and form a higher monospecific canopy layer above the shorter angiosperm canopies; (ii) A. angustifolia populations are characterized by size distributions with many large individuals and a long tail of relatively rare, small individuals (have symmetry coefficient <0); (iii) the symmetry of the size distribution of A. angustifolia populations is negatively related to the abundance of large (d.b.h. ≥ 10.0 cm) individuals in the population; and (iv) the abundance of A. angustifolia trees is negatively related to the abundance of angiosperm trees, as the successional accumulation of angiosperm stems would not be accompanied by the recruitment of new A. angustifolia. These expectations were evaluated using data on 25 populations of A. angustifolia sampled in the Rio Grande do Sul State in southern Brazil. The first, third and fourth expectations were met, while the second one was only partially met. This was because populations showed a bimodal distribution regarding symmetry in size distribution, with most populations showing normal or negative symmetry, and those logged, adult‐depleted populations showing positive skewness.
Species of street tree is important for southern hemisphere bird trophic guilds
Authors: YOUNG KAREN M. , DANIELS CHRISTOPHER B. , JOHNSTON GREG
Published: June 2007

Abstract  Urban environments are highly modified with unique assemblages of bird species. Much of the research on urban bird assemblages comes from the northern hemisphere. Southern hemisphere bird assemblages differ from northern hemisphere assemblages in that they contain a large proportion of nectarivores. In this study we focus on bird use of street trees in Australia. We investigate the relative influence of tree species (plane tree, Platanus x acerifolia; red gums, Eucalyptus camaldulensis; jacaranda, Jacaranda mimosifolia; bottlebrush, Callistemon citrinus), season and the environment surrounding street trees, on the abundance and species richness of birds in Adelaide, South Australia. Our study considers birds in terms of granivore, nectarivore and insectivore trophic guilds. Nectarivores accounted for the greatest proportion of observations, in terms of abundance, in each of the tree species investigated. Species of street tree was a significant influence on bird use of the trees for all birds and each dietary guild. Red gums were used more than the other tree species by nectarivores, while plane trees were used more than the other trees by insectivores. Use of the tree species by granivores varied with the season. The measures of the environment surrounding street trees were largely unimportant with the exception of traffic for nectarivores in some cases. Urban avifauna use street trees and the species of tree will strongly influence its use by birds. However, the pattern of use of street tree species varied at different times of year and differed between different trophic guilds of birds. The dominance of nectarivores in the southern avifauna will likely produce different patterns of urban environment use to northern hemisphere avifaunas.
Determining adequate trapping effort and species richness using species accumulation curves for environmental impact assessments
Authors: THOMPSON GRAHAM G. , THOMPSON SCOTT A. , WITHERS PHILIP C. , FRASER JASON
Published: June 2007

Abstract  Environmental impact assessments (EIA) require that the proponent indicates the potential impact that a development will have on the biodiversity of the area. As part of this assessment it is normal practice to inventory the vertebrate species in the area. We show here how species accumulation curves can be used as a tool by environmental consultants to indicate the adequacy of their trapping effort and predict species richness for a disturbance site. The shape of a species accumulation curve is influenced by the number of species in an assemblage and the proportional number of singletons (rarely caught species) in the survey sample. We provide guidelines for the number of individuals that need to be caught in a trapping program to achieve 80% and 90% of the species in a habitat, and we indicate how this number can be adjusted to accommodate variations in relative species abundance.
Effect of a postfire environment on the establishment ofProsopis caldeniaseedlings in central semiarid Argentina
Authors: De VILLALOBOS ANA E. , PELÁEZ DANIEL V. , BÓO ROBERTO M. , MAYOR MIRTA D. , ELIA OMAR R.
Published: June 2007

Abstract The objective of this work was to evaluate postfire environmental effects on the emergence, survival and growth ofProsopis caldeniaseedlings in relation to different controlled fire frequencies, seed scarification methods, and planting site. Seedling emergence was significantly higher in experimental units exposed twice and three times to controlled fire than in unburned experimental units. The highest average seedling survival was recorded with triple exposure to controlled fires. Emergence, survival and growth of seedlings from seeds exposed to acid scarification and 600°C for 5 min were higher in the burned experimental units than in the unburned ones. In the former, seedling survival was higher beneath aP. caldeniacanopy than in an adjacent open site, though seedling emergence was similar in both planting sites. Our results suggest that postfire conditions characterized by a reduction in the vegetative cover and competition interference and an increase in soil temperatures and nutrients levels (e.g. nitrogen and phosphorus) may facilitate the establishment ofP. caldeniaseedlings in the Caldenal.
TO SEE OR NOT TO SEE? THE PRESENCE OF RELIGIOUS IMAGERY IN THE PROTESTANT HOUSEHOLD
Authors: HAMLING TARA
Published: June 2007

The essay focuses on two case studies of seventeenth‐century domestic decoration, at Lanhydrock House in Cornwall and the Butterwalk in Dartmouth, North Devon: both plasterwork ceilings with complex iconography, both dating from the 1630s, and both created by Puritan patrons. It is proposed that due to inherent physical difficulties in the process of viewing, our study of figurative imagery on ceilings requires an interpretive approach which places the visual qualities of the imagery second to the impact of its presence. In short, the meaning of the imagery is less important than its effect. In pursuing this argument, the essay draws from ideas and approaches within the interdisciplinary field of visual studies; specifically, an interest in the physical dynamics of viewing and the mechanics of visual perception, allied with an awareness of the specificity of visual experience according to historical and cultural context. This focus on questions of the visual is allied with anthropological and archaeological approaches focusing on the relationship between art, belief and behaviour. The essay concludes that placing religious imagery on ceilings within the domestic interior allowed Protestant patrons to exploit the power of the visual in the service of reformed faith while minimizing the risk of idolatrous abuse.
INVOLVED SPECTATORSHIP IN ARCHAIC GREEK ART
Authors: HEDREEN GUY
Published: June 2007

It is argued that models of spectatorship developed by Alois Riegl and Richard Wollheim offer a productive means of understanding how the Archaic Greek eye cup works. Eye cups represent the faces of particular mythological creatures who expect to see their mythical counterparts in the space occupied by spectators. The decoration of the cups is structured so as to invite the beholder to enter imaginatively into the Dionysiac world. Some representations of silens shown with frontal faces invite a similar response. A significant amount of Archaic poetry experienced, like the vases, in symposia also induced symposiasts temporarily to adopt fictional or mythical personae. As Nietzsche observed in The Birth of Tragedy, a comparable form of involved spectatorship is also at the heart of early Greek drama. A common aesthetic conception of involved spectatorship manifested itself concretely in several different media or cultural forms in late Archaic Greece.
LOW ART, POPULAR IMAGERY AND CIVIC COMMITMENT IN THE FRENCH REVOLUTION
Authors: WALCZAK GERRIT
Published: June 2007

By way of a case study devoted to Jean‐Jacques Hauer (1751–1829), one of the minor figures making their Salon debut in the French Revolution, this essay explores the relations between art and historical events in times of radical transformation. A citizen–artist serving with the National Guard, the painter was a humble practitioner enjoying his greatest success at the height of collective militancy known as the sans‐culotte movement. The French Revolution allowed Hauer to go public, and most of his œuvre is closely tied to its tangled politics. Representations from the death of Marat to the plight of the royal family are examined in the context of shifting discourses, sectionary politics and civic commitment.
Changes in autonomic cardiac control in patients with epilepsy after discontinuation of antiepileptic drugs: a randomized controlled withdrawal study
Authors: Lossius M. I. , Erikssen J. E. , Mowinckel P. , Gulbrandsen P. , Gjerstad L.
Published: June 2007

The aim of this study was to assess cardiac autonomic control in patients with epilepsy before and after withdrawal of antiepileptic drugs (AEDs). The study was prospective, randomized and double blinded. Spectral analysis of heart rate variability (HRV) in 24 h ECG‐registration before and after withdrawal of AEDs was used to assess autonomic cardiac control. The assessment of HRV with spectral analysis was based on sinus rhythm and normal heart beats [normal to normal beat (NN)]. Thirty‐nine patients had 24 h rhythms free from any ectopic beats both before and after intervention, and were included in the analysis. Significant differences were found in the withdrawal group: filtered RR intervals for all 5 min segments of the analysis; percentage of differences between adjacent filtered RR intervals that are greater than 50 ms for the whole analysis; very low frequency power; low frequency power and high frequency power. The results demonstrate that slow withdrawal of AEDs in seizure‐free patients with epilepsy on drug mono‐therapy resulted in an increase in both parasympathetic and sympathetic functions, indicative of increased power amongst patients following cessation of AED treatment. As low HRV has been associated with increased mortality in patients with other diseases, this increased HRV may be beneficial.
Clinical and experimental features of MuSK antibody positive MG in Japan
Authors: Ohta K. , Shigemoto K. , Fujinami A. , Maruyama N. , Konishi T. , Ohta M.
Published: June 2007

We investigated the presence of antibodies (Abs) against muscle‐specific tyrosine kinase (MuSK) in Japanese myasthenia gravis (MG) patients. MuSK Abs were found in 23 (27%) of 85 generalized seronegative MG (SNMG) patients but not in any of the ocular MG patients. MuSK Ab‐positive patients were characterized as having female dominance (M:F, 5:18), age range at onset 18 to 72 (median 45) years old, and prominent oculobulbar symptoms (100%) with neck (57%) or respiratory (35%) muscle weakness. Limb muscle weakness was comparatively less severe (52%), thymoma absent. Most patients had good responses to simple plasma exchange and steroid therapy. MuSK IgG from all 18 patients was exclusively the IgG 4 subclass and bound mainly with the MuSK Ig 1–2 domain. Serial studies of 12 individuals showed a close correlation between the variation in MuSK Ab titers and MG clinical severity (P = 0.01 by Kruskal–Wallis). MuSK Ab titers were sharply decreased in patients who had a good response to early steroid therapy or simple plasma exchange, but there was no change, or a rapid increase on exacerbation after thymectomy. Measurement of MuSK Ab titers aids in the diagnosis of MG and the monitoring of clinical courses after treatment.
Cross‐species amplification at microsatellite loci in Australian quolls including the description of five new markers from the Chuditch (Dasyurus geoffroii)
Authors: SPENCER PETER B. S. , CARDOSO MARIA , HOW RICHARD A. , WILLIAMS JASON , BUNCE MICHAEL , SCHMITT LINCOLN H.
Published: June 2007

The quolls are the largest native predators remaining on mainland Australia. We describe the cross‐species testing of all available microsatellite loci for representative across the entire distribution of quolls, with the additional characterization of five new microsatellite loci from the Chuditch. All primers produced clear and polymorphic amplification patterns containing between nine and 17 alleles and with high levels of diagnostic variability. These highly polymorphic primers make them useful additional tools in planning conservation strategies across related conspecifics, many of which are under threat.
kakusan: a computer program to automate the selection of a nucleotide substitution model and the configuration of a mixed model on multilocus data
Authors: TANABE AKIFUMI S.
Published: June 2007

The application of different substitution models to each gene (a.k.a. mixed model) should be considered in model‐based phylogenetic analysis of multigene sequences. However, a single molecular evolution model is still usually applied. There are no computer programs able to conduct model selection for multiple loci at the same time, though several recently developed types of software for phylogenetic inference can handle mixed model. Here, I have developed computer software named ‘kakusan’ that enables us to solve the above problems. Major running steps are briefly described, and an analysis of results with kakusan is compared to that obtained with other program.
Introduction
Authors: Croft Stuart
Published: June 2007

The ‘war on terror’– perhaps how it has led to an ‘age of terror’– has come to dominate many aspects of international relations and indeed of relations between the state and the citizen since the ‘defining moment’ of the 2001 attacks. This special issue examines whether there is an ‘age of terror’, and if so, how that ‘age of terror’ has led to new approaches and to new thinking on the part of Western states and establishments by drawing on the UK's experience in Northern Ireland, the nature of collaboration on counter-terrorism across the European Union and in thinking about the implications of terrorism for strategy. State approaches are critiqued, and alternatives suggested, in thinking about the relationship between human rights and the ‘war on terror’, and indeed in reconceptualizing the study of terrorism. In the final articles of this issue alternative and non-state critiques, approaches and analyses are developed.
Nevus of Ota: Clinical Aspects and Management
Authors: Chan Henry H.L. , Kono Taro
Published: June 2007

Nevus of Ota, or nevus fuscoceruleus ophthalmo‐maxillaris, is a dermal melanocytic hamartoma that presents as bluish hyperpigmentation along the first or second branches of the trigeminal nerve. Extra‐cutaneous involvement has been reported, especially ocular involvement. Nevus of Ota affects between 0.014%–0.034% of the Asian population. Clinical differential diagnoses include facial café‐au‐lait patch, spilus nevus, and acquired bilateral nevus of Ota‐like macules. Previous treatment modalities, including cryotherapy and microsurgery, can be associated with scarring. In the last decade, the use of Q‐switched lasers has revolutionized the treatment of this condition. This review summarizes the clinical, histologic, and management aspects of this dermal melanocytic hamartoma.
A Comparison of the Concordance of Digital Images, Live Examinations, and Skin Biopsies for the Diagnosis of Hospitalized Dermatology Consultation Patients
Authors: Scheinfeld Noah , Kurz Jeremy , Teplitz Ellen
Published: June 2007

Objective. The goal of this study was to compare live and digital image examination of hospitalized dermatology consultation patients. Design. A medical student digitally imaged patients with a Nikon Coolpix 950 digital camera (Nikon Corp., Tokyo, Japan). A resident reviewed these images and the student recorded the differential diagnosis. Digital examination was followed by live dermatologic examination by the dermatology resident and then by a supervising board certified dermatologist. The diagnoses in 29 of these cases were compared with definitive diagnostic tests (e.g., skin biopsy). Setting. Montefiore Hospital, Bronx, NY Patients. In March, 2000, 48 of 58 consecutive hospitalized patients for whom dermatology consultations were requested and from whom consent for photographs could be obtained. Main Outcome Measures. The accuracy and consistency of the examiners' top (up to three) digital diagnoses, (up to three) live diagnoses, and histopathologic diagnoses were compared. Results. Eighty‐one percent (38/47) of resident digital consult diagnoses agreed with live resident diagnoses. Live resident diagnosis agreement with live supervising board certified dermatologist's diagnosis was 90% (18/20). Resident digital image diagnosis correlation with definitive diagnostic test results was 76% (22/29). Live supervising board certified dermatologist diagnosis correlation with definitive diagnostic test results was 73% (14/19). Conclusions. Digital image review results in reliable and accurate diagnosis compared to live consultations. For inpatient consultations, three‐dimensional lesions are more amenable to digital diagnosis than flat, generalized rashes.
Evolution of Biologic Therapies for the Treatment of Psoriasis
Authors: Kenneth B. Gordon , Thomas S. McCormick
Published: June 2007

Over the past three decades, laboratory and clinical research findings have shown that T cells are the primary mediators of psoriasis pathogenesis and that psoriasis can be treated by eliminating these T cells or interfering with their activation or activity. Based on these observations, many new biologic therapies to treat psoriasis are now in development. These agents, developed primarily through recombinant DNA techniques, are designed to target T cells and the immunologic cascade associated with their activation. Four basic strategic approaches that focus on the steps involved in the immunopathology of psoriasis are: 1) elimination of the pathogenic T cells; 2) inhibition of T‐cell activation, proliferation, and migration; 3) immune deviation to down‐regulate the type 1 (TH1) response predominant in psoriasis; and 4) blockade of cytokine production. The goal of these new therapies is to improve the treatment of psoriasis, particularly moderate to severe disease, with agents that are well tolerated and safe for long‐term use.
Cutaneous Signs
Authors: Aboud Khalid Al , Hawsawi Khalid Al , Ramesh V. , Aboud Daifullah Al , Githami Ahmad Al
Published: June 2007

Cutaneous signs play a significant role in clinical medicine. Signs have often been named after the initial observer. They may indicate either dermatologic or systemic illness and aid the examiner in diagnosis and relevant investigations. Some are specific, some have been described in other conditions, and few have lost their relevance. Most of the signs are related to the pathogenesis of the disease but the cause of some is not clear.
Cutaneous Manifestations of Disease in Athletes
Authors: Bender Thomas W.
Published: June 2007

Various means of skin injury in athletes are examined, supplementing those discussed in Cutaneous Manifestations of Disease Part 1 (November%sol;December). Skin injury due to mechanical means such as corns, calluses, talon noir (calcaneal petechiae), tennis toe, jogger's nipples, and piezogenic pedal papules will be discussed followed by a thorough discussion of environmental means of skin injury. There are a variety of ways that the environment may affect athletes both during competition and years after the competition is finished. The discussion will conclude with a look at performance‐enhancing drugs and their effect on an athlete's skin, and how the practitioner can better appreciate and perhaps prevent the long‐term sequelae of drug abuse.
Hibernoma in the Left Scapula
Authors: Sugiura Keiji , Sugiura Mariko , Hayakawa Ritsuko , Shamoto Mikihiro
Published: June 2007

A 42‐year‐old man experienced a tumor in the left scapula area a few years ago. Because he had no objective symptoms such as fever, pain, or restriction of movement, he ignored the tumor and left it untreated. In November of 2000 he discovered that the tumor was growing larger, and began to fear that it was malignant. He presented to the Department of Environmental Dermatology at Nagoya University School of Medicine in December of 2000. We observed a clear outline, a long elliptical shaped tumor in his left scapula area. The tumor was soft, but not adhesive to the surrounding tissue or accompanied by inflammation. We proposed that he should have surgery under a local anesthetic to excise and diagnose the tumor. The excised tumor had a brown and gray capsule (Figure 1) and was approximately 7x5x2 cm. The tumor was a broad bean‐shaped, kidney‐like form. Histopathologic findings (routine hematoxylin‐eosin stain) revealed an eosinophilic capsule around the tumor cells. The tumor had a lobular structure, and was composed of lipid‐free cells (eosinophilic granular cell), multivacuolated cells, univacuolated cells, and some blood vessels (Figure 2). There were no mitotic cells, nuclear atypia, nor lipoblastoma. From the above pathologic findings, we diagnosed the tumor as hibernoma.

Removed tumor

image

Histopathologic findings (hematoxylin‐eosin stain, original magnification x 200)

image
How Do You Foster Medication Adherence for Better Acne Vulgaris Management?
Authors: Koo John
Published: June 2007

Suboptimal medication adherence is one of the major reasons for treatment failure among patients with acne vulgaris. Motivating patients to adhere to treatment, especially during the maintenance phase, remains a challenge. Although the literature on medication adherence in the acne vulgaris patient population is sparse, the available literature on patients with dermatologic and nondermatologic disorders suggests that a multifactorial approach, combining nonpharmacologic interventions and effective, well tolerated, and simplified drug regimens, appears to be associated with the greatest success. Furthermore, it is important to evaluate the patient for underlying affective disorders (e.g., depression) that can undermine adherence. The dermatologist can play a major role in enhancing patient adherence by prescribing adherence‐enhancing therapeutic regimens and by forming a therapeutic alliance with patients.
Oral Lichen Planus Part I: Epidemiology, Clinics, Etiology, Immunopathogeny, and Diagnosis
Authors: Jacques Claudio de Moura Castro , Pereira Ana Líbia Cardozo , DrOdont Marcia Grillo Cabral , Cardoso Abel Silveira , Ramos‐e‐Silva Marcia
Published: June 2007

This article presents a review of the literature on oral lichen planus, focusing on important aspects of its epidemiology, etiopathogeny, and clinical manifestations. The oral form is an important clinical presentation of lichen planus. It may precede or accompany the skin lesions, or it may be the only manifestation of the disease. Dermatologists, dentists, otorhinolaryngologists, and other specialists who deal with the oral cavity must be aware of this disease so they can diagnose, treat, and keep these patients under observation.
PEMPHIGUS: An Acronym for a Disease With Multiple Etiologies
Authors: Brenner Sarah , Mashiah Jacob , Tamir Einat , Goldberg Ilan , Wohl Yonit
Published: June 2007

The acronym PEMPHIGUS is suggested to encompass the numerous factors involved in the pathogenesis and course of the disease. In the following review the authors present studies documenting these factors. The acronym can serve as a handy tool to direct the physician's investigation of a case of pemphigus, aiding in its diagnosis and in the prevention of future flare‐ups.
Familial Epidermolysis Bullosa With Aplasia Cutis Congenita: Bart's Syndrome?
Authors: Benvenuto Cristiane , Kraemer Christine K. , Kruse Ricardo L. , Cestari Tania F.
Published: June 2007

A boy was born at term to a 39‐year‐old mother after an uneventful pregnancy. On examination, soon after birth, he presented an erythematous ulcerated lesion, covered by a thin membrane, affecting the right leg and foot. The borders of the ulcer showed active granulation and small superficial vessels could be visualized underlying the defect. His left hallux was hypoplastic with anonychia. All other foot nails were dystrophic (Figure 1). Other than the skin defect, the child had no added defects or abnormalities. The histopathology of a biopsy taken from the periphery of the lesion demonstrated dermal‐epidermal junction detachment, suggestive of epidermolysis bullosa (EB) (Figure 2). A study of the pedigree of his family revealed, including the patient, eight affected members, four women (his sister, his mother, his mother's mother, and his mother's half‐sister) and four men (the patient himself, his two first cousins, and his mother's grandfather) (Figure 3). The patient's mother reported the same problem at birth, affecting the same leg, and showed no surprise when the physicians gave her the baby. She, and both of the patient's cousins, had active lesions of epidermolysis bullosa, the mother on her legs and the two cousins on their hands, caused by trauma (Figure 4). The patient's 12‐year‐old sister also had aplasia cutis congenita (ACC) (with similar lesions on the right leg) and EB. The management was conservative, and the patient was maintained under careful monitoring, with progressive healing of the lesion. After 2 months, reepithelization was complete and milia were prominent over the scar (Figure 5). On the 1‐year follow‐up exam, the child presented normal physical and neurologic development, without new cutaneous lesions except those induced by skin fragility just like his older sister and all affected family members.

Right leg and foot showing an erythematous ulcerated lesion and a hypoplastic hallux with anonychia

image

Biopsy histopathology: detachment of the dermal‐epidermal junction

image

Pedigree of the patient's family with eight affected members: the patient himself, his sister, his mother, his mother's mother, his mother's half‐sister, his two first cousins (who were brothers), and his mother's mother's father

image

Patient's mother's right leg: active lesion of epidermolysis bullosa resultant from local trauma

image

Right leg and foot after 3 months of progressive healing of the lesion: complete reepithelization and prominent milia over the scar

image
New Uses of Vinyl Tape for Reliable Collection and Diagnosis of Common Superficial Mycoses
Authors: Miranda Mario F.R. , Silva Ademir J.G.
Published: June 2007

Background. Scalpel blade sampling of a lesion with clinical suspicion of superficial mycosis May eventually harm the patient, especially anxious children, and when sampled from areas such as the neck and the genitals. In these cases—provided that an acceptable level of confidence in results can be warranted—vinyl tape skin strip‐pings, or strip cultures, could be preferable.

Patients and Methods. Eighty‐five patients presenting with scaly lesions clinically suspected of superficial mycoses were randomly included in this study. Thin, crystal clear vinyl tape strips were firmly applied to lesions, pulled up, and then attached glue‐face down to glass slides, on which a drop of 10% potassium hydroxide/40% dimethyl sulfoxide solution had previously been placed. Once scales were cleared, microscopic examination was performed. For specimens yielding negative results, further scales were scraped from lesions, cleared, and examined in the conventional manner. Patients with proven negative results in both techniques have been considered a control group.

Results. Sixty cases of superficial mycoses were confirmed (dermatophytosis, 38; candidiasis, 12; tinea versicolor, 10). Of these, 59 (98.33%) yielded positive results on vinyl tape preparations, with clear visualization of organisms' structures. The technique failed to demonstrate fungal elements in a single case, subsequently diagnosed as tinea capitis. The additional 25 patients were regarded as our control group.

Conclusions. In addition to improved patient compliance, ease of performance, and low cost, the technique seems appropriate for using in an office environment during a routine medical visit. Whenever vinyl tape specimens yield negative results, a scraping‐sampled preparation should be provided.
Assessment of Etiologic Agents in Acne Pathogenesis
Authors: Burkhart Craig N. , Gottwald Lorie
Published: June 2007

Acne is a chronic inflammatory disease of the pilose‐baceous units. Traditional etiologic factors include increased sebum production, ductal hyperkeratosis, abnormality of the microbial flora within the pilose‐baceous unit, and mediators of inflammation. Recent developments do not refute these familial elements, but rather refine particular aspects. Interleukin‐1α influences hypercornification of the infundibulum as well as the inflammatory response by inducing the production of vascular endothelial growth factor in dermal papilla cells and follicular keratinocytes of the pilosebaceous unit. New retinoids have been developed based on controlling cellular proliferation and differentiation in the pilosebaceous unit by their action on nuclear receptors of cells. Dermal inflammation is not due to presence of bacteria, but from biologically active mediators produced by Propionibacterium acnes. The environment within the pilosebaceous unit is probably more important than the absolute number of P. acnes organisms. Indeed, the major role of the sebaceous gland appears to be supplying P. acnes needed nutrients. Moreover, the microbiologic principle ofbiofilms appears to be applicable to P. acnes in acne.
Evaluating Patient Acceptance of a Teledermatology Link of an Urban Urgent‐Care Dermatology Clinic Run by Residents With Board Certified Dermatologists
Authors: Scheinfeld Noah , Fisher Michael , Genis Paul , Long Heather
Published: June 2007

Background. A teledermatology system was established in a dermatology urgent‐care clinic staffed by dermatology residents in the emergency department. These residents had previously lacked attending dermatology supervision.

Methods and Patients. Resident physicians took digital pictures of patients' lesions and downloaded the images onto a network personal computer (PC). The images were stored on the hospital's server and then viewed within 5 minutes by an attending dermatologist, in a different location, using a network PC with monitor. Resident and attending physicians discussed the cases over the telephone. Patient acceptance was assessed via separate written surveys. Fifty‐one patients, approximately 10 resident physicians, and two attending dermatologists participated in the study.

Results. Patient acceptance of the teledermatology system was high (93%.) Teledermatology May prove a viable means of evaluating dermatologic complaints in the emergency department.
Polyarteritis Nodosa and Cutaneous Polyarteritis Nodosa
Authors: Courtney R. Herbert , Glenn G. Russo
Published: June 2007

Cutaneous vasculitis can present with a variety of lesions and associated symptoms. It is important for the clinician to be able to recognize vasculitis lesions and know when to pursue further laboratory studies that will determine the extent of the disease process in a patient. This review compares and contrasts polyarteritis nodosa with its cutaneous counterpart. The diagnostic workup and management of these two entities as well as the overall approach to a patient with a possible vasculitic condition are emphasized.
Henoch‐Schönlein Purpura in an Adult
Authors: Micki N. Ly , Thomas S. Breza
Published: June 2007

A 35‐year‐old white man with no prior illness presented with a 10‐day history of colicky abdominal pain worsened with meals, and back pain. This was followed in 3 days by an asymptomatic purpuric eruption on his ankles and lower extremities, which spread to the elbows and lumbosacral areas. The rash became confluent and palpable at the time of presentation. He had some nausea, but no vomiting. He denied fever, chills, weight loss, cough, arthritis, diarrhea, melena, dysuria, visual problems, and upper respiratory tract or other infectious symptoms. He was initially prescribed ranitidine for the abdominal pain, which did not provide relief. The patient was on no other medications. Clinical examination revealed an afebrile and uncomfortable man with abdominal pain and backache. Skin examination showed innumerable 3–5‐mm nonblanching palpable purpuric lesions on the lower extremities especially at the ankles, elbows, and lumbosacral areas (Figures 1 & 2). There was mild edema at the knees and ankles. The abdominal examination revealed diffuse tenderness on palpation, but there was no guarding or rebound tenderness. There were no oral lesions. Stool guaiac examination was negative. Routine hematoxylin‐eosin staining of the skin biopsy specimen revealed a necrotizing leukocytoclastic vasculitis with neutrophils (Figure 3). Direct immunofluorescence staining revealed a +3/3 intense granular immunoglobulin (Ig) A and C3 staining of the cutaneous vasculature (Figure 4). Laboratory examination showed normal complete blood count, platelet, metabolic profile, and liver function tests, coagulation studies, erythrocyte sedimentation rate, lipase, amylase, antineutrophil cytoplasmic antibody, antinuclear antibody, antistreptolysin‐O titer, rheumatoid factor, cryoglobulin, complement tests, serum electroprotein phoresis, and viral hepatitis A, B, and C serologies. The urine analysis showed mild proteinuria. The acute abdominal series and abdominal ultrasound were essentially normal. The patient was treated initially with intravenous methylprednisolone 60 mg q.d. with marked improvement of the abdominal pain and gradual fading of the lesions. He was eventually tapered off oral prednisone 40 mg q.d. over the next 7 weeks. Attempts to taper the prednisone quickly resulted in worsening abdominal pain and reappearance of the palpable purpura. Two months later, the patient's rash was cleared, and he is being monitored for possible renal complications.

Hematoxylin‐eosin stain of skin biopsy showing leukocytoclastic vasculitis with neutrophils

image

Direct immunofluorescence stain of skin biopsy showing a +3/3 intense granular immunoglobulin A and C3 staining of the cutaneous vasculature

image
Persistent Erythema, Telangiectases, and Facial Flushing After Carcinoid Tumor Excision
Authors: Barbara Giomi , Carla Cardinali , Marzia Caproni , Paolo Fabbri
Published: June 2007

A 26‐year‐old woman with an uneventful family medical history presented for evaluation and treatment of a facial dermatosis of 6 years duration. Examination revealed an intense erythema symmetrically distributed over her face, with a particularly marked involvement of the forehead, nose, cheeks, and chin and an evident sparing around the eyes (Figure 1). On the zygomatic prominences, arborizing telangiectases could also be observed (Figure 2). Cervical and submandibular lymph nodes were not palpable. The patient complained of a burning sensation and referred to day‐to‐day fluctuation in reddening, together with recurrent severe flushing episodes of the same areas, sometimes induced by heat, emotion, or gustatory stimuli such as hot beverages and highly spiced foods. The persistent erythema had developed in the previous 4 months, while facial flushing, initially subsiding between attacks, had appeared first in 1995. In the same period, the patient had also suffered from abdominal pain, chronic watery diarrhea, and paroxysmal hypotension. One year later she had undergone appendectomy following acute appendicitis. Anatomicopathological and immunohistochemical assessments revealed the presence of a carcinoid tumor about 4 cm in diameter, showing positive staining for neuronal specific enolase, chromogranin, and synaptophysin. Shortly after surgical intervention, laboratory investigation documented normal plasma and platelet serotonin (5‐hydroxytryptamine [5‐HT]) and normal urinary 5‐hydroxyin‐dolacetic acid (5‐HIAA) levels. Furthermore, computed tomography and magnetic resonance imaging excluded metastatic disease in the liver, and echocardiography was within normal limits. The patient observed a rapid improvement of systemic symptoms that vanished in a few weeks, but continued suffering from cutaneous flushing and progressively developed the facial erythrosis. During the hospitalization, serum levels of serotonin and its metabolite were repeatedly normal: total 5‐HT=124 ng/mL (normal range, 90–180); platelet 5‐HT=567 ng/109 platelets (normal range, 200–600); urinary 5‐HIAA=3.2 mg/24 hours (normal range, 2–6). Histamine also showed normal blood levels. Anti‐Helicobacter pylori antibodies were slightly increased (30 U/mL; normal value <15 U/mL). Instrumental investigations (computed tomography of abdomen and chest) performed to discover metastatic spread or carcinoid multicentricity were all negative again. Based on the anamnestic and clinical findings, a diagnosis of facial flushing and erythemato‐telangiectatic rosacea due to preexistent carcinoid was established. The patient was started on metronidazole gel 1% and referred to an internal medicine follow‐up program. After 1 month, the facial erythema had markedly reduced.

Intense erythema of the forehead, nose, cheeks, and chin with sparing around the eyes

image

Arborizing telangiectases of the zygomatic prominences

image
Botulinum Toxin in the Treatment of Axillary Hyperhidrosis
Authors: Ibrahim Galadari , Jameelah Alkaabi
Published: June 2007

Introduction. Axillary hyperhidrosis can be a source of social isolation and embarrassment. The available treatments are either ineffective or have intolerable side effects. The search for a simple, long‐lasting, and safe treatment has led to the use of botulinum‐A toxin injections in those with excessive axillary hyperhidrosis.

Materials and Methods. Fifteen patients participated in this study. All had a history of axillary hyperhidrosis of 1–6 years duration and were using different types of therapies without any benefit. Each patient was injected intradermally with 125 units of botulinum‐A toxin (Dysport, Spenywood Pharmaceutical) in 5–6 points over an elliptical area on each side. Patient follow‐up was performed using the iodine‐starch test.

Results. A total of 14 out of the 15 patients had complete anhidrosis 1 week after the injection. This result lasted for periods ranging from 1–6 months. No side effects were encountered.

Conclusion. Intradermal injection of botulinum‐A toxin seems to be a safe, rapid, and effective method of treatment in axillary hyperhidrosis.
Fibroepithelioma of Pinkus Presenting as a Sessile Thigh Nodule
Authors: Philip R. Cohen , Jaime A. Tschen
Published: June 2007

A 68‐year‐old white man noticed the rapid enlargement of a newly appearing, painless lesion on his left leg during the previous month. There was no history of arsenic ingestion or local radiotherapy. A nontender, lobulated, sessile, red, 15×15×10 mm nodule protruded from the lateral side of his proximal right thigh (Figure 1). A tangential excision of the lesion was performed and the surgical site was allowed to heal by secondary intention. Microscopic examination showed anastomosing strands of basaloid cells extending from the overlying epidermis into the dermis (Figure 2). Some of the basaloid cells had atypical nuclei. Eccrine ducts were present within the strands of tumor cells. A fibromucinous stroma loosely surrounded the tumor. Focally, in the deeper portions of the tumor within the reticular dermis there was palisading of the peripheral row of cells and retraction of these tumor cells from the surrounding stroma (Figure 3). The tumor was completely removed in the sections examined. The pathologic changes were characteristic for the diagnosis of fibroepithelioma of Pinkus variant of basal cell carcinoma.

Distant (A) and closer (B) views of a fibroepithelioma of Pinkus that presents on the patient's lateral right proximal thigh as a sessile nodule

image

Crusted polypoid nodule with a proliferation of anastomosing strands of basaloid epithelium embeded in abundant dense fibrous tissue (hematoxylin‐eosin stain, original magnification×4)

image

Another view shows some areas with stromal edema and focal retraction from the reticulated basaloid tumor (hematoxylin‐eosin stain, original magnification×4).

image
Chemical Warfare Agents: Their Past and Continuing Threat and Evolving Therapies Part I of II
Authors: Kathleen J. Smith , Henry Skelton
Published: June 2007

Chemical warfare agents are potentially accessible to even underdeveloped nations because they are easily and inexpensively produced. This means that they are ideal for use by terrorists and in military operations against civilian populations and troops. In terms of cutaneous injury, vesicants—mainly sulfur mustard—are the most significant chemical warfare agents. Advances in understanding the pathophysiology of the lesions produced by sulfur mustard have led to the research and development of barrier creams as well as pre‐ and post‐exposure therapies to moderate the damage and accelerate healing. Part I of this paper will discuss the history and classification of chemical agents; Part II, which will appear in the September/October 2003 issue of SKINmed, will discuss characteristic manifestations of exposure to chemical agents, as well as prevention and therapy
Cutaneous Lymphomas and Association to Sex Hormones
Authors: Wohl Yonit , Golan Haim , Brenner Sarah
Published: June 2007

Male gender is interpreted as a risk factor for developing mycosis fungoides and perhaps other cutaneous and extracutaneous lymphomas. In this review the authors examine epidemiologic, clinical, pathologic, and molecular data in an effort to understand whether and to what extent gender or sex hormones are involved in the pathogenesis of lymphoproliferative disorders.
Subantimicrobial Dose Doxycycline for Acne and Rosacea
Authors: Joseph B. Bikowski
Published: June 2007

Acne vulgaris and rosacea present therapeutic challenges due to their chronicity, potential for disfigurement, and psychosocial impact. Although pathophysiologically distinct, both conditions have major inflammatory components. Consequently, topical and systemic antimicrobial agents are routinely prescribed for extended periods. Emergence of resistant strains of Propionibacterium acnes, adverse events, and compliance issues associated with chronic systemic tetracycline use have led to new treatment approaches. At subantimicrobial doses, tetracyclines reduce inflammation via anticollagenolytic, antimatrix‐degrading metalloproteinase, and cytokine down‐regulating properties. Subantimicrobial dose (SD) doxycycline (Periostat 20 mg) has clinical utility in periodontitis and has been investigated in a double‐blind, placebo‐controlled trial in the treatment of moderate facial acne as well as in an open label study in the treatment of rosacea. The results of subantimicrobial dose doxycycline treatment in early trials support its benefits and further investigation in acne and rosacea.
Smallpox: What the Dermatologist Should Know
Authors: Phyllis I. Spuls , Jan D. Bos , Donald Rudikoff
Published: June 2007

Despite the eradication of naturally occurring smallpox in 1977, stores of the virus have been maintained in laboratories in the United States and Russia. It is feared that certain rogue states and terrorist organizations may have illicitly acquired the virus with the intent of unleashing it as an agent of bioterrorism. The United States and other nations have begun vaccinating individuals in the military and health care workers who might become exposed. Primary care providers and dermatologists will be called upon to evaluate potential index cases and vaccination reactions. In this report, the authors review the essential clinical aspects of smallpox and potential reactions to smallpox vaccination. Special attention is given to eczema vaccinatum, which can occur in vaccinees and their family contacts with active or quiescent atopic dermatitis or a personal history of eczema.
Diseases on Hair Follicles Leading to Hair Loss Part I: Nonscarring Alopecias
Authors: Katharina Wiedemeyer , Wolf‐Bernhard Schill , Christoph Löser
Published: June 2007

Hair follicles are unique structures with exceptional regenerative potential. They are believed to be crucial for epidermal homeostasis and reepithelialization after damage to human skin. Like other, more active and quickly proliferating organ systems, hair follicles may be easily disturbed in their normal growth cycle by systemic and local influences, including specific skin diseases. This may lead to hair loss, a very common complaint in men and women. The difficulties in reviewing the diseases of hair follicles lay in the long list of different etiologic factors (infectious, autoimmune, inflammatory, neoplastic, physical, chemical, congenital) and a still missing classification system according to etiopathogenetic principles. In this article (Part I of II), the structure and function of hair follicles, the diagnostic approach to diseases causing hair loss, and the most common nonscarring alopecias (telogen effluvium, anagen effluvium, androgenetic alopecia, and alopecia areata) are reviewed in regard to pathogenesis, clinical findings, and current options of treatment. Part II will focus on scarring alopecias.
Ultraviolet Carcinogenesis in Nonmelanoma Skin Cancer. Part I: Incidence Rates in Relation to Geographic Locations and in Migrant Populations
Authors: Mona Almahroos , Amal K. Kurban
Published: June 2007

Over the past two decades a worldwide increase in the incidence of skin cancer to near epidemic proportions has led to increased morbidity and appreciating cost. Well known risk factors include UV radiation, x or? irradiation, chemical carcinogens, genetic aberrations, and immunosuppression. This article reviews and analyzes the evidence for UV radiation's role in the pathogenesis of nonmelanoma skin cancer (NMSC). Observations on the incidence of NMSC among migrants to temperate regions show an increase in both basal cell carcinoma and squamous cell carcinoma. There is also an increase in NMSC in areas with lower latitudes. Irradiation of human skin grafted to animals and animal models that develop NMSC lend further support to the role of UV radiation in the pathogenesis of NMSC. In the forthcoming Part II of this review, epidemiologic evidence will be presented attesting to the relationship between UV radiation and NMSC.
Foods, Diet, and Skin Diseases
Authors: Ada Lo Schiavo , Anna Aurilia , Vincenzo Guerrera
Published: June 2007

Human skin is continuously exposed to internal and external influences that may alter its condition and functioning. As a consequence, the skin may undergo alterations leading to immune dysfunction, imbalanced epidermal homeostasis, or other skin disorders. New theories are developing that link food intake and health. The objective of this review is to evaluate current knowledge about the interrelation of food and skin, particularly the effect of nutrients on some cutaneous immune disorders and therapeutic actions of nutrients in skin disorders.