bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Low-Dose Oral Erythromycin on Gastric Aspirates in Ventilated Neonates Less than 32 Weeks of Gestation
Authors: Dellagrammaticas H.D. , Iacovidou N. , Megaloyanni E. , Papadimitriou M. , Kapetanakis J.
Published: April 2003

In this prospective study, the 24-hour gastric aspirate volume was carefully recorded before, 24 and 48 h after administering 1.7 mg/kg/8-hourly of oral erythromycin to 16 ventilated neonates less than 32 weeks of gestation. Their median gestational age was 28.5 weeks (range 23–31 weeks), their median birthweight was 1,045 g (range 690–1,560 g) and the median day of life at which erythromycin was commenced was 9.5 days (range 4–16 days). Prior to administering erythromycin median 24-hour gastric aspirate volume, expressed as a percentage of the milk volume given over the same period, was 38.5% (range 20.0–100%). It was significantly lower 24 h (median 12%, range 0–41%, p = 0.0004) and 48 h (median 5%, range 0–21%, p = 0.0004) after commencing erythromycin. There was also significant reduction of gastric aspirate volume between 24 and 48 h after commencing erythromycin (p = 0.0024). Milk volume increment over the same period was not significant (p = 0.1022). These preliminary results warrant further evaluation through a randomised controlled trial.
New Strategies in Dandruff Treatment: Growth Control of Malassezia ovalis
Authors: Baroni Adone , De Rosa Roberto , De Rosa Alfredo , Donnarumma Giovanna , Catalanotti Piergiorgio
Published: April 2003

Background: Cutaneous infections induced by Malassezia ovalis (Pityrosporum ovale) represent a therapeutic problem due to the high rate of recurrence. Objective: We studied feasible strategies to control the growth of M. ovalis, compatible with topical use in cosmetic formulations. Studies were performed on the effects of pH, ionic strength, cinnamic acid and related compounds on mycotic growth. Methods:M. ovalis was cultivated in modified Sabouraud agar. The effects of pH, ionic strength and cinnamic acid and related compounds on mycotic growth were studied by the membrane filter method. Results: In vitro growth of M. ovalis is strongly affected by pH and ionic strength. pH 4.5 induced a growth inhibition of about 95% and 1 M NaCl, at the optimal growth pH, reduced cell growth by over 90%. Cinnamic acid showed an inhibitory effect of 50% at 0.005 g/dl; 30 min incubation with cinnamic acid 0.5 g/dl had a mycocidic effect. Conclusion: These results suggest the use of cosmetic compositions containing cinnamic acid or buffered acidic lotions and shampoos in the treatment of M. ovalis infections of the scalp, eventually in addition or alternative to antimycotic drugs or in maintenance therapy. Cosmetic formulations with high ionic strength or skin irritant derivatives such as cinnamaldehyde cannot be proposed for practical use.
Anti-Inflammatory Activity of 2,4,6-Trihydroxy-α-p-Methoxyphenyl- acetophenone (Compound D-58)
Authors: Malaviya Rama , Malaviya Ravi , Uckun Fatih M.
Published: April 2003

Background: Active oxygen radicals as well as a variety of cytosolic protein tyrosine kinases play a role in the regulation of prostaglandin E2 (PGE2), a key inflammatory mediator, released by skin cells in response to irradiation with ultraviolet B light (UVB). Identification of chemical compounds that can interrupt such events may provide a basis for the development of potent anti-inflammatory agents. Objective: To investigate the effect of a novel genistein analog, 2,4,6-trihydroxy-α-p-methoxyphenylacetophenone, with antioxidant property (compound D-58), on UVB-induced inflammatory responses. Methods: Epidermal cell cultures were irradiated with UVB both in the presence and absence of compound D-58 and the PGE2 released in the medium was determined by ELISA. For in vivo studies, skin inflammation was induced in mice either by carrageenan challenge of the air pouch or by an acute exposure of skin to UVB radiation. The resulting inflammatory mediator release, skin edema and the histological changes of the skin were determined both in the presence and absence of compound D-58. Results: Compound D-58 treatment effectively inhibited the development of edema and histological changes in the skin of UVB-irradiated mice as well as the release of PGE2 in vitro as well as in vivo. Conclusion: Compound D-58 (2,4,6-trihydroxy-α-p-methoxyphenylacetophenone) has potent anti-inflammatory properties.
Homoeopathic Arnica in Postoperative Haematomas: A Double-Blind Study
Authors: Ramelet A.-A. , Buchheim G. , Lorenz P. , Imfeld M.
Published: April 2003

Objective: To determine whether homoeopathic Arnica can reduce postoperative haematomas in venous surgery. Design: Randomized, prospective, multicentric, double-blind placebo-controlled trial. Participants: 130 consecutive patients undergoing saphenous stripping (204 legs), hospitalized in a clinic. Interventions: A homoeopathic medicine (Arnica CH5) and an indistinguishable placebo, administered sublingually by a nurse the night before and immediately after the operation. Outcome Measures: Clinical evaluation of haematomas 6 days postoperatively. Results: Groups were well matched (sex, age, history of bleeding or thrombosis, drug intake, previous intake of homoeopathic drugs, type of operation and anaethesia, operator). One drop-out has been replaced. No statistically significant difference in postoperative haematomas was found between the Arnica and placebo groups (p = 0.342). Subanalysis of all other items did not reveal any statistical difference either. Conclusions: In this study, with this dosage, we did not observe any preventive effect of homoeopathic Arnica CH5 on poststripping haematomas.
Incidence Patterns of Lyme Disease and Cutaneous B-Cell Non-Hodgkin’s Lymphoma in the United States
Authors: Munksgaard Lars , Frisch Morten , Melbye Mads , Hjalgrim Henrik
Published: April 2003

Background: Several reports have suggested a link between infection with Borrelia burgdorferi (the spirochete causing Lyme disease) and development of cutaneous B-cell non-Hodgkin’s lymphoma (CBCL). Methods: We did a correlation analysis of CBCL and Lyme disease using data from the Surveillance, Epidemiology and End Results program and from the Centers for Disease Control and Prevention. Results: We could not demonstrate a geographic correlation between incidence rates of Lyme disease and CBCL. Conclusion: This observation suggests that infection with B. burgdorferi is not a major risk factor for CBCL in the USA.
Atopic Signs and Symptoms: Assessing the ‘Atopy Score’ Concept
Authors: Uter W. , Schwanitz H.J. , Pfahlberg A. , Gefeller O.
Published: April 2003

Background: Score concepts have been suggested for the standardised diagnosis of atopic dermatitis, incorporating various anamnestic and clinical minor criteria of atopy, including the ‘Erlangen Score’, developed in the hospital-based setting of a dermatitis clinic. Objective: To evaluate the properties of this score in the context of a population-based epidemiological study. Methods: The association between relevant atopic criteria and previous or current flexural eczema was evaluated in 2,352 hairdressing apprentices. Results: The association was not as strong as in the patient-based studies, comparing the respective odds ratios. Accordingly, the discriminating power of the Erlangen Score was poor, resulting in low sensitivity (55.7%) and specificity (73.8%) for, e.g., 8 points as cutpoint. Conclusion: While the score appears useful to summarise minor criteria, the individual relevance of its point values should not be overestimated in view of a low positive predictive value in a population (compared to a clinical) setting.
Antidesmoglein Autoantibodies in Silicosis Patients with No Bullous Diseases
Authors: Ueki H. , Kohda M. , Nobutoh T. , Yamaguchi M. , Omori K. , Miyashita Y. , Hashimoto T. , Komai A. , Tomokuni A. , Ueki A.
Published: April 2003

Background: Pemphigus is an autoimmune bullous disease characterized by the presence of antidesmoglein autoantibodies. However, the mechanism of its autoantibody production remains unknown. In previous reports, we have described rare cases of pemphigus and pemphigoid associated with silicosis. It is well known that during long-term silicosis, some autoimmune diseases, such as systemic sclerosis, systemic lupus erythematosus or rheumatoid arthritis, can occur. Objective: The aim of this study was to explore the presence of pemphigus or pemphigoid autoantibodies in silicosis patients without clinical bullous diseases or collagen diseases. Method: The presence of pemphigus antibodies was examined in 54 silicosis patients with no associated bullous diseases, using immunofluorescence, the enzyme-linked immunosorbent assay (ELISA) for desmoglein 1 and 3, and immunoblotting methods. In the antibody-positive cases, HLA genotyping of peripheral lymphocytes was performed with PCR-RFLP. Results: Seven out of the 54 patients were found to be positive for pemphigus antibodies and 1 for bullous pemphigoid by immunofluorescence. In addition, by ELISA, 6 patients were found to be positive against the desmoglein 1 antigen, 2 against the desmoglein 3 antigen and 2 against both desmoglein 1 and desmoglein 3. Conclusion: The results of the present study strongly suggest the occurrence of pemphigus and pemphigoid autoantibodies in patients with silicosis. It remains unclear whether such patients will develop an autoimmune bullous disease in the future. Accordingly, long-term follow-up of antibody-positive patients is required.
Non-Herlitz Junctional Epidermolysis bullosa without Hair Involvement Associated with BP180 Deficiency
Authors: Guerriero Cristina , De Simone Clara , Venier Antonio , Rotoli Maurizio , Posteraro Patrizia , Zambruno Giovanna , Amerio Pierluigi
Published: April 2003

Junctional epidermolysis bullosa (JEB) is a clinically and genetically heterogeneous recessively inherited blistering disease of the skin and mucous membranes due to impaired epithelial adhesion. In particular, defective expression of the 180-kD bullous pemphigoid antigen (BP180) has been correlated to a non-lethal (non-Herlitz) form of JEB, generalized atrophic benign epidermolysis bullosa (GABEB), characterized by widespread skin blistering healing with atrophy and by atrophic alopecia with onset in childhood. We report the case of a 33-year-old man suffering from a generalized blistering skin disorder since birth. He also presented nail dystrophy and tooth abnormalities. Mucosal involvement was limited to gingival erosion. Alopecia was absent and body, axillary and pubic hair were normal. Immunofluorescence analysis showed a markedly reduced expression of BP180, electron microscopy studies evidenced hypoplastic hemidesmosomes and Northern blot analysis confirmed a striking decrease in the amount of BP180 mRNA. The clinical features of our patient confirm that BP180 deficiency usually results in a non-Herlitz JEB form. However, the degree of skin, mucous membranes and hair involvement appears more variable and less typical than originally described for GABEB.
Unusual Annular Erythema Associated with Myelodysplastic Syndrome
Authors: Yamamoto T. , Soejima K. , Yokozeki H. , Koyano T. , Katayama I. , Nishioka K.
Published: April 2003

We report a case of unusual annular erythema associated with myelodysplastic syndrome (MDS). A 58-year-old male with MDS developed annular erythema on his back, scaly erythema on the dorsa of hands, and exsudative erythema on his eyelids. Histological examination revealed a mononuclear cell infiltrate around vessels and follicles in the mid- to lower dermis. He had no history of treatment with granulocyte-colony-stimulating factor (G-CSF). Serum granulocyte-macrophage-colony-stimulating factor (GM-CSF) level was slightly elevated (5.84 pg/ml, normal <2.0 pg/ml), whereas other cytokines including G-CSF, IL-6, and IL-8 were within normal limits. Skin manifestations were much improved by systemic mepitiostane, and serum GM-CSF level returned to normal levels.
Assessment of the Clinical Effect of Topical Tacalcitol on Ichthyoses with Retentive Hyperkeratosis
Authors: Okano M.
Published: April 2003

Background: Topical tacalcitol (1α,24-dihydroxyvitamin D3) has been demonstrated to produce beneficial clinical effects on epidermo-hyperproliferative disorders such as psoriasis and pityriasis rubra pilaris. However, the efficacy of the agent has not been elucidated in retentive hyperkeratotic disorders. Objective: The object of the study was to assess the clinical efficacy of topical tacalcitol against ichthyoses with retentive hyperkeratosis; X-linked ichthyosis (XLI), ichthyosis vulgaris (IV), and acquired ichthyosis (AI). Methods: Tacalcitol was topically applied on 9 patients with the retention ichthyoses, using a single-blinded, bilaterally paired approach with right-left comparison of tacalcitol and the base. Results: Clinical improvement obtained by topical tacalcitol exclusively was not superior to that of the vehicle alone in any of the ichthyotic patients. Conclusion: Topical tacalcitol therapy was ineffective against ichthyoses without epidermal hyperproliferation.
Pigmented Paget’s Disease of the Male Breast: Report of a Case
Authors: Nakamura Satoshi , Ishida-Yamamoto Akemi , Takahashi Hidetoshi , Hashimoto Yoshio , Yokoo Hideki , Iizuka Hajime
Published: April 2003

An 83-year-old man with pigmented Paget’s disease of the breast is reported. He had a blackish swollen right nipple with bloody discharge that lasted for 8 months. Histopathology of the lesion disclosed intraepidermal and dermal atypical cells forming small clusters and underlying intraductal carcinoma. Melanocytes were dispersed in the epidermis. Dermal melanophages were also detected. The atypical cells were positive for carcinoembryonic antigen, human-milk fat globule protein and a recently described new antigen, RCAS-1, but negative for S-100 or HMB-45. We diagnosed this case as Paget’s disease of the male breast. Paget’s disease of the breast is usually nonpigmented and occurs almost exclusively in women. Pigmented Paget’s disease of the male breast is extremely rare, and only a few cases have been reported. Albeit rare, pigmented Paget’s disease has to be included in the differential diagnosis of pigmented lesions of the nipple.
Effect of Ketoconazole 1% and 2% Shampoos on Severe Dandruff and Seborrhoeic Dermatitis: Clinical, Squamometric and Mycological Assessments
Authors: Piérard-Franchimont C. , Piérard G.E. , Arrese J.E. , De Doncker P.
Published: April 2003

Ketoconazole (KET) is active to control dandruff and seborrhoeic dermatitis. Objective assessments comparing the 1% and 2% shampoo formulations are scant. This open, randomized parallel-group trial was carried out to differentiate the effectiveness of KET 1% and 2% in severe dandruff and seborrhoeic dermatitis. A total of 66 patients with severe dandruff or seborrhoeic dermatitis were randomized to each of the two groups. A 2-week run-in phase was followed by a 4-week treatment phase, in turn followed by a 4-week follow-up. The efficacy of treatments was evaluated by combining squamometry X, Malassezia spp. counts and clinical assessments. After 2 and 4 weeks of treatment, KET 2% was significantly superior over KET 1% (p < 0.001) for decreasing both in flakiness and Malassezia density from baseline. The same trend was observed in the mean change from baseline in the overall dandruff severity score. Only 6 mild adverse events were reported. During follow-up KET 2% showed a trend to fewer relapses than KET 1%. KET 2% had superior efficacy compared to KET 1% in the treatment of severe dandruff and scalp seborrhoeic dermatitis. Biometrological evaluations were correlated with the clinical improvements and therefore useful to incorporate in future dandruff studies.
Prognostic and Therapeutic Implications of Sentinel Lymphonodectomy and S-Staging in Merkel Cell Carcinoma
Authors: Düker I. , Starz H. , Bachter D. , Balda B.-R.
Published: April 2003

Background: Merkel cell carcinoma (MCC) is a rare but very aggressive neuroendocrine neoplasm of the skin with a high propensity for early lymph node metastasis and subsequent distant spread. Optimal treatment and prognostic factors are poorly defined. Objective: The purpose of this study is to assess the prognostic and therapeutic relevance of sentinel lymphonodectomy in MCC. Methods: Five patients with biopsy-proven MCC underwent gamma-probe-guided sentinel lymphonodectomy assisted by lymphatic mapping. From each sentinel lymph node (SLN), a series of paraffin sections was histologically and immunohistochemically examined for the presence of micrometastases, which were then staged according to the recently published S classification. Results: Four of the 5 patients showed metastatic disease in the SLNs, 3 of which were classified as S2, 1 as S3. Only 1 of the S2 patients demonstrated additional positive nodes at completion lymphonodectomy. The patient staged as S3 refused a radical lymph node dissection and died within 1 year due to widespread metastasis. Conclusions: Sentinel lymphonodectomy is a low-morbidity procedure which enables an early detection and exact staging of regional lymph node metastases with potentially high prognostic and therapeutic relevance in MCC.
Interferon-Gamma-Induced RANTES Production by Human Keratinocytes Is Enhanced by IL-1β, TNF-α, IL-4 and IL-13 and Is Inhibited by Dexamethasone and Tacrolimus
Authors: Wakugawa Motoshi , Nakamura Koichiro , Akatsuka Masahiro , Nakagawa Hidemi , Tamaki Kunihiko
Published: April 2003

Background and Methods: Recent studies have shown that RANTES plays a role in the pathogenesis of inflammatory skin diseases. We examined the production of RANTES by human keratinocytes (KCs) when cultured with various cytokines. Results: IFN-γ (100 ng/ml) or IL-1β (100 ng/ml) significantly induced RANTES production by KCs in 48-hour culture. These cytokines synergistically increased RANTES production by KCs. TNF-α (100 ng/ml), IL-4 (100 ng/ml) or IL-13 (100 ng/ml) markedly enhanced the RANTES production by KCs induced by IFN-γ (100 ng/ml) although none of those cytokines significantly enhanced that induced by IL-1β (100 ng/ml) in 48-hour culture. Dexamethasone (10–8 M) strongly inhibited RANTES production by KCs induced by the combination of IFN-γ and IL-4, while tacrolimus (FK-506, 10–8 and 10–6 M) showed partial inhibition. Conclusions: These results revealed that RANTES production by KCs is regulated by inflammatory cytokines, such as IFN-γ, IL-1β, TNF-α, IL-4 and IL-13, and can be modulated by immunosuppressive drugs. Our data suggest that RANTES is involved in skin inflammation.
Grover’s Disease Associated with Sarcoptes scabiei
Authors: Kaddu Steven , Müllegger Robert R. , Kerl Helmut
Published: April 2003

An 83-year-old man presented with a 4-month history of discrete, itchy papules mainly distributed on the trunk and upper extremities. Histopathologic examination of two biopsies from lesions on the trunk revealed mainly focal suprabasal acantholysis and an inflammatory infiltrate composed mainly of lymphocytes with a few eosinophils. The overall clinical and histopathologic features were consistent with Grover’s disease. However, scrapings taken from the skin lesions showed numerous mites of Sarcoptes scabiei. Subsequent treatment with an antiscabies cream led to a rapid complete cure, and no skin lesions have been observed during a 6-month follow-up. A review of the literature revealed 2 other cases of cutaneous lesions fulfilling the clinical and histopathologic features of Grover’s disease in which mites of S. scabiei were demonstrated. Our observation further highlights the unusual association of Grover’s disease with S. scabiei mites and emphasises the importance of excluding this easily treatable skin infestation in all patients with Grover’s disease.
Combination Therapy Improves the Recovery of the Skin Barrier Function: An Experimental Model Using a Contact Allergy Patch Test Combined with TEWL Measurements
Authors: Hachem Jean-Pierre , De Paepe Kristien , Vanpée Els , Kaufman Leonard , Rogiers Vera , Roseeuw Diane
Published: April 2003

Background: Nickel (Ni) allergic contact dermatitis (ACD) alters the skin barrier. Objective: Our aim was to compare the efficacy of combination therapies on ACD, using a topical corticosteroid and a corneotherapy agent (barrier cream), with that of a single therapy with corticosteroids. Methods: On day 1, 3 Ni test patches were applied on each forearm of 14 Ni-patch-test-positive females. Four contained 5% Ni and 2 physiological saline. Either topical corticosteroid or barrier cream were matched with the combination of both products on 3 of the 4 Ni ACD. The fourth was not treated. Clinical scoring, transepidermal water loss (TEWL) and stratum corneum (SC) capacitance were measured before (day 1) and after (days 4–8) ACD. Results: The combination therapy showed a significant decrease in TEWL values and an increase in SC capacitance. Conclusion: Combining a topical corticosteroid with corneotherapy agents prevents the delay in the healing process of skin barrier disruption due to ACD.
Epidermal Grafting for Depigmentation due to Discoid Lupus erythematosus
Authors: Gupta Somesh
Published: April 2003

Background: Longstanding lesions of discoid lupus erythematosus (DLE) may heal with thin, depigmented scar(s). The depigmentation may fail to respond to medical therapies. Objective: To evaluate the efficacy of suction blister epidermal grafting in longstanding, quiescent, depigmented scar(s) of DLE. Methods: The suction blisters were raised on the lateral aspect of the upper third of the thigh in 4 patients (3 males, 1 female) with depigmented scars of DLE on the face. The roofs of the blisters were transferred to the dermabraded recipient area. Both donor and recipient sites were dressed with nonadherent tulle. Results: The dressings were removed after 7 days. The graft take was complete. The pigmentation achieved was more than 100% of the grafted area due to peripheral spread of the pigmentation and more than 75% of the depigmented area. The color match was good. There was no loss of pigment or recurrence/relapse of the disease during the follow-up of 6 months to 1 year. Conclusions: Our preliminary results suggest that leukodermic scars of healed inactive DLE lesions can be successfully treated with epidermal grafting.
Unusual Halo Nevi – Darkening Rather than Lightening of the Central Nevus
Authors: Huynh Phung M. , Lazova Rossitza , Bolognia Jean L.
Published: April 2003

Although the classic halo nevus is a brown nevus with a surrounding rim of depigmentation, i.e. a stage I halo nevus, these nevi can have several clinical stages. The central nevus may lose its pigmentation and appear pink with a surrounding halo (stage II), the central papule may disappear leading to a circular area of depigmentation (stage III) or the depigmented area may repigment (stage IV), leaving no trace of its prior existence. Herein we describe an unusual phenomenon – darkening of the central nevus rather than lightening – following the appearance of the halo phenomenon. An 18-year-old boy who had multiple atypical nevi developed multiple halo nevi beginning at the age of 12 years. Following the appearance of the peripheral halos, 2 of his nevi that were originally solid medium brown in color darkened and the hyperpigmentation had a reticulated pattern with perifollicular sparing. One possible explanation is a postinflammatory hyperpigmentation induced by the infiltrating lymphocytes.
Chronic Borreliosis Presenting with Morphea- and Lichen sclerosus et atrophicus-Like Cutaneous Lesions
Authors: Kaya Gürkan , Berset Magali , Prins Christa , Chavaz Pierre , Saurat Jean-Hilaire
Published: April 2003

We report on a case of chronic cutaneous borreliosis with manifestations clinically compatible with morphea and lichen sclerosus et atrophicus. The histopathologic features of these lesions were those of acrodermatitis chronica atrophicans. Our case illustrates the concept that clinical aspects of morphea and lichen sclerosus et atrophicus pertain to the spectrum of cutaneous borreliosis.
Cyclosporin for Atopic Dermatitis in Children
Authors: Harper J.I. , Berth-Jones J. , Camp R.D.R. , Dillon M.J. , Finlay A.Y. , Holden C.A. , O’Sullivan D. , Veys P.A.
Published: April 2003

This paper details a UK consensus conference held in London in April 2000 to establish guidelines for the use of cyclosporin A for atopic dermatitis in children. It should be reserved for the severest refractory atopic dermatitis. In view of its potential toxicity, careful monitoring is mandatory, in particular blood pressure and renal function.
Characteristic Intracytoplasmic Material in a Perianal Wart That Contains Human Papillomavirus Type 56 and 16 DNA
Authors: Suzuki Tamio , Adachi Ayumi , Tomita Yasushi
Published: April 2003

We report the case of a perianal wart in which human papillomavirus type 56 and 16 DNAs were detected, arising in a 29-year-old healthy Japanese female. Clinically, moist erythema and small flat pinkish papules appeared around the anus and worsened over a period of 6 months. Histopathologically, no signs of dysplasia or atypia were apparent. An area of intracytoplasmic material, which was homogeneous and eosinophilic, was contained in each epidermal cell. The wart showed HPV-56 and HPV-16 DNAs by PCR and reverse-phase dot blot hybridization. Additional Southern blot analysis showed the amount of HPV-56 DNA to be more than 10 times that of HPV-16 DNA. This is the first case, to our knowledge, of a perianal wart with intracytoplasmic material, which contains HPV DNAs causing mucous lesions.
Psychosomatic Liaison Service in Dermatology
Authors: Fritzsche Kurt , Ott Johannes , Zschocke Ina , Scheib Peter , Burger Thorsten , Augustin Matthias
Published: April 2003

Background: Empirical investigations examining the psychosocial distress and need for care of dermatology patients are rare. Little is known about the use of psychotherapeutic interventions in routine care. Objective: To evaluate the psychosocial distress of dermatological inpatients, the need for psychotherapeutic interventions and their realization in the framework of a psychosomatic liaison service. Methods: 86 patients from one unit at the University Dermatology Clinic in Freiburg underwent psychodiagnostic interviews and completed self-rating instruments, elucidating mental disorders, psychosocial distress, coping methods, quality of life, treatment motivation and psychotherapeutic interventions. Results: Using ICD-10 criteria, mental and behavioral disorders were diagnosed in 46%; most frequent were mood and anxiety disorders. Professional assessment indicated a need for psychotherapeutic treatment in 51%, while 28% of the patients wished for psychotherapy; actual intervention occurred in 38%. Conclusions: The need for psychotherapeutic treatment can only be handled within the framework of a liaison service in close collaboration with care givers.
Acquired Hair Fragility in Pili anulati: Causal Relationship with Androgenetic Alopecia
Authors: Hofbauer Günther F.L. , Tsambaos Dionysios , Spycher Max A. , Trüeb Ralph M.
Published: April 2003

Pili anulati are defined by characteristic alternating light and dark banding in the hair shaft, due to air-filled spaces between the macrofibrillar units of the hair cortex, and are regarded as a congenital hair shaft disorder without increased hair fragility. Two cases of pili anulati are presented, in which fragility of hair developed in a causal relationship with the onset of androgenetic alopecia. Accordingly, trichorrhexis-nodosa-like hair fracturing was exclusively limited to the androgenetic region. In general, secondary trichorrhexis nodosa is an unspecific finding related to excess stress of hair in relation to its fragility. With onset of hair thinning due to androgenetic alopecia, progressive reduction of hair shaft diameter may cause increased fragility in pili anulati. In this case, hair shaft fracturing occurs within the area of androgenetic alopecia and colocalizes with the air-filled cavities of pili anulati.
A Case of Pemphigus foliaceus Which Occurred after Five Years of Remission from Pemphigus vulgaris
Authors: Kimoto Masayuki , Ohyama Manabu , Hata Yasuki , Amagai Masayuki , Nishikawa Takeji
Published: April 2003

A 77-year-old Japanese female developed pemphigus foliaceus (PF) after 5 years of remission from pemphigus vulgaris (PV). The patient had painful erosions in her mouth and flaccid blisters of the skin and was diagnosed as having PV, which responded well to corticosteroid treatment. She was then free from any lesion of PV for 5 years with a low dose of corticosteroid. Then she developed scaly erythematous lesions on the skin and was diagnosed as suffering from PF. Enzyme-linked immunosorbent assay (ELISA) using recombinant desmoglein 1 (Dsg-1) and Dsg-3 revealed that she had anti-Dsg-3 IgG in the PV stage, no antibodies during remission and anti-Dsg-1 IgG in the PF stage. These findings indicate that the target antigen was shifted from Dsg-3 to Dsg-1 along with the phenotype after a 5-year interval in this patient.
Acne excoriata – Look for Allergy!
Authors: Kränke Birger , Brabek Eva , Derhaschnig Johann , Aberer Werner
Published: April 2003

Acne excoriata (AE) is a frequent variant of self-inflicted skin conditions, which occurs predominantly in females. The condition seems to be almost always found in persons with psychological problems. Therapeutic approaches are often unsatisfying since this special group of patients typically does not recover with dermatological treatment. We report a 37-year-old female patient who had suffered for 5 years from AE. Exact history taking revealed that her manipulations were correlated with episodes of contact with bird products like feathers and eggs. The diagnosis of a bird egg syndrome could be proved by skin prick tests (ALK Abello, Denmark) as well as laboratory results (CAP FEIA, Pharmacia, Sweden), and consequent avoidance of handling bird products was the only but effective therapeutic measurement. In patients with suspected artefactual diseases, we strongly recommend to listen to the patients’ complaints in order to make the correct diagnosis and not to overlook a potential stimulus.
Clear Cell Papulosis (Pagetoid Papulosis) in a Non-Asian Patient
Authors: Gianotti Raffaele , Cambiaghi Stefano , Locatelli Andrea , Gelmetti Carlo
Published: April 2003

Clear cell papulosis is a recently described disorder which is characterized by multiple flat, slightly elevated, hypopigmented papules, distributed mainly on the lower part of the trunk of healthy children. Histologically, the disease shows ‘clear cells’ with a pagetoid appearance spread among keratinocytes in basal and suprabasal layers of the epidermis. These cells stain for AE1, CEA and EMA, making a relationship to eccrine or apocrine elements likely. All cases reported until now describe Asian children. The first European child with clear cell papulosis is presented.
Superficial Black Network: An Additional Dermoscopic Clue for the Diagnosis of Pigmented Spindle and/or Epithelioid Cell Nevus
Authors: Argenziano Giuseppe , Soyer H. Peter , Ferrara Gerardo , Piccolo Domenico , Hofmann-Wellenhof Rainer , Peris Ketty , Staibano Stefania , Chimenti Sergio
Published: April 2003

Dermoscopy is a valuable method for improving the diagnostic accuracy of pigmented skin lesions. Specific dermoscopic criteria have been described for differentiating pigmented spindle and/or epithelioid cell nevi (SECN; Spitz nevi and Reed nevi) from cutaneous melanomas. In the present study, we report an additional dermoscopic feature of SECN, namely a distinctive type of pigment network, described as superficial black network, which was observed in 10.5% of SECN. Histopathologically, this network corresponds to focal areas of pigmented parakeratosis, producing a black reticulated appearance on the horizontal plane.
Successful Treatment in Two Cases of Steroid-Dependent Cutaneous Polyarteritis nodosa with Low-Dose Methotrexate
Authors: Schartz Noël Emile Célestin , Alaoui Siham , Vignon-Pennamen Marie Dominique , Cordoliani Florence , Fermand Jean Paul , Morel Partrice , Rybojad Michel
Published: April 2003

To the best of our knowledge, only 3 cases of cutaneous polyarteritis nodosa (PAN) treated successfully with methotrexate (MTX) have been reported in the medical literature. We report 2 further cases of steroid-dependent cutaneous PAN treated successfully with low-dose weekly MTX therapy. The clinical and biological tolerance of MTX was excellent. The cutaneous lesions started to regress within 3 weeks. One of the patients reported full recovery which lasted 2 years after stopping the therapy. So, MTX seems to be an interesting therapy in the treatment of PAN because of its relatively low toxicity, its simple use, its quick action and prolonged results after MTX has been stopped.
Anetoderma in a Systemic Lupus erythematosus Patient with Anti-PCNA and Antiphospholipid Antibodies
Authors: Álvarez-Cuesta César Cosme , Raya-Aguado Cristina , Fernández-Rippe María Luisa , Sánchez Tomás Soler , Pérez-Oliva Narciso
Published: April 2003

Anetoderma is a rare elastolytic disorder included within the group of cutaneous atrophies. Its pathogenesis is not yet clearly established, but immunological mechanisms could play an important role in dermal elastolysis. It has been associated with different autoantibodies and autoimmune disorders. We present a case of anetoderma in a systemic lupus erythematosus patient with anti-proliferating-cell-nuclear-antigen and antiphospholipid antibodies, highlighting the peculiarities of such an association.
Scleroderma Subsets Are Best Detected by the Simultaneous Analysis of the Autoantibody Profile Using Commercial ELISA
Authors: Parodi Aurora , Drosera Massimo , Barbieri Loris , Rebora Alfredo
Published: April 2003

Objective: Antinuclear antibodies are often present in patients with systemic sclerosis but do not provide useful prognostic information if studied individually. Although an autoantibody profile should be studied, this has never been done in a large series of patients. Methods: Anticentromere, anti-topoisomerase-I, anti-extractable-nuclear-antigen, antihistone and anticardiolipin antibodies were studied by means of enzyme immunosorbent assay in 90 systemic sclerosis patients. Results: We confirmed that anticentromere antibodies characterize limited forms of the disease with less frequent visceral involvement while anti-topoisomerase-I antibodies characterize diffuse forms with severe gastrointestinal, heart and lung involvement. Antihistone antibodies alone or associated with anticentromere antibodies characterize a disease subset with more frequent visceral involvement and a probably poor outcome. Patients with anticardiolipin antibodies, instead, did not display severer heart or vascular involvement. Conclusions: Systemic sclerosis patients are often found to have antinuclear antibodies. In addition to the well-known disease subsets identified by anti-topoisomerase-I and anticentromere antibodies, another one can be established, characterized by antihistone antibodies often associated with anticentromere antibodies. Patients displaying this profile have high prevalence of lung, kidney and heart involvement.
Treatment of Refractory Atopic Dermatitis Using ‘Wet-Wrap’ Dressings and Diluted Corticosteroids: Results of Standardized Treatment in both Children and Adults
Authors: Devillers A.C.A. , de Waard-van der Spek F.B. , Mulder P.G.H. , Oranje A.P.
Published: April 2003

Background: ‘Wet-wrap’ dressings with diluted corticosteroids form an alternative treatment in patients with refractory atopic dermatitis (AD). Objective: To evaluate a standardized treatment, using wet-wrap dressings with diluted corticosteroids, in patients with refractory AD. Methods: Results of treatment, complications and possible side effects were retrospectively evaluated in 14 children and 12 adults. Results: Skin lesions improved dramatically during 1 week of inpatient treatment. A significant decrease in early-morning serum cortisol levels was measured. Levels below the normal range were only observed after 1 week in 2 adults and on day 4 in 3 children. Suppression of the hypothalamus-pituitary-adrenal-cortex axis in 1 adult and a new exacerbation of AD in 2 children and 3 adults complicated long-term treatment at home. Additional complications included folliculitis, a Pseudomonas aeruginosa infection, a secondary bacterial infection and refractory skin lesions between bandages. Conclusion: Wet-wrap dressings and diluted corticosteroids form an effective treatment in patients with refractory AD.
Lichen amyloidosus Associated with Kimura’s Disease: Successful Treatment with Cyclosporine
Authors: Teraki Yuichi , Katsuta Michie , Shiohara Tetsuo
Published: April 2003

We describe here a case of a 33-year-old man who had lichen amyloidosus associated with Kimura’s disease. In this case, treatment with cyclosporine dramatically improved the lesions of both Kimura’s disease and lichen amyloidosus. Although Kimura’s disease and lichen amyloidosus are both rare distinct entities, to our knowledge, 11 cases of association of Kimura’s disease and lichen amyloidosus have been described previously.
Basal Cell Carcinoma of the Earlobe after Auricular Acupuncture
Authors: Brouard Michel , Kaya Gürkan , Vecchietti Gianluca , Chavaz Pierre , Harms Monika
Published: April 2003

The genesis of familial and sporadic basal cell carcinomas involves activation of the Sonic hedgehog signal transduction pathway. Other known factors for the development of basal cell carcinoma are ultraviolet exposure, X-rays, race, age, gender and decreased DNA repair capacity. We here report the case of a right earlobe sporadic basal cell carcinoma in a 65-year-old woman. This case is unusual because of its earlobe localization and its association with multiple auricular acupuncture treatments. This observation suggests a connection between local traumas, which occur in the course of acupuncture treatment and ear piercing, and the genesis of basal cell carcinoma. The incidence of minor adverse events associated with acupuncture is high, but serious events are uncommon. Acupuncture is not known to date for promoting the development of tumors. This connection remains to be elucidated.
Molecular Genetics of Neuroendocrine Tumors
Authors: Calender A.
Published: April 2003

Through insights into the molecular genetics of neuroendocrine tumors (NETs), the genes predisposing to multiple endocrine neoplasia (MEN) syndromes were identified. In MEN1, tumors occur in the parathyroids, endocrine pancreas, anterior pituitary, adrenal glands and thymic neuroendocrine tissues. The MEN1 gene encodes a putative growth-suppressor protein, menin, binding JunD, a transcriptional factor belonging to the AP-1 complex. However, new partners binding menin remain to be found. The MEN1 gene might be involved in 1–50% of sporadic NETs. Another critical mechanism involved in NETs is the deregulation of the RET-signalling pathways by oncogenic point mutations responsible for MEN2 syndromes. MEN2 refers to the inherited forms of medullary thyroid carcinoma. The RET proto-oncogene, a tyrosine-kinase receptor, is activated by missense mutations occurring either in the extracellular dimerization domain or intracellular tyrosine kinase catalytic regions. In both cases the receptor is constitutionally activated in the absence of natural ligands. Endocrine tumors also belong to the clinical pattern of Recklinghausen (NF1) and von Hippel-Lindau (VHL) diseases. The genes for both syndromes have been characterized and provide new pathways for endocrine tumorigenesis related to G-protein physiology (NF1) and transcriptional regulation and/or endothelial cell proliferation (VHL), respectively. Here, we propose a basic overview of recent data on genetic events leading a normal endocrine cell towards a fully malignant phenotype.
Natural History of Neuroendocrine Enteropancreatic Tumors
Authors: Mignon Michel
Published: April 2003

Neuroendocrine enteropancreatic tumors (NEEPTs) include tumors developing from the pancreatic islets and the duodenal loop, and those developing from gut serotonin-secreting cells (mid-gut carcinoids). When functioning, they are rare tumors with frequently inconsistant clinical and biological characteristics. Provocative dynamic tests are very useful. Their natural history, with the exception of insulinomas and mid-gut carcinoids, is still incompletely known due to their rarity, relatively recent description, slow evolution and the absence of definitive reliable markers for prognosis. The following factors affect the natural history of NEEPTs. (1) Inclusion or not within the spectrum of multiple endocrine neoplasia type-1 (MEN1), such an integration often dramatically modifies the management strategy. In patients with MEN1, NEEPTs are often multiple, diffusely spread in the duodenopancreatic area and of small size. Definite cure by surgery is then very scarce. Mid-gut carcinoid tumors are the most protean NEEPTs. In contrast to appendiceal carcinoids, usually with a benign course, mid-gut carcinoids have a more malignant course and are very common indeed: local transmural invasion, early metastasis to lymph nodes and/or liver, and symptoms from hormone oversecretion. Carcinoid syndrome is usually well controlled by long-acting somatostatin analogs. (2) Disease spreading, i.e. liver and bone metastases, are the major causes of death in patients with NEEPTs. Liver metastases (LMs) are synchronous in about 75% of the patients with LMs but may develop during follow-up (about 25% of the patients with LMs were without LMs at the initial evaluation). Development of bone metastases has a very poor prognosis accompanying LM progression.
Prognostic Value of Heart Rate Variability Analysis in Patients with Carcinoid Syndrome
Authors: Hoffmann Jürgen , Grimm Wolfram , Menz Volker , Wied Matthias , Sprenger Anja , Arnold Rudolf , Maisch Bernhard
Published: April 2003

Background/Aims: Recently, a decrease in heart rate variability measures was found in patients with carcinoid syndrome suffering from carcinoid heart disease compared to those without cardiac involvement of carcinoid syndrome. The prognostic relevance of this finding, however, was not clear. Patients and Methods: Therefore, 35 patients with carcinoid syndrome (21 men, age 56 ± 11 years), all of them suffering from metastatic carcinoid tumors, were followed prospectively at our institution. Digital 24-hour Holter monitoring, echocardiography, and serum serotonin and urine 5-hydroxyindole acetic acid (5-HIAA) samplings were performed in all study patients at baseline. Indices of time domain heart rate variability obtained from Holter recordings included the standard deviation of all normal RR intervals (SDNN) representing overall variability, the square root of the mean of the squared differences between adjacent normal RR intervals (rMSSD), and the percentage of the number of pairs of adjacent normal RR intervals differing by >50 ms (pNN50), both indices reflecting predominantly vagal influences on heart rate. Results: During a mean follow-up of 18 ± 7 months, 15 of 35 patients with carcinoid syndrome (43%) died. Patients with cardiac manifestation of the carcinoid syndrome showed a tendency towards an increased mortality in comparison to patients without cardiac involvement (p = 0.09). Patients with the combination of decreased heart rate variability (SDNN <100 ms) and presence of carcinoid heart disease had a significant worse prognosis (p = 0.04) compared to patients without carcinoid heart disease and preserved heart rate variability (SDNN ≧100 ms). Conclusions: The presence of carcinoid heart disease in combination with decreased heart rate variability is associated with the most adverse prognosis in the setting of carcinoid syndrome.
Relation of Serum Antioxidant Vitamins to the Risk of Colorectal Adenoma
Authors: Breuer-Katschinski B. , Nemes K. , Marr A. , Rump B. , Leiendecker B. , Breuer N. , Goebell H.
Published: April 2003

The relation between risk of colorectal adenoma and serum concentrations of vitamins A, C, E and carotene was examined in a population-based case-control study of 105 cases of colorectal adenoma and a similar number of hospital controls showing no polyps at colonoscopy and a second control group of population controls. There were no significant associations with serum concentrations of vitamins C and E and carotene. Serum concentrations of vitamin A were significantly inversely related to the risk of colorectal adenoma when cases were compared with both control groups. After adjustment for energy intake, smoking, alcohol, estrogen therapy, body-mass-index and social class the inverse association between vitamin A and colorectal adenoma was even more marked. For the highest versus the lowest quartile of serum levels the adjusted RR was 0.23 (0.07–0.73) in relation to hospital controls and 0.08 (0.02–0.25) in relation to population controls. These findings suggest that the risk of developing colorectal adenomas is reduced in those with high vitamin A levels.
Prostaglandin E Inhibits Indomethacin-Induced Gastric Lesions through EP-1 Receptors
Authors: Suzuki Keizo , Araki Hideo , Mizoguchi Hiroyuki , Furukawa Osamu , Takeuchi Koji
Published: April 2003

Backgrounds and Aims: We examined the effect of various prostaglandin E (PGE) analogs specific to EP receptor subtypes on indomethacin-induced gastric lesions in rats and investigated which EP receptor subtype is involved in the protective action of PGE2 using EP-receptor knockout mice. Methods: Gastric lesions were induced by subcutaneous administration of indomethacin (35 mg/kg). Gastric motility was measured using a balloon method, while neutrophil chemotaxis determined using a Boyden chamber. Results: Indomethacin-induced gastric lesions were significantly prevented by PGE2 as well as atropine, and the former effect was mimicked by sulprostone (EP1/EP3) and 17-phenyl PGE2 (EP1) and antagonized by an EP1 antagonist, ONO-AE-829. Neither butaprost (EP2), ONO-NT-012 (EP3) nor 11-deoxy PGE1 (EP3/EP4) showed any protection on the lesions. Indomethacin caused a marked increase in gastric motility; the response preceded the onset of lesions and was inhibited by atropine as well as PGE derivatives acting as EP1 receptors. Neutrophil chemotaxis was inhibited by PGE2, butaprost and slightly by 11-deoxy PGE1, but not by either 17-phenyl PGE2, ONO-NT-012 or atropine. In addition, indomethacin caused damage similarly in both wild-type and knockout mice lacking EP1 or EP3 receptors, yet the protective action of PGE2 was observed in wild-type and EP3 receptor knockout mice but totally disappeared in mice lacking EP1 receptors. Conclusion: PGE2 inhibits indomethacin-induced gastric lesions, through EP1 receptors, and this effect may be functionally associated with inhibition of gastric motility but not of neutrophil activation/migration.
MUC1 Mucin Core Protein Binds to the Domain 1 of ICAM-1
Authors: Hayashi Toshiaki , Takahashi Tohru , Motoya Satoshi , Ishida Tadao , Itoh Fumio , Adachi Masaaki , Hinoda Yuji , Imai Kohzoh
Published: April 2003

Background: MUC1 is aberrantly expressed on a variety of epithelial tumors. We have reported that MUC1 plays important roles in separation from primary site, invasion into the stromal tissue, and protection from immune responses. The aim of this study is to determine the precise binding of MUC1 to intercellular adhesion molecule 1 (ICAM-1) that accelerates the cancer metastasis. Methods: A cell aggregation assay between MUC1 cDNA transfectants and ICAM-1 expressing cells was employed. An anti-MUC1 antibody, anti-ICAM-1 antibody or synthetic peptide of MUC1 core protein was added to the assay to inhibit the cell aggregation. Results: MUC1 transfectants showed a significantly higher aggregation rate compared to the control cells. This aggregation was further enhanced by the inhibition of O-glycan biosynthesis. It was inhibited by either an anti-MUC1 antibody recognizing the tandem repeat domain of MUC1 core protein or an anti-ICAM-1 antibody identifying domain 1. It was also inhibited by a synthetic MUC1 peptide of 40 amino acids corresponding to two tandem repeats. Conclusions: The results revealed that a tandem repeat domain of MUC1 mucin core protein binds to domain 1 of ICAM-1, suggesting a potential role of MUC1- ICAM-1 interaction in the metastasis of epithelial tumors.