bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Technology in Knowledge Management Strategies in Australia: Recent Trends
Authors: Zyngier Suzanne
Published: July 2003

Research in the UK, Europe and the USA has shown different understandings of the concept of knowledge management and of the role of technology in implementation strategies. Theorists currently place knowledge management in its third phase where technological approaches have given way to strategies focused on human issues in the transfer of knowledge. This paper focuses on findings on attitudes to the use of technology in organisational strategies to manage knowledge disclosed in field research by survey of the current business understanding of the concept of knowledge management and of its uptake trends in the Australian corporate environment. This will be done by providing background to the study, by reference to results and discussion of further research possibilities.
Acquiring and Applying Contextualised Tacit Knowledge
Authors: Richards Debbie , Busch Peter
Published: July 2003

The acquisition and application of knowledge, in particular tacit knowledge (TK), are seen as decisive competitive factors in the knowledge society of the twenty-first century. Despite much talk about the importance of knowledge transfer, little research shows how to identify and measure TK, less research addresses how to transfer TK between individuals and even fewer of these approaches offer any technology that can assist with transfer. This paper does not address the issues of identification and measurement of TK. The purpose of this paper is two-fold: describe a knowledge acquisition and representation technique, known as Ripple Down Rules (RDR), which can be used to capture knowledge, explicit and tacit, in context from those already identified as experts and to describe a set-theoretical technique, known as formal concept analysis (FCA) to assist transfer of the RDR knowledge to another human.

Unlike most knowledge acquisition approaches, the RDR knowledge acquisition technique does not rely on the expert to specify what they know. Instead, knowledge becomes codified by the RDR system while the domain expert exercises his or her expertise. The approach does not capture all organisational knowledge, but the knowledge that is captured will be a mixture of different types of knowledge, including formal and codified knowledge that can be learnt from a book and practice-based knowledge that is passed on while on the job. The knowledge captured using RDR may be transferred to another individual through the use of FCA to retrospectively and automatically develop knowledge models that the user can explore. This work offers a possible solution to three knowledge management challenges: capture, utilisation and preservation of knowledge within an organisation.
The Cat's Cradle Network
Authors: Pigott Diarmuid , Gammack John , Hobbs Valerie
Published: July 2003

In this paper we will argue that the representation of context in knowledge management is appropriately served by the representation of the knowledge networks in an historicised form. Characterising context as essentially extra to any particular knowledge representation, we argue that another dimension to these be modelled, rather than simply elaborating a form in its own terms. We present the formalism of the cat's cradle network, and show how it can be represented by an extension of the Pathfinder associative network that includes this temporal dimension, and allows evolutions of understandings to be traced. Grounding its semantics in communities of practice ensures utility and cohesiveness, which is lost when mere externalities of a representation are communicated in fully fledged forms. The scheme is general and subsumes other formalisms for knowledge representation. The cat's cradle network enables us to model such community-based social constructs as pattern languages, shared memory and patterns of trust and reliance, by placing their establishment in a structure that shows their essential temporality.
Pitavastatin Inhibits Upregulation of Intermediate Conductance Calcium-Activated Potassium Channels and Coronary Arteriolar Remodeling Induced by Long-Term Blockade of Nitric Oxide Synthesis
Authors: Terata Yutaka , Saito Takashi , Fujiwara Yoshimasa , Hasegawa Hitoshi , Miura Hiroto , Watanabe Hiroyuki , Chiba Yoshikatsu , Kibira Satoshi , Miura Mamoru
Published: July 2003

We have reported that intermediate conductance Ca2+-activated K+ channels (ImK) showed augmented expression in angiotensin II (AII) type 1 receptor-dependent manner in post-ischemic rat heart. ImK has tyrosine phosphorylation sequence in the C-terminus and motifs for NFĸB and AP1 in the promoter. While statin inhibits AII-mediated vascular remodeling via anti-inflammatory effect independent of cholesterol lowering. To test the possible effect of statin on expression of ImK, Wistar-Kyoto rats received L-nitro-arginine methyl ester (LNAME: 1 mg/ml in drinking water) for 4 weeks in group L. While in L+P group, rats received both LNAME and pitavastatin (PTV: 1 mg/kg/day in drinking water). Temporal profile of ImK mRNA was examined by RT-PCR using specific primers for ImK. Results: Long-term LNAME administration produced significant hypertension and resulted in marked microvascular remodeling characterized by medial thickening and perivascular fibrosis of coronary arterioles (100–200 µm in diameter). RT-PCR revealed significant up-regulation of ImK mRNA with two distinct peaks in L group in the early phase (days 3–7) and the late phase (4 weeks). PTV partially inhibited a rise in systolic blood pressure, but completely abolished the first peak of ImK upregulation (0.76 ± 0.04 vs. 3.96 ± 1.43 folds at day 7, p < 0.001). Co-treatments with PTV also significantly inhibited medial thickening and perivascular fibrosis. These findings indicate that statin inhibits microvascular remodeling induced by chronic inhibition of NO synthesis through the action independent of cholesterol lowering.
Extracellular Concentrations of Catecholamines and Amino Acids in the Dorsomedial Hypothalamus of Kindled Rats
Authors: Gören M. Zafer , Aker Rezzan , Yananlı H. Raci , Onat Filiz Yılmaz
Published: July 2003

Epilepsy affects homeostasis and autonomic nervous system functions. It has been thought that the dysfunction in the autonomic neural mechanisms could be a cause of sudden unexpected death in patients with epilepsy. The kindling model of epilepsy is considered to be an animal model for complex partial seizures with secondary generalization. The objectives of this study were to investigate the extracellular γ-aminobutyric acid (GABA), glutamate, noradrenaline and dopamine levels in the dorsomedial nucleus of the hypothalamus in non-epileptic and kindled epileptic rats and to explain some of the cardiovascular changes in the kindling model of epilepsy. Stimulation electrodes were stereotaxically implanted into the basolateral amygdala and electrical stimulation was applied 3 times a day at a constant current. The rats were then kindled to full stage 5 seizures. Microdialysis experiments were performed to demonstrate the neurotransmitter levels in the dorsomedial nucleus of the hypothalamus 3–5 days after being kindled. Decreases in noradrenaline and dopamine levels in the dorsomedial nucleus were detected in the conscious kindled animals. This finding is in agreement with prior findings that the noradrenergic system has a negative role in the process of kindling. The basal level of glutamic acid and GABA remained unchanged in the kindled group when compared to non-epileptic animals, and similarly, neither blood pressure nor heart rate responses to bicuculline or N-methyl-D-aspartate were affected by the acute kindled state. These findings suggest that the autonomic changes in kindling require further studies.
Inhibition of Neutrophil Migration and Oxygen Free Radical Release by Metipranolol and Timolol
Authors: Djanani Angela , Kaneider Nicole C. , Meierhofer Christian , Sturn Daniel , Dunzendorfer Stefan , Allmeier Helmut , Wiedermann Christian J.
Published: July 2003

Propanolol and metoprolol exert adrenoceptor-independent effects including scavenging of free radicals and inhibition of protein kinase C leading to inhibition of leukocyte migration and radical release as a consequence. Whether topically used metipranolol and timolol exert such effects is unknown. Neutrophil chemotaxis was tested using modified Boyden microchemotaxis chambers. Respiratory burst activity of neutrophils was detected fluorometrically. Radical scavenging properties were tested using 2′,7′-dichlorofluorescein diacetate. Metipranolol and timolol inhibited neutrophil chemotaxis at doses in the micromolar range, oxygen free radical production triggered with formyl-Met-Leu-Phe was inhibited at higher concentration. Protein kinase C involvement, suggested to trigger free radical production with phorbol myristate acetate, was antagonized. A direct radical scavenging effect of the β-blockers was also seen. Inhibition of neutrophil chemotaxis and free radical production is a novel mode of action of metipranolol and timolol that may be relevant for beneficial effects in the topical treatment of eye disease.
Phenobarbital-Imprinted Overinduction of Adult Constituent CYP Isoforms
Authors: Agrawal Arun K. , Shapiro Bernard H.
Published: July 2003

Newborn male and female rats were treated with therapeutic-like levels of phenobarbital to determine whether early exposure to the barbiturate permanently alters (i.e., imprints) mechanisms regulating induction of constituent CYP (cytochrome P-450) isoforms. When the rats were 65 and 150 days old, they were rechallenged with phenobarbital at doses reflecting either the possible inducing activities of environmental agents (1 mg/kg) or at the minimal anticonvulsant therapeutic dose for the rat (10 mg/kg). The expression levels (mRNA and protein) of constituent, gender-dependent CYP2C6, CYP2C7, CYP2C11, CYP2C12, CYP2C13, and CYP3A2 and nonconstitutive CYP3A1 were monitored at various times (i.e., 0.1–136 h) during the rechallenge period. The major female-specific CYP2C12 and male-specific CYP2C13 were unresponsive to induction, whereas the major male-specific CYP2C11 responded to phenobarbital administration with a 100% increase in transcript levels that were not translated into new protein. The expression of the other isoforms was significantly elevated by both doses of phenobarbital (10 mg >1 mg), though CYP2C6, CYP3A1, and CYP3A2 levels were increased an additional 30–50% when the animals were neonatally exposed to the barbiturate, demonstrating for the first time that mechanisms regulating induction of constitutive CYPs in adults are imprintable at birth. This overinduction response appears to result, at least in part, from phenobarbital-programmed alterations in the sexually dimorphic plasma growth hormone profiles that normally regulate expression of the isoforms. The long-term health consequences of the overinduction response and possible clinical significance are discussed.
Veno-Occlusive Disease in a Fetus Caused by Pyrrolizidine Alkaloids of Food Origin
Authors: Rasenack R. , Müller C. , Kleinschmidt M. , Rasenack J. , Wiedenfeld H.
Published: July 2003

We report the occurrence of veno-occlusive disease in a preterm neonate who was symptomatic with hepatomegaly and ascites and was delivered by caesarean section for threatening fetal asphyxia and died shortly afterwards. Post mortem examination revealed veno-occlusive disease typical for pyrrolizidine alkaloid poisoning. The content of pyrrolizidine alkaloids in the liver could be confirmed. Analysis of a herbal mixture which was used for cooking in the family revealed high amounts of the respective alkaloids clarifying the source of the poison and the causal relationship.
Etiology and Prognosis of Fetal Ascites
Authors: Schmider Annette , Henrich Wolfgang , Reles Angela , Kjos Siri , Dudenhausen Joachim W.
Published: July 2003

Objective: To examine the prenatal course and outcomes of neonates with isolated fetal ascites. Methods: A retrospective analysis (from 1990 through 2000) was performed on 26 consecutive cases presenting with fetal ascites. A systematic diagnostic protocol which included fetal blood sampling for karyotyping, serology and serial ultrasound examinations to determine etiology was followed in all cases after diagnosis. Pregnancy outcome was assessed by a chart report or autopsy reports. Results: The majority of cases were associated with fetal malformations (n = 11). Five fetuses had malformations with associated syndromes. Less commonly associated were intrauterine infections (n = 3), intestinal perforation (n = 2), genetic disorders (n = 2), neoplasm (n = 1) and growth retardation (n = 1). In only 1 case (4%) was the etiology idiopathic. Secondary generalized hydrops occurred only in 4 of 26 cases. Only 13 of 16 liveborn infants survived past the neonatal period and only 4 cases are doing well at childhood age without any sequelae. Conclusion: A wide range of etiologies were associated with isolated fetal ascites. Those with malformations had the worst pregnancy outcome. Prenatal diagnosis was made in 92% utilizing a systematic diagnostic workup. The diagnosis of idiopathic ascites has become rare due to the improvement in prenatal diagnosis.
Checkmark Fetal Heart Rate Pattern Associated with Severe Fetal Hypoxia
Authors: Kashiwagi Satoshi , Miyakoshi Kei , Ishimoto Hitoshi , Tanaka Mamoru , Yoshimura Yasunori
Published: July 2003

A 31-year-old nulliparous woman developed vaginal bleeding after spontaneous rupture of the membranes at 40 weeks of gestation. Fetal heart rate monitoring showed checkmark and sinusoidal patterns. A 3,281 g male neonate was delivered by emergency cesarean section, with Apgar scores of 1 and 3 at 1 and 5 min, respectively. The neonate exhibited severe acidosis with arterial blood gas pH of 6.96, and was diagnosed to have severe hypoxic-ischemic encephalopathy. An umbilical artery branch was noted in the membrane near the cervical os and found to be torn, representing hemorrhagic vasa previa. Severe fetal hypoxia resulting from hemorrhagic vasa previa might be associated with checkmark fetal heart rate pattern.
Absent Ductus venosus in the Fetus: Review of the Literature and First Report of Direct Umbilical Venous Drainage to the Coronary Sinus
Authors: Perles Zeev , Nir Amiram , Nadjari Michael , Ergaz Zivanit , Raas-Rothschild Annick , Rein Azaria J.J.T.
Published: July 2003

The ductus venosus connects the portal and umbilical veins with the inferior vena cava and acts as a sphincter to protect the fetus from placental overcirculation. Its absence usually causes hydrops fetalis and is associated with high mortality rate, chromosomal anomalies and congenital malformations. In this condition, the umbilical vein almost always drains directly into right-sided structures such as inferior vena cava or right atrium. We reviewed the literature and describe the first case of a fetus with absent ductus venosus and direct connection of the umbilical vein to the coronary sinus.
Correlation of Prenatal Ultrasound and Postnatal Outcome in Meconium Peritonitis
Authors: Shyu Ming-Kwang , Shih Jin-Chung , Lee Chien-Nan , Hwa Hsiao-Lin , Chow Song-Nan , Hsieh Fon-Jou
Published: July 2003

Objectives: To study the relationship between prenatal ultrasound features and postnatal course of meconium peritonitis. Methods: Meconium peritonitis was diagnosed by prenatal ultrasound. Fetuses were treated by intrauterine paracentesis of ascites when indicated, and symptomatic newborns received surgery. Results: Totally 17 cases were enrolled. Prenatal ultrasound findings include abdominal calcification (16/17), fetal ascites (12/17), hydramnios (9/17), pseudocyst (7/17) and dilated bowel loop (6/17). Persistent ascites, pseudocyst or dilated bowel loop are most sensitive (92%) to predict postnatal surgery (p = 0.022). The survivors have a higher gestational age at birth (36.4 vs. 33.3 weeks, p = 0.008). Persistent ascites and postnatal persistent pulmonary hypertension of the newborns significantly correlate with neonatal mortality (p = 0.029 and 0.022). Conclusion: Prenatal ultrasound can predict the neonatal outcome in meconium peritonitis.
Pre-Eclampsia: Maternal Risk Factors and Perinatal Outcome
Authors: Al-Mulhim Abdul-Aziz , Abu-Heija Adel , Al-Jamma Fathia , El-Harith El-Harith A.
Published: July 2003

Objective: The aim of this study was to throw light on the incidence of pre-eclampsia (PE) in women attending for care and delivery at a hospital in Saudi Arabia, and analyze the maternal risk factors and outcome of mothers and neonates in pregnancies complicated by PE. Methods: This retrospective study involved almost all women (n = 27,787) who delivered at King Fahad Hospital of the University in a 10-year period (1992–2001). The maternal records were reviewed for age, parity, gestational age, mode of delivery, antenatal care, onset of PE, severity of proteinuria, and the frequency of antenatal and intrapartum complications. The neonatal records were reviewed for perinatal outcome including birth weight, frequency of stillbirths, and neonatal deaths. Results: Among the study cohort of maternities, 685 women, i.e. 2.47%, were diagnosed as having PE among whom a high proportion (42.0%) were nulliparous women. Similarly, PE was encountered at a high percentage (40.0%) in women at the extreme of their reproductive age (< 20 and >40 years), and more women with PE delivered prematurely (30.2%) as compared to healthy controls (13.5%). Spontaneous vaginal deliveries were less frequent in women with PE (69.2%) as compared with healthy controls (86.2%). Instrumental deliveries, with spontaneous labor, amounted to 15.9% in women with PE, but they comprised only 2.9% in healthy women. The deliveries were more likely to be induced (22.8%) or be performed by cesarean section (14.9%) in women with PE than in healthy controls (6.8% and 9.6%). Placental abruption was the most common maternal complication (12.6%) in women with PE, followed by oligouria (7.9%), coagulopathy (6.0%), and renal failure (4.1%). The perinatal outcome of maternities with PE shows that stillbirths (2.34%) and early neonatal deaths (1.02%) comprised an overall mortality rate of 33.6 per 1,000. More stillbirths and neonatal deaths showed a tendency to be associated with the severe form of PE (diastolic BP ≧120), as compared with the mild form (diastolic BP 90–110). Stillbirths and neonatal deaths appear to be associated with women who had no or irregular antenatal care and whose proteinuria amounted to or exceeded 3 g per 24 h, when delivery occurred at 28th gestational week or less, and when the birth-weight of the neonates was between 500 and 1,000 g. Conclusion: We document a hospital-based incidence rate of PE of 2.47%, with a high proportion of PE cases occurring among nulliparous women and those at the extreme ends of the reproductive age. More maternal and neonatal complications were encountered in women with PE when the PE was severe, when the pregnancy had to be terminated early, when there was no regular antenatal care, the birth-weight was low, or the proteinuria was severe.
Prenatal Diagnosis of ‘True Tail’ with Cartilage Content?
Authors: Noack Frank , Reusche Erich , Gembruch Ulrich
Published: July 2003

A human tail is a rare congenital anomaly with a prominent lesion from the lumbosacrococcygeal region. According to Dao and Netzky human tails are classified into ‘true tails’ and ‘pseudotails’. True tails comprise only mesenchymal tissue (adipose, connective, muscle, nerve tissue, blood vessels, and cutis). They are presumed to be remnants of the embryologic tail. All other lumbosacrococcygeal protrusions are summarized as pseudotails. Superficially they may resemble true tails. They contain normal or abnormal tissue, e.g. cartilage, lipoma and glioma. We report a case of prenatal diagnosis of a human tail in association with omphalocele, hydrocephalus and antiphospholipid-antibody syndrome resulting in a severe fetal growth restriction. Due to cartilage content the appendage had to be classified as ‘pseudotail’. However, anatomical position and the decrease of length observed by consecutive ultrasound examinations at 14 and 21 weeks of gestation was suggestive of delayed regression of a ‘true tail’. Furthermore, the association of antiphospholipid-antibody syndrome with congenital malformations is discussed.
Validation of a Multicenter Registry Database of Intra-Aortic Balloon Pumping in a Variety of Clinical Settings
Authors: Ohman E. Magnus , Miller Michael F. , Joseph Debra L. , Cohen Marc , Freedman Jr. Robert J. , Stone Gregg W. , Urban Philip M. , Reddy Ramachandra C. , Christenson Jan T. , Ferguson, III James J.
Published: July 2003

The Benchmark Counterpulsation Outcomes Registry is a computerized database that incorporates prospectively gathered data on indications for intra-aortic balloon counterpulsation (IABP) use, patient demographics, concomitant medications and in-hospital complications and outcomes. This report summarizes the validation of the Benchmark Registry. Three audits were performed on the Registry data – the first by the sponsor and the second two by independent auditors. The data for categorical variables that could be answered by checking a box were extremely robust, with most items having at least a 95% agreement rate (except catheter size, which had an 82% agreement rate). The data were slightly less robust for quantitative variables that required a written answer (at least an 80% agreement rate). This high agreement rate supports the conclusion that the Benchmark Counterpulsation Outcomes Registry data are generalizable and suggests that the Registry is a powerful tool for tracking the evolving practice of IABP use, including indications, insertion characteristics, duration, complications and outcomes in patients undergoing IABP.
New Insights into the Combined Burden of Type 2 Diabetes and Hypertension
Authors: Padilla Ricardo , Estacio Raymond O.
Published: July 2003

Hypertension and type 2 diabetes are very common medical conditions that often occur in combination. A large amount of clinical trial data has proven the significance of improving blood pressure (BP) in type 2 diabetic patients in order to prevent cardiovascular morbidity and mortality, diabetic nephropathy and end-stage renal disease. The goal BP for all type 2 diabetics should be below 130/80 mm Hg, and below 125/75 mm Hg in subjects with significant proteinuria. Most investigators agree that angiotensin-converting enzyme inhibitors should be the first-line agents because of their cardioprotective effects. In the end, it may be that the specific drug choice has less overall importance than the actual attainment of adequate BP control. Treatment of hypertension in type 2 diabetics will often require multiple agents to achieve the goal BP.
Statistical Methods in Genomics Research
Authors: Satagopan Jaya M. , Smith Alex D.
Published: July 2003

Recent advances in marker technologies have led to increasing interest in and investigation on the role of genetic alterations in disease etiology and progression. Allelic or mutational data are used in linkage disequilibrium (i.e., association) studies to identify genes conferring disease risk. The extent of risk conferred by these genetic loci can be immensely useful for disease prevention initiatives and population-based medical intervention. Lately, gene microarrays are used to compare expression levels in different types of diseases, with the goal to identify genes involved in causal or functional pathways leading to tumor or tumor progression. Statistical methods are intrinsic to the successful design of these studies, analysis of the resulting data, and interpretation of the results. This paper provides a brief introductory summary to some of the commonly used statistical methods in genetic studies.
Chronic ‘Immunological’ Rhinosinusitis: General Aspects, Cytokines, Chemokines and Possible Therapeutic Consequences
Authors: Caversaccio Marco , Uguccioni Mariagrazia , Hartnell Adele , Conroy Dolores
Published: July 2003

Chronic rhinosinusitis is an inflammatory condition of the nose and the paranasal sinuses characterized by an infiltration of neutrophils, eosinophils in addition to lymphocytes (T), mast cells and macrophages. An international clinical definition of chronic rhinosinusitis exists, but not on an immunological basis. Chronic rhinosinusitis has different etiologies with consequently different immunological inflammatory mediator results. These inflammation mediators are responsible for propagating the inflammation. The complex interactions among these cells are mediated by a group of secreted low-molecular-weight proteins that are collectively designated as cytokines to denote their role in cell-to-cell communication. Cytokines assist in regulating the development of immune effector cells, act locally and some cytokines possess direct effector functions of their own. Higher levels of IL-1β, -3, -4, -5, -6, GM-CSF, IFN-γ, TNF-α and TGF-β have been reported in chronic rhinosinusitis compared to control tissues, but in the literature no concordant results have been found, possibly due to inhomogeneous groups. The attraction of leukocytes to tissues is essentially guided by chemokines (chemotactic cytokines). IL-8, MCP-3 and MCP-4, eotaxins 1 and 2 are increased, but as for the other cytokines no concordant results are diposable today.
The Role of CC Chemokines in Chronic Sinusitis
Authors: Maune S. , Meyer J.E.
Published: July 2003

Chronic sinusitis is a complex disease with a substantial health care impact. Multiple factors play a role in the pathogenesis of this disease, but the initial process is still not well understood. Characteristic infiltrates of eosinophils are a hallmark of this disease. The selective appearance of T lymphocytes and eosinophils in growing polyps seems to be mediated by locally produced CC chemokines in cooperation with proinflammatory cytokines. Both are able to induce vascular adhesion molecules and attract rolling eosinophils as haptotaxins to the site of inflammation. Associated atopic diseases, like asthma or perennial allergies, have a higher eochemoattractant activity, which may contribute either to the nasal or bronchial mucosal accumulation of eosinophils. This could potentiate the eosinophilic effects in both tissues and possibly explain the severer symptomatology and higher recurrence rate of nasal polyps. RANTES, eotaxins 1 and 2 and IL-5 certainly play a role in chronic sinusitis. To our mind, the exact part of each mediator does not seem to be important, because just the complex cooperation of chemokines and also cytokines allows the underlying inflammatory process to become a chronic sinusitis. Therapeutic targets for eosinophil-related diseases are the impairment of CC chemokine expression and release by glucocorticoids, proteolytic degradation by endogenous enzymes, inhibition/antagonism of the CCR-3 and also endogenous antagonism by other chemokines.
The Diagnosis and Treatment of Spontaneous Cerebral Spinal Fluid Otorrhea in the Adult
Authors: Gacek Richard R. , Gacek Mark R.
Published: July 2003

We describe the demographic, radiologic and surgical features in adult patients with spontaneous cerebrospinal fluid otorrhea (SCSFO). Review was made of office and hospital charts of 21 patients with SCSFO and 2 patients with spontaneous CSF rhinorrhea, which were repaired successfully from 1989 to 1998. The responsible lesions for SCSFO and rhinorrhea in the adult are arachnoid granulations (AG) or villi, which are aberrantly distributed in areas of the anterior, middle and posterior cranial fossae. The ages of the 21 patients ranged from 38 to 83 years (mean 63 years), with all but one older than 50 years. The sex ratio was 14 women to 7 men; the CSF leak was right-sided in 13 and left-sided in 8 patients. Eighteen of the spontaneous CSF leaks were located in the middle cranial fossa surface of the temporal bone (TB) while 2 were on the posterior fossa border of the TB. The middle fossa leaks were managed by craniotomy and repair with fascia, whereas the posterior fossa defects were obliterated by adipose tissue inserted through an intact canal wall mastoidectomy. The most comon radiologic finding on computerized tomography was a soft tissue mass adjacent to a tegmen bone defect. The demographic, radiologic and pathologic findings in this series of 21 TB and 2 paranasal sinus spontaneous CSF leaks support the concept that the responsible lesions are AGs that are aberrantly located adjacent to pneumatized parts of the skull.
Microbiology and Management of Bacterial Cervical Lymphadenitis in Children
Authors: Brook Itzhak
Published: July 2003

This review describes the microbiology, diagnosis and management of cervical lymphadenitis (CL) in children. The most common bacterial organisms causing acute unilateral infection associated with facial trauma or impetigo are Staphylococcus aureus and group A β-hemolytic streptococci. Other causes include Bartonella henselae, Francisella tularensis, Pasteurella multocida, Yersinia pestis, Actinobacillus actinomycetemcomitans, Burkholderia gladioli, Mycobacterium tuberculosis and nontuberculous mycobacteria. Other rare aerobic pathogens are Streptococcus pneumoniae and gram-negative rods. Studies that utilized methodologies that were adequate for the recovery of anaerobes demonstrated the importance of these organisms in CL. The predominant anaerobes were Peptostreptococcus spp., gram-negative bacilli and Fusobacterium spp. The most common viruses are Epstein-Barr virus, cytomegalovirus, herpes simplex virus, adenovirus, enterovirus, roseola, rubella and the human immunodeficiency virus. Therapy includes administration of antibiotics effective against the causative pathogen(s). Proper selection of therapy can be guided by culture of the lesion. Surgical drainage may be necessary in case of suppuration.
Non-Ionizing Electromagnetic Radiations, Emitted by a Cellular Phone, Modify Cutaneous Blood Flow
Authors: Monfrecola G. , Moffa G. , Procaccini E.M.
Published: July 2003

Background: Our surroundings are full of non-ionizing electromagnetic radiation (EMR) of different frequency and power. The non-ionizing EMRs emitted by television, computer and cellular phone (CF) sets have been increasing over the past few years. Objective: The aim of our study was to assess the effects of non-ionizing EMRs (frequency 3 × 108 to 3 × 1011 Hz), emitted by CFs, on cutaneous blood flow in healthy volunteers. Methods: Thirty healthy volunteers (14 male and 16 female; age: 18–53 years) entered the study. Measurements of cutaneous blood flow were taken under standard conditions (temperature and humidity), using a laser Doppler He-Ne flowmeter that was applied to the ear skin by an optical fibre probe. Microflow values were recorded without CF contact with the skin (T₀), with the CF turned off but in contact with the ear skin (T1), with CF contact and turned on (T2), with CF contact, turned on and receiving (T3). The microflow values were also recorded backwards: with CF contact and set turned on (T4), with CF contact and turned off (T5), without CF contact (T6). Results: The mean value of basal microflow (T₀), expressed as perfusion units (PU), was 51.26 ± 11.93 PU. During the T1 phase, the microflow increase was 61.38%; in T2 it was 131.74%, in T3 157.67%, in T4 139.21% and in T5 122.90%; in T6, the microflow value was 57.58 ± 10 PU (similar to the basal microflow). Statistically significant cutaneous microflow values (p < 0.050) were observed comparing the T1 to T5 values with basal microflow (T₀). Furthermore, in comparison with T1 values (CF turned off in contact with the ear skin), the T2, T3 and T4 data were statistically significant (T2 vs. T1: t = 7.763 with p < 0.050; T3 vs. T1: t = 9.834 with p < 0.050; T4 vs. T1: t = 8.885 with p < 0.050).
Silver-Coated Textiles Reduce Staphylococcus aureus Colonization in Patients with Atopic Eczema
Authors: Gauger Anke , Mempel Martin , Schekatz Annika , Schäfer Torsten , Ring Johannes , Abeck Dietrich
Published: July 2003

Background: In atopic eczema (AE), skin colonization with Staphylococcus aureus is known to play a major triggering and possibly pathophysiological role. Methods: In this open-labeled controlled side-to-side comparative trial, affected sites (flexures of both elbows) in 15 patients diagnosed as having generalized or localized AE were evaluated regarding S. aureus colonization and clinical severity of AE over a 2-week period. Flexures of the elbows were covered with silver-coated textiles on one arm and cotton on the other for 7 days followed by a 7-day control period. Results: A highly significant decrease in S. aureus colonization could be seen on the site covered by the silver-coated textile already 2 days after initiation lasting until the end of the treatment. Seven days after cessation, S. aureus density remained significantly lower compared to baseline. In addition, significantly lower numbers of S. aureus were observed on the silver-coated textile site in comparison to cotton at the end of treatment as well as at the time point of control. Clinical improvement correlated with the reduction of S. aureus colonization. Conclusion: A superior improvement achieved by silver-coated compared to cotton textiles paralleled a potent anti-S.-aureus effect.
Patch-Test-Induced Subjective Complaints
Authors: Kamphof W.G. , Kunkeler L. , Bikkers S.C.E. , Bezemer P.D. , Bruynzeel D.P.
Published: July 2003

Background: Many patients report subjective complaints during epicutaneous patch testing. Objective: To demonstrate the possible relationship between the occurrence of subjective complaints and patch testing. Methods: All consecutive patients who were referred to our clinic for patch testing, during 1 year, were investigated to study a possible association of the patch test procedure and subjective complaints like tiredness, shakiness or feeling unwell. The patients were asked to fill in a form concerning subjective complaints on the days of the investigation. Only those without complaints on the day the patches were applied were included in the study (n = 102). Results: Of the 102 patients, 17 had complaints on both days 2 and 3, 14 only on day 2, 6 only on day 3 and 65 did not develop any complaints at all. The number of patients with complaints on both days 2 and 3 (n = 17) was larger than was to be expected from chance (n = 4.6; p < 0.01). There was a significant correlation between the number of positive patch test reactions and the number of complaints on day 2 (r = 0.19; p << 0.001) and on day 3 (r = 0.15; p < 0.001). Positive patch tests were found in 72.2% of the patients who reported the complaint of shakiness; this proportion is significantly higher than expected from chance (p < 0.05). Conclusion: The results confirm those of our earlier study and demonstrate that patch testing can cause subjective complaints, especially when positive patch tests are present.
Occlusive Treatment of Chronic Hand Dermatitis with Pimecrolimus Cream 1% Results in Low Systemic Exposure, Is Well Tolerated, Safe, and Effective
Authors: Thaçi Diamant , Steinmeyer Katrin , Ebelin Marie-Eve , Scott Graham , Kaufmann Roland
Published: July 2003

Background: Pimecrolimus cream 1% (Elidel®, SDZ ASM 981) is a novel, non-steroid inflammatory cytokine inhibitor, effective in the treatment of atopic dermatitis. Here, we evaluate the treatment of chronic hand dermatitis with pimecrolimus cream 1%. Objectives: To determine pimecrolimus blood concentrations, and evaluate the safety, tolerability and efficacy following application of pimecrolimus cream 1% to subjects with chronic hand dermatitis. Method: In this open-label, multiple-topical-dose, non-controlled, pharmacokinetic study, pimecrolimus cream 1% was applied twice daily to dorsal and palmar areas (affected and unaffected) of both hands. Evening applications (except day 8) were immediately followed by overnight occlusion (≧6 h). Full pharmacokinetic profile (days 1, 8 and 22), trough concentrations (days 3 and 15), physical examinations, laboratory measurements and adverse events were recorded. Efficacy was assessed via Investigators’ Global Assessment (IGA), total key signs and symptoms and the subject’s overall self-assessment. Results: Twelve patients completed the study. The majority of pimecrolimus blood concentrations (73.6%) remained below the limit of quantitation (0.1 ng/ml). The maximum concentration observed was 0.91 ng/ml and the maximum area under the concentration-time curve from 0–12 h post dose was 7.6 ng·h/ml. Treatment was well tolerated locally and systemically. No serious adverse events occurred; 4/13 subjects showed a total of 6 adverse events at the application site: burning (n = 4), and pruritus (n = 2). No clinically relevant or drug-related changes were observed. Clear efficacy of the treatment was shown by all 3 assessment methods. Disease state at day 22 had improved in 11 (85%) subjects compared with baseline (IGA). Conclusion: Twice daily topical treatment of moderate to severe chronic hand dermatitis with pimecrolimus cream 1% results in low pimecrolimus blood levels, is well tolerated, safe, and effective.
A Case of Nonscarring Subepidermal Blistering Disease Associated with Autoantibodies Reactive with Both Type VII Collagen and Laminin 5
Authors: Umemoto Naoka , Demitsu Toshio , Toda Sunao , Ohsawa Masumi , Noguchi Tadahide , Kakurai Maki , Yamada Tomoko , Suzuki Masayuki , Nakagawa Hidemi , Komai Ayako , Hashimoto Takashi
Published: July 2003

A 35-year-old Japanese woman had recurrent, pruritic, vesicular lesions on the face, neck and upper back as well as erosive lesions of the oral cavity and genitalia. The skin and mucosal lesions healed without scarring upon the systemic administration of corticosteroid and azathioprine. Direct immunofluorescence revealed linear deposits of IgG, IgA and C3 at the cutaneous basement membrane zone. Indirect immunofluorescence on 1 M NaCl-split human skin sections demonstrated that the patient’s IgG antibodies reacted with the dermal side of the split, while IgA antibodies weakly reacted with the epidermal side. By immunoblot analyses, the patient’s serum reacted with the NC1 domain of type VII collagen as well as both the α3- and β3-subunits of laminin 5. We regarded our case as a nonscarring subepidermal blistering disease with autoantibodies to both type VII collagen and two different subunits of laminin 5. Such a case has not been previously reported.
Unusual Skin Manifestation of Cutaneous Amyloidosis
Authors: Hung Chih-Chun , Wang Chun-Min , Hong Hong-Shang , Kuo Tseng-tong
Published: July 2003

A 76-year-old man with a 20-year history of extensive cutaneous amyloidosis is reported. He had asymptomatic symmetric brownish reticulated pigmented patches with well-demarcated borders on his thighs, lower legs, dorsal feet and both arms. The trunk and popliteal fossae were not affected. A skin biopsy specimen showed abundant amyloid deposits in the papillary dermis and reticular dermis. Despite the extensive cutaneous involvement and large amount of amyloid in the deep dermis, no evidence of systemic amyloidosis could be found. Various manifestations of cutaneous amyloidosis are reviewed. We report this case to remind dermatologists of the protean presentations of cutaneous amyloidosis.
Gianotti-Crosti Syndrome Associated with Endogenous Reactivation of Epstein-Barr Virus
Authors: Terasaki Kenjiro , Koura Sumio , Tachikura Toshio , Kanzaki Tamotsu
Published: July 2003

A 6-year-old girl with Gianotti-Crosti syndrome, which appeared to be caused by a reactivation of Epstein-Barr virus (EBV), is presented. The patient had had infectious mononucleosis at the age of 3 years. Since the titer of anti-EBV capsid antigen antibody was high at 1,280 and the titer of early antigen DR IgG, which increases during the early stage or reactivation, was high at 80 during the recovery stage, the patient was diagnosed as having Gianotti-Crosti syndrome associated with reactivation of EBV. Its clinical symptoms associated with reactivation of EBV were similar to those of that associated with primary EBV infection, in that the present patient had acrolocated papulovesicular dermatitis, superficial lymph node enlargement and mild hepatopathy. This patient provides valuable information in that reactivation was also observed with EBV like other types of herpesvirus.
Schimmelpenning-Feuerstein-Mims Syndrome with Hypophosphatemic Rickets
Authors: Zutt M. , Strutz F. , Happle R. , Habenicht E.M. , Emmert St. , Haenssle H.A. , Kretschmer L. , Neumann Ch.
Published: July 2003

The Schimmelpenning-Feuerstein-Mims syndrome (SFM syndrome) is a rare and variable multisystem defect consisting of congenital, extensive linear nevus sebaceus and associated abnormalities in different neuroectodermal organ systems. We present the history of a 52-year-old female patient with disproportionate hyposomia and asymmetric constitution. From birth she suffered from a right-sided, extensive nevus sebaceus following Blaschko’s lines extending on the scalp, neck, right arm and trunk. At the age of 5 years, she developed a generalized growth retardation, along with deformations of bones. At the age of 11, hypophosphatemic rickets was diagnosed causing this growth retardation. Moreover, the patient developed a precocious puberty at the age of 9 years. When we saw the patient 40 years after the diagnosis had been made, phosphaturia had returned to normal. Specific therapy of hypophosphatemic rickets is straightforward and efficient in preventing late complications like growth retardation. We suggest to conduct appropriate laboratory tests in early childhood in patients with an extensive systematized sebaceous nevus or with additional signs of growth retardation or skeletal involvement, in order to exclude hypophosphatemic rickets associated with SFM syndrome.
Clinical and Therapeutic Aspects of Polymorphous Light Eruption
Authors: Dummer Reinhard , Ivanova Katya , Scheidegger E. Paul , Burg Günter
Published: July 2003

Background: Polymorphous light eruption (PLE) is an idiopathic eruption induced by ultraviolet (UV) radiation (UVR). Objective: Evaluation of the clinical aspects, diagnostic criteria of PLE in a major Swiss referral center. Methods: 25 patients with PLE were tested with a standardized protocol for the assessment of photodermatoses. Results: 25 patients (22 women vs. 3 men) were identified. Papular and papular-vesicular eruptions were the most common clinical presentations. 6 of 25 patients had a reduced minimal erythema dose (MED) für UVA and 8 of 25 patients had a reduced MED for UVB. Photoprovocation was positive in 11 of 20 patients for UVA and 7 of 20 patients for UVB. Photohardening with narrow-band UVB was successful in 8 of 10 patients. Combined UVA/UVB therapy had a satisfactory effect in 10 of 15 patients. Narrow-band UVB therapy was still successful after ineffective UVA/UVB therapy. Conclusion: The MED was of no value for the diagnosis of PLE. The typical lesions were reproduced by UVA and UVB photoprovocation. We recommend photohardening with narrow-band UVB (311 nm).
Effect of High-Dose Intravenous Immunoglobulin Therapy in Stevens-Johnson Syndrome: A Retrospective, Multicenter Study
Authors: Prins Christa , Vittorio Carmela , Padilla R. Steven , Hunziker Thomas , Itin Peter , Förster John , Bröcker Eva-B. , Saurat Jean-Hilaire , French Lars E.
Published: July 2003

Background:Stevens-Johnson syndrome (SJS) is a severe cutaneous drug reaction associated with considerable morbidity, possible transition to toxic epidermal necrolysis (TEN) and death in certain cases. Objective: To determine whether treatment with high-dose IVIG in SJS patients may improve outcome. Methods: Data from 12 patients (collected between January 1997 and November 2000 from7 university dermatology centers in Europe and North America) diagnosed with SJS according to a recent consensus definition was analyzed retrospectively. All patients had progressive ongoing epidermal detachment at the time of treatment initiation. Patients with overlap syndromes and TEN were excluded. Tolerance, survival at 45 days after onset and total healing time were assessed. Results: Twelve SJS patients (mean age 44 years) were treated with IVIG at a mean dose of 0.6g/kg/day for an average of 4 days. An objective response to IVIG infusion was observed in all patients within a mean of 2 days, and the overall survival rate was 100%. Total skin healing occurred, on average, within 8.3 days. Time to total healing was shorter in a group of patients with fewer severe underlying diseases who had received IVIG infusion rapidly after the onset of skin lesions. Conclusion: High-dose IVIG may be effective in blocking the progression of SJS and reducing the time to complete skin healing.
Posttransplant CD30+ Anaplastic Large Cell Lymphoma with Skin and Lymph Node Involvement
Authors: Yurtsever H. , Kempf W. , Laeng R.H.
Published: July 2003

Posttransplant (i.e. status with the transplant present) lymphoproliferative disorders (PTLD) are common conditions in transplant recipients. Most examples are of B cell origin, and CD30+ T cell PTLD are very rare. We report a CD30+ anaplastic large cell lymphoma (ALCL) in the skin of the right lower leg and in draining lymph nodes of the right inguinal region in an immunosuppressed 59-year-old male who had received a renal graft 9 years previously. Unlike the vast majority of PTLD, an incomplete T cell immunophenotype was observed, and there was evidence of T cell lineage at the genetic level reflected by a rearranged T cell receptor γ gene. The neoplastic cells were non-reactive to the anaplastic lymphoma kinase (ALK) 1 protein. In addition, Epstein-Barr virus and human herpesvirus 8 sequences were absent. Arguments against a primary cutaneous ALCL, which is also ALK-1 negative, include systemic presentation at the time of initial diagnosis and immunoreactivity of the neoplastic cells to epithelial membrane antigen. Typically, our rare example of a posttransplantation systemic ALCL showed an aggressive behaviour and a poor response to both chemotherapy and local irradiation.
Unusual Manifestation of Specific Cutaneous Involvement by B-Cell Chronic Lymphocytic Leukemia: Spontaneous Regression with Scar Formation
Authors: Kazakov D.V. , Belousova I.E. , Michaelis S. , Palmedo G. , Samtsov A.V. , Kempf W.
Published: July 2003

We report a patient with specific cutaneous involvement by B-cell chronic lymphocytic leukemia, who demonstrated unusual clinical features during the course of the disease, namely several spontaneous regressions of skin lesions with the formation of scars. In addition, histologically proven keratoacanthoma was found. During the follow-up period of approximately 1.5 years, the patient experienced several recurrences of skin lesions and their partial spontaneous regression. The scars persisted and remained unchanged. We hypothesize that vascular injury combined with edema could have accounted for dermal ischemia and the subsequent development of the scarring lesions.
Treatment of Verrucous Carcinoma with Imiquimod and CO2 Laser Ablation
Authors: Heinzerling L.M. , Kempf W. , Kamarashev J. , Hafner J. , Nestle F.O.
Published: July 2003

An 82-year-old female patient presented with a large perianal hyperkeratotic tumor extending into the anal canal. Staging did not reveal any metastatic spread. Diagnosis of verrucous carcinoma or Buschke-Löwenstein tumor, respectively, was based on typical clinical and histologic features. Moreover, human papillomavirus 6b DNA sequences could be detected by PCR. Surgical excision could not be performed due to the general health status of the patient; thus, alternative therapy methods were necessary. Treatment with imiquimod cream 5% (Aldara®), a topical immune response modifier applied once a day and left for 12 h, led to significant partial tumor regression and clear demarcation of the tumor. The remaining tumor, now feasible for treatment with CO2 laser, was removed in two sessions in local anesthesia. In a third session, tumor parts in the anal canal were vaporized. This case demonstrates that the combination of imiquimod and CO2 laser ablation is an effective treatment option for verrucous carcinoma.