bluuebunny/crossref_metadata_2025 huggingface dataset:
Is it Appropriate for Nondermatologist Physicians to Perform Skin Biopsies?
Authors: Sellheyer K. , Bergfeld W. F.
Published: August 2010

Physicians of various specialties submit cases for histopathological examination. Using the dermatopathology report as an objective verification tool of clinical diagnostic accuracy we assessed the diagnostic abilities of nondermatologist physicians, who performed various types of skin biopsies, and compared them with those of dermatologists. In total, 4,451 cases were analyzed. Dermatologists diagnosed twice the number of neoplastic and cystic skin lesions correctly (75%) than nondermatologists (40%). The clinical diagnosis rendered by family practitioners matched only in 26% the histopathological diagnosis. Plastic surgeons did better than family physicians but still had a diagnostic accuracy rate of only 45% for skin tumors. Inflammatory skin diseases were correctly diagnosed in 71% of the cases by dermatologists but in only 34% of the cases by nondermatologists. In our view, it is appropriate for nondermatologists to perform skin biopsies only, if they have required sufficient knowledge in basic dermatology and dermatopathology. A skin biopsy consists not only of the technical aspects of the actual procedure but necessitates an understanding of basic dermatology and dermatopathology to facilitate clinicopathological correlation.
Multiple Trichoepitheliomas and Basal Cell Carcinomas: A Novel Syndrome?
Authors: Tan J. , Levitt J. , Phelps R.
Published: August 2010

We present a case of a sixty‐one‐year‐old Hispanic man with multiple familial trichoepithelioma, and basal cell carcinoma (BCC). Facial papules and nodules appeared around age five, increasing in number with age. Two BCCs were diagnosed and treated elsewhere, one of which prompted enucleation of the left eye and radiation therapy to that area at age fifty. Physical examination showed nodules (0.5 to 2.5 cm in size) on the scalp, face, ears, arms and the upper back. Biopsies from such tumors demonstrated three histological patterns: pure trichoepithelioma, trichoepithelioma with unequivocal BCC, and basaloid neoplasms of uncertain histogenesis. The trichoepithelioma shows the typical pattern: hair papillae, cystic, retiform basaloid cells and abundant stroma. The BCCs, which were often admixed with the trichoepitheliomas, were nodular type with peripheral palisading, stromal retraction, central confluent necrosis and adenoid features. The basaloid neoplasm of uncertain histogenesis showed cords and nests of basaloid cells without follicular differentiation. Immunohistochemically BCC’s areas showed more uniform and stronger staining for BCL‐2 than in trichoepithelioma though the latter showed papillary mesenchymal staining. No significant difference was observed for Ber‐EP4 and CD34. We conclude this may represent a unique malignant degeneration or a contiguous gene syndrome.
Herpetic Cytopathic Features Confined to Folliculosebaceous Units: What does it Mean?
Authors: Walsh N , Boutilier R , Glasgow D , Shaffelburg M
Published: August 2010

The histopathological changes of herpes simplex, zoster and varicella are considered to be indistinguishable from one another. The clinical setting with adjunctive studies generally clarifies the diagnosis. Vesicular lesions in all 3 conditions can involve epidermal and adnexal epithelium with characteristic cytopathic features. We describe 3 patients with non‐vesicular eruptions on the head and neck whose biopsies revealed exclusive folliculosebaceous involvement by herpes. All three patients developed typical herpes zoster within days of the biopsy. There is compelling scientific evidence in the literature indicating that, in herpes zoster, the virus is transported from dorsal root or trigeminal ganglia via myelinated nerves to the skin. These terminate at the isthmus of hair follicles and primary infection of follicular and sebaceous epithelium occurs. Secondary spread of infection to the epidermis follows. In contrast, data pertaining to recurrent herpes simplex indicates that axonal transport of the virus from sensory ganglia to the skin is directed primarily to the epidermis, via terminal non‐myelinated nerve twigs. The clinical evolution of our 3 cases and scientific data in the literature indicate that exclusive folliculosebaceous involvement by herpes, in the setting of a non‐vesicular eruption, represents early herpes zoster.
Paracolloid of the Skin
Authors: Wang C. , Novick S. , Wang A. R.
Published: August 2010

The concept of paracolloid was raised by Dupre et al. in 1979 to describe a rare lesion, in which large amounts of homogeneous, pale pink, non‐amyloid material in sun‐exposed skin. The deposits consisted of haphazardly arranged microfilaments of 3–4 nm in diameter. Here we report another case. A 54‐year‐old white male presented with a 2 × 2 cm boggy, erythematous plaque involving the bridge and tip of the nose for two years. The lesion enlarged slowly and intermittently drained pinkish fluid. A shave biopsy revealed extensive homogeneous, pale pink material with fissure and clefts in the dermis. The deposits wrapped up hair follicles and sebaceous glands, and superficially mixed with scattered solar elastic fibers and globules. There were scattered fibroblasts, focal mild perivascular and perifollicular lymphocyte and plasma cells. Adjacent skin showed prominent solar elastosis. A thin grenz zone was present abutting an atrophic epidermis with actinic keratosis. The deposits showed faint Congo red stain with focal weak apple‐green birefringence, faint PAS stain, and negative Verhoeff‐van Gieson stain. Masson’s trichrome stain and immunohistochemical stain for collagen IV were negative.
Raccoon Heartworm Causing a Leg Mass
Authors: Warthan M.L. , Warthan M.M. , Lesher J.
Published: August 2010

A 29‐year‐old man from east texas presented with a 3‐month history of a large, isolated, painful subcutaneous nodule on his lower right leg. An excisional biopsy showed zones of necrosis in the epidermis, dermis, and subcutaneous adipose tissue with a neutrophilic infiltrate. The dermis showed a mixed infiltrate with necrotic debris and a non‐gravid adult female filarial nematode with a thick, multi‐layered cuticle, paired uteri, and an intestine. The histologic features were diagnostic for dirofilaria tenuis, the raccoon heartworm. Dirofilaria tenuis causes heartworm infection in raccoons and infrequently causes human disease. When humans do contract dirofilariasis, the mode of transmission is via a bite from a mosquito infected with dirofilaria larvae. Humans are a dead end host and dirofilaria cannot reproduce in humans, but they do cause various lesions at the site of the mosquito bites. We report a very rare case of human dirofilaria tenuis infection manifesting as a subcutaneous nodule. Dirofilaria tenuis infections are very rare in the U.S., and usually occur in the Southeastern U.S.
CD99 Immunoreactivity in Metastatic Malignant Melanoma
Authors: Wilkerson AE , Glasgow MA , Hiatt KM
Published: August 2010

CD99, also known as p30/32, is a glycoprotein product of the MIC2 gene, which is located on the short arm of both chromosome X and Y. This transmembrane protein was originally utilized in immunohistochemistry as a unique marker for Ewing sarcoma, other primitive neuroectodermal tumors, and more recently in a wide variety of tumors. It’s expression in malignant melanoma (MM) has not been well documented. A recent study at our institution demonstrated membranous staining in approximately 61% of primary MM. As CD99 is expressed by hematopoeitic cells, it has been proposed as a mechanism for lymphocytes to gain access to the vasculature.1 This study is designed to determine if CD99 expression in melanoma cells has a similar role using cases of metastatic MM from our archives. Our evaluation shows that 13 of 28 cases (46.4%) demonstrated membranous CD99 staining. A case of this magnitude has not been previously reported.Â Reference: 1. Shenkel AR, Mamdouh Z, Chen X, Liebman RM, Muller WA. CD99 plays a major role in the migration of monocytes through endothelial junctions. Nature Immunol 2002;3:143–150.
Cutaneous Myoepithelial Carcinoma in a Neonate
Authors: Wiser E. , Owen L. , Junkins‐Hopkins J.
Published: August 2010

A 27‐day‐old female neonate presented with a bleeding growth on the abdomen. The clinical differential diagnosis included pyogenic granuloma and hemangioma. Histology shows an ulcerated, spindled and round cell tumor in the dermis with ill‐defined margins that invade the subcutaneous fat. The tumor exhibits a biphasic growth pattern with plump spindled cells arranged in fascicles, as well as epithelioid cells arranged in sheets. Some cells show plasmacytoid features. The tumor cells have pleomorphic, vesicular nuclei. Single cell necrosis and mitotic activity is prominent. Myxoid and chondroid stromal changes are focally seen. Immunohistochemical stains show strong positivity for S100 protein, calponin, and, focally, AE1/AE3. Portions of the both the spindled and epithelioid cell components show staining with EMA. Desmin and MSA stains were negative. The tumor does not stain for CD 31, CD 30, CD 45, CD 20, CD 34, CK 20, MART‐1, or HMB45. These histologic features are consistent with a cutaneous myoepithelial carcinoma. Cutaneous myoepitheliomas are rare tumors of myoepithelial cells which surround eccrine and apocrine glands. While most myoepitheliomas are benign, tumors with high mitotic activity may have a risk for recurrence or metastasis. This is, to our knowledge, the youngest patient described with myoepithelial carcinoma.
Rickettsia Africae, a Tick‐borne Pathogen in Travelers to Sub‐Saharan Africa
Authors: Witkiewicz A. , Shupack J. , Meehan S.
Published: August 2010

A 31 year‐old female presented with fever, arthralgias and myalgia ten days after returning from Zimbabwe. On physical exam she had scattered small, pink papules over the lower abdomen and two hemorrhagic pustules with central necrosis (eschars) on her left leg and left buttock. There was inquinal lymphadenopathy with no splenomegaly or hepatomegaly. A punch biopsy was performed which showed necrotizing vasculitis with ulceration of overlying epidermis and papillary dermis. Immunohistochemical studies performed at the Center for Disease Control and Prevention were positive for spotted group Rickettsiae. Treatment with doxycycline 200 mg/d for two weeks resulted in complete recovery. The clinical and histopathologic findings were consistent with Tick Bite Fever caused by Rickettsia africae.
A Virtual Microscopy Image Database for Dermatopathology Education.
Authors: Woosley J.
Published: August 2010

A comprehensive collection of high quality histologic slides is essential for education of pathology and dermatology trainees in dermatopathology. However, maintenance of the quality of the teaching slide collection is constantly challenged by slide loss, breakage, and stain fading. Recut replacement slides are not always easily attainable. When they are, the most important diagnostic features may not be as well represented in recuts. The ScanScope (Aperio Technologies) virtual microscopy instrument and software have been used to create a dermatopathology image database. Histologic sections on glass microscope slides are scanned at X20 to obtain a high‐resolution digital image of the entire section (virtual slides). This magnification is optimal for demonstrating most cutaneous pathologic processes, where low or intermediate power pattern recognition is of primary diagnostic importance. Images can be viewed with the ImageScope virtual slide viewing software. The software is intuitive to use and closely mimics viewing of a slide at the microscope. Virtual slide image quality is equivalent to that seen at the microscope. Unique teaching slides can be reproduced in unlimited quantities and slides are never lost, broken, or misfiled. Internet, intranet, or DVD access permits continuous availability of a teaching slide collection to trainees.
Painful Subungal Dyskeratotic Tumors in Incontinentia Pigmenti
Authors: Young A. , Manolson P. , Cohen B. , Klapper M. , Barrett T.
Published: August 2010

A 65‐year‐old woman presented with multiple subungal lesions for the past forty years. These were associated with increasing pain with growth, relieved only by destruction. They were treated as subungal warts by electrocautery and surgical excision. A biopsy of one lesion was interpreted as squamous cell carcinoma with subsequent partial amputation of the affected digit. She continued to develop painful subungal growths involving all her fingers, requiring repeated surgeries. On physical examination, subungal tumors associated with hyperkeratosis and erythema of the nail bed were found on the right thumb and ring finger. Subungal hyperkeratosis involved all other fingers. On histological examination, there was marked dyskeratosis with features of subungal keratoacanthoma or squamous cell carcinoma. This patient has a history of incontinentia pigmenti (IP) since childhood and she has three daughters with IP. We report a case of painful subungal dyskeratotic tumors in IP, considered as keratoacanthomas by some, as they grow rapidly and may demonstrate spontaneous resolution, albeit rarely. The distinguishing features of subungal tumor in IP are its occurrence in young women with multiple lesions and signs of IP, and its tendency to erupt persistently over a course of several years.
Kikuchi‐Fujimoto’s Disease with Skin Manifestations
Authors: Yu I.T. , Fung M.
Published: August 2010

A fourteen‐year‐old female presented with persistent fever, abdominal pain, splenomegaly and multiple intra‐abdominal lymphadenopathies. She underwent an exploratory laparotomy. Biopsies of the mesenteric lymph nodes revealed necrotizing histiocytic lymphadenitis, characterized by para‐cortical fibrinous necrosis with karyorrhectic debris and histiocytic palisading, and paucity of the polymorphic neutrophils. She also developed concurrent skin lesions with scattered small non‐itching vesicles and blisters over her back and lower legs. A punch biopsy revealed vacuolar interface changes, sub‐epidermal blister formation, mild superficial perivascular infiltration, and follicle necrosis. Karyorrhectic debris and CD68‐positive cells are noted around the follicle. A direct immunofluorescent study was negative for complement or immunoglobulin depositions. The patient was diagnosed as Kikuchi‐Fujimoto’s disease, or necrotizing histiocytic lymphadenitis, a benign self‐limited lymph node disorder most commonly occurred in young females. Patients with Kikuchi’s disease are typically presented with isolated cervical lymphadenopathy with or without accompanying fever. Multiple lymph node involvement, splenomegaly and/or cutaneous lesions are rare occurrences. The present patient experienced a severe inflammatory response syndrome manifested by respiratory failure, pancytopenia, and disseminated intravascular coagulopathy. She recovered completely after two weeks of intensive medical treatment. She has had no respiratory symptoms, residual lymphadenopathies or documented skin lesions in her follow‐up three months after discharge.
1st die Sensibilisierung bei der Allergie ubiquitär?
Authors: SALEN ERNST B.
Published: August 2010

Verf. führt Gründe für die Auffassung an, dass die Sensibilisierung bei der Allergie universell ist, wenn auch verschiedene Gebiete des Gewebes, das Träger der allergischen Reaktivität ist, für verschiedene Allergene in verschiedenem Grade sensibilisiert sein können.

Als Beweis dafür, dass die Harnwegsbeschwerden, die mitunter z. B. zusanimen mit dem Asthmaanfall auftreten, Ausdruck: einer allergischen Reaktion in den Uroqenitalwegen sein Können, werden zwei Fälle angeführt.

Die vom Verf. gemachten Beobachtungen lassen es wahrscheinlich erscheinen, dass eine allergische »Cystitis» auch isoliert vorkommen kann, also ohne dass andere allergische Manifestationen vorzukommen brauchen.
Ein Beitrag zur Kenntnis der anaphylaktischen in vitro Reaktion auf Tuberkulin
Authors: GRÖNWALL ANDERS
Published: August 2010

Die Tuberkulinpräparate PPD und Standard PPD nach Seibert sind nicht fähig im Schultz‐Dale‐Versuch die anaphylaktische Kontraktion der Uterusmuskulatur von tuberkulösen Meerschwinchen auszulö. Die Reaktion kann dagegen mit Tuberkulin nach Schubert und gewissen anderen Tuberkulin‐präparaten hervorgerufen werden. Die Ursachen fü diese Abweichungen werden diskutiert.

Der Verf. dankt Professor A. Tiselius für Ratschläge und Diskussion sowie für die überlassung der Tuberkulinpräparate. Den Professoren T. Svedberg, A. Westerlund and J. Reenstierna danke ich für ihr wohlwllendes Interesse und for die zur Verfügung gestellte experimentelle Ausrüstung.

Die Untersuchung ist mit Finanzieller Unterstützung von »Svenska nationalföreningen mot Tuberkulos» ausgeführt.
VERTEBRAL ARTERY INSUFFICIENCY AND ROTATIONAL OBSTRUCTION
Authors: Andersson Rune , Carleson Rolf , Nylén Olle
Published: August 2010

Abstract. A case of intermittent vertebro‐basilar insufficiency is reported. The combination of a hypoplastic right vertebral artery and marked rotational obstruction of the left one, which had an anomalous origin, seems to have been the cause of the compromised blood flow. Surgical treatment of the presumed contributing obstructive factor was tried. The value of performing arteriograms in various positions of the head is emphasized.
INFLUENCE OF NICOTINIC ACID ON INDIVIDUAL PLASMA PHOSPHOLIPIDS IN HYPERCHOLESTEROLEMIC SUBJECTS
Authors: Vikrot Olle , Berlin Ragnar , Oldfelt Carl Olof
Published: August 2010

Abstract. In ten patients with hypercholesterolemia plasma lipids, including individual phospholipids, were analyzed before and 2 to 18 months after high‐dose nicotinic acid therapy. Free fatty acids were increased, while cholesterol, triglycerides and total phospholipids decreased. Among the individual phospholipids there was a significant decrease of lysolecithin in absolute as well as relative amounts. The other phospholipid fractions did not change significantly. The possible mechanisms of nicotinic acid effects on plasma lipids are discussed.
THE DIABETES SURVEY IN BERGEN, NORWAY, 1956
Authors: Aspevik E. , Jorde R. , Ræder S.
Published: August 2010

Abstract. A follow‐up study of 209 persons examined in the diabetes survey in Bergen in 1956 is discussed. The material was divided into five groups on the basis of laboratory findings from 1956. Latent diabetics. In 1956 diabetes was strongly suspected in most persons in this group. The follow‐up study showed positive diabetes in 21 of 23 persons. The average age of the men was 69, of the women 75. Two used insulin and 3 peroral antidiabetics. In the remainder the disease could be kept under control by diet. Diabetic complications of moderate degree were observed in 7 persons. The mortality during the observation period was 60% for both sexes. Cardiovascular disease was found in a large percentage of the deceased. Borderline cases. In this group diabetes was found to have developed in 8 of the 41 persons examined. The average age of the men was 65, of the women 70. The diabetics of this group had easily controllable diabetes. The diagnosis is still uncertain in 46% of the group. Glycosuria, non‐diabetics. Diabetes was found in 5 of the 41 persons examined. Screened positive, non‐diabetics. Diabetes was found in 2 of the 36 persons examined. Normal material. Diabetes was, somewhat surprisingly, found in 7 of the 68 persons examined. As the attendance at the followup survey was only 70%. it is possible that a certain degree of selection had taken place. It can therefore hardly be assumed that the prevalence of diabetes in this group is representative of the development of diabetes in the constituency of NygÅrd during the observation period. The follow‐up study also showed a considerable reduction in glucose tolerance during the observation period, the average levels of both fasting blood sugar and 2‐hour blood sugar after administration of glucose showing a clear increase in all diagnostic groups.
Serum Cholesterol and Triglyceride Concentrations of Finns and Finnish Lapps
Authors: Aromaa A. , Björkstén F. , Eriksson A. W. , Maatela J. , Kirjarinta M. , Fellman J. , Tamminen M.
Published: August 2010

Abstract. Serum cholesterol and triglyceride (TG) concentrations have been studied in six Finnish population groups in South and East Finland and in one group of Finnish Lapps in North Finland. Altogether 11 626 Finns, aged 15 or above and 828 Lapps of all ages were studied. Serum cholesterol and TG concentrations of the Lapp children were higher in the age group 0–4 than in the age groups 5–9 and 10–14. Mean serum cholesterol of girls aged 0–9 was higher than that of the boys. The sex and age dependence of mean lipid values in the adults were in several respects similar to those observed in other industrialized populations. The serum cholesterol mean rose with age to reach a maximum in age group 50–59 in men, in age group 60–69 in women. Among the adults, women had lower cholesterol means than men only in age groups 30–39 and 40–49. The serum TG distribution was markedly skewed, and logarithmic transformation brought it closer to normal. Maximal log(TG) values (> 12 hours' fast) were attained by men aged 30–39 and by women aged 60–69. Men had considerably higher TG levels than women in middle‐aged groups. Of all the sex and age groups studied, the men aged 30–39 had the most skewed cholesterol frequency distribution. Up to this age variability in men's cholesterol values also increased, as reflected by an increasing S.D. As to women, the cholesterol S.D. increased until the age of 60–69. In all the age groups above 14 years, the variability of TG values was larger in men than in women, but it was not age dependent.
Five‐year Mortality in the City of Bergen, Norway, According to Age, Sex and Blood Pressure
Authors: Holme Ingmar , Waaler Hans Th.
Published: August 2010

ABSTRACT. The City of Bergen was covered by a Mass Miniature Radiology Survey in 1963‐64. On the initiative of the University of Bergen, examinations of BP were included. The initial survey has been reported previously (1). This analysis concerns the relationship between the 5 1/4‐year cause‐specific mortality and BP. Non‐attenders have excess mortality in relation to attenders and this is mostly explained by a generally high mortality among bedridden people. The age‐specific total mortality shows a clear pattern of a general increase with increasing BP. At high systolic BP levels, the 5‐year mortality is independent of whether the age is 45 or 75. The systolic age‐adjusted curve for males increases quite linearly, while the diastolic curve is more U‐shaped. Thus, when comparing the predictive power of BP, allowance must be made for this fact. Using a second order polynomial prediction function, diastolic BP seems to be somewhat “better” than the corresponding systolic BP for age‐adjusted total mortality. However, using a linear prediction function, this conclusion is reversed. The mortality from cerebral stroke shows a dramatic increase with increasing BP. The diastolic curve shows a bend‐off for high values, above 110 mmHg. This may be due to the offer of treatment which such patients received after the screening. Also the CHD mortality curve flattens for high BP values, especially for diastolic BP.
Haemodynamics and Renal Function Following Injection of Bumetanide
Authors: Abrahamsen Arne M.
Published: August 2010

ABSTRACT Haemodynamics and renal function have been investigated in 12 patients with valvular heart disease before and after injection of 2 mg bumetanide in the right heart catheter. There were no significant changes in oxygen consumption, arteriovenous oxygen difference, cardiac index, heart beats per minute, stroke volume or right and left ventricular stroke work 35 min after the injection, whereas pulmonary and systemic arteriolar resistance showed a slight but insignificant reduction. Mean pulmonary capillary venous pressure, left ventricular end‐diastolic pressure, mean pulmonary arterial pressure and mean pressure in the right atrium were highly significantly reduced after injection, systolic left ventricular pressure showing a significant but slight decrease. The creatinine and urea clearances increased considerably during the first 50 min after injection of bumetanide, but diminished during the second period to levels somewhat lower than the initial values. There was also a marked increase in the clearances of sodium, potassium, calcium, magnesium and phosphate. It is concluded that bumetanide is a very potent diuretic which changes haemodynamic parameters towards normal values.
Fluid Turnover in Renal Cysts
Authors: Jacobsson L. , Lindqvist B. , Michaelson G. , Bjerle P.
Published: August 2010

ABSTRACT Cystic puncture was performed percutaneously in 18 patients with solitary renal cysts and in 22 with multiple, congenital renal cysts. With the aid of tritiated water it was possible to estimate the fluid turnover in the cysts and compare it with their volume, pressure and potassium and creatinine levels. Fluid turnover was rapid in all the renal cysts. Two to five hours after i. v. injection of tritium, the tritium concentration in cystic fluid averaged 88% of the concentration in plasma fluid in patients with polycystic kidneys and 73% in patients with solitary cysts. Fluid turnover was more rapid in small than in large cysts, but there was no such difference between cysts with high and low pressure. It is possible that the fluid turnover was slightly faster in cysts with high potassium and creatinine levels than in those with low levels. The results show that the fluid turnover in a renal cyst of 10 ml is considerable— probably more than 100 ml/24 hours. This indicates that fluid inflow to the cyst comes mainly from cells in the cyst wall and not from a single glomerule. Fluid probably leaves the cyst actively via cells in the cyst wall, since the fluid turnover does not increase with high cyst pressure. The fluid turnover is probably secondary to the active solute transportation, which is performed by the cyst cells. This means that these cells have a tubular cell‐like function and should respond to pharmacotherapy.
Serum Triglycerides and Cholesterol and Serum High‐Density Lipoprotein Cholesterol in Highly Physically Active Men
Authors: Lehtonen A. , Viikari J.
Published: August 2010

ABSTRACT. The influence of extensive physical activity upon plasma lipids, in particular HDL cholesterol, was investigated. The material consisted of 23 regularly training men (mean age 44 years, average exercise 83 km running or skiing weekly), 15 healthy men (mean age 47 years), 10 young men (mean age 22 years), 12 healthy women (mean age 32 years) and 18 hyperlipidaemic patients. The exercise increased serum HDL cholesterol and FFA concentrations and decreased triglyceride levels significantly, but had no significant effect upon serum cholesterol concentration. There was a positive correlation between the amount of weekly exercise in km and plasma HDL cholesterol concentration. Exercising more than 70 km/week increased plasma HDL concentration clearly above the normal level. The advantages of an increase in plasma HDL cholesterol are discussed.
Homozygous Expression of Haemophilia B in a Heterozygote
Authors: Holmberg Lars , Nilsson Inga Mane , Henriksson Per , Ørstavik Karen Helene
Published: August 2010

ABSTRACT. A case of clinically severe haemophilia B in a woman is described. In 1977 she was delivered of a healthy male child, showing that she is heterozygous for the haemophilia gene. This seems to be the first report of a proven heterozygote with the homozygous expression of severe haemophilia.
Effects of Some Cardioactive Drugs on the Oxygen Affinity of Whole Blood
Authors: Berntorp Kerstin , Berglund Stig , Johansson Bengt W.
Published: August 2010

ABSTRACT.Increasing amounts of Digoxin, Lasix®, Teofyllamin and CI‐775 were added to human blood in vitro and the whole blood oxygen affinity was measured. We found no definite proof that any of the drugs was able to affect the oxygen affinity of the red cells even at unphysiologically high concentrations.
Response to Bicycle Exercise Testing in Long‐Standing Juvenile Diabetes
Authors: Storstein Liv , Jervell Jak
Published: August 2010

ABSTRACT. Submaximal bicycle ergometry was used in the evaluation of cardiac function in 22 patients with juvenile diabetes and 21 age‐matched control subjects. Six patients had moderate to severe retinopathy and 2 had peripheral neuropathy. Half of the patients, but only 3 of the controls, were smokers. No differences were found in BP, serum cholesterol, triglycerides and serum creatinine levels between diabetics and controls. None had proteinuria. Patients with juvenile diabetes had higher heart rates (HR) at rest as well as during and after exercise than the healthy controls. Diabetics also had a reduced HR response to postural changes compared with the controls. Five diabetics and one control had a pathological exercise ECG (0.05>p>0.1) that may indicate early non‐symptomatic coronary heart disease. The observed changes in HR may be due to autonomic neuropathy.
Doppler Ultrasound in Mitral Stenosis
Authors: Knutsen K. M. , Bae E. A. , Sivertssen E. , Grendahl H.
Published: August 2010

ABSTRACT. In 16 patients with mitral stenosis (MS), alone or in combination with either mitral insufficiency (2 pats.) or aortic valve disease (3 pats.), the mean diastolic pressure gradients across the mitral valve calculated by Doppler ultrasound were significantly correlated to the catheterization data. The average mean pressure drop by Doppler was 11.8 mmHg and by catheterization at rest 16.7 mmHg. A significant correlation between gradients was also found in 5 patients who exercised supine on a bicycle. Atrioventricular pressure half‐time (T1/2), i.e. the time during which the pressure drops from the peak value to half of its initial value by the Doppler technique, was significantly correlated to mitral valve area (MVA) determined from catheterization data. Increasing T1/2 reflected decreasing MVA. It is concluded that Doppler ultrasound is a useful method in the evaluation of patients with MS.
The Influence of Previous Physical Activity on Survival and Reinfarction after First Myocardial Infarction
Authors: Siltanen Pentti , Romo Matti , Haapakoski Jaason
Published: August 2010

ABSTRACT. In 497 consecutive cases of fatal or non‐fatal primary myocardial infarction and sudden coronary death, occurring on the area of Helsinki city, survival and reinfarction rates during 3 years after the attack were analyzed in relation to the level of off‐the‐job and on‐the‐job physical activity of the victims prior to the attack. High previous on‐the‐job physical activity had no influence on the survival and reinfarction rate after the primary acute ischaemic attack. High off‐the‐job physical activity consisting of sports or heavy work at least 4 hours weekly (24 cases) was associated with significantly lower overall and coronary mortality during two first years after onset of the primary attack as compared with medium‐level (187 cases) or low‐level (286 cases) physical activity. The difference was apparent already during the early hours of the attack. In subjects with high‐ vs. low‐level previous leisure‐time physical activity the respective first day survival figures were 88 and 75%, the 2 years figures 88 and 62%, and the 3 years figures 75 and 58%. Previous cardiovascular diseases particularly hypertension, as well as previous heavy smoking in earlier asymptomatic men, worsened the prognosis. There were no significant differences in reinfarction rate between subjects with different previous physical activity, but there was a trend to higher reinfarction rate in the group of high physical activity and to lower rate in the low‐activity group. The findings support the view, that previous high leisure‐time physical activity consisting of sports of heavy work at least four hours weekly possess in cases of the first acute myocardial infarction some fatality reducing power, which probably operates over two years after the attack.
Malabsorption of Vitamin B12 in Dermatitis Herpetiformis and Its Association with Pernicious Anaemia
Authors: KASTRUP W. , MOBACKEN H. , STOCKBRÜGGER R. , SWOLIN B. , WESTIN J.
Published: August 2010

ABSTRACT Serum vitamin B12 concentrations were determined in 129 patients and a pentagastrin test performed in 116 patients with dermatitis herpetiformis (DH). Low serum vitamin B12 levels were found in 27 patients (21%) and achlorhydria in 30. Forty‐two patients with achlorhydria and/or vitamin B12 deficiency were subjected to further haematological and gastrointestinal investigations. Functional or morphological involvement of the small intestine was seen in almost all patients with vitamin B12 deficiency but, in addition, atrophic gastritis resulting in defective secretion of intrinsic factor (pernicious anaemia) was found in 8 cases (7% of all DH patients). Thus, a low vitamin B12 level in DH patients should result in a careful gastrointestinal examination as both an atrophic gastritis and a coeliac‐like enteropathy have further clinical implications.
Assessment of Atrial Contribution to Left Ventricular Filling during Cold Pressor Test by M‐mode Echocardiography in Patients with Coronary Artery Disease
Authors: HÖGLUND C. , CARLENS P. , ROSENHAMER G.
Published: August 2010

ABSTRACT. To determine whether temporarily increased afterload causes changes in left ventricular (LV) diastolic properties, we examined 19 patients with coronary artery disease (CAD) and 14 healthy subjects by M‐mode echocardiography during immersion of the left hand in ice water. The M‐mode echocardiograms were digitized to assess the percentage of atrial contribution (%AC) to LV filling as a marker of diastolic properties. Six patients and 5 controls had to be excluded owing to inability to clearly define the endocardium in the left ventricle throughout the entire heart cycle. In the control situation, the %AC did not differ significantly between the two groups. During the cold pressor test, the mean %AC at peak systolic and peak diastolic pressures was significantly higher in the CAD group than in the control group (p < 0.05). Thus, by using M‐mode echocardiography during the cold pressor test it is possible to document an increased atrial contribution to LV filling in patients with CAD. It is suggested that the mechanism is increased myocardial stiffness evoked by ischaemia with a resultant increased role of atrial contraction.
Cortisol Insufficiency Caused by Electroconvulsive Therapy
Authors: THORÉN M. , WERNER S.
Published: August 2010

ABSTRACT. A 30‐year‐old woman was treated with a series of electroconvulsive therapy (ECT) due to a personality disorder with depressive symptoms. Three days after the last ECT, anisocoria was noticed. It subsided after 2 days, and attacks of syncope, vertigo, anorexia and weight loss started. These symptoms ceased by administration of cortisone acetate and fluoro‐cortisone. During an observation time of five years, repeated attempts to omit the corticosteroids or reduce the cortisone dose to < 20 mg/day have resulted in immediate symptoms of Cortisol deficiency. Plasma adrenocorticotrophin (ACTH) and Cortisol and urinary Cortisol were low during Cortisol withdrawal. Cortisol response to ACTH stimulation and Cortisol and ACTH response to hypoglycemia were normal. The Cortisol deficiency was considered to be due to a defect in the central nervous regulation of ACTH secretion. As it occurred in close connection to ECT, it seems likely that the treatment induced a defect, or aggravated a preexisting one, in neural pathways controlling corticotrophin‐releasing factor and ACTH secretion.
THE NATURAL HISTORY OF HYPERTENSIVE HEART DISEASE AS SUGGESTED BY ECHOCARDIOGRAPHY.
Authors: NIELSEN INGOLF
Published: August 2010

ABSTRACT. Heart morphology and function in hypertension is viewed as a continuum between the following types as land marks: 1) concentric/septal hypertrophy and increased systolic function. 2) slightly dilated left ventricle, no hypertrophy, increased systolic function. 3) eccentric hypertrophy, slightly reduced systolic function. 4) dilated cardiomyopathy without signs of ischaemic heart disease. 5) dilated cardiomyopathy with signs of ischaemic heart disease.

The time course of the development of hypertensive heart disease is suggested.
Mortality in Pacemaker‐treated Patients
Authors: BERGFELDT LENNART , ALLEBECK PETER , EDHAG OLOF
Published: August 2010

ABSTRACT The mortality in pacemaker‐treated patients is due to underlying disorders, and is increased in patients with ischemic heart disease, congestive heart failure, diabetes and renal dysfunction. We have recently shown that the HLA B27‐associated inflammatory disease process is the probable underlying cause in 15–20% of permanently paced men. Consequently, we undertook this study to evaluate any impact on mortality of HLA B27 and associated rheumatic disorders. The mortality among pacemaker patients was compared with that of the general population. Comparisons were also made between pacemaker patients with and without HLA B27 and associated disorders. We did not find any influence on mortality associated with the immunogenetic marker HLA B27 or with HLA B27‐associated rheumatic disorders.
Vitamin D status and PTH in young men: a cross‐sectional study on associations with bone mineral density, body composition and glucose metabolism
Authors: Frost M. , Abrahamsen B. , Nielsen T.L. , Hagen C. , Andersen M. , Brixen K.
Published: August 2010

Objective  Although vitamin D and bone metabolism are closely related, few studies have addressed the effects of vitamin D status on bone in men at time of peak bone mass. The objectives of this study were to evaluate the prevalence of vitamin D inadequacy in a cross‐sectional study in young men and the effects of vitamin D and parathyroid hormone (PTH) on bone mass, bone markers and metabolic function.

Design and Participants  The study population consisted of 783 men aged 20–29 years.

Measurements  Bone mineral density (BMD) of the total hip, femoral neck and lumbar spine was measured. dual‐energy X‐ray absorptiometry was used to evaluate total body fat mass (BFAT). Visceral fat mass and abdominal subcutaneous fat mass (ViFM and ScFM) were assessed using magnetic resonance imaging. A radioimmunoassay was used to measure the level of 25‐hydroxy vitamin D (25OHD).

Results  The prevalence of vitamin deficiency (serum 25OHD < 50 nm) was 6·3% during summer and 43·6% during winter. Serum 25OHD was associated with BMD at all sites and inversely associated with bone‐specific alkaline phosphatase and directly with carboxyterminal telopeptide of type‐1‐collagen. 25OHD and PTH were inversely associated with BFAT, whereas 25OHD also was inversely associated with body mass index, waist–hip ratio, ViFM and ScFM after adjustment for confounders. The associations were found only to be present in participants with insufficient levels of 25OHD. 25‐Hydroxy vitamin D and PTH were inversely related to insulin resistance in vitamin‐insufficient participants only. No associations between PTH or 25OHD and blood pressure were noted.

Conclusion  The study showed a high prevalence of 25OHD deficiency in young, northern European men, which was significantly associated with decreased BMD. PTH and 25OHD were found to be inversely related to the markers of insulin resistance.
How do you monitor the patient with Turner’s syndrome in adulthood?
Authors: Conway Gerard S. , Band Margaret , Doyle Jacqueline , Davies Melanie C
Published: August 2010

Within endocrinology, the long‐term management of Turner syndrome (TS) in adults is fast becoming a specialist subject in its own right. The complications of TS can affect every system in the body, and the main reason why it falls to endocrinologists to coordinate health care is that many features are clearly within the endocrine remit: hypothyroidism, diabetes, hypertension, osteoporosis, hypogonadism. Endocrinologists as general physicians can often cover surveillance of problems in other areas such as congenital heart disease, inflammatory bowel disease and deafness, calling upon specialist input only if the need arises. In this way, a simple ‘one stop shop’ can offer a well‐woman service for women with TS in a cost‐effective manner. Such a service requires a multidisciplinary approach.
Properties of glass–ceramic materials for fixed partial denture construction
Authors: CHUNG K. , DUH J.
Published: August 2010

SUMMARY
In order to determine the feasibility of constructing fixed partial dentures using glass‐ceramic materials, the flexural strength and marginal fit of three experimental glass ceramic materials, and DICOR® as control, were studied. The flexural strength ranged from 1058 MPa to 1295 MPa. Ceramic and alumina addition provided significant strength as tested by ANOVA and multiple range tests (P < 0.05). The range for the cemented bridge margins was from 48.9 μm to 80.4 μm. The tested ceramics had no statistically significant differences in margin openings for the same sites (P < 0.05). However, the openings on the mesial side of the premolar abutment and the distal end of the molar abutment of the fixed partial denture did have statistically significant differences (P < 0.01). Appropriate addition of alumina led to an increase in bending strength. The alumina stabilizes and strengthens the glass‐ceramic material by incorporation into the silicone network.
The relationship between the severity of periodontitis and occlusal conditions monitored by the K6 Diagnostic System®
Authors: SAKAGAMI R. , KATO H.
Published: August 2010

SUMMARY
The occlusal conditions of periodontitis patients were investigated by using a computerized monitoring device. Thirty‐three mild to severe periodontitis patients were enrolled in the study and they were categorized into three groups by their periodontitis severity. Each subject answered a preliminary questionnaire, received routine dental examinations, and underwent MKG/EMG tests using the K6 Diagnostic System. Clinical manifestations of periodontitis were confirmed by the questionnaire and the routine clinical examinations. According to the MKG tests, the traces of maximum opening distance and vertical freeway space showed no significant statistical difference among the groups. However, the velocity of terminal tooth contact was significantly delayed in the severe periodontitis group. According to the EMG tests, there was no significant difference in the rest mode EMG activities, but the function mode EMG activities significantly weakened in the severe periodontitis group. These results showed that severe periodontitis patients had poor occlusal conditions that might have been triggered by the instability of centric occlusion due to attachment loss.
Bilateral masseteric contractile activity in unilateral gum chewing: differential calculus
Authors: CHRISTENSEN L.V. , MOHAMED S.E.
Published: August 2010

SUMMARY
Twelve healthy subjects performed 10 s, 15 s, 20 s, and 25 s of right‐sided and, subsequently, left‐sided gum chewing. The contractile activities of the ipsilateral (chewing side) and contralateral (non‐chewing side) masseter muscles, mainly the concentric contractions of the phase of jaw closing and the isometric contractions of the phase of dental occlusion, were recorded through cumulative surface electromyography (EMG). A linear function (y = ax + b) described the association between an increase in the duration (x) of unilateral gum chewing and the cumulative EMG (y) of both the ipsilateral and the contralateral masseter muscle, and because of different slopes (a) of the two straight lines a geometric function (y = aqx) described the progressively larger differences between the paired and straight lines. When differential calculus was applied to the exponential functions, it became evident that the chewing forces generated by the ipsilateral masseter muscle continually exceeded those generated by the contralateral masseter muscle, and that the positive work (force x distance) produced by the concentric contractions of the ipsilateral masseter muscle continually exceeded that produced by the concentric contractions of the contralateral masseter muscle. It was inferred that mechanophysical work plays a major role if clinical muscle fatigue develops during prolonged unilateral gum chewing.
Setting properties of alginate impression materials in dynamic viscoelasticity
Authors: SHIGETO N. , YAMADA Y. , IWANAGA H. , SUBIANTO A. , HAMADA T.
Published: August 2010

summary
The viscoelastic properties of three alginate impression materials were investigated. A landmark of working time was calculated using a raw phase–time curve. A landmark of setting time was calculated from an inflection point of the divided difference of the first order in the share modulus–time curve. As a result, the working time was common at the point of δ=45° in variable frequencies. The mean value was obtained with less deviation. The setting times obtained were similar for variable frequencies, The mean values showed a distinct difference for each impression material.
Proximo‐cervical adaptation of Class II‐composite restorations after thermocycling: a quantitative and qualitative study
Authors: SCHUCKAR M. , GEURTSEN W.
Published: August 2010

summary
Sixty caries‐free extracted human molars were used to determine the proximo‐cervical adaptation and sealing of Class II‐composite restorations related to the location of the cavity margins: 1.0 mm or 0.5 mm coronal to the cementum‐enamel‐junction (CEJ), at the CEJ, and 0.5 mm apical to the CEJ. All cavities were filled with a hybride type composite resin, which was combined at the CEJ and apical to the CEJ with a dentine adhesive in half of the specimens. The proximo‐cervical adaptation and sealing was determined before and after thermocycling (TC, 2000 cycles, 5–55°C) by SEM and dye penetration tests. Furthermore, an analysis of the interfaces between the enamel or dentine and the filling material was performed to determine whether or not there is a significant correlation between micromorphological factors of the dental hard tissues (enamel acid etch pattern, dentine resin tag pattern) and the marginal adaptation of the composite restorations. The data were statistically evaluated by means of H‐tests (Kruskall–Wallis), U‐tests (Mann–Whitney), and Chi2‐tests (P < 0.05).

It was found that the proximo‐cervical adaptation is statistically significant dependent on the position of the margin. 1.0 mm coronal to the CEJ an excellent marginal sealing was found before and after TC, whereas all other groups revealed a significant deterioration of the marginal integrity after TC. Using a dentine adhesive significantly improved the marginal sealing in cavities at the CEJ before and after TC, however the marginal quality was not achieved as in the case of the normally structured enamel 1.0 mm coronal to the CEJ following acid etching. In defects 0.5 mm apical to the CEJ the dentine adhesive only improved the cervical adaptation before TC. The evaluation of the tooth/ filling interfaces revealed that there is no statistically significant correlation between the enamel acid etch pattern resp. dentine resin tag pattern and the marginal sealing.
The coronoid process as a cause of mandibular hypomobility–case reports
Authors: GROSS M. , GAVISH A. , CALDERON S. , GAZIT E.
Published: August 2010

summary
In an attempt to draw the clinician's attention to the coronoid process site While evaluating the aetiology of the restriction of mandibular opening, four cases are illustrated. These cases represent a diversity of causes hampering the free rotational movement of the coronoid process in space during jaw function. Case 1 is an example of unilateral hyperplastic coronoid process and osteochondroma; case 2 shows unusually shaped short and divergent coronoid processes combined with a bucally displaced maxillary third molar on one side; cases 3 and 4 represent an anatomical variation of an extremely narrow vestibular space due to the close proximity of the medial aspect of the coronoid process to the distal molar. It is suggested that each clinical examination include the width of the buccal vestibular space while performing mandibular movements.