bluuebunny/crossref_metadata_2025 huggingface dataset:
Fellows' Forum in Dialysis edited by Mark A.Perazella: Blood Flow Surveillance of Hemodialysis Grafts: Insights from Two Case Reports
Authors: Atray Naveen K. , Paulson William D.
Published: March 2003

It is widely recommended that all hemodialysis grafts undergo blood flow (Qa) surveillance, and that stenosis be corrected when accompanied by a low Qa or decrease in Qa (ΔQa). This recommendation has, however, become increasingly controversial. Studies have shown that although there is an association between Qa and thrombosis, the accuracy of Qa in predicting thrombosis within individual patients is poor. We describe two cases that demonstrate common causes of poor predictive accuracy. These cases also show that application of Qa surveillance algorithms is often complex and ambiguous. Most studies reporting that surveillance with intervention reduces thrombosis or prolongs graft life have used historical or sequential control groups, or have been retrospective. Accurate assessment of the benefit of graft surveillance must await studies that are fully prospective and randomized with concurrent control groups. Until such studies have demonstrated sufficient benefit, we do not recommend periodic Qa surveillance with intervention of all hemodialysis grafts.
Evaluation of the Effectiveness of a Directly Observed Therapy Program with Vietnamese Tuberculosis Patients
Authors: Mac Jacqueline T. , Doordan Ann , Carr Catherine A.
Published: March 2003

Tuberculosis (TB) has long been recognized as a major public health problem. The rate of TB is high in immigrants, and the frequency of drug resistance is increasing. A major reason for the development of resistant infections as well as relapse is poor adherence to TB treatment. In response to this problem, directly observed therapy (DOT) was introduced to the TB program in Santa Clara county in 1993. The purpose of this study is to compare the completion rates, relapse rates, and sputum conversion rates between a DOT group and a non‐DOT group of Vietnamese TB patients. A chart review was completed with a convenience sample of 25 records of DOT patients and 25 records of non‐DOT patients. Frequencies and percentages were used to analyze the completion rates and the relapse rates. The results show that the completion of therapy rate was 16% higher in the DOT group and the relapse rate was 8% lower. A t‐test indicated that the sputum conversion rate was significantly more rapid in the DOT group than in the non‐DOT group (p < 0.05). Vietnamese TB patients appear to benefit from the DOT program.
Enhancing Low‐Income Parents' Capacities to Promote Their Children's Health: Education Is Not Enough
Authors: Williamson Deanna L , Drummond Jane
Published: March 2003

In 1996 the Capital Heath Region in Edmonton, Alberta integrated a primary health care component into Head Start programs. One aspect of the primary health care component (PHC‐HS) was a series of education sessions aimed at strengthening parents' capacities to enhance their children's health. To make the education sessions relevant, 10 focus groups with 65 parents of children who attended Head Start were conducted prior to the sessions. Findings indicated that participants' ability to enhance their children's health and manage their children's illnesses was limited as much by low incomes, inadequate health care coverage, and lack of transportation as it was by a lack of knowledge. Results provide evidence that health education sessions alone are not adequate to significantly enhance low‐income parents' capacities to promote their children's health. Efforts to strengthen the abilities of low‐income individuals and families to promote their health will be most effective if health education is accompanied by policy advocacy and social action strategies that challenge the socioeconomic and political conditions that negatively affect health. Public health nursing's commitment to social justice, as well as findings about the limitations that low incomes, inadequate health care benefits, and lack of transportation placed on participants' ability to enhance their children's health, underscore the need for public health nurses (PHNs) to address structural conditions contributing to health inequities. As such, an overview of literature that details strategies and theoretical models for challenging socioeconomic and political conditions which restrict the ability of low‐income individuals and families to enhance their health is provided.
Health Promotion Practices of the Older Adult
Authors: Resnick Barbara
Published: March 2003

The purposes of this study were to explore the overall primary and secondary health promotion activities of a group of older adults who resided in a life care community. This was a descriptive study, and included 194 out of 200 residents who participated in a single face‐to‐face interview. The majority of the participants were female (80%), white (98%), and cognitively intact (Mini Mental Status Exam [MMSE] scores of 27.0 ± 4.1). Those in the oldest age group were less likely to monitor their cholesterol intake, have their stools checked for occult blood, or have a mammogram or Pap test over the previous 2 years. The most common reasons for not having these tests were advanced age, not being told to by their primary health care provider, and no interest in pursuing abnormal findings. Health care providers should consider an individualized approach to health promotion and disease prevention and help the older adult make his or her own decisions regarding participation in these activities.
An Evaluation of Interventions to Decrease Intimate Partner Violence to Pregnant Women
Authors: McFarlane Judith , Soeken Karen , Wiist William
Published: March 2003

Prevention of abuse to women is a national priority; however, research has focused on identification of abuse rather than evaluating interventions. To evaluate the differential effectiveness of three levels of intervention, Brief, Counseling, and Outreach, a longitudinal study with repeated evaluation interviews at 2‐, 6‐, 12‐, and 18‐months postdelivery was completed at two urban public health prenatal clinics. The participants were 329 pregnant, physically abused Hispanic women. Both physical abuse and women's use of community resources were measured. Repeated measures ANOVA showed that severity of abuse decreased significantly (p < 0.001) across time for all intervention groups. Violence scores at 2‐months postdelivery were significantly lower for the Outreach group (p < 0.05) compared to the Counseling only group, but not significantly lower than the Brief intervention group. At 6‐, 12‐, and 18‐month follow‐up there were no statistically significant differences among the intervention groups. The use of lay outreach for abused pregnant women merits further research. Abuse screening by itself, however, may be the most effective intervention to prevent abuse to pregnant women.
Defining Risk in Home Visiting
Authors: Kendra Mary Agnes , George Valerie D
Published: March 2003

Risks associated with home visiting have been acknowledged in the nursing literature since the 19th century, yet there is not a well‐defined body of literature on this subject. This void in the literature needs to be addressed in view of the current emphasis on practice in the community and the increase in the number of nurses and other health professionals that are new to the field who currently make visits. This article explores how different disciplines define risk and risk taking, identifies attributes of those who become involved in risk situations, and proposes the Cognitive‐Perceptual Model of Risk in Home Visiting (CPMRHV) for community and public health nursing. The CPMRHV model provides a framework for identifying how field workers (FWs) perceive, assess, and evaluate situations relative to risk and suggests the development of policies and procedures to empower them and to assure the quality of care.
Factors Influencing Long‐Term Home Care Utilization by the Older Population: Implications for Targeting
Authors: Lee Taewha , Kovner Christine T. , Mezey Mathy D. , Ko Il‐Sun
Published: March 2003

This research was designed to explore factors that affect the choice of long‐term care modalities in the older population and to discuss the appropriate target population of home health care services within the entire long‐term care system. The study subjects' activities of daily living limitations, cognitive status, and sociodemograhic data at the time of admission were obtained from retrospective chart reviews. The sample included 134 older subjects who were receiving long‐term care from a Long‐Term Home Health Care Program or a nursing home in New York City. The results indicated that Long‐Term Home Health Care Program use by older persons was characterized by a higher rate of being admitted from private homes, less cognitive impairments, less limitations in activities of daily living, and younger age than older patients who were nursing home residents. Consequently, in the choice of different care modalities, health‐related factors of the older population were found to be more important predictors than sociodemographic characteristics or support system. The implication to both nurses and researchers is the development of eligibility criteria that captures the unique characteristics of disabled older persons in each of the different long‐term care programs to serve them better in a cost‐effective manner.
Parish Nursing: Nurturing Body, Mind, Spirit, and Community
Authors: Brudenell Ingrid
Published: March 2003

Abstract  Parish nursing is a model of nursing care that focuses on health promotion and disease prevention within a faith community. A descriptive study was conducted in the intermountain West to determine how faith communities form parish nursing programs and what their effect is. Thirteen congregations representing eight denominations with parish nurse/health ministries participated. Parish nurses, parish nurse coordinators from two medical centers, pastors, and hospital chaplains (n = 24) were interviewed and provided documents from their programs. Over time, congregations formed parish nursing/health ministries using strategies in a developmental process. The process involved significant support from the pastor, congregation members, and the parish nurses. Collaboration between faith communities and health organizations were successful using a limited domain approach to attain specific health goals. Parish nursing is making a contribution to integrating faith and health practices, promoting health, and increasing accessibility to health care and congregational activities. Conclusions and recommendations are included for future research, practice, and education.
Prevalence and New Phenotypic and Radiologic Findings in Congenital Onychodysplasia of the Index Finger
Authors: Prais Dario , Horev Gadi , Merlob Paul
Published: March 2003

Congenital onychodysplasia of the index finger (COIF) is a rare condition characterized by dysplastic changes in the nail with variable phenotypic manifestations. Its prevalence is unknown. We describe three newborn patients with various clinical and radiologic expressions of this entity. The first, born to a mother treated with multiple antidepressant drugs, had bilateral nail dysplasia of the index finger without bony involvement. The second presented with bilateral hypoplastic nail of the index finger and bilateral symphalangism of the fifth finger; aplastic distal phalanges of the second finger was also noted radiologically. The third baby (born to a diabetic mother treated with insulin), had micronychia and brachydactyly of the right index finger and syndactyly of the second and third fingers; the radiologic finding was bilateral brachymesophalangia of the index finger. It would seem that, besides the nail dysplasia of the index finger, COIF may also be associated with bone dysplasia of the same finger.
Neutrophilic Dermatosis‐Associated Sterile Chronic Multifocal Osteomyelitis in Pediatric Patients: Case Report and Review
Authors: Nurre Lisa D. , Rabalais Gerard P. , Callen Jeffrey P.
Published: March 2003

Atypical pyoderma gangrenosum (PG) and Sweet syndrome are neutrophilic dermatoses that share some common features. Sterile chronic recurrent multifocal osteomyelitis is a rare association of these neutrophilic dermatoses that has only been reported in children. We report a 3‐year‐old girl who initially presented with pain in her left hand and right leg. Roentgenograms and bone scan revealed findings of multifocal osteomyelitis affecting both femurs, the right tibia, left clavicle, right eighth costochondral junction, and left ulna. She was treated with antibiotics without improvement. Bone biopsy of the left ulna revealed histologic changes consistent with osteomyelitis, however, all cultures for bacteria, mycobacteria, and fungi were negative. She subsequently developed an ulcer surrounded by a violaceous, undermined border at the site of the bone biopsy, which also did not improve during antibiotic treatment. A biopsy specimen from this lesion demonstrated a dense perivascular and periappendageal infiltrate of neutrophils within the dermis and edema of the papillary dermis compatible with a neutrophilic dermatosis. She was treated with oral prednisone which resulted in resolution of skin lesions, bone pain, and soft tissue swelling. This case further documents the association between PG or Sweet syndrome and multifocal sterile osteomyelitis.
Pili Torti with Congenital Deafness (Bjornstad Syndrome): A Case Report
Authors: Loche  , Bayle‐Lebey  , Carriere  , Bonafe  , Bazex  , Schwarze
Published: March 2003

We report Bjornstad syndrome in a 5‐year‐old girl with severe bilateral congenital loss of hearing and pili torti. The mode of inheritance of this rare syndrome seems to be heterogeneous. A maternal uncle of the patient was deaf from birth and his hair had shown the same abnormalities at the same age; an autosomal recessive transmission can be assumed.
Bullous Mastocytosis: A Fatal Outcome
Authors: Murphy M. , Walsh D. , Drumm B. , Watson R.
Published: March 2003

Abstract: A 6‐week‐old boy was referred with a generalized bullous rash since birth. Examination revealed bullous mastocytosis with initially no evidence of systemic involvement. Hepatosplenomegaly was noted at 6 months, and at 12 months he was found to have generalized lymphadenopathy. He developed bouts of vomiting associated with increased blistering. At 17 months he had sudden collapse following a brief bout of vomiting and was apneic and asystolic on arrival at the emergency department. The cause of death was attributed to massive hypotension secondary to mast cell degranulation. Although childhood mastocytosis has a favorable course in general, the subset of children with congenital bullous mastocytosis is at higher risk of sudden death and a more guarded prognosis should be given.
Hypersensitivity Reaction in a Child Due to Lamotrigine
Authors: Brown Timothy S. , Appel James E. , Kasteler J. Scott , Callen Jeffrey P.
Published: March 2003

Lamotrigine is an anticonvulsant with a broad spectrum of activity that has been approved in the United States for use in adults with either partial or generalized seizures. This drug is being widely prescribed by pediatricians and neurologists because it is effective in children with idiopathic, resistant, generalized seizures and does not impair cognition. As with other anticonvulsants, a hypersensitivity syndrome has been described. Anticonvulsant hypersensitivity syndrome consists of the hallmark features of fever, rash, and lymphadenopathy. We report the first case of hypersensitivity syndrome in a child due to lamotrigine in which we believe the coadministration of valproic acid increased the duration of the reaction. Our patient had a high spiking fever, generalized morbilliform eruption, facial edema, lymphadenopathy, eosinophilia, atypical lymphocytosis, and an elevation in his liver function tests. The syndrome resolved with the discontinuation of the medication. Anticonvulsant hypersensitivity syndrome may occur with the administration of lamotrigine. Variable presentations may be seen, as hypersensitivity syndromes may be multisystem in nature. The prompt recognition of the signs and symptoms of this condition allows an accurate diagnosis so that the drug may be discontinued and other anticonvulsant treatment options instituted.
Development of Diaper Rash in the Newborn
Authors: Visscher Marty O. , Chatterjee Ranjit , Munson Karen A. , Bare Diane E. , Hoath Steven B.
Published: March 2003

Abstract: Diaper rash is a common infant malady. This study documents the earliest stages of rash in a cohort of 31 healthy term newborns over the first 28 days of life. The diaper area was evaluated using a standardized diaper rash grading scale. The anal, buttock, genital, intertriginous, waistband, and leg areas were assessed separately. At birth the average grade was 0.1 and none of the infants had specific features of advanced rash. Nineteen percent had dryness and/or slight redness. By day 7, 71% of infants had some features of skin compromise, giving rise to an overall grade of 0.6. Both the frequency and overall grade increased during postnatal weeks 2 and 3. Overall scores for days 21 and 28 were the same (1.1). The perianal area had the highest overall regional rash grade. Gender differences were present for the genital area only. These findings indicate that epidermal barrier breakdown is an uncommon finding at birth. Clinical signs of irritated skin in the diaper area develop progressively over the first postnatal month. A better understanding of the mechanisms conferring epidermal barrier protection at birth may be important for developing skin care products and practices to extend this protection later into life.
A Cutaneous Eruption from G‐CSF in a Healthy Donor
Authors: Torrelo Antonio , Madero Luis , Mediero Imelda G. , Zambrano Antonio
Published: March 2003

Abstract: A healthy 12‐month‐old donor treated with G‐CSF for collection of stem cells from peripheral blood developed a discrete, papular, erythematous eruption which histologically showed irregularly shaped lymphocytes with mitoses. We suggest that such a reaction is due to activation of lymphocytes by G‐CSF in a normal host, leading to atypical changes in cellularity.
The Frequency of Histologically Dysplastic Nevi in 199 Pediatric Patients
Authors: Haley Jennifer C. , Hood Antoinette F. , Chuang Tsu‐Yi , Rasmussen James
Published: March 2003

Abstract: Many uncertainties surround the definition, frequency, and significance of dysplastic nevi in children. Consequently the management of dysplastic nevi in the pediatric population has been largely derived from the studies of adults. Biopsies are usually performed on this young age group because of lesion change or abnormal appearance. One might therefore assume that the frequency of histologically diagnosed dysplastic nevi would be higher in children than in adults. We decided to attempt to verify this assumption by determining the frequency of dysplastic nevi diagnosed histologically in the pediatric population. To do this we reviewed 199 cutaneous pathology reports of nevi removed from patients less than 18 years old and submitted to a community‐based dermatopathology laboratory. The diagnosis of dysplastic nevus was made based on histologic criteria recommended by the World Health Organization Melanoma Program. We found that 3 of 199 nevi submitted for histologic analysis met the histologic criteria for dysplastic nevus. There were no melanomas. Our data suggest that there is an extremely low frequency of histologically confirmed dysplastic nevi within the general pediatric population.
Lipoid Proteinosis: Report of Four Siblings and Brief Review of the Literature
Authors: Nanda Arti , Alsaleh Qasem A. , Al‐Sabah Humoud , Ali Abdulla M. A. , Anim Jehoram Tei
Published: March 2003

Abstract: Lipoid proteinosis (Urbach–Wiethe disease) is a rare autosomal recessive disorder associated with deposition of periodic acid‐Schiff (PAS)‐positive hyaline material in various tissues including skin, mucous membranes, and internal organs. A family is reported in which four siblings (two boys and two girls) born to nonconsanguineous parents had lipoid proteinosis. All had the characteristic hoarseness of voice and three had skin lesions. The diagnosis was confirmed by the presence of typical features on light and electron microscopy.
Erythema Toxicum Neonatorum: An Immunohistochemical Analysis
Authors: Marchini Giovanna , Ulfgren Ann‐Kristin , Loré Karin , Ståbi Berit , Berggren Veronica , Lonne‐Rahm Solbritt
Published: March 2003

Abstract: Erythema toxicum neonatorum is a benign rash of unknown etiology, present to various degrees in most term newborns and characterized by an accumulation of eosinophils in dermal lesions. The recruitment of leukocytes to tissues implicates the involvement of adhesion molecules, cytokines, and chemokines. We therefore performed immunohistochemistry on punch biopsy specimens from cutaneous lesions of ten 1‐day‐old infants with erythema toxicum using specific monoclonal antibodies directed against a variety of adhesion molecules, cytokines, chemokines, and cell type‐specific membrane markers. Biopsy specimens of noninflamed skin from four matched newborns and four adults served as controls. The immunohistologic features of erythema toxicum in all 10 infants included a strong staining of the adhesion molecule E‐selectin in the vessel wall and the presence of numerous inflammatory cells that were identified as dendritic cells (CD1a, CD83, HLA‐DR, CD40, and ICAM‐1 positive), eosinophils (EG2 positive), neutrophils (CD15 positive), macrophages (CD14, CD68, and Mac387 positive), and E‐selectin‐expressing cells. Furthermore, the lesions showed a high incidence of the proinflammatory cytokines interleukin (IL)‐1α and IL‐1β and of the chemokines IL‐8 and eotaxin. This immunologic activity was reduced or absent in noninflamed skin from newborn controls and adults. We conclude that there is an accumulation and activation of immune cells in the lesions of erythema toxicum, also present in noninflamed skin of 1‐day‐old infants, but to a lower level. The physiologic significance of the rash remains to be elucidated.
Subepidermal Calcified Nodule: Report of Two Cases and Review of the Literature
Authors: Nico Marcello Menta S. , Bergonse Fabiane N.
Published: March 2003

Abstract: Subepidermal calcified nodule (SCN) is a form of calcinosis cutis that most commonly occurs in children. The typical clinical presentation is of a solitary verrucous nodule on the face, but occasionally multiple lesions may be seen. We describe SCN on the eyelids of two female patients; one of whom had four lesions. The histopathology was typical of calcinosis cutis. Both patients were in good health.
Congenital Granular Cell Tumors Localized to the Arm
Authors: Zaenglein Andrea L. , Meehan Shane A. , Orlow Seth J.
Published: March 2003

Abstract: We report an instance of congenital granular cell tumors localized to the arm of a female infant. While granular cell tumors are well described during infancy as congenital epulis of the oral cavity, this case is unusual in both its location and histologic characteristics. The lesions, located around the antecubital fossa, were comprised of CD34‐positive, S‐100‐negative granular cells. In addition, there were numerous eccrine glands in the upper dermis. The salient features of the case are discussed and reviewed in the context of the literature pertaining to this unusual entity.
Persistent Atypical Lymphocytic Hyperplasia Following Tick Bite in a Child: Report of a Case and Review of the Literature
Authors: Hwong Heidi , Jones Dan , Prieto Victor G. , Schulz Claudia , Duvic Madeleine
Published: March 2003

We report a 6‐year‐old girl who developed a red papule on the posterior neck at the site of a previous tick bite. Initial biopsy was performed a year after the bite and the specimen showed a dense lymphoid infiltrate with admixed CD30+ cells. The patient was referred to our center because of concern about the development of a CD30+ lymphoproliferative disorder. The lesion was completely excised. Histology showed no evidence of a clonal lymphoproliferative disorder or Borrelia infection, but persistence of CD30+ cells. This case demonstrates that a tick bite reaction can persist for more than 1 year and show immunophenotypic and morphologic overlap with a CD30+ lymphoproliferative disorder. Complete history with thorough clinical and histopathologic evaluation is necessary to arrive at the correct diagnosis.
The First Case of Exophytic Pilomatricoma in an Asian Male
Authors: Holme S. A. , Varma S. , Holt P. J. A.
Published: March 2003

Pilomatricomas are benign cutaneous neoplasms that occur frequently in children and usually present as slow‐growing, firm, dermal nodules. They are the second most common skin lesion excised from children. A rare exophytic variety has been described, but to our knowledge this has not previously been reported in Asian children. We present this case to highlight the clinical features and to affirm that race may not play a role in the etiology of pilomatricomas. We also illustrate how these lesions can be effectively treated by shave excision.
Gianotti–Crosti Syndrome Preceded by Oral Polio Vaccine and Followed by Varicella Infection
Authors: Erkek Emel , Senturk Gonca Boztepe , Özkaya Özay , Bükülmez Gül
Published: March 2003

Gianotti–Crosti syndrome (papular acrodermatitis of childhood) is considered a nonspecific cutaneous host response to a variety of infectious agents, particularly viruses. Herein we report a case of Gianotti– Crosti syndrome preceded by oral polio vaccine and followed by varicella infection. The present case may support the hypothesis of initial immunization and following viral infection as a possible mechanism for Gianotti–Crosti syndrome.
Dermatosurgery Using Subcutaneous Infusion Anesthesia with Prilocaine and Ropivacaine in Children
Authors: Moehrle Matthias , Breuninger Helmut
Published: March 2003

Pediatric surgical procedures under local anesthesia have been limited by the pain of injections and, because of low body weight, rapidly reached maximum doses. In subcutaneous infusion anesthesia (SIA) highly diluted local anesthetics are administered by flow‐ and volume‐controlled infusion pumps. This article presents a retrospective review of the use of SIA in children undergoing excision of dermatologic problem lesions. A total of 354 surgical procedures, predominantly excisions of nevi in 271 children (3 months–16 years) were performed in 1999: 67 children were operated on under general anesthesia and 204 children with local anesthesia. For local anesthesia we used SIA with diluted prilocaine and ropivacaine (equivalent mixtures of 0.3%, 0.15%, 0.08%). The 67 children operated on under general anesthesia were younger (mean age 3.05 ± 2.93 years, median age 2.00 years) than the 204 children who had surgery with SIA (mean age 9.00 ± 4.2 years, median age 9.00 years). The sizes of excisions under general anesthesia were larger (maximum 1060 cm2, mean 76 ± 225 cm2, median 7 cm2) than those under SIA (maximum 628 cm2, mean 22 ± 100 cm2, median 3 cm2). No side effects of local anesthesia were observed in these pediatric procedures. The additional use of ropivacaine resulted in prolonged postoperative analgesia. SIA in children is a well‐accepted, safe anesthesia that in some cases offers an alternative to general anesthesia.
The True and the False: Pixel‐Byte Syndrome
Authors: Cutrone Mario , Grimalt Ramon
Published: March 2003

The possible use of retouched images for fraudulent purposes in scientific articles, posters, and conferences is not a future but a present possibility (probably already used) that poses serious questions as to the need for additional control mechanisms other than scientific peer quality review in evaluating and accepting articles. We propose the term “pixel‐byte syndrome” to illustrate how easy it might be to electronically create a new syndrome for fraudulent purposes. The aim of this article is to stimulate discussion among professionals, add some examples of easy‐to‐realize frauds and sow the seeds of doubt in the minds of some of the referees of journal articles and the scientific secretariat of congresses in reviewing digitally retouched images.
Aplasia Cutis Congenita of the Trunk with Fetus Papyraceus
Authors: Kelly Benjamin J. , Samolitis Nancy J. , Xie Don‐Ling , Skidmore Robert A.
Published: March 2003

Abstract: Aplasia cutis congenita (ACC) is the absence of localized or widespread areas of skin at birth. A frequently cited classification schema is based on location and the presence of associated anomalies. Histologically it is characterized by dermal fibrosis and absence of adenexal structures. We present a newborn female with extensive truncal ACC associated with fetus papyraceus.
Congenital Tufted Angioma
Authors: Satter Elizabeth K. , Graham Bradley S. , Gibbs Neil F.
Published: March 2003

Abstract: A 7‐year‐old Filipino girl presented to the dermatology clinic with a slowly enlarging plaque on the inner aspect of her upper left arm. Although she had this lesion since birth, it had gradually enlarged and become indurated and slightly painful. The histopathologic examination showed a vascular proliferation within the dermis, with a “cannonball” appearance consistent with a tufted angioma. We review the literature and discuss the clinical presentation of this rare vascular tumor.
Verruciform Xanthoma in Association with Milroy Disease and Leaky Capillary Syndrome
Authors: Wu Jashin J. , Wagner Annette M.
Published: March 2003

Abstract: An 18‐year‐old Caucasian boy with Milroy disease involving the right leg presented with erythematous, smooth‐topped, waxy papules on the dorsum of his right foot. A 12‐year‐old Caucasian girl with leaky capillary syndrome presented with hemorrhagic verrucous papules on the dorsum of the toes of both feet. Histopathologic analysis revealed changes consistent with xanthoma. Both patients were treated with leg compression, curettage, and electrodesiccation. Although similar papules have been described in the setting of lymphedema from other causes, this is the first report of verruciform xanthoma associated with Milroy disease or leaky capillary syndrome.
Juvenile Subcorneal Pustular Dermatosis: A Case Report
Authors: Koçak Mukadder , Birol Ahu , Erkek Emel , Bozdoǧan Önder , Atasoy Pınar
Published: March 2003

Abstract: Subcorneal pustular dermatosis is a chronic, relapsing, pustular dermatosis that usually develops in elderly women. It is rarely seen in childhood and adolescence. The hallmark of the disease is formation of a subcorneal pustule detected on histopathologic examination. Herein we present a 13‐year‐old girl diagnosed with subcorneal pustular dermatosis based on the typical clinical and histologic findings. Direct and indirect immunofluorescence and serum protein electrophoresis had negative results. The patient partially recovered after 5 weeks of treatment consisting of oral dapsone and a topical steroid ointment.
Endothelial Dysfunction, Oxidation of Low‐Density Lipoprotein, and Cardiovascular Disease
Authors: Holvoet Paul
Published: March 2003

Abstract: The oxidative modification of low‐density lipoprotein (LDL) may be dependent or independent of lipid peroxidation. This peroxidation may be initiated by metal ions, possibly in association with phospholipase activity or catalyzed by myeloperoxidase independent of metal ions. It results in the generation of aldehydes, which substitute lysine residues in the apolipoprotein B‐100 moiety and thus in the generation of oxidized LDL. Endothelial injury, associated with increased production of free radicals during oxidative stress, is associated with increased prostaglandin synthesis and platelet adhesion/activation. These processes are associated with the release of aldehydes, which induce the oxidative modification of LDL in the absence of lipid peroxidation and thus in the generation of malondialdehyde (MDA)‐modified LDL. We have demonstrated an association between coronary artery disease (CAD) and increased plasma levels of oxidized LDL. The increase of circulating oxidized LDL is most probably independent of plaque instability. Indeed, plasma levels of oxidized LDL were very similar for patients with stable CAD and for patients with acute coronary syndromes. Acute coronary syndromes, however, were associated with increased release of MDA‐modified LDL that was independent of the necrosis of myocardial cells. These data suggest that oxidized LDL is a marker of coronary atherosclerosis whereas MDA‐modified LDL is a marker of plaque instability. Recently, a prospective study in cardiac transplant patients suggested an active role of oxidized LDL in the development of CAD. Oxidized LDL may contribute to the progression of atherosclerosis by enhancing endothelial injury by inducing foam cell generation and smooth muscle proliferation.
Feasibility Study on Donor Apheresis Red Cell and Platelet Simultaneous Collection for Blood Center Routine Use
Authors: Kurahashi Masao , Ogawa Yoshiaki
Published: March 2003

Abstract: This study was conducted to determine if single donor platelet and red cell simultaneous collection by apheresis technique can be applied to routine blood product collection at blood centers. Both apheresis red cell product and platelet product were successfully collected and manitol, adenine, and phosphate (MAP) additive solution was added to the red cell concentrates during collection. During a 49 day storage study period, the red cell product quality was maintained and found to be equivalent to that of red cell products derived from whole blood collected by the traditional method. This study demonstrated the possibility of applying this collection method for routine use for single donor apheresis platelet product and red cell product preparation at blood centers.
Long‐Term Improvement of Idiopathic Hypertrophic Cranial Pachymeningitis by Lymphocytapheresis
Authors: Yamamoto Takeshi , Goto Keigo , Suzuki Asuka , Nakamura Noriyuki , Mizuno Yoshikuni
Published: March 2003

Abstract: We report on a 48‐year‐old man with idiopathic hypertrophic cranial pachymeningitis (IHCP) manifesting headache, facial pain, and tongue pain with unilateral atrophy, dysarthria, and dysphagia. Although steroid therapy ameliorated these symptoms, they recurred after he developed steroid‐induced diabetes mellitus. We treated the patient by lymphocytapheresis (LCP), which resulted in an improvement of his symptoms, a reduction in the CD4 lymphocyte population, a reduction of the CD4/CD8 ratio, and a reduced thickening of the dura mater that lasted for more than 14 months. Results presented here suggest that LCP can be effective in the treatment of IHCP.
Current Topics on Cytokine Removal Technologies
Authors: Matsuda Kenichi , Hirasawa Hiroyuki , Oda Shigeto , Shiga Hidetoshi , Nakanishi Kazuya
Published: March 2003

Abstract: It has been widely accepted that cytokines play important roles in the development of organ failure in various pathophysiological conditions of critically ill patients. Various new technologies, including continuous renal replacement therapy, have been developed for the removal of causative humoral mediators in sepsis or other critical conditions. Nonselective blood purification technologies, such as hemofiltration and plasma exchange, are applied in cytokine removal technology. However, the more selective blood purification technologies, such as adsorption, and the combination of those technologies, should be considered in future applications. Only through a prospective randomized controlled study can it be elucidated whether or not these technologies have efficacy in the treatment of sepsis and critically ill patients with hypercytokinemia. We should join and discuss the design of future clinical trials with a standardized strategy for the evaluation of the technologies.
A Case of Thrombotic Thrombocytopenic Purpura Refractory to Plasma Exchange
Authors: Okamoto Masanori , Abe Takaya , Shouno Mineo , Kitabata Yukiko , Narukawa Nobuhiko , Kobata Hirotugu , Akizawa Tadao
Published: March 2003

Abstract: We experienced a case of thrombotic thrombocytopenic purpura (TTP) finally relieved after 74 sessions of plasma exchange (PE). The patient was a 56‐year‐old male. In August 1999, he was examined in emergency because of brown urine and a lowered level of consciousness. As TTP was suspected according to the laboratory findings of abnormally high lactate dehydrogenase and total bilirubin, decreased platelet counts, and numerous fragmented erythrocytes, he was admitted to the ICU of our hospital. Immediately after admission, PE was started consecutively. Upon concomitant use of antiplatelet drugs and prostacyclin, the level of platelet counts recovered to 100,000/μl once, but decreased again. Thus, in addition to the PE, prednisolone and vincristine were administrated, which elevated the level of platelet counts to 200,000 to 300,000/μl. Since the erythrocyte fragmentation was noted frequently, PE was continued twice a week. From the 60th day of admission onward, however, his body temperature rose above 40°C with a rapid increase of C‐reactive protein. A blood culture detected methicillin‐resistant Staphylococcus aureus (MRSA) which derived from a left lung abscess. During the course of anti‐MRSA treatment, he presented acute renal failure and acute hepatic dysfunction, but survived because of the combined therapy. He was discharged on the 180th day of admission. These results suggest that a combined therapy of steroid and vincristine is effective to treat TTP refractory to PE, but careful attention should be paid to the complications caused by immunosuppression.
Pathophysiology of Septic Shock and Multiple Organ Dysfunction Syndrome and Various Therapeutic Approaches with Special Emphasis on Immunoglobulins
Authors: Werdan Karl
Published: March 2003

Abstract: The pathophysiology of sepsis and septic shock is dominated by an imbalance of pro‐ and antiinflammatory mediators produced by toxin‐activated inflammatory cells. Both the overshooting of proinflammatory mediators as well as the development of immune paralysis are deleterious to the patient. Available therapeutic approaches with monoclonal antibodies and antagonists targeted against toxins and mediators have focused mainly on inhibition of overshooting proinflammation; the results, however, have been disappointing. Due to these disappointing results of specific antiinflammatory regimens, adjuvant treatment of sepsis and septic shock with intravenous immunoglobulins (IVIgs) has regained interest although this indication has at best been validated in part. Likely beneficial mechanisms of action may include the improvement of serum bactericidal activity due to neutralizing and opsonizing IgG and IgM antibodies as well as stimulation of phagocytosis and neutralization of bacterial endo‐ and exotoxins; another attractive mode of action may represent Ig‐mediated modification and specific suppression of proinflammatory cytokine release from endotoxin‐ and superantigen‐activated blood cells. For the total group of patients with sepsis and septic shock, a reduction in mortality by IVIg could not be documented; however, in the SBITS study with 653 patients included, a moderate improvement in sepsis morbidity and multiple organ dysfunction syndrome was demonstrated. In defined sepsis subgroups, a reduction in mortality by IVIg has been seen in each small, not yet confirmed trial. Thus, IVIg is not a magic bullet of sepsis treatment, but it may reduce morbidity and thereby may be useful in the therapeutic mosaic of sepsis treatment.
Leukocytoreduction for Acute Leukemia
Authors: Porcu Pierluigi , Farag Sherif , Marcucci Guido , Cataland Spero R. , Kennedy Melanie S. , Bissell Michael
Published: March 2003

Abstract: Both in children and adults, acute leukemia may present with extremely high blast counts; a phenomenon known as hyperleukocytosis. Respiratory failure, intracranial bleeding, and severe metabolic abnormalities frequently occur in acute hyperleukocytic leukemias (AHLs) and are the primary determinants of the high early mortality (20% to 40%) observed. The process leading to these complications has long been known as leukostasis, but the biological mechanisms underlying its development and progression have remained unclear. Traditionally, leukostasis has been attributed to overcrowding of leukemic blasts in the microcirculation, and its treatment has focused on prompt leukocytoreduction. However, it is becoming increasingly evident that leukostasis results from the adhesive interactions between leukemic blasts and the endothelium; a mechanism that none of the current therapies directly addresses. The endothelial damage associated with leukostasis is likely to be mediated by cytokines released in situ and by subsequent migration of leukemic blasts in the perivascular space. The adhesion molecules displayed by the leukemic blasts and their chemotactic response to the cytokines in the vascular microenvironment are probably more important in causing leukostasis than the cell number. This may explain why leukostasis may develop in some patients with AHL and not in others, and why some patients with acute leukemia without hyperleukocytosis (<50,000 blasts/mm3) develop leukostasis and respond to leukocytoreduction. Leukapheresis effectively reduces the blast count in many patients with AHL and is routinely used for immediate leukocytoreduction. However, the most appropriate use of leukapheresis in acute leukemia remains unclear, and the procedure may not prevent early death more efficiently than fluid therapy, hydroxyurea, and prompt induction chemotherapy. The use of cranial irradiation remains very controversial and is not generally recommended. The identification of the adhesion molecules, soluble cytokines, and chemotactic ligand‐receptor pairs mediating endothelial cell damage in AHL should become a priority if better outcomes are desired.
Fluctuations in the Peripheral Blood Leukocyte and Platelet Counts in Leukocytapheresis in Healthy Volunteers
Authors: Yamaji Ken , Yang Kwangseok , Tsuda Hiroshi , Hashimoto Hiroshi
Published: March 2003

Abstract: Leukocytapheresis (LCP) for the treatment of patients with diseases that involve an abnormal autoimmune reaction aims to improve the condition of the patient's pathology and to correct imbalances in immunological regulation mechanisms by removing the responsible leukocytes from the peripheral blood. To clarify the mechanism of therapeutic effect, LCP was conducted in healthy volunteers to investigate changes in peripheral blood leukocyte and platelet counts over time during the treatment. The subjects were 10 healthy male volunteers. LCP was performed once in each volunteer for 3,000 ml of blood volume. The peripheral blood counts decreased significantly, reaching a minimum of 20.0% of the baseline number of leukocytes, 10.1% of the baseline number of neutrophils, and 40.3% of the baseline number of lymphocytes. The number of removed leukocytes was about 6.6 × 109 cells, including about 3.5 × 109 neutrophils, as well as about 5.0 × 1011 platelets. After the completion of LCP, the peripheral leukocyte levels increased transiently (overshoot), and at 2 h after the completion of the treatment, they reached 193.4% of the baseline value. Since LCP is capable of reducing the peripheral blood leukocyte count over a short period of time, its impact on peripheral blood is great. In addition, in view of the overshoot phenomenon and the appearance of immature granulocytes, the LCP may affect not only the peripheral blood, but also the bone marrow pool, the marginal pool, and the leukocytes present in the tissues.
Do Bird Perching Structures Elevate Seed Rain and Seedling Establishment in Abandoned Tropical Pasture?
Authors: Holl Karen D.
Published: March 2003

Lack of seed dispersal has been shown to be a major factor limiting tropical forest recovery in abandoned pasture land. The goal of this work was to determine whether bird perching structures serve to enhance seed dispersal and seedling establishment in an abandoned pasture in Costa Rica. Two types of perching structures (crossbar and branch) were tested. Bird visitation rates were significantly higher on branch than on crossbar perches. The number of animal‐dispersed seeds was significantly higher below branch perches than below crossbar perches or in open pasture. Despite differences in seed rain, percent cover of animal‐dispersed plants and the number of seedlings of animal‐dispersed plant species were similar below both perch types and in open pasture. Baiting perches with bananas did not increase either bird visitation rates or seed rain. These results suggest that, although bird perching structures increase seed dispersal, they do not overcome other barriers to tropical forest recovery such as seed predation and low seed germination.
Photosynthetic Responses to Light for Rainforest Seedlings Planted in Abandoned Pasture, Costa Rica
Authors: Loik Michael E. , Holl Karen D.
Published: March 2003

Efforts to reforest tropical pasture with native tree species have increased in recent years, yet little is known about the physiology of most tropical trees. The goal of this study was to assess the effect of habitat on photosynthetic responses to light for seedlings of four native rainforest species (Calophyllum brasiliense, Ocotea glaucosericea, Ocotea whitei, and Sideroxylon portoricense) planted to facilitate tropical rainforest recovery in southern Costa Rica. Seedlings were planted in primary forest, in open abandoned pasture, and in the shade of remnant trees within the pasture. Growth, morphology, photosynthetic gas exchange responses to light, and chlorophyll fluorescence (an indication of the integrity of photosynthetic processes) were measured in the three habitats. Height and leaf area were generally greater for seedlings in tree shade compared to those in the forest and open pasture. Photosynthetic rates were higher for plants in open pasture and tree shade compared to those in the forest for two of the four species. Chlorophyll fluorescence results indicated flexibility in the photosynthetic processing of light energy that may help plants tolerate the bright light of the pasture. This study demonstrates that, for certain species, seedlings under remnant pasture trees do not exhibit the level of photosynthetic stress experienced in open abandoned pasture. Seedling responses to light, in combination with other factors such as increased nutrient input through litterfall, help explain the enhanced growth of seedlings under remnant pasture trees. Planting seedlings under remnant trees may increase the success of future efforts to restore tropical forest in abandoned agricultural land.