bluuebunny/crossref_metadata_2025 huggingface dataset:
Reactions leading to the formation and breakdown of stilpnomelane in the Otago Schist, New Zealand
Authors: Li G. , Essene E. J. , Peacor D. R. , Coombs D. S.
Published: March 2003

Semi‐pelitic rocks ranging in grade from the prehnite–pumpellyite to the greenschist facies from south‐eastern Otago, New Zealand, have been investigated in order to evaluate the reactions leading to formation and breakdown of stilpnomelane. Detrital grains of mica and chlorite along with fine‐grained authigenic illite and chlorite occur in lower‐grade rocks with compactional fabric parallel to bedding. At higher grades, detrital grains have undergone dissolution, and metamorphic phyllosilicates have crystallized with preferred orientation (sub)parallel to bedding, leading to slaty cleavage. Stilpnomelane is found in metapelites of the pumpellyite–actinolite facies and the chlorite zone of the greenschist facies, but only rarely in the biotite zone of the greenschist facies. Illite or phengite is ubiquitous, whereas chlorite occurs only rarely with stilpnomelane upgrade of the pumpellyite‐out isograd. Chemical and textural relationships suggest that stilpnomelane formed from chlorite, phengite, quartz, K‐feldspar and iron oxides. Stilpnomelane was produced by grain‐boundary replacement of chlorite and by precipitation from solution, overprinting earlier textures. Some relict 14 Å chlorite layers are observed by TEM to be in the process of transforming to 12 Å stilpnomelane layers. The AEM analyses show that Fe is strongly partitioned over Mg into stilpnomelane relative to chlorite (KD≈2.5) and into chlorite relative to phengite (KD≈1.9). Modified A′FM diagrams, projected from the measured phengite composition rather than from ideal KAl3Si3O10(OH)2, are used to elucidate reactions among chlorite, stilpnomelane, phengite and biotite. In addition to pressure, temperature and bulk rock composition, the stilpnomelane‐in isograd is controlled by variations in K, Fe3+/Fe2+, O/OH and H2O contents, and the locus of the isograd is expected to vary in rocks of different oxidation states and permeabilities. Biotite, quartz and less phengitic muscovite form from stilpnomelane, chlorite and phengite in the biotite zone. Projection of bulk rock compositions from phengite, NaAlO2, SiO2 and H2O reveals that they lie close to the polyhedra defined by the A′FM minerals and albite. Other extended A′FM diagrams, such as one projected from phengite, NaAlO2, CaAl2O4, SiO2 and H2O, may prove useful in the evaluation of other low‐grade assemblages.
Metamorphic zircon formation by solid‐state recrystallization of protolith igneous zircon
Authors: Hoskin P.W.O. , Black L.P.
Published: March 2003

Protolith zircon in high‐grade metagranitoids from Queensland, Australia, partially recrystallized during granulite‐grade metamorphism. We describe the zircon in detail using integrated cathodoluminescence, U–Pb isotope, trace element and electron backscatter diffraction pattern (EBSP) analyses. Primary igneous oscillatory zoning is partially modified or obliterated in areas within single crystals, but is well preserved in other areas. A variety of secondary internal structures are observed, with large areas of transgressive recrystallized zircon usually dominant. Associated with these areas are recrystallization margins, interpreted to be recrystallization fronts, that have conformable boundaries with transgressive recrystallized areas, but contrasting cathodoluminescence and trace element chemistry. Trace element analyses of primary and secondary structures provide compelling evidence for closed‐system solid‐state recrystallization. By this process, trace elements in the protolith zircon are purged during recrystallization and partitioned between the enriched recrystallization front and depleted recrystallized areas. However, recrystallization is not always efficient, often leaving a ‘memory’ of the protolith trace element and isotopic composition. This results in the measurement of ‘mixed’ U–Pb isotope ages. Nonetheless, the age of metamorphism has been determined. A correlation between apparent age and Th/U ratio is indicative of incomplete re‐setting by partial recrystallization. Recrystallization is shown to probably not significantly affect Lu–Hf ages. Recrystallization has been determined by textural and trace element analysis and EBSP data not to have proceeded by sub‐grain rotation or local dissolution/re‐precipitation, but probably by grain‐boundary migration and defect diffusion. The formation of metamorphic zircon by solid‐state recrystallization is probably common to high‐grade terranes worldwide. The recognition of this process of formation is essential for correct interpretation of zircon‐derived U–Pb ages and subsequent tectonic models.
A Critical Review of Sodium Profiling for Hemodialysis
Authors: Stiller Siegfried , Bonnie‐Schorn Edeltraud , Grassmann Aileen , Uhlenbusch‐Körwer Ingrid , Mann Helmut
Published: March 2003

In sodium profiling, the sodium concentration in the dialysis fluid, instead of being constant, follows a time‐dependent profile over the course of a hemodialysis session. The main aim of this manipulation is to avoid osmotic disequilibrium by keeping plasma osmolality in the physiological range. Further advantages of sodium profiling are a reduction in the incidence of muscle cramps, improved sodium removal, and improved vascular stability. Many different profiles have been used by various investigators. However, if sodium profiling is not appropriately conducted, sodium accumulation with resulting augmented thirst, increase of interdialytic weight gain, and hypertension may result. Sodium accumulation may, in fact, explain the reduced intradialytic morbidity reported in some short‐term sodium profiling studies. Randomized, double‐blind studies meeting strict statistical criteria and providing a careful control to maintain equivalent sodium balances between the compared treatments are difficult to perform and have not yet been published. However, because sodium profiling has potential benefits, provided that sodium balance is carefully controlled, it should nevertheless be regarded as a tool that experienced nephrologists can use for the treatment of patients who experience intolerable side effects during standard dialysis.
HEPARIN‐INDUCED THROMBOCYTOPENIA IN DIALYSIS: Alternative Methods of Anticoagulation for Dialysis‐dependent Patients with Heparin‐induced Thrombocytopenia
Authors: O'Shea Susan I. , Ortel Thomas L. , Kovalik Eugene C.
Published: March 2003

Dialysis patients who are continually exposed to heparin are at risk for heparin‐induced thrombocytopenia (HIT). Heparin‐induced antibodies have been reported to occur in 0–12% of hemodialysis (HD) patients. The diagnosis or suspicion of HIT in this patient population requires careful confirmation of the diagnosis and substitution of heparin with an alternate anticoagulant for dialysis. Alternate agents such as the direct thrombin inhibitors (hirudin and argatroban) are available, but careful dosing and monitoring of the anticoagulant effect are required. Despite careful dosing, hemorrhagic complications have occurred with these agents. Unfortunately there are limited options for treatment of hemorrhagic complications and no specific antidotes are available for the direct thrombin inhibitors. In this report the currently available alternatives to heparin for dialysis, including dosing and monitoring recommendations, are reviewed.
A Phase II Trial of Oral Trimethylcolchicinic Acid in Patients with Hormone Refractory Prostate Cancer
Authors: Brockstein Bruce E. , Shepard Dale R. , Kugler John W. , Fishkin Paul A. , Arrieta Rose , Ratain Mark J. , Vokes Everett E. , Vogelzang Nicholas J.
Published: March 2003

Hormone refractory prostate cancer (HRPC) will affect more than 40,000 men in the United States in 1999, and only a few drugs have activity in this disease. We studied trimethylcolchicinic acid (TMCA), an oral colchicine derivative, in a Phase II trial involving 18 chemotherapy‐naive men with HRPC. TMCA, 5 mg/m2/day, was given orally for 4 or 5 days with cycles repeated every 3 weeks. No patients showed an objective response by clinical or prostate specific antigen criteria. Neutropenia and stomatitis were common on this schedule. One fatal episode of neutropenic fever occurred. Pharmacokinetics suggested drug accumulation on Days 4 and 5. The cumulative area under the curve (AUC) of concentration × time correlated with the log neutrophil nadir, the log platelet nadir, and the severity of stomatitis. We conclude that TMCA has no clinical effect on HRPC despite severe hematologic toxicity and stomatitis, and that its hematologic toxicity is related to the AUC.
African American Men with Prostate Cancer Treated by Simultaneous Irradiation
Authors: Williams W. Hamilton , Critz Frank A. , Benton James B. , Levinson Keith , Falconer Walter , Harrison Emerson , Holladay Clinton T. , Holladay David A.
Published: March 2003

Objectives: Reportedly, African American men (AAM) with prostate cancer present with more advanced disease and have worse outcomes than white men (WM). We evaluate this concept in our series of men with prostate cancer treated with modern simultaneous irradiation in a busy private practice.

Materials and Methods: From 1993 to 1998, 1270 men with clinical stage T1T2N0 prostate cancer were treated by ultrasound‐guided transperineal implantation of I‐125 in the prostate and seminal vesicle (median dose 12,000 cGy) followed by external‐beam radiation therapy (4500 cGy) including an additional 750 cGy seminal vesicle boost in men with adverse prognostic factors. None received neoadjuvant or adjuvant hormone therapy. The median pretreatment prostate specific antigen (PSA) level for 141 AAM and 1129 WM was 8.6 ng/ml and 7.1 ng/ml, respectively, a significant difference (p = 0.0001). Disease freedom is defined as achievement and maintenance of a PSA nadir of ≤ 0.2 ng/ml. The median follow‐up is 24 months (range 12–66 months).

Results: Disease‐free survival for the entire group is 89% (± 3%) at 5 years. Overall, or when analyzed by stage, Gleason score, or age, AAM present with higher pretreatment PSA levels than WM. However, according to pretreatment PSA groups of ≤ 4.0 ng/ml, 4.1–10.0 ng/ml, 10.1–20.0 ng/ml, and > 20.0 ng/ml, the 5‐year disease‐free survival rates for AAM and WM in these groups are 100% and 95%, 85% and 92%, 67% and 80%, 76% and 83%, respectively. No significant difference in disease freedom is observed within the above PSA groups or by analysis of Gleason score or stage. With disease freedom as an end point, race is not a significant factor on multivariate analysis.

Conclusions: AAM present with higher pretreatment PSA levels than WM both overall and when stratified by stage, Gleason score, or age. In this series, however, disease‐free survival rates of AAM and WM are not significantly different overall or according to pretreatment variables. Thus, race does not appear to be an adverse prognostic factor after simultaneous irradiation.
The Anti‐Androgen Transfer
Authors: Kim Simon P. , Moran Edgar M. , Bowes Eric D. , Tennant Adam G. , Bennett Charles L.
Published: March 2003

Objectives: Financial and nonfinancial barriers affect the care of prostate cancer patients. In this study, we evaluated whether financial considerations were a primary reason for lower income veterans with prostate cancer to transfer their care to Veterans Affairs (VA) Hospitals, and if so, which aspects of medical care were most affected by these considerations.

Materials and Methods: Interviews with 106 veterans with prostate cancer were undertaken after the transfer of their care to the VA medical system. Respondents provided information about the primary reasons they shifted their care.

Results: Although 64.2% of the patients had private health insurance before their initial visit to the VA, only 26.4% retained their private health insurance at the time of the interview, and 53.8 % transferred their entire medical care to the VA after the diagnosis of prostate cancer. Reasons for transferring care to the VA included the costs of oral anti‐androgen therapy (34.9%), copayment costs for physician visits (30.2%), a feeling that medical care would be better in the VA system (26.4%), and copayment costs of luteinizing hormone‐releasing hormone analogs (8.5%). Reasons for transfer varied with stage of disease at diagnosis (p < 0.05). The most common reasons for transfer were anti‐androgen therapy costs among metastatic patients and, among patients with localized cancer, physician copayments and a feeling that care would be of higher quality in the VA system.

Conclusions: Our findings suggest that there is a phenomenon, termed the “anti‐androgen transfer,” that leads veterans with metastatic prostate cancer to transfer to the VA setting. The enactment of a comprehensive pharmaceutical benefit to the Medicare program will affect transfers of metastatic prostate cancer patients to the VA medical system.
Immunohistochemical Characterization of Stromal Nodules in Benign Prostatic Hyperplasia
Authors: Kong Xiangtian , Zeng Li , Yang Yong , Xia Tongli , Gu Fangliu , Guo Yinglu , Lee Chung
Published: March 2003

The goal of this study is to characterize stromal nodules in benign prostatic hyperplasia (BPH) in a Chinese population. BPH specimens were obtained by superpubic enucleation. Immunohistochemical staining for vimentin, muscle actin (HHF35), and smooth muscle actin (1A4) was conducted in serial sections of 55 consecutive stromal nodules of BPH specimens. The simplest stromal nodules were undifferentiated nodules that contained vimentin‐negative and smooth muscle actin‐negative cells. These cells were designated as undifferentiated mesenchymal cells. Immunohistochemical staining identified two cell types. Smooth muscle cells contained smooth muscle actin and vimentin, while fibrocytes contained vimentin but not smooth muscle actin. Fibrous nodules contained fibrocytes. Two more types of stromal nodules were fibromuscular nodules, which contained mixtures of fibrocytes and smooth muscle cells, and muscular nodules, which contained only smooth muscle cells. Of 55 stromal nodules, 11 (20%) were undifferentiated, 5 (9%) were fibrous, 37 (67%) were fibromuscular, and 2 (4%) were muscular.
Building Community Health Nursing in the People's Republic of China: A Partnership Between Schools of Nursing in Ottawa, Canada, and Tianjin, China
Authors: Edwards Nancy , Bunn Helen , Chun Mei Wang , Dao Hui Zou
Published: March 2003

Community health nursing in China is an emerging specialty. A multi‐component collaborative endeavor between the Schools of Nursing of Tianjin Medical University, China, and the University of Ottawa, Canada is described. This project, funded by the Canadian International Development Agency, commenced in 1989. It has laid the groundwork for an expanded role for community health nurses in Tianjin, a municipality of 11 million people located in Northeast China. The historical context for the evolution of community health nursing in China and the emergence of community health nursing as a priority area within the project are described. Major project activities are highlighted, illustrating several underlying principles for strengthening the educational preparation of baccalaureate nurses who can apply community health skills. These include creating a critical mass of faculty who can teach community health nursing, modelling classroom and clinical teaching of community health nursing, bridging the gap between nursing in the community and nursing in the hospital, and developing a prototype for baccalaureate community health nursing experience. Lessons learned from this initiative are summarized.
A Cholesterol Intervention Program for Public Health Nurses in the Rural Southeast: Description of the Intervention, Study Design, and Baseline Results
Authors: Keyserling Thomas C , Ammerman Alice S , Atwood Jan R , Hosking James D , Krasny Cristina , Zayed Hany , Worthy Betty H
Published: March 2003

Residents of the rural South are at high risk for heart disease and are frequently identified as having high blood cholesterol, but sources for nutrition counseling in rural areas are often limited. To increase the availability of high quality nutrition counseling, the Food for Heart Program was developed for public health nurses and is designed to circumvent many of the obstacles common to dietary counseling. We conducted a randomized trial to assess the effectiveness of this program to lower blood cholesterol. In this report, we describe the study design, intervention program, and baseline characteristics of participants. Nurses at 17 health departments screened 781 subjects to enroll 468 with high blood cholesterol: three‐quarters of the subjects were female, the mean age was 55, and 80% were white. Participants were at high risk for heart disease: 60% had two or more risk factors for coronary disease, the majority were overweight with a mean BMI of 29, and the mean cholesterol was 257 mg/dL. Reported baseline dietary intake included relatively modest consumption of high fat meats and snack foods, excessive consumption of sweets, modest intake of complex carbohydrates, and inadequate consumption of fruits and vegetables.
The Crisis Nature of Health Care Transitions for Rural Older Adults
Authors: Magilvy Joan K , Congdon JoAnn G
Published: March 2003

The complex health, socioeconomic, and environmental problems experienced by many American elders often place them at high risk for disease and disability. Over time, acutely or chronically ill older persons experience numerous transitions across various health care settings. Although availability of health services is improving in rural areas, barriers such as distance, geography, and poor distribution often limit access to health care. In a longitudinal rural ethnography, the health care transition experiences of older adults, families, and health care providers were examined. A major ethnographic theme emerged from analysis data from interviews, participant observations, and photographs: the crisis nature of health care transitions experienced by rural older adults and their families and observed by rural nurses and other health care providers. Several patterns were observed including the crisis was compounded by surprise; limited knowledge of local resources exacerbated the crisis; inconsistent discharge planning disrupted transitions; changing family support necessitated admission to nursing homes; continuity of care in nursing home discharge lessened transition crisis; and rural home health care was identified as a strength. Recommendations were made for community‐based interventions to improve the transition experience. Comprehensive care management services provided by public health nurses (PHNs) in the local rural community were recommended.
Developing Political Competence: A Comparative Study Across Disciplines
Authors: Rains Joanne W , Barton‐Kriese Paul
Published: March 2003

Political activism is one way that nurses care for individuals and communities, and intervene in the broad range of socioeconomic factors influencing health. Though policy advocacy is a core public health function and a valuable nursing activity, the process of acquiring requisite skills and attitudes for political involvement is not often explored. What crucial experiences enfranchise nursing students toward future policy involvement? What is the student journey toward political competence? Do nursing students vary from students of other disciplines in this process? In‐depth interviews were conducted with baccalaureate nursing students and political science students who were near graduation. Content analysis of interview transcripts revealed several themes. Despite rich examples of activism, nursing students viewed public policy as a barrier, and did not see connections between the personal, professional, and political. Nursing seemed grounded in application and service, demonstrating by involvement that they could “walk the walk.” Political science involvement originated in theory, and resulted in more articulate discourse on the subject: they could “talk the talk.” The data suggest a need for interdisciplinary dialogue, faculty modelling of political competence, opportunities for students to realize personal, professional, and political connections, and a concern of socialization in the context of global citizenship.
Quality Care in a Medicaid Managed Care Program: Adequacy of Prenatal Care for Teens in Chicago
Authors: Gifford Blair D
Published: March 2003

This study considers whether obstetricians offer less adequate care to teen prenatal patients in the Healthy Moms, Healthy Kids (HMHK) Medicaid managed care program in Chicago than to non‐Medicaid patients. Telephone surveys of obstetricians offices (n= 101) were conducted to determine the content of care in the first prenatal visit. These survey data are combined with demographic and practice background data from The American Medical Association's Physician Master File. Analysis indicates there were no significant differences between groups for receiving: (1) medical histories, (2) physical exam and tests, (3) health promotion counseling, and (4) availability of birthing education materials. Analysis further indicates, however, that teen Medicaid patients are less likely to receive blood tests and some urinalysis‐related tests. Not receiving these tests is especially problematic because pregnant teens are more likely to drop out of the prenatal care regimen after their first visit, and teens are more likely to have poorer birth outcomes.
Quality of Life and Related Factors among Elderly Nursing Home Residents in Southern Taiwan
Authors: Tseng Su‐Zu , Wang Ruey‐Hsia
Published: March 2003

This study explored subjectively perceived quality of life and related factors of elderly nursing home residents. In this study, 161 residents aged 65 and older were selected from 10 nursing homes in Southern Taiwan. The results showed: (1) the mean score of quality of life was 15.86 and the standardized score was 52.87, a medium rating for the overall sample; (2) different educational levels, and socioeconomic status were significantly different in the quality of life, the other sociodemographic variables were not significantly different in the quality of life. (3) length of residence in the nursing home was significantly negative relative to the quality of life. Physical function, activities of daily living, social support from nurses, social support from nursing aides, social support from families, and frequency of family interaction were significantly positive relatative to the quality of life. (4) Activies of daily living, social support from nurses, socioeconomic status, and physical function were the significant predictors in the quality of life, which explained 40.1% of the total amount of variance. Activities of daily living, social support from nursing aids, socioeconomic status, physical function and frequency of interaction with family were the significant predictors in the quality of life, which explained 39.5% of the total amount of variance. Results generated from this study may act as a reference for the staff of nursing homes to understand the quality of life and related factors among elderly residents. This study also acts as a reference for future intervention programs in this field.
Outcome Effectiveness of Community Health Workers: An Integrative Literature Review
Authors: Swider Susan M.
Published: March 2003

Community health workers (CHWs) are promoted as a mechanism to increase community involvement in health promotion efforts, despite little consensus about the role and its effectiveness. This article reviews the databased literature on CHW effectiveness, which indicates preliminary support for CHWs in increasing access to care, particularly in underserved populations. There are a smaller number of studies documenting outcomes in the areas of increased health knowledge, improved health status outcomes, and behavioral changes, with inconclusive results. Although CHWs show some promise as an intervention, the role can be doomed by overly high expectations, lack of a clear focus, and lack of documentation. Further research is required with an emphasis on stronger study design, documentation of CHW activities, and carefully defined target populations.
CLINICAL AND LABORATORY INVESTIGATIONS: Pityriasis Lichenoides in Children: Clinicopathologic Review of 22 Patients
Authors: Romaní Jorge , Puig Lluís , Fernández‐Figueras María Teresa , de Moragas José M.
Published: March 2003

Abstract: Pityriasis lichenoides (PL) is a cutaneous disease of unknown origin, with an autoinvolutive course, that can occur in pediatric patients. Traditionally, acute and chronic variants have been described, but other special forms of presentation have been reported. We reviewed the clinical records and histopathologic specimens of all pediatric patients diagnosed with PL in our hospital from 1980 to 1995 to assess the clinicopathologic features of this disorder in our environment. Twenty‐two of the 118 cases reviewed were pediatric patients less than 15 years old (12 males and 10 females, 18.6% of all patients). Their ages ranged from 3 to 15 years, with a mean of 9.3 years. Most of the patients (72%) had the chronic variant of the disease, while the remainder had an acute course. One patient suffered from acute ulceronecrotic PL. Systemic treatments prescribed were erythromycin in eight patients, PUVA in five patients, and methotrexate in one patient. Three patients had a prolonged course with more than two episodes. Acute and chronic PL are polar extremes, but individual cases cannot be classified only on the basis of histopathologic data, since coexistence of lesions in different stages of evolution can lead to sampling bias. Acute ulceronecrotic forms and the presence of a variable degree of cellular atypia in the infiltrate are liable to cause differential diagnostic problems with lymphomatoid papulosis (LP), which cannot be completely resolved on the basis of T‐cell receptor clonal rearrangement detection.
Dermatosis in a Child with Kwashiorkor Secondary to Food Aversion
Authors: Eastlack Jennifer P. , Grande Kimberly K. , Levy Moise L. , Nigro James F.
Published: March 2003

Kwashiorkor is a common affliction of children worldwide. It occurs less often in developed countries, but has been reported under a variety of circumstances, including poverty, neurologic disease, and mal‐absorption. Because of its rare occurrence in the United States and because the affected child has an edematous rather than wasted appearance, physicians often do not consider it as a diagnostic entity. This article describes a case of kwashiorkor in a child with food aversion that manifested as “flaky paint dermatitis.” Our discussion will attempt to delineate underlying conditions that may predispose to kwashiorkor. In addition, biochemical and cellular etiologic factors that may be linked with classical and nonclassical skin findings of kwashiorkor are considered. Finally, we present a differential diagnosis for any child with a generalized eczematous or desquamative rash. Our aim is to increase the ability of health care providers to identify and treat children with kwashiorkor in a timely manner.
Prepubertal Hidradenitis Suppurativa: Two Case Reports and Review of the Literature
Authors: Mengesha Yebabe M. , Holcombe Travis C. , Hansen Ronald C.
Published: March 2003

Abstract: Hidradenitis suppurativa (HS) is a chronic suppurative scarring disease of apocrine sweat gland‐bearing skin in the axillary, anogenital, and, rarely, the breast and scalp regions. Females are more commonly affected than males and it is usually seen at puberty or later. We report two girls with prepubertal hidradenitis suppurativa whose initial presentation predated any signs of puberty. This early onset is very rare and its etiology remains unknown. Severe disease can be seen in prepubertal children and surgical intervention is effective in these cases.
Complications of Minocycline Therapy for Acne Vulgaris: Case Reports and Review of the Literature
Authors: Somech Raz , Arav‐Boger Ravit , Assia Ayala , Spirer Zvi , Jurgenson Uri
Published: March 2003

Abstract: In order to raise the awareness of the potential side effects that can be induced by minocycline, we report three adolescent girls who experienced serious adverse reactions to this therapy, which was prescribed for acne vulgaris.
Transient Beneficial Effect of GH Replacement Therapy and Topical GH Application on Skin Ulcers in a Boy with Prolidase Deficiency
Authors: Monafo Virginia , Marseglia Gian Luigi , Maghnie Mohamad , Dyne Katherine M. , Cetta Giuseppe
Published: March 2003

Abstract: A diagnostic examination for short stature in a boy with chronic ulcers of the feet due to prolidase deficiency, a rare disorder associated with intractable ulcers of the skin, led to the diagnosis of growth hormone (GH) deficiency. Replacement treatment with r‐hGH associated with the topical application of a GH‐containing ointment when the boy was 13 years old resulted in complete but transitory healing of the ulcers, which can probably be attributed to the growth‐promoting effects of GH on dermal connective tissue.
An Ultrastructural Study of Lipodystrophia Centrifugalis Abdominalis Infantilis, with Special Reference to Fibrous Long‐Spacing Collagen
Authors: Kagoura Masayori , Toyoda Masahiko , Matsui Chihiro , Higaki Shuichi , Morohashi Masaaki
Published: March 2003

Abstract: Lipodystrophia centrifugalis abdominalis infantilis (LCAI) in a 2.5‐year‐old Japanese girl is reported. Clinically she had a curved cutaneous depression with a slightly elevated erythematous border on the left abdomen beyond the left groin. The regional lymph node was palpable. Histologic examination showed a decrease of the fat, an inflammatory infiltrate mainly composed of lymphocytes, and septal fibrosis in the subcutaneous tissue. Immunohistochemical analysis found that infiltrating lymphocytes were mainly positive against CD4. Ultrastructurally nuclei in the adipocytes were crescent shaped and located toward the periphery of the cell. Some banded structures with a periodicity of 150 nm, and with intraperiodic bands, referred to as fibrous long‐spacing collagen (FLSC), were observed in the septal area of the fatty tissue. These results indicated that FLSC was correlated with the breakdown of fibrillar collagens in LCAI.
Calcified Cutaneous Nodules on the Heels of Children: A Complication of Heel Sticks as a Neonate
Authors: Williamson D. , Holt P. J. A.
Published: March 2003

Abstract: We report the presence of calcified nodules on the heels secondary to heel sticks in healthy monozygotic twins in childhood. The subjects were born preterm at 34 weeks. The heels were normal at birth. While in the hospital, they underwent multiple heel sticks as a means of venesection. The wounds failed to heal normally and warty lesions developed. Calcified cutaneous nodules secondary to heel sticks have been reported primarily in high‐risk, preterm infants. There have also been two reports of their development in normal healthy infants. To date, all reported lesions have been asymptomatic, with spontaneous resolution by 18–30 months. These cases indicate that such lesions can in fact be chronic, extending into childhood, when they may become symptomatic. Dermatologists should therefore consider this diagnosis as a cause of warty, calcified nodules on the heel in childhood as well as in infants and in neonates.
Familial Cutaneous Mastocytosis
Authors: Chang Anwell , Tung Rebecca C. , Schlesinger Todd , Bergfeld Wilma F. , Dijkstra Jacob , Kahn Teri A.
Published: March 2003

Cutaneous mastocytosis appears to occur sporadically; however, familial inheritance has been reported in 50 families since the mid‐1880s. We report four cases of telangiectasia macularis eruptiva perstans (TMEP) occurring in three generations of a family. Whereas most patients with TMEP manifest in adulthood, all of the members of this family developed initial lesions during childhood. This is the third documented instance of familial mastocytosis affecting members of three generations, and the first report of familial TMEP. Although the inheritance pattern is unknown, the presentation of disease in this family further supports the hypothesis of an autosomal dominant mode of transmission with incomplete penetrance.
Kikuchi Disease with Facial Rash and Erythema Multiforme
Authors: Kaur Sukhjot , Thami Gurvinder P. , Mohan Harsh , Kanwar Amrinder J.
Published: March 2003

Kikuchi disease, or histiocytic necrotizing lymphadenitis, is a benign illness characterized by fever and cervical lymphadenopathy predominantly in young women. It has a self‐limiting course. Skin changes occur in about one‐third of patients and are of a nonspecific nature. A case of Kikuchi disease with cutaneous involvement in the guise of erythema multiforme and a facial rash is reported. The differential diagnosis with systemic lupus erythematosus and Rowell syndrome is discussed.
Neutrophilic Dermatoses in Two Children with Idiopathic Neutropenia: Association with Granulocyte Colony‐Stimulating Factor (G‐CSF) Therapy
Authors: Prendiville Julie , Thiessen Paul , Mallory Susan B.
Published: March 2003

Painful neutrophilic skin lesions were observed in two children receiving granulocyte colony‐stimulating factor (G‐CSF) for treatment of idiopathic neutropenia. A girl with cystic fibrosis and cyclic neutropenia developed an erythematous papular eruption without fever or neutrophilia 7 months after commencing therapy with G‐CSF. A skin biopsy specimen revealed microscopic, sterile, neutrophilic abscesses. A boy with chronic neutropenia and recurrent inflammatory skin lesions developed multiple erythematous nodules following administration of G‐CSF. A biopsy specimen showed neutrophilic panniculitis. We believe that these skin eruptions belong to a spectrum of neutrophilic dermatoses that can be induced or aggravated by G‐CSF therapy.
Lymphangioma Circumscriptum Treated with Pulsed Dye Laser
Authors: Lai Chan‐Ho , Hanson Sonali G. , Mallory Susan Bayliss
Published: March 2003

Lymphangioma circumscriptum is a lymphatic malformation that involves the skin and may extend to subcutaneous tissue and muscle. Treatment of these lesions is challenging. Surgical excision may be performed but recurrence is common. Herein we report a child with a symptomatic lymphangioma circumscriptum that was treated with pulsed dye laser with good results. For superficial lymphatic malformations containing blood, pulsed dye laser might be considered as a treatment option.
Sonographic Findings in a Series of Rapidly Involuting Congenital Hemangiomas (RICH)
Authors: Rogers Maureen , Lam Albert , Fischer Gayle
Published: March 2003

We report 10 patients with lesions consistent with the clinical entity of rapidly involuting congenital hemangioma (RICH). These are congenital vascular tumors bearing some resemblance to infantile hemangiomas, but with important clinical differences. The lesions in our patients were firm, red or purple plaques or tumors, sometimes with surface telangiectasia and almost all with a pale or blanched halo. They were fully developed at birth and underwent no further expansion. All promptly began to resolve and this progressed rapidly over the early months of life, with complete resolution, sometimes with residual atrophy, occurring at less than 1 year of age in most of the patients. Sonography was performed in all of our cases. A remarkably consistent picture was demonstrated. The lesions were uniformly hypoechoic and mostly confined to the subcutaneous fat. They were diffusely vascular, being traversed by multiple tubular vascular channels. Some of the channels were compressible, with a venous flow signal, while others demonstrated low resistant arterial flow. These features are consistent with recently described histopathologic findings in these rapidly involuting lesions. We feel that this entity can be reliably diagnosed in most cases with a consideration of the unique clinical features and with the use of noninvasive imaging studies.
Three Low Density Lipoprotein Apheresis Techniques in Treatment of Patients with Familial Hypercholesterolemia: A Long‐Term Evaluation
Authors: Richter Werner O. , Donner Markus G. , Schwandt Peter
Published: March 2003

Low density lipoprotein (LDL) apheresis is a treatment option for patients with severe hypercholesterolemia not adequately responding to drug treatment who have developed coronary heart disease. We regularly treated 18 patients with immunoadsorption, 8 with heparin induced extracorporeal LDL precipitation (HELP) and 8 with dextran sulfate adsorption for a mean of 4.6 ± 2.6 years. The effects on LDL cholesterol, high density lipoprotein (HDL) cholesterol, and lipoprotein (a) were comparable among all 3 techniques. Twelve patients were treated for longer than 5 years and 18 patients for longer than 3 years. The evaluation of coronary angiograms (23 patients) revealed a definite regression of coronary lesions in 3 patients; in all other patients, there was a halt in progression. Three patients suffered a sudden cardiac death and 1 patient a nonfatal myocardial infarction due to the occlusion of a coronary bypass. In 9 of 11 patients, no atherosclerotic lesions developed in the coronary bypasses. No severe side effect of either procedure was observed. In conclusion, aggressive lipid lowering by LDL apheresis can stabilize coronary atherosclerosis in most patients.
Immunoadsorption as a Tool for the Immunomodulation of the Humoral and Cellular Immune System in Autoimmune Disease
Authors: Braun Norbert , Risler Teut
Published: March 2003

Immunoadsorption onto staphylococcal protein A is a newly developed semiselective extracorporeal adsorption technique for immunoglobulins applied in patients suffering from severe autoimmune disease. Its effect on the humoral and cellular immune system was investigated using standard immunological assays. The elimination capacity for total IgG and IgG subclasses 1, 2, and 4 was more than 90% but for subclass IgG3 varied between 30 and 90%. Autoantibodies, e.g., anti‐dsDNA, anti‐glomerular basement membrane (anti‐GBM), anti‐cardiolipin, and anti‐human leukocyte antigen (anti‐HLA) antibodies, were eliminated in comparable amounts. The affinity of protein A for circulating immune complexes (CIC) was 300 times greater than for soluble IgG. HLA‐II expression on monocytes and T lymphocytes was reduced over time during repeated IAs (IA). The number of activated T lymphocytes declined while the percentage of naive T cells increased. A diminished CD4/CD8 ratio normalized during IA treatment. These results indicate that IA actively modulates the humoral as well as the cellular immune system in addition to its immunoglobulin reducing effect.
The Role of Immunoadsorption Using Dextran‐Sulfate Cellulose Columns in the Treatment of Systemic Lupus Erythematosus
Authors: Suzuki Kimihiro
Published: March 2003

Abstract: Immunoadsorption using dextran sulfate (DS)‐cellulose columns is reviewed. An extracorporeal selective adsorption system using such columns has been developed and clinically used to remove anti‐DNA from the circulating blood of systemic lupus erythematosus (SLE) patients. These columns can adsorb pathogenic anti‐DNA subgroups of high avidity and/or cationic antibodies, anticardiolipin, anti‐CLβ2GPI, and anaphylatoxins. An open clinical study on 19 SLE cases (the mean number of apheresis sessions totaled 3.7 times; the mean dose of prednisolone, 38 mg/day) revealed that the mean SLE disease activity index (SLEDAI) score significantly decreased from the pretreatment level of 10.2 to 4.5 after treatment. Several case reports have indicated that this modality might also be useful for treating patients with antiphospholipid syndrome. Compartment model analyses showed the one‐compartment model to be the most suitable for the kinetics of anti‐DNA during and following the apheresis procedure. The indications for immunoadsorption in the treatment of SLE remain controversial. A steroid‐sparing effect might be one of them, but further controlled studies are necessary to verify this hypothesis.
Plasmapheresis in the Treatment of Amanita Phalloides Poisoning: II. A Review and Recommendations
Authors: Jander S. , Bischoff J. , Woodcock B.G.
Published: March 2003

Abstract: Amanita phalloides poisoning is the most common cause of lethal mushroom poisoning (lethality >20% in adults, >50% in children). However, there is no standard treatment strategy and no antidote against the ensuing hepatic failure. This review of 14 investigations published over the last 20 years shows that the introduction of detoxification techniques, in particular the use of plasmapheresis, in combination with supportive therapy to prevent the absorption of aminitine toxins into blood, produced a substantial reduction in mortality. The main complications in using these techniques include infections and coagulation disorders. Because of the latency period in the development of symptoms, treatment should begin on the first suspicion that an intoxication is present. The best therapeutic results can be expected when the detoxification techniques are applied in combination with conservative therapies within the first 36–48 h. Using this approach, mortality rates in some recent studies have been below 10%.
Comparison of Different Treatment Regimens in a Case of Homozygous Familial Hypercholesterolemia
Authors: Palcoux Jean‐Bernard , Meyer Martine , Jouanel Pierre , Vanlieferinghen Philippe , Malpuech Georges
Published: March 2003

Abstract: The laboratory results of five periods of different treatment regimens were compared in a 19‐year‐old girl with homozygous familial hypercholesterolemia (FH): weekly low‐density lipoprotein (LDL) apheresis sessions with dextran sulfate columns (LA 15, Kaneka Corporation, Osaka, Japan) without statin administration; weekly LDL apheresis with polyacrylate columns (DALI, Fresenius Adsorber Technology, Bad Homburg, Germany) without statin; LDL apheresis as in Period 2 with 40 mg atorvastatin daily; LDL apheresis as in Period 2 with 80 mg atorvastatin daily; and fortnightly LDL apheresis sessions with polyacrilate and administration of 80 mg atorvastatin daily. The five treatments were given in the above order, and each lasted at least 2 months. To compare the effectiveness of the different methods, the blood levels of total cholesterol, LDL‐cholesterol and high‐density lipoprotein (HDL)‐cholesterol were measured before each session, and the percentage decreases in the blood levels of total cholesterol and LDL‐cholesterol were recorded during sessions in Periods 1 and 2. In Periods 1 and 2, the biological effectiveness of LDL apheresis was comparable. Atorvastatin (40 mg daily) improved the blood levels of total cholesterol and LDL‐cholesterol, but lowered HDL‐cholesterol values. Increasing the daily dose of atorvastatin from 40 mg to 80 mg did not significantly improve LDL‐cholesterol levels. When the time between two sessions was longer (Period 5), the total cholesterol and LDL‐cholesterol values worsened and were comparable to those of Period 2 during which there was no atorvastatin treatment. In this case of homozygous FH, weekly sessions of LDL apheresis in association with atorvastatin at dose of 40 mg per day gave the best results.
Restoration of Biogeochemical Function in Mangrove Forests
Authors: McKee Karen L. , Faulkner Patricia L.
Published: March 2003

Forest structure of mangrove restoration sites (6 and 14 years old) at two locations (Henderson Creek [HC] and Windstar [WS]) in southwest Florida differed from that of mixed‐basin forests (>50 years old) with which they were once contiguous. However, the younger site (HC) was typical of natural, developing forests, whereas the older site (WS) was less well developed with low structural complexity. More stressful physicochemical conditions resulting from incomplete tidal flushing (elevated salinity) and variable topography (waterlogging) apparently affected plant survival and growth at the WS restoration site. Lower leaf fall and root production rates at the WS restoration site, compared with that at HC were partly attributable to differences in hydroedaphic conditions and structural development. However, leaf and root inputs at each restoration site were not significantly different from that in reference forests within the same physiographic setting. Macrofaunal consumption of tethered leaves also did not differ with site history, but was dramatically higher at HC compared with WS, reflecting local variation in leaf litter processing rates, primarily by snails (Melampus coffeus). Degradation of leaves and roots in mesh bags was slow overall at restoration sites, however, particularly at WS where aerobic decomposition may have been more limited. These findings indicate that local or regional factors such as salinity regime act together with site history to control primary production and turnover rates of organic matter in restoration sites. Species differences in senescent leaf nitrogen content and degradation rates further suggest that restoration sites dominated by Laguncularia racemosa and Rhizophora mangle should exhibit slower recycling of nutrients compared with natural basin forests where Avicennia germinans is more abundant. Structural development and biogeochemical functioning of restored mangrove forests thus depend on a number of factors, but site‐specific as well as regional or local differences in hydrology and concomitant factors such as salinity and soil waterlogging will have a strong influence over the outcome of restoration projects.
Some Remarks on the Socio‐Cultural Background of Restoration Ecology
Authors: Pfadenhauer Jörg
Published: March 2003

Restoration ecology plays an important role in nature conservation policy in Europe today. It establishes the scientific basis for restoring ecosystems altered or destroyed by man to a more “natural” state. The goals of restoration ecology can generally be described in terms of increased biodiversity, enhanced water retention capacity, avoidance of soil erosion, etc. In practice, however, a discrepancy exists between the high ideals of restoration goals and reality, where one often encounters limiting factors. These limiting factors can include the conflict between different restoration goals, the unpredictability of restoration goals owing to long‐term effects and stochastic events, the insufficient social acceptance of landscape changes during restoration processes, and the use of restoration processes themselves (e.g., undisturbed succession, certain management measures like impoverishment of fertilized areas) as restoration goals in place of a certain resource quality (such as species composition, population sizes, water quality). Two examples from southern Germany show that restoration goals in European cultural landscapes can only be implemented successfully when they are integrated into the respective land use systems.