bluuebunny/crossref_metadata_2025 huggingface dataset:
A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension
Authors: Iannello Silvia , Libertini Luciano , Martini Romeo , Spina Sebastiano , Busacca Giancarlo , Ricciardi Nunziato , Andreozzi Giuseppe , Belfiore Francesco
Published: April 2003

The aim of this paper is to describe and discuss, on the basis of a thorough review of the literature, the case of a 70-year-old woman with probable cirrhosis secondary to chronic hepatitis B and C, uncomplicated portal hypertension (without ascites, encephalopathy or bleeding varices), splenomegaly and hypersplenism, and an unusual, spontaneous, large splenorenal shunt and recanalization of the umbilical vein. The tortuous and varicose splenorenal shunt was diagnosed by abdominal ultrasound and CT investigations. A duplex Doppler ultrasonography evaluation was performed to study shunt flow direction and velocity. No gastroesophageal varices were identified on endoscopic examination. The clinical relevance of spontaneous splenorenal shunt, often associated with fundic gastric varices, is discussed.
New Perspectives in Gastric Acid Suppression: Genetic Polymorphisms Predict the Efficacy of Proton Pump Inhibitors
Authors: Egan Laurence , Murray Joseph
Published: April 2003

Proton pump inhibitors are highly effective in the management of acid-peptic diseases. These drugs potently inhibit acid secretion from gastric parietal cells by irreversibly inhibiting activity of the H+, K+ ATPase (proton pump). Early studies of the pharmacokinetics of proton pump inhibitors demonstrated considerable variation in drug clearance rates among patients and healthy volunteers. This variation was also reflected in a wide range of the efficacy of acid suppression by standard doses of proton pump inhibitors among study subjects; those with slower clearance and higher drug concentrations experienced superior acid suppression. Proton pump inhibitors are predominantly inactivated by the 2C19 isoform of the hepatic cytochrome P450 mixed function oxidase system. The cytochrome P450 2C19 gene is polymorphic, with three known inactivating mutations. Individuals with one or two mutant cytochrome P450 2C19 alleles metabolize proton pump inhibitors more slowly than those with two wild-type alleles and experience higher drug levels. An individual’s cytochrome P450 2C19 genotype predicts the degree of acid suppression in response to a standard dose of a proton pump inhibitor. Emerging data suggests that the clinical effectiveness of proton pump inhibitors in the treatment of acid-peptic diseases may also be dependent on cytochrome P450 2C19 genotype.
Topographic Esophageal Manometry: An Emerging Clinical and Investigative Approach
Authors: Clouse Ray , Prakash Chandra
Published: April 2003

Topographic esophageal manometry utilizes an increased number of pressure sensors and three-dimensional displays to fully reveal the pressure continuum representing peristalsis. The techniques demonstrate that peristalsis is comprised of a chain of pressure segments, beginning at the upper esophageal sphincter and continuing through lower sphincter aftercontraction. Topographic methods have already proven useful in both research and clinical settings. Description of the techniques, the topographic representation of normal and abnormal esophageal motility, and advantages of topography over conventional manometric methods are discussed in this review.
Fecal Occult Blood Testing for Iron Deficiency: A Reappraisal
Authors: Harewood Gavin , Ahlquist David
Published: April 2003

Fecal occult blood (FOB) tests have been evaluated primarily for the application of colorectal cancer screening. Less is known about the performance characteristics of FOB tests for the evaluation of iron deficiency, the most common other application. As most clinically important occult gastrointestinal bleeding arises from the proximal gut, it is critical that FOB tests target analytes that are stable during the enteric transit. Available data indicate that guaiac-type and immunochemical tests are insensitive for the detection of proximal gut bleeding, and their use may confound the evaluation of iron deficiency. In contrast, the heme porphyrin test is sensitive for both proximal and distal sources of occult gastrointestinal bleeding, and this FOB test would appear to be the most rational selection for use in patients with iron deficiency or anemia. Outcome data are needed to better assess the impact of FOB testing on algorithms for evaluation of iron deficiency.
Chronic Intestinal Pseudo-Obstruction
Authors: Hirano Ikuo , Pandolfino John
Published: April 2003

Chronic intestinal pseudo-obstruction (CIPO) is a syndrome defined by the presence of chronic intestinal dilation and dysmotility in the absence of mechanical obstruction or gross inflammatory disease. Specific diseases may affect any level of the brain-gut axis. For most patients, the diagnosis relies upon a combination of historical, laboratory, manometric and histological features. Recent advances into the autoimmune nature of etiologies such as Chagas’ disease and paraneoplastic dysmotility and into the genetic basis of mitochondrial neurogastrointestinal encephalomyopathy, multiple endocrine neoplasia IIB and Hirschsprung’s disease have greatly refined our understanding and diagnosis of these disorders. At present, medical therapy of CIPO remains limited. Current and future developments in pharmacologic agents targeting specific enteric neurotransmitters and motility patterns hold much promise for improving the care of the patients afflicted with this complex and often debilitating syndrome.
The Validity of the MMSE and SMQ as Screening Tests for Dementia in the Elderly General Population – A Study of One Rural Community in Japan
Authors: Maki Naruhiko , Ikeda Manabu , Hokoishi Kazuhiko , Nebu Akihiko , Komori Kenjiro , Hirono Nobutsugu , Tanabe Hirotaka
Published: April 2003

Objective: To compare the validity of the Mini Mental State Examination (MMSE) and the Short-Memory Questionnaire (SMQ) as screening tests to detect dementia in the elderly general population. Subjects: Six hundred and sixty-two subjects and their informants from the elderly general population sample who had completed these tests. Setting: One rural community survey in Japan. Method: We used receiver-operating characteristic analysis to compare the performance of the MMSE and the SMQ with the clinical diagnosis of dementia according to DSM-III-R. Results: The areas under the receiver-operating characteristic curve of the MMSE and the SMQ were 0.980 (SE = 0.006) and 0.982 (SE = 0.008), respectively. This differed from chance to a highly significant degree for both the MMSE and the SMQ, but the difference between the two scales was not statistically significant. Conclusion: As screening tests to detect dementia in the elderly general population, the SMQ which is assessed by informants demonstrates a statistically significant discriminating ability as well as the MMSE.
Detection of Dementia in Primary Care: The Linköping Study
Authors: Ólafsdóttir María , Skoog Ingmar , Marcusson Jan
Published: April 2003

We examined to what extent dementia and cognitive impairment are detected in a primary health care centre. A systematic sample of patients aged 70 years and above, who attended a primary health care centre for a doctor’s consultation (n = 350) were examined with a neuropsychiatric examination and an interview with a close informant. Dementia was diagnosed according to DSM-III-R. Medical records from the health centre were examined for entries on cognitive decline or dementia, other diagnoses and prescribed drugs. The prevalence of dementia was 16.3% and a further 3.1% had questionable dementia. Cognitive disturbances or dementia were noted in case records in 15 out of 57 (26%) demented cases, and in 1 out of 11 (9%) questionable dementias. Compared to non-demented patients, the demented had more diagnoses and a higher number of prescribed drugs. Severity and duration of dementia were associated with an increased detection.
Prenatal Exposure to the Pesticide Dieldrin or the GABAA Receptor Antagonist Bicuculline Differentially Alters Expression of GABAA Receptor Subunit mRNAs in Fetal Rat Brainstem
Authors: Liu Jiangping , Brannen Kimberly C. , Grayson Dennis R. , Morrow A. Leslie , Devaud Leslie L. , Lauder Jean M.
Published: April 2003

We have previously shown that GABA acts as a trophic signal for monoamine neurons in embryonic day 14 (E14) rat brainstem cultures [Liu et al., J Neurosci 1997a;17:2420–2428]. The organochlorine pesticide dieldrin and the classical GABAA receptor antagonist bicuculline interfere with the trophic actions of GABA and alter expression of several GABAA receptor subunit mRNA transcripts in these cultures [Liu et al., J Neurosci Res 1997b;49:645–653]. In the present study, we investigated whether prenatal exposure to dieldrin or bicuculline from E12–17 would alter mRNA expression of α1, β3, γ1, γ2S and γ2L GABAA receptor subunits in fetal (E17) rat brainstem using competitive RT-PCR to absolutely quantify these transcripts. The effects of dieldrin and bicuculline on expression of GABAA receptor subunit transcripts were similar across subunits. Dieldrin and bicuculline decreased expression of α1, β3 and γ1 transcripts compared to vehicle-injected controls, but did not significantly alter expression of γ2S and γ2L transcripts. Taken together, these studies indicate that in utero exposure to organochlorine pesticides acting as GABAA receptor antagonists may alter the expression and subunit composition of developing GABAA receptors. If these changes persist, they could have long-lasting effects on developing GABAergic neural circuitry, GABAA receptor function and GABA-mediated behaviors.
Dopamine Receptors and Dopamine Transporter in Brain Function and Addictive Behaviors: Insights from Targeted Mouse Mutants
Authors: Drago John , Padungchaichot Poolpol , Accili Domenico , Fuchs Sara
Published: April 2003

Recent advances in molecular biology have resulted in a number of genetically manipulated mice with defined changes at dopamine receptor and the dopamine transporter (DAT) loci. Mice with targeted mutations at the D1 receptor (D1R) are growth-retarded and show downregulated expression of dynorphin and substance P. Behavioral assessment indicates that mutants have deficiencies in spatial learning and initiating movement, as well as in responding to novel stimuli. D1R mutants do not become locomotor activated with cocaine or show upregulated immediate early gene (IEG) expression, but D2 receptor-dependent IEG changes are intact. Acute cocaine administration increases substance P levels, suggesting that striatal expression of this neuropeptide can be modulated by D1R-independent processes. Failure of locomotor activation is also seen with repeated amphetamine treatment. Surprisingly, D1R-deficient mice retain cocaine-conditioned place preference. In contrast, D2 receptor knockout mice are bradykinetic, show increased striatal enkephalin expression and an absence of opiate rewarding effects. D3 receptor mutants are hyperactive when assessed in an exploratory assay and display reduced anxiety-associated behavior in an elevated plus maze test. The recently described D4 receptor homozygous mutants exhibit a reduction in baseline locomotor activity and were shown to be supersensitive to the locomotor activating effects of alcohol and psychostimulant drugs. As expected, DAT knockout mice are hyperactive and do not respond to cocaine or amphetamine. The observation that D2 and D4 dopamine receptor and DAT mutants show compensatory effects, together with the complicating issue of their hybrid genetic background may temper conclusions regarding the direct effects of the targeted mutation on phenotype.
Evidence for a Central Cholinergic Deficit in Congenital Ornithine Transcarbamylase Deficiency
Authors: Butterworth R.F.
Published: April 2003

Congenital ornithine transcarbamylase (OTC) deficiency is the most common inborn error of urea cycle enzymes in humans. A large percentage of survivors of neonatal OTC deficiency suffer severe developmental disorders, including seizures, mental retardation and cerebral palsy. Neuropathological studies reveal ventricular enlargement, cerebral atrophy and delayed myelination, as well as Alzheimer type II astrocytosis. Using the sparse-fur (spf) mouse model of congenital OTC deficiency, studies of central cholinergic integrity revealed a developmental delay in choline acetyltransferase activity and of high-affinity [3H]-choline uptake in several brain structures. Subsequent studies of muscarinic cholinergic binding site distribution showed a widespread loss of M1 sites, consistent with cholinergic cell loss. These alterations are similar to those reported in Alzheimer’s disease, suggesting that the severe cognitive dysfunction in congenital OTC deficiency may at least partly result from a muscarinic cholinergic lesion. Possible mechanisms involved in the pathogenesis of cholinergic cell loss in congenital OTC deficiency include ammonia-induced inhibition of pyruvate and α-oxoglutarate oxidation, resulting in decreased synthesis of acetyl CoA and a cerebral energy deficit, as well as NMDA receptor-mediated excitotoxicity. Treatment of spf mice with acetyl-L-carnitine (ALCAR) results in partial recovery of the developmental choline acetyltransferase deficit, suggesting a potential therapeutic benefit of ALCAR in congenital OTC deficiency. Other therapies currently used include ammonia-lowering strategies (using sodium benzoate or sodium phenylacetate) and, in severe cases, liver transplantation.
Serotonin Receptor Agonists That Increase Cyclic AMP Positively Regulate IGF-I in Mouse Mandibular Mesenchymal Cells
Authors: Lambert H. Wayne , Lauder Jean M.
Published: April 2003

Evidence from the present study suggests that activation of both 5-HT1A and 5-HT4 (5-hydroxytryptamine) receptor subtypes stimulates cyclic adenosine monophosphate (cAMP) synthesis in cultured embryonic mouse mandibular mesenchymal cells (micromass cultures). When these cells were grown in serum-free medium and treated with 10–8 M agonist selective for either the 5-HT1A or 5-HT4 receptor subtype (8-OH-DPAT and SC53116, respectively), this significantly stimulated cAMP synthesis and increased insulin-like growth factor I (IGF-I), but not IGF-II, protein levels compared to vehicle-treated controls, as measured by semi-quantitative immunobinding assays. Consistent with these results, IGF-I was significantly decreased when mandibular mesenchymal cells were grown in serum-containing medium (which contains micromolar amounts of 5-HT from fetal calf serum) and treated with 10–8 M antagonist selective for the 5-HT1A or 5-HT4 receptor subtype (NAN-190 on SDZ-205,557). Forskolin also stimulated cAMP and IGF-I (but not IGF-II) in both serum-containing and serum-free cultures. These results indicate that activation of 5-HT receptors that increase cAMP promotes synthesis of IGF-I. This may occur by activation of the cAMP response element sequence present in the IGF-I promoter region. Stimulation of the adenylyl cyclase pathway by activation of 5-HT1A or 5-HT4 receptors may be one mechanism by which serotonin regulates IGF-I synthesis in developing craniofacial mesenchymal cells.
Activation of Microglia during Developmentally Regulated Cell Death in the Cerebral Cortex
Authors: Upender Madhvi B. , Naegele Janice R.
Published: April 2003

Neuronal elimination in the developing CNS is accomplished by an orderly type of cellular suicide called programmed cell death. The principal non-neuronal cells implicated in regulating programmed cell death and subsequent phagocytosis of dying neurons are the brain’s macrophage population, the microglia. Little is known about the signaling between microglia and neurons during programmed cell death. However, macrophages in non-neural tissues express receptors for immunoglobulin (IgG) and complement, and these molecules help regulate phagocytosis of dying cells and foreign organisms. Since many of the neurons generated early in CNS development are transient cell types that are immunoreactive for IgG [Upender et al.: J Comp Neurol 1997; 384:271–282], we hypothesized that IgG might alter the phagocytic properties of microglia within the developing nervous system and potentiate engulfment of dying cells. To begin to address this hypothesis, we first asked whether cortical neurons immunoreactive for IgG or calbindin-D28k exhibit morphological evidence of programmed cell death in the cerebral cortex of neonatal rat pups. Secondly, we quantified the incidence of contacts made by microglia on IgG- vs. calbindin-immunoreactive neurons. Thirdly, perturbation experiments were performed to elevate intracortical levels of IgG and the incidence of microglia:neuron contacts were determined. We found that although the nuclei of some IgG-immunoreactive neurons exhibited condensation and fragmentation characteristic of programmed cell death, we did not observe pyknotic calbindin-immunoreactive neurons. IgG-immunoreactive neurons were also more likely to be contacted by microglia than calbindin-immunoreactive neurons. Elevating intracortical levels of IgG experimentally led to a dramatic increase in the expression of microglia complement receptors throughout the cerebral cortex. Taken together, these results suggest that IgG normally present within neuronal subsets in the developing cerebral cortex could serve to locally regulate the expression of complement receptors on microglia.
Lysine-Rich Histone (H1) Is a Lysyl Substrate of Tissue Transglutaminase: Possible Involvement of Transglutaminase in the Formation of Nuclear Aggregates in (CAG)n/Qn Expansion Diseases
Authors: Cooper Arthur J.L. , Wang Jianping , Pasternack Ralf , Fuchsbauer Hans-Lothar , Sheu Rex K.-F. , Blass John P.
Published: April 2003

Histone H1, which contains about 27% lysine, is an excellent lysyl donor substrate of Ca2+-activated guinea pig liver tissue transglutaminase as judged by rapid fluorescence enhancement in the presence of the glutaminyl-donor substrate 1-N-(carbobenzoxy-L-glutaminylglycyl)-5-N-(5′N′N′-dimethylaminonaphthalenesulfonyl) diamidopentane. Sodium dodecyl sulfate gel electrophoresis of a 30-min reaction mixture revealed the presence of fluorescent high-Mr aggregates, which are also formed when histone H1 is incubated solely with activated tissue transglutaminase. Aggregate formation is even more pronounced when histone H1 is incubated with activated tissue transglutaminase and dimethylcasein (glutaminyl donor only). The findings suggest not only that histone H1 is an especially good lysyl substrate of tissue transglutaminase, but that it is also a glutaminyl substrate. Histone H1 is a good lysyl substrate of transglutaminase purified from Streptoverticillium mobaraense, suggesting that the ability of histone H1 to act as a transglutaminase lysyl substrate is widespread. In agreement with previous studies, it was found that human β-endorphin is a moderately good substrate of tissue transglutaminase. At least 8 neurodegenerative diseases, including Huntington’s disease, are caused by (CAG)n expansions in the genome and by an expansion of the corresponding polyglutamine domain within the expressed, mutated protein. Polyglutamine domains are excellent substrates of liver and brain transglutaminases. A hallmark of many of the (CAG)n/polyglutamine expansion diseases is the presence of polyglutamine-containing aggregates within the cytosol and nuclei of affected neurons. Transglutaminase activity occurs in both of these compartments in human brain. In future studies, it will be important to determine whether transglutaminases play a role in (1) cross-linking of histone H1 to glutaminyl donors (including polyglutamine domains) in nuclear chromatin, (2) the formation of nuclear aggregates in (CAG)n/polyglutamine expansion diseases, (3) DNA laddering and cell death in neurodegenerative diseases and (4) depletion of neuropeptides in vulnerable regions of Huntington’s disease brain.
Non-Invasive Methods for Studying Brain Energy Metabolism: What They Show and What It Means
Authors: Kemp G.J.
Published: April 2003

This review summarises the ways in which magnetic resonance spectroscopy (MRS) and related methods can be used as windows on brain energy metabolism in vivo. 31P-MRS can measure acute changes in non-oxidative ATP synthesis in transient states, and at steady state reflects the balance of ATP demand and mitochondrial function. 13C-MRS labelling methods can measure a variety of carbon fluxes. The few 31P- and 13C-MRS studies of the response to functional activation suggest quite large increases in oxidative metabolism. Functional magnetic resonance imaging measures the hyperoxygenation that results from increase in cerebral blood flow in excess of glucose oxidation, attenuated somewhat by a smaller increase in oxygen consumption. Previous positron emission tomography studies disagree on the size of activation response. These are powerful but demanding techniques, valuable in understanding both normal physiology and pathophysiology. However, discrepancies remain to be reconciled, and this will require increasing sophistication of both techniques and analytical models.
Carcinoma of the Glans penis Arising 20 Years after Lichen sclerosus
Authors: Simonart T. , Noel J.C. , De Dobbeleer G. , Simonart J.M.
Published: April 2003

Lichen sclerosus (LS) is an inflammatory disease of incompletely characterized pathogenesis. The relation between LS and carcinoma is well known in women, but in men it is still a matter of debate whether LS is a premalignant lesion or not. We describe a case of LS of the glans penis which occurred in 1976. Within the next 20 years, the patient developed carcinoma at this site.
Low-Dose Narrow-Band UVB Phototherapy Combined with Topical Therapy Is Effective in Psoriasis and Does Not Inhibit Systemic T-Cell Activation
Authors: de Rie M.A. , Out T.A. , Bos J.D.
Published: April 2003

Background: Psoriasis is a chronic T-cell-mediated inflammatory skin disease which can be treated with topical medication, phototherapy or systemic medication. A subgroup of psoriatic patients does not respond to monotherapy and needs combination therapy. We used low-dose narrow-band UVB phototherapy, combined with balneotherapy, short-contact anthralin, liquor carbonis detergens and calcipotriol for treatment of psoriatic patients in our day care centre. Objective: Our purpose was to study the efficacy, induction of erythema and effect on systemic T-cell activation of this combination therapy. Methods: Skin reflectance spectrophotometry was used to measure skin erythema. The Psoriasis Area and Severity Index (PASI) was used to evaluate psoriatic patients. Serum soluble IL-2 receptor (sIL2-R) levels were measured by an ELISA. Results: The possible erythematogenic effect of low-dose narrow-band UVB irradiation was studied (skin reflectance spectrophotometer) in a control group of psoriatic patients (n = 11). No induction of skin erythema was seen. Subsequently, this low-dose irradiation regimen was used in combination with topical medication in 26 psoriatic patients. A 90% decrease in the PASI was seen after a mean number of 35 treatment sessions. Seventeen patients (65%) remained in remission during the following 6 months. Serum sIL-2R levels were elevated in all patients (mean 913 U/ml) and did not change during treatment. Conclusion: Our data indicate that low-dose narrow-band UVB can be used successfully, in combination with topical treatment, in a day care setting to treat psoriatic patients. Since sIL-2R serum levels were not decreased, it can be speculated that this treatment does not induce systemic immunosuppression.
Malignant Melanoma Developing from an Intradermal Nevus
Authors: Hashiro M. , Miyamoto T. , Sonoda S. , Okumura M.
Published: April 2003

A 58-year-old man presented a black nodule with satellites located in the left upper region of the umbilicus. Clinical history and microscopic findings led us to diagnose it as a malignant melanoma developing from an intradermal nevus. Histopathologically, melanoma cells developed upward from the nest of the intradermal nevus and no junctional activity was shown. Cases of malignant melanoma arising from an intradermal nevus have rarely been reported. Moreover, previously reported cases showed melanoma cells beneath the intradermal nevus.
Low-Productive Alpha-Herpesviridae Infection in Chronic Lichenoid Dermatoses
Authors: Nikkels A.F. , Sadzot-Delvaux C. , Rentier B. , Piérard-Franchimont C. , Piérard G.E.
Published: April 2003

Background: Herpes simplex virus (HSV) and Varicella-zoster virus (VZV) are responsible for various atypical mucocutaneous manifestations in the immunosuppressed population. One of the causative pathomechanisms suggests an altered virus-host cell relationship. Objective/Methods: This report investigates by histology, immunohistochemistry and in situ hybridization the histological and virological features of 6 protracted, indolent HSV infections and 2 prolonged zoster infections. Results: Histopathology revealed a lichenoid dermatitis in all patients. Specific HSV-1, HSV-2 and VZV in situ hybridization proved the viral origin of the cutaneous lesions. Immunohistochemical assessment demonstrated the intracellular presence of the HSV glycoproteins gB, gC and gD in epidermal keratinocytes which did not exhibit cytolysis. Similar findings were obtained for the VZV gE and gB. Conclusion: These results suggest that in some instances HSV and VZV infections may present a protracted disease course associated with a lichenoid inflammatory pattern and a non-cytolytic virus-host cell relationship.
Acne neonatorum and Familial Hyperandrogenism
Authors: Bekaert C. , Song M. , Delvigne A.
Published: April 2003

We report a case of acne neonatorum developed in a boy since birth. His mother and his aunt had different signs of hyperandrogenism including acne and hirsutism. This case illustrates the correlation between acne neonatorum and familial hyperandrogenism. It shows the importance of the family history and the eventual clinical and serological presence of hyperandrogenism in the mother when confronted with acne neonatorum.
Granulomatous Vulvitis, Granulomatous Cheilitis: A Single Diagnosis?
Authors: Thiriar S. , Deroux E. , Dourov N. , Evrard L. , Peny M.O. , Simon P. , Parent D.
Published: April 2003

We report two cases of labial swelling (oral and vulvar) with a granulomatous histology in patients with a history of Crohn’s disease. The differential diagnosis of granulomatous vulvitis and cheilitis, as well as the symptomatology and treatment of vulvar and oral Crohn’s disease are further discussed. To our knowledge, reported cases of vulvar and oral Crohn’s disease are quite scarce in the literature, but the disease might be underdiagnosed. We hope to contribute to an earlier recognition and a better management of the vulvar and oral mucocutaneous lesions of Crohn’s disease.
Prolactin: Does It Have a Role in the Pathogenesis of Psoriasis?
Authors: Giasuddin A.S.M. , El-Sherif A.I. , El-Ojali S.I.
Published: April 2003

Background: The aetiopathogenesis of psoriasis is still not fully understood. Recently, it has been reported that prolactin (PRL) exerts a proliferative effect on human keratinocytes in vitro. PRL may, therefore, play an important role in the pathogenesis of psoriasis. Objective: To assess the serum PRL level in patients with psoriasis vulgaris (PV). Methods: Serum levels of PRL were estimated in 12 patients with PV (age: 11–45 years with mean ± SD 30.4 ± 10.2 years; sex: 7 males, 5 females) and the results were compared with those in 9 patients with atopic dermatitis (age: 15–47 years with mean ± SD 28.1 ± 11.9 years; sex: 4 males, 5 females) and 20 normal control subjects (age: 16–45 years with mean ± SD 36.1 ± 11.9 years; sex: 15 males, 5 females). Results: Serum PRL in PV (mean ± SD 25.8 ± 16.1 ng/ml) was significantly higher compared to those in atopic dermatitis (mean ± SD 9.1 ± 4.7 ng/ml) and normal control subjects (mean ± SD 10.3 ± 5.3 ng/ml; ANOVA → p = 0.0008). Three patients with PV (2 males and 1 female with ages of 35, 40 and 11 years, respectively) had the highest serum levels well above the normal range but they were <100 ng/ml, the minimum limit for the diagnosis of prolactinoma (χ2 test → p <0.025). Conclusion: Since PRL belongs to the growth hormone family, its raised serum level may have a role in the hyperproliferation of kerationocytes in vivo, the hallmark of the psoriasis disease process.
Combination of PUVAsol and Topical Calcipotriol in Vitiligo
Authors: Parsad D. , Saini R. , Verma N.
Published: April 2003

Background: A large variety of therapeutic agents are being tried for the treatment of vitiligo, but psoralens continue to be mainstay of treatment although they are not uniformly effective. Recent advances in pathophysiology have established a perturbed calcium homeostasis in affected skin, and melanocytes were shown to express vitamin D3 receptors. Objective: The purpose of present study was to determine the efficacy of the combination of PUVAsol with topical calcipotriol in the treatment of vitiligo. Methods: Nineteen patients with essentially bilateral symmetrical lesions were enrolled in a randomized, double-blind, right/left comparative study of 18 months duration. An oral dose of 0.6 mg/kg 8-methoxypsoralen was given 2 h before exposure to sunlight thrice weekly to all patients. The patients were advised to apply calcipotriol (50 μg/g) on one side of the body and placebo ointment over the lesions on the other side twice daily. Results: At the end of 6 months, 12 patients (70%) showed marked to complete improvement on calcipotriol-treated sides as compared to 6 patients (35%) showing similar improvement on placebo-treated sides (p <0.05). At the end of treatment, 13 patients (76%) showed marked improvement in calcipotriol-treated lesions whereas 9 patients (53%) showed moderate to marked improvement in placebo-treated lesions. The repigmentation of hands and feet was much better with the combination of PUVAsol and calcipotriol. Conclusion: The combination of PUVA and calcipotriol is highly effective and works faster and may be used for shortening the therapy with PUVA in the treatment of vitiligo.
PUVA Treatment for Alopecia areata
Authors: Şahin S. , Yalçın B. , Karaduman A.
Published: April 2003

Background: PUVA has been suggested as an alternative treatment modality for resistant, diffuse alopecia areata (AA). However, there are conflicting reports on its efficacy. Objective: The aim of this study was to investigate the efficacy of PUVA treatment of AA in a Turkish population. Methods: Twenty-four patients (15 female and 9 male) suffering from extensive AA for more than 1 year were included in a retrospective study. PUVA was administered to the whole body 3 times a week. Only 75–100% hair regrowth was defined as cosmetically acceptable. Results: Excellent hair regrowth was achieved in 37.5% of the patients. The therapeutic efficiency was not related to age and sex of the patients, duration and extent of the disease (p <0.05). Conclusion: PUVA can be an alternative therapy for patients with extensive AA independently of the duration of disease.
Gravitational Syndrome and Tensile Properties of Skin in the Elderly
Authors: Piérard-Franchimont C. , Letawe C. , Fumal I. , van Cromphaut I. , Piérard G.E.
Published: April 2003

Background: To evaluate the influence of gravitational edema due to chronic venous insufficiency upon the tensile properties of skin. Method: A total of 30 women aged 66–75 years participated in the study. Evaluations were made twice in the same subjects following the use or nonuse of daytime elastic compression. Mechanical properties of the skin were measured in the midportion of the legs using a computerized suction device. Results: The consistency of skin which shows abnormal rheological characteristics at the site of gravitational edema was significantly modified by compression therapy. Both skin extensibility and hysteresis were increased after wearing tight stockings although the biologic elasticity remained unchanged. Conclusion: Noninvasive measurements of the tensile properties of the skin represent an objective assessment of the severity of leg edema and of its correction by compression therapy.
Juvenile Hyaline Fibromatosis: Clinical Heterogeneity in Three Patients
Authors: Mancini G.M.S. , Stojanov L. , Willemsen R. , Kleijer W.J. , Huijmans J.G.M. , van Diggelen O.P. , de Klerk J.B.C. , Vuzevski V.D. , Oranje A.P.
Published: April 2003

Background: Systemic hyalinoses are genetic generalized fibromatoses characterized by an accumulation of hyalin in the dermis. Two distinctive syndromes are recognized in the literature: infantile systemic hyalinosis (ISH) and juvenile hyaline fibromatosis (JHF). ISH and JHF are sometimes difficult to separate since they show significant overlap. Observations: We report on 3 children from two unrelated families suffering from JHF. The first child is severely handicapped by joint contracture, massive hyperplasia of the gingivae, diffuse skin papules and subcutaneous nodules occupying the scalp, face, perianal area, palms, soles and chest. At the same age, the second child only shows pearly skin papules on the face, groin and perianal area and gingival hyperplasia without joint stiffness or any other subjective complaint. The third patient, a brother of the second child, developed mild skin abnormalities by the end of the first year. The occurrence in siblings and consanguinity in the second family suggests autosomal recessive inheritance. Histological skin examination in the 3 cases showed hyaline deposition in the dermis and abnormal ultrastructure of fibroblasts. Biochemical findings showed mucopolysaccharide abnormalities in both families. Conclusion: Our patients do not only illustrate the different expressions of JHF but also show some overlap with ISH, suggesting a common cause for both disorders. Genetic studies will finally answer this question.
Acanthosis nigricans with Severe Obesity, Insulin Resistance and Hypothyroidism: Improvement by Diet Control
Authors: Kuroki R. , Sadamoto Y. , Imamura M. , Abe Y. , Higuchi K. , Kato K. , Koga T. , Furue M.
Published: April 2003

We report on a 27-year-old man with acanthosis nigricans (AN) associated with severe obesity, insulin resistance and hypothyroidism. A very low-calory diet treatment decreased his weight and then ameliorated the insulin-resistant state. These effects were followed by remarkable improvement of the AN prior to the correction of the hypothyroidism. This confirms that AN may be mainly attributed to insulin resistance rather than hypothyroidism per se.
Multiple Fixed Drug Eruption Caused by Iomeprol (Iomeron®), A Nonionic Contrast Medium
Authors: Watanabe H. , Sueki H. , Nakada T. , Akiyama M. , Iijima M.
Published: April 2003

Most cases of drug eruption caused by nonionic contrast media (NICM) reported to date have been of the erythema multiforme type. Herein we report the first case of multiple fixed drug eruption (FDE) caused by iomeprol (Iomeron®). A 67-year-old woman developed multiple pea-sized erythematous papules on the trunk and extremities 4 days after receiving 100 ml of iomeprol for a computed tomography examination. Some of the papules coalesced, forming 7 large plaques on the limbs. Six months later, the patient was mistakenly administered iomeprol again. On the following morning, erythematous plaques admixed with vesicles recurred at the same sites as during the previous episode. In both episodes, the lesions cleared leaving pigmentation that faded with 6 weeks. Both patch testing and an intradermal test with iomeprol on lesional pigmented skin were positive. The present case indicates that NICM may cause multiple FDE and that repeated administration of the causative agent may increase the severity of the eruption.
Lichenoid Cutaneous Drug Reaction at Injection Sites of Granulocyte Colony-Stimulating Factor (Filgrastim)
Authors: Viallard A.M. , Lavenue A. , Balme B. , Pincemaille B. , Raudrant D. , Thomas L.
Published: April 2003

Colony-stimulating factors are widely used for bone marrow recovery after chemotherapy. Various cutaneous side-effects have been described in most cases involving neutrophils. We report the first case of lichenoid reaction at injection sites of granulocyte colony-stimulating factor (G-CSF) in a 40-year-old patient treated for breast cancer. The eruption cleared after drug withdrawal, no recurrence was observed after drug replacement by granulocyte-macrophage colony-stimulating factor. Mainly lymphocyte-mediated lichenoid eruption to G-CSF was shown. Cutaneous side-effects to G-CSF do not share unequivocal pathogeny based on stimulation of neutrophils.
A Prospective Study of the Influence of HIV Status on the Seroreversion of Serological Tests for Syphilis
Authors: Janier M. , Chastang C. , Spindler E. , Strazzi S. , Rabian C. , Marcelli A. , Morel P.
Published: April 2003

The evolution of serological tests for syphilis (STSs) after therapy in HIV+ patients is a major point of controversy, with possible seroreactivation and illicit seroreversion in these patients. The aim of our study was to evaluate the long-term outcome of STSs in a cohort of HIV+ male homosexuals with a history of treated syphilis as compared with HIV– controls. Patients and Methods: Sixty-nine HIV+ male homosexuals with a documented history of treated syphilis and positive baseline treponemal tests were prospectively studied between 1986 and 1993. A medical examination, HIV staging, CD4+ cell count, VDRL, FTA-Abs tests and TPHA were performed every 6 months. Controls consisted of 49 HIV– patients with similar inclusion criteria over the same period. Comparisons between subgroups were based on χ2 and Kruskal-Wallis tests. Analysis of negativation of the STS used the failure data methods (Kaplan-Meier, log-rank and Cox’s model). Results: Patients had a mean age of 38 years, a baseline CD4+ cell count of 578/mm3, elapsed time since last syphilis of 7.5 years and a median follow-up of 4.3 years. Controls had a mean age of 42 years, elapsed time since last syphilis of 5.3 years and a median follow-up of 4.7 years. Time to seroreversion was shorter in HIV+ patients for TPHA (p = 0.009, log-rank test) and FTA-Abs test (p = 0.001, log-rank test), even after adjustment for stage of syphilis, age and time since the last episode of syphilis. The decrease in VDRL titres was not different between the 2 groups (p = 0.053, log-rank test). Seroreversion of the TPHA, FTA-Abs test and VDRL test was not significantly related to stage of syphilis, time elapsed since the last episode of syphilis, age or history of STDs in both groups. Seroreversion of the TPHA and VDRL test was not related to baseline CD4+ cell count. However, seroreversion of the FTA-Abs test was related to a low baseline CD4+ cell count (p = 0.003). In HIV+ patients, a significant decrease in titres was noticed for TPHA, FTA-Abs test and VDRL test over time, but this time effect remained only for TPHA titres after adjustment for the CD4+ cell count. Conclusion: TPHA may serorevert in HIV+ patients. Thus, a non-reactive TPHA does not exclude a past syphilis infection in such patients. Evolution of the VDRL test after therapy is regular in HIV+ patients. The VDRL test remains adequate for controlling the efficacy of treatment in these patients.
Safety of Itraconazole in Diabetic Patients
Authors: Verspeelt J. , Marynissen G. , Gupta A.K. , De Doncker P.
Published: April 2003

Background: Onychomycosis and dermatomycoses can result in serious complications in patients with underlying chronic diseases such as diabetes. To avoid these complications, these dermatological disorders need to be treated efficiently, for example with the triazole antifungal itraconazole. Itraconazole can inhibit the metabolism of drugs by CYP 3A4 and therefore might affect the efficacy of antidiabetic agents. Objective: To investigate this, we assessed the safety of itraconazole in diabetic patients with onychomycosis or dermatomycoses. Methods: We reviewed pharmacokinetic and safety data from clinical trials and postmarketing surveillance over the past 10 years. Results: Postmarketing surveillance (a review of all adverse-event reports in patients receiving itraconazole concomitantly with insulin or an oral antidiabetic agent) revealed 15 reports suggestive of hyperglycemia and 9 reports suggestive of hypoglycemia; in most patients, no change in antidiabetic effect was reported. From clinical trials including a total of 189 diabetic patients treated with itraconazole for various infections (mainly systemic infections and vaginal candidiasis), only one itraconazole-related adverse event was recorded; this was a case of aggravated diabetes in a renal transplant recipient who was also receiving cyclosporine. Adverse effects due to drug-drug interactions are not expected in diabetic patients receiving oral antidiabetic agents that are not metabolized through the CYP 3A4 system (e.g. tolbutamide, gliclazide, glibenclamide, glipizide and metformin). Conclusion: Itraconazole can be used safely and efficiently for the treatment of dermatological disorders in diabetic patients.
Necrobiotic Palisading Granuloma at Injection Site of Disodium Clodronate: A Case Report
Authors: Lalinga A.V. , Pellegrino M. , Laurini L. , Miracco C.
Published: April 2003

The authors describe an adverse localized cutaneous reaction caused by the injection of disodium clodronate, histologically presenting as a necrobiotic palisading granuloma. This lesion is considered as an immunological type of granuloma that can be caused by various chemical or physical stimuli. Disodium clodronate should be included among the medicaments that can trigger this infrequent type of tissue reaction.
Impetigo herpetiformis during the Puerperium
Authors: Katsambas A. , Stavropoulos P.G. , Katsiboulas V. , Kostakis P. , Panayiotopoulos A. , Christofidou E. , Petridis A.
Published: April 2003

We report on a 29-year-old primigravida who developed impetigo herpetiformis 1 day after delivery. To our knowledge, this patient is the second reported case of impetigo herpetiformis presenting during the puerperium. The patient responded quickly to systemic administration of methotrexate and prednisolone.
Implications of Psoriasis as a New Disease
Authors: Altschuler E.L.
Published: April 2003

It is noted that psoriasis appears not to have been described until the return of explorers from the New World back to the Old. Thus, it is suggested that in fact psoriasis is a new disease to the Old World. One implication of this is that any infectious agent which is a candidate cofactor in the pathogenesis of psoriasis must itself be new to the Old World after the time of the explorers.
Twenty-Eight Cases of Juvenile-Onset Adamantiades-Behçet Disease in Germany
Authors: Treudler R. , Orfanos C.E. , Zouboulis Ch.C.
Published: April 2003

Background and Objective: Adamantiades-Behçet disease is a rare entity at a juvenile age. We aimed to enlighten epidemiological and clinical characteristics of juvenile-onset disease in Germany. Methods: Data from the German Registry were used to compare clinical and epidemiological features of patients with juvenile-onset (≤16 years) and adult-onset (>16 years) disease diagnosed according to the criteria of the International Study Group. Results: Twenty-eight (17%) of 168 patients of the German Registry exhibited the onset of the disease and 8 (5%) of them the complete symptom complex at a juvenile age. Juvenile-onset disease was characterized by an increase in familial cases (25 vs. 8% in patients with adult-onset; p = 0.047). The frequency of diagnostic signs was similar between the two study groups. In juvenile-onset disease, delayed development of the complete symptom complex (median value 35 months vs. 12 months after onset; p = 0.014) and lower prevalence of severe complications (9 vs. 29%; p = 0.042) were detected. Conclusions: The major clinical features of juvenile-onset and adult-onset disease in Germany are comparable, but in juvenile-onset disease, the course is delayed and patients experience less severe complications. In addition, there is a higher rate of familial occurrence of the disease in patients with juvenile-onset.
Vulval Diseases Need an Interdisciplinary Approach
Authors: Bauer A. , Greif C. , Vollandt R. , Merker A. , Elsner P.
Published: April 2003

Background: Vulval diseases are common, but their frequency and importance are often underestimated. Objective: The study intended to evaluate the number of patients with vulval diseases seen in medical practice. Furthermore, the acceptance of an interdisciplinary vulval disease clinic, managed by a dermatologist in cooperation with a gynaecologist and a psychologist, was evaluated. Methods: In April and Mai 1998, a mailing survey of all gynaecologists (n = 239), general practitioners (n = 244) and dermatologists (n = 96) in Thuringia, Germany, containing 7 questions concerning patients with vulval diseases was performed. Results: 49% (n = 286) of the questionnaires were returned. On average, 97% of the physicians regularly treated females with genital diseases. The most common diseases mentioned by all specialities were local fungal and bacterial infections. The further ranking of diagnosis was different between the specialities. It was estimated that 83% of patients with chronic disorders would develop additional psychological problems. The necessity of an interdisciplinary vulval disease clinic in Thuringia was stated by 71% of the interviewed physicians. 76% of the gynaecologists and 75% of the general practitioners welcomed the introduction of the clinic. Interestingly, only 51% of the dermatologists felt that a vulval disease clinic was necessary. Conclusion: The majority of the physicians in Thuringia welcomed an interdisciplinary vulval disease clinic to improve the conditions for women suffering from genital diseases.
Evaluation on the Antipruritic Role of Transcutaneous Electrical Nerve Stimulation in the Treatment of Pruritic Dermatoses
Authors: Tang William Yuk Ming , Chan Loi Yuen , Lo Kuen Kong , Wong Tze Wai
Published: April 2003

Background: Pruritus is a common and sometimes distressing symptom in many dermatological conditions. Response to conventional pharmaceutical agents may not be satisfactory, and adverse effects are real problems. Objective: To evaluate the short-term efficacy and adverse effects of transcutaneous electrical nerve stimulation (TENS) for ameliorating pruritus in patients with dermatoses. Methods: A prospective 1-week study using TENS given once daily for treating pruritic dermatoses in 5 patients. Results: Significant amelioration of pruritus was obtained without adverse effect referable to TENS treatment, and a subjective reduced use of conventional topical drugs was also reported by all patients. Conclusions: TENS is a useful aramentarium for short-term amelioration of pruritus in pruritic dermatoses. Long-term efficacy and safety await further studies.
Spindle Cell Hemangioma
Authors: Tomasini Carlo , Aloi Filippo , Soro Elisabetta , Elia Vincenzo
Published: April 2003

A 27-year-old woman presented with multiple nodules closely grouped on her right upper distal extremity. The lesions, dating from childhood, increased slowly in time. Microscopic examination of one nodule showed the histologic features of spindle cell hemangioendothelioma (SCH). At the periphery of the nodule there were also some features of the so-called sinusoidal hemangioma. Clinically, SCH can present as a solitary lesion or as multiple lesions in zonal distribution. When the lesions are multiple, the diagnosis of Maffucci’s syndrome should be considered. SCH may be interpreted as a reactive process secondary to thrombosis and recanalization occurring in angiomatous lesions with different clinical presentations. Spindle cells are probably mesenchymal cells modified by blood pressure. For this entity the term hemangioma seems to be preferable to that of hemangioendothelioma.