bluuebunny/crossref_metadata_2025 huggingface dataset:
An unusual case of primary systemic amyloidosis
Authors: Ambrosone L. , Mansi L. , Salvatore T. , Marino F. , Orabona P. , Rambaldi A. , Rambaldi P.F. , Rambaldi M.
Published: September 2006

Here we report an unusual case of primary systemic amyloidosis. The cutaneous lesions were polymorphic and included involvement of both external auditory canals. The visceral involvement was covert. Mapping of amyloid deposits was performed using scintigraphy with technetium‐99m (V) dimercaptosuccinic acid ([99mTc (V)] DMSA). Therapy with melpha‐lan, prednisone and colchicine resulted in considerable improvement.
Linear IgA bullous dermatosis induced by piroxicam1
Authors: Camilleri Michael , Pace Joseph L.
Published: September 2006

Linear IgA bullous dermatosis (LABD) is an acquired, autoimmune, heterogeneous subepidermal blistering disorder usually idiopathic in nature, but in recent years a variety of drugs have been reported to induce this disorder. We describe the first reported patient who developed LABD after ingestion of the non‐steroidal anti‐inflammatory agent (NSAID) piroxicam.
The efficacy of a new topical treatment for psoriasis: Mirak
Authors: Seyger M.M.B. , van de Kerkhof P.C.M. , van Vlijmen‐Willems I.M.J.J. , de Bakker E.S.M. , Zwiers F. , de Jong E.M.G.J.
Published: September 2006

Background A new natural product for the treatment of psoriasis has recently become available in many European countries: Mirak. The Mirak Home Care Packs consist of natural spring water, volcanic earth and vitamin E cream. Recently, the efficacy of Mirak has come into question. As this treatment is used by many psoriasis patients in Europe, it is important for dermatologists to be informed about the clinical effects of the therapy.

Aim To evaluate the efficacy and side effects of the Mirak Home Care Packs.

Methods By means of a placebo‐controlled left/right comparison, both clinical and histological parameters were evaluated during 6 weeks of treatment.

Results The reduction in induration was significantly greater in the Mirak‐treated lesions than in the lesions treated with a placebo. A reduction in desquamation was found in both treatments; the difference between the treatments was not statistically significant. A decrease in number of proliferative cells in the Mirak‐treated lesions was seen, but the difference with placebo‐treated lesions was not significant. The other investigated parameters did not change during treatment. No side effects were seen.

Conclusions The Mirak Home Care Pack induces a modest therapeutic effect compared to placebo treatment, without significant side effects. Treatment with the Mirak Home Care Packs alone will probably not be able to compete with the already existing treatments for psoriasis.
Multinucleate cell angiohistiocytoma: a report of two cases
Authors: Aloi F. , Solaroli C. , Tomasini C. , Pippione M.
Published: September 2006

We report the clinical, histological and immunological features of two cases of multinucleate cell angiohistiocytoma (MCAH) in women of 32 and 53 years of age, respectively. Clinically, MCAH occurs mostly in middle‐aged women and consists of crops of reddish‐purple, dome‐shaped papules especially on the limbs. Histologically, the reticular dermis presents an increased number of small vascular channels with plump endothelial cells embedded in a fibrohistiocitic stroma with numerous bizarre multinucleate cells. Bizarre multinucleated cells are not specific to MCAH; they can be observed in numerous other cutaneous conditions. However, MCAH presents quite distinctive clinico‐pathological findings and may be easily differentiated from other cutaneous disorders.
Disseminated papular acantholytic dyskeratosis
Authors: Ciupinska Magdalena , Kalbarczyk Kazimierz , Jablonska Stefania
Published: September 2006

We present two cases of elderly women with clinically atypical transient disseminated papular eruption, showing suprabasal epidermal clefts with dyskeratosis and acantholysis. The clinical picture did not correspond to either Darier's disease, Hailey's disease or Graver's acantholysis. In spite of clinical similarity the cases differed in course and outcome. Overlapping dyskeratosis and acantholysis varied in different specimens. The case with transient acantholytic lesions of short duration showed much more pronounced dyskeratosis than the other in which several relapses occurred in a 4‐year period. Such cases defying classification belong to the heterogeneous group of papular acantholytic dyskeratosis. (c) 1998 Elsevier Science B.V. All rights reserved
Allergic contact dermatitis from naftifine in a child without cross‐reaction to terbinafine
Authors: Goday J.J. , González‐Güemes M. , Yanguas I. , Ilardia R. , Soloeta R.
Published: September 2006

Allergic contact dermatitis from naftifine has been scarcely described in the English literature, all of them in adults. We report a case of a 12‐year‐old girl who developed an acute eczema on her neck after application of a naftifine cream. This fact was confirmed by a patch‐test study. We did not find a cross‐reaction to terbinafine, a structurally linked allylamine.
Cellulitis of the eyelids associated with sinusitis and brain abscess
Authors: Shinagawa Yumiko , Ando Iwao , Kukita Atsushi , Kitazawa Eriko , Saruki Kiyofumi , Aoki Makoto
Published: September 2006

Erythema in the orbital area can indicate systemic and life‐threatening diseases. We experienced an unusual and serious case of orbital cellulitis that was difficult to distinguish from a case with good prognosis. A 21‐year‐old man developed an erythema around his eyes. He exhibited no symptoms that would suggest lesions in deep tissues, but his condition turned out to be cellulitis retrogradely metastasized from an odontogenic sinusitis traced to a dental treatment problem. Computed tomography revealed complication of a large abscess in the frontal lobe. Cellulitis of the orbital area requires particular clinical discretion.
Amelanotic lentigo maligna and amelanotic lentigo maligna melanoma: a report of three cases mimicking intraepidermal squamous carcinoma
Authors: Allan S. J.R. , Dicker A.J. , Tidman M.J. , McLaren K.M. , Hunter J.A.A.
Published: September 2006

The clinical diagnosis of amelanotic melanoma may pose diagnostic difficulties. We report three cases of amelanotic lentigo maligna, two of which developed an invasive component (lentigo maligna melanoma). The clinical appearances in each case mimicked intraepidermal squamous carcinoma.
Efficacy and safety of mizolastine 10 mg in a placebo‐controlled comparison with loratadine in chronic idiopathic urticaria: results of the MILOR study1
Authors: Dubertret L. , Aguttes M. Murrieta , Tonet J.
Published: September 2006

Background

Mizolastine is a novel histamine H1‐antagonist registered in Europe for the management of allergic rhinitis and urticaria.

Objectives

To compare the clinical efficacy and safety of mizolastine with loratadine and placebo in patients with chronic idiopathic urticaria (CIU).

Methods

A multicentre, double‐blind, parallel group study was designed in which 247 patients with CIU were randomised after a 1‐week placebo run‐in period to 10 mg daily mizolastine (n= 88), 10 mg daily loratadine (n= 79), or placebo (n= 80) for a 4‐week treatment period.

Results

Mizolastine and loratadine both relieved symptoms of CIU. After 2 weeks' treatment, the severity of pruritus (visual analogue score (VAS) assessed by patients) decreased significantly in both the mizolastine and loratadine groups compared with placebo (mizolastine: –36.7 mm, P= 0.0001; loratadine: –29.8, P= 0.0071; placebo: –16.3); this improvement with both active treatments was maintained throughout the treatment period, the difference being significant only for the mizolastine group (P= 0.0090). Both active treatments were also associated with reduced weekly episodes of urticaria compared with placebo, which was significant after 2 weeks' treatment (mizolastine: 7.9 episodes, P= 0.0061; loratadine: 8.3, P= 0.0221; placebo: 13.3). Angioedema was improved to a clinically significant extent with mizolastine, and loratadine compared with placebo in those patients who had this symptom before treatment Overall tolerability of both treatments was similar to placebo, and there were no clinically relevant effects on cardiac repolarisation with either mizolastine or loratadine.

Conclusion

Mizolastine (10 mg daily) is confirmed as an effective and well tolerated agent, comparable to loratadine and superior to placebo, for the management of CIU. Mizolastine acted as rapidly as loratadine in improving urticarial symptoms from the first day of treatment.
Immunomodulators in the treatment of cutaneous lymphoma
Authors: Rogalski Christina , Dummer Reinhard , Burg Günter
Published: September 2006

Background

Cutaneous lymphoma involves clonal proliferation of immunocompetent cells. Immunointerventional strategies are a rational approach to the treatment of cutaneous lymphoma given the pathophysiological aspects of the disease.

Objective

Immunomodulatory therapies in cutaneous lymphoma are reviewed, including interferons, interleukin‐2, cyclosporin A, monoclonal antibodies, autologous bone marrow transplantation, fusion toxins, thymopentin and extracorporeal photopheresis as well as recently reported methods such as vaccination therapy, mycophenolate, and new retinoids.

Results/Conclusion

Cutaneous lymphoma is sensitive to immunointerventions. This approach should be used in early stages of the disease when it is more susceptible and benefits better from immunomodulatory treatment modalities.
Kikuchi‐Fujimoto lymphadenitis with cutaneous involvement
Authors: Rakic L. , Arrese J.E. , Thiry A. , Piérard G.E.
Published: September 2006

We report a case of Kikuchi‐Fujimoto disease with cutaneous involvement in a European man. In contrast, the disease is most prevalent in women of Asian descent. The condition is probably under‐recognized when histology is not used to identify lymphadenitis of protracted course. Skin lesions may mimic clinically other unrelated disorders including lymphomas and immune or infectious dermatoses. Histology of skin lesions may bring a clue to the diagnosis when apoptotic plasmacytoid monocytes are recognized. The relationship between Kikuchi‐Fujimoto disease and lupus erythematous remains a matter of debate.
Follicular mycosis fungoides: presentation of a case and review of the literature
Authors: Grau Cristina , Pont Virginia , Matarredona Jaime , Fortea José Miguel , Aliaga Adolfo
Published: September 2006

Follicular mycosis fungoides is a rare variant of mycosis fungoides (MF). Structural‐wise there are several acneiform lesions made up of comedones, cysts and hyperkeratosis. The main histological finding is atypical lymphocytic infiltration around follicular structures, without epidermotropism. The association with follicular mucinosis is widely discussed in the literature. We report a case of follicular (MF) and review the cases published to date.
L‐carnitine supplementation in patients with cystic acne on isotretinoin therapy★
Authors: Georgala Sophia , Schulpis Kleopatra H. , Georgala Catherina , Michas Timos
Published: September 2006

Background

Patients with cystic acne (CA) on Isotretinoin (Iso) therapy might present muscular symptoms as side effect of the drug. Myalgia, weakness, hypotension are also some of the main characteristics of carnitine (car) deficiency.

Methods

Two hundred and thirty (N= 230) patients with CA were treated with Isotretinoin (0.5 mg/kg per 24 h). All the patients were requested to visit our out‐patient department at the onset of muscular symptoms. Laboratory tests including car (total, free, acylcarnitine) were determined in blood and urine before treatment, at the onset of muscular symptoms and after the end of a 45 day study. Fifty percent of the patients with muscular involvement received l‐carnitine (100 mg/kg per 24 h per os) (group C) and 50% placebo (group P).

Results

Their laboratory tests showed the well known increases of their liver enzymes and lipids, whereas car blood levels were remarkably decreased at the onset of their muscular symptoms and or at the end of the study. Their supplementation with l‐car, in patients of group C(N= 20) without Iso discontinuation or reduction, resulted in the disappearance of their muscular symptoms within 5–6 days and normalisation not only of the increased levels of their liver enzymes but also those of car, at the 45 day of their therapy. Additionally, the patients who received placebo (group P, N= 20) continued complaining for mualgias. The rest of the patients (group A, N= 190) did not experience any muscular symptoms, their laboratory tests showed elevation of liver enzymes and lipids and a decrease in car levels in the blood whereas a remarkable increase of car excretion was determined in their urine.

Conclusions

Iso therapy decreases car blood levels in patients with CA. l‐car supplementation might treat liver and muscular side effects of the drug. These hopeful preliminary results need further investigation.
Itraconazole and tèrbinafine in perspective: from petri dish to patient
Authors: De Doncker P.
Published: September 2006

Objective To compare the antifungal activity of itraconazole and terbinafine in vitro and to relate them to their experimental in vivo activity and to their efficacy in patients with superficial fungal infections (tinea pedis and onychomycosis).

Results Fungal infections such as onychomycosis and tinea pedis are often treated with oral antifungals. With the introduction of newer agents such as terbinafine and itraconazole, efficacy and safety have been improved. In vitro evaluation showed somewhat better results against dermatophytes for terbinafine than for itraconazole, but in vivo results were at least equivalent. Moreover, itraconazole is a broad‐spectrum agent with higher cure rates for infections other than dermatophytosis (e.g. for Candida infections) than terbinafine, according to ex vivo studies. A review of all published clinical trials, comparing the efficacy and safety of terbinafine and itraconazole in a meta‐analysis revealed similar and high cure rates (>70%) for both antifungal agents and similar adverse event profiles. Both treatments were safe and well tolerated.

Conclusions Antifungal research has responded to the challenges of treating superficial infections by developing effective, well‐tolerated, fast‐acting antifungal therapies. The reduction in treatment duration has also led to improved patient's compliance. The most noticeable difference between itraconazole and terbinafine is the 1‐week pulse concept of itraconazole in contrast to the continuous treatment concept of terbinafine.
EEMCO guidance for the assessment of skin topography1
Authors: Lévêque J.L.
Published: September 2006

Numerous factors can modify the visibility or the actual dimensions of the skin microrelief and wrinkles. To quantify these changes, several methods, including clinical and non‐invasive ones, have been proposed. This article reviews the advantages et drawbacks of all of them and lists some experimental recommendations to make the results of studies using these methods, more reliable.
Immunopathological examination of esophagus as a useful criterion of cure in pemphigus vulgaris
Authors: Torzecka Jolanta Dorota , Sysa‐Jedrzejowska Anna , Waszczykowska Elzbieta , Wozniacka Anna , Dziankowska‐Bartkowiak Bozena , Narbutt Joanna
Published: September 2006

Background

We performed histopathological and immunopathological examinations of the esophagus in patients with pemphigus vulgaris during clinical remission.

Methods

In the group of 14 patients without serum antibodies, five were treated with low doses of steroids and cyclophosphamide (as maintenance treatment), while nine had already completed the therapy.

Results

In all five cases under maintenance treatment we found bound pemphigus antibodies in vivo. Acantholysis was present in two of these. In all nine non‐treated patients, acantholysis and immunopathological findings were negative.

Conclusions

Our studies reveal that the absence of bound ‘pemphigus vulgaris’ antibodies in the esophagus by immunological examination could be regarded as proof of complete cure and could be the decisive finding to stop pemphigus treatment.
Serum level of sELAM‐1 in psoriatic patients correlates with disease activity
Authors: Krasowska Dorota , Pietrzak Aldona , Lecewicz‐Torun Barbara
Published: September 2006

Background

Endothelial leucocyte adhesion molecule‐1 (ELAM‐1) acts as an adhesion ligand for neutrophils and monocytes and the expression of this molecule on the vascular endothelium may reflect its ability to recruit neutrophils from circulation. The next step is the transendothelial migration of neutrophils into lesional psoriatic skin. ELAM‐1 may also exist in a soluble form.

Methods

We determined the serum levels of ELAM‐1 by ELISA in 41 patients with psoriasis and 20 controls.

Results

Patients with acute psoriasis displayed higher levels of ELAM‐1 (85.45 ± 47.72 ng/ml) than controls (36.02 ± 15.60 ng/ml) and patients with chronic disease (61.24 ± 27.91 ng/ml). In 25 patients we measured the serum level of ELAM‐1 twice: at the beginning and after treatment of the disease and we did not find any significant changes. We also found a correlation between serum ELAM‐1 and PASI score.

Conclusions

These data suggest that there is a high serum level of E‐selectin in psoriatic subjects even after clearing of the disease. Serum E‐selectin may reflect the general activation of endothelial cells in the disease and may be a new sensitive marker of disease activity.
Watermelon‐stomach as a cause of chronic iron deficiency anemia in a patient with systemic sclerosis
Authors: Fábián György , Tóvári Eszter , Baranyay Ferenc , Czirják László
Published: September 2006

Watermelon‐stomach is a rare cause of gastrointestinal bleeding. There has been an increasing number of reports on the association of this lesion with diseases of the scleroderma group, causing chronic, sometimes severe gastrointestinal blood loss. The present report presents the case of a 75‐year‐old female with limited cutaneous systemic sclerosis and watermelon‐stomach, which was the cause of her long‐standing sideropenic anemia.
Bockenheimer's syndrome
Authors: van Geest A.J. , Veraart J.C.J.M. , de Haan M. , Neumann H.A.M.
Published: September 2006

A case of a very extensive form of the rare Bockenheimer's syndrome (genuine diffuse phlebectasia) in a 45‐year‐old female patient is presented. The subject presented phlebectasias of the upper right leg, the vulva and the right side of the abdomen. The diagnostic and therapeutic possibilities for cases of patients with Bockenheimer's syndrome are described.
Laugier‐Hunziker syndrome: case report and treatment with the Q‐switched Nd‐Yag laser
Authors: Ferreira Maria João Branco , Ferreira Ana Macedo , Soares A. Pinto , Rodrigues J.C. Fernandes
Published: September 2006

We report the case of a 46‐year‐old Caucasian female presenting with mucocutaneous pigmentation on the lips, oral mucosa, hands, feet and nails, as well as on a psoriatic plaque. She was successfully treated with Q‐switched Nd‐Yag laser, with double frequency, for both the mucosal and cutaneous lesions.
Management of androgenetic alopecia★
Authors: Tosti A. , Camaeho‐Martinez F. , Dawber R.
Published: September 2006

Background

Androgenetic alopecia (AGA) is the most frequent cause of hair loss affecting up to 50% of men and 40% of women by the age of 50.

Methods

This paper outlines the current status of diagnosis and offers guidelines for optimal management of AGA in both men and women.

Results

The diagnosis of AGA can usually be confirmed by medical history and physical examination alone. A trichogram can be useful to assess the progression of the hair loss. A scalp biospy is diagnostic but usually not required. In women with signs of hyperandrogenism, investigation for ovarian (polycystic ovarian disease) or adrenal (late‐onset congenital adrenal hyperplasia) disorders is required. Mild to moderate AGA in men can be treated with oral finasteride or topical minoxidil. Oral finasteride at the dosage of 1 mg/day produced clinical improvement in up to 66% of patients treated for 2 years. The drug is effective for both frontal and vertex hair thinning. Medical treatment with finasteride or minoxidil should be continued indefinitely since interruption of therapy leads to hair loss with return to pretreatment status. Mild to moderate AGA in women can be treated with oral antiandrogens (cyproterone acetate, spironolactone) and/or topical minoxidil with good results in many cases. Hair systems and surgery may be considered for selected cases of severe AGA both in men and in women.

Conclusions

Patients with AGA should be informed about the pathogenesis of the condition. If used correctly, available medical treatments arrest progression of the disease and reverse miniaturization in most patients with mild to moderate AGA.
Subcorneal pustular dermatosis involving the face
Authors: Lotery Helen E. , Eedy David J. , McCusker Grainne
Published: September 2006

We report an interesting case of subcorneal pustular dermatosis in a young woman with prominent involvement of the face. Facial involvement in this condition has not previously been reported.
Aneurysmal fibrous histiocytoma: an unusual variant of cutaneous fibrous histiocytoma
Authors: McKenna Dermot B. , Kavanagh Gina M. , McLaren Kathryn M. , Tidman Michael J.
Published: September 2006

Aneurysmal fibrous histiocytoma (AFH) (Santa‐Cruz DJ, Kyriakos M. Aneurysmal (‘Angiomatoid’) fibrous histiocytoma of the skin. Cancer 1981;47:2053–2061) is a distinct but poorly recognized clinicopathological variant of cutaneous fibrous histiocytoma (CFH) that may result from the slow extravasation of blood into the tumour. The resulting lesion can have a very different clinicopathological appearance resulting in diagnostic confusion. We describe a patient with an AFH that presented as a pigmented nodule on the foot and discuss clinical recognition and histological differentiation from other tumours.
Herpetic whitlow in an AIDS patient
Authors: García‐Plata M.D. , Moreno‐Giménez J.C. , García A. Vélez , Blanco F. Valverde , Roldán J.C. Fernandez
Published: September 2006

This case confirms that cutaneous herpes simplex virus (HSV) infections in many AIDS patients is important not only for the difficulty in diagnosis of herpetic lesions, but also for the possibility that co‐infection by HSV and HIV can adversely affect prognosis in these patients.
Subcutaneous fat necrosis of the newborn
Authors: Repiso‐Jiménez J.B. , Márquez J. , Sotillo I. , García‐Bravo B. , Camacho F.
Published: September 2006

Subcutaneous fat necrosis of the newborn (SFN) is an uncommon disease that affects newborns who have suffered from tissue hypoxia during or following delivery. This disease appears during the first weeks of life. It consists of indurate, erythematous or purple‐erythematous nodules and plaques in the skin. Histology of a biopsy specimen shows granulomatous necrosis in the subcutis with radial crystals in lipocytes and giant cells. Spontaneous resolution in a few weeks is usual, but the mobilization of calcium from the necrosed subcutis together with the action of some hormones may cause hypercalcemia and certain serious complications. A newborn female child developed SFN after dystocic delivery causing cerebral frontal lobe hemorrhage. The skin nodules resolved spontaneously in a few weeks and no complications were observed 1 year later.
Immunohistochemical study of apoptosis markers and involvement of chemokine CXCR4 in skin Merkel cell carcinoma
Authors: Tucci MG , Lucarini G , Giangiacomi M , Zizzi A , Criante P , Ricotti G , Biagini G
Published: September 2006

Background  Merkel cell carcinoma (MCC) is a rare, aggressive cancer of the skin that mainly affects elderly patients. Because of its rarity, there is no established treatment or proven markers to guide therapy or prognosis. Immunohistochemical expression of apoptosis proteins is considered a useful marker of both malignancy and tumour progression. Apoptosis plays a fundamental role in skin homeostasis, and apoptotic cells have been detected in normal and diseased skin. Chemokines posses a wide range of biological activities and CXCR4 is expressed in some cancer cells, where it plays an efficient role in metastasis formation.

Objective  To identify immunohistochemical parameters that can help clinicians select the most suitable therapy for skin MCC.

Design  Antibodies against ki67, bcl‐2, p53, survivin, p16 and CXCR4 were tested to assess the usefulness of these antigens as indices of proliferation potential and predictors of prognosis.

Methods  Immunohistochemical detection of apoptosis inhibitors and CXCR4 was performed on tissue from 12 patients with primary MCC. After excision of the primary lesion, five survived and had no metastases, and seven experienced local recurrence or lymph node metastases.

Results  Expression of ki67 and survivin was increased in patients with local recurrence or metastasis (retrospectively classified as ‘poor prognosis’) compared with those with a ‘good prognosis’, and bcl‐2 expression was significantly greater (P = 0.003). P53 and p16 immunostaining was moderate in both groups. A positive correlation was observed between survivin and mutant p53 in the poor prognosis group (r = 0.593, P = 0.033; regression coefficient). High values of p53 were measured in patients with high levels of survivin and vice versa. CXCR4 was not detected at all.

Conclusions  Our results show strong MCC cell apoptosis inhibition and a high cell proliferation capacity. The positive correlation between survivin and p53 may be a predictor of MCC spread via the lymphatic network. Absent CXCR4 expression may reflect a less aggressive form, with less efficient development of distant and non‐organ‐selective metastasis formation.
Dermatofibrosarcoma protuberans: a population‐based cancer registry descriptive study of 66 consecutive cases diagnosed between 1982 and 2002
Authors: Monnier D , Vidal C , Martin L , Danzon A , Pelletier F , Puzenat E , Algros MP , Blanc D , Laurent R , Humbert PH , Aubin F
Published: September 2006

Background  Dermatofibrosarcoma protuberans (DFSP) is a rare malignant tumour of the skin, with an estimated incidence of 0.8 to five cases per 1 million people per year.

Objective  To study epidemiological, immunohistochemical and clinical features, delay in diagnosis, type of treatment and outcome of DFSP from 1982 to 2002.

Methods  Using data from the population‐based cancer registry, 66 patients with pathologically proved DFSP were included (fibrosarcomatous DFSP were excluded). Each patient lived in one of the four departments of Franche‐Comté (overall population of 1 million people) at the time of diagnosis. The main data sources came from public and private pathology laboratories and medical records. The rules of the International Agency for Research on Cancer were applied.

Results  The estimated incidence of DFSP in Franche‐Comté was about three new cases per 1 million people per year. Male patients were affected 1.2 times as often as female patients were. The trunk (45%) followed by the proximal extremities (38%) were the most frequent locations. DFSP occurred mainly in young adults between 20 and 39 years of age. Mean age at diagnosis was 43 years, and the mean delay in diagnosis was 10.08 years. Our 66 patients initially underwent a radical local excision. Among them, 27% experienced one or more local recurrences during 9.6 years of follow‐up. There was one regional lymph node recurrence without visceral metastases. These recurrences were significantly related to the initial peripheral resection margins. We observed a local recurrence rate of 47% for margins less than 3 cm, vs. only 7% for margins ranging from 3 to 5 cm [P = 0.004; OR = 0.229 (95%, CI = 0.103–0.510)]. The mean time to a first local recurrence was 2.65 years. Nevertheless, there was no death due to the DFSP course at the end of the follow‐up, and the final outcome was favourable.

Conclusion  Our study emphasizes the importance of wide local excision with margins of at least 3 cm in order to prevent local recurrence. However, the recent development of inhibitors of signal transduction by the PDGFB pathway should soon modify the surgical strategy, which is often too mutilating.
Polymerase chain reaction detection of Clostridium perfringens in feces from captive and wild chimpanzees, Pan troglodytes
Authors: Fujita Shiho , Kageyama Takashi
Published: September 2006

Background  For veterinary management of non‐human primates in captivity, and conservation of wild‐living primates, management of their health risks is necessary. Incidences of pathogenic bacteria in the fecal specimens are considered as one of the useful indicators for non‐invasive health monitoring.

Methods  We carried out the detection of Clostridium perfringens in feces from captive and wild chimpanzees by the rapid polymerase chain reaction method.

Results  The bacterium was detected in most fecal specimens (80%) in captive chimpanzees. Contrarily, the detection rate in the wild chimpanzees was low, with 23% (n = 12) of 53 fecal samples from the Bossou group, Guinea, and 1.2% (1/81) in the Mahale group, Tanzania.

Conclusions  These results show that the intestinal microflora differs between Pan populations under various living conditions, being influenced by their diet and environment.
Relationship between smoking status and periodontal conditions: findings from national databases in Japan
Authors: Ojima M. , Hanioka T. , Tanaka K. , Inoshita E. , Aoyama H.
Published: September 2006

Background and Objective:  The association between cigarette smoking and periodontitis was examined employing two nationally representative samples of adults in Japan.

Material and Methods:  Data were derived from the Survey of Dental Diseases (SDD) and the National Nutrition Survey (NNS) in 1999. In the SDD, periodontal conditions were evaluated by calibrated dentists utilizing the Community Periodontal Index (CPI), whereas in the NNS, participants were interviewed on the basis of smoking status by enumerators. Among 6805 records electronically linked via a household identification code, 4828 records of individuals aged 20 yr or older were analyzed.

Results:  The prevalence of periodontal disease varied significantly by smoking status (p < 0.0001): 39.3%, 49.5% and 47.3% (CPI ≥ 3), and 7.9%, 11.7% and 12.4% (a more severe form of periodontitis, CPI = 4), for nonsmokers, former smokers and current smokers, respectively. In adults aged ≥ 40 yr (n = 3493), logistic regression models revealed greater probabilities (approximately 1.4 times higher) of periodontitis [CPI ≥ 3, odds ratio = 1.38 (1.12–1.71), p = 0.0024] and a more severe form of periodontitis [odds ratio = 1.40 (1.04–1.89), p = 0.0288] in current smokers compared with nonsmokers, following adjustment for possible confounding factors.

Conclusion:  Based on the findings of this study and other numerous reports, cigarette smoking leads to deterioration of periodontal conditions in Japanese adults.
Transforming growth factor‐β3 affects plasminogen activator inhibitor‐1 expression in fetal mice and modulates fibroblast‐mediated collagen gel contraction
Authors: Li Wai‐Yee , Huang Eunice Y. , Dudas Marek , Kaartinen Vesa , Warburton David , Tuan Tai‐Lan
Published: September 2006

For over two decades, the precise role of transforming growth factor‐β (TGF‐β) isoforms in scarless healing of mammalian fetal skin wounds has generated much interest. Although their exact role remains to be established, it has been suggested that high TGF‐β3 activity may correlate with a scarless phenotype. Previously, we showed that plasminogen activator inhibitor‐1 (PAI‐1), a known TGF‐β downstream molecule and marker of fibrosis, is also developmentally regulated during fetal skin development. In this study, the relationship between TGF‐β3 and PAI‐1 was investigated using embryonic day 14.5 TGF‐β3 knockout (ko) mice. The results showed increased PAI‐1 expression in the epidermis and dermis of ko mice, using an ex vivo limb‐wounding study. Furthermore, increased PAI‐1 expression and activity was seen in embryo extracts and conditioned media of ko dermal fibroblasts. When TGF‐β3 knockout fibroblasts were placed into three‐dimensional collagen matrices, they were found to have decreased collagen gel contraction, suggesting altered cell–matrix interaction. These findings provide a further avenue for the interactive role of TGF‐β3 and PAI‐1 during fetal scarless repair.
A randomized, double‐blind, placebo‐controlled multicenter trial evaluating topical zinc oxide for acute open wounds following pilonidal disease excision
Authors: Ågren Magnus S. , Ostenfeld Ulla , Kallehave Finn , Gong Yan , Raffn Kjeld , Crawford Michael E. , Kiss Katalin , Friis‐Møller Alice , Gluud Christian , Jorgensen Lars N.
Published: September 2006

The purpose of this randomized, double‐blind, placebo‐controlled multicenter trial was to compare topical zinc oxide with placebo mesh on secondary healing pilonidal wounds. Sixty‐four (53 men) consecutive patients, aged 17–60 years, were centrally randomized to either treatment with 3% zinc oxide (n=33) or placebo (n=31) by concealed allocation. Patients were followed with strict recording of beneficial and harmful effects including masked assessment of time to complete wound closure. Analysis was carried out on an intention‐to‐treat basis. Median healing times were 54 days (interquartile range 42–71 days) for the zinc and 62 days (55–82 days) for the placebo group (p=0.32). Topical zinc oxide increased (p<0.001) wound fluid zinc levels to 1,540 (1,035–2,265) μM and decreased (p<0.05) the occurrence of Staphylococcus aureus in wounds. Fewer zinc oxide (n=3) than placebo‐treated patients (n=12) were prescribed postoperative antibiotics (p=0.005). Serum‐zinc levels increased (p<0.001) postoperatively in both groups but did not differ significantly between the two groups on day 7. Zinc oxide was not associated with increased pain by the visual analog scale, cellular abnormalities by histopathological examination of wound biopsies, or other harmful effects. Larger clinical trials will be required to show definitive effects of topical zinc oxide on wound healing and infection.
Longer‐term changes in quality of life in chronic leg ulceration
Authors: Franks Peter J. , Moffatt Christine J. , Doherty Debra C. , Smithdale Rachael , Martin Ruth
Published: September 2006

Studies that have examined patients' health‐related quality of life have consistently shown improvements following intensive and effective treatments over relatively short follow‐ups. However, little is known of the longer‐term effects of treatment on patients. As part of a study in southwest London, United Kingdom, all patients having a current leg ulcer were examined (n=113) and those who were able completed the Nottingham Health Profile (n=95) and were then followed up at 24 and 48 weeks. The patients had a mean age of 76±13 (SD) years, with 60 (63.2%) being women. Before the study, the ulcer had been present for a median of 8 months (range 0.5–144), and a median area of ulceration of 4.0 cm2 (range 0.5–171.5 cm2). After 24 weeks, there was a significant improvement in pain (mean difference [d]=9.6, p=0.002), which was true for both the 41 patients with ulcers present (d=10.07, p=0.013) and the 43 patients whose ulcers had healed (d=11.46, p=0.047). However, after 48 weeks, these improvements had been reduced in both groups (healed ulceration d=5.76, unhealed patients d=6.41). Energy, which had improved after 24 weeks in the patients whose ulcers, had healed (d=11.46), deteriorated in both patient groups after 48 weeks (healed=−5.67, unhealed=−13.43). Mobility status was maintained with healed ulceration (d=1.05) but deteriorated with unhealed ulceration (d=−13.19). The positive effects of treatment on health‐related quality of life may not be sustained over time. This may be a consequence of the general deterioration in the health status of these elderly patients as they age.
Administration of prednisolone phosphate–liposomes reduces wound contraction in a rat partial‐thickness wound model
Authors: Richters Cornelia D. , Paauw Nanne J. , Mayen Ilvy , Van Bloois Louis , Metselaer Josbert M. , Storm Gert , Pont John S. du , Hoekstra Matthias J. , Kreis Robert W. , Kamperdijk Eduard W.A.
Published: September 2006

Macrophages play an important role in the inflammatory phase of wound healing and their activity regulates fibroblasts and keratinocytes. Modulation of macrophage function may result in improvement of the wound healing process. Prednisolone phosphate (PLP) encapsulated into liposomes was administered to partial‐thickness wounds in rats. A single dose of 75 μg/kg, applied directly after wounding, resulted in up to a 30% reduction of wound contraction at 28 days after wounding. This effect could not be achieved in the group that was administered free PLP or liposomes containing phosphate‐buffered saline to the wound. The number of myofibroblasts was up to 50% lower in wounds treated with the liposomal PLP at 4 days after wounding. The number of macrophages present in the wounds was not statistically different between groups. Most probably, the production of cytokines and growth factors by macrophages is altered after phagocytosing the liposomes, resulting in reduced wound contraction.
Delivery of plasmid DNA expression vector for keratinocyte growth factor‐1 using electroporation to improve cutaneous wound healing in a septic rat model
Authors: Lin Michael P. , Marti Guy P. , Dieb Rami , Wang Jiaai , Ferguson Mark , Qaiser Rabia , Bonde Pramod , Duncan Mark D. , Harmon John W.
Published: September 2006

We have previously shown that wound healing was improved in a diabetic mouse model of impaired wound healing following transfection with keratinocyte growth factor‐1 (KGF‐1) cDNA. We now extend these findings to the characterization of the effects of DNA plasmid vectors delivered to rats using electroporation (EP) in vivo in a sepsis‐based model of impaired wound healing. To assess plasmid transfection and wound healing, gWIZ luciferase and PCDNA3.1/KGF‐1 expression vectors were used, respectively. Cutaneous wounds were produced using an 8 mm‐punch biopsy in Sprague–Dawley rats in which healing was impaired by cecal ligation‐induced sepsis. We used National Institutes of Health image analysis software and histologic assessment to analyze wound closure and found that EP increased expression of gWIZ luciferase vector up to 53‐fold compared with transfection without EP (p<0.001). EP‐assisted plasmid transfection was found to be localized to skin. Septic rats had a 4.7 times larger average wound area on day 9 compared with control (p<0.001). Rats that underwent PCDNA3.1/KGF‐1 transfection with EP had 60% smaller wounds on day 12 compared with vector without EP (p<0.009). Quality of healing with KGF‐1 vector plus EP scored 3.0±0.3 and was significantly better than that of 1.8±0.3 for treatment with vector alone (p<0.05). We conclude that both the rate and quality of healing were improved with DNA plasmid expression vector for growth factor delivered with EP to septic rats.
Effect of Development Stage on the Artemisinin Content and the Sequence Characterized Amplified Region (SCAR) Marker of High‐Artemisinin Yielding Strains of Artemisia annua L.
Authors: Zhang Long , Ye He‐Chun , Li Guo‐Feng
Published: October 2006

The effects of development states on the artemisinin content of clone S1 of Artemisia anuua L. grown in a greenhouse were investigated in the present study. The artemisinin content increased gradually during the phase of vegetative growth and reached its highest level at 8–9 mg/g dry weight (DW) when the S1 was 6 months old on a long day (LD) photoperiod. Treatment with 9–18 d of short day (SD) photoperiod resulted in the artemisinin content reaching and being maintained at a higher level (2.059–2.289 mg/g DW), twofold that of control plants and plants of S1 presented at the pro‐flower budding and flower‐budding stages. The artemisinin content varied in different parts of the plant. The artemisinin content of leaves was higher than that of florets and branches. The artemisinin content in middle leaves was higher than that of bottom leaves, and then top leaves. Different densities of capitate glands (the storage organ of artemisinin) located on the surface of leaves, florets, and branches explained the variations in artemisinin content in these parts of the plant. The correlation coefficient between artemisinin content and density of capitate glands on the surface of different organs was 0.987. The genetic marker for artemisinin content was screened using random amplified polymorphic DNA (RAPD) and sequence characterized amplified region (SCAR) techniques. The random primer OPA15 (5′‐TTCCGAACCC‐3′) could amplify a specific band of approximately 1 000 bp that was present in all high‐artemisinin yielding strains, but absent in all low‐yielding strains in three independent replications. This specific band was cloned and its sequence was analyzed. This RAPD marker was converted into a SCAR marker to obtain a more stable marker.

(Managing editor: Wei Wang)
The impact of kleptoparasitic invasions on the evolution of gall‐size in social and solitary Australian Acacia thrips
Authors: CHAPMAN THOMAS WILLIAM , FRANCIS‐GEYER KAREN LEAH , SCHWARZ MICHAEL PHILIP
Published: October 2006

Abstract
Many species of gall‐inducing Acacia thrips are attacked by kleptoparasitic thrips who enter the gall, destroy the occupants, and then use the gall for producing their own offspring. The hypothesis tested here is that pressure exerted by kleptoparasites (genus Koptothrips) not only provoked the evolution of soldiers in the gall‐inducing clade, but have also influenced the evolution of gall size and morphology. Various size dimensions of invaded galls were compared to those of uninvaded galls using data from six gall‐inducing species and their kleptoparasites. For the non‐social gall‐inducing species (K. ellobus and K. nicholsoni) invaded galls showed no significant size differences from galls that had not been invaded. For the four social gall‐inducing species (K. habrus, K. intermedius, K. waterhousei and K. morrisi) invaded galls were significantly narrower and/or shorter than uninvaded galls. Galls of social species that had not been invaded and contained adult soldiers were significantly larger than galls where soldiers were still at a larval stage, suggesting that gall size is related to gall age in these species. An hypothesis is proposed that links the timing of invasion by kleptoparasites to size of the host gall: induction of a smaller gall by host founders will reduce the period of vulnerability to invasion (before soldiers become adults) for social thrips by allowing foundresses in these smaller galls to begin laying soldier‐destined eggs relatively sooner.
Personal and Social Responsibility for Health
Authors: Wikler Daniel
Published: September 2006

Everyone wants to be healthy, but many of us decline to act in healthy ways. What bearing, if any, should these choices have on the ethics of clinical practice and health policy? Should risk-takers have the same claim on scarce resources, such as organs for transplant, as those whose plight is due to no choices of their own? And is there any reason not to impose fees and taxes on risk-takers, be they smokers or mountain climbers, to defray the added expense of the care they may need? In health resource allocation aimed at reducing the burden of disease, should we regard certain burdens as individual responsibilities: for example, dealing with stigma, or caretaking for family members?

Socioeconomic status (SES) and health expectancy are strongly linked. To the extent that this results from risk-taking by the poor, is reduction of SES-linked health inequalities a morally important social goal? International public health aims at improving health on a population level. The World Health Organization has been criticized for failing to distinguish genuine health risks from personal lifestyle choices, as when it speaks of a tobacco-related “epidemic” as if cigarette use were a contagious disease like malaria. Should personal responsibility for health be taken into account in setting the agenda for global public health, and in measuring progress by countries in improving health. This paper addresses applications of the notions of personal and social responsibility for health. It also looks at the vulnerability of the notion of personal responsibility for health to intentional manipulation by self-interested parties in health policy debates.
International Justice and Health: A Proposal
Authors: Sreenivasan Gopal
Published: September 2006

This paper discusses obligations of international distributive justice-specifically, obligations rich countries have to transfer resources to poor countries. It argues that the major seven OECD countries each have an obligation to transfer at least one percent of their GDP to developing countries.

The strategy of the paper is to defend this position without having to resolve the many debates that attend questions of international distributive justice. In this respect, it belongs to the neglected category of nonideal theory. The key to the strategy is to show that a significant amount of good would be accomplished by a one percent transfer, despite the fact that one percent is quite a small amount.

To make this showing, the paper takes health as a fundamental measure of individual well-being and examines the improvement in life expectancy that would likely result from devoting the one percent transfer to the major determinants of health. It adduces data indicating that substantial progress towards raising life expectancy in developing countries to the global average of 64.5 years can be expected from expenditures of $125 per capita, divided between health care, education, and basic nutrition and income support. A one percent transfer from the major seven is enough to cover expenditures on that scale for the poorest fifth of the world's population.
Human Wrongs and the Tragedy of Victimhood
Authors: Lu Catherine
Published: September 2006

No serious student of victimhood and injustice can fail to appreciate their complicated origins and problematic legacies. For individuals and societies emerging from communal violence, oppression, and atrocity, the quest for moral regeneration–through acknowledgment, understanding, and transformation–is as difficult and perplexing as it is pressing. Challenging moral questions abound in the aftermath of human wrongs that admit no easy answers. Indeed, the ethics and politics of transition have been widely contested in theory and practice, by people who share the same basic moral/political concerns to redeem the suffering of victims and to forge a future that never again repeats the violations of the past.
Letting the Exception Prove the Rule
Authors: Byers Michael
Published: September 2006

It is unlikely that George W. Bush feels constrained by international law when deciding whether to use military force abroad. Nevertheless, many of the United States' allies are reluctant to cooperate with and participate in military actions that cannot reasonably be justified under international law. And supportive allies, while perhaps not strictly necessary to the United States in its recent and foreseeable military campaigns, do make the military option easier to pursue. A war against Iraq would be difficult without access to bases and airspace in countries as diverse as Turkey, Saudi Arabia, Germany, and Canada. For this reason, at least, it would seem to be worth the president's while to adhere to international law where possible and, where this is not possible, to seek to change the rules.

International lawyers in the Department of State, together with lawyers in other parts of the U.S. government, have excelled in shaping the law to accommodate the interests of the United States. One example, though by no means the only one, concerns the response to the September 11, 2001, terrorist attacks.