bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors of patient satisfaction/dissatisfaction in a dental faculty outpatient clinic in Turkey
Authors: Gürdal Pelin , Çankaya Hülya , Önem Erinç , Dinçer Semanur , Yílmaz Tarkan
Published: March 2003

Abstract – Objectives: Being service providers, dental professionals should satisfy their consumers/dental patients. This study investigates satisfaction with dental care among the patients of a dental faculty outpatient clinic of a major university in İzmir, Turkey. Method: The study was performed on 1001 patients of whom 674 filled out the questionnaire containing sociodemographic items and open‐ended questions to determine the factors of (dis)satisfaction. The open‐ended questions were content analyzed, and each patient was scored according to his comments: “complaining: (0)”, “both praising and complaining: (1)”, “no comment: (2)”, and “praising: (3)”. Each factor that has an impact on the decision of the study sample was determined by statistical analyses of data, using student t‐test, chi‐square test, and multiple regression analysis. Results: Most of the patients were highly educated (74.7%), had a high income (48.7%), and were young to middle‐aged (73.1%). There was a well‐balanced gender representation. The patient sample had sought care mostly for dental caries, periodontal diseases, problems with old restorations, and prosthetic rehabilitation. Of 1001 patients, 38.6% were satisfied with the dental care they received, 23.8% were both satisfied and dissatisfied, 5% were dissatisfied, and 32.7% failed to comment. No significant differences were observed between the satisfaction/dissatisfaction scores and sociodemographic variables of the patients in the groups (P>0.05). The most important components of satisfaction were found to be “relationship between dentists and patients” (P<0.001), “organized service system” (P<0.001), and ‘’scientific ability of dental personnel” (P<0.001). The most prominent complaints were “long treatment span” (P<0.001), “disorganized service system” (P<0.001), and ‘’slowness of radiographical examination procedures” (P<0.001). Conclusions: Despite the significant variations among the cultural and ethnic structures of different societies, personal interactions have priority in establishing satisfying dental service.
Modified IOTN: an orthodontic treatment need index for use in oral health surveys
Authors: Burden Donald J. , Pine Cynthia M. , Burnside Girvan
Published: March 2003

Abstract – This paper reports the results of a study of the reliability of a modified version of the Index of Orthodontic Treatment Need (IOTN) for use in oral health surveys. Twelve non‐specialist dental examiners were trained in the use of the Modified IOTN using a standardised teaching protocol lasting approximately 1.5 hours. Following a school‐based calibration exercise it was found that nearly all the examiners achieved either good or excellent agreement (mean Kappa=0.74). The average sensitivity and specificity scores were 0.90 and 0.84, respectively. The Modified IOTN appears to overcome the training and reliability problems that often accompany the use of orthodontic indices by non‐specialists in oral health surveys.
Validation of a Chinese version of the Oral Health Impact Profile (OHIP)
Authors: Wong May C. M. , Lo Edward C. M. , McMillan Anne S.
Published: March 2003

Abstract –

Objectives: To translate the original English version of Oral Health Impact Profile (OHIP) into a Chinese version, to validate the translated instrument for use among the elderly in Hong Kong and to derive a Chinese short‐form OHIP.

Methods: The original English version of OHIP was translated into Chinese. Elderly persons aged 60–80 years were interviewed by two trained interviewers and examined clinically by one of two calibrated dentists. Information on subjects' demographic background and oral health conditions were collected.

Results: A total of 586 elderly persons were interviewed and clinically examined. Cronbach's alpha of the translated OHIP subscales ranged from 0.69 to 0.84 and the test–retest correlation coefficient ranged from 0.72 to 0.92. Construct validity of the translated Chinese version was supported by the finding that the OHIP‐49 and subscale scores increased as the subject's perceived oral health status changed from healthy to unhealthy. Also, those who had a perceived dental treatment need had higher mean OHIP‐49 and subscale scores compared to those who did not. The short‐form OHIP derived in this study demonstrated comparable validity and reliability with the full version of OHIP.

Conclusion: The translated Chinese version of OHIP demonstrated good validity and reliability. It is available for use by researchers in oral health‐related quality of life studies in Chinese elderly populations. In situations where a Chinese short‐form of OHIP is desirable, there are now two validated Chinese versions for researchers to choose.
Targeting dental sealants in school‐based programs: evaluation of an approach
Authors: Kumar Jayanth V. , Wadhawan Sangeeta
Published: March 2003

Several guidelines have been published in the United States to promote the appropriate use of sealants in both individual care and public health programs. Targeting sealants to children and teeth at high risk for dental caries has been accepted as a desirable strategy in school‐based programs. However, there is little evidence to show that programs are complying with these guidelines. This report examined the extent to which sealants were targeted to high‐risk children at 11 different school‐based programs in New York State. Data on 3357 children ages seven to nine were analyzed. The percent of children receiving sealants ranged from 41% to 88%. While in two sites (St. Lawrence & Onondaga) fewer than 52% of the children received sealants; more than 73% received sealants in the remaining nine sites (P < 0.05). The results suggest that there was a wide variation in the implementation of the guidelines for sealant use. Some reasons for not adhering to the guidelines were: difficulty in assuring parents and local dentists that some children were not at risk for caries; lack of confidence in the risk‐assessment method; uncertainty regarding what constitutes deep pits and fissures; fear of misclassifying children and requests by school administrators, parents and local dentists that all children should benefit from preventive measures.
Type III and Type IV hypersensitivity reactions due to mitomycin C
Authors: Kunkeler Lia , Nieboer Cees , Bruynzeel Derk P.
Published: March 2003

A 71‐year‐old man developed an exfoliative dermatitis of the palms of the hands and soles of the feet, and a generalized itch, during treatment with intravesical instillations of mitomycin C for an undifferentiated carcinoma of the bladder. Patch tests with mitomycin C 0.03%, 0.1% and 0.3% aq. were positive. Because of the serious consequences of this finding, the patient was retested with mitomycin C in pet. (same concentrations), a more stable preparation. This showed clear positive reactions. During this last series of patch tests, he developed palpable purpura on the legs. We postulated that this reaction was an immune‐complex‐mediated reaction, caused by the 2nd series of patch tests with mitomycin C. To prove this, we performed histopathological and immunofluorescense investigations, and these showed the reaction to be consistent with Henoch‐Schönlein‐type purpura. We therefore conclude that this patient developed systemic reactions to mitomycin C, characterized by an eczematous dermatitis as well as purpuric reactions. The intravesical installations with mitomycin C have been stopped. The patient's skin problems (the purpura as well as the eczema) have completely resolved and have not recurred.
Irritant thresholds in subjects withcolophony allergy
Authors: Smith H. R. , Holloway D. , Armstrong D. K. B. , Basketter D. A. , McFadden J. P.
Published: March 2003

The factors which determine individual susceptibility to the development of allergic contact dermatitis (ACD) are not well defined. Since it is known that the presence of skin irritation is well‐documented as a promoter of sensitization, the sensitivity to irritation of subjects with ACD has been compared with a normal control group. Whilst 78% of those with a positive patch test reaction to the contact allergen colophony (colophonium) responded to a concentration of no higher than 2.5% sodium lauryl sulfate (SLS), only 44% of the matched control group reacted at this level of SLS. Thus, the results are consistent with the hypothesis that individuals with enhanced susceptibility to skin irritation are also more liable to develop allergic skin reactivity.
Quantitative structure‐activity relationships: sulfonate esters in the local lymph node assay
Authors: Roberts D. W. , Basketter D. A.
Published: March 2003

The biological activity of skin‐sensitizing chemicals is related to their ability to react, either directly or after metabolic activation, with appropriate skin proteins. For direct acting electrophilic compounds, this ability can be modelled, using the RAI (relative alkylation index) approach, by a combination of electrophilicity and hydrophobicity parameters. The development of predictive quantitative structure‐activity relationships (QSAR) models of skin sensitization, using mechanism‐based physicochemical parameters, has been greatly facilitated by the introduction of the murine local lymph node assay (LLNA), which is able to describe the extent of the biological response in objective and quantitative terms. In the present work, sensitization response data in the LLNA is generated for a series of 6 sulfonate esters. An RAI‐based hybrid QSAR/dose‐response relationship is derived using a negative hydrophobicity coefficient in the RAI expression, to model the effect of retention of the hydrophobic test chemicals in the stratum corneum. Dose‐response analyses are used to estimate EC3 and EC20 values as quantitative indices of skin sensitization potential for each compound, and regression analysis is applied to develop QSARs correlating these EC3 and EC20 values with an RAI‐based parameter. The high statistical quality of these QSARs demonstrates both the consistency of the LLNA method for generating high quality skin sensitization data, and the value of the RAI approach in development of mathematical models for skin sensitization.
Assessment of balsam of Peru patch tests
Authors: Bjarnason Bolli , Flosadóttir Ellen , Fischer Torkel
Published: March 2003

To find an ideal test technique for as low a dose of balsam of Peru (Myroxylon Pereirae) as possible, subjects testing positive to balsam of Peru are re‐tested with a 25% concentration of balsam of Peru in petrolatum. Applications are with Finn Chambers® for 6 different application times, and directly by foils for 96 h (4 days (D)). The goals are to confirm which subjects are positive and which are not, and, using that information, to see if it is possible to distinguish between these 2 groups, tested concomitantly at much lower serial dose levels, in terms of perfusion or by visual assessments. 5 different serial doses are applied with strips for 3–96 h (4D) and with foils for 96 h (4D). The Finn Chamber® tests allow a distinction between visually positive and negative subjects supported by perfusion assessments. With the foils, a 24× lower serial dose level than with the 25% test substance is sufficient to distinguish between positive and negative subjects in terms of perfusion values. This approach requires readings up to 9 days. With this test, the visual approach yields only 3 of 10 positive subjects. This study demonstrates that a lower test dose is possible with perfusion assessments compared to visual ones.
The outcome of an additional patch‐test reading on days 6 or 7
Authors: Jonker Maureen J. , Bruynzeel Derk P.
Published: March 2003

In a retrospective study (period 1997–1998), the usefulness of an additional patch‐test reading on day (D) 6 or 7 was investigated. In 62 out of 760 patients (8.2%), 77 late‐positive reactions, those manifest after D3, were seen. 4 late reactions of allergens of which a related allergen reacted earlier (at D2 or D3) in the same patient were not incorporated in the study as late‐positive. Allergens most involved in producing late‐positive reactions were nickel sulfate (20 reactions), neomycin sulfate (7), tixocortol‐21‐pivalate (5), p.t. butylphenol formaldehyde resin (5) and Cl+Me isothiazolinone (5). Special attention is paid to ?+ reactions at D6 or D7, because these reactions could add extra information to the outcome of patch‐test readings, considering that this might be a group of allergens that has been positive between D3 and D6/7 or become positive later on. When this group is included, the total number of late‐positive reactions is 105 in 88 out of 760 patients (11.6%). By doing D3 readings in combination with D6 or D7 readings only, one would miss 24 positive reactions. However, we concluded that it was preferable to have a reading on D2 and D3. An extra reading on D6 or D7 is very useful as it gives additional information in 8.2% of patch‐tested patients.
Contact allergy to 5,5′‐di‐tert‐butyl‐2,2′‐dihydroxy‐(hydroxymethyl)‐dibenzyl ethers, sensitizers in p‐tert‐butylphenol‐formaldehyde resin
Authors: Zimerson Erik , Bruze Magnus
Published: March 2003

Allergy to p‐tert‐butylphenol‐formaldehyde resin (PTBP‐F‐R) is not rare. This resin consists of a large number of substances, most of which are still unknown. More knowledge about the sensitizers in the resin is a good basis for development of diagnosis, treatment and prevention. The aim of this investigation was to study allergens in PTBP‐F‐R by isolation of some medium molecular weight substances from the resin and patch testing these in individuals hypersensitive to PTBP‐F‐R. 2 isolated substances were shown to be allergens in PTBP‐F‐R, 5,5′‐di‐tert‐butyl‐2,2′‐dihydroxy‐3,3′‐dihydroxymethyl‐dibenzyl ether and 5,5′‐di‐tert‐butyl‐2,2′‐dihydroxy‐3‐hydroxymethyl‐dibenzyl ether. 13 patients hypersensitive to PTBP‐F‐R were patch tested with serial dilutions of 5,5′‐di‐tert‐butyl‐2,2′‐dihydroxy‐3,3′‐dihydroxymethyl‐dibenzyl ether and 12 of them reacted positively. 12 patients hypersensitive to PTBP‐F‐R were patch tested with serial dilutions of 5,5′‐di‐tert‐butyl‐2,2′‐dihydroxy‐3‐hydroxymethyl‐dibenzyl ether and 11 of them reacted positively. Positive patch test reactions were seen down to 0.0000025 mmole×l−1 (≈0.01 ppm) for both 5,5′‐di‐tert‐butyl‐2,2′‐dihydroxy‐3,3′‐dihydroxymethyl‐dibenzyl ether and 5,5′‐di‐tert‐butyl‐2,2′‐dihydroxy‐3‐hydroxymethyl‐dibenzyl ether in the most sensitive patient. HPLC analysis of 2 PTBP‐F‐Rs showed the presence of 1.0–1.7% w/w 5,5′‐di‐tert‐butyl‐2,2′‐dihydroxy‐3,3′‐dihydroxymethyl‐dibenzyl ether and 0.75–0.90% w/w 5,5′‐di‐tert‐butyl‐2,2′‐dihydroxy‐3‐hydroxymethyl‐dibenzyl ether in the resins.
Do cool water or physiologic saline compresses enhance resolution of experimentally‐induced irritant contact dermatitis?
Authors: Levin Cheryl Y. , Maibach Howard I.
Published: March 2003

Acute irritant contact dermatitis (ICD) is frequently treated with cool water or saline compresses. While presumed effective, little quantitative evaluation documents the treatment’s benefit. This study sought to determine the efficacy of both distilled water and physiologic saline compresses on experimentally‐induced ICD. 24‐h application of both the lipophilic nonanoic acid (NAA) and the hydrophilic sodium lauryl sulfate (SLS) were used to induce irritant contact dermatitis in 9 healthy volunteers. Following irritation, compresses were applied 0.5 h 2× daily for 4 consecutive days. Transepidermal water loss (TEWL), laser Doppler flowmetry (LDF), chromametry and visual scoring were used to quantify results. Cool compresses of both water and saline significantly reduced TEWL and LDF, with no statistically significant difference between the efficacy of the saline or water compresses. Chromametry and visual scoring did not detect a significant effect with either the water or saline compresses. The results suggest an improvement with 2×‐daily application of either water or physiologic saline compresses in the treatment of acute ICD, though true clinical benefit will be elucidated through further experimentation. Certainly, the current recommendation regarding the use of cool compresses for treating ICD should not be discarded.
Wearing test with 2 different types of latex gloves with and without the use of a skin protection cream
Authors: Allmers Henning
Published: March 2003

72 subjects reporting symptoms indicating Type I hypersensitivity reactions to natural rubber latex (NRL) gloves were included in this study. 44 of them had a positive prick test to NRL. They underwent wearing tests using 2 types of NRL gloves with high (n=63) and low (n=70) allergen contents. Unigloves MalaysiaTM with a high allergen content caused positive skin reactions in 47% of SPT‐positive and no IgE‐negative subjects. After application of Hand SenseTM skin protection cream, the frequency of positive skin responses in wearing tests decreased to 30% in prick‐test‐positive subjects. The Biogel DiagnosticTM gloves with low allergen caused hypersensitivity with and without Hand Sense in 2 cases (5%) of the prick‐test‐positive. 60% of all test participants had a positive prick test to NRL. No prick‐test‐negative subjects showed any urticaria during the glove‐wearing test. Our study demonstrates that high allergen contents in latex gloves frequently elicit skin responses in NRL‐sensitized subjects. Since other skin protection creams have shown to increase allergic symptoms, it is encouraging to report that Hand SenseTM skin cream may hamper the uptake of allergens from gloves, thus decreasing allergic reactions.
The prevention of occupational hand dermatitis in bakers, confectioners and employees in the catering trades
Authors: Bauer A. , Kelterer D. , Stadeler M. , Schneider W. , Kleesz P. , Wollina U. , Elsner P.
Published: March 2003

Occupational skin diseases (OSD) are among the most frequent occupational diseases (OD). Compared to other occupations, bakers, confectioners and employees in the catering trades are at a high risk of developing OSD. In January 1999, the interdisciplinary Skin Disease Prevention Program in the Baking, Hotel and Catering Industries (SDPP) conducted by the Department of Dermatology and Allergology at the Friedrich Schiller University, Jena, in cooperation with the Research Center for Applied System Safety and Industrial Medicine, Erfurt, and the technical experts at the Social Insurance for the Food Industry and Related Professions (Berufsgenossenschaft für Nahrungsmittel und Gaststätten– (BGN)), Erfurt, was initiated. Following detailed analysis of the occupational exposure of the employees and their personal occupational disease history, the patients’ diagnosis and therapy was re‐evaluated and supplemented if necessary. Individual skin care and protection regimes were demonstrated and practically trained. Skin care and protection products were supplied. Skin‐care and protection seminars were offered to volunteering participants. From January to December 1999, 29 affected employees were examined in the OSD clinic. 22 employees (76%) suffered from irritant contact dermatitis. The follow‐up data of 11 employees are available. In 8 employees (73%), the skin disease improved or disappeared. Moreover, in 1 employee (9%), the skin condition was stabilized even though he continued working. In only 2 employees (18%) did the skin condition worsen. These preliminary results showed that most of the OSD were due to lack of or unsuitable skin care and protection. The program will be extended to cover a larger number of food industry employees with OSD.
Contact urticaria from rice
Authors: Yamakawa Yuko , Ohsuna Hiroyuki , Aihara Michiko , Tsubaki Kazufumi , Ikezawa Zenro
Published: March 2003

A 30‐year‐old man with atopic dermatitis had had erythema and itching of the hands after washing rice in water, though he had always eaten cooked rice without problems. Handling test with water used to wash regular rice was performed on abraded hands, and produced urticarial erythema after several minutes. Applications of water used to wash allergen‐reduced rice were negative for urticarial reaction. Prick test with water used to wash regular rice was +++. However prick test reaction with water used to wash allergen‐reduced rice was +. Histamine‐release test of regular rice‐washing water was grade 3 and that of allergen‐reduced rice grade 1. In immunoblotting analysis with regular rice washing water, there were no bands with this patient. These results suggest that the allergen responsible for contact urticaria in this patient might be water‐soluble, heat‐unstable, and not contained in allergen‐reduced rice.
Patch test sensitization caused by para‐tertiary‐butylcatechol:
Authors: Hillen Uwe , Frosch Peter J. , John Sven M. , Pirker Claudia , Wundenberg Judith , Goos Manfred
Published: March 2003

Para‐tertiary‐butylcatechol (PTBC) has been patch tested in Europe at 1% in petrolatum (pet.) and is now suspected of induction of patch test sensitization. A prospective study was initiated to obtain detailed data on this undesirable risk. A dilution series of PTBC (1%, 0.5%, 0.25%, 0.1% pet.) was used. Patch tests were read on days (D) 1–3, 7, 14 and 21 after application. Patients who were unable to return for late readings were telephoned and asked to report any reaction at the patch test sites. 40 out of 46 patients included completed the study. Patch tests were negative in 35 patients. 4 patients showed a positive patch test at later readings only (D7–D21); 2 patients reacted to a concentration as low as 0.1%. Rechallenge was performed in 2 of these patients, revealing a clearly positive reaction as early as D2 after patch test application. PTBC clearly induced patch test sensitization in 10% of the patients. It cannot be excluded that patch testing with 0.25% PTBC or with even lower concentrations might induce patch test sensitization. The optimal patch test concentration still has to be determined but may be within the range of 0.01% to 0.25% PTBC.
Patch testing for permanent‐pressallergic contact dermatitis
Authors: Metzler‐Brenckle Lorrie , Rietschel Robert L.
Published: March 2003

During the decade of the 90s, 24 cases of permanent‐press textile‐resin contact dermatitis were identified. The most common allergen associated with these cases was dimethylol propylene urea (DMPU). Although previous reports had suggested ethylene urea melamine formaldehyde resin (EUMF) or dimethylol dihydroxy ethylene urea (DMDHEU) as the most appropriate test materials for this type of contact dermatitis, we could not confirm EUMF as appropriate but, with some limitations, can support DMDHEU due to its widespread and continued use. DMPU has been withdrawn from the marketplace and replaced with what may be less reactive materials. In this study, we also observed discordance between EUMF patch tests in the range of 30%, which is consistent with previous reports about the biovariability of patch test results.
The preservative iodopropynyl butylcarbamate: frequency of allergic reactions and diagnostic considerations
Authors: Schnuch A. , Geier J. , Brasch J. , Uter W.
Published: March 2003

The preservative iodopropynyl butylcarbamate (IPBC) (0.1% in petrolatum) was tested in 4883 consecutive patients for 18 months between January 1998 and June 1999. With regard to the MOAHLFA‐Index, the study population comprised 37% males; 17% with occupational and 19% with atopic dermatitis; 31% with hand, 10% with leg and 17% with face dermatitis; 61% were age 40 and above. According to readings at D3, 0.3% were allergic to IPBC, with 14 + and 2 + + reactions. Doubtful or irritant reactions occurred twice as frequently. Patients exposed for 24 h (n = 1814) reacted less frequently (0.1%) than the remaining patients exposed for 48 h (0.5%). Considering the possibility that a certain proportion of + reactions could be false positive, the reaction pattern was evaluated. More than 80% of the positive reactions displayed a crescendo or plateau time pattern. Furthermore, 18 of 43 doubtful reactions (?) appeared as late as D3 (thus, these could be false negative), whereas the majority of doubtful reactions occurred earlier and displayed a decrescendo pattern (corresponding to a typical irritant pattern). In conclusion, the large proportion of ‘?’ reactions may be due not only to the irritant potential of the substance, but also to test concentrations not being high enough to elicit an allergic reaction. We propose that higher concentrations of IPBC (0.3%) should be evaluated in a study also addressing suitable validation tests like ROAT or PUT.
Type IV allergy in the food processing industry: sensitization profiles in bakers, cooks and butchers
Authors:   Andrea Bauer, Geier Johannes , Elsner Peter
Published: March 2003

Data about the impact of allergic contact dermatitis in food processing occupations are scarce. The objective of this study was to identify the most frequent allergens and sensitization profiles in employees of the food processing industry. The results of patch testing performed in 873 bakers, cooks and butchers suspected of having occupational allergic contact dermatitis from 33 dermatological departments of the Information Network of Departments of Dermatology (IVDK) from 1992 to 1999 were analysed. A final diagnosis of allergic contact dermatitis was made in 213 patients (24.4%). Qualitative and quantitative differences in allergen profiles could be identified. Significantly higher sensitization rates were found in employees in the food processing industry, compared to the total test population, for nickel sulphate (22.4% versus 17.2%, p < 0.0005), thiuram mix (4.9% versus 2.6%, p < 0.0005), formaldehyde (3.5% versus 2.1%, p < 0.005) and Compositae mix (6.2%, p < 0.0005). Significantly lower sensitization rates were found for thimerosal (4.5% versus 6.9%, p < 0.05). For patch testing in food workers, we recommend the standard, the rubber and the Compositae series, as well as patients' own products according to the individual history.
Occupational dermatoses among fibreglass‐reinforced plastics factory workers
Authors: Minamoto Keiko , Nagano Megumi , Inaoka Tsukasa , Futatsuka Makoto
Published: March 2003

Fibreglass‐reinforced plastics (FRP) factory workers are at high risk of developing occupational dermatoses because of their exposure to many chemicals used in the manufacture of plastics as well as to glass fibre or dust. Patch tests were carried out on 29 workers involved in FRP manufacturing processes where unsaturated polyester (UP) resin was used, to investigate the causes of their skin problems. Of the 22 workers who reported experiencing skin problems, 16 showed positive results to at least 1 chemical, including 6 cases of multiple sensitivity. 2 showed positive reactions to UP base resin, 6 to cobalt chloride, 5 to benzoyl peroxide (BPO), 4 to methyl ethyl ketone peroxide (MEKPO), 2 to para‐tertiary butyl catechol (PTBC), 1 to styrene and 1 to formaldehyde. After taking into account their exposures and reported causes by questionnaires and their patch test results, 7 cases were diagnosed as allergic contact dermatitis (ACD) due to chemicals, 3 as irritant contact dermatitis (ICD) due to chemicals, and 3 as dermatitis due to mechanical irritation (MI) from glass fibre or dust, as well as 9 as ACD and/or MI. 18 of the total of 29 subjects (62.1%), including 2 workers without a history of skin problems, were sensitized to at least 1 chemical. Cobalt, peroxides, PTBC and UP base resin were the common causes of ACD.
Dose–time relationships for elicitation of contact allergy to para‐phenylenediamine
Authors: Hextall J. M. , Alagaratnam N. J. , Glendinning A. K. , Holloway D. B. , Blaikie L. , Basketter D. A. , McFadden J. P.
Published: March 2003

Skin‐sensitizing chemicals exhibit dose–response relationships for the elicitation of contact dermatitis. Previously, considerable work has been carried out in which the elicitation of allergic skin reaction has been examined as a function of the applied concentration. However, the relationship between exposure time, dose and response has not been explored in any depth. The present work has extended our initial assessment of the relationship between both exposure time and concentration for para‐phenylenediamine (PPD) in a group of 19 PPD‐allergic volunteers. The results clearly demonstrate that a relationship exists between both exposure time and concentration. Positive responses to PPD were directly proportional to exposure time: at 5 min 16% responded; at 15 min, 38%; at 30 min, 50%; and at 120 min, 69%. A similar direct relationship was found between concentration of PPD and response: after 120 min, 22% of patients had responded to 0.01%, and 69% to 1% PPD. All exposures for 1 and 2 min were negative. Subsequent evaluation using repeated 5 min open application testing demonstrated a cumulative effect, as after 8 days 39% of the panel reacted, more than double the number that reacted to a single occluded 5‐min treatment. It was noted that there was marked subject variability in exposure time and dose required to elicit an allergic response. These results are of relevance for the general interpretation of patch test data, especially with regard to risk assessment.
Contact allergy to the monomers in p‐tert‐butylphenol‐formaldehyde resin
Authors: Zimerson Erik , Bruze Magnus
Published: March 2003

In many adhesive formulations p‐tert‐butylphenol‐formaldehyde resin (PTBP‐F‐R) is used as a binder. Contact allergy to this resin is not rare. In patients hypersensitive to PTBP‐F‐R, and butylphenol derivatives therein, it is for diagnostic and preventive reasons necessary to know the nature of the primary sensitizing substances, as well as the cross‐reaction patterns for these. The aim of this study was to investigate contact allergy to monomers in PTBP‐F‐R and potential cross‐reacting substances. 12 patients hypersensitive to PTBP‐F‐R were patch tested with 2 monomers, the raw materials formaldehyde and p‐tert‐butylphenol, and 3 closely related substances. High pressure liquid chromatography (HPLC) was used to investigate the purity of the test substances. It was shown that the monomers 2‐methylol p‐tert‐butylphenol and 2,6‐dimethylol p‐tert‐butylphenol could elicit allergic reactions in humans hypersensitive to PTBP‐F‐R. No simultaneous reactions or cross‐reactions were shown to formaldehyde, p‐tert‐butylphenol, p‐tert‐butylcatechol, 2(3)‐tert‐butyl‐4‐hydroxyanisole (BHA) or 3,5‐di‐tert‐butyl‐4‐hydroxytoluene (BHT). It was also shown that low amounts of contaminants in the test substances, if not taken into account, could influence the conclusions drawn from the test results obtained.
Contact hypersensitivity in hand dermatitis
Authors: Li Lin‐Feng , Wang Jing
Published: March 2003

Contact hypersensitivity (CHS) in hand dermatitis (HD) was studied by patch testing (PT) 105 consecutive adult HD patients and 361 cases of suspected non‐hand allergic contact dermatitis (NHD). The suspected offending agents were also investigated by a questionnaire. Age and sex distribution was no different between the 2 groups. The total positivity rate of PT in the HD group was much lower than in the control group (46.7% versus 63.2%, p < 0.01, χ2‐test). The most common allergens in HD were rubber mix(17.1%), p‐phenylenediamine (PPD) (14.3%), fragrance mix (9.5%), nickel (9.5%), colophonium (6.7%) and potassium dichromate (2.9%), while those in the control group, in sequence, were nickel (20.5%), rubber mix (16.9%), PPD (14.1%), fragrance mix (12.7%), potassium dichromate (5.5%) and colophonium (5.0%). The positivity rate to nickel was lower in the HD group (9.5% versus 20.5%, p < 0.05, χ2‐test), while there was no significant difference for the other allergens. HD was divided arbitrarily into 5 groups: (1) vesicular form, in which fine papules and vesicles can be detected. 65.7% of the HD was vesicular form and 55.1% of them were PT positive; (2) fissured form, in which dry skin with fine fissures or desquamation is seen. 8.6% of the HD was fissured form and 30% of them were PT positive; (3) hyperkeratotic form, in which the lesions are thick, hyperkeratotic plaques – 6.7% of the HD was this form and no positive reaction was found; (4) hand and foot dermatitis (HFD) – 12.4% of HD was HFD and 53.8% of them were PT positive; (5) pompholyx – 6.7% of the patients had pompholyx and one positive result to nickel was detected. The suspected offending agents were reported in only 13 (12.4%) patients. These results suggest that CHS is less common in HD than in NHD and that other factors, such as skin irritation, may play more of a role in HD. Nickel allergy is less common in HD than in NHD. CHS may play a role in more than 1/2 of vesicular form HD, HFD and in some fissured HD also, but is less common in hyperkeratotic HD and pompholyx. Only a small proportion of the HD patients could report the suspected offending agents and PT should be performed in all patients with chronic HD.
Skin protection programmes
Authors: Agner Tove , Held Elisabeth
Published: March 2003

Educational programmes, including evidence‐based recommendations on skin protection (skin protection programmes), have been proposed for the prevention of irritant contact dermatitis in occupations with a high frequency of this disease. Recent intervention studies directed at wet‐work employees showed a positive influence on wet‐work behaviour and on clinical skin symptoms. The structure and implementation of skin protection programmes are discussed.
The quantitative and qualitative analysis of the craniofacial skeleton of mice lacking the IGF‐I gene
Authors: McAlarney M.E. , Rizos M. , Rocca E.G. , Nicolay O.F. , Efstratiadis S.
Published: March 2003

Insulin‐like growth factors are mediators of growth hormone and are believed to also stimulate growth independently. Insulin‐like growth factor I (IGF‐I) null mutant mice exhibit a lower rate of skeletal growth compared with their wild‐type (control) littermates. Although their general body dimensions seem proportionate, their heads appear shortened with a blunt nose compared with the controls.  The aim of this project was threefold: 1) to investigate whether differences in shape/form exist between the craniofacial skeleton of the IGF‐I null mutant mice and their control littermates by using three techniques; 2) to determine whether the three techniques yield similar, different, or complementary information regarding the size and shape of specimens; and 3) to investigate whether the histological sections obtained from the craniofacial skeleton exhibit any differences between the two groups.  Thirty adult male mice, 12 mutant and 18 wild type, obtained from 11 litters were examined. Lateral and superio‐inferior radiographs of their head were analyzed by the procrustes, the macroelement, and the traditional cephalometric techniques. Later, the animals were processed for routine histological examination.  The IGF null mutant mice demonstrated a generalized decrease of craniofacial size (43–64% of the normal adult size) and a non‐allometric change of shape when compared with their wild‐type littermates. While the mandible did not exhibit any shape changes, the facial and cranial areas demonstrated prominent changes. Examination of histological sections did not reveal any structural difference between the two groups at the adult stage. Furthermore, procrustes and macroelement techniques offer a more complete, detailed, and comprehensive description of the specimens compared.
Encapsulated fat necrosis – A clinicopathological study of 8 cases and a literature review
Authors: Kiryu Hiromaro , Rikihisa Wataru , Furue Masutaka
Published: March 2003

Eight cases of encapsulated fat necrosis are described. The patients were two males and six females from 10 to 77 years of age. The majority of the lesions clinically presented as asymptomatic, multiple, mobile, small nodules. All patients were treated by simple excisions of the nodules. Grossly, the lesions were whitish‐yellow in color, smoothly‐surfaced, round nodules measuring 3 to 20 mm in the greatest diameter. Histopathologically, the nodules were basically composed of variably degenerated and necrotic fatty tissue covered by fibrous connective tissue capsule associated with occasional calcification and inflammatory cell infiltrates. Among several terms proposed for this disease, encapsulated fat necrosis is considered most preferable term based on the clinical and histological findings of the present and reported cases.
Melanocytes in nevi and melanomas synthesize basement membrane and basement membrane‐like material. An immunohistochemical and electron microscopic study including immunoelectron microscopy
Authors: Schaumburg‐Lever G. , Lever I. , Fehrenbacher B. , Möller H. , Bischof B. , Kaiserling E. , Garbe C. , Rassner G.
Published: March 2003

Light microscopic studies have shown that nevus cell nests and melanoma nests are surrounded by basement membrane (BM) material containing type IV collagen and laminin. This study confirms this by electron microscopy and relates it to proteins which interact with the basement membrane. Nevi except for dysplastic and Spitz nevi, malignant melanomas, and melanoma metastases were studied by immunohistopathology, routine electron microscopy (EM), and immunoelectron microscopy. The lesions were incubated with monoclonal antibody (moAb) against type IV collagen, laminin, and the integrin α6 and studied by light microscopy. In addition, melanomas were studied by immuno‐EM after incubation with a moAb against matrix metalloproteinase‐2 (MMP‐2). Nevus cell nests and melanoma nests are surrounded by BM material containing type IV collagen and laminin by immuno‐EM. The BM material various in thickness and is amorphous. Type IV collagen, laminin, and MMP‐2 are synthesized by melanoma cells as well as adjacent fibroblasts. Destruction or loss of the BM is not mandatory for melanoma invasion or even metastasis. Possibly the BM material is a protective wall for melanoma cells. Interactions between melanocytes and the extracellular matrix of which the BM is a part, can be traced back to the migration of melanocytes from the neural crest.
Benign mucinous metaplasia of the penis. A lesion resembling extramammary Paget's disease
Authors: Fernando Val‐Bernal J. , Hernández‐Nieto Emilia
Published: March 2003

Benign mucinous metaplasia in the surface epithelium of the genital area is rare and has only been reported once in the vulva. A unique case of benign mucinous metaplasia of the prepuce in a 65‐year‐old man is reported here. The lesion measured 0.6 cm, was located in the mucous surface of the foreskin, and showed acid mucin containing cells. We regard benign mucinous metaplasia as a reactive rather than a neoplastic process. The main lesions to be considered in the differential diagnosis are mucinous syringometaplasia, extramammary Paget's disease, cutaneous squamous cell carcinoma in situ with mucinous metaplasia, superficial spreading malignant melanoma, and epidermotropic metastasis. The confinement of mucin‐containing cells to the epidermis, the absence of nuclear atypia, the basal orientation of the nuclei, the predominant location of the cells in the upper layers of the epithelium, and the fact that the mucinous cells are replacing the squamous epithelium rather that infiltrating it, all assist in recognizing mucinous metaplasia of the penis as a specific and benign entity.
Cutaneous malignant melanoma associated with extensive pseudoepitheliomatous hyperplasia. Report of a case and discussion of the origin of pseudoepitheliomatous hyperplasia
Authors: Hanly Andrew J. , Jorda Merce , Elgart George W.
Published: March 2003

We report a case of cutaneous malignant melanoma associated with extensive pseudoepitheliomatous hyperplasia. Pseudoepitheliomatous hyperplasia may mimic squamous cell carcinoma and may complicate the diagnosis of cutaneous melanoma. This diagnostic pitfall is important to both recognize and be cognizant of, so as to avoid diagnostic errors. The observation of the pseudoepitheliomatous hyperplasia, in this case with an extensive proliferation of eccrine ducts, provides further evidence that cutaneous pseudoepitheliomatous hyperplasia arises within the eccrine apparatus.
Mixed syringocystadenoma papilliferum and papillary eccrine adenoma occurring in a scrotal condyloma
Authors: Coyne J. D. , Fitzgibbon J. F.
Published: March 2003

This paper describes an unusual appendage tumour with mixed elements of syringocystadenoma papilliferum (SCAP) and papillary eccrine adenoma (PEA) occurring in a scrotal condyloma. The occurrence of SCAP in association with a condyloma is an unusual event; however, the presence of SCAP in association with PEA is of greater significance.
Nodular hidradenocarcinoma with prominent squamous differentiation: case report and immunohistochemical study
Authors: Park Hyang Joon , Kim You Chan , Cinn Yong Woo
Published: March 2003

We report the case of a 24‐year‐old woman with nodular hidradenocarcinoma on the scalp. While histopathology of the tumor showed a circumscribed, lobulated intradermal mass with prominent squamous differentiation, the immunohistochemical study with antibodies to cytokeratins, CAM 5.2 and 19, epithelial membrane antigen, carcinoembryonic antigen, S‐100 protein and p53 all demonstrated positivity. These findings confirmed that the tumor was of eccrine sweat gland origin and it was thought to be a nodular hidradenocarcinoma differentiating toward the eccrine duct and/or secretory portions. She was treated with a wide local excision and no recurrence was observed 18 months after excision.
Cutaneous epithelioid malignant nerve sheath tumor with rhabdoid features: a histologic, immunohistochemical, and ultrastructural study of three cases
Authors: Morgan Michael B. , Stevens Lex , Patterson James , Tannenbaum Myron
Published: March 2003

Introduction: Malignant rhabdoid tumors are morphologically defined as sheets of loosely cohesive cells with eccentric nuclei and hyaline, paranuclear inclusions. Although originally described as a distinctive renal neoplasm of childhood, these tumors have since been described in all age groups and in a variety of extrarenal sites. In the latter setting, it is thought that the rhabdoid phenotype is comprised of histogenetically unrelated tumors, that regardless of histogenesis, pursue a biologically aggressive behavior.

Methods: We report on the clinical, histologic, immunophenotypic, and ultrastructural characteristics of three cases of cutaneous malignant rhabdoid tumor.

Results: Each of the cases arose on the trunk or the extremity of elderly men. None of the patients had neurofibromatosis. All of the lesions histologically showed sheets of loosely cohesive polygonal cells with eccentric nuclei and hyaline paranuclear inclusions. Each of the cases showed the following immunophenotype: S‐100 (+), synaptophysin(+), vimentin (+), alpha smooth muscle actin (−), CD‐30 (−), HMB‐45 (−), and pankeratin(−). Ultrastructure of two of the cases yielded similar results showing paranuclear filamentous aggregates of intermediate filaments, cell membrane dense plaques, and rudimentary cell junctions consistent with nerve sheath differentiation. Tonofilaments, dense bodies, microtubules, neurosecretory granules, and melanosomes were not identified. Each of the patients died of widely metastatic disease within 1 year of diagnosis.

Conclusions: Cutaneous epithelioid malignant nerve sheath tumor is a potentially aggressive tumor capable of showing rhabdoid differentiation thus simulating a variety of neoplasms. Immunophenotyping and ultrastructural analysis reliably discriminates these lesions from melanoma, de‐differentiated carcinoma, lymphoma, and rhabdomyosarcoma.
Cardiac epithelioid angiosarcoma presenting as cutaneous metastases
Authors: Val‐Bernal J. Fernando , Figols Javier , Arce Félix P. , Sanz‐Ortiz Jaime
Published: March 2003

Background: Cardiac angiosarcoma is a rare tumor that has a predilection for middle‐aged males and a marked predominance in the right atrium. The tumor may present abruptly with a fulminant clinical course. Initial presentation with metastatic disease is rare. Only one case has been reported of a patient who presented with cutaneous metastases.

Methods and results: We here report the case of a 51‐year‐old man who initially presented with cutaneous metastases in the absence of cardiac symptoms. The skin biopsy was diagnosed as metastatic undifferentiated sarcoma. The patient died 26 days later with widely disseminated disease. At autopsy a tumor arising in the wall of the left atrium and in the interatrial septum was found. After an immunohistochemical study including CD31 and CD34 stains the diagnosis of cardiac pure epithelioid angiosarcoma was made. To the best of our knowledge this tumor variant has not been documented in the heart until now.

Conclusion: Although cardiac angiosarcoma is a rare neoplasm, its presence should be suspected in patients with cutaneous metastatic angiosarcoma without an evident source of the tumor, even in absence of cardiac symptoms.
Olmsted syndrome
Authors: Fonseca Eduardo , Peña Carmen , Del Pozo Jesús , Almagro Manuel , Yebra Ma. Teresa , Cuevas Jesús , Contreras Félix
Published: March 2003

Olmsted syndrome is an uncommon inherited disorder of keratinization that presents mutilating palmoplantar keratoderma, perioral hyperkeratosis, leukokeratosis and alopecia. We report a case of this rare syndrome diagnosed in a 48‐year‐old woman and confirms the existence of a generalized abnormality in keratin expression. Immunoreactivity in our case suggests an abnormal expression of keratins 5 and 14 similar to the observed in other hyperproliferative disorders.
Expression of PGP 9.5 in granular cell nerve sheath tumors: an immunohistochemical study of six cases
Authors: Mahalingam Meera , LoPiccolo Danielle , Byers H. Randolph
Published: March 2003

Background: Protein gene product 9.5 (PGP 9.5) is expressed in brain at 20 to 50 times the levels detected in other organs. Immunohistochemical studies reveal this protein is localized to both central and peripheral neurons. Recently, PGP 9.5 is reported to be a useful marker for cellular neurothekeomas. Herein we test whether PGP 9.5 is a new marker for granular cell nerve sheath tumors.

Material and Methods: An immunohistochemical analysis for PGP 9.5 expression was carried out on all cases with the diagnosis of granular cell nerve sheath tumor seen over a 2‐year period. In addition, we compared expression of PGP 9.5 with other accepted markers for neuroectodermal tumors including anti‐S‐100 protein and NKI/C3 monoclonal antibodies.

Results: Six granular cell nerve sheath tumors were diagnosed in over 80,000 dermatopathology specimens in the two‐year period. These cases were all positive for PGP 9.5 as well as for S‐100 protein and NK1/C3.

Conclusion: These findings identify PGP 9.5 as a new immunohistochemical marker for use in the diagnosis of granular cell tumors. They also strengthen the histogenetic relationship between granular cell nerve sheath tumors and tumors of Schwann cell or perineurial origin.
Tumor of the follicular infundibulum with sebaceous differentiation
Authors: Mahalingam Meera , Bhawan Jag , Finn Ronald , Stefanato Catherine M.
Published: March 2003

Background: Tumor of the follicular infundibulum (TFI) is a relatively rare tumor which clinically presents as a solitary keratotic papule usually on the head and neck which on microscopic examination typically reveals a plate‐like fenestrated epithelial tumor composed of pale staining cells.

Methods: We describe a new variant of TFI. An 80‐year‐old male with a history of multiple basal cell carcinomas and a squamous cell carcinoma presented with a 2‐year history of a red, scaly, slightly elevated plaque on the lateral aspect of his right buttock.

Results: Histopathological examination revealed plate‐like reticulate epithelial outgrowths of large and pale cells with foci of sebaceous differentiation and numerous colloid bodies. Differential diagnosis included superficial basal cell carcinoma with sebaceous and ductal differentiation, tumor of the follicular infundibulum, an unusual fibroepithelioma of Pinkus or an eccrine fibroadenoma with sebaceous differentiation.

Conclusion: This case illustrates a hybrid adnexal tumor with histologic features common to both tumor of the follicular infundibulum and superficial epithelioma with sebaceous differentiation.