bluuebunny/crossref_metadata_2025 huggingface dataset:
Nodular fat necrosis associated with lupus‐induced pancreatitis
Authors: Stanford Alan R. , Mezebish David S. , Cobb Mark W.
Published: August 2010

A 29–year‐old black vi/oman presented with a 6–year history of lupus nephritis, cerebritis, arthritis, and recurrent facial erythema. She was admitted to the National Naval Medical Center following an acute lupus flare manifested by the onset of acute tubular necrosis requiring the initiation of hemodialysis. The patient had also developed a Staphylococcus aureus septicemia secondary to an infected IV site. During the first and second weeks in hospital, the patient responded well to aggressive antibiotic therapy and oral prednlsone. As the oral prednisone was decreased from 60 mg to 40 mg per day on day 19 in hospital, the patient developed several tender, erythemafous, subcutaneous nodules over the lower extremities (Fig. 1). There was no cutaneous ulceration or drainage. Although the initial clinical diagnosis was erythema nodosum, a deep incisional biopsy was performed to rule out infectious, vasculitic, or lupus panniculitis.

Histologic findings of a representative leg nodule included lobular panniculitis with extensive fat necrosis,' ghost cell' formation, acute suppurative inflammation, and focal calcification (Fig. 2). Stains and cultures for organisms were negative. These findings were felt to be pathognomonic for nodular fat necrosis associated with pancreatic disease.

Laboratory data revealed serum amylase and lipase to be markedly elevated at 1342 U/L (A/=28–110 U/L) and 4160 U/L (W=7–60 U/L), respectively; white blood cell count and differential were within normal limits. Other significant laboratory data included an anti‐DNA of 692 lU/mL (A/=<100 IU/mL) and positive anti‐Sjogren's syndrome‐A.

Simultaneous punch biopsy of an erythematous facial macule revealed epidermal atrophy, vacuolar interface change, and a mild perivascular and periadnexal lymphohistiocytic infiltrate, consistent with lupus erythematosus. Computed tomography (CT) scan and ultrasound exannination of the abdominal cavity failed to provide further evidence of pancreatitis.

Although the patient was initially asymptomatic, 1 week following the onset of her leg nodules she developed severe ankle and knee arthralgias, abdominal pain, nausea, and vomiting which were attributed to her pancreatitis. She was treated with high‐dose prednisone and Cytoxan for control of her lupus flare, which brought about the resolution of her leg nodules and associated symptoms over the following 6 weeks. Only post‐inflammatory hyperpigmentation remained in the skin overlying the sites of nodular fat necrosis.
Granular cell tumor (Abrikossoff tumor) of the clitoris
Authors: Ortiz‐Hidalgo Carlos , de la Vega Guillermo , Moreno‐Collado Clemente
Published: August 2010

A 60‐year‐old woman presented to the Department of Dermatology of the ABC Medical Center in Mexico City with a 2‐month history of a progressive growth in the region of the clitoris that had been increasing rapidly. Examination revealed a firm growth measuring 3 cm in diameter; the overlying surface was smooth and free of ulceration. Vaginal speculum examination showed no mucosal irregularities or displacement. Rectal examination was normal. Inguinal lymph nodes were clinically negative. A wide excisional biopsy was performed with ample skin margins.

The specimen consisted of a mass measuring 3.5 × 1.2 × 0.5 cm that was pale tan, homogeneous, and firm. Prepared sections showed a cellular tumor composed of compact irregular strands and nodules of polyhedral cells containing centrally located, round to oval vesicular nuclei with no significant atypia of mitosis. These cells had granular eosinophilic cytoplasm with distinct cell borders (Fig. 1). The cytoplasmic granules were diastase‐resistant periodic acid‐Schiff (PAS) positive. The tumor cells were positive for S–100 protein and for neuron‐specific enolase (NSE), and were negative for actin, desmin, and cytokeratin. The tumor showed compression and obliteration of the cavernous sinuses (Fig. 2) outlined by the S–100 immunostain and actin. (Figs 3 and 4).
A case of nevus comedonicus syndrome associated with neurologic and skeletal abnormalities
Authors: Seo Young‐Joon , Piao Yong‐Jun , Suhr Ki‐Beom , Lee Jeung‐Hoon , Park Jang‐Kyu
Published: August 2010

A 12‐year‐old male was referred to us with recurrent pus discharge from tender nodules on the right axilla dating from the neonatal period. The nodules were black, characterized by scarring with dilated follicular openings and there were black papules filled with comedo‐like keratin plugs in both axillae. Physical examination revealed a bowing deformity of the right third finger and retardation in language ability. The patient was referred to the Departments of Neurology and Orthopedics in Chungnam National University Hospital, Korea.

Histologic examination of one of the black comedo‐like lesions showed a bulbous and dilated infundibulum that contained laminated keratin, indicating a diagnosis of nevus comedonicus. A CT scan of the brain revealed dysgenesis of the corpus callosum. The IQ (intelligence quotient) score of the patient, measured by the Korean Wechsler Intelligence Scale for Children‐Revised, was 94. The only difficulty noted for ordinary life was learning language. A radiograph of the right hand revealed hyperextension and an ulnar drift deformity of the right middle finger. Corrective osteotomy with external fixation and an iliac bone autograft were performed. Intermittent neurologic follow‐up visits were ordered for the noted language deficit. At present the patient only exhibits difficulty in calculation.

Oral antibiotics were administered to the skin lesions on occasion for secondary infections and inflammation of the cysts and comedones. Extraction of the comedones was performed as needed.
Scurvy in a 10‐month‐old boy
Authors: Larralde Margarita , Santos Muñoz Andrea , Boggio Paula , Di Gruccio Vanesa , Weis Isaac , Schygiel Adolfo
Published: August 2010

We report a 10‐month‐old boy with inflammatory and necrotic gingival lesions, fever, irritability, and pseudoparalysis of the legs. Laboratory examinations revealed moderate anemia and skeletal X‐rays showed osteopenia, scorbutic rosary at the costochondral junctions, and “corner sign” on the proximal metaphyses of the femora. The boy had been fed only with diluted cow's milk. He had never taken solid food, vitamin C, or iron complement. Seventy‐two hours after starting oral vitamin C supplementation, there was significant improvement in the patient's gingival lesions and general health. The clinical presentation and laboratory and imaging findings, together with the dramatic response to ascorbic acid intake, allowed us to confirm the diagnosis of infantile scurvy.

Scurvy, a dietary disease due to the deficient intake of vitamin C, is uncommon in the pediatric population. In an infant who has never received vitamin C, the combination of gingival lesions, pseudoparalysis, and irritability strongly suggests a diagnosis of scurvy. The clinical picture, together with the laboratory data, radiological studies, and therapeutic response to vitamin C administration, confirmed the diagnosis.
Efficacy of 10% silver nitrate solution in the treatment of common warts: a placebo‐controlled, randomized, clinical trial
Authors: Ebrahimi Sedigheh , Dabiri Nader , Jamshidnejad Esmaeel , Sarkari Bahador
Published: August 2010

Background  Warts are a common skin lesion, especially in children and young adults, caused by human papillomaviruses. So far, there is no definitive therapy for warts and the treatment is modified regularly to obtain the best result with the least discomfort to the patient. The aim of this placebo‐controlled clinical trial was to evaluate the clinical efficacy, tolerability, and safety of 10% silver nitrate solution for the treatment of common warts.

Methods  Sixty individuals attending pediatrics and dermatology clinics and health centers in Yasuj, south‐west of Iran, were recruited. The patients were divided into two groups: 30 patients received 10% silver nitrate solution (case group) and 30 control patients received black ink (placebo group). Silver nitrate solution was used every other day for 3 weeks. After 3 weeks, the patients were evaluated for healing, and treatment was continued for another 3 weeks if the lesions were still present.

Results  Complete regression of lesions was achieved in 19 of the 30 (63.33%) case patients. No significant side‐effect was noted in the treated patients apart from temporary brownish discoloration of the skin which resolved 1 week after treatment.

Conclusion  This study demonstrated that 10% silver nitrate solution can be used effectively for the treatment of warts with no serious complications.
Cutaneous tumefaction in empyema necessitatis
Authors: Reyes Cesar V.
Published: August 2010

Background  Empyema necessitatis refers to a collection of exudative fluid that extends directly from the pleural cavity to the thoracic wall to form a mass in the extrapleural soft tissue of the chest. It was an uncommon complication of tuberculous pleural effusion even in the pre‐antibiotic era, and has also been associated with bacterial lung abscess, actinomycosis, blastomycosis, and malignancies.

Methods  Seven instances of chest wall mass lesion secondary to empyema necessitatis, diagnosed by fine‐needle aspiration biopsy (FNAB), are reported.

Results  Three cases were tuberculous, two were mesotheliomatous, one was caused by pulmonary small cell carcinoma, and another was due to coexisting Actinomyces and Actinobacillus. In all patients, subsequent pleural fluid cytologies demonstrated empyema with the respective etiologies identified.

Conclusions  The usefulness of FNAB in the diagnosis of empyema necessitatis, supported by radiographic imaging and ancillary procedures, is well illustrated by these seven cases.
Is there a role for infliximab in the current therapy of hidradenitis suppurativa? A report of three treated cases
Authors: Moschella Samuel L.
Published: August 2010

Background  Hidradenitis suppurativa is one of the follicular occlusion diseases favoring the flexural areas of the body. Because of the past failure of medical therapy, surgery is today the definitive therapeutic approach. There is a need for effective medical anti‐inflammatory therapy to control the disease and minimize the pathologic and socioeconomic consequences of the disease process. Generally the patients fail to respond to topical or systemic antibiotics and retinoids. Temporary responses are achieved with intralesional steroids and cyclosporin.

Methods  The association of hidradenitis suppurativa with inflammatory bowel disease permitted the opportunity to utilize infliximab and to observe not only its impact on the bowel, but also skin.

Results  Infliximab dramatically and favorably impacted on three cases of hidradenitis, but also in one of the patients who also had pyoderma gangrenosum.

Conclusions  Infliximab appears to be an effective medical approach to the management of hidradenitis suppurativa and also to prepare the patient for “curative” surgery. However, one must be cognizant of the potential of acquired drug resistance or adverse drug reactions, which can be minimized by “no vacations” from this systematic therapy and the use of methotrexate to minimize the above potential problems.
Multiple condylomata lata: a case report
Authors: Hua Haikang , Zhu Xiaohong , Yang Lijia , Li Ming , Jiang Pingdong
Published: August 2010

An unusual form of secondary syphilis was reported, characterized by multiple papules involving the intertriginous areas. The skin biopsy was performed but was nondiagnostic. Later on, serologic tests confirmed the diagnosis. This patient is presented to emphasize the importance of considering syphilis in any patient with an at‐risk sexual history and popular verrucous lesions of the skin folds.
Leflunomide in subacute cutaneous lupus erythematosus – two sides of a coin
Authors: Suess Anke , Sticherling Michael
Published: August 2010

Background  Subacute cutaneous lupus erythematosus (SCLE), a distinct clinical subset of lupus erythematosus, remains a therapeutic challenge, especially in cases resistant to topical and standard systemic therapy. Leflunomide, a novel antirheumatic drug, has shown efficacy in the treatment of systemic lupus erythematosus in pilot studies.

Methods  We report two patients with SCLE who demonstrated the spectrum of possible clinical responses to leflunomide therapy.

Results  One patient experienced a complete clinical remission of symptoms, whereas the other developed a massive skin reaction which was distinctly related to the commencement of leflunomide therapy.

Conclusion  To our knowledge, this is the first time that remission and deterioration of SCLE by leflunomide therapy have been described.
Clinical importance of Demodex folliculorum in patients receiving phototherapy
Authors: Kulac Mustafa , Ciftci Ihsan Hakkı , Karaca Semsettin , Cetinkaya Zafer
Published: August 2010

Background  Patients with immunodeficiency are prone to infestation with Demodex folliculorum mites. Ultraviolet (UV) radiation can lead to immunosuppression and sebaceous gland hyperplasia. Although some cases of demodicidosis related to UV radiation exposure have been reported, no studies have been performed on the incidence of D. folliculorum and its clinical characteristics in patients receiving phototherapy.

Objective  To investigate the effects of phototherapy on the density of D. folliculorum infestation and its clinical characteristics.

Methods  This was a cross‐sectional study. Forty‐five patients receiving phototherapy and 43 age‐ and sex‐matched healthy controls were enrolled to the study. The sociodemographic characteristics, occupational information, and skin types (2, 3, 4, or 5) of both patients and controls were carefully recorded. The dermatologic diseases requiring phototherapy, type and number of phototherapy treatments, and cumulative UV doses of all patients were noted. The clinical findings that may relate to demodicidosis were recorded. Standardized skin surface biopsies were taken from three anatomic regions (forehead, cheek, and nasal dorsum) and suspected lesions; five or more D. folliculorum mites per square centimeter of skin was defined as demodicidosis.

Results  Twelve (26.7%) patients received psoralen plus UV‐A (PUVA) and 33 (73.3%) received narrow‐band UV‐B. Demodicidosis was detected in 13 (28.9%) patients and three (7%) controls. The difference in the demodicidosis rate between patients and controls was statistically significant (P = 0.01). In eight of the 13 patients (61.5%) with demodicidosis, clinical demodicidosis was present. Demodicidosis was present in seven of the 12 patients (58.3%) receiving PUVA and in six of the 33 patients (18.2%) receiving narrow‐band UV‐B. The difference in demodicidosis rates between patients receiving PUVA and those receiving narrow‐band UV‐B was statistically significant (P = 0.02). A statistically significant difference was also found between the mean D. folliculorum densities of patients and controls in all anatomic regions.

Conclusion  Demodicidosis should be included in the differential diagnosis of facial eruptions in patients receiving phototherapy.
Hydroquinone‐induced exogenous ochronosis: a report of four cases and usefulness of dermoscopy
Authors: Charlín Raúl , Barcaui Carlos B. , Kac Bernard Kawa , Soares Deborah Brazuna , Rabello‐Fonseca Rosa , Azulay‐Abulafia Luna
Published: August 2010

Hydroquinone is the first choice of topical bleaching agents used in treatment of melasma. In Brazil, hydroquinone is widely prescribed by physicians and often used by patients without a prescription. The principal adverse effects of its chronic use are confetti‐like depigmentation and exogenous ochronosis. The latter manifests clinically with gray‐brown or blue‐black hyperpigmentation, as well as pinpoint hyperchromic papules that look like caviar, and therefore called caviar‐like. On histopathology, curved ochre‐colored structures, ‘banana‐shaped’ fibers, appear in the papillary dermis. No description of dermoscopy in ochronosis is found in the literature. We report four cases of hydroquinone‐induced exogenous ochronosis. Dermoscopy was performed in two patients on the areas with ochronosis, and in addition to the melasma findings, amorphous densely pigmented structures obliterating some follicular openings were observed. Exogenous ochronosis is an avoidable dermatosis that is difficult to treat. Dermatologists should be able to differentiate it from melasma and immediately discontinue hydroquinone. Dermoscopy might become a valuable resource in approaching exogenous ochronosis.
Pseudoxanthomatous mastocytosis
Authors: Srivastava Neeraj , Chand Satish , Singh Sanjay
Published: August 2010

A 50‐year‐old woman presented with itchy, multiple, flat, yellowish, waxy papules and plaques diffusely involving her face, trunk, and upper extremities for 5 years (Fig. 1). Itching was moderate to severe in intensity and was episodic, without any identifiable aggravating or relieving factors. On rubbing the lesions with a blunt object erythema was elicited. Her ophthalmological examination was normal. Her complete hemogram was normal along with other routine investigations. Patient's slit skin smear for acid‐fast bacilli and rk39 dip‐stick ELISA for post‐kala‐azar dermal leishmaniasis were negative. Ultrasound examination of her abdomen was normal and skeletal survey showed no evidence of bony changes. Histological examination showed diffuse dense infiltrate of numerous mast cells filling up the papillary dermis and most of upper‐ and mid‐reticular dermis. Overlying epidermis showed moderate epidermal hyperplasia and hyperpigmentation. There was sparse scattering of neutrophils within the infiltrate. Extracellular mast cells granules were also seen (Fig. 2). Diagnosis of diffuse cutaneous mastocytosis of pseudoxanthomatous variety was made.

Pretreatment photographs of the patient; (a) face; (b) trunk

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Histopathology showing dense diffuse infiltrate of numerous mast cells filling up the papillary dermis and most of the upper and mid‐reticular dermis (H&E; a, ×100; b, ×400)

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The patient was prescribed treatment in the form of H1 and H2 blockers (fexofenadine and ranitidine) and trimethylpsoralen and ultraviolet A (PUVA) photochemotherapy. After 2 months of treatment, there has been marked improvement in the appearance and itching.
Rosacea with extensive extrafacial lesions
Authors: Pereira Teresa M. , Vieira Ana Paula , Basto A. Sousa
Published: August 2010

Rosacea is a very common skin disorder in the clinical practice that primarily affects the convex areas of the face. Extrafacial rosacea lesions have occasionally been described, but extensive involvement is exceptional. In the absence of its typical clinical or histological features, the diagnosis of extrafacial rosacea may be problematic. We describe an unusual case of rosacea with very exuberant extrafacial lesions, when compared with the limited involvement of the face.
NailQoL: a quality‐of‐life instrument for onychomycosis
Authors: Warshaw Erin M. , Foster Jovonne K. , Cham Peter M. H. , Grill Joseph P. , Chen Suephy C.
Published: August 2010

Background  The disease burden onychomycosis is not trivial. The aim is to develop a quality of life instrument to measure the onychomycosis burden.

Methods  402 patients with mycologically‐confirmed onychomycosis completed a baseline questionnaire of 39 quality of life items (modified Skindex‐29 questions and 10 additional nail‐specific questions). Internal consistency, reproducibility and responsiveness of the final instrument, NailQoL were measured.

Results  15 items consisting of symptom (3), emotion (10), and functional (2) domains were retained in NailQoL. Symptom and emotion subscales = 0.80–0.92. Administration α demonstrated good internal consistency (Cronbach's of the instrument to 46 patients at one month after baseline revealed good reproducibility (ICC 0.88–0.91). Responsiveness was measured in 292 patients at 18 months; statistically significant better NailQoL scores were found in individuals with complete cure (mycological and clinical) (P < 0.01).

Conclusion  NailQoL represents a new concise, valid, reliable, and responsive instrument for measuring burden of skin disease for patients with onychomycosis.
Body‐site distribution of common acquired melanocytic nevi associated with severe sunburns among children in Lithuania
Authors: Valiukeviciene Skaidra , Gollnick Harald , Stang Andreas
Published: August 2010

Background  The aim of this cross‐sectional study is to provide information on subsite‐specific densities of melanocytic nevi by age, sex, and in relation to the history of severe sunburns.

Materials and methods  This study was conducted in Kaunas, Lithuania, on a sample of 484 children aged 1–2 years, 4–5 years, 9–10 years, and 14–15 years. The questionnaire provided information about the history of severe sunburns since birth. Site‐specific numbers and densities of melanocytic nevi of all sizes and nevi 2 mm or greater were studied. We used log‐linear and Poisson regression models to estimate the effects of age, sex, and severe sunburns on the nevus density.

Results  The predicted total body density of nevi shows a considerable increase up to the age of roughly 10 years. Thereafter, the density increase tapered off. Median densities of nevi were highest on the face. The median density of nevi on the upper arms is higher than on the forearms. Similarly, the median density of nevi on the thighs is higher than on the lower legs. Estimates of the relative nevus densities related to the history of severe sunburns tend to be small with the exception of the legs for nevi 2 mm or greater (relative nevus density = 2.09, 95% CI 1.49–2.93).

Conclusion  Nevus densities are highest on maximally or intermittently sun‐exposed skin areas. With the exception of the legs among women, the subsite‐specific ranking of nevus densities among adolescents follows a similar ranking as the skin melanoma incidence in Lithuania.
Complications after body piercing in patient suffering from type 1 diabetes mellitus
Authors: Antoszewski Bogusław , Jędrzejczak Marta , Kruk‐Jeromin Julia
Published: August 2010

Background  Body piercing has been a well‐known practice of body ornamentation. Nowadays, it is believed to involve from 6.5% to 50% of the population. Complications after body piercing procedures are variable.

Objective  The aim of this report is to present complications after body piercing in a patient suffering from type 1 diabetes mellitus.

Methods  A twenty‐four‐year‐old woman came to our plastic surgery outpatient clinic complaining of penetration of earring clips to her earlobes. This caused inflammation and continuous decubitus ulcers on the posterior surfaces of both earlobes.

Conclusion  On the basis of observations of the described patient, it can be concluded that unregulated diabetes is a contraindication to body piercing procedures.
Spontaneous resolution of a delayed granulomatous reaction to cosmetic tattoo
Authors: Jones Brad , Oh Carol , Egan Conleth A.
Published: August 2010

A 27‐year‐old woman presented with linear, flesh‐colored papules along her vermillion borders, 4 years after a cosmetic lip tattoo was applied. A biopsy of the lesion was performed and histology showed it to be a granulomatous reaction surrounding the tattoo pigment. Following the biopsy, the lesions began to resolve spontaneously within 4 weeks and were not noticeable at a follow‐up review. Granulomatous reactions are rare after cosmetic facial tattoos and may respond to topical corticosteroids or laser ablation. We present a unique report of a delayed granulomatous reaction to a cosmetic tattoo completely resolving without any specific treatment.
A mixed immunoblistering disorder exhibiting features of bullous pemphigoid and pemphigus foliaceus associated with Spirulina algae intake
Authors: Kraigher Oliver , Wohl Yonit , Gat Andrea , Brenner Sarah
Published: August 2010

An 82‐year‐old healthy woman presented with bullae, partly hemorrhagic, on the trunk and extremities (Fig. 1), secreting erosions, and submammary macerations (Fig. 2). The blistering disease developed over a 2‐year period, during which she reported taking no drugs. She did, however, begin using a food supplement containing the blue–green alga Spirulina platensis 1 year before the onset of the eruption.

Hemorrhagic bullae on the extremities

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Submammary bullae, secreting erosions, and macerations

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 At admission, the Nikolsky sign was positive. The first biopsy showed a subepidermal bulla with a denuded surface and sparse perivascular lymphocytic infiltrate with scattered eosinophils (Fig. 3). The second biopsy, taken during admission, demonstrated an intra‐ and subcorneal vesicular dermatitis with slight superficial acantholysis. Direct immunofluorescence disclosed immunoglobulin G (IgG) and C3 at the dermoepidermal junction. Indirect immunofluorescence was also positive at the dermoepidermal junction. A salt split test demonstrated IgG, IgM, and C3 on the upper side of the bulla. Immunoblotting of the serum was negative and showed no pemphigoid or pemphigus antigens. Enzyme‐linked immunosorbent assay (ELISA) for desmoglein 1 and 3 antibodies was also negative.

The first biopsy showing subepidermal hemorrhagic bulla with denuded surface and sparse perivascular lymphocytic infiltrate with scattered eosinophils (hematoxylin and eosin, ×10)

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 Diagnostic investigations for neoplasia, Wood's lamp exposure of urine, purified protein derivative (PPD), and antinuclear antibody (ANA) were negative.

 With a diagnosis of mixed immunoblistering disorder exhibiting features of bullous pemphigoid and pemphigus foliaceus, prednisone 60 mg was started and gradually tapered, and topical treatment was begun with creams containing silver sulfadiazine and triamcinolone/neomycin. Suspecting the involvement of Spirulina in the disease, the food supplement was stopped. With this treatment, the patient steadily improved with no appearance of new blisters.

 An in vitro interferon‐γ release test with the Spirulina‐containing food supplement, conducted to explore the connection between the agent and the eruption, yielded a slight increase in interferon (19%). The result was considered to be borderline, but, in view of the clinical picture and the fact that the patient was being treated with 20 mg prednisone at the time, the test can be considered as positive.

 Three months after completion of the prednisone treatment, and with avoidance of the Spirulina‐containing supplement, the patient was free of lesions with no recurrences.
Paleodermatology
Authors: Lupi Omar
Published: August 2010

The study of the human skin evolution, allows a new vision to ancient questions such as the significance of human skin color variation, the correlations between bipedality and loss of body hair, and the correlations among epidermal appendages and structures of the skin with the changes on environment and evolution of humans.

Paleodermatology would be an appropriated term to designate the study of the human skin evolution. The etymology of this word comes from a Greek root (paleo = ancient). It is a multidisciplinary subject for researchers such as dermatologists, anthropologists, physiologists, and orthopedics. It should include the evaluations regarding physiology, thermoregulation, and the evolution of the human skin structures.
Frequency of acyclovir‐resistant herpes simplex viruses isolated from the general immunocompetent population and patients with acquired immunodeficiency syndrome
Authors: Ziyaeyan Mazyar , Alborzi Abdolvahab , Japoni Aziz , Kadivar Mohammad , Davarpanah Mohammad Ali , Pourabbas Bahman , Abassian Amin
Published: August 2010

Background  Herpes simplex virus (HSV) infections are usually chronically recurrent in the normal population and represent a significant cause of morbidity in immunocompromised patients. Acyclovir (ACV) is widely used for the treatment and prophylaxis of HSV infections. The emergence of ACV‐resistant strains has been frequently reported as a result of long‐term ACV therapy.

Aim  Despite the widespread use of ACV, there are no data available in our area on the frequency of ACV‐resistant HSVs. The purpose of this study was to evaluate the susceptibility of HSV isolated from normal subjects and patients with acquired immunodeficiency syndrome (AIDS) to ACV.

Methods  HSVs were isolated from the orofacial region of normal individuals and patients with AIDS. The susceptibility of isolated HSV strains to various concentrations of ACV was determined by plaque reduction assay. The sensitivity of the viral strains was expressed as IC50 (the concentration of drug reducing the viral plaque by 50%).

Results  One hundred and thirty‐three isolates from 102 normal subjects and 31 patients with AIDS were tested. One HSV‐1 isolate from normal individuals had intermediate susceptibility. Two ACV‐resistant isolates (one HSV‐1 and one HSV‐2), with IC50 ≥ 2 to ≤ 3 µg/mL, and one highly resistant HSV‐2 isolate, with IC50 ≥ 5 µg/mL, were detected in patients with AIDS.

Conclusions  Our data show that the prevalence of ACV‐resistant strains is very low in the general immunocompetent population; however, in patients with AIDS, the prevalence of ACV‐resistant strains is remarkable (P = 0.001). Alternative antiherpetic agents should be employed to control and reduce the emergence of ACV‐resistant strains in patients with AIDS.
Role of BP180NC16a‐enzyme‐linked immunosorbent assay (ELISA) in the diagnosis of bullous pemphigoid in China
Authors: Feng Suying , Lin Lin , Jin Peiying , Wu Qinxue , Zhou Wuqing , Sang Honggui , Shao Changgeng
Published: August 2010

Background  Autoantibodies of bullous pemphigoid (BP) patients react with two components of the hemidesmosome of stratified epithelia: the BP antigen 230 (BP230) and the BP antigen 180 (BP180). Recently, strong evidence has been provided that autoantibodies to BP180 play a key role in subepidermal blister formation in BP patients, and NC16A contains an important antigen determinant of BP.

Objective  To study the role of BP180NC16a enzyme‐linked immunosorbent assay (BP180NC16a‐ELISA) in the diagnosis of BP in China.

Methods  Sera from BP patients (n = 42) and control subjects (normal controls, n = 24; pemphigus patients, n = 18) were measured by BP180NC16a‐ELISA. All BP sera were obtained at presentation from patients who had not received previous systemic treatment. The values of immunoglobulin G (IgG) antibody levels measured by ELISA were compared with those measured by indirect immunofluorescence (IIF) (gold standard for the diagnosis of BP) on salt‐split skin.

Results  Using BP180NC16a‐ELISA, 41 of the 42 BP sera were positive, whereas only one of the serum samples from 24 normal controls was positive and all the pemphigus sera showed a negative result. Thus, the sensitivity and specificity of BP180NC16a‐ELISA were both 97.62%. There was no correlation between the mean ELISA values and IIF titers. The ELISA and IIF results were further compared and analyzed using a 2 × 2 contingency table, which showed that they were not significantly different.

Conclusions  It is suggested that BP180NC16a‐ELISA is a useful tool for the diagnosis of BP.
Human mesenchymal stem cells may be involved in keloid pathogenesis
Authors: Akino Kozo , Akita Sadanori , Yakabe Aya , Mineda Takao , Hayashi Tomayoshi , Hirano Akiyoshi
Published: August 2010

Background  The pathogenesis of keloid is poorly understood. Although vigorous investigations have attempted to elucidate the mechanisms or causative factors of keloid, there are little data on why keloids are very intractable and recur easily in each patient.

Methods  In an attempt to analyze the possible interaction between human mesenchymal stem cells and keloid‐derived fibroblasts, the dual‐chamber cell‐migration assay, cell proliferation, ultrastructural morphology, and Western blot analysis were used to investigate the production of the extracellular matrices of the coculture.

Results  Cell proliferation was not significantly different between keloid‐derived fibroblasts and normal dermal fibroblasts during a 4‐day observation period. There was a significant cell migration of human mesenchymal stem cells when keloid‐derived fibroblasts were placed in the bottom chamber, compared to when normal dermal fibroblasts were placed in the same way in 8‐µm diameter pore membranes (190.6 ± 51.45 and 32.0 ± 6.20 cells/field, respectively, P < 0.01). With 3‐µm diameter pores, the human mesenchymal stem cells migrated in the pores only when the keloid‐derived fibroblasts were placed in the bottom chambers (6.4 ± 3.84 cells/field). Monolayer coculture of human mesenchymal stem cells and keloid‐derived fibroblasts demonstrated further functional differentiation, such as collagen secretion and abundant rough endoplasmic reticulum. Western blot analysis of the cells in the modified dual‐chamber culture demonstrated most significantly abundant fibronectin expression when the human mesenchymal stem cells contained keloid fibroblasts.

Conclusion  The results of this study may indicate that human mesenchymal stem cells participate and recruit in keloid pathogenesis by differentiating themselves toward keloid recalcitrant formation and progression.
Comorbidity of psychiatric disorders in children and adolescents with alopecia areata in a child and adolescent psychiatry clinical sample
Authors: Ghanizadeh Ahmad
Published: August 2010

Background  This study reports the comorbidity of lifetime psychiatric disorders in children and adolescents with alopecia areata (AA) in a child and adolescent psychiatry clinical sample.

Methods  Fourteen patients with AA were interviewed using the Diagnostic and Statistical Manual of Mental Disorders‐Fourth edition (DSM‐IV) criteria and the Kiddie‐Schedule for Affective Disorders and Schizophrenia‐Present and Lifetime‐Farsi Version (KSADS‐PL‐Farsi Version).

Results  The rate of at least one psychiatric disorder was 78%. The rate of major depressive disorder was 50%, and the most common anxiety disorder was obsessive–compulsive disorder (OCD) (35.7%).

Conclusions  There is a very high rate of psychiatric disorders in children and adolescents with AA. This high rate of OCD has not been reported previously. There seems to be a clinical association between OCD and AA in children and adolescents.
Successful radiotherapy of facial angiosarcoma
Authors: Gkalpakiotis S. , Arenberger P. , Vohradnikova O. , Arenbergerova M.
Published: August 2010

Cutaneous angiosarcoma of the face and scalp is a rare malignant vascular tumor that affects mostly Caucasian elderly males. At present, connections concerning the etiology of this neoplasm with radiation therapy, exposure to environmental carcinogens and chronic lymphedema have been described. Due to the difficult histologic evaluation, high local recurrence and tendency to early metastasing, angiosarcoma poses generally a very poor prognosis. We report the case of an 80‐year‐old patient who experienced successful removal of large, exophytic growing angiosarcoma of the face achieved with radiotherapy with long‐term relapse‐free survival.
Chronic nonhealing ulcer in a finger of a toddler – a rare presentation of the hair thread tourniquet syndrome
Authors: Kumaravel S.
Published: August 2010

Background  Hair‐thread tourniquet syndrome is caused by a strand of hair or thread tightly wrapped around an appendage. Affected parts include toes, phallus, fingers, clitoris, labia and even uvula. This disorder can be quite serious if not promptly recognized and treated; permanent tissue damage or even loss of the appendage can occur.

Material  A rare and delayed presentation of hair‐thread tourniquet syndrome as a non‐healing, discharging ulcer in a two‐year‐old child is presented.

Results  Identification of the fiber with loupes, complete removal of the fiber, and a dorsal longitudinal incision made to ensure complete release of any fibrotic constriction bands were the components of successful management in this child.

Conclusions  Successful treatment depends on prompt recognition of the problem and alleviation of constriction, be it simple removal of the offending agent or surgical exploration and release. Medical professionals caring for children and parents should be made aware of the signs and symptoms of this rare but dangerous condition to ensure early diagnosis and prompt appropriate management.
Intravenous fluids warming by mattress is simple and efficient during pediatric surgery
Authors: Serour F. , Weissenberg M. , Boaz M. , Ezri T. , Gorenstein A.
Published: August 2010

Background/Aim: Temperature control is essential during pediatric surgery. The effectiveness of two methods of warming intravenous (i.v.) fluids to preserve normothermia was compared during abdominal surgery.

Methods: Intraoperative core temperature (CT) was measured in 59 children, 8 years of age and younger. Patients were randomly allocated to two study groups according to the method of fluids warming. In Group M (n = 30), fluids were warmed by placing the i.v. tubing under a warming mattress, and in Group T (n = 29), by using an active i.v. fluid tube warming system. Observations of CT, infusion fluid temperature (IFT) at the entry to the patient and other relevant parameters were made at 30‐min intervals throughout the surgical procedure.

Results: The two groups did not differ significantly by age, gender, body weight or length of surgical procedure. Although baseline IFT was significantly lower in Group M than in Group T (33.8 °C vs. 35.1 °C), it increased during the procedure by 1.2 °C in Group M compared to a 0.2 °C increase in Group T. Baseline CT was also lower by 0.5 °C in Group M compared to Group T (NS), but CT increased in Group M by 1.0 °C compared to 0.2 °C in Group T, resulting in similar final CTs.

Conclusions: The increase in CT was more pronounced in patients where fluids were warmed under the warming mattress (Group M) than in those with fluids warmed by a coil warming device (Group T). The elevation in CT seen in Group M is associated with an increase in infusion fluid temperature at the line just before the i.v. cannula. Both methods of fluid warming (by placing the i.v. tubing under warming mattress and by using a fluid warming system) effectively preserved normothermia during abdominal surgery in children.
Reversal of rocuronium with edrophonium during propofol versus sevoflurane anesthesia
Authors: Zhou T. J. , Chiu J. W. , White P. F. , Forestner J. E. , Murphy M. T.
Published: August 2010

Background: The use of volatile anesthetics for maintenance of anesthesia can enhance the action of non‐depolarizing muscle relaxants and interfere with the reversal of neuromuscular blockade. In this study, we studied the antagonism of rocuronium with edrophonium‐atropine during propofol‐ versus sevoflurane‐based anesthesia.

Methods: Following induction of anesthesia with propofol (2–2.5 mg kg−1, iv) and fentanyl (1–2 μg kg−1 iv), rocuronium 0.6 mg kg−1 iv was administered to facilitate tracheal intubation. Patients were then randomized to receive either a propofol infusion (100 μg kg−1 min−1) or sevoflurane (1.0%, end‐tidal) in combination with nitrous oxide 66% for maintenance of anesthesia. Neuromuscular blockade was monitored using electromyography at the wrist, and reversed with edrophonium 1.0 mg kg−1 and atropine 0.015 mg kg−1 when the first twitch hight (T1) of the train‐of‐four (TOF) stimulation recovered to 25% of the baseline value. Anesthetic maintenance with propofol or sevoflurane was continued following reversal until a TOF ratio of 0.7 was attained.

Results: The clinical duration of action (i.e., time to 25% T1 recovery) was similar during both propofol‐ (39.3±14.6 min) and sevoflurane‐based (48.1±19.7 min) anesthesia. However, the reversal time from 25% T1 to TOF ratio of 0.7 was significantly longer with sevoflurane [Median 2.8 (range 0.5–18.8) min] compared with propofol [1.5 (0.75–3) min] (P<0.05).

Conclusions: We conclude that the clinical duration of action after a single dose of rocuronium, 0.6 mg kg−1 iv, was similar during both propofol‐ and sevoflurane‐based anesthesia. However, the reversal of rocuronium‐induced residual blockade was slower and more variable in the presence of sevoflurane.
Inadvertent knotting of a thoracic epidural catheter
Authors: Hsin S.‐T. , Chang F.‐C. , Tsou M.‐Y. , Liao W.‐W. , Lee T.‐Y. , Lui P.‐W. , Luk H.‐N.
Published: August 2010

We report a case of corrosive injury of upper gastrointestinal and respiratory tracts scheduled for feeding jejunostomy under thoracic epidural anesthesia. An epidural catheter was inserted at the T8–T9 intervertebral space and threaded 7 cm beyond the tip of the Tuohy needle in a rostral direction. Resistance was noticed during attempts to inject the local anesthetic. As resistance could not be relieved by changing the position of the patient, kinking of the epidural catheter was suspected. Following informing the patient of the associated risks, the catheter was retrieved successfully by gentle and steady pulling. A tight double‐knot of catheter was found. No neurological sequelae to the procedure were noticed.
Comparison of the effect of ketamine added to bupivacaine and ropivacaine, on stress hormone levels and the duration of caudal analgesia
Authors: Akbas M. , Titiz T. A. , Ertugrul F. , Akbas H. , Melikoglu M.
Published: August 2010

Background:  The aim of this study was to compare bupivacaine 0.25% and ropivacaine 0.2%, singly and in combination with ketamine, for caudal administration in children. Duration of analgesia, the need for other analgesics and the stress response were measured.

Methods:  Eighty children were ramdomized into four groups of twenty. The bupivacaine group received bupivacaine 0.25% and the ketamine/bupivacaine group received bupivacaine 0.25% plus 0.5 mg/kg ketamine. The ropivacaine group received ropivacaine 0.2%, and the ketamine/ropivacaine group received ropivacaine 0.2% plus 0.5 mg/kg ketamine. The duration of analgesia and analgesic requirements were recorded for each group, as were peri‐operative and post‐operative concentrations of the stress hormones insulin, glucose and cortisol.

Results:  Ketamine, added to either bupivacaine or ropivacaine for caudal analgesia, gave a longer duration of analgesia (P < 0.05) than bupivacaine or ropivacaine alone. In all groups, blood insulin concentration was increased, and cortisol concentration reduced. Glucose concentration was significantly increased in all groups (P < 0.05).

Conclusions:  Ketamine can safely be added to ropivacaine 0.2% or bupivacaine 0.25% for caudal anesthesia in order to prolong duration of analgesia and reduce the need for additional analgesics. Stress hormone levels are partially attenuated.
Cerebral physiological responses to bolus injection of racemic,S(+)‐ orR(−)‐ketamine in the pig
Authors: Schmidt A. , Øye I. , Åkeson J.
Published: August 2010

Background: Little is known about the influence of ketamine and its enantiomers on cerebral haemodynamics, and there are no direct comparison reports. This study was designed to evaluate cerebrovascular responses to bolus injections of racemic,S(+)‐ andR(−)‐ketamine in an established experimental model.

Methods: Anaesthesia was induced with propofol in 14 pigs and maintained with fentanyl and vecuronium. The intra‐arterial xenon clearance technique was used to calculate the cerebral blood flow (CBF). Eight pigs (part I) were given three consecutive 60‐s intravenous (i.v.) bolus injections of 10 mg/kg of racemic ketamine (Ketalar®, Pfizer), and cerebral and systemic physiological responses were studied for 30 min after each injection. Following the determination of equipotent doses of the racemate and its enantiomers by recumbency tests, bolus injections of racemic ketamine (10 mg/kg),S‐ketamine (5 mg/kg) andR‐ketamine (20 mg/kg) were given in randomized sequence to another six pigs (part II) and evaluated at 1, 5, 10, 15, 25 and 40 min.

Results: No statistically significant acute tolerance in the CBF response to racemic ketamine was found in part I of the study. In part II, the decreases in the mean arterial pressure (MAP) and CBF byS‐ketamine were significantly smaller than those by racemic andR‐ketamine (bothP < 0.001). No study drug had any significant effect on the cerebral arteriovenous oxygen content difference (Cavo2) over time, butS‐ketamine was associated with lowerCavo2than racemic ketamine (P = 0.008) andR‐ketamine (P = 0.016).

Conclusions: Bolus injection ofS‐ketamine was associated with less cerebral and systemic haemodynamic depression than racemic orR‐ketamine in equipotent doses in this experimental model. These findings indicate possible advantages ofS‐ketamine over racemic ketamine.
Local anesthesia for functional endoscopic sinus surgery employing small volumes of epinephrine‐containing solutions of lidocaine produces profound hypotension
Authors: Yang J. J. , Li W. Y. , Jil Q. , Wang Z. Y. , Sun J. , Wang Q. P. , Li Z. Q. , Xu J. G.
Published: August 2010

Background:  Local anesthetic containing epinephrine is commonly used in many operations for the main purpose of hemostasis. A randomized, controlled, prospective clinical trial was designed to find out hemodynamic changes after local infiltration of different concentrations and/or different dosages of epinephrine during functional endoscopic sinus surgery (FESS) under general anesthesia.

Methods:  One hundred and eight adult patients undergoing elective FESS under general anesthesia were randomly allocated into four groups. Group I received 2% lidocaine 2 ml with epinephrine (5 µg/ml); group II received 1% lidocaine 4 ml with epinephrine (2.5 µg/ml); group III received 1% lidocaine 4 ml with epinephrine (5 µg/ml); and group IV received 1% lidocaine 4 ml for local infiltration. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were monitored continuously in the radial artery and recorded in 6 min: before infiltration (baseline), 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, and 6 min after local infiltration. The lowest blood pressure (BP) in this period was also recorded.

Results:  Significant hemodynamic changes, particularly a decrease in BP (P < 0.001) with a slight increase in HR (P < 0.001) at approximately 1.5 min and an increase in SBP at approximately 3 min (P < 0.01) after local infiltration, were observed in group I, group II and group III compared with the baseline, but not in group IV. No significant hemodynamic differences were observed between group I, group II and group III at the same time points (P > 0.05).

Conclusion:  Local infiltration of low‐dose epinephrine causes temporary significant hemodynamic changes particularly a marked decrease in BP during FESS under general anesthesia.