bluuebunny/crossref_metadata_2025 huggingface dataset:
Imaging in the Dialysis Patient: Nuclear Medicine Studies in the Dialysis Patient
Authors: Meller Johannes , Sahlmann Carsten O. , Becker Wolfgang
Published: March 2003

Nuclear medicine (scintigraphy) studies that are performed in patients being prepared for regular dialysis treatment include the measurement of renal clearance and dynamic studies of renal perfusion and function. Static scintigraphy with 99mTc‐DMSA may be used in the evaluation of children at risk of renal damage and further functional deterioration. In patients on peritoneal dialysis, nuclear medicine procedures enable the diagnosis of structural complications such as intra‐abdominal herniations and leaks. Diagnosis of infections of the vascular access sites in patients on hemodialysis and of the catheter tunnel in patients on peritoneal dialysis can be made with high diagnostic accuracy using radiolabeled, autologous leukocytes. Scintigraphy is valuable in delineating the extent of deposits of amyloid and parenchymal microcalcifications, and may be helpful in the functional evaluation of organs and tissues involved in the pathophysiology of renal impairment and dialysis. If radioiodine therapy with 131I is performed in patients on hemodialysis with benign or malignant thyroid disease, then pretherapeutic dosimetry is necessary to avoid over‐ and undertreatment. Radioiodine therapy in the dialysis patient leads to only insignificant contamination of dialysis equipment and marginal exposure to the medical staff.
Key Concepts in Biostatistics: Using Statistics to Answer the Question “Is There a Difference?”
Authors: Szczech Lynda Anne , Coladonato Joseph A. , Owen William F.
Published: March 2003

Biostatistics seeks to answer the question “Is there a difference?” in the rate of a disease or characteristic among subgroups of patients. The goal of this article is to introduce and define measures used in epidemiology and discuss different types of analyses in clinical research with an emphasis on the concepts and implications of the analyses rather than the mathematics. The implications of the use of measures such as incidence and prevalence, as well as odds, risk, and hazards ratios may affect study conclusions. An understanding of the distinction between these summary measures is essential. The concepts of univariate and multivariate analyses, a discussion of what it means to control for potential confounders, and a description of statistical power and significance are also presented. These concepts are integral to the design and analysis of clinical studies. An understanding of their advantages and applications will enhance the reader's ability to understand and evaluate the literature.
Sharpening the Focus on Populations: An Intentional Community Health Nursing Approach. Part II.
Authors: Diekemper Margaret , SmithBattle Lee , Drake Mary Ann ,   Margaret Diekemper is an Assistant Professor of Nursing at the Maryville University Nursing Program, St. Louis, Missouri. Mary Ann Drake and Lee SmithBattle are Assistant Professors of Nursing at St. Louis University, St. Louis, Missouri.
Published: March 2003

An interpretive study conducted in a Midwestern metropolitan area was designed to examine expertise in everyday community health nursing (CHN) practice. Twenty‐five nurses from three practice areas (traditional, nontraditional, and program development) participated in group and individual interviews and field observations, sharing stories of their practice. Transcribed interviews and field observation notes were analyzed as a text. One of the major findings of the study focused on experiences of the nurses as they developed the population aspects of their everyday practice. Part I describes the natural development of a population focus of CHN generalists whose care most often targeted individuals and families. The stories of how their practices evolved and were supported by their institutions provided insights into how nurses develop a broad population‐focused practice perspective. Part II examines the practice of those CHN specialists who nurse their target populations from an intentional perspective. Their population‐focused practice, in which they repeatedly displayed what the research team terms multilingual and multiperspectival skills, was solidly based in their prior individual and family‐focused experience and expertise in program planning and evaluation.
African American Women's Experiences with Physical Activity in their Daily Lives
Authors: Nies Mary A. , Vollman Michael , Cook Thomas ,   Mary A. Nies is an Associate Professor, Michael Vollman is a Lecturer and Doctoral Student, and Thomas Cook is an Assistant Professor at Vanderbilt University Medical Center, School of Nursing, Nashville, Tennessee.
Published: March 2003

Sedentary behavior is a major public health problem for African American women. A qualitative study used focus groups to explore African American women's experiences with physical activity in their daily lives. Women aged 35–50 were recruited to participate in the focus groups. Transcripts from the focus groups were coded and analyzed. African American women's facilitators of physical activity were daily routine, practical and convenient activities, personal safety, child care, weight loss, stress reduction, knowledge and commitment, enjoyment, pets, family and peer support, home and work facilities, and daylight and climate conditions. Barriers to physical activity were lack of child care, no person to exercise with, competing responsibilities, lack of space in the home, inability to use exercise facilities at work, lack of motivation, fatigue, and unsafe neighborhood. This information will provide the basis for generating new strategies to increase physical activity for African American women in the community.
Tracking of Avoidance of Alcohol Use and Smoking Behavior in a Fifth Grade Cohort over Three Years
Authors: Felton Gwen , Parsons Mary Ann , Ward Dianne S. , Pate Russell R. , Saunders Ruth P. , Dowda Marsha , Trost Stewart ,   Gwen Felton and Mary Ann Parsons are Professors at the College of Nursing, University of South Carolina, Columbia, South Carolina. Dianne S. Ward and Russell R. Pate are Professors, Ruth P. Saunders is an Assistant Professor, Marsha Dowda is a Statistician, and Stewart Trost is a Research Assistant at the School of Public Health, University of South Carolina, Columbia, South Carolina.
Published: March 2003

This study examined the maintenance of positive health behavior (avoidance of alcohol use and cigarette smoking) and factors associated with the maintenance of these behaviors from fifth through seventh grade by a cohort of rural students (N= 232). African American and White students showed similar patterns of high avoidance of alcohol until seventh grade. Although more girls avoided use than boys, avoidance decreased in both groups with progression in grade. Mothers', fathers', and best friends' drinking behaviors influenced avoidance behavior; drinking was less likely to occur among those whose parents and friends did not drink. Friends' drinking behavior influenced alcohol use as early as fifth grade. Smoking avoidance was maintained by 74% of the students over the 3 years. Although there were no racial differences in smoking, African Americans started smoking about 1 year earlier than Whites. During seventh grade, an increase in smoking occurred among boys and girls, but was particularly striking among girls. Avoidance of smoking was influenced by mothers' behavior but not fathers'. Best friends' smoking behavior exerted a major influence on avoidance between grades 6 and 7. In grades 5 and 6, those who avoided smoking were more physically active than smokers, but by seventh grade their physical activity declined to a similar level as smokers. Rural adolescent boys seemed to be at early risk for alcohol use and smoking, while rural girls delayed involvement by 1 to 2 years. Communities, schools, and families can help adolescents avoid alcohol use and smoking through early prevention efforts.
From Rhetoric to Reality: The Changing Face of Public Health Nursing in Southern Ontario
Authors: Falk Rafael Adeline R. ,   Adeline Falk Rafael is an Assistant Professor at the University of Western Ontario, London, Ontario, Canada.
Published: March 2003

A feminist, postmodern oral history was undertaken to make visible the work and struggles of public health nurses in Southern Ontario in the midst of drastic cutbacks and dramatic changes in public health. The study focused on the period between 1980 and 1996, during which time two distinct practice modalities were apparent: district nursing and program‐focused practice. The narrators' stories describe the nature of their work in both those modalities, the skills and expertise they demonstrated, and the often conflicting influences of medicine and the health promotion movement that dramatically changed their practice. District nursing was characterized by the public health nurse's integral connection with the community; program‐focused practice, occurring at a time when political and economic factors also impacted on practice, was characterized by a loss of that integrality. Narrators saw many positive aspects to the changes in public health but identified problems as well. They articulated a preferred vision for the future as one in which “nurses should be nursing.” To do that, public health nurses are challenged to return their practice to a nursing center rather than struggling to conform to dominant paradigms in public health.
Health‐Enhancing Behaviors Correlated with Breastfeeding Among a National Sample of Mothers
Authors: Pesa Jacqueline A , Shelton M. Mitchell
Published: March 2003

Participation in health‐enhancing behaviors not only influences the health of the mother, but of the newborn child as well. Characteristics of the mother, especially with regard to the practice of health‐enhancing behaviors, have typically been excluded from studies examining breastfeeding. The purpose of this study was to identify health‐enhancing behaviors correlated with breastfeeding among a national sample of mothers. The third National Health and Nutrition Examination Survey (NHANES III) provided the sample for this study. All mothers between the ages of 17 and 45 (n= 578) with children aged 3 or younger at the time of the interview, who breastfed, were included. Seven health‐enhancing behaviors served as the independent variables in a logistic regression analysis. Odds ratios and 95% confidence intervals were calculated from the estimated regression coefficients, and comparison of proportions were made using Pearson chi‐square tests of homogeneity. Smoking less than 100 cigarettes in a lifetime, consuming five or more fruits and/or vegetables daily, and visiting a dentist annually were significantly associated with breastfeeding among the mothers in this sample. The results of this study point to a connection between the health‐enhancing behaviors of the mother and breastfeeding. This information can be used to help professionals and practitioners gain a clearer picture of the breastfeeding mother. Multicomponent education programs targeted at new mothers can use this information to guide program development. Breastfeeding mothers may have better overall health as compared to mothers who do not breastfeed, therefore, they may serve as role models in peer‐structured activities.
Conducting Focus Groups Cross‐Culturally: Experiences with Pacific Northwest Indian People
Authors: Strickland C. June
Published: March 2003

Many disciplines have used focus groups in research and the use has increased in the past 15 years ( Smith, 1995). Procedural concerns have been explored, such as the selection of the participants, the location, and the size of the group, but little attention has been given to the consideration of cultural influences. The purpose of this paper is to focus attention on the impact of culture in conducting focus groups. Experiences from 15 focus groups conducted in two qualitative research studies with two Washington state Indian tribes over a 5 year period are presented and illustrate the importance of culture in conducting focus groups. Communication patterns, roles, relationships, and traditions were found to be important elements that must be considered in conducting focus groups cross‐culturally. While some strategies discovered were found to be helpful, additional research is needed.
Articulating the Culture and Tradition of Community Health Nursing
Authors: SmithBattle Lee , Diekemper Margaret , Drake Mary Ann
Published: March 2003

While community health nursing (CHN) leaders speculate about the future, nurses on the front lines care for vulnerable families and populations in the midst of diminishing resources, radical changes in health care delivery systems, and unwieldy bureaucracies. Narrative data from a recent interpretive study provided an unexpected opportunity to explore how CHN practice in diverse settings is evolving in response to such changes. Data consisted of interviews and observations of 25 nurses in their practice setting. Several clinical stories or exemplars are selected to highlight how the “culture” of agency settings shapes public health nursing (PHN) practice in ways that need to be recognized and strengthened or affirmed. Clinical storytelling can play a crucial role in preserving the PHN tradition and restoring and transforming local cultures when PHNs, administrators, educators, and researchers commit to PHN excellence.
An Oral Health Promotion Module for the Primary Health Care Nursing Course in Acornhoek, South Africa
Authors: Ogunbodede Eyitope O. , Rudolph Michael J. , Tsotsi Norma M. , Lewis Helen A. , Iloya Jonathan I.
Published: March 2003

The severe personnel shortage in the health professions in most developing communities is well documented. This dearth of health workers and the widespread adoption of the primary health care approach (PHCA), requires that health professionals be trained to understand and effectively utilize the skills offered by other disciplines in the health care field. Nurses are expected to play active roles in the promotion of health including oral health, particularly in the rural under‐served communities. There is a paucity of oral health education in nursing curricula. This article describes a 4‐day module on oral health promotion developed and delivered to 36 nurses as part of a 12‐month primary health care nursing (PHCN) training course. The module utilized a variety of educational methods and materials to facilitate and encourage both individual and group learning. The module was evaluated using both student academic attainment and perceptions as outcome measures. The evaluation and the experience of facilitating this module show that an oral health promotion module of short duration can sensitize nurses to the importance of oral health and increase oral health knowledge and skills.
Peer Education Project with Persons who have Experienced Homelessness
Authors: Connor Ann , Ling Catherine Gaines , Tuttle Johnna , Brown‐Tezera Belinda
Published: March 2003

This paper describes an unconventional health education project implemented by nurse practitioners in a nurse‐managed clinic serving persons who are homeless. The nurse practitioners perceived that there were a number of potential barriers to providing health education to the homeless patients. These barriers included the fact that this patient population is part of a marginalized subculture affected by a variety of overwhelming social problems. An additional barrier was that the nurses often differed from their homeless patients in terms of race, gender, socioeconomic status, formal education, culture, and life experience. The nurse practitioners designed the Peer Health Education Project (PHEP) to try to overcome some of these barriers. The purpose of the PHEP was to increase the health education knowledge and empowerment of persons who had experienced homelessness so that they could serve as peer health educators with others who were living on the streets. The project model was based on the philosophy of Paulo Freire (1973). The peer health educators served as both leaders and participants in each education session. The educators set the agenda and the nurses acted as facilitators. The project was successful in preparing peer educators. Other indicators of the success of the project included increased empowerment, self‐esteem, dignity, hope, self‐confidence, and community participation of the peer educators.

“I realize that I can make a difference … that I can help someone else … that I can turn my life around … and offer someone hope … that my life of homelessness and drug addiction can be put to good use …”— A peer health educator
Caregiving and Help Seeking by Mothers of Low Birthweight Infants and Mothers of Normal Birthweight Infants
Authors: May Kathleen M , Hu Jie
Published: March 2003

The purpose of this research was to describe perceptions of infant health, caregiving at home, and help seeking by mothers of low birthweight (LBW) infants (n= 30) and mothers of normal birthweight infants (n= 30). In this descriptive study, data were analyzed through multiple regression, t tests, and content analysis of responses to researcher‐constructed questionnaires. There were statistically significant relationships between: infant health and both confidence in caregiving (R2= 0.18, p < 0.001) and caregiver burden (R2= 0.29, p < 0.001); preparation for caregiving and confidence in caregiving (R2= 0.10, p < 0.05); and confidence in caregiving and caregiver burden (R2= 0.12, p < 0.01). Compared with mothers of normal birthweight infants, mothers of LBW infants perceived poorer infant health, t (58) =–2.02, p= < 0.05, and more caregiver burden, t (58) = 3.50, p= < 0.001. Mothers reported seeking help from a variety of resources, mostly nonprofessional for questions on infant care or nonserious infant health problems, and mostly physicians for questions on serious infant health problems. Nurses can use knowledge of mothers' perceptions of infant health, caregiving, and help seeking to facilitate mothers' management of caregiving and resource use.
A Substance Use Prevention Framework: Considering the Social Context for African American Girls
Authors: Guthrie Barbara J , Low Lisa Kane
Published: March 2003

Shifting patterns of substance use (that is, early initiation, increased marijuana use, narrowing differences in gender use) and the disproportionate socioeconomic obstacles that are related to substance use among ethnically diverse adolescent females create the need to develop ethnic and gender‐specific substance use prevention frameworks. This article describes and applies a substance use prevention framework to African American females. Gender socialization and self‐efficacy are presented as key concepts, along with the assertion that every substance use prevention framework should examine the influences of specific societal factors (such as racism, sexism, classism, and ageism) on substance use. Rationale and guidelines for designing ethnically sensitive and gender‐specific research projects and intervention programs regarding substance use prevention are offered. Public health nurses (PHNs) are uniquely positioned to use this framework in their work with African American adolescent girls, specifically, and in general with other ethnically diverse groups.
Factors Associated with Cane Use Among Community Dwelling Older Adults
Authors: Aminzadeh Faranak , Edwards Nancy
Published: March 2003

Guided by the Theory of Planned Behavior (TPB), this study examined factors associated with cane use among community dwelling older adults. Data were collected in a cross‐sectional survey of a convenience sample of 106 community residing older adults in Ottawa, Canada. Using a stepwise discriminant analysis, subjective norms, attitudes, and age surfaced as the key variables associated with cane use in this sample. The discriminant function accounted for 67% of the variance in cane use and correctly classified 91% of cases (Wilks's λ= 0.33, χ2= 110.12, df = 3, p < 0.0001). The findings provide evidence for the utility of the TPB in its application to understanding cane use behaviors of older persons and have important implications for the design of theory‐based fall prevention interventions to enhance the acceptance and effective use of mobility aids.
Adolescent Health Behaviors and Related Factors: A Review
Authors: Spear Hila J. , Kulbok Pamela A
Published: March 2003

This review examined research relevant to adolescent health behavior in order to identify key behaviors and factors related to behaviors for targeting health‐promoting interventions. The 34 studies reviewed sampled mainly Caucasian subjects ranging in age from 12 to 24 years. The majority of the studies were descriptive and cross‐sectional, and they dealt with a specific health behavior or group of behaviors such as eating, sleeping, and exercise. Primary factors related to health behavior included gender, family structure, ethnicity, knowledge, and attitudes. Increased knowledge of factors that impact adolescent health behaviors is essential so that public health nurses (PHNs) and other health professionals can be more responsive to developmental and lifestyle factors influencing the health of youth within families and communities.
Mothers' Decision‐Making Processes Regarding Health Care for Their Children
Authors: Gross Gloria Jean , Howard Mabel
Published: March 2003

This research study explored mothers' decision‐making processes regarding health care for their children. Identifying how decisions are made by mothers about health care for their children will assist health care professionals to be appropriate advocates for mothers, to improve quality of life, and to contain costs of health care for children. A sample of 114 rural mothers (51 with one child, 63 with more than one child) completed questionnaires identifying demographics, social support, client and professional interaction elements, self‐determinism, competence in problem‐solving skills, and relationships to responses to health care scenarios. Qualitative data were also gathered by structured in‐depth interviews of 7 subjects. ANOVA, correlations, and factor analysis were completed to analyze data. Most of the mothers' decisions were based on the perceived degree of seriousness, mother's degree of fear of the child's condition, attitude of the health care provider, previous experience with the situation, and social support for the mother. There were no significant differences in decision‐making processes by first time mothers and by mothers with more than one child. Implications include teaching mothers assessment skills to identify serious versus nonserious situations and to utilize other social supports.
Development and Expert Evaluation of “Moms on the Move,” a Physical Activity Intervention for WIC Mothers
Authors: Fahrenwald Nancy L. , Sharma Manoj
Published: March 2003

Abstract The purpose of this descriptive study was to develop and evaluate “Moms on the Move,” a provider‐counseled physical activity intervention for mothers enrolled in the Women, Infants, and Children (WIC) program. The intervention was based on the Transtheoretical Model (TTM) of behavior change. The evaluation occurred in two stages. In the first stage, physical activity behavioral experts (n=4) evaluated the: (a) rationale for intervention components; (b) linkages between behavior change constructs, intervention activities, and study outcomes; (c) literature support for the TTM behavior change constructs; and (d) the intervention brochure. The expert evaluation tool was adapted from the “Educational Materials Review Form.” Each item in the expert evaluation met the ≤ 3.0 mean criterion for acceptability (range, 1.33–2.67). Revisions were made based on expert comments before stage 2. In the second stage, WIC mothers (n=5) evaluated the intervention brochure. The 9‐item WIC mothers' evaluation tool was adapted from a simple tool for community members. In the second stage evaluation, the mean total score for the intervention brochure evaluation was 44.0 (SD=1.22), which met the a priori criterion to retain as is. Mean item responses ranged from 4.8 to 5.0 (5.0=great). This evaluation indicates that “Moms on the Move” is a promising physical activity intervention for WIC mothers, which should be implemented for efficacy testing.
Acute Infectious Purpura Fulminans: Pathogenesis and Medical Management
Authors: Darmstadt Gary L.
Published: March 2003

Abstract: Purpura fulminans (PF) is a potentially disabling and life‐threatening disorder characterized by acute onset of progressive cutaneous hemorrhage and necrosis, and disseminated intravascular necrosis. Acute infectious PF occurs most commonly in the setting of meningococcemia due to elaboration of endotoxin. Presence of purpura, particularly when generalized, is an important predictor of a poor outcome following meningococcal infection. Histopathologic hallmarks of acute infectious PF are dermal vascular thrombosis and secondary hemorrhagic necrosis, findings which are identical to those of the Shwartzman reaction. Acute infectious PF and the Shwartzman reaction have a common pathogenesis, involving a disturbance in the balance of anticoagulant and procoagulant activities of endothelial cells. This disturbance, which is triggered by endotoxin, appears to be mediated by cytokines, particularly interleukin‐12, interferon‐7, tumor necrosis factor‐α, and in‐terleukin‐1, leading to the consumption of proteins C and S and antithrombin III. State‐of‐the‐art therapeutic interventions based on recent advances in our understanding of the pathogenesis of acute infectious PF are discussed.
Eosinophilic Pustular Folliculitis in Infancy: Report of Two New Cases
Authors: Larralde Margarita , Morales Susana , Santos Muñoz Andrea , Lamas Fernando , Schroh Roberto , Corbella Cristina
Published: March 2003

Eosinophilic pustular folliculitis (EPF) is a cutaneous inflammatory follicular disorder of unknown etiology. The diagnosis is made on the basis of clinical and histopathologic features. We describe two patients who had recurrent episodes of pruritic follicular papular and pustular lesions on the face, extremities, and trunk. The eruptions lasted for 1 month with intermittent remissions. Laboratory tests disclosed no infectious or parasitic etiology in patient 2. In patient 1 we isolated methicillin‐resistant
Staphylococcus aureus in a blood culture. He had sepsis with lung and liver involvement. EPF is a self‐limited dermatosis. On occasion, skin lesions may become superinfected, resulting in localized pyoderma or rarely systemic infection (sepsis). Histologically both of our patients showed a moderate mixed inflammatory infiltrate with numerous eosinophils centered around hair follicles. Their lesions responded well to topical corticosteroids.
Linear Childhood Discoid Lupus Erythematosus Following the Lines of Blaschko: A Case Report with Review of the Linear Manifestations of Lupus Erythematosus
Authors: Green Justin J. , Baker Donald J.
Published: March 2003

Seventeen cases of childhood discoid lupus erythematosus (DLE) have been previously reported in the literature. We describe the first reported case of childhood linear DLE following the lines of Blaschko. The clinical and histologic characteristics of childhood DLE are discussed and a review of the linear manifestations of childhood LE is presented.
Atypical Erythema Toxicum Neonatorum of Delayed Onset in a Term Infant
Authors: Chang Mary Wu , Jiang S. Brian , Orlow Seth J.
Published: March 2003

We describe a 10‐day‐old term infant who presented to the emergency room with an acute pustular eruption. Laboratory tests and clinical outcome confirmed the diagnosis of erythema toxicum neonatorum. A full septic workup was performed and all cultures were negative. Wright‐stained smear of pustular contents showed a predominance of neutrophils with 10% eosinophils. The white blood cell count was 19,000/mm3 with 10% eosinophils. The eruption resolved spontaneously at 15 days of age leaving no sequelae. This is the first fully documented case of erythema toxicum in a term infant occurring as late as 10 days of age. When erythema toxicum presents in an atypical fashion, diagnostic tests are important to exclude other causes of pustular dermatoses of the neonate.
Panniculitis in Juvenile Dermatomyositis
Authors: Ghali Fred E. , Reed Ann M. , Groben Pamela A. , McCauliffe Daniel P.
Published: March 2003

Abstract: Panniculitis is a rarely reported clinical finding in dermatomyositis. We present a 14‐year‐old African American boy with a 4‐year history of dermatomyositis referred for evaluation of tender, indurated plaques and nodules on the trunk and proximal extremities. A biopsy specimen revealed epidermal and dermal changes consistent with dermatomyositis. Although calcification was absent, a striking lobular panniculitis was observed. A total of seven cases of clinical panniculitis in association with dermatomyositis have been published. As in our patient, it typically presents as indurated, tender plaques and nodules on the arms, thighs, and buttocks. Although in the vast majority of cases panniculitis found in association with dermatomyositis is subclinical and represents an incidental histopathologic finding, the case we present further emphasizes the need to recognize panniculitis as a rare, but clinically relevant pathologic feature seen in certain lesions of juvenile dermatomyositis.
Neonatal Erosions and Ulcerations in Giant Congenital Melanocytic Nevi
Authors: Giam Yoke‐Chin , Williams Mary L. , LeBoit Philip E. , Orlow Seth J. , Eichenfield Lawrence F. , Frieden Ilona J.
Published: March 2003

Abstract: We report 10 cases of neonatal erosions or ulcerations in giant congenital melanocytic nevi. Histopathologic examination, performed in eight cases, demonstrated benign findings. Clinical follow‐up for an average of 3.8 years (range 2 weeks to 8 years) has not revealed the development of cutaneous melanoma. We conclude that erosions or ulcerations in giant melanocytic nevi in neonates are often benign and do not necessarily signify the presence of cutaneous melanoma.
Kasabach–Merritt Syndrome: Identification of Platelet Trapping in a Tufted Angioma by Immunohistochemistry Technique Using Monoclonal Antibody to CD61
Authors: Seo Seon kyo , Suh Jin chun , Na Gun yeon , Kim Ik su , Sohn Kyung rak
Published: March 2003

Abstract: Kasabach–Merritt syndrome (KMS) consists of large and rapidly growing vascular tumors associated with thrombocytopenia, generalized petechiae, and bleeding. The cause of the thrombocytopenia is thought to be related to the trapping of platelets by the abnormal endothelium of the tumor. We report an infant with KMS that developed in association with a large tufted angioma. In this case we directly demonstrated platelet trapping in the vascular lumen of the tumor by an immunohistochemical technique using a monoclonal antibody against CD61, a marker of platelets and megakaryocytes.
Dermatomyofibroma: Case Report and Review
Authors: Rose Christian , Bröcker Eva‐B.
Published: March 2003

Abstract: This case report describes a 4‐year‐old boy with a dermatomyofibroma on the posterior aspect of the neck. Dermatomyofibroma is a recently described, rare, benign proliferation of myofibroblasts of the skin, mainly found in young women. Only a few cases have been reported in males. This entity is not generally well known and probably often misdiagnosed. To our knowledge the patient presented here is the youngest diagnosed thus far.
Malnutrition‐Associated Rash of Cystic Fibrosis
Authors: Darmstadt Gary L. , McGuire Joseph , Ziboh Vincent A.
Published: March 2003

Abstract: Rash is a rare presenting sign of cystic fibrosis (CF) complicated by protein‐calorie malnutrition. We measured essential fatty acid (EFA) levels in the serum of a 4‐month‐old girl with an erythematous, desquamating, periorificially accentuated rash in association with malnutrition and her 2‐year‐old sister who was diagnosed concurrently with CF but had no rash or signs of malnutrition. Both patients had biochemical evidence of EFA deficiency, suggesting that development of the rash is multifactorial. Clinical presentation, management, and possible modes of pathogenesis of the rash are reviewed. Pathogenesis of the rash appears to involve a complex interaction among deficiencies of EFAs, zinc, protein, and possibly copper, leading to disordered prostaglandin metabolism or cytokine production, or free radical‐induced damage to cellular membranes due to a lack of nutrient‐derived protective antioxidants.
Lichen Scrofulosorum
Authors: Torrelo Antonio , Valverde Emilio , Mediero Imelda G. , Zambrano Antonio
Published: March 2003

Abstract: A 12‐month‐old boy with pulmonary tuberculosis developed a papular lichenoid eruption which showed epithelioid granulomas on histology, consistent with lichen scrofulosorum. Stains and cultures for mycobacteria in the skin were negative, and a polymerase chain reaction (PCR) analysis failed to detect the DNA of Mycobacterium tuberculosis in a skin biopsy specimen, thus making lichen scrofulosorum one of the remaining manifestations of M. tuberculosis infection in which evidence of the bacillus has not been found to date. Lichen scrofulosorum is now considered a rare form of tuberculid but should not be neglected.
High‐Dose Systemic Corticosteroids Can Arrest Recurrences of Severe Mucocutaneous Erythema Multiforme
Authors: Martinez Anna E. , Atherton David J.
Published: March 2003

Abstract: We treated two children with a total of five recurrences of erythema multiforme major with pulsed dose, systemic corticosteroid therapy on an open basis, and report herein the beneficial effects of this regime. We mean to further reevaluate this therapy on a controlled study basis.
Cutis Marmorata Telangiectatica Congenita: Clinical Findings in 85 Patients
Authors: Amitai Dan Ben , Fichman Susanna , Merlob Paul , Morad Yair , Lapidoth Moshe , Metzker Aryeh
Published: March 2003

Abstract: Cutis marmorata telangiectatica congenita (CMTC) is an uncommon, sporadic, congenital cutaneous condition presenting with persistent cutis marmorata, telangiectasia, phlebectasia and possible ulceration of the involved skin, skin atrophy, and undergrowth of the involved extremity. To further the current understanding of this disorder, we analyzed the clinical features of a large series of patients with CMTC. The files of 85 patients with CMTC who were examined in our center over the last 20 years were reviewed. The data recorded included patient sex, age at onset, nature and distribution of the lesions, associated abnormalities, and course of disease. CMTC was characterized by early recognition of the lesions (94% at birth) and equal sex distribution. The lesion was unilateral in 65% of patients and most commonly involved the limbs (69%). Additional capillary lesions, noted in 20% of patients, may well have been an extension of the CMTC itself. Associated anomalies were found in 18.8% of patients. Almost half of the patients showed a definite improvement in the reticular vascular pattern on follow‐up. No familial cases of CMTC were noted. CMTC is more prevalent than previously recognized, affects both sexes equally, and has a mostly localized distribution; additional vascular lesions are associated with the disorder, but other anomalies occur less often. Prognosis is generally good.
Disseminated Lupus Vulgaris and Papulonecrotic Tuberculid: Case Report
Authors: Senol Mustafa , Ozcan Atilla , Aydin Abdullah , Karincaoglu Yelda , Sasmaz Sezai , Sener Serpil
Published: March 2003

Abstract: The incidence of tuberculosis and extrapulmonary forms of this disease is increasing all over the world. Lupus vulgaris is the most prevalent form of cutaneous tuberculosis in Europe and the Middle East. Papulonecrotic tuberculid, the most common form of hyperergic response to mycobacteria or their fragments, is uncommon in children. We report lupus vulgaris with papulonecrotic tuberculid in a 12‐year‐old girl who had a 3‐year history of slowly growing plaques on her trunk, extremities, and the tip of her nose and papuloulcerative lesions over her entire body. A skin biopsy specimen showed minimally caseating granulomatous inflammation. Staining for acid‐fast bacilli was negative in both plaques and papules. Polymerase chain reaction identified Mycobacterium tuberculosis DNA in the patient's sputum, gastric fluid, and plaques and was negative in the papules. She was started on antituberculous therapy with four drugs and her lesions responded rapidly.
Use of Squaric Acid Dibutylester (SADBE) for Cutaneous Warts in Children
Authors: Micali Giuseppe , Nasca Maria Rita , Tedeschi Aurora , Dall'oglio Federica , Pulvirenti Nella
Published: March 2003

Abstract: We evaluated the efficacy of squaric acid dibutylester (SADBE) contact immunotherapy for the treatment of warts on a series of 188 children. Included in the study were those children who satisfied at least two of the following criteria: single or multiple sites with several warts, warts resistant to repeated medical and/or surgical treatments, recurrent multiple warts, and patient or parent refusal to undergo destructive or surgical treatment. Excluded from the study were children with single warts or with flat warts located exclusively on the face and children less than 2 years of age. Treatment consisted of twice weekly applications of serial dilutions of SADBE (0.03–3%) for no more than 10 weeks. Of the 148 children who completed the study, 124 (84%) showed complete clinical resolution with no significant side effects. Of those with total clinical resolution, 101 completed a 24‐month follow‐up with no relapses. Twenty‐four (16%) children were nonrespondent. No apparent correlation between treatment response and age, gender, anatomic site, lesion type, or atopy was found. Contact immunotherapy with SADBE is a relatively safe and effective alternative treatment in the management of multiple and resistant cutaneous warts in children.
Tungiasis in a 3‐Year‐Old Child
Authors: Gelmetti Carlo , Carrera Carlo , Veraldi Stefano
Published: March 2003

Abstract: Tungiasis is an infestation of the skin caused by the flea Tunga penetrans. It is not rare in western Europe because of tourism to tropical and subtropical countries. However, tungiasis has been very rarely reported in children. We describe a case of tungiasis in a 3‐year‐old child. The infestation was localized to the second toe of the left foot and was characterized by an atypical clinical presentation.
Knuckle Pads: Does Knuckle Cracking Play an Etiologic Role?
Authors: Peterson Christopher M. , Barnes Cheryl J. , Davis Loretta S.
Published: March 2003

Abstract: Very little has been published on knuckle pads and the cosmetic and psychological effects they can have. In children, most knuckle pads are considered to be idiopathic; however, familial cases as well as those caused by trauma have been described. We report a 14‐year‐old African American girl with a 3‐year history of slowly enlarging hyperkeratotic nodules over multiple finger joints and on the lateral aspects of several fingers. These lesions were initially confined to the patient's left hand but subsequently involved the right hand. The patient and her mother denied any unusual hobbies or sports in which the patient's fingers might be traumatized. The patient, however, was noted to crack her knuckles during her clinic visit. To the mother's surprise, the patient admitted to doing this quite frequently on a daily basis. A diagnosis of knuckle pads was made and confirmed histologically. To our knowledge, this is the first reported case of knuckle pads with cracking of the knuckles as the possible etiology.
Louse Comb Versus Direct Visual Examination for the Diagnosis of Head Louse Infestations
Authors: Mumcuoglu Kosta Y. , Friger Michael , Ioffe‐Uspensky Inna , Ben‐Ishai Fiameta , Miller Jacqueline
Published: March 2003

Abstract: The techniques used for diagnosis of head louse (Pediculosis capitis) infestation are a source of controversy. Most epidemiologic and diagnostic studies have been done using direct visual examination. The main objective of this study is to compare the efficacy of direct visual examination versus the louse comb method. The hair of each child was examined twice; one team used a screening stick and another team used a louse comb. Seventy‐nine boys and 201 girls, 7–10 years old were examined. Examination with a louse comb found that 25.4% of the children were infested with both lice and nits, while another 31.3% had nits only. Boys were significantly less infested with lice and nits than girls (lice: 15.2 and 29.6%; nits: 21.5 and 35.4%, respectively). The infestation rate with lice and nits was significantly higher in children with long (68.9%) and medium‐length (63.9%) hair than in children with short hair (44.0%) (p < 0.01). Direct visual examination found that 5.7% of the children were infested with both lice and nits, and another 49.0% with nits only. The average time until detection of the first louse was 57.0 seconds with the comb as compared to 116.4 seconds by direct visual examination. Diagnosis of louse infestation using a louse comb is four times more efficient than direct visual examination and twice as fast. The direct visual examination technique underestimates active infestation and detects past, nonactive infestations.
Multiple Familial Smooth Muscle Hamartomas
Authors: Gualandri Lorenzo , Cambiaghi Stefano , Ermacora Elisa , Tadini Gianluca , Gianotti Raffaele , Caputo Ruggero
Published: March 2003

Abstract: Smooth muscle hamartoma is a cutaneous abnormality characterized by a disorganized proliferation of normal muscle fibers of arrector pili. Usually a single congenital hypertrichotic plaque involves the trunk and the extremities. Multiple lesions have rarely been reported in the literature. We describe three members of the same family with multiple skin‐colored patches on the back and legs, histologically confirmed as smooth muscle hamartomas. To our knowledge this is the first report of multiple smooth muscle hamartomas in different members of the same family and quite interestingly involving the same skin site.
Eccrine Angiomatous Hamartoma: A Report of Symmetric and Painful Lesions of the Wrists
Authors: Morrell Dean S. , Ghali Fred E. , Stahr Benjamin J. , McCauliffe Daniel P.
Published: March 2003

Abstract: Eccrine angiomatous hamartoma (EAH) is a rare, benign cutaneous lesion histologically defined as a proliferation of eccrine glands within a closely associated vascular stroma. Typically EAH presents as a solitary flesh‐colored, hyperhidrotic, painful papule or plaque appearing at birth or during childhood. Only two previously reported cases have been described involving multiple, symmetrically located lesions. The occurrence of knuckle pads in patients with EAH has not been reported. We present an instance of multiple painful EAH lesions occurring symmetrically on the extensor wrists in a 14‐year‐old girl with knuckle pads.
Primary Cutaneous Mycobacterium kansasii Infection in a Child
Authors: Chaves Antonio , Torrelo Antonio , Mediero Imelda G. , Menéndez‐Rivas Mercedes , Ortega‐Calderón Arturo , Zambrano Antonio
Published: March 2003

Abstract: A 6‐year‐old girl with a primary cutaneous form of Mycobacterium kansasii infection is presented. Disseminated infection and immune deficiency were excluded in our patient. She was successfully treated with surgical excision and oral erythromycin. Primary cutaneous M. kansasii is an exceedingly rare infection in children.
Effects of Breathable Disposable Diapers: Reduced Prevalence of Candida and Common Diaper Dermatitis
Authors: Akin Frank , Spraker Mary , Aly Raza , Leyden James , Raynor William , Landin Wendell
Published: March 2003

Infants wearing breathable disposable diapers experienced significantly less diaper dermatitis (DD) compared to infants wearing standard, nonbreathable disposable diapers in a series of double‐blind clinical trials. Severe DD, including confirmed infection with Candida albicans, was reduced by 38–50% among infants wearing highly breathable (HB) diapers. The prevalence of DD was inversely related to the breathability of the garments. The inhibitory effect of breathable diapers on the survival of Candida was further confirmed in controlled experiments with adult volunteers. A suspension of C. albicans cells was applied to delineated sites on the volar forearm. Each site was then covered by a full‐thickness patch from either an HB or a standard diaper. Survival of Candida colonies was reduced by almost two‐thirds in the breathable diaper‐covered sites compared to the control sites.
Cimetidine and Levamisole Versus Cimetidine Alone for Recalcitrant Warts in Children
Authors: Parsad Davinder , Pandhi Roma , Juneja A , Negi K S
Published: March 2003

Various immunomodulating agents have been used in the treatment of recalcitrant warts, but none is uniformly effective. Aggressive surgical therapy of warts in children is painful and may require general anesthesia. Drugs such as cimetidine and levamisole have been tried with varying success rates. Given the different target of activities of immunomodulation by cimetidine and levamisole, we questioned whether the combination might be more effective and conducted a double‐blind comparative trial of a combination of cimetidine and levamisole versus cimetidine alone. Forty‐four patients with multiple recalcitrant warts were assigned to one of two treatment groups (groups A and B) in double‐blind fashion. Of the 44 patients, 19 in group A and 20 in group B could be evaluated. At the end of therapy, cure rates (complete clearance) obtained were 31.5% of those in group A and 65% of those in group B (combination treatment). A statistically significant improvement was seen in patients treated with the combination of levamisole and cimetidine (p=0.0150). The rate of regression was faster in group B (average regression period of 7.8 weeks compared with 11 weeks in group A). The present study demonstrated that the combination of cimetidine with levamisole is more effective than cimetidine alone and is a highly effective therapy for the treatment of recalcitrant warts.
Lichenoid Sarcoidosis in a 3‐Year‐Old Girl
Authors: Seo Seon Kyo , Yeum Jung Sub , Suh Jin Chun , Na Gun Yoen
Published: March 2003

We report a case of lichenoid sarcoidosis in a 3‐year‐old girl. She had numerous discrete skin‐colored or erythematous, infiltrated follicular papules on the buttocks and extremities since 2 months of age. Histopathologic examination showed follicular plugging and an upper dermal granulomatous infiltrate of epithelioid cells closely surrounding the follicular ducts. No acid‐fast bacilli were seen in the sections examined. Chest radiograph and high‐resolution computed tomography (CT) showed no hilar lymphadenopathy or pulmonary parenchymal changes. An angiotensin‐converting enzyme level was elevated. The Mantoux reaction was negative and results of ophthalmologic examinations were normal. Treatment was started with triamcinolone 0.2 mg/kg and prednicarbate ointment. Some lesions healed completely and others showed residual pitting.
Juvenile Acanthosis Nigricans and Insulin Resistance
Authors: Hermanns‐Lê Trinh , Hermanns Jean François , Piérard Gérald E.
Published: March 2003

Acanthosis nigricans in obese adolescents is frequently associated with hyperinsulinemia and insulin resistance. We report three cases of this condition. In the early stage the skin lesions appeared to be erythematous and pruritic, mimicking an inflammatory dermatitis. Dietary control and oral metformin hydrochloride markedly improved the lesions. Topical calcipotriol may also help to control the skin condition.
Squamous Cell Carcinoma in Pansclerotic Morphea of Childhood
Authors: Wollina Uwe , Buslau Michael , Weyers Wolfgang
Published: March 2003

Squamous cell carcinoma (SCC) has only occasionally been reported in patients with systemic sclerosis. It is very rare in morphea. Herein we describe SCC presenting as malignant ulcers in pansclerotic morphea of childhood in a 16‐year‐old boy.