bluuebunny/crossref_metadata_2025 huggingface dataset:
Nurse independent prescribing and nurse supplementary prescribing practice: national survey
Authors: Courtenay Molly , Carey Nicola
Published: August 2010

Title.  Nurse independent prescribing and nurse supplementary prescribing practice: national survey

Aim.  This paper is a report of a survey to provide an overview of nurse independent prescribing and nurse supplementary prescribing across the United Kingdom.

Background.  Evidence examining the frequency of prescribing by nurses is conflicting, and it is evident that several factors hamper prescribing practice. As of May 2006, legislative changes gave appropriately qualified nurses virtually the same independent prescribing right as doctors. However, there is currently no evidence available about the prescribing practices of these nurses.

Method.  A random sample of 1992 qualified Nurse Independent/Nurse Supplementary Prescribers registered with the Nursing and Midwifery Council was sent a postal questionnaire in 2006. A total of 1400 (70%) questionnaires were returned, of which 1377 were completed.

Findings.  Eight hundred and ninety‐one (65%) respondents worked in primary care, and 333 (24·3%) worked in secondary care. Three quarters of the sample had more than 5‐year clinical experience in the area in which they prescribed prior to entering the prescribing programme. One thousand one hundred and seven (87%) participants had used nurse independent prescribing and 568 (44·6%) nurse supplementary prescribing. Restriction of local arrangements, implementation of the Clinical Management Plan and access to doctors hampered or prevented prescribing.

Conclusion.  The adoption of prescribing by nurses in the United Kingdom has increased patient choice with regard to access to medicines. A number of factors which hamper or prevent prescribing require further exploration.
Centralization and research governance: does it work?
Authors: Howarth Michelle , Kneafsey Rosie , Haigh Carol
Published: August 2010

Title.  Centralization and research governance: does it work?

Aim.  This paper is a report of a study to evaluate the impact and success of the United Kingdom centralized Research Management and Governance model.

Background.  Research is crucial to the generation of new knowledge and for the development of nursing services. However, poor research conduct has prompted a growing international impetus to govern and monitor research activity. In 2004, a centralized Research Management and Governance Model aimed at fostering a quality research culture through streamlining bureaucratic management processes was implemented across 14 primary care provider organizations in the United Kingdom.

Methods.  A questionnaire survey was undertaken in 2004 to explore researchers’ experiences (n = 76) of the model across the 14 organizations, and semi‐structured interviews were conducted with five research and development managers. The interview transcripts were independently thematically analysed.

Findings.  Governance processes were seen as useful or very useful by 36·8% (n = 28) of researchers viewed, and 47·3% (n = 36) thought they were a hindrance or not useful. Managers suggested that the model supported the research infrastructure and had reduced paperwork. The benefits of centralization were balanced against managers’ perceptions of reduced autonomy and control.

Conclusions.  Centralizing research governance is an effective way of maximizing research resources, but researchers still may not value the process. Partnership working can streamline research governance mechanisms, but needs to be adequately resourced and transparent. This model could be of benefit to international colleagues who are charged with the management of research.
Existential struggle and self‐reported needs of patients in rehabilitation
Authors: Sigurgeirsdottir Jonina , Halldorsdottir Sigridur
Published: August 2010

Title.  Existential struggle and self‐reported needs of patients in rehabilitation

Aim.  This paper is a report of a study to increase understanding of patients’ experience of rehabilitation and their self‐reported needs in that context.

Background.  Nurses need to be able to recognize patient needs to plan effective and individualized care. Needs‐led nursing care is emphasized in the nursing literature, but few studies in rehabilitation have explored needs from the patient’s perspective.

Method.  The sample of this phenomenological study was purposively selected and the data consisted of 16 in‐depth interviews with 12 people aged between 26 and 85 years. The data were collected in 2005.

Findings.  The findings showed that being a patient in rehabilitation involves existential struggling, as the reason behind patients’ rehabilitation, accident or illness usually leads to trying to cope with existential changes while needing to adapt to new characteristics of life and self. This makes patients vulnerable and their self‐reported needs include individualized caring and emotional support from family, peers and staff. Participants also reported a need for a sense of security in a stable and homelike environment, with assistance, help and presence. Finally, they reported needing goal‐oriented and progressive care in which realistic and achievable goals were established. Individualized patient education enhanced their independence and empowered them towards a new and progressive lifestyle.

Conclusion.  A new emphasis is needed in rehabilitation nursing, involving assessment of existential well‐being of patients by means of skilful interpersonal relationship based on individualized caring and emotional support and recognition of each patient’s own hierarchy of needs.
Symptom manifestations and expressions among Korean immigrant women suffering with depression
Authors: Bernstein Kunsook Song , Lee Jeong‐Seop , Park So‐Youn , Jyoung Joung‐Pyo
Published: August 2010

Title.  Symptom manifestations and expressions among Korean immigrant women suffering with depression

Aim.  This paper is a report of a study to investigate the culture‐specific symptom manifestation and expression of depression in Korean immigrant women in the United States of America (USA).

Background.  The literature indicates that Korean immigrants to the USA report higher levels of depressive symptoms than immigrants from other Asian ethnic groups, and women immigrants tend to encounter more gender‐related emotional difficulties. However, because of traditional cultural beliefs, immigrants may not seek treatment for depression and, when they do, tend to leave treatment prematurely.

Methods.  We used an ethnographic method based on Spradley’s Developmental Research Sequence with a sample of 17 Korean immigrant women who scored mild‐to‐severe depression on a Korean version of the Hamilton Depression Inventory Scale. Data were collected from 2005 to 2006, and consisted of tape‐recorded interviews, field notes and diaries.

Findings.  Depressive symptoms were complex, intertwined and felt in all domains of the person’s existence. They were expressed mainly through emotional and physical suffering, and the expression of suffering as a way of life. Themes elicited were emotional entrapment, shame and failure as women, disappointment at not being able to live a normal life and emotional restraint, as emotions were not generally expressed verbally but instead were expressed somatically, bodily and metaphorically.

Conclusion.  Being aware of culture‐specific symptoms of depression among Korean immigrant women can assist nurses in caring for them and thus improving their therapeutic alliances and preventing them from prematurely terminating treatment.
Preparing nurses to prescribe medicines for patients with diabetes: a national questionnaire survey
Authors: Courtenay Molly , Carey Nicola
Published: August 2010

Title.  Preparing nurses to prescribe medicines for patients with diabetes: a national questionnaire survey

Aim.  This paper is a report of a study to examine Nurse Independent/Nurse Supplementary Prescribing for people with diabetes and the extent to which these nurses feel prepared for this role.

Background.  An area of care in which nurses, caring for people with diabetes, are involved is the management of medications. There is little or no evidence examining the prescription of medicines by nurses for people with this condition.

Methods.  The United Kingdom Nursing and Midwifery Council database was used to select a random sample of 1992 Registered Nurse Independent/Nurse Supplementary Prescribers. Of these, 1400 questionnaires were returned. Medicines for people with diabetes were prescribed by 439 respondents. This paper reports on the findings of these 439 nurses. The data were collected in 2006.

Results.  Four hundred and nine (95·1%) participants had used independent prescribing and 214 (49·8%) used supplementary prescribing. The majority of respondents were highly experienced and worked in primary care. Some nurses (7·6%) reported that the prescribing programme did not meet their need. The needs of nurses who had undertaken specialist training in diabetes were met to a statistically and significantly greater extent than those without this training. Nurse prescribing was viewed positively by nurses prescribing for people with diabetes.

Conclusion.  Prescribing has extended the role that nurses in the United Kingdom are able to play in the management of diabetes. Specialist training is a prerequisite for nurses adopting this role. There is a need to explore the prescribing programme and the extent to which it meets the needs of nurses prescribing for people with diabetes.
Accident and emergency staff opinion on the effects of family presence during adult resuscitation: critical literature review
Authors: Walker Wendy
Published: August 2010

Title.  Accident and emergency staff opinion on the effects of family presence during adult resuscitation: critical literature review.

Aim.  This paper is a report of a critical literature review to identify the positive and negative effects of family presence during adult resuscitation, as perceived by accident and emergency healthcare staff based in primary (out‐of‐hospital) and secondary (in‐hospital) environments of care.

Background.  The controversial practice of family presence during resuscitation of adults has stimulated debate over the past two decades, giving rise to a growing body of literature and the development of clinical guidelines for practice.

Methods.  A search was carried out for the period 1987–2007 using the Science Direct, CINAHL, Medline, EMBASE, psychINFO and BNI databases and the search terms resuscitation, witnessed resuscitation, family presence, relatives’ presence, attitudes and opinions and accident and emergency.

Results.  Eighteen studies were included in the critical review, primarily comprising retrospective survey research. The majority of studies were descriptive in design. A standardized approach to the appraisal process was achieved through the utilization of guidelines for critiquing self‐reports. The findings revealed that accident and emergency healthcare staff perceive both positive and negative effects as a consequence of family presence during adult resuscitation and their opinions suggest that there are more risks than benefit.

Conclusion.  Further research is essential if family presence during resuscitation of adults is to be better defined and understood. Qualitative methods of enquiry are recommended as a way of gaining a deeper insight into and understanding of this practice.
Hypertension control, predictors for medication adherence and gender differences in older Chinese immigrants
Authors: Li Wen‐Wen , Wallhagen Margaret I. , Froelicher Erika S.
Published: August 2010

Title.  Hypertension control, predictors for medication adherence and gender differences in older Chinese immigrants

Aim.  This paper is a report of a study to explore the relationship between demographic and cultural factors and antihypertensive medication adherence in older Chinese immigrants.

Background.  Hypertension is a well‐known controllable risk factor for cardiovascular diseases worldwide, but only 20–80% of patients who take antihypertensive medications adhere adequately to their treatment regimen.

Methods.  A cross‐sectional study was conducted between 2002 and 2003, with a convenience sample of 75 older men and 69 older women (n = 144, response rate 80%). Medication adherence was defined as ≥80% of the total score on the Morisky scale.

Findings.  Age (75·2 ± 5·7 vs. 75·9 ± 7·0 years, P = 0·51) and length of stay in the United States of America (12·7 ± 6·4 vs. 12·7 ± 6·6 years, P = 0·97) were similar for men and women. More men were married (85% vs. 46%, P < 0·01). A smaller proportion of men were poor (39% vs. 65%, P < 0·01), believed in religion (49% vs. 70%, P = 0·01), and could speak no English (32% vs. 57%, P < 0·01). Fewer men used Chinese herbs to treat hypertension (4% vs.13%). Hypertension control was low for men and women (53% and 48%, P = 0·51). Adherence in men and women was 69% and 75% (P = 0·42) respectively. For men, shorter length of stay in the United States of America was negatively associated with non‐adherence (OR = 0·16; 95% CI: 0·05, 0·57). No association between length of stay and non‐adherence was found for women.

Conclusion.  More research, including gender‐specific studies, is needed to understand better how to develop an effective and culturally sensitive strategy to help older Chinese immigrants manage their hypertension.
Global estimation of invasion risk zones for the western corn rootworm Diabrotica virgifera virgifera: integrating distribution models and physiological thresholds to assess climatic favourability
Authors: Aragón Pedro , Baselga Andrés , Lobo Jorge M.
Published: August 2010

1. Biological invasions represent a major threat to human health, ecosystem functioning and global biodiversity. Insect pests affecting agriculture and forestry are of special importance. Estimations of climatic similarity between a species’ native range and potential zones of invasion can be useful for preventing new invasions, spreads and ulterior contacts among populations from multiple invasions.

2. We estimated areas climatically favourable for the establishment of the western corn rootworm (WCR), an insect pest of maize Zea mays in North America that has recently invaded Central Europe through multiple invasions, and it has the potential of invasion mainly in the Northern Hemisphere.

3. We used complementary techniques to assess the biological relevance of predictors and obtain areas of climatic favourability. The biological relevance of variables was first assessed accounting for two main components of the WCR’s environmental niche (marginality and specialisation). Then, the most relevant predictors were used to obtain either climatic envelopes or environmental distances regarding the WCR’s native range. Model outputs and predictor relevance were independently assessed in the currently invaded region of Europe and through the spatial projection of proposed physiological thresholds from previous empirical studies. Lastly, as examples of application for given time periods, we fed back results of environmental distances with maize data for a 10‐year period in Europe, and refined global risk maps with the main maize zones for the year 2000.

4. We present global zones of climatic favourability and invasion risk for the WCR, with emphasis on the Northern Hemisphere. The northern and north‐west range limits predicted by the climatic envelope in the WCR’s native range mirrored the independently characterised physiological limits. Also, our model outputs explained some of the patterns observed in Europe supporting the validity of our procedures.

5. Synthesis and applications. Assessments of climatic favourability for the western corn rootworm can provide information on areas of invasion risk. Our study highlights the combination of holistic and reductionist approaches as a useful protocol to evaluate models and/or infer causality. Our methodology can be an efficient tool in combating future potential invasions, spreads and secondary contact zones of insect pests by reducing uncertainty regarding where to allocate prevention and/or eradication efforts.
Quantification of viral DNA and liver enzymes in plasma improves early diagnosis and management of herpes simplex virus hepatitis
Authors: Beersma M. F. C. , Verjans G. M. G. M. , Metselaar H. J. , Osterhaus A. D. M. E. , Berrington W. R. , van Doornum G. J.
Published: August 2010

Summary.  Herpes simplex virus (HSV) hepatitis is a rare and potential life‐threatening disease. The diagnosis of HSV hepatitis is hampered by its indifferent clinical presentation, which necessitates confirmatory laboratory data to identify HSV in the affected liver. However, liver biopsies are often contraindicated in the context of coagulopathy, are prone to sampling errors and have low sensitivity in mild HSV hepatitis cases. There is an unmet need for less invasive diagnostic tools. The diagnostic and therapeutic value of HSV DNA load and liver enzyme level kinetics was determined in five patients with HSV hepatitis and twenty disease controls with HSV‐DNAemia without hepatitis. At time of hospitalization, patients with HSV hepatitis had a higher median (± interquartile range) HSV DNA load (6.0 × 106 ±1.2 × 109) compared to disease controls (171 ± 2845). Viral DNA load correlated with liver transaminase levels and disease severity. Antiviral treatment led to rapid decline of HSV DNA load and improvement of liver function of patients with HSV hepatitis. The data advocate the prompt and consecutive quantification of the HSV DNA load and liver enzyme levels in plasma of patients suspected of HSV hepatitis as well as those under antiviral treatment.
Adaptation of Staphylococcus aureus to ruminant and equine hosts involves SaPI‐carried variants of von Willebrand factor‐binding protein
Authors: Viana David , Blanco José , Tormo‐Más María Ángeles , Selva Laura , Guinane Caitriona M. , Baselga Rafael , Corpa Juan M. , Lasa Íñigo , Novick Richard P. , Fitzgerald J. Ross , Penadés José R.
Published: August 2010

Staphylococci adapt specifically to various animal hosts by genetically determined mechanisms that are not well understood. One such adaptation involves the ability to coagulate host plasma, by which strains isolated from ruminants or horses can be differentiated from closely related human strains. Here, we report first that this differential coagulation activity is due to animal‐specific alleles of the von Willebrand factor‐binding protein (vWbp) gene, vwb, and second that these vwb alleles are carried by highly mobile pathogenicity islands, SaPIs. Although all Staphylococcus aureus possess chromosomal vwb as well as coagulase (coa) genes, neither confers species‐specific coagulation activity; however, the SaPI‐coded vWbps possess a unique N‐terminal region specific for the activation of ruminant and equine prothrombin. vWbp‐encoding SaPIs are widely distributed among S. aureus strains infecting ruminant or equine hosts, and we have identified and characterized four of these, SaPIbov4, SaPIbov5, SaPIeq1 and SaPIov2, which encode vWbpSbo4, vWbpSbo5, vWbpSeq1 and vWbpSov2 respectively. Moreover, the SaPI‐carried vwb genes are regulated differently from the chromosomal vwb genes of the same strains. We suggest that the SaPI‐encoded vWbps may represent an important host adaptation mechanism for S. aureus pathogenicity, and therefore that acquisition of vWbp‐encoding SaPIs may be determinative for animal specificity.
Biochemical analysis of PIFTC3, the Trypanosoma brucei orthologue of nematode DYF‐13, reveals interactions with established and putative intraflagellar transport components
Authors: Franklin Joseph B. , Ullu Elisabetta
Published: August 2010

DYF‐13, originally identified in Caenorhabditis elegans within a collection of dye‐filling chemosensory mutants, is one of several proteins that have been classified as putatively involved in intraflagellar transport (IFT), the bidirectional movement of protein complexes along cilia and flagella and specifically in anterograde IFT. Although genetic studies have highlighted a fundamental role of DYF‐13 in nematode sensory cilium and trypanosome flagellum biogenesis, biochemical studies on DYF‐13 have lagged behind. Here, we show that in Trypanosoma brucei the orthologue to DYF‐13, PIFTC3, participates in a macromolecular complex of approximately 660 kDa. Mass spectroscopy of affinity‐purified PIFTC3 revealed several components of IFT complex B as well as orthologues of putative IFT factors DYF‐1, DYF‐3, DYF‐11/Elipsa and IFTA‐2. DYF‐11 was further analysed and shown to be concentrated near the basal bodies and in the flagellum, and to be required for flagellum elongation. In addition, by coimmunoprecipitation we detected an interaction between DYF‐13 and IFT122, a component of IFT complex A, which is required for retrograde transport. Thus, our biochemical analysis supports the model, proposed by genetic analysis in C. elegans, that the trypanosome orthologue of DYF‐13 plays a central role in the IFT mechanism.
Ether cleaving methyltransferases of the strict anaerobe Acetobacterium dehalogenans: controlling the substrate spectrum by genetic engineering of the N‐terminus
Authors: Kreher Sandra , Studenik Sandra , Diekert Gabriele
Published: August 2010

The anaerobic cleavage of ether bonds of methoxylated substrates such as vanillate or veratrol in acetogenic bacteria is mediated by multi‐component enzyme systems, the O‐demethylases. Acetobacterium dehalogenans harbours different inducible O‐demethylases with various substrate spectra. Two of these enzyme systems, the vanillate‐ and the veratrol‐O‐demethylases, have been characterized so far. One component of this enzyme system, the methyltransferase I (MT I), catalyses the cleavage of the substrate ether bond and the subsequent transfer of the methyl group to a corrinoid protein. For the C‐termini of the methyltransferases I of the vanillate‐ and the veratrol‐O‐demethylases, a TIM barrel structure of the enzymes was predicted, whereas the N‐termini are not part of this conserved structure. The deletion of the N‐terminal regions led to a significant increase of activity (up to 20‐fold) and an extended substrate spectrum of the mutants, which also comprised non‐aromatic compounds such as the thioether methionine and diethylether. The exchange of the N‐termini of the two methyltransferases I resulted in chimeric enzymes whose substrate specificities were those of the enzymes from which the N‐termini were derived. This demonstrated the crucial role of the N‐termini for the substrate specificity of the methyltransferases.
General stress response in α‐proteobacteria: PhyR and beyond
Authors: Staroń Anna , Mascher Thorsten
Published: August 2010

In addition to stress‐specific responses, most bacteria can mount a general stress response (GSR), which protects the cells against a wide range of unspecific stress conditions. The best‐understood examples of GSR are the σB‐cascade of Bacillus subtilis and the RpoS response in Escherichia coli. While the latter is conserved in many other proteobacteria of the β‐, γ‐ and δ‐clades, RpoS homologues are absent in α‐proteobacteria and their GSR has long been a mystery. Recent publications finally unraveled the core of the GSR in this proteobacterial class, which is mediated by EcfG‐like σ‐factors. EcfG activity is controlled by NepR‐like anti‐σ factors and PhyR‐like proteins that act as anti‐anti‐σ factors. These unusual hybrid proteins contain an N‐terminal EcfG‐like domain that acts as a docking interface for NepR, and a C‐terminal receiver domain typical for bacterial response regulators. Upon phosphorylation, PhyR titrates NepR away from EcfG, thereby releasing the σ‐factor to recruit RNA polymerase and initiate transcription of its target genes. In this issue of Molecular Microbiology, Herrou et al. describe the function and three‐dimensional structure of PhyR from Caulobacter crescentus. This structure is key to understanding the mechanism of the reversible, phosphorylation‐dependent partner switching module that orchestrates the GSR in α‐proteobacteria.
Eosinophilic Cellulitis (Wells' Syndrome)
Authors: Fisher George B. , Greer Kenneth E. , Cooper Philip H.
Published: August 2010

ABSTRACT: Two patients with eosinophilic cellulitis are reported and 22 additional cases from the literature are reviewed. Cutaneous lesions are variable in appearance and may be confused with cellulitis, urticaria, insect bites, or contact dermatitis. Microscopically, there is a dense dermal infiltrate of eosinophils. Subsequently, granulomatous features with characteristic “flame figures” become apparent. Peripheral eosinophilia is common. The etiology of eosinophilic cellulitis is unknown, although a hypersensitivity mechanism is suspected. Treatment with systemic corticosteroids is frequently effective, but the disease is often characterized by relapses that can occur for several years.
Lyme Disease in Rio de Janeiro, Brazil
Authors: Azulay Rubem David , Azulay‐Abulafia Luna , Sodré Celso Tavares , Azulay David Rubem , Azulay Monica Manela
Published: August 2010

Abstract: Five patients living in Rio de Janeiro, Brazil, were found to have Lyme disease. These are among the first known cases in South America.
Tinea Capitis in Adults in Southern Taiwan
Authors: Lee Julia Yu‐Yun , Hsu Ming‐Long
Published: August 2010

Abstract: We report the clinicomycologic study of 27 culture‐proven cases of tinea capitis from southern Taiwan during the years 1988 to 1990. The series is notable for its predominance of adults (63%), of women (89%), and of Trichophyton violaceum infection (74%). The age distribution was clearly bimodal; the median age was 6 years for children and 56 years for adults (older than 18 years). Whether or not these findings represent a new trend of tinea capitis in southern Taiwan remains to be determined. Clinically, our cases of black‐dot ringworm caused by T. violaceum often presented with subtle changes of scaling, hair loss, and black dots. The keys to the correct diagnosis are (1) a high clinical index of suspicion with careful inspection of the scalp for the presence of black dots, and (2) microscopic examination and culturing of the black dots or plucked hairs.
PROFILE OF ALOPECIA AREATA IN NORTHERN INDIA
Authors: SHARMA VINOD K. , DAWN GOUTAM , KUMAR BHUSHAN
Published: August 2010

Background. Epidemiologic studies of alopecia areata (AA) are available from USA, Japan, and European countries, but there is a paucity of literature on AA from Asian countries, especially from the Indian subcontinent.

Methods. In a prospective, hospital‐based study lasting for a decade (1983–1992), the epidemiology of AA was studied, including associated diseases and risk factors for development of severe AA. Simultaneously a similar study was carried out in age‐ and sex‐matched controls.

Results. Eight hundred and eight patients (532 men, 276 women) and 572 age‐ and sex‐matched controls (370 men, 202 men) were studied. The incidence of AA was 0.7% of new dermatology outpatients. The majority of patients (712, 88%) were below 40 years of age, including 196 children < 16 years of age (24%). Almost half (46%) of the women patients had onset of AA in childhood, compared to only 19% in men (P < 0.001).

Alopecia was total, universal, or extensive in 154 patients (19%). An onset in the first two decades was more often associated with severe alopecia (P < 0.001), especially in men (P < 0.01). Alopecia areata was recorded in family members of 70 patients (9%), being more frequent in the severe forms of AA (16%). Evidence of atopy was recorded in a total of 146 instances (18%). The frequency of atopy was the same in circumscribed alopecia (18.1%) and severe alopecia (18.2%). Nail changes were found in 162 patients (20%) and were more frequent in 76 (47%) with the severe form of AA (P < 0.001). On 39 occasions (5%), autoimmune‐related diseases were detected: vitiligo in 15 (1.8%), thyroid disorders in 8 (1%), lichen planus in 6 (0.7%), collagen vascular diseases in 5 (0.6%), diabetes mellitus in 4 patients (0.4%), and pemphigus foliaceus in 1 (0.1%) patient. Patients with family members having vitiligo (recorded in 5.9% of patients), were more frequently affected with severe alopecia (P < 0.001).

Conclusions. Alopecia areata in North Indians showed a preponderance in men (M:F = 2:1) and the majority of persons with disease (88%) were below 40 years of age. Onset in childhood was more frequent in girls or women, but the incidence of severe alopecia was higher in boys or men with onset at an earlier age. Diseases associated with autoimmunity were seen in only 5% of patients. Atopy was found to be associated in 18% of patients, but its reported association with younger age of onset and severe alopecia was not confirmed. Presence of vitiligo in family members and onset before 20 years of age, especially in boys or men, were found to be risk factors for severe alopecia.

Int J Dermatol 1996; 35:22–27
ACUTE URTICARIA CAUSED BY PIGEON TICKS (ARGAS REFLEXUS)
Authors: VERALDI STEFANO , SCARABELLI GABRIELE , GRIMALT RAMON
Published: August 2010

A 28‐year‐old man was admitted to our institute because of acute urticaria appearing a few hours earlier. The patient stated that during sleep he had been bitten by a large number of “insects,” which had dropped from wooden ceiling beams under the roof of his room. The patient was living in the center of Milan in a very old house, where numerous pigeons had built their nests under the rooftop. The patient brought along with him some examples of these “insects,” which were later classified as pigeon ticks (Argas reflexus) (Figs. 1, 2). Dermatologic examination revealed the presence of numerous wheals and erythemato‐papular lesions on the neck and trunk. These lesions were of different shapes and sizes, bright red in color, and with a small central ulceration corresponding to the tick bite. In addition, there were numerous excoriated lesions due to scratching; the patient in fact complained of very intense pruritus. The general physical examination was within normal limits.
TREATMENT OF ALOPECIA AREATA WITH SQUARIC ACID DIBUTYLESTER
Authors: MICALI GIUSEPPE , CICERO ROSA LICASTRO , NASCA MARIA RITA , SAPUPPO ANTONIO
Published: August 2010

Background. Among contact allergens that are frequently used in the treatment of alopecia areata (AA), squaric acid dibutylester (SADBE) stands out for its good tolerability and its mild side effects.

Methods. One hundred and forty‐four patients with AA of varying degrees were treated with SADBE. Of these, 71 had AA affecting less than 50% of the scalp, and 73 had a severe form, including 13 patients with alopecia totalis (at) and two with alopecia universalis (AU). The patients were treated using both traditional and nontraditional methods.

Results. In the less severe form, we obtained a 80% rate of regrowth, compared to the 49% of the more severe form including 13 cases of at and the two of au. The failure rate was higher for patients with the more severe form (29%) compared to a 7% rate only for patients with mild AA. We also observed four cases of initial regrowth on the side of the scalp opposite to the site of application (‘castling phenomenon‘). Among those patients who were treated with application of SADBE on the right side of the back, three displayed regrowth on the left side of the scalp, (i.e., on the opposite side) and in an area distant from the site of application; for two patients the regrowth began on the right side of the scalp and one of them also displayed growth of fine hairs in the right dorsal region, the site of application of the compound.

Conclusions. Our data further support the hypothesis of a systemic action of SADBE; however, further confirmation on a larger sample of cases is needed.
Subcutaneous fat necrosis of the newborn
Authors: Mather CPT Mary K. , Sperling LTC Leonard C. , Sau COL Purnima
Published: August 2010

The patient in this study was an 18‐day‐old healthy boy, delivered by caesarean section at 33 weeks gestation, and the product of a pregnancy complicated by gestational diabetes and preterm labor. At 10 days old, three dermal and subcutaneous nodules were noted on the midline of the back (Fig. 1). The nodules measured 1–3 cm in size; they were firm, mobile, and multilobulated in quality. The overlying epidermis was slightly erythematous, but otherwise appeared normal.

A skin biopsy obtained 8 days after the lesions were first noted is shown in Fig. 2(a); necrosis of the fat with giant cell formation and characteristic needle‐shaped clefts within residual fat cells can be seen (Fig. 2b).
Paget's disease of the breast in a man with neurofibromatosis
Authors: Holloway Kathryn B. , Ramos‐Caro Francisco A. , Flowers Franklin P.
Published: August 2010

A 68‐year‐old white man with type 1 neurofibromafosis presented with a 1 ‐year history of a pruritic non‐healing eruption on his left breast. The persistent lesion had been gradually enlarging. This had been unsuccessfully treated with both corticosteroid and antifungal creams. Physical examination of the involved breast revealed a well‐demarcated 5 × 3 cm red, slightly Jnfiltrated piaque with adherent fine white scale and erosions with serous exudate (Fig. 1). The areola was completely obscured by the lesion and the nipple could not be identified. Neither a breast mass nor axillary adenopathy was present. A punch biopsy confirmed the diagnosis of Paget's disease. The patient subsequently underwent a left modified radical mastectomy with ipsilateral lymph node dissection. The final pathology revealed intraductal carcinoma, comedo and noncomedo type, with overlying pagetoid cells in the epidermis (Figs 2–4). Special stains included a positive epithelial membrane antigen, focally positive carcinoembryonic antigen, and negative S‐100. All 21 lymph nodes submitted from the axillary lymph node dissection were negative for tumor.
Basal cell carcinoma of trunk and extremities
Authors: Maafs Eduardo , Barreda Fernando De la , Delgado Ricardo , Mohar Alejandro , Alfeirán Antonio
Published: August 2010

Background Basal cell carcinoma is the most common malignancy in Caucasians. Information about basal cell carcinoma in the Mexican population is scarce.

Objective To determine the epidemiologic and clinical characteristics and treatment results of basal cell carcinoma located on the trunk and extremities of patients seen at the Institute Nacional de Cancerología of Mexico.

Methods A retrospective study was performed of patients with confirmed diagnosis of basal cell carcinoma located on the trunk and extremities seen at the Institute Nacional de Cancerología of Mexico between 1966 and 1993.

Results Ninety‐one patients with basal cell carcinoma located on the trunk and extremities were found (6% of all patients with diagnosis of basal cell carcinoma). The median age was 64 years; 52% of the patients were women and 48% were men. A total of 119 basal cell carcinomas at these locations were diagnosed. The size of the skin tumor ranged from 0.3 to 22 cm (mean, 3.9 cm). Treatment results were evaluated in 62 patients (follow‐up ranged from 24 to 240 months; mean, 80 months). Overall tumor control was accomplished in 95% of cases. Three patients died as a result of basal cell carcinoma.

Conclusions Basal cell carcinoma in the Mexican population is not as infrequent as previously thought, although it is less commonly located on the trunk and extremities than in Caucasians.
Conjunctival involvement in familial chronic benign pemphigus (Hailey‐Hailey disease)
Authors: Oguz Oya , Gokler Gökhan , Ocakoglu Özcan , Og̀uz Velittin , Demirkesen Cuyan , Aydemir Ertug̀rul H.
Published: August 2010

A 25‐year‐old woman with a 1‐year history of malodorous, red, and eroded lesions in frictional sites was seen in the dermatology department. She did not give a family history of a similar condition. She had an 18‐month‐old baby and her initial complaint was of genital pruritus with profuse vaginal discharge which appeared within 2 months of delivery. She was treated for candidal vaginitis but pruritus persisted and skin lesions occurred on both sides of the groin. The lesions subsided as long as the local treatment for candidal vaginitis was continued, but recurred more than three times in a year, each time with additional and more severe lesions involving the axillae, retroauricular sites, and scalp. She received no specific treatment during this time and her complaint about the eyes was the reason she was referred to a dermatologist.

On dermatologic examination, impetigo‐like, serpiginous plaques with severe erythema, erosions, and an active border were observed behind the ears, in the axillae, and in the pubis; these tended to expand peripherally and were partly covered with greasy yellowish scales particularly on the scalp. Satellite pustules and vesicles were observed at the adjacent sites (Fig. 1). Conjunctivae were bilaterally hyperemic and fine yellowish scales were also apparent on the palpebral rim (Figs 2 and 3). Ophthalmologic examination revealed severe conjunctival oedema and ulcerating blepharitis. Cornea appeared normal and vision was unimpaired. Results of Schirmer's test (15 and 17 mm) were within the normal range of tear secretion without an anaesthetic. Swab cultures from the peripheral pustules and erosions showed S. aureus infection while Sabourraud culture remained negative. Skin and conjunctiva biopsies for direct microscopy and immunofluorescence were performed. Histopathologic features were identical in either specimen disclosing suprabasal blister formation, acantholysis, and villus‐like protrusions lined by a single layer of basal cells (Fig. 4). IgG, IgA, IgM, and complement C3 immunofluorescence was not detected at the epidermis of the skin adjacent to serpiginous lesions. A direct immunofluorescent test of conjunctival biopsy also remained negative.

The patient was given clarithromycine 500 mg/day for 10 days and topical treatment was also applied. A rapid response was obtained within the first week of treatment.
Candida folliculitis mimicking tinea barbae
Authors: Kapdaǧli Halit , Öztürk Gunseli , Dereli Tugrul , Inci Ramazan , Hilmioǧlu Zuleyha , Kazandi Ali Can , Erboz Sezer
Published: August 2010

A 55‐year‐old man, a farmer, was referred to our dermatology department in June 1993 with inflammatory and infiltrated nodular lesions on his left cheek and neck. These nodular lesions had appeared about a month previously and had enlarged quickly. He was unaware of any antecedent trauma.

Physical examination revealed a painless, slightly erythematous, soft, fluctuant plaque which measured 8 cm in diameter. It consisted of follicular papules and pustules and was partially covered with brown‐black crusts (Fig. 1), Two similar plaques, 3 cm in diameter, were also detected on the neck. The regional lymph nodes were not palpable. The hair on the lesions was easily removed with a pair of forceps without causing pain.

The patient had not previously had any skin disease. Laboratory investigations, including full blood count, erythrocyte sedimentation rate, serum concentrations of sodium, potassium, chloride, transaminases, alkaline phosphatase, sugar, cortisol, and renal function tests, were all normal. No fluorescence was seen on Wood's light examination.

Direct microscopic examination with 15% potassium hydroxide solution revealed yeast cells and hyphae in three consecutive scrapings of the lesions. Candida albicans was isolated from the mycologic cultures; but no growth was observed in mycologic cultures of oral and anogenital mucosae swabs. Bacteriologic cultures of the lesions were also negative.

A skin biopsy was performed for histologic confirmation. Examination of the biopsy specimen revealed dermal oedema and PAS(‐I‐) yeast cells among the infiltration of lymphocytes and plasma cells (Fig. 2).

The patient was started on a regimen with fluconazole 100 mg once a day orally for a week, after which the dosage was decreased to 100 mg once every other day for a month. Also, the hair on the lesions was depilated. We noted a significant clinical improvement at the fifth week of the therapy (Fig. 3). Repeated mycologic examinations of the lesions were all negative even 1 month after the end of the therapy
Gastrointestinal malignant melanoma
Authors: Woollons Arjida , Derrick Elizabeth K. , Price Margaret L. , Darley Charles R.
Published: August 2010

Case 1

A 69‐year‐old man was referred for investigation of abdominal pain, progressive weight loss, and iron deficiency anaemia. Faecal occult bloods were positive and there was no medical history of note. Physical examination revealed a firm mobile mass in the right iliac fossa. There was no organomegaly or lymphadenopathy, the retinae were clear, and no cutaneous lesions were evident. Abdominal ultrasound scan, small bowel enema, and colonoscopy were all normal, as were renal and liver function tests. Abdominal CT showed a soft tissue mass within the right iliac fossa. The patient underwent a right hemicolectomy and a large 10 × 10 cm caecal tumor was removed which was infiltrating the surrounding small bowel. Histology showed this to be metastatic malignant melanoma, confirmed by morphologic and immunochemical studies, and the tumor infiltrated the submucosa. The tumor cells stained positively with S100 protein. Resection was complete (Fig. 1a). On close enquiry postoperatively the patient recalled a mole on his back that had disappeared spontaneously 20 years previously. Five years after surgery he remained in good health with no signs of recurrence and no cutaneous lesions.

Case 2

A 60‐year‐old man was referred with a 3‐month history of nausea, lower abdominal pain, and weight loss. The medical history was unremarkable. Clinical examination showed a mass in the right iliac fossa, but no lymphadenopathy or organomegaly. Sigmoidoscopy to 15 cm was normal, and a barium enema showed diverticular disease only. Ultrasound examination of the abdomen was normal. Gastroscopy showed a small polyp in the body of the stomach; biopsies showed this to be malignant melanoma.

One week later the patient presented as an emergency with an acute abdomen. At laparotomy an intestinal perforation was found with nodular metastases in the stomach, duodenum, and small bowel. An amelanotic nodule on his right thigh was biopsied at the same time, and histology of these lesions showed malignant melanoma. The stomach lesions showed extensive infiltration of the antrum and proximal duodenum by solid sheets of malignant melanocytes, invading throughout the full thickness of the muscularis propria (Fig. 1b). A Polya gastrectomy was performed a month later, by which time the patient had developed further cutaneous deposits of melanoma. Two months after discharge he was readmitted with pancreatic spread and obstructive jaundice which was relieved when a stent was inserted. He was transferred to the local hospice for terminal care, and died shortly afterwards.
Leukocytoclastic vasculitis ‐ correlation between different histologic stages and direct immunofluorescence results
Authors: Grunwald Marcelo H. , Avinoach Ilana , Amichai Boaz , Halevy Sima
Published: August 2010

Background

Leukocytoclastic vasculitis is a well‐known clinico‐pathologic entity. A good correlation between clinical and direct immunofluorescence (DIF) findings has been shown only in the early stages of vasculitis. Our purpose was to determine the correlation between different stages of vasculitis, etiology of vasculitis, and DIF findings.

Methods

Histologic and DIF studies were performed and evaluated from 40 patients with leukocytoclastic vasculitis.

Results

Thirty‐seven out of 40 patients (92%) showed positive DIF findings in the blood vessel walls. Eight patients were in the early stage of vasculitis and exhibited deposits mainly of fibrinogen, C3, and IgM. Seventeen patients were at the fully developed vasculitis stage and showed albumin, fibrinogen, and IgG deposits. Fifteen patients were in the late stage of vasculitis and showed deposits of mainly fibrinogen and C3 in the blood vessel walls.

Conclusions

The present study demonstrates that DIF examination is a very sensitive test in the diagnosis of vasculitis, and can be used in all stages of vasculitis and not only in the early stages as has been shown in previous studies.
Steatocystoma multiplex localized only in the face
Authors: Ahn Sung Ku , Hwang Sang Min , Lee Seung Hun , Lee Won Soo
Published: August 2010

A 60‐year‐old man presented with lesions on his face to the Department of Dermatology, Wonju Christian Hospital on November 10, 1994. There were over 10, slightly elevated, flat‐topped, yellowish colored, subcutaneous nodules on the face (Fig. 1). The lesions had first appeared on the left upper eyebrow at the age of 58 years, and since then they had abruptly increased in size and number and had spread into both temporal areas. Their size varied from 3 to 10 mm in diameter. No other lesions were observed on the extremities or trunk. The patient's past and family history were noncontributory and the results of routine laboratory findings were within normal limits or were negative.

Histopathologic examination of the lesion on the forehead showed a folded empty cyst in the mid‐dermis. The wall of the cyst was composed of two or three layers of squamous epithelium without a granular layer, and they contained flattened sebaceous lobules of varying sizes (Fig. 2). These findings were consistent with steatocystoma. Some of the lesions were removed, but the patient refused further treatment.
Simultaneous occurrence of herpetiform pemphigus and endemic pemphigus foliaceus (fogo selvagem)
Authors: Cunha Paulo Rowilson , Jiao Diane , Bystryn Jean‐Claude
Published: August 2010

A 32–year‐old woman from Franco da Rocha, one of the last endemic areas of pemphigus foliaceus (fogo selvagem, FS) in the state of Sao Paulo, Brazil,’2 developed generalized FS based on clinical (see Fig. 1), histologic and immunologic criteria.3 She had subcorneal vesicles with acantholytic cells histologically, circulating intercellular immunoglobulin G (IgG) autoantibodies at a titer of 640, and deposits of IgG in epidermal intercellular spaces. Her sister also had FS. The course of the disease was chronic with periods of remission and relapses. Six years later, she developed pruritic erythematous edematous plaques with overlying vesicles and blisters in a herpetiform pattern on the abdomen and forearm (Fig. 2) that resembled lesions of dermatitis herpetiformis. The lesions disappeared with prednisone 40 mg/day. Five years later, while affected with typical lesions of FS, she developed intensely pruritic erythematous urticarial edematous plaques (Fig. 3), some of which were covered with vesicles typical of herpetiform pemphigus (HP) (Fig. 4). Histologically these lesions showed epidermal spongiosis, with eosinophilic exocytosis and acantholysis (Fig. 5). Direct immunofluorescence (DIF) was positive for granular intercellular deposits of IgG and C3 in the epidermis (Fig. 6). IgA Studies were negative. Circulating Intercellular IgG autoantibodies were present at a titer of 80. By immunoblotting, the sera reacted to a 160 kD antigen which co‐migrated with desmoglein–1 detected by monoclonal antibody (AE 23) (kindly provided by Dr. Tung‐Tien Sun, New York University Medical Center, New York) and by pemphigus foliaceus sera (Fig. 7). Thus, after 12 years of FS, the patient developed a mixed bullous disease with concomitant clinical and laboratory features typical of HP and FS.