bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Care Quality and Addiction Severity: A Prospective Cohort Study
Authors: Kim Theresa W. , Samet Jeffrey H. , Cheng Debbie M. , Winter Michael R. , Safran Dana Gelb , Saitz Richard
Published: August 2006

Background. Alcohol and drug use disorders are chronic diseases that require ongoing management of physical, psychiatric, and social consequences. While specific addiction‐focused interventions in primary care are efficacious, the influence of overall primary care quality (PCQ) on addiction outcomes has not been studied. The aim of this study was to prospectively examine if higher PCQ is associated with lower addiction severity among patients with substance use disorders.

Study Population. Subjects with alcohol, cocaine, and/or heroin use disorders who initiated primary care after being discharged from an urban residential detoxification program.

Measurements. We used the Primary Care Assessment Survey (PCAS), a well‐validated, patient‐completed survey that measures defining attributes of primary care named by the Institute of Medicine. Nine summary scales cover two broad areas of PCQ: the patient–physician relationship (communication, interpersonal treatment, thoroughness of the physical exam, whole‐person knowledge, preventive counseling, and trust) and structural/organizational features of care (organizational access, financial access, and visit‐based continuity). Each of the three addiction outcomes (alcohol addiction severity (ASI‐alc), drug addiction severity (ASI‐drug), and any drug or heavy alcohol use) were derived from the Addiction Severity Index and assessed 6–18 months after PCAS administration. Separate longitudinal regression models included a single PCAS scale as the main predictor variable as well as variables known to be associated with addiction outcomes.

Main Results. Eight of the nine PCAS scales were associated with lower alcohol addiction severity at follow‐up (p≤.05). Two measures of relationship quality (communication and whole‐ person knowledge of the patient) were associated with the largest decreases in ASI‐alc (−0.06). More whole‐person knowledge, organizational access, and visit‐based continuity predicted lower drug addiction severity (ASI‐drug: −0.02). Two PCAS scales (trust and whole‐person knowledge of the patient) were associated with lower likelihood of subsequent substance use (adjusted odds ratio, [AOR]=0.76, 95 percent confidence interval [95% CI]=0.60, 0.96 and AOR=0.66, 95 percent CI=0.52, 0.85, respectively).

Conclusion. Core features of PCQ, particularly those reflecting the quality of the physician–patient relationship, were associated with positive addiction outcomes. Our findings suggest that the provision of patient‐centered, comprehensive care from a primary care clinician may be an important treatment component for substance use disorders.
Hospital Competition, Managed Care, and Mortality after Hospitalization for Medical Conditions in California
Authors: Rogowski Jeannette , Jain Arvind K. , Escarce José J.
Published: August 2006

Objective. To assess the effect of hospital competition and health maintenance organization (HMO) penetration on mortality after hospitalization for six medical conditions in California.

Data Source. Linked hospital discharge and vital statistics data for short‐term general hospitals in California in the period 1994–1999. The study sample included adult patients hospitalized for one of the following conditions: acute myocardial infarction (N=227,446), hip fracture (N=129,944), stroke (N=237,248), gastrointestinal hemorrhage (GIH, N=216,443), congestive heart failure (CHF, N=355,613), and diabetes (N=154,837).

Study Design. The outcome variable was 30‐day mortality. We estimated multivariate logistic regression models for each study condition with hospital competition, HMO penetration, hospital characteristics, and patient severity measures as explanatory variables.

Principal Findings. Higher hospital competition was associated with lower 30‐day mortality for three to five of the six study conditions, depending on the choice of competition measure, and this finding was robust to a variety of sensitivity analyses. Higher HMO penetration was associated with lower mortality for GIH and CHF.

Conclusions. Hospitals that faced more competition and hospitals in market areas with higher HMO penetration provided higher quality of care for adult patients with medical conditions in California. Studies using linked hospital discharge and vital statistics data from other states should be conducted to determine whether these findings are generalizable.
New Venture Financing and Subsequent Business Growth in Men– and Women–Led Businesses
Authors: Alsos Gry Agnete , Isaksen Espen John , Ljunggren Elisabet
Published: August 2006

This study investigates the possible funding gap for women–owned compared with men–owned new businesses. With longitudinal data from new businesses in Norway, gender differences in funding perceptions and behaviors, as well as in actually obtained amounts of funding, are explored. While there are few detected gender differences with respect to funding perceptions and behavior, women obtain significantly less financial capital to develop their new businesses. Moreover, the results indicate that the lower levels of financial capital that women business founders achieve are associated with lower early business growth compared with their male counterparts.
A Forensic Entomology Case from the Amazon Rain Forest of Brazil
Authors: Pujol‐Luz José R. , Marques Helder , Ururahy‐Rodrigues Alexandre , Rafael José Albertino , Santana Fernando H.A. , Arantes Luciano C. , Constantino Reginaldo
Published: August 2006

ABSTRACT: The first case of application of forensic entomology in the Brazilian Amazonia is described. The corpses of 26 men were found in the rainforest in Rondonia State, Brazil. Fly larvae collected on the bodies during autopsy were identified as Paralucilia fulvinota (Diptera, Calliphoridae). No data or specimens were collected at the crime scene. At the laboratory, the larvae developed into pupae in 58 h and into adults in 110.5 h. The total development time for P. fulvinota was measured in field experiments inside the forest. The age of the larvae when collected from the bodies was estimated as the difference between the time required for them to become adults and the total development time for this species. The estimated age of the maggots and the minimum postmortem interval was 5.7 days.
Fatal Bromethalin Poisoning
Authors: Pasquale‐Styles Melissa A. , Sochaski Mark A. , Dorman David C. , Krell Willane S. , Shah Aashit K. , Schmidt Carl J.
Published: August 2006

ABSTRACT: Bromethalin is a neurotoxin found in some rodenticides. A delusional 21‐year‐old male presented to a hospital with altered mental status the day after ingesting a bromethalin‐based rodenticide. He died 7 days after his self‐reported exposure to c. 17 mg bromethalin (equivalent to 0.33 mg bromethalin/kg). His clinicopathologic course was characterized by altered mental status, obtundation, increased cerebrospinal fluid pressure, cerebral edema, death, and diffuse histologic vacuolization of the white matter in the central nervous system seen on microscopic examination at autopsy. The presence of a demethylated form of bromethalin in the patient's liver and brain was confirmed by gas chromatography with mass spectrometry. Clinical signs and lesions observed in this patient are similar to those seen in animals poisoned with bromethalin. This case illustrates the potential for bromethalin ingestion to result in fatal human poisoning.
Blunt Force Cranial Trauma in the Cambodian Killing Fields*
Authors: Ta'ala Sabrina C. , Berg Gregory E. , Haden Kathryn
Published: August 2006

ABSTRACT: In this paper we present a unique pattern of blunt force cranial trauma that was observed in 10 of a sample of 85 crania from a Cambodian skeletal collection comprised of Khmer Rouge victims. Initial examination of the trauma, which presents as substantial damage to the occipital with fractures extending to the cranial base, suggested the pattern was classifiable as a basilar or ring fracture. However, further investigation, including trauma analysis and historical research, revealed that this fracture type is distinctive from basilar and ring fractures. Historical data indicate that a particular execution method was the likely source of the trauma. Recognition of this trauma pattern is significant because it exemplifies the distinct fracture configuration resulting from an apparently categorical and methodical execution technique. Identification of this fracture type could potentially assist forensic investigators in the recognition of specific methods of murder or execution.
Use of “Therapeutic Complication” as a Manner of Death
Authors: Gill James R. , Goldfeder Lara B. , Hirsch Charles S.
Published: August 2006

ABSTRACT: Analyses of deaths due to therapeutic complications (TCs) provide important quality of care information for medical providers. In New York City, 463 deaths were investigated by the Office of Chief Medical Examiner and certified with TC as the manner of death in 2003. The TC manner of death is used for fatalities due to predictable complications of appropriate medical therapy. All death certificates and select autopsy, hospital, and investigation reports were reviewed. Data concerning cause of death, contributing conditions, age, race, and sex were extracted. The types of complications and the causes of death were classified into various types of surgical and nonsurgical categories of complications. These included: postoperative infections, pulmonary emboli, and technical and medication complications. The use of TC as a manner of death has benefits and limitations. Without the TC option, one is forced to certify certain deaths (e.g., penicillin anaphylaxis) either as natural or accident. The TC option allows easy identification and tracking of medical complications for public health purposes and also allows more consistent reporting of natural and medical‐accidental deaths. In general, complications that occur during emergency surgeries/procedures for natural disease, tend to be certified with a natural manner. The “but for” test may be used to distinguish natural from TC deaths. There are criteria for distinguishing TC from accidents and homicides. TCs that occur during treatment of a potentially life‐threatening injury, are superceded by the manner dictated by the circumstances of the initiating injury. The certification of TC usually does not address errors of omission, clinical judgement/management, or missed diagnoses.
Nontypeable Haemophilus influenzae strains with the capsule‐associated insertion element IS1016 may mimic encapsulated strains
Authors: KARLSSON EVA , MELHUS ÅSA
Published: August 2006

With the elimination of Haemophilus influenzae type b through vaccination, it has been suggested that other types of H. influenzae strains might acquire virulence traits and emerge as important pathogens. The gene sequence IS1016 has been associated with an increased capacity to cause severe infections. It is usually present in encapsulated strains but is sometimes harbored by nontypeable H. influenzae strains. To explore this further, 118 H. influenzae isolates, collected from both patients and healthy carriers, were investigated with PCR with reference to this gene sequence. Isolates positive for the insertion element were bio‐ and serotyped. The presence of hmw genes for adherence, the genetic profile, and the ability to form biofilm in vitro were investigated. A total of 15 isolates were IS1016‐positive, whereof 12 were nontypeable. All 12 nontypeable isolates were obtained from healthy carriers, and 92% of the isolates were biotype I. They cross‐reacted to some extent with type‐specific antisera or exhibited a restricted genetic diversity like encapsulated strains. Furthermore, they lacked hmw‐genes, and their ability to form biofilms was comparable with a capsule‐deficient type b strain. Although this subset of strains mimicked traits usually exhibited by encapsulated strains, the isolation frequency did not seem to have been affected by vaccination.
Orbital giant cell angiofibroma
Authors: EREÑO COSME , LÓPEZ JOSÉ I. , PÉREZ JOSÉ , GRANDE JAVIER , BILBAO FRANCISCO J.
Published: August 2006

A case of giant cell angiofibroma in a 73‐year‐old man is reported. The tumour was located in the upper‐inner quadrant of the right orbit and recurred 16 months after surgical removal. The clinicopathological features of this rare neoplasm–that is nowadays considered a variant of solitary fibrous tumour–are reviewed and briefly commented on.
Low‐grade endometrial stromal sarcoma with sex cord‐like differentiation metastatic to the thoracic spines
Authors: AL‐SALAM SUHAIL , EL‐TERIFI HASSAN , GHAZAL‐ASWAD SAAD
Published: August 2006

We report a case of monostotic low‐grade stromal sarcoma (ESS) with sex cord‐like elements metastatic to the thoracic spines, which to the best of our knowledge has not previously been documented. A 48‐year‐old female who had undergone total abdominal hysterectomy for low‐grade endometrial stromal sarcoma 7 years previously presented with insidious onset of severe back pain of 2 months' duration. Magnetic resonance image (MRI) showed involvement of the eleventh and twelfth thoracic vertebral bodies. Decompression at the level of T10–12 was performed. Histologically, the laminae of thoracic vertebrae 11 and 12 were replaced by sheets of ovoid cells with plump nuclei intermixed with anastomosing trabeculae, cords and small nests, reminiscent of a sex‐cord stromal tumor pattern. The tumor cells showed diffuse nuclear immunostaining for estrogen receptors (ER) and progesterone receptors (PR), as well as membranous immunostaining for CD10. The immunostaining for smooth muscle actin was focal and sparse. These findings confirmed the diagnosis of metastatic low‐grade ESS with sex cord‐like differentiation. Low‐grade ESS with sex cord‐like differentiation is an uncommon tumor which rarely metastasizes to the bone, and use of a panel of ER, PR, CD10, actin, cytokeratin and inhibin immunostains is essential to establish the diagnosis.
Histological variety of floral variant of follicular lymphoma
Authors: KOJIMA MASARU , YAMANAKA SHOUJI , YOSHIDA TAKATOMO , SHIMIZU KEN , MURAYAMA KAYOKO , OHNO YOSHIHIRO , ITOH HIDEAKI , MOTOORI TADASHI , MASAWA NOBUHIDE , NAKAMURA SHIGEO
Published: August 2006

To further clarify the histopathological findings of the floral variant of follicular lymphoma (FVFL), we studied 13 Japanese cases. Two histological subtypes of neoplastic follicles of FVFL have been described: (i) A macrogerminal center pattern where the mantle zone lymphocytes were invaginated into the neoplastic germinal center, often reminiscent of a floral design. (ii) A microgerminal center pattern where the massive invasion of mantle zone lymphocytes resulted in almost complete breakage of the neoplastic follicles. In the former pattern, the neoplastic germinal center usually contained large clusters of tumor cells, whereas in the latter, small clusters of up to 20 tumor cells or isolated tumor cells were observed in the neoplastic germinal centers. Moreover, occasional tumor cells showed a lymphocytic and/or histiocytic Reed‐Sternberg cell (L&H cells)‐like morphology. Both types of neoplastic follicles were observed to a varying degree in most cases. The macrogerminal center pattern was predominant in nine cases (70%), whilst the microgerminal center pattern was predominant in only four cases (30%). Three lesions (23%) had a marginal zone component. Immunohistochemistry showed that atypical follicular center cells, including L&H cells, were CD3−, CD5−, CD10+, CD20+, CD43−, bcl‐2+, cyclinD1−. The overall histological findings of the macrogerminal center are similar to those of florid progressive transformation of germinal center (PTGC), whilst the microgerminal center pattern is similar to that of nodular lymphocyte‐predominant Hodgkin lymphoma. Initially, the differential diagnosis between FVFL and florid PTGC was emphasized. However, the present study indicates that nodal marginal zone B‐cell lymphoma possessing floral follicles and nodular lymphocyte‐predominant Hodgkin lymphoma should be added to the differential diagnosis of FVFL. The germinal center B‐cell nature of FVFL is most clearly recognizable by immunohistochemistry, though histological appearance alone may cause some diagnostic problems.
Rapid diagnosis of Mycobacterium tuberculous peritonitis with real‐time PCR in a peritoneal dialysis patient
Authors: DERVISOGLU ERKAN , SAYAN MURAT , SENGUL ERKAN , YILMAZ AHMET
Published: August 2006

A 49‐year‐old female patient on continuous ambulatory peritoneal dialysis presented with fever, abdominal pain and loss of appetite. While peritoneal fluid bacterial cultures remained negative, she had no relief after 3 weeks of broad‐spectrum antibiotics for possible bacterial peritonitis. In a peritoneal fluid sample, Mycobacterium tuberculosis DNA was detected by nucleic acid amplification using real‐time PCR testing. The initiation of antituberculous therapy (isoniazid, rifampicin, ethambutol and pyrazinamide) was followed by resolution of fever and abdominal pain within one week. Nucleic acid amplification tests can play an important role in the species‐specific diagnosis of tuberculous peritonitis.
How to outwit the enemy: dendritic cells face Salmonella
Authors: BIEDZKA‐SAREK MARTA , EL SKURNIK MIKA
Published: August 2006

Salmonella enterica serovar Typhi causes typhoid fever, a serious life‐threatening systemic infection. In mice, a similar disease is caused by Salmonella enterica serovar Typhimurium. During typhoid fever, soon after attachment to the mucosal surface of the gut, bacteria come into contact with the dendritic cells (DCs). The ability to sample antigens, process and present them to naıÐve and mature T cells, in the context of major histocompatibility complex molecules, makes DCs indispensable for mounting a specific and efficient immune response to invading pathogens. These bacteria, however, have evolved a number of mechanisms to interfere with or subvert DC functions. This review aims to describe how Salmonella clashes with dendritic cells at different stages of infection as well as the war strategies of these two opposing sides.
Granular cell tumor arising metachronously in the bronchus and esophagus
Authors: KURODA NAOTO , KOHNO NAO , IWAMURA SHIN‐ICHI , HAMAGUCHI NOBUMASA , OHARA MASAHIKO , HIROUCHI TAKASHI , MIZUNO KEIKO
Published: August 2006

We present a case of granular cell tumor (GCT) occurring in the esophagus 7 years after operation for bronchial GCT. A 59‐year‐old Japanese man complained of epigastralgia, and endoscopic examination of the upper digestive tract disclosed a submucosal tumor in the lower esophagus. Histological examination of the endoscopic mucosal resection of the esophageal tumor showed a proliferation of neoplastic cells with an eosinophilic and granular cytoplasm. The cytoplasm of the neoplastic cells was histochemically positive for PAS stain and immunohistochemically positive for S‐100. This tumor did not fulfill any of the diagnostic criteria for malignancy at either the macroscopic or microscopic level. I believe that this is the first case of GCT occurring metachronously in the respiratory and digestive tracts. Clinicians and pathologists should bear in mind that GCT may arise metachronously in the respiratory and digestive tracts.
Myeloid sarcoma of the extrahepatic bile ducts presenting as obstructive jaundice
Authors: GONZÁLEZ‐VELA M. CARMEN , VAL‐BERNAL J. FERNANDO , MAYORGA MARTA , CAGIGAL M. LUISA , FERNÁNDEZ FIDEL , MAZORRA FRANCISCO
Published: August 2006

We report a rare case of myeloid sarcoma (MS) of the extrahepatic bile ducts presenting as obstructive jaundice in a patient without leukemia at time of diagnosis. A 75‐year‐old female presented with a one‐month history of abdominal pain and jaundice. Computerized tomography scan of the abdomen showed stenosis of the extrahepatic bile ducts. Endoscopic retrograde cholangiography disclosed an irregular narrowing of the common biliary duct, suggestive of a cholangiocarcinoma, and resection was performed. Histologic examination showed diffuse transmural infiltration of malignant cells. These cells exhibited medium‐sized round nuclei with central nucleoli and eosinophilic cytoplasm, and were strongly positive for myeloperoxidase, CD68, lysozyme, CD45, CD117 (c‐kit protein) and CD43. Eight months following surgery the patient presented with multiple cutaneous nodules and bone marrow trephine biopsy showed acute myelomonocytic leukemia. A literature search identified two previously reported cases of MS of the extrahepatic biliary duct. MS should be taken into consideration in the differential diagnosis of a patient with obstructive jaundice. Immunohistochemistry is essential for a correct diagnosis.
Effect of systemic administration of nicotine on healing in osseous defects. An experimental study in rabbits. Part II
Authors: Balatsouka Dimitra , Gotfredsen Klaus , Sørensen Lars , Lindh Christian H. , Berglundh Tord
Published: August 2006

Objectives: The aim of the present study was to analyze the effect of systemic administration of nicotine on bone healing in osseous defects in the tibia of rabbits.

Material and methods: Sixteen female rabbits received nicotine (n=8; test group) or saline (n=8; control group) via subcutaneously placed mini‐osmotic pumps for 8 weeks. The animals underwent three surgical operations during the experimental period, and body weight was registered weekly. Blood samples were collected to determine cotinine and prostaglandin E2 levels. Bone preparations were made in the right leg of all rabbits after 4 weeks and in the left leg after 6 weeks of nicotine/placebo exposure. Thus, 2‐ and 4‐week healing groups were created for the bone defects. After 8 weeks, the animals were killed. Tissue blocks including the bone defects were prepared for histological analysis.

Results: The animals in the test group lost weight, while the control group gained weight during the experiment. The prostaglandin E2 levels in plasma increased significantly following nicotine exposure in the test group. No significant differences in the percentage of vessels and bone density in the osseous defects were found between the test and the control groups after 2 and 4 weeks of healing.

Conclusions: In this experiment, systemic administration of nicotine over 4 or 6 weeks, respectively, influenced body weight and systemic prostaglandin E2 levels but not the amount of blood vessels and the bone mineral density in bone defects after 2 or 4 weeks of healing.
Split‐crest and immediate implant placement with ultra‐sonic bone surgery: a 3‐year life‐table analysis with 230 treated sites
Authors: Blus Cornelio , Szmukler‐Moncler Serge
Published: August 2006

Abstract: Ultra‐sonic bone surgery (USBS) has been recently introduced as a novel osteotomic technique. This clinical study reports on the application of this new technique to perform ridge‐split procedures. Over a period of 3.5 years, 57 patients underwent a split‐crest procedure with the aim to place 230 implants, 78 in the mandible and 152 in the maxilla, in order to rehabilitate nine full arches, three hemi‐arcades, 43 partial bridges and 24 single crowns. The initial ridge width varied between 1.5 and 5 mm, average was 3.2 mm. The final width of the ridge ranged from 4 to 9 mm, average was 6 mm. The split length varied between 4.5 and 40 mm, average was 15 mm. Inserted implants were 3.25–5 mm in diameter however most of them (82.4%) were standard implants of 3.75 mm; implant length was classically 10–13 mm. Two hundred and twenty‐eight (99.1%) out of the 230 planned implants were placed, the two non‐suitable sites were in the maxilla. In the mandible, the ridge augmentation procedure was drastically eased by performing a basal longitudinal discharge notch. At second stage surgery, eight implants failed to osseointegrate; the success rate for the placed implants was 96.5%. All implants have been loaded for at least 2 months and no implant was lost after loading. One hundred and eighty‐one and 77 implants have been loaded for at least 6 and 12 months, respectively. The 3‐year life‐table analysis of loaded implants showed a cumulative survival rate of 100%. The split‐crest procedure performed with USBS showed to be safe and comfortable.
Osteotome sinus floor elevation without grafting material: a 1‐year prospective pilot study with ITI implants
Authors: Nedir Rabah , Bischof Mark , Vazquez Lydia , Szmukler‐Moncler Serge , Bernard Jean‐Pierre
Published: August 2006

Objective: The aim of the present pilot study was to evaluate: (1) the predictability of an osteotome sinus floor elevation procedure with ITI‐SLA implants without placing a bone grafting material, and (2) the possibility to gain bone height without filling the created space with a bone grafting material.

Material and methods: Seventeen patients received 25 implants protruding in the sinus. Most implants (21/25) were 10 mm long, eight were inserted in type 2 bone, 12 in type 3 and five in type 4 bone. At implant placement, the mean residual bone height (RBH) under the maxillary sinus was 5.4±2.3 mm; it was 5.7±2.6 mm on the mesial side and 5.1±1.9 mm on the distal side. Nineteen implants had less than 6 mm of bone on at least one side and six implants had less than 6 mm on both sides. A healing period of 3–4 months was allowed before abutment tightening at 35 Ncm. The percentage of stable implants at abutment tightening and at the 1‐year control was calculated. The endo‐sinus bone gain and the crestal bone loss (CBL) at the mesial and distal sides were measured.

Results: Abutments were tightened after 3.1±0.4 months. All implants but one (96%) resisted the applied 35 Ncm torque. At the 1‐year control, all implants were clinically stable and supported the definitive prosthesis. All showed endo‐sinus bone gain; the mean gain was 2.5±1.2 mm. The mean CBL was 1.2±0.7 mm. Endo‐sinus bone gain and RBH showed a strong negative correlation (r=−0.78 on the mesial side and −0.80 on the distal side). A good correlation (r=0.73) was found between implant penetration in the sinus and endo‐sinus bone gain.

Conclusion: Elevation of the sinus membrane alone without addition of bone grafting material can lead to bone formation beyond the original limits of the sinus floor. Despite a limited RBH at implant placement, a healing period of 3 months was sufficient to resist a torque of 35 N cm and to lead to a predictable implant function at the 1‐year control.
Grover's disease (transient acantholytic dermatosis): relationship of acanthoiysis to acrosyringia
Authors: Antley C. M. , Carrington P. R. , Mrak R. E. , Smoller B. R.
Published: August 2006

Transient acantholytic dermatosis is often associated with excessive sweating, fever, and bed confinement. The patho‐genesis of this disease has been postnlated to be poral occlusion of damaged eccrine intraepidermal ducts. Histological and immunohistochemical and ultrastructural studies were performed on 10 biopsies from 10 patients with transient acantholytic derinatosis. Immunoreactions for carcinoembryonic antigen and cytokeratin‐7 to identify eccrine duct epithelium were performed on all 11 biopsies. In addition. 5 of the biopsies were immunoreacted for cytokeratin 8. All immunoreactions were reviewed independently by two observers to determine extent of reactivity and whether it correlated with areas of epidermal acanthoiysis. Among the 11 biopsies, 8 showed acanthoiysis not associated with eccrine duct outflow tracts. In 2 biopsies the acanthoiysis was consistently associated with acrosyringea; in one case acanthoiysis was inconsistently associated with eccrine outflow tracts. Epidermal acanthoiysis in patients with Grover's disease is associated with the outflow tracts of eccrine ducts in a subgroup of patients. Although leakage of sweat from occluded sweat ducts in acrosyringia may be the mechanism operating in a subgroup of patients with Grover's disease, this does not appear to be the subgroup of patients in whom Grover's disease develops in the setting of being bedridden and/or sweating.
Demodex mites in acne rosacea
Authors: Roihu Tia , Kariniemi Arja‐Leena
Published: August 2006

The hair follicle mites Demodex folliculorum and Demodex brevis and their role in the pathogenesis of rosacea have been the subject of much debate in the past. We studied the prevalence of Demodex mites in facial skin biopsies obtained from 80 patients with rosacea, 40 with facial eczematous eruption and 40 with lupus erythematosus discoides. The mite prevalence in the rosacea group (51%) was significantly higher than in the rest of the study population (eczema 28% and lupus discoides 31%). Demodex mites were found on all facial sites. The most infested areas in the whole study group were the forehead (49%) and the cheeks (44%). Males were more frequently infested (59%) than females (30%). We did not find any significant difference in mite counts of infested follicles between rosacea and the control group. A lympho‐histiocytic cell infiltration was seen around the infested hair follicles. Our results suggest that Demodex mites may play a role in the inflammatory reaction in acne rosacea.
Genital Paget's disease with clear cells in the epidermis of the axilla
Authors: Makino Takafumi , Nakamura Sawako , Nakayama Hidetoshi , Mihara Motoyuki
Published: August 2006

We report an 84‐year‐old man with extramaminary Paget's disease (EMPD) involving the genital region. Microscopic examination revealed very few clear cells appearing pagetoid in the lower portion of prickle cell layer of the right axilla epidermis, with no clinically detectable eruption. Their histochemical, immunohisto chemical and lectin‐binding reactions were almost identical to those in the genital lesion. However, although the axillary lesion was diagnosed as subclinical Paget's condition, the clinical course showed no aggressive or destructive nature. Our case suggests that not all subclinical Paget's conditions become malignant, and that in some cases the clear cells may be precursors of Paget's cells developing multifocally.
Pagetoid Merkel cell carcinoma: epidermal origin of the tumor
Authors: Hashimoto Ken , Lee Min W. , D'Annunzio Donald R. , Balle Mark R. , Narisawa Yukata
Published: August 2006

We report a case of intraepidermal Merkel cell carcinoma which occurred on the face of a 76‐year‐old white male. This slow‐growing tumor was mostly confined in the epidermis and pilosebaceous apparatus where tumor cells spread in a pagetoid fashion forming tumor cell nests. Histologically it resembled a superficial spreading melanoma. A heavy lymphocytic infiltration was seen beneath the epidermal lesion as is often seen in pagetoid melanomas. Histochemical and ultrastructural features such as the presence of cytokeratin 20, synaptophysin, neuron specific enolase, desmosomes, and dense cored granules confirmed the diagnosis of Merkel cell carcinoma. Occasional mitotic cells and many apoptotic cells were found in the tumor. Dylon positive, amyloid depositions were seen in the lower epidermis and papillary dermis; they were probably derived from apoptotic tumor cells. It was thought that apoptosis limited the speed of growth of this tumor. We believe that this is probably the most convincing case of intraepidermal Merkel cell carcinoma originating from epidermal Merkel cells or its precursors (stem cells).
Specific distribution patterns of hCDC47 expression in cutaneous diseases
Authors: Hiraiwa Atsuro , Fujita Masatoshi , Adachi Ayumi , Ono Hiroki , Nagasaka Tetsuro , Matsumotoi Yoshinari , Ohashi Masaru , Tomita Yasushi , Ishibashi Masahide
Published: August 2006

hCDC47 is a human member of the MCM family, which has been implicated to be concerned with the regulatory machinery causing DNA to replicate once per cell cycle. In a previous paper, we described hCDC47 expression as being localized in the proliferative component of normal tissues, and showed greater expression in squamous cell skin carcinomas than in seborrheic keratosis. In the present study, we compared its expression in another type of skin tumor and variotis non‐neoplastic cutaneous proliferative diseases. Two patterns of distribution of hCDC47‐positive cells were observed. Keratoacanthomas showed a peripheral pattern in which only the cells located the basal cell layers were positive. Psoriasis vulgaris also showed this peripheral type of location, with the cells in the suprabasal layers also occasionally expressing hCDC47. Verruca vulgaris demonstrated a diffuse pattern, with positive epithelial cells distributed throughout the layers. Basal cell carcinomas also showed a similar pattern. The keratoacanthomas showed the highest hCDC47 positive cell rate (43.1%), followed by verruca vulgaris (42.5%). psoriasis vulgaris (23.4%), and basal cell carcinoma (17.3%). Our results suggest participation of hCDC47 in these proliferative disorders involving keratinocytes.
Quantitative immunohistochemical differences in Langerhans cells in dermatitis due to internal versus external antigen sources
Authors: Prieto Victor G. , Sadick Neil S. , McNutt N. Scott
Published: August 2006

Cutaneous hypersensitivity reactions can develop against antigens delivered through the epidermis (contact dermatitis) or through the blood vessels (e.g., drug eruptions). On routine histology alone, it is not always possible to determine the route of the antigen. Langerhans cells (LC) are the main antigen‐presenting cells in contact dermatitis. Dermal dendrocytes (DC) are antigen‐presenting cells and may be involved in dermal reactions. We tested the hypothesis that there is a difference between dermatitis due to external and internal antigen sources with regard to the number or function of LC and DC. In 85 cases of dermatitis, numhers of S100 and HLA‐DR reactive cells per linear millimetre of epidermis were counted. The amount of epidermal spongiosis was evaluated qualitatively. In 35 cases, the numher of DC per mm2 (as defined by Factor XIIIa expression) was evaluated. The patients were then divided into two groups based on whether the final clinical evaluation considered the dermatitis to be secondary to an external (35 cases) or internal antigen (50 cases). Dermatitis due to external antigens had significantly more LC/mm and more frequent HLA‐DR expression than dermatitis due to internal antigens, mean ± SEM; 21.2±2.04 vs. 9.1±1.02 (p<0.00001) and 16.3±2.49 vs. 6.0±0.92 (p=0.0001), respectively. Spongiosis was more marked in external antigen cases. DC were more numerous in internal than in external antigen cases, but the differences were not statistically significant. In our model, determination of numbers of LC/mm is the variable with the highest power to discriminate between internal and internal sources. Quantification of HLA‐DR+ LC and degree of spongiosis provide little additional discriminatory power.
Cathepsin D expression in skin metastasis of breast cancer
Authors: Inoue Hiroyoshi , Kawada Akira , Takasu Hiroshi , Maruyama Ryuji , Hata Yasuki , Hiruma Masataro , Tajima Shingo , Ishibashi Akira
Published: August 2006

Cathepsin D, an aspartic proteinase, correlates with invasion and metastasis in breast cancer and with poor prognosis. In the present study, we examined the immunohistological expression of cathepsin D in both primary (5 cases) and skin‐metastatic breast cancers (13 cases) and compared it to those in gastric (2 cases) and lung (4 cases), and primary eccrine cancers (3 cases). All breast and gastric cancers were adenocarcinomas. The 2 gastric cancers were poorly differentiated, while the 4 lung cancers consisted of 2 poorly differentiated adenocarcinomas, 1 poorly differentiated large cell carcinoma, and 1 moderately to poorly differentiated squamous cell carcinoma. We also surveyed the immunohistological distribution of cathepsin B, carcinoembryonic antigen, gross cystic disease fluid protein‐15, c‐erbB‐2, and estrogen receptor. In almost all breast cancer samples, the cancer cells demonstrated strong expression of cathepsin D in the cytoplasm, but weak staining patterns with other antibodies. Gastric and lung cancer cells did not respond with cathepsin D (except one metastatic lung cancer) or the other immunohistological markers. Since cathepsin D is strongly expressed in primary and metastatic lesions of breast cancer, cathepsin D could be useful as an adjunct to a panel of immunohistochemical stains in determining the primary site of origin of metastatic cancer in the skin.
Numbers and differentiation status of melanocytes in idiopathic guttate hypomelanosis
Authors: Wallaces Michael L. , Grichnik James M. , Prieto Victor G. , Shea Christopher R.
Published: August 2006

The etiology and pathogenesis of idiopathic guttate hypomelanosis (IGH) are largely unknown. To investigate whether the pathologic alteration in IGH involves changes in melanocytic differentiation, cell number, or both, we studied nine lesions of IGH by immunoperoxidase, using monoclonal antibodies against the KIT receptor and a panel of melanocyte differentiation antigens (tyrosinase‐related protein‐1, tyrosinase, and gp100/pme117). In each case, compared with grossly normal non‐lesional skin, IGH lesions showed markedly reduced numbers both of KIT+ cells and of cells expressing melanocyte differentiation antigens (p < 0.0001). Double immunofluorescence labeling of lesions revealed only scattered cells with a less‐differentiated phenotype, i.e. cells positive for KIT but having low or undetectable TRP‐1. These results indicate that the pathogenesis of IGH involves an absolute decrease in the number of melanocytes; a block in melanocyte differentiation does not appear to be a major component of the process.
Myxoid dermatofibrosarcoma protuberans: morphological, ultrastructural and immunohistochemical features
Authors: Orlandi Augusto , Bianchi Luca , Spagnoli Luigi Giusto
Published: August 2006

Two uncommon cases of dermatofibrosarcoma protuberans with prominent myxoid changes are presented. The tumors appeared as large multinodular cutaneous plaques that arose at the sites of excision of previous tumors some years earlier. In addition to limited Fibrous storiform features, focally observed in deep and peripheral portions of the tumors, a diffuse myxoid pattern could be observed. The latter consisted of homogeneous areas of rare, stellate or spindle‐shaped cells, haphazardly scattered in abundant myxoid matrix. Cells of myxoid neoplastic tissue showed mainly a positive immunoreaction for fibrohistocytic markers and the absence either of muscular, neural of human progenitor cell antigens. Mitotic figures were fewer and cell proliferation rates were lower in myxoid as compared to those of typical dermatofibrosarcoma protuberans used as a control. The ultrastructural examination of myxoid areas revealed a prevalent Fibroblast‐like cell population showing dilated cytoplasmic vesicles, sometimes containing glycosaminoglycans‐like substances. The extent of myxoid changes together with the characteristic morphological, ultrastructural and immunohistochemical features confirm that myxoid dermatofibrosarcoma protuberans is a distinct variant of this fibrohistiocytic tumor to be considered in the differential diagnosis among myxoid tumors of the skin.
Further confirmation of the association of human herpesvirus 8 with Kaposi's sarcoma
Authors: Li Ning , Anderson William K. , Bhawan Jag
Published: August 2006

Recently, a new herpesvirus‐like DNA sequence named Kaposi's sarcoma‐associated herpesvirus (KSHV) or human herpesvirus 8 (HHV8) has been isolated from almost all cases of Kaposi's sarcoma (KS). It has not been found in most benign and malignant cutaneous hemangioproliferative disorders other than KS. To further verify the specificity of the association of this new viral DNA with KS, we examined in total 42 cases of vascular neoplasms of endothelial derivation using nested polymerase chain reaction (PCR) for the presence of a 233‐bp segment of this KSHV/HHV8 on paraffin‐embedded specimens. In our investigation, we added an additional step to conventional PCR protocol that uses UV light to pretreat all the PCR regeants except Taq DNA polymerase and the target DNA to eliminate the false positives caused by trace contamination. All 15 cases of typical KS, both AIDS and non‐AIDS related, as well as 4 cases of atypical vascular tumors suspicious of KS, were positive for this KSHV/HHV8 DNA sequence. The remaining 23 cases of hemangioproliferative disorders other than KS, including angiosarcoma, capillary hemangioma, angiolymphoid hyperplasia with eosinophilia, epithelioid hemangioma, histiocytoid hemangioma, hemangioendothelioma, and microvenous hemangioma, were negative for HHV8. These results confirm the previous observation that KSHV/HHV8 is specific for KS within hemangioproliferative cutaneous disorders, and PCR for detection of KSHV/HHV8 might be used as an additional diagnostic tool in distinguishing KS.
Diagnostic value of CD34 immunostaining in desmoplastic trichilemmoma
Authors: Illueca Carmen , Monteagudo Carlos , Revert Angeles , Liombart‐Bosch Antonio
Published: August 2006

Desmoplastic trichilemmoma (DT) is a variant of trichilemmoma, characterized by a central prominent desmoplastic component which may simulate invasive carcinoma. We have studied the morphologic and immunohistochemical features of seven cases of DT. Immunohistochemistry was performed on paraffin sections using monoclonal antibodies to CD34 (QBEND/10), vimentin and GCDFP‐15. CD34 was also tested in seven cases of basal cell carcinoma (BCC), three with outer root sheath differentiation and four with morphea‐form features, and five squamous cell carcinomas. Histologically, features of conventional trichilemmoma were seen at the periphery of the seven lesions. In contrast, at the center, the epithelial cells tended to cluster in narrow irregular cords and nests entrapped in a dense collagenous stroma. One case of DT coexisted with a BCC. In all cases of DT, epithelial tumor cells showed CD34 immunostaining. All cases of BCC, including the one contiguous to a DT, were CD34 negative. CD34 immunodetection in the epithelial cells of the pseudoinvasive component of DT may be of great value in the differential diagnosis with other desmoplastic tumors of the skin, and particularly with BCC.
Desmoplastic fibroblastoma
Authors: Junkins‐Hopkins Jacqueline M. , Johnson Waine C.
Published: August 2006

Previous reports of a distinctive, fibrous, soft‐tissue tumor include eight patients with subcutaneous lesions and six patients with intramuscular lesions. We report a 48‐year‐old woman with a 2‐cm cutaneous and subcutaneous nodule on the left arm with the same histologic features. An excisional biopsy showed a large, well circumscribed tumor replacing the reticular dermis and subcutaneous tissue. The tumor was relatively hypocellular and composed primarily of large, spindled, plump or stellate fibroblasts haphazardly dissecting between thickened Fibrotic collagen bundles. The stroma contained a large amount of much which was positive with alcian blue at pH 2.5, and relatively numerous mast cells were present. The fibroblastic‐like cells were positive with Vimentin and Factor XIIIA and negative with S‐100, desmin, actin and keratin.
Functional involvement of urokinase‐type plasminogen activator receptor in pemphigus acantholysis
Authors: Xue Wei , Hashimoto Ken , Toi Yoichiro
Published: August 2006

Urokinase‐type plasminogen activator (uPA) has been well documented in the development of pemphigus acantholysis. The function of its receptor (uPA‐R) in pemphigus acantholysis has only recently attracted attention. Increased expression of uPA‐R has been demonstrated in pemphigus vulgaris. In this study, we have further explored the functional involvement of uPA‐R in pemphigus acantholysis. Our results show that uPA‐R expression is significantly increased in acantholytic foci of pemphigus vulgaris and pemphigus foliaceus but not in bullous pemphigoid or normal skin specimens; the expression of uPA‐R in cultured human keratinocytes is subjected to regulation by pemphigus vulgaris IgG but not by pemphigoid IgG or normal human IgG; furthermore, anti‐uPA‐R monoclonal antibody effectively inhibits pemphigus vulgaris IgG induced acantholysis in skin organ cultures. These data suggest that uPA‐R may play an important role in the pathogenesis of pemphigus acantholysis.
Specific skin manifestations in CD56 positive acute myeloid leukemia
Authors: Kuwabara Hiroko , Nagai Masami , Yamaoka Genji , Ohnishi Hiroaki , Kawakami Kimihiro
Published: August 2006

We found 16 CD56+ cases (29.6%) among 54 acute myeloid leukemia (AML) patients; they showed significantly Frequent cutaneous involvement compared to CD56‐ cases (43.8% vs.15.8%, p<0.05). Four of the CD56+ AML cases with specific skin manifestations were reviewed histologieally. In all cases, cutaneous leukemic cells were seen in the dermis and subcutaneous tissue with accentuation around the adnexa/nerve, but sparing the epidermis. In addition, angiocentric/angiodestructive and prominent cohesive tumor cell growth were seen in two rases, respectively. These findings suggest that the expression of CD56 may often be associated with the cutaneous involvement in AML, and that the above histological findings should remind us of the possibility of specific skin manifestations in CD56+ AML.
ICAM‐3 and E‐selectin endothelial cell expression differentiate two phases of angiogenesis in infantile hemangiomas
Authors: Verkarre Virginie , de Serre Natacha Patey‐Mariaud , Vazeux Rosemay , Teillac‐Hamel Dominique , Chretien‐Marquet Bertrand , Le Bihan Christine , Leborgne Michèle , Fraitag Sylvie , Brousse Nicole
Published: August 2006

Cellualar adhesion molecules are newly identified mediators of angiogenesis. Infantile hemangiomas, characterized in the early stages by a proliferation of poorly differentiated vessels followed in the late stages by a vascular differentiation and regression of the tumor, represent an interesting model to study angiogenesis. We studied by immunohistochemistry the distribution of HLA‐DR and three adhesion molecules ICAM‐3. E‐selectin and VCAM‐I on endothelial cells in different stages of vessel differentiation in infantile hemangiomas. We found high levels of ICAM‐3 expression on proliferating vessels, while its expression was low or undetectable on well differentiated vessels. A different set of E‐selection antibodies showed a more heterogenous pattern of distribution and VCAM‐1 antigens were found in both proliferating and differentiated vessels. HLA‐DR expression on endothelial cells was inversely correlated to the vascular differentiation. Our results are consistent with the hypothesis that ICAM‐3 plays a role in the early stages of vessel formation. Our results also suggest that variation of E‐selectin and HLA‐DR expression may be related either to vessel differentiation or may reflect the acquisition of an activated endothelial cell status.