bluuebunny/crossref_metadata_2025 huggingface dataset:
Aminoethylethanolamine: a new allergen in cosmetics?
Authors: Foti Caterina , Bonamonte Domenico , Mascolo Giuseppe , Tiravanti Giovanni , Rigano Luigi , Angelini Gianni
Published: March 2003

Amphoacetates are organic compounds used in many industrial applications and in cosmetic formulations for the skin, hair and mucosa, as surfactants, mild foaming and cleansing agents in concentrations ranging from 0.1% to 50%. Despite the fact that they have been in use for many years, cases of contact allergy to them are extremely rare. We describe 4 patients who developed an eczematous reaction after use of detergents containing amphoacetates. Patch testing showed positive reactions to sodium lauroamphoacetate (Miranol® HM Special, Rhodia, England) as is or diluted at decreasing concentration (10%, 5% and 1%) in water and to aminoethylethanolamine (AEE) at the concentration of 1% in various vehicles (ethanol, acetone, and sodium laurylethersulfate 1% aqueous solution) and at decreasing concentrations ranging from 1% to 0.005% in water. AEE is one of the reagents used in the synthesis of amphoacetates. This molecule, that is structurally an ethylenediamine derivative, has sensitizing power and is reported as a cause of occupational contact allergy in cable jointers. Combined eczematous reactions to AEE and sodium lauroamphoacetate can be consequent to the presence of the former substance as an impurity in amphoacetates‐containing products, as demonstrated by ion chromatography‐mass spectrometry analysis.
Natural vegetable fats in the prevention of irritant contact dermatitis
Authors: Schliemann‐Willers S. , Wigger‐Alberti W. , Kleesz P. , Grieshaber R. , Elsner P.
Published: March 2003

Chronic irritant contact dermatitis (ICD) is one of the most pressing problems in occupational medicine and is common in the food processing industry. To date, protective creams that fulfil the special requirements in the foodstuffs industry have not been available. Therefore, we studied the efficacy of pre‐exposure application of natural vegetable fats in the prevention of experimentally induced ICD. A panel of 20 healthy volunteers was tested with a repetitive irritation test using sodium lauryl sulfate (SLS) as a standard irritant in a randomized study. Application sites were assessed clinically and by the use of bioengineering techniques (evaporimetry, chromametry, and corneometry). Rape seed and palm fats showed significant protective potential. Gas‐chromatographic analysis revealed differences in the fatty acid composition of the vegetable. Higher content of linoleic acid and lower content of oleic acid was associated with beneficial effects. Our results are a new approach in the prevention of ICD and towards the development of new protective preparations for workplaces in the foodstuffs industry.
Allergic contact dermatitis from shellac in mascara
Authors: Le Coz Christophe‐J. , Leclere Jean‐Marie , Arnoult Elisabeth , Raison‐Peyron Nadia , Pons‐Guiraud Annick , Vigan Martine , Of Revidal‐gerda The Members
Published: March 2003

We report 6 cases of allergic contact dermatitis of the eyelids due to mascara. Allergy occurred in women aged 17–34 years, between September 1999 and June 2001. The main ingredient responsible for allergy was shellac, which gave positive patch test reactions in 5/5 patients. This resinous substance is mainly used in cosmetics, food and industry. The exact nature of the hapten remains unknown, and its presence and level in shellac can vary with the source and the treatments applied to it. One patient was also sensitized to quaternium‐22, a quaternary ammonium compound in the cosmetic. These reports underline the rôle of networks, such as REVIDAL‐GERDA, in monitoring the emergence of contact allergens and disseminating such information among the medical community.
An assessment of the comparative sensitization potential of some common isothiazolinones
Authors: Alexander B. R.
Published: March 2003

The isothiazolinones are known contact sensitizers. Data are presented which demonstrate that, in comparison with the chlorinated and dichlorinated compounds which share immunological cross‐reactivity, the unchlorinated isothiazolinones have a lower potential for sensitization and no documented immunological cross‐reaction with the chlorinated isothiazolinones.
Do monoterpenes released from feverfew (Tanacetum parthenium) plants cause airborne Compositae dermatitis?
Authors: Paulsen E. , Christensen L. P. , Andersen K. E.
Published: March 2003

The Compositae plant feverfew (Tanacetum parthenium) is an important sensitizer in Europe and has been suspected of causing airborne Compositae dermatitis. A previous investigation of substances emitted from feverfew plants detected no sesquiterpene lactones, however, but mainly monoterpenes. The aims of this study were to test whether feverfew‐allergic patients were also sensitive to some of the above‐mentioned monoterpenes and, if so, to study associations between sensitization patterns, relevance of feverfew allergy and clinical features. 17 patients with + +/+ + + reactions to feverfew and parthenolide were tested with 15 selected monoterpenes and 2 sesquiterpenes. Of the 17 persons, 13 had positive and/or doubtful positive reactions to 1 or more monoterpenes. Only 1 person was allergic to several monoterpenes. Her history of gradually worsening Compositae dermatitis culminating in a probable airborne dermatitis, mimicking photosensitivity, and the disappearance of symptoms upon removal of feverfew plants suggest monoterpenes as a possible contributing factor. Similar associations between doubtful positive monoterpene reactions and clinical patterns, fragrance/colophonium allergy and relevance of feverfew allergy were not established with certainty. In conclusion, sensitization to the sesquiterpene lactones of feverfew is not invariably accompanied by sensitization to its volatile monoterpenes. The presence of monoterpene allergy, however, may contribute to airborne Compositae dermatitis.
Contact sensitization from Compositae‐containing herbal remedies and cosmetics
Authors: Paulsen Evy
Published: March 2003

The Compositae (Asteraceae) family of plants is currently an important cause of allergic plant contact dermatitis in Europe. The family comprises some of the oldest and most valued medicinal plants, and the increasing popularity of herbal medicine and cosmetics may theoretically result in a growing number of Compositae sensitizations from these sources. According to the literature at least 15 species, including among others arnica (Arnica montana), German and Roman chamomile (Chamomilla recutita and Chamaemelum nobile), marigold (Calendula officinalis), Echinacea and elecampane (Inula helenium), have been suspected of sensitization or elicitation of Compositae dermatitis. Epidemiological data are available for 2 species only, arnica and German chamomile, the rest of the evidence being anecdotal. Based on this, sensitization seems to occur relatively frequently with a few species such as arnica and elecampane, and occurs rarely with the majority, especially the widely used German chamomile. Sesquiterpene lactones are the most important allergens, but there are a few cases of sensitization from a coumarin, a sesquiterpene alcohol and a thiophene. The risk of elicitation of dermatitis by using Compositae‐containing products in Compositae‐sensitive individuals is by‐and‐large unknown.
Cephalometric evaluation of the effects of pendulum appliance on various vertical growth patterns and of the changes during short‐term stabilization
Authors: Toroğlu Ms , Uzel İ , Çam Oy , Hancioğlu Zb
Published: March 2003

The aim of this study was to evaluate the effects of the pendulum appliance in dental Class II patients with varying vertical growth patterns and to evaluate the changes during the short‐term stabilization period of 3 months. The sample (n=30) was divided into two groups based on their FMA°. The high‐angle group consisted of 14 patients (10 girls and 4 boys) and had a mean age of 157.7±8.0 months. The low‐angle group consisted of 16 patients (8 girls and 8 boys) and had a mean age of 155.5±18.6 months. Pretreatment, posttreatment and poststabilization cephalometric radiographs were obtained to measure the changes. Mann–Whitney U and Wilcoxon tests were used for statistical evaluation. The amount of upper molar distalization was 5.9 mm (p<0.001) in the high‐angle group and 1 mm (p<0.001) in the low‐angle group, showing no intergroup difference. The amount of anchorage loss at the second premolars was 4.8 mm (p<0.001) in the high‐angle group and 6.6 mm (p<0.001) in the low‐angle group. Upper incisors moved anteriorly for 2.1 mm (p<0.05) in the high‐angle group and 4.1 mm (p<0.001) in the low‐angle group. Intergroup difference was statistically significant (p<0.001). During the stabilization period, 1.5 mm of anchorage loss was measured at the upper molar region in the high‐angle group and 1.7 mm of anchorage loss was measured at the upper molar region in the low‐angle group. During the stabilization period, upper second premolars and incisors tended to move back to their original places. The results of this study showed that pendulum appliance could move the upper molars distally in a short period of time without depending on the patient compliance. Care should be taken to prevent anchorage loss and to stabilize the upper molars for, at least, 3 months.
Efficiency of root torquing auxiliaries
Authors: Pancherz H , Löffler A , Obijou C
Published: March 2003

In an experimental typodont study simulating the third stage of Tip‐Edge treatment, the effect of five torquing auxiliaries on upper four incisors was assessed using the method of laser reflection. The auxiliaries analysed were: (1) Two‐Spurs 0.016′′, (2) Four‐Spurs 0.016′′, (3) Reciprocal Lateral Torque 0.016′′, (4) Torque Bar 0.022×0.018′′, 20°, and (5) Torque Bar 0.022×0.018, 30°. When comparing the wires, the efficiency (amount and speed of root tipping) varied considerably: (1) The Two‐Spurs wire was the most efficient auxiliary of the five tested and showed good torque effect on the central incisors. (2) The Four‐Spurs wire acting on all four incisors was less efficient than the Two‐Spurs wire. (3) The Reciprocal Lateral Torque wire exhibited good palatal root torque on the central incisors and labial root torque on the lateral incisors. (4) The Torque Bars (20° and 30°) were the least efficient wires of the auxiliaries tested and showed only small torque effects on the central and lateral incisor teeth. In clinical work using the Tip‐Edge technique, the Two‐Spurs torquing auxiliary should be the wire of choice for an efficient palatal root torque of the upper central incisors.
Expansion: how much can the periodontium tolerate?
Authors: Bassarelli T. , Melsen B.
Published: March 2003

Arch length discrepancy can be resolved either by extraction or expansion. Normally, the choice of the clinician is founded on evidence‐based treatment outcome reports. The adverse effect related to either approach is considered carefully before deciding. In the adult patient, the retraction of soft tissues consequent to extractions may be undesirable. Also, the deep bite may be difficult to correct if incisor proclination is to be avoided. Expansion has been reported to elicit gingival dehiscences. This is a report of a borderline case where the crowding is resolved acceptably through extreme expansion, but without any adverse periodontal effects.
Elastic tissue in scars and alopecia
Authors: Elston Dirk M. , McCollough Martha L. , Warschaw Karen E. , Bergfeld Wilma F.
Published: March 2003

A recent report suggests that elastic fibers appear in scars in a time‐dependent fashion. This observation prompted our investigation, because we have found elastic tissue stains helpful in determining the pattern of scarring in cases of permanent alopecia. We carried out this investigation to determine if the Verhoeff‐Van Gieson (VVG) elastic stain can reliably differentiate scarred from non‐scarred dermis and to test our hypothesis that elastic stained sections are helpful in distinguishing lichen planopilaris (LPP) from lupus erythematosus (LE), central progressive alopecia in black females (“follicular degeneration syndrome” and “hot comb alopecia” are other terms used to describe this condition) and classic ivory white idiopathic pseudopelade. We studied histological sections from surgical scars of known duration, stained with the VVG elastic stain and VVG‐stained sections of scalp biopsies from patients with established lesions of permanent alopecia. In most cases, both vertical and transverse sections were examined. In every case, the VVG stain clearly differentiated scar from the normal surrounding dermis. Distinct patterns of elastic tissue allowed for correct classification in most of the well‐established cases of permanent alopecia studied. We determined that the Verhoeff‐Van Gieson stain is an excellent stain to evaluate the pattern of scarring in cases of permanent alopecia and elastic tissue stains may be helpful in the histological evaluation of alopecia.
A morphologic study of dermatofibrosarcoma protuberans: expansion of a histologic profile
Authors: Sigel Jessica E. , Bergfeld Wilma F. , Goldblum John R.
Published: March 2003

Dermatofibrosarcoma protuberans (DFSP) is a fibrohistiocytic tumor of intermediate malignancy characterized by a distinctive storiform growth pattern and frequent local recurrences. In this study, we retrospectively reviewed 48 cases of DFSP diagnosed at the Cleveland Clinic Foundation between 1970 and 1999 to determine the prevalence of morphologic variations including the presence of giant cell fibroblastoma (GCF)‐like areas, multinucleated giant cells, hypercellular zones and fibrosarcomatous change. Results: The cohort consisted of 42 patients (20 males, 22 females) with a median age at diagnosis of 40 years (range: 10–73 years). Forty‐one primary tumors and seven recurrences were evaluated from these 42 patients. Tumor sites included the trunk (22 cases), head and neck (8 cases), upper extremities (7 cases) and lower extremities (6 cases). GCF‐like areas were identified in seven (14.6%), multinucleated giant cells in ten (20.8%), hypercellular zones in 12 (25%) and fibrosarcomatous change in six (12.5%) cases, respectively. Combinations included giant cells and GCF‐like areas (two cases), giant cells and hypercellular zone (two cases), and GCF‐like areas and hypercellular zones (one case). Our findings suggest that DFSP has a wider range of morphologic features, including GCF‐like areas, multinucleated giant cells, hypercellular zones and fibrosarcomatous change, than has been previously recognized in the literature.
bcl‐2 protein expression in aggressive and non‐aggressive basal cell carcinomas
Authors: Ramdial Pratistadevi K. , Madaree Anil , Reddy Roshilla , Chetty Runjan
Published: March 2003

bcl‐2, the well known anti‐apoptotic gene, cloned more than a decade ago, promotes cell viability without promoting cell proliferation. With few exceptions, high bcl‐2 protein expression is associated with a favourable outcome in epithelial tumours. bcl‐2 immunoreactivity in basal cell carcinomas (BCCs) is contradictory, with 67–100% immunopositivity being reported. Although BCCs are traditionally regarded as low‐grade, indolent tumours, aggressive BCCs (A‐BCCs) are mutilative, locally destructive tumours that often recur. bcl‐2 protein expression as a predictor of BCC aggressiveness is poorly documented in the English‐language literature. The bcl‐2 protein immunoprofile of 50 clinically non‐aggressive (NA‐BCCs) and 25 clinically A‐BCCs was investigated. Of the latter, 17 manifested with one, two or three recurrences. bcl‐2 protein expression in each of the recurrences was also evaluated. bcl‐2 expression was scored as follows: 0–5% positive cells=negative, 6–25%=1+, 26–50%=2+, 51–75%=3+, >75%=4+. “High” labeling encompassed 3+ or 4+ labeling while “low” labeling referred to 1+ or 2+ labeling. Although bcl‐2 positivity was noted in all BCCs, low bcl‐2 labeling was a statistically significant feature of A‐BCCs (p < 0.01). High bcl‐2 labeling of NA‐BCCs was a reflection of the bcl‐2 labeling of the dominant constituent nodular or superficial subtypes. Micronodular BCCs revealed 2+ or 3+ labeling. Initial and recurrent A‐BCCs with a pure or predominantly infiltrative component, demonstrated 1+ or 2+ bcl‐2 labeling. The differential bcl‐2 expression in the various clinicopathological subtypes of BCCs suggests that, despite the common derivation of these tumours from a primitive basaloid stem cell and a limited potential for metastasis, they form a heterogeneous group of tumours that differ markedly in histologic and biological behaviour. While the superficial and nodular BCCs are indolent slow‐growing tumours with high bcl‐2 labeling, the aggressive BCCs are infiltrative, desmoplastic tumours with low bcl‐2 labeling. In mixed tumours, heterogeneity of labeling is a distinctive feature and is contributed to in part by the labeling trends of the different histological subtypes. The micronodular BCC shows varied bcl‐2 labeling but in combined tumours occupies a niche intermediate between the non‐aggressive nodular and superficial and the aggressive infiltrative subtypes. The initial and subsequent biopsies of recurrent, adequately excised BCCs share a pure or mixed, predominantly infiltrative, stroma‐rich histomorphology with low bcl‐2 labeling, reflecting the immunoprofile of a more aggressive growth pattern.
Pigmented squamous cell carcinoma of the skin: morphologic and immunohistochemical study of five cases
Authors: Morgan Michael B. , Lima‐Maribona Janice , Miller Richard A. , Kilpatrick Timothy , Tannenbaum Myron
Published: March 2003

Invasive pigmented squamous cell carcinoma (PSCC) of the skin is reportedly rare. Herein, we evaluate an additional five cases and compare their relative frequency with non‐pigmented squamous cell carcinoma (SCC). Of 46,791 archived cases of SCC, a total of five cases of PSCC were discovered for a relative frequency of ∼0.01%. Grossly, each tumor presented as a rapidly growing crusted papule on actinic damaged skin of the face. Microscopically, all were composed of a mixture of keratininized squamous cells and melanin‐producing dendritic melanocytes. The squamous cells stained for epithelial membrane antigen, and both low and high molecular keratins. The melanocytes stained for S‐100 and HMB‐45. A matched series of 31 SCCs were subjected to an identical immunohistochemical battery of stains to determine if a histologically subtle and unsuspected number of intratumoral melanocytes existed in SCC. Each of the cases failed to show intratumoral melanocytes. The differential diagnosis and possible histogenesis of PSCC is discussed and the importance of extensive pathologic examination to prevent misdiagnosis is emphasized. Despite the histologic dissimilarity, the long‐term prognosis of the reported cases was similar to conventional SCC.
Cutaneous involvement by angioimmunoblastic T‐cell lymphoma with remarkable heterogeneous Epstein‐Barr virus expression
Authors: Brown Holly A. , Macon William R. , Kurtin Paul J. , Gibson Lawrence E.
Published: March 2003

Introduction: Initially described as an abnormal immune reaction, most cases of angioimmunoblastic lymphadenopathy with dysproteinemia (AILD)‐like T‐cell infiltrates are now regarded as a peripheral T‐cell lymphoma (AILD T‐NHL). AILD T‐NHL is characterized clinically with constitutional symptoms, generalized lymphadenopathy, hepatosplenomegaly, skin rash, and polyclonal hypergammaglobulinemia. Epstein‐Barr virus (EBV) is frequently detected in involved lymph nodes, but the presence of EBV in cutaneous infiltrates of AILD T‐NHL has rarely been examined. We present a patient with AILD T‐NHL with cutaneous involvement that shows marked heterogeneity of EBV expression in the lymph node and skin biopsies, and review the histological findings of AILD T‐NHL in the skin.

Methods: Two skin biopsies of a diffuse maculopapular rash and a lymph node were examined and immunophenotyped. In situ hybridization for detection of EBV in the lymph node and skin biopsies was utilized. In order to attempt to delineate which lymphocytes were EBV positive, skin biopsies were dual labeled with CD3, CD45RO, CD20 and EBV. The skin biopsies and lymph node were submitted for gene rearrangement studies by polymerase chain reaction (PCR). Capillary electrophoresis of fluorescently labeled PCR products was utilized for PCR product quantitation.

Results: The histological features of the lymph node were diagnostic of AILD T‐NHL and a T‐cell clone was identified by PCR. The skin biopsies showed an atypical superficial and deep perivascular polymorphous infiltrate consistent with cutaneous involvement by AILD T‐NHL. Both skin biopsies showed the same clonal T‐cell receptor gene rearrangement as the lymph node. In situ hybridization of the lymph node and one skin biopsy showed a few scattered EBV‐positive lymphocytes (<1% of the infiltrate). A second skin biopsy revealed 40–50% of the lymphocytes as EBV positive. Dual staining for CD20 and EBV identified a minority of EBV‐infected lymphocytes as B‐cells, but most of the EBV‐positive cells lacked staining for CD3 and CD45RO.

Conclusions: In our patient, the same T‐cell receptor gene rearrangement was found by PCR in all three biopsy sites. Most cases of AILD T‐NHL contain only a few EBV‐positive cells, but in our patient the extent of EBV expression ranged from <1% to 40–50% of the AILD T‐NHL cutaneous infiltrate. To our knowledge, this case is the most extensive and heterogeneous expression of EBV in cutaneous AILD T‐NHL to date.
Primary cutaneous Langerhans cell histiocytosis showing malignant phenotype in an elderly woman: report of a fatal case
Authors: Itoh Hiroshi , Miyaguni Hitoshi , Kataoka Hiroaki , Akiyama Yutaka , Tateyama Sunao , Marutsuka Kousuke , Asada Yujiro , Ogata Katsumi , Koono Masashi
Published: March 2003

Background: Langerhans cell histiocytosis (LCH) is a proliferating disorder of Langerhans cells (LC) that are characterized by the presence of Birbeck granules. LCH has been considered to be a disease of childhood and there have been limited cases of adult LCH. We report here a fatal case of histiocytic tumor showing Langerhans cell phenotype, arising in the skin of a 74‐year‐old woman.

Method: In addition to routine histological and immunohistological sections, electron microscopic examination and human androgen receptor gene (HUMARA) assays were performed.

Results: Histological examination revealed a dense dermal infiltrative proliferation of fairly large tumor cells with abundant ill‐defined cytoplasms and oval or indented nuclei, in which numerous eosinophils were associated with the tumor nests. Tumor cells were positive with anti‐S‐100 and CD1a antibodies but negative with HMB‐45 antibody or other epithelial or lymphocytic markers. Ultrastructural analysis showed typical Birbeck granules in the cytoplasm of the tumor cells. HUMARA assay of the tumor tissue revealed the nonrandom X inactivation pattern, indicating the clonal proliferation.

Conclusions: We diagnosed this tumor as Langerhans cell histiocytosis with a clonal neoplastic phenotype originated in the skin. Although she demonstrated no recurrence nor metastases for 6 months after surgical resection of primary skin lesion and subsequent radiation therapy, the tumor recurred and extended multisystemically, and she died of multiple organ failure 14 months after initial diagnosis. Therefore, we would like to emphasize this case as LC “sarcoma” or “malignant” LCH.
Type‐I cryoglobulinemia‐like histopathologic changes in tick bites: a useful clue for tissue diagnosis in the absence of tick parts
Authors: M. Stefanato Catherine , Phelps Robert G. , Goldberg Lynne J. , Perry Ann E. , Bhawan Jag
Published: March 2003

Background:  The histopathologic findings of localized reactions to tick bites may present as diagnostic dilemmas, especially if there is no history of a tick bite, or if the tick's mouthparts are not present in the biopsied skin.

Objective:  Skin biopsies of patients with a clinical history of a tick bite were selected and reviewed with the aim of detecting a common histopathologic denominator which could serve as a useful clue to the diagnosis, especially when the tick's mouthparts are absent.

Methods:  Hematoxylin and eosin‐stained slides of 15 skin biopsies of tick bites were retrieved from three dermatopathology and pathology laboratories. Where additional paraffin‐embedded tissue was available, additional sections were also stained with periodic acid‐Schiff (PAS) and phosphotungstic acid‐hematoxylin (PTAH).

Results:  In every case in which adequate tissue was available (13/15 biopsies), the capillaries and postcapillary venules of the superficial and deep vascular plexi adjacent to the attachment's site were filled with thrombi. Fibrin thrombi were seen in association with other more numerous thrombi characterized by homogeneous eosinophilic hyaline material similar to the cryoprecipitate present in type I (monoclonal) cryoglobulinemia. All thrombi were positive for PAS and PTAH; however, the latter staining was minimally present in the hyaline thrombi. In most cases, the site of the tick bite showed ulceration, with an underlying wedge‐shaped superficial and deep perivascular and occasionally interstitial mixed lymphohistiocytic infiltrate. In addition, there were eosinophils, numerous neutrophils and extravasated erythrocytes. Other findings included suppurative necrosis (7/15) cases, giant‐cell reaction (one case), fat necrosis (one case) and eccrine gland necrosis (one case).

Conclusions:  Vascular eosinophilic hyaline thrombi were found to be a frequent histologic manifestation of a tick bite. This finding may be related to the secretory products of the tick's saliva during inoculation. We believe that a tick bite should be suspected when focal intravascular hyaline occlusion is observed, and that it should be included in the differential diagnosis of type I (monoclonal) cryoglobulinemia, even if there is no history of a tick bite or if tick parts are not present in the skin biopsy specimen.
Congenital composite hemangioendothelioma: case report and reappraisal of the hemangioendothelioma spectrum
Authors: Reis‐Filho Jorge S. , Paiva Maria Emília , Lopes José Manuel
Published: March 2003

Background:  Composite hemangioendothelioma is the most recently described entity of the hemangioendothelioma (HE) spectrum. To the best of our knowledge, only eight cases of this entity have been hitherto described. All of the previous cases affected adults; local recurrences were observed in three cases, and one case showed lymph node metastasis. We herein describe a new and previously unreported congenital case of this rare vascular tumor, arising on the acral extremity of the left forearm, which was diagnosed when the patient was 23 years old.

Results:  The histological examination disclosed a heterogeneous vascular neoplasm composed of retiform HE‐like (80%), spindle cell hemangioma‐like (15%), cavernous hemangioma‐like (∼3%), epithelioid HE‐like (∼2%) areas, and rare foci with an angiosarcoma‐like pattern (< 1%). A distinctive and unique finding of the present case was the presence of large granular eosinophilic macrophages filling some vessels of the retiform HE‐like areas. A below‐elbow amputation was performed. The patient is alive and well, without evidence of residual or metastatic disease 7 years after the treatment.

Conclusions:  The authors expand the concept of composite hemangioendothelioma by adding a congenital case and provide a reappraisal of the hemangioendothelioma spectrum.
CD30 antigen expression in cutaneous inflammatory infiltrates of scabies: a dynamic immunophenotypic pattern that should be distinguished from lymphomatoid papulosis
Authors: Gallardo Fernando ,   Carlos Barranco, Toll Agustí , Pujol Ramon M.
Published: March 2003

Background: Expression of CD30 antigen is a distinct marker of lymphocyte activation that was originally described in the Reed–Sternberg cells of Hodgkin's disease. The observation of CD30+ cells has been considered a diagnostic feature of cutaneous CD30 lymphoid proliferations. However, CD30 expression has also been reported in some cutaneous benign inflammatory infiltrates.

Methods: Eleven skin biopsies from patients with scabies were double‐blindly and retrospectively analysed. A panel of histopathological parameters and immunophenotypic expression of CD4, CD8, CD30 and S‐100 antigens was studied. CD30 and S‐100 antigens expression were related to clinical features.

Results: Large CD30+ cells were demonstrated in eight (8/11) biopsies, corresponding to patients with long‐standing lesions (3 months or longer). However, no expression of the CD30 antigen was observed in all biopsy specimens (3/11) corresponding to early lesions (2 months or less). The presence of S‐100 positive cells in the papillary dermis was an almost constant feature.

Conclusions: CD30+ large cells seem to be a common feature in long‐standing infiltrates of scabies. CD30 expression in scattered cells of a cutaneous lymphoid infiltrate cannot be assessed as a strong diagnostic argument of neoplastic cutaneous CD30+ lymphoid proliferation (lymphomatoid papulosis/cutaneous CD30+ lymphoma). Therefore, the possibility that large atypical CD30+ cells may be also present in several benign inflammatory diseases should be always considered.
MMP‐2, TIMP‐2 and MT1‐MMP are differentially expressed in lesional skin of melanocytic nevi and their expression is modulated by UVB‐light
Authors: Krengel S. , Alexander M. , Brinckmann J. , Tronnier M.
Published: March 2003

Background:  In malignant melanoma, recent studies have demonstrated an important role of matrix‐metalloproteinase 2 (MMP‐2), its co‐activating enzyme membrane‐type matrix‐metalloproteinase 1 (MT1‐MMP), and the endogenous inhibitor of MMP‐2, tissue‐inhibitor of matrix metalloproteinase 2 (TIMP‐2). Melanocytic nevi are benign neoplasms of the melanocytic lineage, but may exhibit dysplastic features that can be difficult to distinguish from early stage melanoma. As shown in earlier studies, nevi show important morphological and phenotypical changes in response to ultraviolet light (UVB) irradiation.

Objective:  To clarify the role of MMP‐2, TIMP‐2 and MT1‐MMP in UVB‐irradiated vs. non‐irradiated melanocytic nevi.

Methods:  Immunohistochemical comparison of the MMP‐2, TIMP‐2 and MT1‐MMP expression pattern.

Results:  MMP‐2 is expressed by lesional keratinocytes and its expression is up‐regulated by UVB‐irradiation. MMP‐2 expression was not observed in melanocytic cells. TIMP‐2, by contrast, is predominantly expressed by melanocytic nevus cells, and its expression is in part down‐regulated by UVB‐irradiation. MT1‐MMP is expressed by basal keratinocytes and to a weaker extent by melanocytic nevus cells.

Conclusions:  MMP‐2 expression by keratinocytes in nevi probably represents the result of activation of keratinocyte turnover in lesional epidermis. MMP‐2 could play a role in the downward movement of junctional nevus cells into the dermis. The reduction of TIMP‐2 expression in melanocytic cells by UV‐light together with the enhanced expression of MMP‐2 in the adjacent epidermis may promote basement membrane degradation. The expression pattern of MT1‐MMP in close proximity to epithelial–mesenchymal interfaces underlines the synergistic role of MT1‐MMP in this process.
Predicting Patterns of Mammography Use: A Geographic Perspective on National Needs for Intervention Research
Authors: Legler Julie , Breen Nancy , Meissner Helen , Malec Don , Coyne Cathy
Published: March 2003

Objective.To introduce a methodology for planning preventive health service research that takes into account geographic context.

Data Sources.National Health Interview Survey (NHIS) self‐reports of mammography within the past two years, 1987, and 1993–94. Area Resource File (ARF), 1990. Database of mammography intervention research studies conducted from 1984 to 1994.

Design.Bayesian hierarchical modeling describes mammography as a function of county‐level socioeconomic data and explicitly estimates the geographic variation unexplained by the county‐level data. This model produces county use estimates (both NHIS‐sampled and unsampled), which are aggregated for entire states. The locations of intervention research studies are examined in light of the statewide mammography utilization estimates.

Data Extraction.Individual level NHIS data were merged with county‐level data from the ARF.

Principal Findings.State maps reveal the estimated distribution of mammography utilization and intervention research. Eighteen states with low mammography use reported no intervention research activity. County‐level occupation and education were important predictors for younger women in 1993–94. In 1987, they were not predictive for any demographic group.

Conclusions.Opportunities exist to improve the planning of future intervention research by considering geographic context. Modeling results suggest that the choice of predictors be tailored to both the population and the time period under study when planning interventions.
Understanding Team‐based Quality Improvement for Depression in Primary Care
Authors: Rubenstein Lisa V. , Parker Louise E. , Meredith Lisa S. , Altschuler Andrea , DePillis Emmeline , Hernandez John , Gordon Nancy P.
Published: March 2003

Objective. To assess the impacts of the characteristics of quality improvement (QI) teams and their environments on team success in designing and implementing highquality, enduring depression care improvement programs in primary care (PC) practices.

Study Setting/Data Sources. Two nonprofit managed care organizations sponsored five QI teams tasked with improving care for depression in large PC practices. Data on characteristics of the teams and their environments is from observer process notes, national expert ratings, administrative data, and interviews.

Study Design. Comparative formative evaluation of the quality and duration of implementation of the depression improvement programs developed by Central Teams (CTs) emphasizing expert design and Local Teams (LTs) emphasizing participatory local clinician design, and of the effects of additional team and environmental factors oneach type of team. Both types of teams depended upon local clinicians for implementation.

Principal Findings. The CT intervention program designs were more evidence‐based than those of LTs. Expert team leadership, support from local practice management, and support from local mental health specialists strongly influenced the development of successful team programs. The CTs and LTs were equally successful when these conditions could be met, but CTs were more successful than LTs in less supportive environments.

Conclusions. The LT approach to QI for depression requires high local support and expertise from primary care and mental health clinicians. The CT approach is more likely to succeed than the LT approach when local practice conditions are not optimal.
Issues in Conducting Randomized Controlled Trials of Health Services Research Interventions in Nonacademic Practice Settings: The Case of Retail Pharmacies
Authors: Weinberger Morris , Murray Michael D. , Marrero David G. , Brewer Nancy , Lykens Michael , Harris Lisa E. , Jeffrey Newell A. , Collins Joyce , Tierney William M.
Published: March 2003

Objective. To describe unexpected challenges and strategies to overcome them when conducting randomized controlled trials (RCT) of health services research interventions in retail pharmacies.

Study Setting. Thirty‐six retail drug stores in Indianapolis.

Study Design. We conducted an RCT to evaluate the effectiveness of an intervention to increase pharmacists’ involvement in caring for customers. We describe: (1) our RCT as originally designed, (2) unexpected challenges we faced; and (3) how we resolved those challenges.

Data Collection/Extraction Methods. Randomized controlled trial.

Principal Findings. Major modifications in research design were necessitated by factors such as corporate restructuring, heightened sensitivity to patient confidentiality, and difficulties altering employees’ behavior. We overcame these barriers by conducting research that is consistent with corporate goals, involving appropriate corporate administrators and technical personnel early in the process, and being flexible.

Conclusions. Health services researchers should conduct RCTs in a variety of nonacademic practice settings to increase generalizability and better reflect the true impact of interventions. Pragmatic problems, although significant, can be successfully overcome.
Localized amyloidosis of the glans penis: a case report and literature review
Authors: Ritter Marylynn , Nawab Rehana A. , Tannenbaum Myron , Hakky Said I. , Morgan Michael B.
Published: March 2003

Background:  Primary localized cutaneous amyloidosis is an uncommon lesion with a varied pathogenesis.

Methods:  We report the case of a 67‐year‐old‐male discovered to have a localized amyloid lesion of the glans penis.

Results: Biopsy of the lesion revealed dermal deposits of amorphous eosinophilic material which stained positive with Congo red and amyloid P protein. Additional stains, including kappa and lambda light chains, amyloid A, and transthyretin, were negative. The lesion has remained asymptomatic, with no evidence of systemic disease identified, and no further treatment has been necessary.

Conclusions: This is the sixth reported case of localized amyloidosis of the glans penis. Based on the clinical behavior and pathologic characteristics, this type of lesion is best classified as primary localized cutaneous amyloidosis, in the same family as the macular/lichenoid type lesions.
Computing facilities available to final‐year students at 3 UK dental schools in 1997/8: their use, and students’ attitudes to information technology
Authors: Grigg P. , Macfarlane T. V. , Shearer A. C. , Jepson N. J. A. , Stephens C. D.
Published: March 2003

Objective: To identify computer facilities available in 3 dental schools where 3 different approaches to the use of technology‐based learning material have been adopted and assess dental students’ perception of their own computer skills and their attitudes towards information technology.

Design: Multicentre cross sectional by questionnaire.

Subjects: All 181 dental students in their final year of study (1997–8).

Results: The overall participation rate was 80%. There were no differences between schools in the students’ self assessment of their IT skills but only 1/3 regarded themselves as competent in basic skills and nearly 50% of students in all 3 schools felt that insufficient IT training had been provided to enable them to follow their course without difficulty.

There were significant differences between schools in most of the other areas examined which reflect the different ways in which IT can be used to support the dental course.

Conclusions: 1. Students value IT as an educational tool. 2. Their awareness of the relevance of a knowledge of information technology for their future careers remains generally low. 3. There is a need to provide effective instruction in IT skills for those dental students who do not acquire these during secondary education.
5.3 Global challenges in research and strategic planning
Authors: Baum Bruce J. , Scott John , Bickel Matthias , Gombos Giorgio , Greenspan John S. , Guo Wei , Park No‐Hee , Purdell‐Lewis David , Ranney Richard , Schwarz Eli , Seymour Greg , Uoshima Katsumi
Published: March 2003

Health sciences research is experiencing dramatic progress. How can dental schools throughout the world best make these research advances relevant for dental students, as well as providing them with the means to assess and utilize the research advances that will occur in the future? This complex question presents a critical challenge to the dental educational community. Research is clearly integral to the mission of dental education. By providing dental students with active learning strategies, dental educators can inculcate the ability for independent scientific thinking and thereby develop reflective as well as technically competent practitioners. However, there is a shortage of well‐trained individuals to fill faculty and research positions in certain parts of the world. Global networks for mutual information exchange are imperative to overcome resource limitations in individual institutions, as is dedicated funding for research in the dental educational setting.
1.3 Development of professional competences
Authors: Plasschaert Alphons , Boyd Marcia , Andrieu Sandra , Basker Robin , Beltran Roberto J. , Blasi Giorgio , Chadwick Barbara , Chambers David , Christersson Cecilia , Haddock Fernando , Kerschbaum Thomas , Kogon Stan , Kovesi Gyorgy , Ozer Fusun , Parkash Hari , Villamil Juanita E. , Vogel Richard I. , Wolowski Anne
Published: March 2003

Competency‐based education, introduced approximately 10 years ago, has become the preferred method and generally the accepted norm for delivering and assessing the outcomes of undergraduate (European) or predoctoral (North America) dental education in many parts of the world. As a philosophical approach, the competency statements drive national agencies in external programme review and at the institutional level in the definition of curriculum development, student assessment and programme evaluation. It would be presumptuous of this group to prescribe competences for various parts of the world; the application of this approach on a global basis may define what is the absolute minimum knowledge base and behavioural standard expected of a ‘dentist’ in the health care setting, while respecting local limitations and values. The review of documents and distillation of recommendations is presented as a reference and consideration for dental undergraduate programmes and their administration.
On the estimation of species richness based on the accumulation of previously unrecorded species
Authors: Cam Emmanuelle , Nichols James D. , Sauer John R. , Hines James E.
Published: March 2003

Estimation of species richness of local communities has become an important topic in community ecology and monitoring. Investigators can seldom enumerate all the species present in the area of interest during sampling sessions. If the location of interest is sampled repeatedly within a short time period, the number of new species recorded is typically largest in the initial sample and decreases as sampling proceeds, but new species may be detected if sampling sessions are added. The question is how to estimate the total number of species. The data collected by sampling the area of interest repeatedly can be used to build species accumulation curves: the cumulative number of species recorded as a function of the number of sampling sessions (which we refer to as “species accumulation data”). A classic approach used to compute total species richness is to fit curves to the data on species accumulation with sampling effort. This approach does not rest on direct estimation of the probability of detecting species during sampling sessions and has no underlying basis regarding the sampling process that gave rise to the data. Here we recommend a probabilistic, nonparametric estimator for species richness for use with species accumulation data. We use estimators of population size that were developed for capture‐recapture data, but that can be used to estimate the size of species assemblages using species accumulation data. Models of detection probability account for the underlying sampling process. They permit variation in detection probability among species. We illustrate this approach using data from the North American Breeding Bird Survey (BBS). We describe other situations where species accumulation data are collected under different designs (e.g., over longer periods of time, or over spatial replicates) and that lend themselves to of use capture‐recapture models for estimating the size of the community of interest. We discuss the assumptions and interpretations corresponding to each situation.
Distribution and habitat specialization of species affect local extinction in dragonfly Odonata populations
Authors: Korkeamäki Esa , Suhonen Jukka
Published: March 2003

The object of our study was to determine the effect of distribution and habitat specialization of odonate species on local extinction in streams in central Finland. We studied the local extinction of the 20 most abundant dragonfly (Odonata) species in 34 small creeks and brooks in central Finland. The historical presence of each studied species in our research area was confirmed using existing records gathered between 1930 and 1975. A minimum of five records was available for each species. During the summers of 1995 and 1996, we investigated the current persistence of 219 separate populations with historical presence. In total, 98 historical populations were vanished. As predicted, we found that species with a narrow distribution were less persistent than species with a broad distribution. Therefore, the extinction risk of a species was inversely related to the width of its regional distribution. Using reference works, species were categorized into two main breeding habitat types: lotic species or lentic species. The species main habitat type was a significant predictor of local extinction risk after statistical removal of the effect of regional distribution on extinction risk. The lotic species had lower local extinction risk than other species. Altogether, the highest extinction risk was found in habitat‐specialist species associated with peatlands, probably due to loss of natural breeding habitat. On the other hand, extinction risk was lower in widely distributed habitat generalist species than true lotic species. The local extinction within species was more common in small dynamic upstream than in larger stable downstream habitats. The results of this study are consistent with meta‐population theory.
Mammalian predator scent, vegetation cover and tree seedling predation by meadow voles
Authors: Pusenius Jyrki , Ostfeld Richard S.
Published: March 2003

Herbivores are thought to respond to the increased risk of attack by predators during foraging activities by concentrating feeding in safe habitats and by reducing feeding in the presence of predators. We tested these hypotheses by comparing tree seedling predation by meadow voles within large outdoor enclosures treated either with scent of large mammalian predators (red fox, bobcat, coyote) or a control scent (vinegar). In addition, we compared the distribution of voles in relation to naturally occurring variation in vegetation cover and the tendency of voles to attack tree seedlings planted in small patches with cover manipulation (intact, reduced or removed cover). Predator scent did not affect the rate or spatial distribution of tree seedling predation by voles, nor did it affect giving up densities (a surrogate of patch quitting harvest rate), survival rates, body size or habitat distribution of voles. In both predator scent and vinegar treatments voles preferred abundant vegetation providing good cover, which was also the site of almost all tree seedling predation. We conclude that large mammalian predator scent does not influence the perception by voles of the general safety of habitat, which is more strongly affected by the presence of cover.