bluuebunny/crossref_metadata_2025 huggingface dataset:
The L‐arginine inhibition of rat middle cerebral artery contractile responses is mediated by inducible nitric oxide synthase
Authors: Alonso M. J. , Rodríguez‐Martínez M. A. , Martínez‐Orgado J. , Marín J. , Salaices M.
Published: December 2004

The effect of L‐arginine (L‐Arg), the nitric oxide synthase (NOS) substrate on the responses to prostaglandin F2α (PGF2α, 10 μM) and K+ (120 mM) in rat middle cerebral artery (MCA) segments was analysed.

PGF2α induced a stable contraction of 0.35 ± 0.06 mN mm−1; the subsequent addition of bradykinin (BK, 1 μM) produced a relaxation of 42 ± 9% of the PGF2α‐induced tone. K+ induced a response consisting of a rapid basal tone increase (1.42 ± 0.16 mN mm−1) followed by a decrease to a stable phase (1.24 ± 0.15 mN mm−1).

L‐Arg (0.1 mM), but not D‐Arg, decreased the basal tone and reduced the contraction to PGF2α in segments with and without endothelium. The contractile response to K+ was also reduced and not maintained in the presence of L‐Arg.

The inhibitory effect of L‐Arg on the PGF2α‐ and K+ ‐induced contractions was completely reversed by the NOS inhibitor, NG‐monomethyl ‐L‐arginine (L‐NMMA, 0.1 mM).

Pre‐incubation of segment with dexamethasome (1 μM), to inhibit inducible NOS (iNOS), or with the antibiotic polymyxin B (10 μg ml−1) reduced the L‐Arg inhibition, whereas it was increased by lipopolysaccharide (LPS, 100 ng ml−1), an inductor of iNOS. L‐NMMA antagonized the effects of dexamethasone and LPS.

The present results suggest that L‐Arg inhibition of the PGF2α‐ and K+ ‐induced contractions in rat MCA is the result of NO synthesis by iNOS stimulation.
Quantitative changes in pharmacodynamic parameters of noradrenaline in different rat aorta preparation: influence of endogenous EDRF
Authors: Zonta F. , Barbieri A. , Reguzzoni M. , Calligaro A.
Published: December 2004

The aim of the present study was to assess the role of endothelia cells in the modulation of vasocontractile responses to noradrenaline in rat isolated aorta when cut as standard helical strips or as ring segments.

Noradrenaline‐potency in helical strip preparations evaluated as –logEC50 was greater than that obtained in endothelium‐intact ring preparations (9.45 ± 0.28 versus 8.69 ± 0.09, respectively) (P < 0.05). The maximum contractile response of helical strips was significantly higher than the response of ring preparations (P < 0.05).

Subsequent experiments were performed on helical strips and ring preparations where the endothelium was removed by rubbing the luminal surface of the aorta with filter paper. Removal of the endothelium potentiated the noradrenaline‐induced contraction in ring preparations, but not in the helical strips.

The nitric oxide synthase inhibitors L‐NAME (3 × 10−5−3 × 10−4 M) or L‐NNA (1 × 104–3 × 10−4 M) which were added to the tissue bath potentiated the noradrenaline‐induced contraction in the endothelium‐intact ring preparations, although only L‐NNA induced a statistically significant potentiation. Both L‐NAME and L‐NNA had no effect on the noradrenaline‐contraction induced in rings without endothelium, or in helical strips with or without endothelium.

Vascular acetylcholine‐induced relaxation is dependent on endothelium derived relaxing factor (nitric oxide). Acetylcholine (10−9–10−6 M) induced a concentration‐dependent relaxation in noradrenaline preconstricted intact rings. The relaxant response was strongly reduced by L‐NAME (3 × 10−5–1 × 10−4 M). The relaxant response to acetylcholine was very weak in ring and helical strip preparations without endothelium, but also, surprisingly, in unrubbed standard helical strips.

The present results suggest that the endothelium of standard helical strip preparations may be greatly damaged, a view confirmed by morphological studies. The structural and functional damage of the endothelium induced very important changes in pharmacodynamic parameters such as in the potency and the maximal responses of vascular preparations to noradrenaline. Therefore, caution must be observed when the potency and intrinsic activity of agonists evaluated on different preparations are compared, even if these come from the same vascular segment.
Differential effects of adrenaline and noradrenaline on the hepatic expression of immediate early genes in mice
Authors: Im Y.‐B. , Won J.‐S. , Suh H.‐W. , Huh S. O. , Kim Y.‐H. , Song D.‐K.
Published: December 2004

The effects of intraperitoneally (i.p.) administered noradrenaline and adrenaline on the hepatic expression of immediate early genes (IEGs) were studied in mice.

Intraperitoneal injections of various doses (0.2–2 mg kg−1) of noradrenaline and adrenaline dose‐dependently induced hepatic c‐fos and c‐jun mRNA levels. The time‐course study showed that there was an increase in c‐fos and c‐jun mRNA levels within 15 min, which reached a peak at 30 min, and returned to the basal levels 1–2 h after noradrenaline or adrenaline injection (2 mg kg−1, i.p.). A Western blot assay revealed that c‐Jun protein levels were maximally increased at 30 min and 1–2 h in noradrenaline‐ and adrenaline‐treated mice, respectively. There was a slight increase in c‐Fos protein, while 46‐kDa Fra protein was prominently increased. Noradrenaline (2 mg kg−1, i.p.) induced 46‐kDa Fra within 15 min, which reached a maximum at 30 min and returned to the basal levels by 1 h. Adrenaline (2 mg kg−1, i.p.) induced 46‐kDa Fra at 30 min, which returned to the basal levels at 4 h.

Noradrenaline (2 mg kg−1, i.p.)‐induced increases in c‐fos and c‐jun mRNA expressions were inhibited by the pre‐treatment with prazosin (α1‐adrenergic antagonist; 0.5 mg kg−1, i.p.), but not with yohimbine (α2‐adrenoceptor antagonist; 1 mg kg−1, i.p.) nor with propranolol (β‐adrenoceptor antagonist; 10 mg kg−1, i.p.). Adrenaline (2 mg kg−1, i.p.)‐induced increases in c‐fos and c‐jun mRNA expressions were inhibited by the pre‐treatment with prazosin or with propranolol, but not with yohimbine. Administration of ICI‐118,551 (β2‐adrenoceptor antagonist; 2 mg kg−1, i.p.), but not betaxolol (β1‐adrenoceptor antagonist; 2 mg kg−1, i.p.), blocked adrenaline (2 mg kg−1, i.p.)‐induced increases in c‐fos and c‐jun mRNA expressions.

The results suggest that noradrenaline elicits the hepatic c‐fos and c‐jun mRNA responses by stimulating α1‐adrenergic receptors, whereas in the case of adrenaline, this is elicited by stimulating both α1‐ and β2‐adrenergic receptors in mice. These catecholamine‐induced hepatic IEG responses may be responsible for mediating some of the catecholamine actions in the liver.
Effects of suramin on electrical and mechanical activities in antrum smooth muscle of the guinea‐pig stomach
Authors: Xue L. , Imaeda K. , Yamamoto Y. , Suzuki H.
Published: December 2004

The effects of suramin on electrical and mechanical responses produced by adenosine triphosphate (ATP), acetylcholine and transmural nerve stimulation were observed in antrum smooth muscle isolated from the guinea‐pig stomach.

Suramin (>10−6 M) inhibited the non‐adrenergic non‐cholinergic inhibitory junction potential, with no alteration of the resting membrane potential, slow wave and the ATP‐induced responses (hyperpolarization and inhibition of slow waves).

The amplitude, but not the frequency, of spontaneous rhythmic contraction was inhibited by suramin (>10−5 M), with no alteration of electrical responses of the membrane.

Transmural nerve stimulation elicited cholinergic excitatory and non‐adrenergic non‐cholinergic inhibitory responses on the spontaneous contraction, and suramin inhibited only the latter.

Suramin did not alter the ATP‐induced inhibition of spontaneous contraction. The contractions produced by low concentrations (<10−7 M), but not high concentrations (10−6–10−5 M), of acetylcholine were inhibited by suramin.

It is concluded that in smooth muscle of the guinea‐pig antrum, suramin inhibits contractions produced spontaneously and by low concentrations of acetylcholine, with no relation to the electrical responses of the membrane. Parallel inhibition by suramin of the electrical and mechanical responses elicited by excitation of non‐adrenergic non‐cholinergic inhibitory nerves may not be causally related to the inhibition of ATP‐receptors.
Cardiovascular actions of nitric oxide synthase inhibition in the portal hypertensive rat
Authors: McDaid J. , McCormick P. A. , Docherty J. R.
Published: December 2004

We have investigated the actions of the nitric oxide synthase inhibitor L‐NMMA in the portal hypertensive Wistar rat in vivo. Resting blood pressure in the anaesthetised portal hypertensive rat was 107.8 ± 11.0/79.2 ± 11.7 mmHg (n= 12), which was significantly lower than in shamoperated animals (143.0 ± 3.8/114.0 ± 4.0 mmHg, n= 19; P <0.01). Cardiac output was significantly higher in portal hypertensive (30.2 ± 1.0 ml min−1 per 100 g, n= 12) than shamoperated animals (23.7 ± 2.2 ml min−1 per 100 g, n= 13; P < 0.01).

Intravenous injection of L‐NMMA (10 mg kg−1) significantly increased systemic blood pressure in both portal hypertensive and sham‐operated animals to 123.0 ± 15.0/93.4 ± 14.0 mmHg and 162.1 ± 5.7/131.6 ± 6.0 mmHg, respectively. The magnitude of the changes were similar in both groups. This increase in blood pressure was accompanied by a decrease in cardiac output to 88.5 ± 2.8% and 91.5 ± 2.4% of control in portal hypertensive and sham‐operated animals, respectively (no significant difference).

L‐NMMA (10 mg kg−1) had similar effects on small mesenteric arterial conductance in both portal hypertensive and sham operated animals, reducing conductance to 84.4 ± 3.6% (n= 6) and 82.7 ± 1.2% (n= 4) of control, respectively.

It is concluded that L‐NMMA has similar effects in vivo in portal hypertensive as compared with sham‐operated rats. Hence, an enhancement of endothelium‐derived nitric oxide is not involved in the hyperdynamic state following portal hypertension in the rat.
Epidural analgesia for pain relief in labour and childbirth – a review with a systematic approach
Authors: Nystedt Astrid , Edvardsson David , Willman Ania
Published: December 2004

Background.  Clinical ambiguity concerning effects of epidural analgesia for pain relief in labour seems to reflect a need for evidence‐based knowledge for midwives.

Aims.  This study aimed to review, with a systematic approach, the literature about effects and risks associated with the use of epidural analgesia for pain relief in labour and childbirth.

Design.  A structured question was formulated and used for deriving search terms, establishing the inclusion of certain criteria and retrieving articles, i.e. what are the effects of epidural analgesia for pain relief in labour and childbirth? References were obtained through searches using MeSH‐terms in Medline and Subheadings (SH) in CINAHL (e.g. Obstetrical Analgesia combined either with psychology or adverse effects and together with, Dystocia, Caesarean Section, Infant Newborn and Breastfeeding). The articles were divided into prospective randomized trials (C), non‐randomized prospective studies (P) and retrospective studies (R). Scientific quality of the studies was assessed on a three‐grade scale: high scientific quality (I), moderate scientific quality (II) or low scientific quality (III).

Results.  Twenty‐four articles were retrieved and systematically assessed. Seven studies were judged as high quality, 15 as moderate quality and two as low quality. The majority of studies appraised in this review failed to obtain or establish a cause and effect relationship. According to the data, it seems clear that the use of epidural analgesia is considered to be an effective method of pain relief during labour and childbirth from the perspective of women giving birth.

Relevance to clinical practice.  Midwives and doctors can recommend this form of pain relief. However, information about possible associations with adverse effects in mothers and infants must be provided to expectant couples.
Nephrology nursing: blurring the boundaries: the reality of expert practice
Authors: Bonner Ann , Walker Annette
Published: December 2004

Background. Expertise in nursing has been widely studied; there have been no previous studies into what constitute expertise in nephrology (renal) nursing. This paper describes a ‘real‐world’ characteristic of expert nephrology nursing practice.

Aims and objectives. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the concept blurring the boundaries.

Design. The study utilized grounded theory methodology and symbolic interactionism.

Methods. The study took place in one renal unit in New South Wales. Sampling was purposive then theoretical; the sample consisting of six non‐expert and eleven expert nurses. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semi‐structured interviews was undertaken.

Results. The study revealed that only expert nephrology nurses ‘blurred the boundaries’ of professional nursing practice. They did this by moving intermittently and purposefully, for the benefit of particular patients, into medical domains in the areas of prescribing, dispensing and ordering of pathology tests. Non‐expert nurses did not cross these professional boundaries.

Conclusions. Blurring the boundaries was a significant feature of expert nursing practice, and this study was the first to describe explicitly nursing boundaries as two distinct entities; that is, formal and informal.

Relevance to clinical practice. There are some nephrology nurses who have sufficient knowledge and experience to prescribe some medications and to order certain investigations.
Falls prevention revisited: a call for a new approach
Authors: Dempsey Jennifer
Published: December 2004

Background. Patient falls constitute a major threat to health services’ ability to provide care. Previous studies confirm that nurses can identify patients at risk and that a preventative programme can reduce the rate of falls but few studies have been evaluated over time.

Aims and objectives. A study was undertaken to test a Falls Prevention Programme in an acute medical area that was re‐evaluated 5 years later to determine if the effects were sustainable.

Design. The design included two groups of patients admitted before and after the programme. Variables such as staffing, equipment, environment and routines were controlled. However, because of ethical approval constraints, some variables such as age, mental status, mobility and gender were not.

Methods. The programme included a risk assessment tool, a choice of interventions, a graphic that alerted others to ‘at risk patients’ and simple patient and staff education. Data were collected using incident forms and a formula was used to calculate a rate of falls. A non‐pairedt‐test compared rates andanovaexamined the relationship of age, gender, mobility and mental status on the incidence of falls. Control graphs determined the stability of the process.

Results. The falls rate was significantly reduced. Control graphs demonstrate that the process achieved greater control with less variation. In the next 5 years the falls rate increased to preprogramme levels and control graphs demonstrated that the process was no longer controlled. Compliance with the programme had deteriorated.

Conclusions. The practice review considered skill mix, patient activity and acuity but provided no definitive answers to explain non‐compliance. The implications to nursing are discussed.

Relevance to clinical practice. Clinicians are called to conduct more rigorous research into falls prevention but it may be more useful to direct research towards examining nursing work and increasing nurse autonomy in falls prevention.
Haematological cancer patients: achieving a sense of empowerment by use of strategies to control illness
Authors: Bulsara Caroline , Ward Alison , Joske David
Published: December 2004

Background.  The role that empowerment plays through involving haematological cancer patients and their families in their treatment and care is undeniable. It encompasses the implementation of various strategies to achieve a sense of empowerment.

Aims and objectives.  This phenomenological study sought to identify core strategies used by cancer patients regardless of their illness stage and prognosis who exhibited a strong sense of empowerment in coping with their condition.

Design.  A phenomenological approach using an in depth interviewing technique was used to identify the common factors which patients and spouses believed could enable them to achieve a measure of control in managing their illness. These measures were referred to as coping strategies.

Methods.  It was decided to conduct a purposive study and re‐interview seven of 12 patients who had previously participated in a pilot Haematology Shared Care project and who had developed a high level of ability in coping with their illness. At the patient's discretion, spouses were invited to participate and to contribute to the interview. Three spouses participated in the interviewing process.

Results.  Common strategies emerged regardless of the patient's stage of illness and prognosis. Informants identified the determination to remain in control of the illness and treatment side effects, having the support of family and significant others, illness acceptance and maintaining hope as crucial to their sense of empowerment.

Relevance to clinical practice.  It is hoped that clinicians will gain a deeper understanding of the varied and numerous strategies used by cancer patients in coping with their illness. This understanding will ensure that by encouraging these strategies, patients and their families will be supported by health professionals to achieve a greater sense of empowerment. As this and other studies have shown, working alongside health professionals contributes to empowerment for both the cancer patient and significant others in their lives.
Study of the skin disease spectrum occurring in an Afro‐Caribbean population
Authors: Dunwell Patricia , Rose Arlene
Published: December 2004

Background There is a scarcity of recent up‐to‐date studies on the incidence of skin disease among Afro‐Caribbeans.

Methods One thousand patients were retrospectively studied for the commonest diagnoses made over a 5‐month period from January to May 2001.

Results The commonest skin diseases seen were acne vulgaris (29.21%), seborrhoeic eczema (22.02%), pigmentary disorders (16.56%), and atopic eczema (6.1%). Other notable common diagnoses included keratosis pilaris, tinea infection, hirsuitism, folliculitis keloidalis nuchae, viral warts, dermatosis papulosa nigra, and confluent and reticulate papillomatosis.

Conclusion The pattern of skin disease seen in the Afro‐Caribbean population studied, more closely resembles those seen in developed countries than those seen in developing countries.
A clinical, prospective, randomized, double‐blind trial comparing skin whitening complex with hydroquinone vs. placebo in the treatment of melasma
Authors: Haddad Alessandra Lima , Matos Luiz Fernando , Brunstein Flavia , Ferreira Lydia Masako , Silva Ademir , Costa Divaldo
Published: December 2004

Objectives To compare, in a double‐blind, randomized, prospective study, the clinical improvement of hyperpigmentation in 30 patients with melasma using hydroquinone or skin whitening complex topically on one side of the face vs. a placebo cream on the other. The study was performed during the period November 2000 to March 2001 at the Federal University of São Paulo, Escola Paulista de Medicina.

Methods Thirty patients received three tubes of cream and were divided into two groups: group 1, one tube containing hydroquinone 4% cream and one tube containing placebo to be applied to opposite sides of the face at night, and standardized sunscreen [sun protection factor (SPF) 25] for daily use; group 2, one tube containing skin whitening complex 5% cream and one tube containing placebo to be applied to opposite sides of the face at night, and standardized sunscreen (SPF 25). All of the tubes had the same appearance and the creams had the same characteristics. The only person who knew what was being used by each patient on each side of the face was the pharmacist. A professional photographer took photographs before and after treatment, which lasted for 3 months. Clinical evaluation was performed by two independent observers and by the patients themselves. Statistical evaluation was by the chi‐squared and kappa methods.

Results Twenty‐five patients completed the study, with an overall improvement of 72% in comparison with placebo. Group 1 (hydroquinone and placebo) presented an improvement of 76.9% with 25% side‐effects, and group 2 (skin whitening complex and placebo) presented an improvement of 66.7% with 0% side‐effects.

Conclusions Both depigmentation agents were useful in the treatment of melasma. The hydroquinone group presented more collateral effects than the skin whitening complex group. Considering that the patients showed Fitzpatrick skin types IV to VI and the study was conducted in the summer, skin whitening complex seems to be an excellent choice for the treatment of melasma.
Cranial fasciitis of childhood
Authors: Larralde Margarita , Boggio Paula , Schroh Roberto , Cusumano Humberto
Published: December 2004

A 2‐month‐old boy was seen at our pediatric dermatology department with a history of a tumoral lesion of the scalp since his birth. On examination he had a single, ovoid, firm, 2 × 1.8‐cm painless subcutaneous mass on the temporal left calvarium, covered by normal skin (Fig. 1). It had experienced explosive growth in the preceding 2 weeks. There was no history of previous trauma in the area. The remainder of the examination was normal. Roentgenographic studies of the skull revealed a soft‐tissue mass without involvement of the underlying bone. Ultrasonography of the lesion showed it to be an echolucid tumor. With the presumed diagnosis of dermoid cyst we sent the patient for surgical removal. At surgery, the lesion did not have the typical surgical appearance of a cyst. The histopathologic exam of the specimen was interpreted as cranial fasciitis of childhood (Fig. 2). Immunohistochemistry showed diffuse positivity for vimentin and muscle actin. After 1 year the patient is free of lesions.

Lesion at the temporal left calvarium

image

Proliferation of loosely arranged spindle cells in a loose myxoid stroma (H&E stain, × 40)

image
Mycosis fungoides associated with malignant melanoma and dysplastic nevus syndrome
Authors: Pielop J. A. , Brownell I. , Duvic M.
Published: December 2004

Background The increased risk of second malignancies, including nonmelanoma skin cancers, in cutaneous T‐cell lymphoma (CTCL) patients has been well documented. However, relatively few studies of malignant melanoma in CTCL patients have been reported.

Methods A database of 250 CTCL patients registered over a 3‐year period was searched to identify patients with diagnoses of both mycosis fungoides (MF) and malignant melanoma.

Results We identified six cases of MF associated with malignant melanoma and one associated with dysplastic nevus syndrome, which is a marker of increased risk of melanoma. In four patients, melanoma was diagnosed along with or before MF. In the remaining two patients, MF was diagnosed prior to melanoma, although dysplastic nevi were noted at the time MF was diagnosed. These two patients received treatment for their MF (one with topical nitrogen mustard and another with radiation therapy and nitrogen mustard) prior to the histologic confirmation of melanoma. Six patients had early stages of MF (IA or IB), while one patient presented with simultaneous erythrodermic mycosis fungoides involving the lymph nodes as well as melanoma metastatic to the lymph nodes from an unknown primary.

Conclusion There is an elevated prevalence of malignant melanoma in MF patients compared to the general US population (P < 0.00001) with a relative risk of 15.3 for observing malignant melanoma in MF patients (95% confidence interval 7.0–33.8). Possible pathologic links between the two diagnoses include effects of mycosis fungoides therapies, immunosuppression secondary to mycosis fungoides, and genetic alterations in the p16 tumor suppressor protein.
An open trial of calcium dobesilate in patients with venous ulcers and stasis dermatitis
Authors: Kaur Charandeep , Sarkar Rashmi , Kanwar Amrinder J. , Attri Ashok K. , Dabra Ajay K. , Kochhar Suman
Published: December 2004

Background Venous leg ulcers and associated stasis dermatitis are a major cause of morbidity, economic loss, and decreased quality of life in afflicted patients. Hence, there has been a renewal of interest in the medical management of varicose veins and ulcers. Calcium dobesilate, a capillotropic agent, has been found to be beneficial in the treatment of varicose veins.

Methods This is an open pilot study of 25 patients (15 with venous ulcers with/without stasis dermatitis, 10 with stasis dermatitis only) who were given calcium dobesilate, 500 mg twice daily, for 8 weeks. The clinical parameters were graded (0–4; 0, absent; 1, mild; 2, moderate; 3, severe; 4, very severe) both before and after therapy, and included pain, itching, tiredness, heaviness, paresthesia, cramps, and leg swelling. Evaluation also included subjective changes in tenderness, oozing, and pigmentation, and measurement of the circumference of the leg for swelling and malleolar edema (measured in millimeters). The venous ulcer sizes were also recorded both before and after therapy. Color Doppler studies were performed to confirm the diagnosis of varicose veins, determine the competence of the valves, and to rule out deep vein thrombosis. Serum biochemistry, hemogram, and urinalysis were performed both before and after treatment. The results were analyzed statistically using the Wilcoxon rank sum test and Student's t‐test.

Results A statistically significant improvement was observed post‐therapeutically in the clinical parameters of pain, itching, tiredness, heaviness, and leg swelling. There was also a significant decrease in ulcer size. The serum biochemistry, hemogram, and urinalysis remained unaffected. Color Doppler studies before treatment revealed venous valvular incompetence in 20 patients. They were repeated in only 10 patients after treatment, four of whom showed improved valvular competence. Recurrence of venous ulcers was seen in five of 12 patients who were followed up after therapy. No significant side‐effects were noted.

Conclusions Calcium dobesilate is an effective adjuvant therapy, with an absence of significant side‐effects, in patients with venous ulcers and stasis dermatitis. More double‐blind trials are required in the future to substantiate and evaluate the role of the drug in these two indications.
Characteristics of superficial mycoses in Malta
Authors: Vella Zahra Loranne , Gatt Paul. , Boffa Michael J. , Borg Eileen , Mifsud Edwin , Scerri Lawrence , Vella Briffa Dino , Pace Joseph L.
Published: December 2004

Background  A study was conducted to determine the chief agents of superficial mycoses in Malta. Data were collected over a 5‐year period from mycologic investigations carried out on all dermatologic specimens sent to the Mycology Laboratory at St. Luke's Hospital in Malta.

Methods  In the period between January 1995 and December 1999, a total of 1271 specimens from skin, nails, or hair were collected from 1200 clinically suspected cases of dermatomycoses.

Results  The fungi cultivated included dermatophytes (n = 371), yeasts (n = 33), and nondermatophyte filamentous fungi (n = 12). Trichophyton rubrum (n = 121) was the most prevalent, followed by Microsporum canis (n = 109), T. mentagrophytes (n = 80), M. gypseum (n = 27), Epidermophyton floccosum (n = 17), T. soudanense (n = 10), T. tonsurans (n = 2), T. verrucosum (n = 2), M. persicolor (n = 1), and T. violaceum (n = 1). Candida species were also cultivated, with C. parapsilosis (n = 14) being the most common, followed by C. albicans (n = 12) and C. tropicalis (n = 6). Nondermatophyte filamentous fungi were isolated from nail specimens only.

Conclusions  In this study, superficial fungal infections were reported more commonly in female (n = 207) than in male (n = 182) patients. M. canis was the chief agent of tinea capitis and tinea corporis, whilst T. rubrum was the main causative agent of tinea pedis, tinea manuum, and tinea unguium. Onychomycosis due to Candida species was more common in female than in male patients.
Repeat courses of intravenous alefacept in patients with chronic plaque psoriasis provide consistent safety and efficacy
Authors: Lowe Nick J. , Gonzalez John , Bagel Jerry , Caro Ivor , Ellis Charles N. , Menter Alan
Published: December 2004

Background Psoriasis is a chronic, relapsing skin disease that may require multiple treatment courses. Alefacept targets the memory T cells implicated in psoriasis pathogenesis. This open‐label study evaluated the safety and tolerability, efficacy, and pharmacodynamics of repeat courses of alefacept in men and women with chronic plaque psoriasis. This article reports the interim results of this ongoing study.

Methods Patients (n = 174) who participated in previous phase II studies of alefacept were included in this retreatment study. Intravenous alefacept (7.5 mg) was administered once weekly for 12 weeks followed by 12 weeks of observation. Initial and subsequent retreatment courses were only given when, in the opinion of the investigators, disease had returned and necessitated treatment; CD4+ T‐cell counts had to be at or above the lower limit of normal.

Results Adverse events were similar regardless of the retreatment course. No opportunistic infections, rebound of disease, or flares were reported. Low titers of anti‐alefacept antibodies occurred in a few patients without related safety issues. Sixty‐six per cent of patients achieved a ≥ 50% reduction in the Psoriasis Area and Severity Index (PASI) at any time after the first dose of retreatment course 1. Patients who received two retreatment courses (n = 50) had consistent or improved responses after the second course; 64% and 68% of these patients achieved a ≥ 50% PASI improvement at any time after the first dose of retreatment courses 1 and 2, respectively. Alefacept selectively reduced memory T cells without cumulative effects.

Conclusions Repeat courses of alefacept were well tolerated, and subsequent retreatment courses were at least as effective as the initial course of therapy.
American Cutaneous Leishmaniasis unresponsive to antimonial drugs: successful treatment using combination of N‐Methilglucamine Antimoniate plus Pentoxifylline
Authors: Báfica André , Oliveira Fabiano , Freitas Luiz A. R. , Nascimento Eliane G. , Barral Aldina
Published: December 2004

Background American cutaneous leishmaniasis is characterized by single or multiple ulcerations. Cytokines, among other factors, have been shown to influence lesion development and tumoral necrosis factor‐alpha is a major cytokine implicated in pathogenesis of ulcers.

Observations We tested oral pentoxifylline, a known tumoral necrosis factor‐alpha inhibitor, at doses of 400 mg (2–3x/day), associated to N‐methylglucamine antimoniate (15 mg/kg/day) in two patients with American cutaneous leishmaniasis unresponsive to antimonial drugs. We observed a satisfactory response with quick cure of skin lesions of these patients.

Conclusions Our results suggest that oral pentoxifylline in association to N‐methylglucamine antimoniate should be consider in refractory cutaneous leishmaniasis patients.
High incidence of demodicidosis in eyelid basal cell carcinomas
Authors: Erbagci Zülal , Erbagci Ibrahim , Erkiliç Suna
Published: December 2004

Background Although UV radiation is the major cause of basal cell carcinoma (BCC), local factors, such as chronic trauma, irritation, or inflammation, may also have some role in its etiopathogenesis. The pilosebaceous follicle mites, Demodex folliculorum and D. brevis, inhabit most commonly and densely certain facial skin areas, including the nose and periorbital regions, where BCC also develops most frequently.

Aim To investigate, in a retrospective histopathologic study, whether a possible etiopathogenetic relationship exists between demodicidosis and eyelid BCCs.

Methods We examined 32 eyelid BCC specimens that contained at least five eyelashes or five hair follicles with respect to the presence and density of Demodex mites. As controls, we evaluated 34 matched specimens consisting of benign eyelid skin lesions.

Results Twenty‐one of 32 BCC cases (65.6%) and eight of 34 control cases (23.33%) had demodicidosis. Mean mite counts were 1.31 ± 1.57 and 0.47 ± 0.99 in BCC cases and controls, respectively. The differences were significant for both prevalence (P < 0.001) and density (P = 0.0052). Although there was a significant positive correlation between increasing mite number and patient age in the control group (r = 0.47, P < 0.05), no significant correlation was found between these two factors in BCC cases (r = −0.102, P > 0.05).

Conclusions Demodicidosis may be one of the triggering factors of carcinogenesis in eyelid BCCs in otherwise predisposed people due to its traumatic/irritating effect or chronic inflammation.
Forage Chicory: A Plant Resource for Nutrient‐Rich Sites
Authors: Alloush G. A. , Belesky D. P. , Clapham W. M.
Published: December 2004

Grazing livestock create localized nutrient patches that increase soil ionic strength (IS) and influence plant productivity. The ability of plant root systems to control ion absorption and flux to xylem, and to sequester ions reaching leaf tissue in bound, nontoxic forms are means of minimizing IS. A greenhouse experiment was conducted to determine the growth and mineral acquisition responses of forage chicory (Cichorium intybus L. cv. Grasslands Puna) to increasing (0.9, 4, 8, and 12 dS m−1) IS in the rhizosphere obtained by additions of NaCl/CaCl2 (1 : 1 m ratio). Plants were harvested four times after planting (20, 27, 34 and 41 d) to identify responses as a function of time. Increased accumulation and localization of Na in roots in comparison to shoots suggested that chicory restricted Na transport to shoots, and that insoluble Na in tissues increased with increasing IS. Soluble cations in shoots were about 50 % of total cations, irrespective of rhizosphere IS and Na uptake. Differences in the cation:anion ratio could not be accounted for by organic acid concentrations in chicory, but substantial accumulation of nonstructural carbohydrates as fructans in roots could contribute to charge balance. Our results demonstrate that forage chicory has moderate tolerance to IS, suggesting that it might be a useful species for sites with potential for IS. Chicory growth would probably be sustained under IS conditions, and the resultant vigorous growth and accumulation of mineral nutrients in shoots would contribute to acceptable nutritive value for grazing livestock. Plants capable of growing in and acquiring nutrients from nutrient‐laden patches in the sward would help minimize erosion and nutrient transport, with positive benefits for water and soil quality.
The Involvement of Cytokinin and Abscisic Acid Levels in Roots in the Regulation of Photosynthesis Function in Flag Leaves during Grain Filling in Super High‐yielding Rice (Oryza sativa)
Authors: Shu‐Qing C. , Rong‐Xian Z. , Wei L. , Zhi‐Rui D. , Qi‐Ming Z.
Published: December 2004

A few rice cultivars with super high‐yielding potential have successfully been released. However, little is known about the physiological mechanisms underlying the formation of super high yield in rice. Here, we report changes of cytokinin (zeatin + zeatin riboside, ZR) and abscisic acid (ABA) contents in roots and leaves during grain filling and their relation to declining photosynthesis function of leaves in super high‐yielding rice cv. Xieyou 9308 and standard rice cv. Shanyou 63, as a control. ZR contents in roots and leaves decreased in a time‐dependent manner, while their ABA contents were relatively stable at earlier grain filling stage and rapidly increased at later grain filling stage in both cultivars. A rapid decrease in ZR content and a rapid increase in ABA content were observed earlier in roots than in leaves for both cultivars. Declining instantaneous photosynthesis rate (IAPS) of leaves in both cultivars coincided with decreasing ZR contents and increasing ABA contents in both roots and leaves. Leaves with 6‐benzyl aminopurine (6‐BA) treatment exhibited increased IAPS and extended active photosynthesis duration (APD), and the result was reversed in leaves with ABA treatment. A rapid decrease in ZR contents and a rapid increase in ABA contents of roots and leaves in Xieyou 9308 obviously lagged behind those in Shanyou 63. These results suggest that decreased ZR content and increased ABA content in roots cause the decline of photosynthetic function during grain filling stage. The highly efficient photosynthetic function of Xieyou 9308 is due to the delayed change of ZR and ABA contents in its roots.
The sugarcane borerDiatraea saccharalis(Fabr.) (Lep., Crambidae) and its parasitoids: a synchrony approach to spatial and temporal dynamics
Authors: Rossi M. N. , Fowler H. G.
Published: December 2004

Abstract: A data set onDiatraea saccharalisand its parasitoids,Cotesia flavipesand tachinid flies, was analysed at five spatial scales – sugarcane mill, region, intermediary, farm and zone – to determine the role of spatial scale in synchrony patterns, and on temporal population variability. To analyse synchrony patterns, only the three highest spatial scales were considered, but for temporal population variability, all spatial scales were adopted. The synchrony–distance relationship revealed complex spatial structures depending on both species and spatial scale. Temporal population variability [SD log(x + 1)] levels were highest at the smallest spatial scales although, in the majority of the cases, temporal variability was inversely dependent on sample size. All the species studied, with a few exceptions, presented spatial synchrony independent of spatial scale. The tachinid flies exhibited stronger synchrony dynamics thanD. saccharalisandC. flavipesin all spatial scales with the latter displaying the weakest synchrony levels, except when mill spatial scales were compared. In some cases spatial synchrony may at first decay and then increase with distance, but the presence of such patterns can change depending on the spatial scale adopted.
Can Ips typographus (L.) (Col., Scolytidae) smell the carrion odours of the dead beetles in pheromone traps? Electrophysiological analysis
Authors: Zhang Q.‐H. , Jakuš R. , Schlyter F. , Birgersson G.
Published: December 2004

Abstract:  Head‐space samples of Ips typographus dead beetles taken from pheromone traps were tested by combined gas chromatography and electroantennographic detection (GC–EAD) on the antennae of the same species, and identified by GC‐mass spectroscopy (MS). The GC‐EAD analysis showed that antennae of both sexes responded to 1‐hexanol and verbenone from the aeration samples, while the typical and strong carrion odours from the dead beetles such as dimethyl disulphide, 3‐methyl‐1‐butenol (isoamyl alcohol), 2,5‐dimethyl pyrazine and isovaleric acid elicited no antennal responses. The EAD active compounds, 1‐hexanol and verbenone, have been shown in earlier studies to be inhibitory on attraction of I. typographus to pheromone traps. Thus, the decreased catching efficacy of pheromone traps with many dead beetles might be the result of the release of 1‐hexanol and verbenone from the dead beetles, but not to the typical carrion smells which are strongly detected by the human nose.
Improving geriatric mental health nursing care: Making a case for going beyond psychotropic medications
Authors: Voyer Philippe , Martin Lori Schindel
Published: December 2004

Providing high‐quality mental health nursing care should be an important and continuous preoccupation in the gerontological nursing field. As the proportion of elderly people in our society is growing, the emphasis on high‐quality care will receive increasing attention from administrators, politicians, organized groups, researchers and clinical nurses. Recent findings illustrate unequivocally the important contribution of nurses to achieving the goal of high‐quality geriatric care. However, the quality of care for the elderly with psychological difficulties has not been addressed. The objective of this article is to illustrate that while nurses can accomplish much to improve the well‐being and mental health of the elderly, their skills are often underutilized. Psychotropic drugs are often the first‐line interventions used by health‐care professionals to treat mental health concerns of elderly persons. Alternative therapies that could be implemented and evaluated, such as psychological counselling, supportive counselling, education and life review, are infrequently used. Nevertheless, current scientific data suggest that it would be very advantageous if nurses were to play a dominant role in the care of elderly people who are depressed or experiencing sleep pattern disturbances. The same can be said about elderly chronic users of benzodiazepines, as well as those with cognitive impairment. Evidence for the use of psychotropic medications as a viable treatment option for the elderly both in the community and in the long‐term care setting who are experiencing mental health challenges is examined. Alternative non‐pharmacological approaches that nurses can use to augment care are also briefly discussed.
A survey of threats and violent behaviour by patients against registered nurses in their first year of practice
Authors: McKenna Brian G. , Poole Suzette J. , Smith Naumai A. , Coverdale John H. , Gale Chris K.
Published: December 2004

ABSTRACT

The purpose of the present study was to determine the prevalence of aggressive behaviours by patients against nurses in the first year of practice, and to determine the psychological impact of this behaviour. An anonymous survey was sent to registered nurses in their first year of practice. From the 1169 survey instruments that were distributed, 551 were returned completed (a response rate of 47%). The most common inappropriate behaviour by patients involved verbal threats (n = 192, 35%), verbal sexual harassment (n = 167, 30%) and physical intimidation (n = 161, 29%). There were 22 incidents of assault requiring medical intervention and 21 incidents of participants being stalked by patients. Male graduates and younger nurses were especially vulnerable. Mental health was the service area most at risk. A most distressing incident was described by 123 (22%) of respondents. The level of distress caused by the incident was rated by 68 of the 123 respondents (55%) as moderate or severe. Only half of those who described a most distressing event indicated they had some undergraduate training in protecting against assault or in managing potentially violent incidents (n = 63 of 123; 51%). After registration, 45 (37%) indicated they had had such training. The findings of this study indicate priorities for effective prevention programmes. The issues highlighted need to be addressed in undergraduate nursing curricula and in the development of orientation programmes supporting new graduates.
Prostate cancer in patients with Hansen's disease
Authors: Kiriyama Isao , Ohgaki Kenji , Ohba Shuji , Egawa Katushi , Nishimura Taiji
Published: December 2004

Hansen's disease causes testicular failure secondarily, and because of this, it has been considered that prostate cancer would not be found in association. Three of 14 patients with chronic leprosy in Suruga National Sanatorium Hansen's Disease Hospital were found to have prostate cancer. A 72‐year‐old with lepromatous leprosy was diagnosed with stage T3a prostate cancer and treated with radical prostatectomy after hormonal therapy, plus irradiation. An 80‐year‐old with lepromatous leprosy was diagnosed with stage T2 prostate cancer and treated with irradiation and follow up only without hormone therapy and surgery because of his low testosterone level and old age. An 82‐year‐old with borderline leprosy was diagnosed with stage T1c prostate cancer and because of the pathological finding of low Gleason score and his old age, he was treated with hormonal therapy only. Two of the three cases had elevated concentrations of follicle‐stimulating hormone and luteinizing hormone, which suggests that their prostatic cancers might have been equivalent to be under the influence of hormone therapy. Therefore, in aged male patients with Hansen's disease, the follicle‐stimulating hormone, luteinizing hormone and testosterone concentrations should be measured, as well as that of prostate‐specific antigen, and a prostate biopsy should be also considered if the prostate‐specific antigen concentration is increased, even with hypogonadism.
Desmoid tumor in a scar from radical nephrectomy for renal cancer
Authors: FUJITA KAZUTOSHI , SUGAO HIDEKI , TSUJIKAWA KOZO , ITOH YASUHIRO
Published: December 2004

Desmoid tumor is a fibroblastic proliferation arising in musculoaponeurotic tissues. We report a case of abdominal desmoid tumor discovered 2 years after radical nephrectomy for right renal cell carcinoma. Surgical extirpation was performed and the patient remained well 2 years later with no evidence of disease. The possibility of desmoid tumors developing in the incised abdominal wall should be considered while following patients after surgery.
Fracture of the penis: Nine cases with evaluation of reported cases in Japan
Authors: ISHIKAWA TOMOMOTO , FUJISAWA MASATO , TAMADA HIROSHI , INOUE TAKAAKI , SHIMATANI NOBORI
Published: December 2004

Background: Fracture of the penis is a relatively rare condition that is defined as a rupture of the tumescent corpora cavernosa as a result of blunt trauma, most commonly during sexual intercourse or masturbation. The fracture is easy to recognize but treatment remains controversial. We, therefore, examined the treatment methods for penile fracture.

Methods: Between December 1990 and March 2001, eight patients underwent immediate surgical repair on the first or second day after fracture of the penis, and one patient underwent surgery on the 30th day after fracture, at Kansai Rosai Hospital. Patient age at presentation ranged from 15 to 55 years. Eight patients came to the hospital 2–23 h after the fracture occurred. All patients complained of penile swelling and ecchymosis. Three patients reported hearing a snapping sound. None of the patients demonstrated macroscopic hematuria.

Results: We treated all of the patients surgically. All patients showed a unilateral injured corporeal rupture. We took a circumferential coronal incision under the glans and repaired with absorbable stitch. At follow‐up, eight of the nine patients who were available reported the achievement of an adequate erection for intercourse without erectile or voiding dysfunction.

Conclusion: All patients were treated surgically and recovered successfully. Therefore, immediate repair is recommended for the treatment of penile fracture.
Management of atrial fibrillation in the emergency department
Authors: Crozier I. , Melton I. , Pearson S.
Published: December 2004

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is a frequent cause for presentation to the emergency department. With an understanding of the pathophysiology and types of AF, efficient and effective management strategies for AF can be formulated. Patients with paroxysmal AF will often revert spontaneously and can initially be managed on an outpatient basis, unless an antiarrhythmic is commenced. In patients with AF and severe underlying heart disease, the management is primarily directed at the underlying heart disease, supplemented with rate‐controlling measures, and prevention of thromboembolic complications. In patients with persistent AF good rate control, early cardioversion and initiation of an antiarrhythmic are likely to reduce the risk of recurrence. (Intern Med J 2003; 33: 182−185)