bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and safety of itraconazole pulse therapy: Brazilian multicentric study on toenail onychomycosis caused by dermatophytes
Authors: Ramos‐e‐Silva Marcia , Marques Silvio Alencar , Gontijo Bernardo , Zaitz Clarisse , Campbell Iphis , Veloso Simone Tavares
Published: September 2006

Background

Itraconazole is a large spectrum triazole with known efficacy in both continuous and pulse therapy for various mycoses.

Objectives

Evaluate the efficacy and tolerability of itraconazole pulse therapy for onychomycosis of the toenails due to dermatophytes, in a prospective, open, non‐comparative and multicentric investigation.

Patients and methods

The trial was completed by 72 patients of an initial total of 89. Treatment consisted of four cycles of itraconazole, 200 mg twice a day, for seven consecutive days each month. Patients were evaluated clinically, mycologically and biochemically before, during and at the end of the investigation, and were divided into two groups according to the measure of normal portion of the most affected nail (target nail), as follows: Group 1: 0–5.9 mm; and Group 2: more than 6 mm.

Results

Improvement was satisfactory and progressive. Results were statistically significant, when comparing the three moments. of the study: pre‐treatment, end of therapy (fourth month) and follow‐up (ninth month) in both groups.

Conclusions

Itraconazole pulse therapy was efficient and safe for the treatment of onychomycosis caused by dermatophytes, although a much higher daily dosage than the known continuous administration was used. Group 1, with nails initially more extensively affected, had a more evident improvement, by the mean variation in millimeters of normal portion of the target nail. This group showed a very satisfactory response, although not reaching total cure, thus demonstrating the great importance of early treatment of this disease. A residual therapeutic effect is maintained even after suspension of the drug. Group 2 obtained better total cure rates, and four pulses were, in general, sufficient, whereas more cycles would have been beneficial for the Group 1 patients with more extensive involvement.
In vivo and in vitro investigations of hydration effects of beauty care products by high‐field MRI and NMR microscopy
Authors: Szayna M. , Kuhn W.
Published: September 2006

Aim

Data obtained from in vivo and in vitro measurements on human skin and skin samples are presented.

Methods

In vivo measurements, using a 3‐Tesla magnetic resonance system, on the forearm of three female volunteers show an increase of signal intensity, after application of cream, between 30% and 58%, depending on the cream type. In‐plane resolution was 90 μm, with slice thickness of 2 mm. Chemical‐shift‐selective in vitro microimaging studies were performed on a 9.4‐T spectrometer using human skin samples from the abdomen. In these experiments, in‐plane resolution was 4 μm and slice thickness was 100 μm.

Results

The results demonstrate clearly the moisturising effect of beauty care products on the stratum corneum, which can be identified in in vitro experiments. No ingress into the skin of the lipid components of the emulsions could be observed in vitro. However, skin occlusion and consequently a long‐lasting moisturising effect cannot be excluded.

Conclusions

These results prove the capability of magnetic resonance imaging to investigate human skin in vivo and in vitro, and to follow the skin penetration of beauty‐care products and pharmaceutical ointments.
Bullous erythema multiforme following herpes zoster and varicella‐zoster virus infection
Authors: Weismann Kaare , Petersen Carsten Sand , Blichmann Christa W. , Nielsen Niels Henrik , Hultberg Birthe Mørch
Published: September 2006

Four cases of herpes zoster‐induced bullous erythema multiforme (EM) are reported. Three patients presented with widespread skin lesions 10 to 14 days after an episode of thoracic herpes zoster. In these patients a high increase in varicella‐zoster virus (VZV) antibody titer was detected, indicating secondary VZV infection. Histologic examinations of skin biopsy from a patient with widespread lesions (case 4) revealed a mixture of EM, toxic epidermal necrolysis and herpetic virus infection. VZV should be included in the list of infectious agents able to trigger EM and Stevens‐Johnson syndrome.
Cutaneous angiomyolipoma: report of two cases with emphasis on HMB‐45 utility
Authors: Büyükbabani Nesimi , Tetikkurt Seza , Öztürk A. Settar
Published: September 2006

Background

Angiomyolipomas are tumors composed of adipose tissue, blood vessels and smooth muscle. Although renal angiomyolipomas are well known, cutaneous tumors have been described only recently. HMB‐45 reactivity, reported for renal angiomyolipomas, has been suggested as a useful tool in differential diagnosis.

Objective

Two cases of cutaneous angiomyolipoma are described and investigated for HMB‐45 reactivity.

Methods

Conventional histochemical and immunohistochemical methods were used.

Results

Immunohistochemical analysis showed no reactivity for HMB‐45 antibody.

Conclusion

We conclude that, unlike renal angiomyolipomas, HMB‐45 reactivity is not helpful in differentiating cutaneous angiomyolipomas.
Incontinentia pigmenti: variable disease expression within an affected family
Authors: Basarab T. , Dunnill M.G.S. , Munn S.E. , Russell‐Jones R.
Published: September 2006

We report a florid case of incontinentia pigmenti in a neonate in which linear vesiculobullous, verrucous and pigmented lesions were present simultaneously at birth. Histology of a vesiculobullous lesion showed vesiculation with numerous eosinophils in the epidermis, and a sparse infiltrate in the dermis with pigmentary incontinence. The mother of our patient described a streaky linear rash on her legs during her own childhood which resolved spontaneously, in addition to partial anodontia, suggesting that she too has the disease, although previously undiagnosed. This emphasises the variable disease expression and the importance of recognising this condition so that patients can be followed up with regard to complications, and genetic counselling can be offered. The issue of prenatal diagnosis is discussed.
Continuing medical education
Authors: Piérard G.E.
Published: September 2006

General description Colour assessment of skin by visual inspection alone may be precise for a given individual although comparison between colours is only possible when they are viewed simultaneously. Subjective colour expression is also difficult to communicate with consistency. The limitations of visual observations may be overcome by colour‐order systems and by instrumental measurements using either reflectance spectrophotometry or reflectance colorimetry following the CLE (Commission Internationale de ľEclariage) recommendations. Image analysis using sensitive colour video cameras is another accurate method to record and compare skin colours. The current instrumental methods have proven both sensitive and reliable. Numerical colour communication expresses colours more precisely than words and allows exact analysis of skin pigmentation and skin colour changes.

Learning objective The reader will be introduced to the origins of skin colours and with basic principles of their measurements. Methods of colour reading are reviewed with particular insight into practical procedures, pitfalls and correct interpretation of data.
Duodenal ulcer patients exhibit a greater skin response to histamine
Authors: Tur Ethel , Aviram Galit , Meidan Michal , Zeltser David , Brenner Sarah
Published: September 2006

Background Histamine is considered a major mediator in the process of gastric acid secretion. When acid peptic activity overpowers the mucosal defense mechanism, peptic ulceration may develop. Is the hyperreactivity of patients with duodenal ulcer to histamine also expressed in the skin?

Objective The aim of the present study was to assess the reactivity of patients with duodenal ulcer to histamine as reflected in the skin, by comparing the erythema and the cutaneous blood flow response to histamine in duodenal ulcer patients and healthy controls.

Methods Twenty volunteers participated in the study: 10 duodenal ulcer patients and 10 age and gender matched healthy controls. Histamine was topically administered to the back and to the volar side of the forearm, and the induced response was quantified by spectrophotometry and laser Doppler flowmetry (LDF). The extent of the response and time parameters were compared.

Results The maximum response, as measured by LDF, was greater in the peptic ulcer patients (P < 0.05) compared to healthy controls. Aging was accompanied by decreased responsiveness in both groups.

Conclusion The results suggest that some peptic ulcer patients exhibit a greater cutaneous response to topical application of histamine than healthy controls. As the methods used are non‐invasive, simple and rapid, they might be useful in preclinical ulcer diagnosis and detection of patients at risk. © 1998 Elsevier Science B.V.
Classic Kaposi's sarcoma in two young heterosexual men
Authors: Potouridou Irene , Katsambas Andreas , Pantazi Vassiliki , Armenaka Melina , Stavrianeas Nikos , Stratigos John
Published: September 2006

Classic Kaposi's sarcoma is primarily a skin disease of the lower extremities affecting predominantly elderly men of Mediterranean origin. We report classic Kaposi's sarcoma first presenting in the third decade in two heterosexual, HIV‐negative, males of Greek origin from Albania. Ten years after onset, the disease became aggressive with unusual clinical features that included exophytic tumors, extensive lesions on the hands as well as the legs, and prominent leg edema. One of the patients also presented lesions on the face, trunk and palate, and bubonic lymphadenopathy. In both cases, CD4 counts were normal and HLA‐DR5 was positive. Treatment included radiation therapy, subcutaneous interferon (alpha 2b) and combined chemotherapy (ABV). At follow up 1 and 2 years later, both patients remain in partial remission with significant improvement in clinical disease, on maintenance interferon.
Juvenile acute cutaneous leishmaniasis: the first case report from North Scandinavia
Authors: Gasior‐Chrzan Barbara
Published: September 2006

A case of juvenile acute cutaneous leishmaniasis is reported. Treatment with freezing with CO2 snow was beneficial in healing of cutaneous lesions and no relapses have occurred.
Clobetasol propionate followed by calcipotriol is superior to calcipotriol alone in topical treatment of psoriasis
Authors: Austad Joar , Bjerke Jens R. , Gjertsen Bjørn T. , Helland Svein , Livden John K. , Morken Tore , Mørk Nils‐jørgen
Published: September 2006

Background Although potent, topical corticosteroids offer effective and rapid healing of psoriatic lesions. Their long term use is limited because of the risk of side effects. Calcipotriol is safe for long‐term treatment, but its initial efficacy is lower than with topical corticosteroids.

Objectives To investigate whether 2 weeks of treatment with clobetasol propionate 0.05% ointment bd followed by 4 weeks of treatment with calcipotriol 50 /μg/g bd would offer therapeutic advantages over 6 weeks of continuous treatment with calcipotriol.

Methods Forty‐nine patients with moderate to severe plaque psoriasis were recruited from five centres in Norway. In a randomised, double‐blind, right‐ versus left‐side comparison, ointments were applied to two symmetrically‐located areas.

Results Two weeks of treatment with clobetasol propionate produced a significantly greater decrease in total symptom score (combined scores of erythema, induration and scaling) than calcipotriol treatment (P < 0.0001). This improvement on the clobetasol.propionate‐treated side of the body was maintained throughout a subsequent 4‐week treatment period when calcipotriol was applied to both sides of the body (P < 0.0001). The superiority of the clobetasol propionate followed by calcipotriol treatment was maintained during a 4‐week, treatment‐free, observation period. Treatments were well tolerated with no rebound effect.

Conclusions Clobetasol propionate ointment bd for 2 weeks followed by treatment with calcipotriol ointment bd for 4 weeks was superior to calcipotriol ointment alone in the treatment of plaque psoriasis.
Adult dermatomyositis with livedo reticularis and multiple skin ulcers
Authors: Yosipovitch G. , Feinmesser M. , David M.
Published: September 2006

Skin ulcers are commonly described in the juvenile form of dermatomyositis; however, in the adult form they are rarely described. We report on a patient with adult dermatomyositis, deep cutaneous ulcers in the skin folds and livedo reticularis eruption.
Sexually transmitted diseases in 1161 HIV‐positive patients: a 38‐month prospective study in southern Spain
Authors: Muñoz‐Pérez M.A. , Rodriguez‐Pichardo A. , Martinez F. Camacho
Published: September 2006

Background HIV infection is primarily a sexually transmitted disease (STD), but intravenous drug use (IDU) is the main risk factor for HIV infection in certain areas, including southern Europe. A number of prospective studies of dermatological findings in HIV‐1 infected patients have been published, almost all from countries where homosexuality is the main risk factor of HIV infection and without correlation with CD4 cell counts. No STD data is included in those studies.

Objective To determine the incidence of STDs in a cohort of 1161 HIV‐1‐positive patients from Spain, in the previous medical history and during the prospective study.

Methods We prospectively examined 1161 HIV‐1‐positive patients for 38 months, 986 men and 175 women. IDU was the risk factor in 74%, while homosexuality was a risk factor in only 9%. CDC stage II was predominant (51%), while stage IV was less frequent (39%). The mean CD4 cell count was 353/mm3. Patients' past and present medical history of STDs was obtained. CD4 cells/mm3 counts were measured at each visit.

Results Six hundred and eighty‐four patients had a past history of STD, whilst new infections were diagnosed in 258 individuals (22%) during the 38‐month study. Pediculosis pubis (26%), gonorrhoea (22%), syphilis (13%), genital Candida infection (11%) and condyloma acuminatum (10%) were the commonest previous STDs, followed by non‐gonococcal urethritis (NGU) (5%), genital herpes (4%) and trichomoniasis (2%). During the 38‐month study period and with strong recommendation of condom use for sexual intercourse, condyloma acuminatum (7%), scabies (6%), syphilis (4%) and genital herpes (3%) were commonly diagnosed, followed by gonorrhoea (1.8%), NGU (1.6%), genital Candida infection (1,5%), pediculosis pubis (0.6%) and trichomoniasis (0.3%). Only genital herpes had a statistically significant association with advanced stage (P= 5.12 × 10‐6) and low CD4 cell counts (180 ± 166 cells/mm3).

Conclusion Despite the predominance of the IDU factor among our patients, the incidence of STDs in the past medical history was surprisingly high. The incidence of STD during the study was also high, despite the advice of using condoms after the diagnosis of HIV infection. STDs may accelerate the course of HIV infection and be a poor prognostic indicator in these patients. If an HIV‐1‐positive patient can acquire an STD, he/she can also transmit HIV infection. This indicates that new publicity campaigns are still needed to stop HIV and STDs infection among HIV‐positive patients as well as in the general population.
Eosinophils, pruritus and psoriasis: effects of treatment with etretinate or cyclosporin‐A
Authors: Schopf R.E. , Hultsch T. , Lotz J. , Bräutigam M.
Published: September 2006

Background The antipsoriatic drugs cyclosporin A (CyA) and etretinate have been found to influence proinflammatory eosinophilic leukocytes and pruritus.

Aim We compared the number of Wood eosinophils, concentration of serum eosinophil cationic protein (ECP), and pruritus in patients with psoriasis treated with either CyA or etretinate.

Study design Patients with psoriasis vulgaris were randomly assigned to treatment for 10 weeks with either CyA (n= 21) or etretinate (n= 10). The psoriasis area‐and‐severity index (PASI‐score) and pruritus (according to a 0–3 scale) served as clinical parameters, the blood esosinophil counts (Coulter Counter) and the serum ECP (RIA, Pharmacia) as laboratory parameters.

Results After CyA treatment the PASI‐score amounted to 24 ± 4%, after etretinate to 56 ± 6% of the initial values (mean ± SEM). One week after CyA treatment, esosinophils dropped from 190 ± 21 to 137 ± 16/μ (P= 0.038, Wilcoxon test), after 10 weeks to 127 ± 18/μ (P= 0.006). By contrast, under etretinate blood eosinophil counts only changed marginally. Before treatment, ECP concentrations of 15.71 ± 1.30 (CyA) and 15.3 ± 5.53 μg/1 (etretinate) were measured (normal range 3–16 /μg/1), ECP remained constant under both CyA and etretinate or tended to increase after 10 weeks; about 50% of the patients exhibited elevated ECP concentrations. Pruritus diminished more with CyA than etretinate therapy. PASI‐scores and pruritus were directly proportional.

Outcome We conclude that treatment of psoriasis with CyA leads to a rapid drop of blood eosinophils and that the activation state of eosinophils does not decrease after antipsoriatic treatment. Pruritus in psoriasis is coupled to disease severity. The underlying antipsoriatic mechanisms of CyA may be linked to lowering the number of blood eosinophils.
Altered sperm function or sperm antibodies are not associated with chlamydial antibodies in infertile men with leucocytospermia
Authors: Habermann Barbara , Krause Walter
Published: September 2006

Objective

Leucocytospermia, defined as a concentration of more than 106 leucocytes/ml of seminal fluid in patients without clinical symptoms due to an adnexitis, is seen in about 10% of patients in an infertility department. Infection with Chlamydia trachomatis is possibly relevant as other pathogenic bacteria were not cultured from the semen in significant numbers.

Setting

University Clinic, Department of Andrology.

Patients

Two hundred and seven patients attending the department for male infertility investigation.

Methods

Analysis on each semen sample included determination of leucocyte count and the MAR test for the detection of sperm antibodies. Chlamydial antibodies in semen were determined using an on‐slide enzyme immunoassay.

Results

No differences between leucocyte counts in patients with and without chlamydial antibodies were detected. In addition, no differences in the sperm parameters or results of MAR‐tests in these two groups was seen. There were no correlations between the leucocyte count and sperm parameters, including the MAR‐test results.

Conclusions

We conclude that antibodies to chlamydiae in semen are not associated with leucocytospermia. Leucocytospermia per se does not appear to be significant for the sperm functions and immune responses to sperm.
Two cases of tinea pedis caused by Scytalidium hyalinum
Authors: Romano Clara , Valenti Lidia , Difonzo Elisa Margherita
Published: September 2006

Two cases of tinea pedis due to Scytalidium hyalinum, the first to be described in Italy, are reported. The patients were a 41‐year‐old woman and a 35‐year‐old man who had spent periods in the Caribbean. The clinical manifestations were indistinguishable from those caused by dermatophytes. In the woman they were striking with ‘moccasin foot’ type lesions, whereas in the man they were less evident, with minor plantar desquamation and interdigital maceration. Diagnosis was based on direct mycological microscopic examination and culture. Clinical and mycological remission were obtained with systemic itraconazole therapy. These cases are reported because infections caused by Scytalidium hyalinum are rare in Europe and their clinical and mycological diagnosis, as well as therapy, may be problematic.
Eosinophilic cellulitis (Wells' syndrome): a new case description
Authors: Ferreli C. , Pinna A.L. , Atzori L. , Aste N.
Published: September 2006

Background

Wells' syndrome was first described by Wells in 1971 as a recurrent granulomatous dermatitis with eosinophilia and was later named eosinophilic cellulitis. It is defined by the following criteria: (i) sudden onset of annular or circinate erythematous‐edematous patches that rapidly evolve to morphea‐like blue‐slate‐colored plaques; (ii) a histological picture usually characterized by the presence of ‘flame figures’ (iii) non‐constant blood hypereosinophilia.

Methods

We describe the case of a 49‐year‐old woman who reported the sudden appearance of a few hard, pasty, oval‐shaped, reddish‐violet, moderately itchy, erythematous‐edematous patches on both arms about 2 months before our observation.

Results

The remote pathologic history showed that the woman have been submitted to quadrantectomy with lymph node dissection followed by cobalt therapy for breast cancer. Based on the pharmacological history, intake of drugs was excluded. Routine blood chemistry and instrumental tests did not show any alteration, nor did assays of the main autoantibodies, complement, circulating immunocomplexes, or tumor markers.

Conclusions

Histologically the picture was compatible with the diagnosis of Eosinophilic cellulitis. Following topical corticosteroid therapy the lesion healed rapidly. It relapsed 2 months later, and was again cured with the same topical treatment. No further relapses were observed in a 1 year follow‐up.
Perifollicular fibroma
Authors: Cho Soyun , Hahm Jeong‐Hee
Published: September 2006

Perifollicular fibroma(PFF) is a rare cutaneous hamartoma that shows differentiation in the connective tissue sheath of the hair follicle. It may be single (congenital or acquired) or multiple (late onset). We report a 14‐year‐old Korean boy with a congenital solitary PFF on the face, which supports the ne void concept of origin rather than a reactive response to injury.
Toxic epidermal necrolysis following morbilli‐parotitis‐rubella vaccination
Authors: Dobrosavljevic Danijela , Milinkovic Mirjana V. , Nikolic Milos M.
Published: September 2006

We present the first reported case of toxic epidermal necrolysis (TEN) caused by morbilli‐parotitis‐rubella (MPR) vaccine. A 13‐year‐old girl developed TEN 7 days after she received live, attenuated, triple MPR vaccine. The history of drug intake and any illness was negative. At admission the patient was acutely ill with high fever. The whole body was erythematous. The epidermis was wrinkled and the Nikolsky sign was positive. Numerous erosions were present on the lips and genital region. On the seventh day of illness, the eruption involved 80% of the skin. Systemic corticosteroid therapy was not employed. The skin and mucosal defects completely epithelized by the end of the third week of illness. Mild keratoconjunctivitis sicca remained because of permanent cup cell damage.
Acquired cutaneous lymphangiectasia in a patient with cirrhotic ascites
Authors: Garcia‐Doval Ignacio , de la Torre Carlos , Losada Antonio , Ocampo Conceptión , Rodríguez Teresa , Cruces Manuel J.
Published: September 2006

Background

Lymphangiectasia results from acquired dilation of lymphatic vessels. Areas of skin affected by obstruction or destruction of lymphatic drainage are said to be prone to the development of lymphangiectasia. Cirrhosis is a cause of alterations of lymph flow.

Methods

Case report.

Results

We report a case of acquired, late‐onset, lymphangiectasia associated with alcoholic hepatic cirrhosis. Lesions were scattered over the right, lower, anterior abdominal wall, a region that is drained by a common group of lymphatic vessels that were probably disordered.

Conclusion

We think that this is the first reported case of lymphangiectasia associated with altered lymph flow in cirrhosis and ascites.
Longitudinal melanonychia associated with hydroxyurea therapy in a patient with essential thrombocytosis
Authors: Cohen Arnon D. , Hallel‐Halevy Dafnah , Hatskelzon Lev , Peretz Eyal , Halevy Sima
Published: September 2006

Occurrence of skin lesions during long‐term therapy with hydroxyurea are well described, but there have been only a few case reports of longitudinal melanonychia associated with hydroxyurea treatment. We report herein longitudinal melanonychia associated with hydroxyurea therapy in a subject with essential thrombocytosis. The prolonged time lapse (1‐year) between initiation of hydroxyurea therapy and the onset of the longitudinal melanonychia should be noted.
Mastocytosis with skin manifestations: current status
Authors: Katsambas Andreas D. , Karpouzis Anthony J. , Koumantaki‐Mathioudaki Elma , Jorizzo Joseph L.
Published: September 2006

Aim

To review our present knowledge about mastocyte origin, mastocytosis classification and management.

Methods

Literature review.

Results

Mastocytoses are chronic and recurrent disorders with symptoms which might either be limited only to the skin or to internal organs as well. The mastocytes, coming from bone marrow progenitor cells, migrate to tissues where they participate in inflammation and in cellular immunity as well as in the metabolism of connective and osseous tissues. Their proliferation causes the appearance of mastocytoses. The classification of the clinical manifestations of the mastocytoses into cutaneous, reactive (under the influence of the degranulator factors) and systemic disease, facilitates dialog among clinicians. Determination of prognosis and appropriate therapeutic regimens depend on individual features.

Conclusions

Mastocytosis diagnosis is verified by histological study of skin lesion biopsy material. Management is symptomatic and unfortunately does not eradicate the disease.
Atypical herpes simplex can mimic a flare of disease activity in patients with pemphigus vulgaris
Authors: Hale Elizabeth K. , Bystryn Jean‐Claude
Published: September 2006

We present a 69‐year‐old white woman with pemphigus vulgaris limited to the oral mucosa who presented with oral pain and difficulty swallowing of 2 days duration, followed by multiple irregular ulcers arising from normal mucosa with no grouping of individual lesions – herpes simplex should be considered in the differential diagnosis of lesions that appear suddenly in patients with PV, particularly if the lesions fail to respond to an increased dose of corticosteroids.
Metastatic ulcerative penile Crohn's disease
Authors: Corazza M. , Ughi G. , Spisani L. , Virgili A.
Published: September 2006

Metastatic Crohn's disease (MCD) is a cutaneous granulomatous reaction which affects patients with bowel disease in areas of the skin distant from the affected bowel. Penile involvement is a very uncommon observation. We report a case of penile ulcerative MCD in a 37‐year‐old man, which requested surgical management. The lesion developed during reactivation of the bowel disease.
Achilles foot screening project: preliminary results of patients screened by dermatologists
Authors: Roseeuw D.
Published: September 2006

Objective Presentation of the preliminary results from the foot screening project, ‘Achilles”, conducted in spring of 1997 and 1998 in several European countries. At the EADV congress, only the preliminary results of the study, i.e. patients screened by dermatologists, were presented.

Subject Foot diseases, especially fungal infections (tinea pedis and onychomycosis).

Methods A questionnaire and a mycological examination in patients visiting a dermatologist for disorders irrespective of their foot problems.

Results The proportion of patients with foot diseases visiting a dermatologist was high (58%). In the total population, fungal infections were the most prevalent clinically diagnosed foot diseases (35%), especially onychomycosis (23%) and tinea pedis (22%). The prevalence of foot diseases increased with advancing age and more men as compared with women had fungal infections of the feet. The most prevalent predisposing factors were vascular disease and sports participation. In subjects with onychomycosis, the big toenail was affected most often. Twenty‐three percent of the participants with clinically diagnosed tinea pedis and/or onychomycosis had infection of both the skin and the nail. The most frequently isolated pathogen was Trichophyton rubrum. Patients with onychomycosis often reported quality of life problems, especially pain and discomfort in walking.

Conclusion The preliminary results of this pan‐European study show that epidemiological studies can give a better idea of foot diseases in dermatological patients. The results indicate a need to pay more attention to foot disease, to predict and prevent future diseases and complications. The most frequent foot diseases were fungal infections, especially onychomycosis, which affects the quality of life of the patients. More results will be available in 1999.
Chlamydia trachomatis and male infertility: chlamydia‐IgA antibodies in seminal plasma are C. trachomatis specific and associated with an inflammatory response1
Authors: Ochsendorf F.R. , Özdemir K. , Rabenau H. , Fenner Th. , Oremek R. , Milbradt R. , Doerr H.W.
Published: September 2006

Background

There is controversy over the role of asymptomatic genital tract infection by Chlamydia trachomatis, its optimal diagnosis, and its place in the etiology of male infertility.

Objective

Comparision of direct detection of Chlamydia trachomatis in semen with the presence of chlamydia‐antibodies in seminal plasma and serum, together with parameters of the spermatogram, in men of infertile relationships.

Study design

Prospective clinical study.

Setting

University hospital tertiary referral center.

Subjects and methods

Two groups of consecutive andrological patients (n = 89 and n= 36) were investigated as follows: semen analysis, including concentration of granulocyte‐elastase; detection of C. trachomatis in semen samples and first void urine by polymerase chain reaction (PCR) and antigen‐ELISA (Celisa®); detection of chlamydia antibodies in serum and seminal plasma by recombinant antibody‐enzyme‐linked immunosorbent assay (rELISA®) and of Chlamydia trachomatis specific antibodies by the ImmunoComb®‐Chlamydia‐Bivalent test.

Results

In 2/125 (1.6%) semen samples Chlamydia trachomatis DNA was detected by PCR. Genus specific anti‐chlamydia‐IgA was found in 12/122 (9%) of the seminal plasmas. This IgA appeared to be specific for C. trachomatis. Seminal plasmas with chlamydia‐IgA antibodies showed higher PMN‐elastase levels than IgA negative samples (P < 0.04). Chla‐mydia‐IgG antibodies were present in 27/89 (30%) of the sera, but in only five of these 27 sera (19%) were the antibodies detected specific for C. trachomatis. There were no associations between any of these variables and the parameters of the routine semen analysis.

Conclusion

IgA‐chlamydial antibodies in seminal plasma appeared to be specific against C. trachomatis and were associated with an inflammatory response in the male genital tract.
Squamous cell carcinoma of the penis arising on lichen sclerosus et atrophicus
Authors: Rubio Juan Francisco Paricio , Revenga Arranz Francisco , Alfaro Torres Jorge , Ramirez Gasca Teresa
Published: September 2006

Squamous cell carcinoma of the penis arising on lichen sclerosus et atrophicus is rarely reported. A case is described in a 63‐year‐old man who had been diagnosed of lichen sclerosus et atrophicus 3 years before. The previously reported cases, the association of these diseases in women and men, and the possible pathogenesis are discussed.
Primary tuberculosis of the penis
Authors: Rossi Riccardo , Urbano Francesco , Tortoli Enrico , Trotta Michele , Zuccati Giuliano , Cappugi Pietro
Published: September 2006

We present a case of primary tuberculosis of the inner lining of the prepuce in a 63‐year‐old man. The condition resembled carcinoma. The diagnosis was based on histopathology and on M. tuberculosis culture. Successful treatment was by a combined medical and surgical approach. The rarity of the case is emphasized.
Unilateral eruptive vellus hair cysts occurring on the face
Authors: Lew B‐L , Lee M‐H , Haw C‐R
Published: September 2006

Eruptive vellus hair cysts (EVHC) are small, cystic papules that usually occur on the chest and extremities. Their aetiology is unknown. Fewer than 10 cases of a variant form of EVHC that occur exclusively on the face have been reported. We describe a case of EVHC limited to the right side of the face. To the best of our knowledge, no case of unilateral EVHC has been reported.
Treatment of poikiloderma of Civatte with the pulsed dye laser: a series of patients with severe depigmentation
Authors: Meijs MM , Blok FAA , De Rie MA
Published: September 2006

Background  Pulsed dye laser (PDL) treatment is widely used for poikiloderma of Civatte. Some adverse events in small numbers of patients have been reported. Guidelines for treatment of poikiloderma of Civatte do not exist.

Objective  To report the occurrence of persistent depigmentation as a late adverse event in a series of patients with poikiloderma of Civatte after treatment with PDL.

Methods  Eight patients (seven women and one man, mean age 48 years) with poikiloderma of Civatte were treated with PDL using a 585‐nm wavelength and a fixed pulse duration of 450 µs. In all patients one or two test PDL patches were performed and reviewed after 3 months. All of the patients tolerated the testing without complications. Subsequent treatments were undertaken at intervals of 3 months.

Results  All patients were treated with fluences between 3.5 and 7 J/cm2, using a 7‐ or 10‐mm spot size. All patients had a good result with respect to clearing of the vascular component. Nevertheless, six of them, treated with 5–7 J/cm2, reported severe depigmentation 4–11 months after treatment. Two patients treated with lower fluences (3.5–5.5 J/cm2) did not report this depigmentation.

Conclusions  Great care is needed when PDL treatment is used for poikiloderma of Civatte. Pigment changes have been incidentally mentioned as late complications but have not been well documented as the late depigmentation has been in this series. It is advisable to use fluences as low as possible, and not exceeding an upper limit of 5 J/cm2, on a 10‐mm spot size. More research is needed to define an optimal pulse duration.
Bacterial vaginosis in a cohort of Danish pregnant women: prevalence and relationship with preterm delivery, low birthweight and perinatal infections
Authors: Svare JA , Schmidt H , Hansen BB , Lose G
Published: September 2006

Objective  To determine the prevalence of bacterial vaginosis (BV) in the second trimester of pregnancy in a Danish population using the Schmidt criteria and to examine whether BV was associated with subsequent preterm delivery, low birthweight or perinatal infections.

Design  Prospective cohort study.

Setting  Department of Obstetrics and Gynaecology at a University Hospital, Denmark.

Population  Three thousand five hundred and forty pregnant women aged 18 years or more.

Methods  A smear from the vagina was obtained from all women, air‐dried and stored for subsequent diagnosis of BV. After rehydration with isotonic saline, the smear was examined in a phase‐contrast microscope at 400×, and the numbers of lactobacilli morphotypes and small bacterial morphotypes were counted. A score for BV was calculated according to the method described by Schmidt. The outcome of pregnancy from 20 weeks of gestation was examined in the 3262 singleton pregnant women who were included in this study before 20 weeks of gestation. The relationship between BV and adverse outcome of pregnancy was examined by univariate and multivariate analyses.

Main outcome measures  Prevalence of BV, preterm delivery (<37 weeks), low birthweight (<2500 g), preterm delivery of a low‐birthweight infant and clinical chorioamnionitis.

Results  The prevalence of BV was 16%, and the rate of preterm delivery was 5.2% in the study population of 3262 singleton pregnant women who were included before 20 weeks of gestation. Mean birthweight was significantly lower in infants of women with BV than in infants of women without BV (3408 versus 3511 g, P < 0.01). Univariate analyses showed that BV was marginally associated with preterm delivery but significantly associated with low birthweight, preterm delivery of a low birthweight infant, indicated preterm delivery and clinical chorioamnionitis. Multivariate analyses, which adjusted for previous miscarriage, previous preterm delivery, previous conisation, smoking, gestational diabetes, fetal death and preterm premature rupture of membranes, showed that BV was significantly associated with low birthweight (OR 1.95, 95% CI 1.3–2.9), preterm delivery of a low‐birthweight infant (OR 2.5, 95% CI 1.6–3.9), indicated preterm delivery (OR 2.4, 95% CI 1.4–4.1) and clinical chorioamnionitis (OR 2.7, 95% CI 1.4–5.1).

Conclusions  The prevalence of BV determined using the Schmidt criteria in the early second trimester of pregnancy was similar to that found in similar studies. The presence of BV before 20 weeks of gestation was an independent risk factor for delivery of an infant with low birthweight, preterm delivery of a low‐birthweight infant, indicated preterm delivery and clinical chorioamnionitis.
The Effect of New Insurance Coverage on the Health Status of Low‐Income Children in Santa Clara County
Authors: Howell Embry M. , Trenholm Christopher
Published: September 2006

Objective. To examine whether providing health insurance coverage to undocumented children affects the health of those children.

Data Sources/Study Setting. The data come from a survey of 1235 parents of enrollees in the new insurance program (“Healthy Kids”) in Santa Clara County, California. The survey was conducted from August 2003 to July 2004.

Study Design. Cross‐sectional study using a group of children insured for one year as the study group (N=626) and a group of newly insured children as the comparison group (N=609). Regression analysis is used to adjust for differences in the groups according to a range of characteristics.

Data Collection. Parents were interviewed by telephone in either English or Spanish (most responded in Spanish). The response rate was 89 percent.

Principal Findings. The study group—who were children continuously insured by Healthy Kids for one year—were significantly less likely to be in fair/poor health and to have functional impairments than the comparison group of newly insured children (15.9 percent versus 28.5 percent and 4.5 percent versus 8.4 percent, respectively). Impacts were largest among children who enrolled for a specific medical reason (such as an illness or injury); indeed, the impact on functional limitations was evident only for this subgroup. The study group also had fewer missed school days than the comparison group, but the difference was significant only among children who did not enroll for a medical reason.

Conclusions. Health insurance coverage of undocumented children in Santa Clara County was associated with significant improvements in children's health status. The size of this association could be overstated, since the comparison sample included some children who enrolled because of an illness or other temporary health problem that would have improved even without insurance coverage. However, even after limiting the study sample to children who did not enroll for a medical reason, a significant association remained between children's reported health and their health coverage. We thus cautiously conclude that Healthy Kids had a favorable impact on children's health.
IgAs Against Acetaldehyde‐Modified Red Cell Protein as a Marker of Ethanol Consumption in Male Alcoholic Subjects, Moderate Drinkers, and Abstainers
Authors: Hietala Johanna , Koivisto Heidi , Latvala Jaana , Anttila Petra , Niemelä Onni
Published: September 2006

Background: Alcohol abuse has been shown to result in the production of antibodies against acetaldehyde‐modified epitopes in proteins. However, as yet, only limited information has been available on the clinical usefulness of such responses as markers of hazardous drinking.

Methods: We developed an ELISA to measure specific IgAs against acetaldehyde‐protein adducts. This method was evaluated in cross‐sectional and follow‐up studies on male heavy drinkers with a current ethanol consumption of 40 to 540 g/d (n=40), moderate drinkers consuming 1 to 40 g/d (n=25), and abstainers (n=16). The clinical assessments included detailed interviews on the amounts and patterns of ethanol consumption and various biochemical markers of alcohol abuse and liver function.

Results: The mean antiadduct IgAs (198±28 U/L) in the alcohol abusers were significantly higher than those in the moderate drinkers (58±11 U/L, p<0.001) or abstainers (28±8 U/L, p<0.001). The values of moderate drinkers were also higher than those in abstainers (p<0.05). The amount of ethanol consumed during the period of 1 month preceding blood sampling correlated strongly with antiadduct IgAs (r=0.67, p<0.001). The sensitivity (73%) and specificity (94%) of this marker were found to exceed those of the conventional laboratory markers of alcohol abuse in comparisons contrasting heavy drinkers with abstainers although not in comparisons contrasting heavy drinkers with moderate drinkers. During abstinence, antiadduct IgAs disappeared with a mean rate of 3% per day. In additional analyses of possible marker combinations, antiadduct IgAs, together with CDT, were found to provide the highest sensitivity and specificity.

Conclusions: Measurements of antiadduct IgAs may provide a new clinically useful marker of alcohol abuse, providing a close relationship between marker levels and the actual amounts of recent ethanol ingestion.
Role of β‐Endorphin, Corticotropin‐Releasing Hormone, and Autonomic Nervous System in Mediation of the Effect of Chronic Ethanol on Natural Killer Cell Cytolytic Activity
Authors: Boyadjieva Nadka , Advis Juan P. , Sarkar Dipak K.
Published: September 2006

Background: We have recently shown that alcohol feeding suppresses natural killer (NK) cell cytolytic activity partly by decreasing the function of hypothalamic β‐endorphin (β‐EP) neurons. The neuronal mechanism by which hypothalamic β‐EP communicates with the spleen to regulate the action of ethanol on NK cells is not known. In the present study, we evaluated the roles of β‐EP neurons, corticotropin releasing hormone (CRH) neurons, and the autonomic nervous system (ANS) in regulation of the ethanol effect on splenic NK cell cytolytic function.

Methods: Male rats were fed an ethanol‐containing liquid diet or control diets. These rats were used to determine the hormone release from the paraventricular nuclei (PVN) of the hypothalamus or used to determine the splenic NK cell cytolytic function after PVN administration of CRH or intraperitoneal (i.p.) administration of a ganglionic blocker chlorisondamine. The release of hormones from the PVN was measured using the push–pull perfusion method. Splenic cytolytic activity was determined using the 4‐hour 51Cr release assay against YAC‐1 lymphoma target cells.

Results: Alcohol feeding decreased the amount of β‐EP but increased the amount of CRH in the push–pull perfusate (PPP) samples collected from the PVN. When exogenous β‐EP was perfused into the PVN, it suppressed the release of endogenous CRH found in PPP samples of the PVN. Conversely, perfusion of an opiate antagonist naltrexone into the PVN increased the levels of endogenous CRH in PPP samples of the PVN. In addition, administration of exogenous β‐EP in the PVN stimulated the cytolytic function of NK cells, an action that was antagonized by CRH as well as by ethanol. Corticotropin‐releasing hormone and ethanol alone also had an inhibitory action on NK cells. Finally, the ganglionic blocker used prevented the effect that ethanol, β‐EP, and CRH had on NK cells. These data suggest that ethanol inhibits the function of NK cells partly by suppressing the influence of the β‐EP–CRH–ANS signal to the spleen.
Alcohol Consumption, Alcoholics Anonymous Membership, and Homicide Mortality Rates in Ontario 1968 to 1991
Authors: Mann Robert E. , Zalcman Rosely Flam , Smart Reginald G. , Rush Brian R. , Suurvali Helen
Published: September 2006

Background: Research has shown a strong link between alcohol use and a variety of problems, including violence. Parker and colleagues have presented a selective disinhibition theory for the link between alcohol use and homicide (and other violence) that posits a causal relationship that is also influenced by other situational and contextual factors. This model is particularly well suited for aggregate‐level investigations. In this study, we examine the impact of alcohol factors, including consumption measures and Alcoholics Anonymous (AA) membership rates, on homicide mortality rates in Ontario, and test predictions derived from the selective disinhibition model.

Methods: Time series analyses with ARIMA modeling were applied to total, male, and female homicide rates in Ontario between 1968 and 1991. The analyses performed included total alcohol consumption, spirits consumption, beer consumption, and wine consumption. Missing AA membership data were interpolated with cubic splines.

Results: For the total population and males, homicide rates were significantly and positively related to total alcohol consumption and to the consumption of beer and spirits. They were also negatively related to AA membership rates in the analyses involving spirits and wine and positively related to unemployment rates in the analyses involving beer, wine, and total alcohol. Among females, none of the measures were significant predictors of homicide mortality rates.

Conclusions: These data provide important support for the selective disinhibition model and confirm important relationships between per capita consumption measures and homicide mortality rates, especially among males, seen in other studies. Additionally, the results for AA membership rates are consistent with the hypothesis that AA membership and treatment for misuse of alcohol can exert beneficial effects observable at the population level.
Unprotected Left Main Coronary Intervention with Drug‐Eluting Stents
Authors: PRICE MATTHEW J.
Published: September 2006

The accepted treatment of unprotected left main coronary artery disease is coronary artery bypass surgery (CABG). The approval of drug‐eluting stents (DES) has increasingly led to their off‐label use in this patient population. Currently, the data supporting the safety and efficacy of DES for unprotected left main disease are derived from nonrandomized, single‐center studies. Several conclusions can be drawn from these studies despite their inherent limitations. Procedural mortality in elective patients with low surgical risk is minimal. One year mortality and 1 year major adverse cardiac events appear to be similar to that of CABG. Technical difficulty and clinical outcome depend crucially on the anatomic location of the left main obstruction. While DES implantation for ostial and shaft lesions is technically straightforward and provides excellent results over follow‐up, distal left main lesions are technically challenging and efficacy is limited largely by target vessel revascularization, most frequently for restenosis within the branch ostia. A systematic approach to the left main lesion can help provide safe and more effective results. Prospective, randomized trials comparing DES to CABG must be completed before percutaneous coronary intervention for unprotected left main coronary artery disease can be considered standard‐of‐care.
Patent Ductus Arteriosus Closure
Authors: KRASUSKI RICHARD A.
Published: September 2006

Patent ductus arteriosus is a common clinical lesion which increases the risk of endocarditis and may lead to heart failure and pulmonary hypertension. Devices and techniques have advanced to the point that in most patients percutaneous closure should be the procedure of choice. Devices are best selected by fully examining the anatomy of the defect. In general coils are best suited for smaller defects and the Amplatzer Duct Occluder excels in moderate to large defects. Follow‐up should include echocardiography to ensure complete closure.