bluuebunny/crossref_metadata_2025 huggingface dataset:
Occludin phosphorylation: identification of an occludin kinase in brain and cell extracts as CK2
Authors: Smales Caroline , Ellis Moira , Baumber Rachel , Hussain Nayer , Desmond Howard , Staddon James M
Published: May 2003

In epithelial and endothelial cells, tight junctions limit paracellular flux of ions, proteins and other macromolecules. However, mechanisms regulating tight junction function are not clear. Occludin, a tight junction protein, undergoes phosphorylation changes in several situations but little is known about occludin kinases. A recombinant C‐terminal fragment of occludin is a substrate for a kinase in crude extracts of brain. This activity was purified about 10 000‐fold and identified as CK2 (casein kinase 2) by peptide mass fingerprinting, immunoblotting and mutation of CK2 sites within the occludin sequence. CK2 is therefore a candidate kinase for regulation of occludin phosphorylation in vivo.
Proton release upon oxidation of tyrosine in reaction centers from Rhodobacter sphaeroides
Authors: Kálmán L. , Williams J.C. , Allen J.P.
Published: May 2003

Markedly different light‐induced protonational changes were measured in two reaction center mutants of Rhodobacter sphaeroides. A quadruple mutant containing alterations, at residues L131, M160, M197, and M210, that elevate the midpoint potential of the bacteriochlorophyll dimer was compared to the YM mutant, which contains these alterations plus a tyrosine at M164 serving as a secondary electron donor [Kálmán et al., Nature 402 (1999) 696]. In the quadruple mutant, a proton uptake of 0.1–0.3 H+/reaction center between pH 6 and 10 resulted from formation of the oxidized bacteriochlorophyll donor and reduced primary quinone. In the YM mutant, a maximal proton release of −0.5 H+/reaction center at pH 8 was attributed to formation of the tyrosyl radical and modeled using electrostatic and direct proton‐releasing mechanisms.
Minimizing respondent attrition in longitudinal research: Practical implications from a cohort study of adolescent drinking☆
Authors: Boys Annabel , Marsden John , Stillwell Garry , Hatchings Kevin , Griffiths Paul , Farrell Michael
Published: May 2003

The methods used to maximize retention in a longitudinal study of adolescent drinking are discussed. Data were collected at three time points: at recruitment to the study, after nine months and at 18 months. Strategies to minimize attrition included the collection of detailed contact information, incentives for participation, postcard and telephone reminders and telephone interviews. Ninety‐six percent of the original sample completed the first follow‐up questionnaire, 92% completed the second and the study lost contact with just 3% of participants. The success of the current project is notable as this type of population is notoriously difficult to retain in longitudinal studies.
Staffing and Organisation of Nursing Care in Cardiac Intensive Care Units in Greece
Authors: Merkouris Anastasios , Papathanassoglou Elizabeth D.E. , Pistolas Dimitrios , Papagiannaki Vasileia , Floros John , Lemonidou Chryssoula
Published: May 2003

Purpose: To explore staffing and organisational characteristics of nursing care in cardiac intensive care units (CICUs) in Greece. Methodology: An exploratory descriptive survey design with additional cross-sectional comparisons was employed. A specifically developed survey-type questionnaire, addressed to nurse managers, was distributed to all CICUs in Greece. Results: The response rate was 76.2% ( N=32 units). Nursing staff per bed ratios over 24 h (whole-time equivalent) were very low and exhibited a mean of 1.25 (±0.53). The total registered nurse to assistance nurse (RN/AN) ratio was 2.74, but a lot of variability was observed and in many units ANs operated in RNs positions. Only 42% of the nurses had participated at in-service continuing education programs and a systematic training program in cardio pulmonary resuscitation (CPR) was provided in only 12 (37.5%) units. The reported frequencies at which specific technical tasks were performed autonomously by nurses varied substantially and reflected a medium to low level of practice autonomy; the most frequently reported tasks were: peripheral IV line insertion, CPR chest compression, titration of vasoactive drugs and administration of analgesics. Higher percentages of nurses had received in-service training associated with the likelihood of performance of several technical tasks ( P<0.03). Conclusions: Future studies need to explore the effect of these organisational characteristics on patient outcomes. The endorsement of nation-wide standards for nursing staffing and training in CICUs is imperative.
Impact of a Region-Wide Approach to Improving Systems for Heart Attack Care: The West Midlands Thrombolysis Project
Authors: Quinn Tom , Allan Teresa F , Birkhead John , Griffiths Rod , Gyde Sylvia , Gordon Murray R
Published: May 2003

Objective: To describe changes in delay to administration of thrombolytic therapy associated with a region-wide audit. Design: Observational study of patients admitted with suspected myocardial infarction (MI) based on continuous audit. Subjects: 18877 patients admitted to 23 hospitals with suspected MI between April 1995 and March 1998. Results: Of 11232 patients with a discharge diagnosis of definite MI, 8802 (46.6%) received thrombolytic therapy during hospitalisation, with 5155 patients eligible for treatment on admission to hospital on the basis of established indications. Call-to-needle time for those eligible for treatment on admission fell from median 105 min in the first year of the project to 85 min in year 3 ( P<0.001), and door-to-needle time fell from 45 to 35 min ( P<0.001). Forty percent of eligible patients were treated within the then current national standard of 90 min from time of call for help, with nearly 49% in the final year and 20% being treated within the new national standard of 60 min, by the third year. Conclusion: The proportion of eligible patients receiving thrombolysis within 1 h of the call for help doubled during the 3-year project but the majority of patients still wait longer than 60-min ‘call-to-needle’. New systems to reduce delays to administration of thrombolysis to within 60 min of call for help are required, including consideration of pre-hospital treatment.
Extravesical ureteroneocystostomy with and without internalized ureteric stents in pediatric renal transplantation
Authors: French Christopher G. , Acott Philip D. , Crocker John F. S. , Bitter‐Suermann Hinrich , Lawen Joseph G.
Published: May 2003

Abstract: The use of ureteric double‐J stents and the Lich‐Gregoir (extravesical) technique of ureteroneocystotomy have both been shown to decrease the rate of urologic complications in adult kidney transplantation (Tx). There are, however, few studies of the systematic use of stents in pediatric renal Tx. Between 1991 and 1997, 32 consecutive pediatric renal transplant recipients routinely received a 6F‐12 cm indwelling double‐J stent and were studied prospectively. These patients were compared with 32 consecutive pediatric recipients in whom a stent was not used. The latter were transplanted between 1987 and 1991 and formed the control group. All patients had a Lich‐Gregoir ureteroneocystotomy. Stents were removed under general‐anesthetic cystoscopy 2–3 weeks after Tx. Immunosuppression for stented patients was polyclonal antibody induction, delayed (7–10 days) cyclosporin A, azathioprine, and prednisone. The control group received the same triple drug regimen but with no induction in 29 of the 32 patients. All patients were followed‐up with at least one ultrasound evaluation in the first month, and a renal scan and repeat ultrasound were performed if there was any rise in serum creatinine. In the stented group there were two patients with urinary leak and no obstructions. In the non‐stented group there were no leaks and one obstruction. There was no graft loss owing to urologic complications in either group. There were three cases of stent expulsion (all in girls) and one case of stent migration in the posterior urethra (a boy). The 1‐yr graft survival rate was 90.6% in the stented group and 65.6% in the non‐stented group. The prophylactic use of an indwelling ureteral stent in pediatric renal Tx did not reduce the risk of urinary leakage or obstruction. Stent migration is a common phenomenon and, while not a serious complication, is traumatic to children. Furthermore, removal of an internalized double‐J stent requires a general anesthetic. We recommend using a stent for selected patients only.
Tacrolimus: The good, the bad, and the ugly
Authors: Chand Deepa H. , Southerland Suzanne , Cunningham Iii Robert J.
Published: May 2003

Abstract: The aim of this study was to evaluate the efficacy and side‐effects of tacrolimus in pediatric transplant patients previously receiving cyclosporin A (CsA). This study was a retrospective chart review strengthened by a concomitant patient interview. Eleven pediatric cardiac or renal transplant patients, who had been converted from CsA to tacrolimus from October 1995 to January 1999 at The Cleveland Clinic Foundation, were included; there were six renal and five cardiac transplant patients. Each chart was reviewed to assess transplanted organ function pre‐ and post‐conversion. For the six renal transplant patients, creatinine levels and biopsy findings were evaluated. For the five cardiac transplant patients, cardiac catheterization and routine biopsy data were analyzed likewise. Epstein–Barr virus (EBV) status was also evaluated in each patient. In addition, each parent or patient was interviewed to ascertain dates of transplant, current medications, and side‐effects. The patients' ages ranged from 6 to 20 yr (mean age 14.6 yr). All patients had been converted to tacrolimus. Eight patients were converted for treatment of refractory rejection, two were converted because of CsA‐associated side‐effects, and one patient was converted empirically for a history of multiple previous transplant rejections. Seven out of eight patients who received tacrolimus for rejection therapy improved. One patient had complete resolution of gingival hyperplasia. Another patient who previously developed hemolytic uremic syndrome on CsA had no further evidence of hemolysis. Four patients were weaned off steroid therapy. Despite conversion, two renal transplant patients progressed to chronic rejection. Five patients exhibited no side‐effects. Side‐effects experienced included transient hyperglycemia in conjunction with steroid use, headaches, and tremors that subsided rapidly. Four of 11 patients developed post‐transplant lymphoproliferative disease (PTLD). Fortunately, reducing the dose of tacrolimus and/or surgical resection of the mass (if present), eradicated the disease. In conclusion, conversion therapy successfully provides an alternate treatment for acute rejection. It also enabled some patients to discontinue steroid therapy, maximizing growth potential. PTLD is a severe, potentially life‐threatening complication that needs to be recognized and monitored closely. In conclusion, tacrolimus has been shown to be a very effective agent for the treatment of refractory organ rejection, but must be used cautiously.
B‐cell dysfunction and depletion using mycophenolate mofetil in a pediatric combined liver and kidney graft recipient
Authors: Ganschow R. , Lyons M. , Kemper M. J. , Burdelski M.
Published: May 2003

Abstract: The use of mycophenolate mofetil (MMF) in combination with cyclosporin A (CsA) and steroids is well established after kidney transplantation (Tx) in children. A 9‐yr‐old girl with primary hyperoxaluria type 1 and systemic oxalosis underwent a combined kidney and liver Tx at our institution. The post‐operative immunosuppression consisted of CsA, prednisolone, and MMF. Four weeks post‐transplant the girl suffered from a severe urinary tract infection caused by Pseudomonas aeruginosa, when the serum immunoglobulin G (IgG) concentration was found to be critically low (< 1.53 g/L). Additionally, there was an isolated B‐cell depletion (240/µL) at that time. In the following course, the B‐cell count was significantly diminished until the MMF was stopped 13 weeks post‐transplant. As a result of the very low serum IgG concentration, intravenous immunoglobulin (IVIG) substitution was necessary. There was no significant loss of immunoglobulins in the ascites and urine and no other medication with possible side‐effects on B cells was given. We suggest that MMF can lead to suppressed IgG production by B cells and can cause a defective differentiation into mature B cells. In vitro studies demonstrated these effects of MMF on B cells, but no in vivo cases of this phenomenon have been reported. B‐cell counts and serum IgG concentrations returned to normal values after discontinuing the MMF. As we can assume that the observed B‐cell dysfunction and depletion were MMF related, we suggest that serum IgG concentrations should be monitored when MMF is used after solid‐organ Tx.
Psychological impact of liver transplantation on children's inner worlds
Authors: Gritti A. , Di Sarno A. M. , Comito M. , De Vincenzo A. , De Paola P. , Vajro P.
Published: May 2003

Abstract: We carried out an in‐depth evaluation of psychosocial status in a sample of 18 children (mean age 6.8 yr, range 4.4–10.8 yr) who had suffered from severe liver disease and undergone orthotopic liver transplantation (OLT). Mean age at OLT was 3.4 yr. The assessment was psychoanalytically oriented and included individual sessions and testing procedures for children – the Children Apperception Test (CAT), the Weschsler Intelligence Scale for Children (WISC‐R), the Weschsler Preschool and Primary Scale of Intelligence (WIPPSI), and the Human Figure Test – and a semi‐structured interview with a separate questionnaire for parents. Patients were compared with an age‐ and gender‐matched control group. The main findings in patients compared with controls were: IQ 91.6 (range 70–117) vs. 118 (range 94–135) (p<0.0001); immaturity of ego and drives (72.2% vs. 27.7%; p=0.018), fear of death (61.1% vs. 11.1%; p=0.04), anxiety of loss (50% vs. 27.7%; p=NS), and depressive feelings (61.1% vs. 22.2%; p=0.04); a mild defect of body image (44.4% vs. 33.3%; p=NS) associated with recurrent representations of motionless (72.2% vs. 38.8%; p=NS) and inexpressive (88.8% vs. 16.6%; p<0.0001) human figures. Fantasies about OLT as a ‘magic rebirth’ or a ‘body transformation’ were detected in few patients (30%). Although a recurrent set of feelings, conflicts, and fantasies about OLT were expressed by children, individual specific psychological responses to this experience were often detected. In spite of the fact that ≈ 50% of the parents mentioned emotional or behavioral disturbances of their child, only three parents were seriously concerned about this problem. The theme of transplantation was most often absent from communication between the child and their parents. Our results suggest that psychic ‘working through’ of the chronic liver disease and OLT experience is difficult for children. Further studies are necessary to verify whether changes of parental attitude to OLT as a ‘family secret’ may facilitate integration of the OLT experience in the child's personality development.
Pretransplant varicella vaccination is cost‐effective in pediatric renal transplantation
Authors: Olson Allan D. , Shope Thomas C. , Flynn Joseph T.
Published: May 2003

Abstract:Because of the severe complications that may result from varicella zoster virus (VZV) infection following renal transplantation (Tx), transplanted varicella‐susceptible children exposed to varicella are typically given varicella zoster immunoglobulin (VZIG) as prophylaxis or are admitted and treated with parenteral acyclovir if VZIG prophylaxis fails. As both VZIG and hospitalization are costly, prevention of varicella infection by vaccination could potentially result in significant cost savings in addition to decreasing morbidity and mortality. To test this hypothesis, we developed a decision‐analysis model to evaluate the cost‐effectiveness of vaccinating patients with chronic renal failure (CRF) against varicella prior to renal transplant. Under baseline assumptions, vaccination for varicella pretransplant was a cost‐effective strategy, with a cost of $211 per patient vaccinated compared with $1,828 per patient not vaccinated. The magnitude of cost savings from vaccination was sensitive to variations in the cost of varicella vaccine, the percentage of patients hospitalized for treatment with acyclovir, and the percentage of patients exposed to varicella infection. One‐ and two‐way sensitivity analyses confirmed that vaccination was the dominant cost‐effective strategy under all conditions examined. We conclude that vaccination for varicella pretransplant is cost‐effective for patients with CRF, and that the magnitude of cost savings is sensitive to the cost of hospitalization, the percentage of patients exposed to varicella, and the cost of varicella vaccination. Pending results of ongoing studies of the safety and efficacy of VZV vaccine in children with CRF, we recommend that VZV vaccine be given to all children with CRF.
Thoracoabdominal bypass graft with liver retransplantation for the treatment of a pseudoaneurysm of the supraceliac aorta after liver transplantation
Authors: Verzaro Roberto , Nishida Seigo , Angelis Michael , Khan Farruk , Tzakis Andreas
Published: May 2003

Abstract:Pseudoaneurysm following liver transplantation is a rare but life‐threatening complication. Treatment is directed towards control of fatal bleeding. Ligation with or without revascularization of the graft is the treatment of choice. When revascularization is not possible, or the liver does not tolerate the arterial blood deprivation, retransplantation is the only option. We report a case of a 14‐month‐old girl who developed a pseudoaneurysm at the anastomosis between the recipient supraceliac aorta and the donor graft. The pseudoaneurysm was excised and the aorta was ligated above and below it. An extra‐anatomical thoracoabdominal arterial graft was used to provide arterial blood supply to the lower torso and also to arterialize a new orthotopic liver graft. This is the first reported case of the use of thoracoabdominal jump graft to vascularize a transplanted liver.
Fading renal hyperfiltration in children following liver transplantation
Authors: Schell Matthias , Lachaux Alain , Hadj‐Aïssa Aoumeur , Dubourg Laurence , Mahmoud Ayman , Boillot Olivier , Saïd Marie‐Hélène , Cochat Pierre
Published: May 2003

Abstract:In a prospective longitudinal study, we investigated the renal function (RF) of 23 children before and after orthotopic liver transplantation (OLT). The aim was to assess both the outcome of pretransplant hyperfiltration and the clinical nephrotoxic effects of cyclosporin A (CsA); children with decreased RF prior to OLT were therefore excluded. The RF study of the 13 remaining patients included glomerular filtration rate (GFR) and effective renal plasma flow (RPF) measured by inulin (Cin: mL/min/1.73 m2) and para‐amino hippurate (Cpah: mL/min/1.73 m2) clearances, respectively. Hyperfiltration prior to OLT was observed in six children, i.e. Cin > 170 [range 172–230] and Cpah > 800 [808–1133]. A significant decrease in RF was noted as soon as 6 months after OLT: Cin (mean±SD) = 107 ± 23 vs. 158 ± 46 (p<0.003); Cpah = 583 ± 119 vs. 791 ± 243 (p<0.004). This was due to loss of hyperfiltration in the six children, as there was no significant difference in RF before and 6 months after OLT in the other seven children. With a 36‐month follow‐up, there was no correlation between CsA trough blood level and RF. In conclusion, following OLT, RF underwent early changes owing to loss of prior hyperfiltration in children without impaired RF before OLT. In addition, no evidence of CsA nephrotoxicity was found and RF remained stable during follow‐up.
Determinants of long‐term survival of pediatric kidney grafts reported to the United Network for Organ Sharing kidney transplant registry*
Authors: Gjertson David W. , Cecka J. Michael
Published: May 2003

Abstract: Pediatric 1‐yr kidney graft survival rates have steadily improved in the US so that, by 1998, over 90% of hospital‐discharged young recipients had survived the first year post‐transplantation (Tx). However, 25% of the early surviving kidney grafts failed at 5 yr, yielding a projected half‐life of 10 yr. Given a median age at transplant of 13 yr (range 0–20 yr), 50% of all current pediatric kidney recipients will need a second graft before the age of 25 years. We examined 8422 pediatric renal transplants reported to the United Network for Organ Sharing (UNOS) Kidney Transplant Registry and, by using a log‐linear multifactorial analysis, determined the relative influence of 26 major transplant factors on long‐term graft survival. Results are reported as percentages of assignable variation (totaling 100% for all 26 factors combined) in pediatric outcomes beyond 1 yr and as adjusted graft survival rates. Transplant center, recipient race and age, transplant year, and panel‐reactive antibody (PRA) had assignable variation percentages of 25, 24, 16, 12, and 4, respectively. When combined, they accounted for 81% of changes in long‐term survival. Besides center effects, Blacks, teenagers, and transplants performed before 1994 exhibited significantly (p < 0.0001) lower adjusted 5‐yr graft survival rates as did the few sensitized (PRA > 40%) pediatric patients (p = 0.02). Patients transplanted with a living donor kidney demonstrated a 5% point advantage at 5 yr post‐Tx over cadaver donor kidneys (p = 0.001). Although the survival rate of pediatric kidney transplants has improved steadily, the long‐term outcomes for teenagers and for Black recipients lag significantly behind those of younger patients and non‐Blacks.
Portal vein phlebolithiasis found post‐liver transplantation in the native liver of a child with biliary atresia
Authors: Bilezikçi B. , Demirhan B. , Kiyici H. , Haberal M.
Published: May 2003

Abstract: Biliary atresia is defined as partial or total obliteration of the extra‐hepatic bile ducts. In advanced cases, liver transplantation (LTx) is considered the most appropriate treatment. This report describes a female patient whose biliary atresia and subsequent cirrhosis required LTx at 1 yr of age. Macroscopic inspection of the hilar region of the native liver post‐Tx revealed the formation of a pouch in the hepatic duct and a stone in the lumen of the portal vein. X‐ray diffraction analysis showed that the stone was composed of cholesteryl cinnamate, gluconic acid phenylhydrazide, Na β broma‐allyl mercaptomethyl penicillinate, and Al2O3 crystals. While the cholesterol component is a known element of gallstones, we attributed the Na β broma‐allyl mercaptomethyl penicillinate to the patient's drug therapy. Our literature search revealed no previous record or crystallographic analysis of portal vein phlebolithiasis. In this report we describe this rare finding.
Psychosocial responses of adolescent cystic fibrosis patients to lung transplantation
Authors: Durst Carolyn L. , Horn Monica V. , MacLaughlin Eithne F. , Bowman C. Michael , Starnes Vaughn A. , Woo Marlyn S.
Published: May 2003

Abstract: What psychosocial issues do adolescent cystic fibrosis (CF) patients experience after undergoing lung transplantation (Tx)? The aim of this study was to determine, using an ethnographic study design, the common themes and emotional responses in post‐lung transplant adolescent CF patients of the Cardiothoracic Transplant Clinic at the Childrens Hospital Los Angeles. Nineteen CF lung transplant recipients were studied (eight males, 11 females: mean age at time of transplant, 15.7 ± 2.7 yr). The mean time interval from Tx to interview was 25.4 months (range 1–58 months). Sixteen patients had living donor lobar lung Tx while three patients received cadaveric lungs. A series of 25 questions was used to assess the psychosocial impact of Tx, and a semi‐structured interview focused on the following five domains: lifestyle, family functioning, social functioning, body image, and psychological functioning. The major themes identified by patients included: a strong desire to set and attain meaningful long‐range goals, the need to control as many aspects of their lives as possible while dealing with parental over‐protectiveness, and the adjustment to a new lifestyle. Common emotional responses included manageable fear/anxiety of lung rejection and uncertainty of the future, impatience with disruptions of daily routines caused by post‐transplant medical management and its effect on the attainment of set goals, and frustration with parental over‐protectiveness. In general, patients reported a positive outlook on life, with greater emphasis on sought‐after goals as well as inter‐personal relationships. This study demonstrates that adolescent CF transplant recipients develop long‐term goals and plans for independence. By identifying and anticipating the emotional needs of this population, health care providers can assist patients in improving the quality of their lives from a physiological, as well as a psychological, viewpoint.
CommentaryFrom living related to in‐situ split liver transplantation: How to reduce waiting‐list mortality
Authors: Testa G. , Malago' M. , Broelsch C. E.
Published: May 2003

Abstract: The insufficient number of suitable cadaveric organs for pediatric recipients is the cause of high pretransplant mortality rates and long waiting times. With the introduction of split and living related liver transplantation, the waiting list mortality rate has dropped from greater than 15% to less than 5% and children are transplanted more rapidly. A 5‐year patient and graft survival rate of greater than 80% has been obtained in those centers where split and living related liver transplantations are routinely performed. The data analyzed in this paper show that the only current solution to cadaveric organ shortage is a ‘multimodal’ approach, where whole liver cadaveric transplantation is associated with split and living related liver transplantation.
Contact sensitivity to calcium hypochlorite
Authors: Salphale Pankaj S. , Shenoi Shrutakirthi D.
Published: May 2003

Eusol (an abbreviation for Edinburgh University solution), consisting of aqueous boric acid and calcium hypochlorite, is widely used in the management of open wounds left to heal by secondary intention (1).
Nickel‐elicited systemic contact dermatitis
Authors: Dou Xia , Liu Ling‐Ling , Zhu Xue‐June
Published: May 2003

20 patients with systemic contact dermatitis due to nickel are described. Of these patients, 15 were female and 5 were male. Their mean age was 24·8 years (16–51 years). All had experienced contact dermatitis in the umbilical area due to continual contact with metal belt‐buckles or buttons. Then, with long‐ or short‐term aggravation of such periumbilical dermatitis, commonly in summer, lesions spread to other sites such as the side of the neck, the flexures of the extremities, etc. All patients showed a positive patch test to nickel sulphate (2·5% in petrolatum) and the dimethylglyoxime test demonstrated the presence of free nickel on metal buttons or belt‐buckles. Punch biopsies performed in 7 patients showed subacute dermatitis. After avoidance of continual exposure to objects containing nickel and foods rich in nickel, as well as treatment with oral antihistamines and topical corticosteroids, all patients improved or cleared. It has been reported that nickel can cause systemic contact dermatitis by some internal systemic route, such as oral intake, transfusion, inhalation, implantation of metal medical devices, etc. In our patients, we found that continual local skin contact could also elicit systemic contact dermatitis.
The composition of fine fragrances is changing
Authors: Rastogi Suresh C. , Menné Torkil , Johansen Jeanne Duus
Published: May 2003

High frequencies of contact allergy to fragrance ingredients have been reported in recent years. Developments in analytical chemistry have made it possible to measure exposure to well‐known fragrance contact allergens. It has been shown that exposure is widespread in different types of products. The products with the highest concentrations of allergens have been shown to be prestige perfumes intended for women. This investigation explores the possible development in formulation of prestige perfumes, with regard to their content of the chemically defined ingredients of the diagnostic patch test material, the fragrance mix (FM). 10 fine fragrances were subjected to chemical analysis: 5 of these had been launched years ago (1921–1990) and 5 were the latest launches by the same companies, introduced 2 months to 4 years before purchase. The analysis revealed that the 5 old perfumes contained a mean of 5 of the 7 target allergens of the FM, while the new perfumes contained a mean of 2·8 of the allergens. The mean concentrations of the target allergens were 2·6 times higher in the old perfumes than in the new perfumes, range 2·2–337. It is concluded that the old perfumes, which are still popular products on the market, have a different composition from the new perfumes. This may be due to change in fashion or to an effort by the fragrance industry to focus on fragrance contact allergy, especially that to the FM ingredients.
Anaphylaxis to polyvinylpyrrolidone after vaginal application of povidone‐iodine
Authors: Adachi Atsuko , Fukunaga Atsushi , Hayashi Kazuhiro , Kunisada Makoto , Horikawa Tatsuya
Published: May 2003

A 59‐year‐old woman who had had several episodes of contact urticaria after hair treatment, developed anaphylaxis after vaginal application of povidone‐iodine solution for disinfection. Prick tests showed wheal‐and‐flare responses to both povidone‐iodine (0·1% aqueous) and polyvinylpyrrolidone (povidone, PVP) (0·001% aq.), but not to iodine or polyoxy‐ethyrenenonylphenyl ether, both of which are also contained in povidone‐iodine solution. We confirmed that basophils from her peripheral blood released considerable amounts of histamine on stimulation by PVPs. It appeared that both the shampoo and the permanent‐wave solution contained polyvinylpyrrolidone N, N‐dimethyl aminoethyl methacrylic acid copolymer diethyl sulphate solution and polyvinylpyrrolidone styrene‐copolymer emulsion. Both these agents in the hair care products provoked an immediate skin response on prick testing. We speculate that sensitization to PVP had been established by these hair care products at a beauty parlor. She was recommended to avoid PVP‐containing products and remained free from symptoms thereafter.
Patch testing with carbamazepine and its main metabolite carbamazepine epoxide in cutaneous adverse drug reactions to carbamazepine
Authors: Lee Ai‐Young , Choi Jun , Chey Won‐Young
Published: May 2003

The value of skin tests in the diagnosis of adverse drug reactions (ADRs) has been limited. Lack of knowledge as to the nature of drug allergens has contributed to these limitations. Several reports have addressed the roles of metabolites in cutaneous ADRs and skin testing. We evaluated the role of a carbamazepine (CBZ) metabolite on the results obtained from patch tests, using CBZ and its main metabolite 10, 11‐epoxide of CBZ (CBZ‐epoxide), on 13 patients with CBZ‐induced drug eruptions and 39 controls with no CBZ‐induced cutaneous ADRs. 10 of the 13 patients showed a positive reaction, and 2 of the 10 patients had a reaction to the CBZ‐epoxide only and 1 to both CBZ and CBZ‐epoxide. None of the 39 controls displayed any reactions to either CBZ or CBZ‐epoxide. Patch testing of suspected drugs, as well as their available metabolites, would be helpful in improving the results.
Spectrum of cross‐photosensitization in 18 consecutive patients with contact photoallergy to ketoprofen: associated photoallergies to non‐benzophenone‐containing molecules
Authors: Durbize E. , Vigan M. , Puzenat E. , Girardin P. , Adessi B. , Desprez PH. , Humbert PH. , Laurent R. , Aubin F.
Published: May 2003

Contact photoallergy to ketoprofen gels has been widely reported, and cross‐sensitivity reactions with other compounds, such as tiaprofenic acid, fenofibrate and benzophenones, are well known. However, positive photopatch tests to other different non‐benzophenone‐related compounds have recently been observed. We report the results of photopatch testing in patients with contact photoallergy to ketoprofen and discuss the spectrum of cross‐sensitization to ketoprofen. 18 consecutive patients with a history of photocontact dermatitis from ketoprofen were investigated. Patch and photopatch tests were performed. As expected, we observed positive photopatch tests to Ketum* gel and ketoprofen 2·5% in petrolatum in all patients (100%). However, it was remarkable to note positive photopatch tests to other unexpected and non‐relevant allergens, including fentichlor (67%), tetrachlorosalicylanilide (28%), triclosan (17%), tribromsalan (11%) and bithionol (11%), with no clinical relevance. Interestingly, these agents belong to the family of halogenated salicylanilides and related compounds, which have been forbidden in Europe since the 1970s. Our results raise the question of hyper‐photosusceptibility to non‐relevant allergens induced by photosensitivity to ketoprofen. The mechanism may involve the high photoreactivity induced by the association of a benzene ring with an oxygen group.
Optimizing the patch‐test concentration of para‐tertiary‐butylcatechol: results of a prospective study with a dilution series
Authors: Hillen Uwe , Frosch Peter J. , Franckson Tom , Pirker Claudia , Goos Manfred
Published: May 2003

Para‐tertiary‐butylcatechol (PTBC), which has long been patch tested internationally at 1% and 0·5% concentrations, was recently shown to induce patch‐test sensitization at the 1% patch‐test concentration. In order to determine a safe patch‐test concentration, we performed a prospective study with lowered patch‐test concentrations. A dilution series of PTBC 0·25%, 0·1%, 0·01% and 0·001% (petrolatum, pet.) was tested on the upper back. Additionally, 0·25% PTBC was tested on the left upper arm to allow patients to carry out self‐examination daily. Patch tests were read on D1–3, D7, D14 and D21 after patch‐test application. Patients who were not able to return for all scheduled readings were telephoned and asked to report any reaction at the patch‐test sites. 65 out of the 101 patients included completed the study. A positive patch‐test reaction was observed in 4 patients during D1–D3, indicating previous sensitization. 1 patient had a doubtful reaction at D3 reading. Negative patch‐test results were noted in 60 patients. None of the patients developed a positive patch‐test reaction during the late readings (D7–D21). Thus, patch‐test sensitization was not observed in any case. Para‐tertiary‐butylcatechol 0·25% pet. is recommended for patch testing internationally.
Evidence‐based diagnosis in patch testing
Authors: Van Der Valk Pieter G. M. , Devos Steven A. , Coenraads Pieter‐Jan
Published: May 2003

Evidence‐based medicine (EBM) is defined as the integration of the best research evidence with clinical expertise and patient values. Based on the principles of EBM, we can conclude that patch testing is cost‐effective only if patients are selected on the basis of a clear‐cut clinical suspicion of contact allergy and only if patients are tested with chemicals relevant to the problem (high pretest probability). Random patch testing (low pretest probability) should be discouraged. Proper pretest probability assessment can only be done in expert centres, because problem‐based testing requires both a thorough knowledge of the patch‐test procedure and knowledge about potential sensitizers in a specific environment.
Methyldibromo glutaronitrile: clinical experience and exposure‐based risk assessment
Authors: Zachariae Claus , Rastogi Suresh , Devantier Charlotte , Menné Torkil , Johansen Jeanne Duus
Published: May 2003

In the year 2000, the level of methyldibromo glutaronitrile (MDGN) allergy in dermatology clinics in Europe exceeded the level of allergies to all other preservatives, with a prevalence of 3·5%. In the present study, cases of primary sensitization and elicitation to MDGN due to cosmetic products were collected over an 8‐month period at the Department of Dermatology, Gentofte University Hospital. The aim was to identify the products related to hand eczema, assess exposure to MDGN in these products and relate the findings to results from a newly developed updated risk assessment model for contact allergy. Out of 24 patients with a positive patch test to MDGN, 17 patients with hand eczema were identified. In 11 of these patients, cosmetic products used in relation to the onset of the disease were shown to contain MDGN (65%). In 8 of these 11 cases, primary sensitization was probable, 5 due to hand/body lotions and 3 due to lotions and/or liquid hand soap. Chemical analysis of 12 products showed that lotions contained 149–390 ppm of MDGN, liquid hand soap 144–399 ppm, a rinsing cream 293 ppm and shampoos 78–79 ppm. The shampoo exposure was not of certain relevance to the eczema. Applying the newly developed updated risk assessment model showed that the concentrations of MDGN in lotions of 149–390 ppm exceeded the calculated maximum acceptable exposure level for MDGN, which would be expected to lead to sensitization in consumers using such products, as seen in the current study. The present cases and updated exposure‐based risk assessment process add to the evidence and need for re‐defining safe‐use concentrations of MDGN in cosmetic products.
Routine patch testing with frullanolide mix: an European Environmental and Contact Dermatitis Research Group multicentre study
Authors: Ducombs G. , Lepoittevin J. P. , Berl V. , Andersen K. E. , Brandão F. M. , Bruynzeel D. P. , Bruze M. , Camarasa J. G. , Frosch P. J. , Goossens A. , Lachapelle J. M. , Lahti A. , Le Coz C. J. , Maibach H. I. , Menné T. , Seidenari S. , Shaw S. , Tosti A. , Wilkinson J. D.
Published: May 2003

Contact sensitivity to plants containing 1 or more sesquiterpene lactones (SLs) is difficult to diagnose. The mixture of SLs (SL mix) has been shown to detect only about 60% of sensitized individuals. In order to improve the diagnosis of sensitization to plants containing SLs, we have tested a mixture of frullanolides contained in Frullania dilatata and Frullania tamarisci at 3 different concentrations (0·01%, 0·033% and 0·1% in petrolatum). 8605 consecutive eczema patients in 1 North American and 15 European dermatology departments were tested with this mix, and 0·35% of positive cases to the different concentrations were found. Routine use of this mix permitted detection of only a small percentage of extra cases and did not improve the SL mix score. The frullanolide mix should therefore be restricted to investigations in particular geographical zones and/or in particular occupations.
Airborne allergic contact dermatitis from 3‐iodo‐2‐propynyl‐butylcarbamate at a paint factory
Authors: Jensen Charlotte Devantier , Thormann Jens , Andersen Klaus Ejner
Published: May 2003

3‐Iodo‐2‐propynyl‐butylcarbamate (IPBC) is a fungicide used in both industrial products and cosmetics. We report the first case of allergic contact dermatitis from airborne exposure to this preservative. A 34‐year‐old female production worker at a paint factory developed dermatitis on air‐exposed skin areas. Patch testing showed a ++ reaction to the preservative IPBC 0·01% in petrolatum. The compound was used as a preservative in wood treatment products manufactured at her work place. Based on animal studies, IPBC is considered safe as a cosmetic preservative. However, widespread use of the chemical might lead to increasing levels of contact allergy, and therefore, close monitoring of IPBC is recommended.
Modelling of flow behaviour in continuous casting tundish
Authors: Singh Rajeev Kumar , Paul Amitava , Ray A. K.
Published: May 2003

One of the steel plants of Steel Authority of India Ltd (SAIL) is considering a proposal to increase the capacity of tundish from the present level of 17 tonne to a targeted level of 25 tonne. As a step towards designing a larger tundish, the flow profile of steel in various alternate tundish configurations considered have been characterized using a 3‐D steady‐state mathematical simulation under assumption of both isothermal and non‐isothermal conditions. Apart from generation of flow profiles of steel inside the tundish, the Residence Time Distribution curves have been predicted for analysis of flow behaviour inside the tundish. Based on the above analysis, the optimum tundish configuration was chosen for further development.
Studies on dust recycling in the electric arc furnace at Uddeholm Tooling AB
Authors: Yang Qixing , Gustafsson Börje
Published: May 2003

The electric arc furnace (EAF) generates dust containing about 21% Zn during primary steelmaking at Uddeholm Tooling AB. Research work on upgrading of the dust has been carried out jointly by Uddeholm Tooling AB and MiMeR, Minerals and Metals Recycling Research Centre, at Luleå University of Technology. The work included laboratory studies and plant trials. The laboratory studies, with 6 dust smelting tests at temperatures around 1650°C, demonstrated that the smelting had no negative effects on qualities of the steel and slag. It was also shown that both carbon and silicon could be used to reduce the oxides in the dust, leading to high metal recoveries. Based on the study results, plant trials were performed at Uddeholm Tooling AB. The trials consisted of 100 EAF heats, recycling dust at a rate of 925 kg/heat. No negative impact has been found on the furnace products and production. The Zn content of the obtained dust increased by 11% and the weight of the generated dust decreased by 42%. The material costs for the dust recycling during the trials were rather low, $0.4 (4–5 SEK)/tonne steel. Some of the test results are interpreted by virtue of mass and energy balances of the dust smelting calculated using the computer software “Chemsage.” By utilizing results from the tests and calculations, the energy consumption for dust smelting was estimated.
On the application of the Perrin process for ferro‐alloy production
Authors: Östberg Gustaf
Published: May 2003

This paper supplements a previous review of the Perrin process for steelmaking with the same focus on its principles, technology and economics. Metallurgically, Perrin's idea of emulsification as a means of achieving rapid reaction also applies to the production of ferro‐alloys. However, the larger proportion of the amount of slag in relation to that of metal makes it necessary to use other procedures for the intimate mixing of the two phases than was the case of steelmaking. Together with the prevailing high reaction temperatures this requirement means that considerable know‐how is needed for acquiring regular production. The major application of the Perrin process to ferro‐alloys has been for low‐carbon ferrochromium, for which it has retained a niche market. To a minor extent it has also been used for ferromanganese and ferronickel. The history and success of the Perrin process for such purposes can be understood in terms of the concept of the so‐called development blocks. This resembles the case of steelmaking inasmuch as its inventor has played a decisive role. The complexity and difficulties of the procedures called for an important contribution by his engineering associates.
Kinetics of carbothermic reduction of magnesia and zinc oxide by thermogravimetric analysis technique
Authors: Hong Lan , Sohn Hong Yong , Sano Masamichi
Published: May 2003

The rates of carbothermic reduction of magnesia and zinc oxide have been investigated using a thermogravimetric analysis technique under argon and CO atmospheres. The experimental results show that zinc oxide can react with carbonaceous materials more easily than magnesia. Both magnesia and zinc oxide can be reduced by charcoal at a lower temperature than by graphite. The carbothermic reduction of magnesia starts at a higher temperature in CO atmosphere than in Ar atmosphere. A kinetic model was developed to analyze the experimental results. The average activation energy value of carbothermic reduction by charcoal calculated from the data of non‐isothermal experiments is 210 kJ/mol for magnesia and 222 kJ/mol for zinc oxide, respectively.
Physical behaviour of slag in a 107‐tonne ladle: production scale experiments and theoretical simulation
Authors: Grip Carl Erik , Jonsson Lage
Published: May 2003

The combined movement of steel, slag and gas in a ladle has been studied with the aid of a multiphase CFD model and measurements in production scale. Comparison of model data and measurements in a production ladle has been carried out for three cases: The ‘open eye’ created during gas stirring, the mixing of top slag during gas stirring in the CAS‐OB and finally for studying sculling phenomena. It was found that the simulated ‘open eye’ appears as a central slag‐free zone with a surrounding ‘splash zone’ characterized by the fact that steel is found on top of the slag. The simulated ‘open eye’ corresponds to the ‘splash zone’. The predicted gas stirring in CAS‐OB gives an efficient stirring of the top slag also. This was confirmed by noting that slag samples taken from the ladle seem to be representative of the mean slag composition. Finally, streamlines during stirring have been compared with sculling and wear observed in the production ladle. Good agreement was obtained.
A model of reoxidation from the top slag and the effect on sulphur refining during vacuum degassing
Authors: Margareta A. , Andersson T. , Jonsson Lage T. I. , Jönsson Pär G.
Published: May 2003

A 2‐dimensional fluid‐flow model covering 3 phases (steel, slag and gas) has been augmented to include thermodynamic equations to study simultaneous reoxidation and desulphurization, including macro kinetic behaviour. The numerical simulations were isothermal. Predicted steel and slag component concentrations were compared with plant data from vacuum degassing and the agreement was found to be quite good. When the initial FeO content in the slag was increased, the predicted desulphurization rate decreased, the final sulphur content in the steel increased, and aluminium loss increased. When the temperature was increased, the predicted aluminium loss decreased somewhat. The effect of changes in temperature on the predicted final sulphur content was influenced by the initial FeO content in the top slag. The results show that the model can be used for future work on the dynamic modelling of slag/metal reactions if the initial FeO content is less than 3–4% (by weight).
Detection of High‐Risk Atherosclerotic Coronary Plaques by Intravascular Spectroscopy
Authors: MORENO PEDRO R. , MULLER JAMES E.
Published: May 2003

Multiple technologies are under development to identify plaque composition and vulnerability. This review article is intended to provide basic knowledge to the interventional cardiologist and the clinician about spectroscopy. The concept of light, the wavelength unit and the electromagnetic spectrum are discussed. Different types of spectra analysis including nuclear magnetic resonance, Raman, fluorescence and diffuse reflectance near‐infrared spectroscopy are then carefully reviewed. Experimental data to identify atherosclerotic plaque composition for each of these techniques is provided. Potential benefits and challenges are addressed. Finally, diffuse reflectance near‐infrared spectroscopy is discussed in more detail as a promising technique to characterize plaque vulnerability in humans. (J Interven Cardiol 2003;16:243–252)