bluuebunny/crossref_metadata_2025 huggingface dataset:
Kyanite‐paragonite‐bearing assemblages, northern Fiordland, New Zealand: rapid cooling of the lower crustal root to a Cretaceous magmatic arc
Authors: Daczko N. R. , Clarke G. L. , Klepeis K. A.
Published: March 2003

Fiordland, New Zealand exposes the lower crustal root of an Early Cretaceous magmatic arc that now forms one of Earth's most extensive high‐P granulite facies belts. The Arthur River Complex, a dioritic to gabbroic suite in northern Fiordland, is part of the root of the arc, and records an Early Cretaceous history of emplacement, tectonic burial, and high‐P granulite facies metamorphism that accompanied partial melting of the crust. Late random intergrowths of kyanite, quartz and plagioclase partially pseudomorph minerals in the earlier high‐T assemblages of the Arthur River Complex, indicating high‐P cooling of an over thickened crustal root by c. 200 °C. The kyanite intergrowths are themselves partially pseudomorphed by paragonite, commonly in the presence of phengitic white mica. Biotite–plagioclase intergrowths that partially pseudomorph phengitic white mica and diopside–plagioclase intergrowths that partially pseudomorph jadeitic diopside, combined with published thermochronology results, are consistent with later rapid decompression. A short duration anticlockwise P–T path may be explained by the high‐P juxtaposition of comparatively cool upper crustal rocks following their tectonic burial and under thrusting during the waning stages of Early Cretaceous orogenesis. This was then followed by the decompression giving the rapid exhumation within 20 Myr of peak metamorphism, as suggested by the isotopic data.
The Comparative Safety of Intravenous Iron Dextran, Iron Saccharate, and Sodium Ferric Gluconate
Authors: Fishbane Steven , Kowalski Edward A.
Published: March 2003

Intravenous iron treatment is an important component of anemia therapy for patients on dialysis. Until recently iron dextran was the only parenteral form of iron available in the United States. This drug has been associated with occasional serious adverse reactions, including full‐blown anaphylaxis. In 1999 the Food and Drug Administration approved a second form of iron for intravenous administration, sodium ferric gluconate in sucrose. It is expected that by the time of this publication, a third agent, iron saccharate will also be approved. In this review the comparative safety of these three agents is critically evaluated.
Compartment Effects in Hemodialysis
Authors: Schneditz Daniel , Daugirdas John T.
Published: March 2003

Compartment effects in hemodialysis are important because they reduce the efficiency of removal of the compartmentalized solute during dialysis. The dialyzer can only remove those waste products that are presented to it, and then only in proportion to the concentration of the solute in the blood. Classically a two‐compartment system has been modeled, with the compartments arranged in series. Because modeling suggests that the sequestered compartment is larger than the accessible compartment, an assumption has been made that the sequestered compartment is the intracellular space. For urea and other solutes that move easily across many cell membranes, compartmentalization may be flow related, that is, related to sequestration in organs (muscle, skin, bone). Although mathematically urea rebound and mass balance can be described with either model, the flow‐related model best explains data showing that urea rebound after dialysis is increased during ultrafiltration, diminished during high cardiac output states, and also reduced during exercise. Whether compartmentalization is increased in vasoconstricted intensive care unit patients receiving acute dialysis remains an open question.
Single‐Pass Continuous Flow Peritoneal Dialysis Using Two Catheters
Authors: Cruz Cosme , Melendez Alma , Gotch Frank A. , Folden Tom , Crawford Terri L. , Diaz‐Buxo Jose A.
Published: March 2003

With a renewed interest in continuous flow peritoneal dialysis (CFPD), our standard practice of implanting a second catheter in those patients facing access failure provided us the opportunity to perform acute studies on CFPD in these patients, since it temporarily provided us with two catheters. Four patients were studied, with a total of five studies performed. A standard protocol was followed utilizing 1.5% dextrose solution, a 2 L fill, an inflow rate of 200 ml/min with a proportionate outflow for a 4‐hour session. A full drain was performed at the end of the study. Our results provided us with a mean effective peritoneal clearance for urea (KpeU) and creatinine (KpeCr) of 40 ml/min and 28 ml/min, respectively, and a mean ultrafiltration rate (Qf) of 13.4 ml/min. Our average mass transfer coefficient (MTC) for urea was 40 ml/min, consistent with kinetic modeling and historical data. The Kpe, MTC, and Qf achieved are significantly higher than other investigators, which could possibly be explained by those obtained by two separate catheters resulting in adequate mixing of the dialysate. These clinical results provide a solid foundation for the future development of this PD modality.
The Dialytic Management of Acute Renal Failure in the Elderly
Authors: Van de Noortgate Nele , Verbeke Francis , Dhondt Annemieke , Colardijn Francis , Van Biesen Wim , Vanholder Raymond , Lameire Norbert
Published: March 2003

In this article the different dialysis strategies in the management of acute renal failure (ARF) in the elderly are discussed. Although peritoneal dialysis (PD) offers some theoretical advantages, there are several medical and technical reasons why it is currently less frequently used. The choice between intermittent hemodialysis (HD) and continuous renal replacement therapy (CRRT) is determined by a number of considerations, the most important ones being hemodynamic stability, the need for hyperalimentation and/or ultrafiltration, and the local experience with one or both techniques. Some recent studies with CRRT in elderly ARF patients describe favorable results. Slow extended daily dialysis (SLEDD) modalities may be particularly indicated in elderly, critically ill ARF patients because these techniques combine the advantages of both CRRT and HD. Finally, the importance of the biocompatibility of dialysis membranes is discussed. Although there are a number of theoretical arguments to use biocompatible membranes, this opinion is not always supported by the results of recent comparative studies. It is the opinion of the authors that all dialysis strategies should be mastered and utilized for appropriate indications in elderly ARF patients.
Editorials: Assessment of Blood Pressure in Hemodialysis Patients
Authors: Agarwal Rajiv
Published: March 2003

It is self‐evident that accurate measurement of blood pressure (BP) is essential for the diagnosis and treatment of hypertension. Patients on hemodialysis typically do not have their BP measured under standardized conditions, a source of error in the assessment of their BP. However, their are some unique sources of error involving interdialytic weight gain, occurrence of sleep apnea and consequent nocturnal hypertension, inability to take BP in both arms in patients who have hemodialysis angioaccess in the arm, and the white coat effect in these patients as well. Precise measurement of BP in hemodialysis patients requires interdialytic ambulatory BP monitoring. However, when ambulatory BP monitoring is not possible, BP obtained in the dialysis unit can be used in a qualitative sense for prediction of hypertension in these patients. A 2‐week average predialysis BP of greater than 150/85 mmHg or a postdialysis BP of greater than 130/75 mmHg has at least 80% sensitivity in diagnosing hypertension. Specificity of at least 80% can be achieved if predialysis BP of greater than 160/90 mmHg or postdialysis BP of greater than 140/80 mmHg are used. However, poor agreement between hemodialysis unit BP and ambulatory BP precludes their use for the precise prediction of BP. Improving measurement techniques in the dialysis unit, averaging multiple BP values, using 20‐minute postdialysis readings, or home BP monitoring can improve BP determination when interdialytic BP monitoring is not possible.
Automated Peritoneal Dialysis Symposium: Treatment of Peritonitis in APD: Pharmacokinetic Principles
Authors: Manley Harold J. , Bailie George R.
Published: March 2003

Clinicians treating peritoneal dialysis (PD)‐associated peritonitis should be aware that continuous ambulatory PD (CAPD) and automated PD (APD) have different effects on the pharmacokinetics of antibiotics. Results from various APD and comparative CAPD pharmacokinetic studies are reviewed. In APD patients, antibiotic half‐lives were shorter during the cycler exchanges. Antibiotic peritoneal clearance was greater in patients treated with APD than those treated with CAPD regimens. Antibiotic clearance depends upon residual renal function and dialysate flow rate. To ensure that maximal antibiotic bioavailability occurs with intermittent intraperitoneal (IP) dosing, it is recommended that the antibiotic‐containing dialysate must dwell at least 4 hours to ensure an adequate antibiotic depot in the body. Knowledge of antibiotic disposition in PD patients will assist clinicians in appropriate IP antibiotic dose selection and prevention of dose‐related adverse effects.
Treating Interdialytic Hyperkalemia with Fludrocortisone
Authors: Imbriano Louis J. , Durham John H. , Maesaka John K.
Published: March 2003

Hyperkalemia is a frequent and dangerous problem in dialysis patients. Many factors contribute to potentially life‐threatening potassium elevation and most remedies used to treat hyperkalemia are handicapped by the consequences of the separate pools of intra‐ and extracellular potassium. Besides the kidney, the colon has the ability to excrete potassium, which can help lower total body potassium. Several prior authors have addressed the colon's ability to up‐regulate potassium secretion, including the effect of aldosterone on fecal potassium content. Potentially dangerous intradialytic maneuvers to lower potassium levels may be avoidable with the use of the mineralocorticoid agonist fludrocortisone.
Race and Prostate Cancer: What Do We Know?
Authors: Young C. Dale , Roach Mack
Published: March 2003

Objectives: Is race an independent prognostic indicator of outcome and overall survival in prostate cancer? African American men have been reported to have the highest incidence and mortality rates for prostate cancer worldwide, but the evidence to explain this is confusing at best.

Materials and Methods: A literature search was conducted, and an effort was made to include all articles published in the last 15 years that evaluated the independent significance of race on survival or disease‐free survival from prostate cancer. Special attention was given to the major prospective randomized trials in which the initial workups, evaluations, and treatments were relatively uniform and in which the opportunity for confounding variables were small.

Results: The appearance of a difference in outcome due to race is most likely a result of an epidemiologic phenomenon that arises when evaluating two different populations that have different distributions with regard to severity of disease. African Americans tend to present with higher prostate specific antigen (PSA) levels and higher Gleason scores, and a larger percentage are likely to belong to the groups with the higher risk of failure, creating the impression that failure is due to race.

Conclusions: On examination of the prospective randomized trials in the literature, “race‐based” explanations for differences in survival should be viewed with a moderate degree of skepticism. So‐called “epigenetic” factors may explain the higher incidence of prostate cancer noted in numerous studies.
Women's Health and the Practice of Public Health Nurses in Northern British Columbia
Authors: Leipert Beverly
Published: March 2003

This study explored women's health and the practice of public health nurses in northern British Columbia using a phenomenological methodology. Ten public health nurses in northern British Columbia were interviewed to determine their perspectives on their practice in the area of women's health. Findings reveal three central themes: women's health, public health nursing practice, and rural context. Several subthemes elaborate on the central themes. Women's health is described in terms of women's health needs, how women stay healthy in northern communities, and conditions that affect women's health. Public health nursing practice is described in terms of activities, strengths, conditions, and ways to strengthen practice. Definitions of rural context are provided and some of the benefits and challenges of living and working in northern communities are presented. Health promotion and illness and injury prevention needs of women are clearly evident in the findings. Public health nurses are well placed in the North to help women meet their health care needs. However, further attention to women's health needs and the expansion of public health nursing services would facilitate improved health for women who live in isolated northern settings. In addition, further research is needed to explicate women's health and public health nursing practice in isolated northern settings in Canada.
Patient Problems and Advanced Practice Nurse Interventions During Transitional Care
Authors: Naylor Mary D , Bowles Kathryn H , Brooten Dorothy
Published: March 2003

This study is a secondary analysis of patient records written by advanced practice nurses (APNs) as they provided discharge planning and 4 weeks of home follow‐up to elderly patients hospitalized with common medical and surgical conditions. The purposes of this study were to examine the problems experienced by elders who were hospitalized and discharged to home, the interventions used by APNs as they cared for these patients, and the linkages between patient problems and APN interventions. Care logs written by the APNs to document the patient problems and nursing interventions were content analyzed and coded using the Problem Classification Scheme and Intervention Scheme of the Omaha System. The results provided a description of the 10 most frequent problems experienced by the patients linked with the APN's interventions. The study provides a description of the nature and complexity of patient problems as they transition from hospital to home and increases our understanding of the contribution of APNs to the care of elders.
Promoting Elder Wellness Through a Community‐Based Blood Pressure Clinic
Authors: Shellman Juliette
Published: March 2003

As the American population ages, we can expect to find greater numbers of older adults with chronic diseases and health concerns. Therefore the implementation of community‐based blood pressure clinics that promote elder wellness becomes increasingly important. This article will describe the development, implementation, and evaluation of a community‐focused elder wellness program in a rural community using Anderson and McFarlane's (1996) Community‐as‐Partner model as a theoretical framework for community health nursing practice. Evaluation results of the elder wellness program suggest that blood pressure screenings provide community health nurses (CHNs) with unique opportunities to promote wellness in older adults when provided in an atmosphere that encourages nurse‐client interactions.
Social Support and Psychological Functioning Among High‐Risk Mothers: The Impact of the Baby Love Maternal Outreach Worker Program
Authors: Navaie‐Waliser Maryam , Martin Sandra L , Tessaro Irene , Campbell Marci K , Cross Alan W
Published: March 2003

This study compared two groups of high‐risk Medicaid‐eligible mothers, 221 who participated in a maternal home visitation program and 198 who did not, to determine whether program participation was associated with improvements in the mothers' psychological functioning 1 year after delivery, and whether these improvements were associated with the type and intensity of support provided by home visitors. The results suggest that, compared to nonparticipants, participants provided with more intensive home visitor support had significantly higher self‐esteem (p= 0.039) and were less depressed (p= 0.015). Participants with less intensive home visitor support, however, did not differ significantly from nonparticipants in their self‐esteem or depression levels. No significant differences were observed in the perceived stress levels of participants as compared with nonparticipants, regardless of the intensity of home visitor support. Mothers who had support from the baby's father, however, had significantly lower perceived stress levels than mothers with no support from the baby's father (p= 0.046). Moreover, the type of support provided by home visitors (emotional, instrumental, informational) did not appear to be related to the mothers' psychological functioning. This study suggests that the intensity of support is an important component of maternal home visitation programs that aim to improve women's psychological functioning.
Developing and Testing Instruments to Measure Client Outcomes at the Comox Valley Nursing Center
Authors: Hilton B. Ann , Budgen Claire , Molzahn Anita E. , Attridge Carolyn B.
Published: March 2003

A Nursing Centre in Canada was initiated to demonstrate nursing practice in a primary health care context, unencumbered by conventional health care agency parameters. As one part of a multimethod evaluation, a 5 instrument client questionnaire was designed. The main instrument was developed by the researchers to measure the impact of the Centre and nurses' work from the perspective of clients. No established instrument could be found that was appropriate for the Centre's diverse client population and nature and variation in outcomes. To guide the development of the new instrument, minimally structured client interviews were conducted with 15 clients. To assess the validity and reliablity of other selected instruments for the population, clients were asked to comment on the appropriateness of items. Based on findings, the Nurses' Work and Client Outcomes Questionnaire (NWCOQ) was developed, the Client Satisfaction Questionnaire and demographic questions modified, and a Cantril Self‐Anchoring ladder to assess health status was supported for use. An open section was added to invite further description of clients' experiences, in particular, the unexpected, contrary or outstanding. Further pilot work was done and the refined five instrument questionnaire then was used to survey all clients who used the Centre during a seven month period. Findings from the NWCOQ revealed the nature of the nurses' work and the degree change occured for clients on multiple health dimensions: physical, emotional, managing their situation, and group and community involvement. Clients were highly satisfied with the Centre and experienced many positive outcomes. The quantitative instruments and results were examined in relation to results from other data collection approaches and data sources. The NWCOQ has evidence of content validity and internal consistency reliability. The use of qualitative methods to develop and refine quantitative instruments for assessment of health outcomes for diverse client populations is highly recommended. This strategy is feasible even when outcome measurement timeframes are short.
The Effectiveness of Health Promotion Counseling for Overweight Adolescent Nursing Students in Taiwan
Authors: Chen Mei‐Yen , Huang Lian‐Hua , Wang Edward K. , Cheng Ne‐Jan , Hsu Ching‐Yun , Hung Li‐Ling , Shiao Yea‐Jwu
Published: March 2003

This study examined the effectiveness of health promotion counseling for overweight adolescent nursing students. The Chinese version of an established health promotion counseling booklet developed by the author of this study was used in the counseling. The study employed a one‐group pre‐ and post‐quasi‐experimental research design from September 1997 to June 1999. A total of 166 (17%) first‐year, junior college nursing students were found to be overweight according to the results of a health examination at the school health center at a junior college in the Taipei Metropolitan Area. Of these 166 students, 58 were randomly selected and 49 of these had complete participation records for the 2‐year study. All subjects received 8 hours of whole group and 12 hours of small group health promotion counseling over a 1‐year period. The results show that health promotion counseling enabled subjects to adopt healthier lifestyles and most of the physiological variables (WLI, HDL, SBP, TC) were significantly improved. This research outcome supports the value of health promotion counseling in school health centers, which incorporates material to help overweight adolescent students live a healthier life.
TB‐HIV Registry Matching in Missouri, 1987–1999
Authors: Libbus M. Kay , Phillips Lynelle , J. Knudson Kimberly
Published: March 2003

Abstract
Mycobacterium tuberculosis (MTB) is an important problem for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. This study investigated whether all cases of MTB reported to the HIV/AIDS Registry (HARS) in Missouri were also reported to the Tuberculosis Information Management System (TIMS) to determine the sensitivity of TIMS and the predictive value of HARS. We found 262 total MTB cases registered in HARS. Of these, 145 (55%) were included in the TIMS. Thirty‐eight of the remaining 117 were caused by mycobacteria other than TB leaving 79 for investigation. Chart review of the 79 revealed 16 cases of MTB. Sensitivities and predictive values were calculated first including unknown/unreported group as being MTB‐positive and the second including this group as being MTB‐negative. Sensitivities for TIMS were 83 and 90%, respectively, and predictive values for HARS were 68 and 63%, respectively. The fact that there were at least 16 unreported cases of MTB has significant public health implications for TB control in Missouri. Public health nursing could work with HARS surveillance staff to help improve the accuracy of case finding and reporting. By whatever means necessary, communications between the TB and HIV programs within the Missouri Department of Health should be enhanced.
Uncombable Hair Syndrome with Angel‐Shaped Phalango‐Epiphyseal Dysplasia
Authors: Fritz T. M. , Trüeb R. M.
Published: March 2003

Abstract: Uncombable hair syndrome or “cheveux incoiffables” is due to a characteristic longitudinal grooving of the hair shaft resulting in a triangular cross section (pili trianguli et canaliculi). In the majority of cases the abnormality is an isolated finding, although uncombable hair‐type changes have been observed in conjunction with other features of ectodermal dysplasia. Ultrastructural studies in the latter have revealed more complex changes of the hair shaft, such as longitudinal grooving in combination with torsion, suggesting classification as a different entity. We describe a 6‐year‐old girl with typical “cheveux incoiffables,” as confirmed by scanning electron microscopy, in combination with angel‐shaped phalango‐epiphyseal dysplasia. The relationship to a previously described syndrome of uncombable hair in combination with retinal dystrophy, juvenile cataract, and brachydactyly, in which both hair and skeletal abnormalities are common, remains to be further elucidated.
Tinea Incognito due to Microsporum gypseum in Three Children
Authors: Romano C. , Asta F. , Massai L.
Published: March 2003

Abstract: Tinea incognito is a dermatophytosis of atypical clinical character due to the absence of classic features of ringworm. It is caused by prolonged use of topical steroids, sometimes prescribed as a result of incorrect diagnosis. The cases reported in the literature have different clinical presentations and have generally been in adults. We report three children with tinea incognito in whom the lesions were psoriasis‐like, eczema‐like, and lichenoid, respectively. Diagnosis was confirmed by mycologic examination, which led to the identification of Microsporum gypseum, a geophilic dermatophyte which is an infrequent agent of mycotic infection in humans.
Auriculotemporal (Frey) Syndrome in Late Childhood: An Unusual Variant Presenting as Gustatory Flushing Mimicking Food Allergy
Authors: Kaddu Steven , Smolle Josef , Komericki Peter , Kerl Helmut
Published: March 2003

Abstract: Auriculotemporal or Frey syndrome is characterized mainly by recurrent episodes of facial gustatory flushing and/or sweating, limited to the cutaneous distribution of the auriculotemporal nerve. Although relatively common in adults following injury to the auriculotemporal nerve or parotid disease, the condition has rarely been reported in children. Moreover, in childhood, auriculotemporal syndrome has been described mainly in infancy and early childhood as a sequel of perinatal birth trauma resulting from assisted forceps delivery. We report a 13‐year‐old girl with a 2‐month history of recurrent, painless, preauricular gustatory flushing without sweating, initially suspected to be a food allergy. Detailed inquiry revealed a history of a bicycle accident with mandibular condyle fracture 7 years prior to the onset of symptoms. Our patient demonstrates an unusual presentation of auriculotemporal syndrome in late childhood as gustatory flushing mimicking food allergy. Awareness of this variant is essential for prompt recognition, thus avoiding unnecessary laboratory tests, especially as this condition usually resolves spontaneously.
Tuberous Sclerosis with Macrodactyly
Authors: Sahoo Bijaylaxmi , Handa Sanjeev , Kumar Bhushan
Published: March 2003

Abstract: Tuberous sclerosis with macrodactyly is a very uncommon presentation. We report a 15‐year‐old girl with a thick, loose hyperpigmented area on the dorsum of the left hand with macrodactyly. A skin biopsy specimen from the dorsum of the left hand revealed dense collagenization in the dermis. Radiographs showed marked irregular thickening of the cortex of the metacarpals and phalanges of the left index and middle fingers.
Garlic Burns
Authors: Rafaat Massoud , Leung Alexander K. C.
Published: March 2003

Abstract: A 3‐month‐old infant with blistering lesions and a second‐degree burn from topical application of garlic is reported. The literature on garlic burns is reviewed.
Dysplastic Nevi of the Scalp and Forehead in Children
Authors: Fernandez Martin , Raimer Sharon S. , Sánchez Ramón L.
Published: March 2003

Abstract: To determine if there is a significant difference in the relative frequency and degree of atypia of sporadic dysplastic nevi from the scalp, face, and neck area in children as compared with nevi from the rest of the body, we reviewed 99 consecutive biopsy specimens of melanocytic nevi from the scalp, face, and neck areas in children less than 18 years of age and compared them with 95 consecutive cases of nevi from other areas of the body in children of the same age. Large numbers of the nevi biopsied from the scalp (13 of 31; 41.93%) and forehead (2 of 10; 20%) were dysplastic. The number of dysplastic nevi from the neck (1 of 58; 1.72%) was not assessed as very different from the incidence found in other regions of the body, where 7 dysplastic nevi (7.36%) from a total of 95 nevi were found. Of the 13 dysplastic nevi from the scalp, 9 showed minimal atypia and 4 showed moderate atypia. No nevi with severe atypia were found. Many pigmented nevi from the scalp and forehead in children in this study were dysplastic. This finding points out the importance of examining the scalp of children for the presence of dysplastic nevi. The majority of nevi from the neck were common nevi.
Familial Atrophia Maculosa Varioliformis Cutis: An Ultrastructural Study
Authors: Dall'Oglio Federica , Nasca Maria Rita , Taparelli Francesca , Bacchelli Barbara , Micali Giuseppe
Published: March 2003

Abstract: Atrophia maculosa varioliformis cutis is a rare and distinctive form of idiopathic facial macular noninflammatory atrophy that may rarely be observed in members of the same family. We describe two brothers, ages 14 and 16 years, with spontaneously appearing, asymptomatic, varioliform and linear atrophic lesions. Their past medical history was positive for varicella occurring in childhood without residual facial scarring. Routine laboratory investigations and screening for circulating autoantibodies were negative. Both patients were concordant for HLA A2 and DQ4.1. Routine and ultrastructural histologic examination of a punch biopsy specimen showed the presence of scarce, small, fragmented elastic fibers and compact collagen bundles associated with hypertrophic fibroblasts in the dermis. Our patients remained clinically stable, untreated, over a 2‐year follow‐up period. No long‐term follow‐up data have previously been reported.
Doubled Dose of Oral Terbinafine is Required for Microsporum canis Tinea Capitis
Authors: Koumantaki Elma , Kakourou Talia , Rallis E. , Riga Panayiota , Georgalla Sophia
Published: March 2003

Fourteen children, ages 1–15 years, with Microsporum canis tinea capitis were given oral terbinafine for 4 weeks at the recommended daily dose according to their weight: 10–20 kg, 62.5 mg; 20–40 kg, 125 mg; > 40 kg, 250 mg. Because none of the patients had clinically responded to treatment by week 4 the dose of terbinafine was doubled (up to 250 mg) for an additional 4–8 weeks in six patients, and continued at the original dose in six patients. Two patients dropped out of the study. On final evaluation, four patients were cured after 8–12 weeks of treatment. All cured patients received the doubled dose of terbinafine, except for one who was on the usual adult dose of 250 mg from the onset. Oral terbinafine was well tolerated by all but one patient, who experienced gastrointestinal disturbance and slightly raised transaminase levels during the first 4 weeks of treatment. Terbinafine side effects were not correlated with dosage or duration of treatment. We conclude that oral terbinafine should be dosed for M. canis tinea capitis at a revised schedule according to body weight: 10–25 kg, 125 mg/day and > 25 kg, 250 mg/day. The appropriate duration of terbinafine treatment remains to be determined.
Treatment of Anogenital Warts in Children with Topical 0.05% Podofilox Gel and 5% Imiquimod Cream
Authors: Moresi J. Margaret , Herbert Courtney R. , Cohen Bernard A.
Published: March 2003

A retrospective analysis of 25 infants and young children with anogenital warts was performed by chart review and telephone interview. Fifteen of 17 patients treated with podofilox 0.5% gel and 6 of 8 patients treated with imiquimod 5% cream improved or cleared with therapy. Only one patient stopped treatment because of irritation. Our experience suggests that these agents can be used safely and effectively in young children. Controlled prospective studies should be undertaken to further evaluate the use of podofilox and imiquimod in the treatment of symptomatic anogenital warts in children.
Epidermal Grafting for Vitiligo in Adolescents
Authors: Gupta Somesh , Kumar Bhushan
Published: March 2003

Vitiligo is a significant problem in children. Many fail to respond to medical treatment and require melanocyte replenishment with one of the various surgical methods. Epidermal grafting using the tops of suction blisters has been found to be the most effective surgical procedure. However, the results of this procedure have never been delineated separately in adolescents and children. There are certain procedural and outcome differences in epidermal grafting among children and adolescents as compared to adults. We performed epidermal grafting in 15 recalcitrant patches of stable vitiligo in 10 children. Thirteen of 15 patches (86.66%) in 8 of the 10 patients (80%) showed more than 75% pigmentation. The results were much better than the overall response rate of 62% in 142 patients (adults as well as children) found in an earlier study. Literature analysis revealed the same trend in other studies.
Congenital Postauricular Swelling in a Child
Authors: Marchioni Daniele , Cuzzola Emanuele , Massone Federica , Ghidini Angelo
Published: March 2003

Abstract: First branchial cleft cysts develop as a result of incomplete fusion of the cleft between the first and second branchial arches. In 1972, Work introduced a modified classification of these anomalies that recognized the existence of two types. Type I lesions, which are extremely rare, present as a cystic mass posterior to the pinna and concha. Type II lesions represent a duplication of both the membranous and cartilaginous portions of the external ear canal. They are associated with fistulas in the concha or in the external ear canal. Clinical and surgical management is often difficult because these anomalies have a variable relationship to the facial nerves. We describe a rare localization of a type I first branchial cleft cyst in a child and the clinical management with successive surgical treatment.
Fixed Drug Eruption in the Genital Area in 15 Boys
Authors: Nussinovitch Moshe , Prais Dario , Ben‐Amitai Dan , Amir Jacob , Volovitz Benjamin
Published: March 2003

ABSTRACT: Fixed drug eruption (FDE) is manifested as localized, circumscribed, round or oval plaques that characteristically recur in the same site with each use of the offending drug. The drugs most commonly implicated are phenolphthalein, barbiturates, antibiotics, salicylates, contraceptives, and anticonvulsants. FDE can appear on different parts of the body. The sites of predilection are the lips, genitalia, and sacral area. There are no reports of large series of pediatric patients with FDE involving the genitalia. We describe 15 boys with genital FDE associated with several drugs. Their average age at diagnosis was 3.2±2.2 years (range 6 months–8 years). The clinical presentation usually consisted of swelling and erythema of the penis and/or scrotum associated with pruritus, restlessness, urinary retention, and painful micturation. The diagnosis was supported by clinical history. The causative drugs were identified and confirmed by a provocation test, resolution after the drug was stopped, and a positive migration inhibiting factor (MIF) test. Genital FDE in children is uncommon, but the drugs associated with this entity are in such widespread use in pediatric practice that its recognition may be important, especially considering its easy treatability.
Evaluation of Adsorption Selectivity Dextran Sulfate Bound Cellulose Beads for the Removal of Anti‐DNA Antibodies
Authors: Hidaka Toshihiko , Suzuki Kimihiro , Matsuki Yasunori , Takamizawa‐Matsumoto Mitsuyo , Kataharada Kouji , Ishizuka Toshiaki , Kawakami Makoto , Nakamura Haruo , Yabuki Tetsuro , Kutsuki Hidetoshi
Published: March 2003

The purpose of this study was to clarify the basic adsorption selectivity characteristics of dextran sulfate (DS) columns (Selesorb, Kaneka Corporation, Osaka, Japan). Recovery rates of blood chemical components, hormones, coagulation factors, and antinuclear antibodies (anti‐SS‐A, SS‐B, Sm, Scl‐70, and RNP antibody) in vitro were assessed by mixing normal volunteers' or patients' sera with DS bound cellulose beads. For tested blood chemical components other than triglyceride and total cholesterol, the recovery rate was not changed significantly by incubation. No significant changes in hormone levels resulted from incubation. Among coagulation factors, the activities of antithrombin III, plasminogen, and factors V, VIII, IX, XI, and XII were significantly reduced by incubation. Among antinuclear antibodies tested, anti‐SS‐A and anti‐RNP were absorbed to some extent, but not anti‐SS‐B, Sm, or Scl‐70 antibodies. Taking into account these characteristics, apheresis therapy using a DS column should be performed.
Apheresis in Thoracic Organ Transplantation
Authors: Robinson John A.
Published: March 2003

The beneficial addition of cyclosporine and tacrolimus to the immunosuppressive armamentarium have unfortunately only partially solved the problems of acute and chronic rejection in thoracic organ transplantation. Apheresis techniques offer creative avenues for modifications of allograft rejection. Plasmapheresis can be used for mechanical reduction of alloantibody burdens in highly sensitized patients and permit transplantation in an otherwise almost hopeless situation and can also be used on a short‐term basis for the treatment of acute humoral rejection. Extracorporeal photochemotherapy holds promise as a possibly synergistic adjunct to conventional therapy and may even reduce the severity of graft vasculopathy. The increasing availability of highly specific column immunoadsorption techniques may further increase the applicability of apheresis in transplantation.
Current Topics on Immunoadsorption Therapy
Authors: Nakaji Shuhei
Published: March 2003

Abstract: Immunoadsorption therapy has become popular for the treatment of various autoimmune diseases as the number of clinically available immunoadsorption columns increases. Immunoadsorption columns for plasma perfusion or direct hemoperfusion available for clinical use such as the Immusorba TR and PH, Selesorb, Prosorba, Immunosorba, Ig‐Therasorb, and Medisorba MG are reviewed in the first part of this article. The peptide columns which immobilize peptides as the ligands are described in the second half. The peptide column has the potential to deliver specific adsorbents if a peptide is appropriately designed to remove the pathogenic substances specifically responsible for the given disease.
Immunoadsorption in Myasthenia Gravis Based on Specific Ligands Mimicking the Immunogenic Sites of the Acetylcholine Receptor
Authors: Takamori Masaharu , Maruta Takahiro
Published: March 2003

Abstract: A specific system for antibody removal from blood circulation in myasthenia gravis (MG) patients was devised by use of the immunoadsorbent bound to an acetylcholine receptor (AChR) peptide that was synthesized corresponding to the sequence of residues 183‐200 of the AChR alpha‐subunit (alpha 183‐200), antibodies which prevent the binding of ACh to AChR. The alpha 183‐200 peptide was confirmed to be immunogenic for induction of an animal model of the disease and for reactivity with MG autoantibodies. We then made use of these results for immunoadsorption therapy through the antigen‐antibody reaction on the molecular level, having given patients relief from myasthenic weakness. The greatest care was taken for the selection of an antigenic region in the molecular structure among various myasthenogenic domains of AChR and for the antigenic conformation of synthetic peptide as the adsorbent to react with antibodies raised against the native protein.
A Review of Leukofiltration Therapy for Decreasing the Morbidity Associated with Cardiopulmonary Bypass and Acute Inflammatory Bowel Disease
Authors: Ortolano Girolamo A. , Capetandes Anthony , Wenz Barry
Published: March 2003

Abstract: Complications of cardiopulmonary bypass (CPB) and acute inflammatory bowel disease (IBD) are associated with increased morbidity and cost. During reperfusion post‐CPB, activated neutrophils adhere to microvascular endothelial cells mediated by cell adhesion molecules (CAMs) and cytokines/chemokines with subsequent myocardial damage caused by activated neutrophil‐derived oxidants and enzymes. Leukofiltration was shown to reduce myocardial reperfusion injury and improve gas exchange as suggested by improvements in surrogate markers of inflammation and clinical end points. In acute IBD, characterized by rectal bleeding and protracted hospital stays, circulating neutrophils emigrate to the inflamed colon and adhere to microvascular endothelial cells by CAMs. Multiple treatments with leukofiltration in IBD were shown to induce long‐term remission of acute IBD. Hence, leukofiltration may reduce reperfusion injury and rectal bleeding in CPB and IBD, respectively, and therefore decrease the morbidity and cost associated with these diseases.
The Role of Blood Component Removal in Essential and Reactive Thrombocytosis
Authors: Greist Anne
Published: March 2003

Abstract: An elevated platelet count is now a common finding in both hospitalized and ambulatory patients with the advent of automated complete blood cell counters. Clinicians may be called upon to make a distinction between a reactive process and a primary hematologic disorder as the cause of a thrombocytosis and to determine whether treatment is indicated. Essential thrombocythemia and other myeloproliferative disorders may present with marked increases in the platelet counts and may be associated with thrombohemorrhagic complications. Reactive thrombocytosis can be caused by iron deficiency and a variety of inflammatory conditions, infections, malignancy, bleeding or hemolysis, splenectomy, and drugs. Acute therapy for all of these disorders has included blood component removal, specifically plateletpheresis. The role of plateletpheresis in current management of thrombocytosis is considered, based on current knowledge of pathophysiology and a review of the literature.
Oxygen Saturation and Hemoglobin A Content in Patients with Sickle Cell Disease Undergoing Erythrocytapheresis
Authors: Nifong Thomas P. , Domen Ronald E.
Published: March 2003

Abstract: Severe hypoxia occurs in patients with acute chest syndrome, and erythrocytapheresis has been shown to improve oxygenation. Patients with sickle cell anemia also have decreased baseline oxygen saturation values, but the effect of erythrocytapheresis on steady‐state oxygenation has not been well studied. We investigated the changes in oxygen saturation versus hematocrit, fraction of hemoglobin A, and transfusion volume during 71 prophylactic erythrocytapheresis procedures performed in 5 stable patients with sickle cell anemia. Each patient had a history of either acute chest syndrome or stroke, but no serious events occurred while enrolled in the chronic exchange program. The oxygen saturation improved from 1% to 6% during erythrocytapheresis in each of our patients (p < 0.001) regardless of preprocedure saturation level or total hematocrit. We have shown that decreased baseline oxygen saturation in sickle cell disease is related to abnormal hemoglobin S levels, and oxygen saturation can be improved with erythrocytapheresis, independent of any change in the total hematocrit.
Extracorporeal Treatment for Septic Patients: New Adsorption Technologies and Their Clinical Application
Authors: Hanasawa Kazuyoshi
Published: March 2003

Abstract: Many kinds of blood purifying technologies have been applied to the treatment of critically ill patients since 1979 when plasma exchange with hollow fiber membranes was developed. These technologies have been applied not only to the removal of toxic substances, but also to the treatment of objective diseases and the removal of the factors relating to the associated inflammation. This article briefly summarizes these methods and their efficacies for critically ill patients, especially those with severe sepsis. Attempts have been made to remove endotoxin, the main cause of sepsis from the circulation, using polymyxin B‐immobilized fiber, charcoal hemoperfusion, and plasma or whole blood exchange. Attempts have also been made to remove proinflammatory cytokines, eicosanoids, and coagulative factors from the circulation in the human body. Continuous hemofiltration or hemodiafiltration is representative technology. The efficacy of these methods has been established, but several issues remain unresolved. All methods of the treatment of severe sepsis are discussed with reference to treatment indications, efficacy, and outcome parameters. In particular, the clinical results of endotoxin removal with polymyxin B‐immobilized fiber are summarized in this article.
Environmental Heterogeneity, Animal Disturbances, Microsite Characteristics, and Seedling Establishment in a Quercus havardii Community
Authors: Dhillion Shivcharn S.
Published: March 2003

In restoration experiments it is imperative to consider the study of mechanisms of how species are maintained and preserved in a system. This paper reports on the results of a field experiment examining the growth and survival of seedlings of Schizachyrium scoparium, a dominant perennial bunchgrass member of the Quercus havardii (sand shinnery oak) communities of semiarid western Texas, on mounds of displaced soil produced by Sylvilagus auduboni (rabbit). The central question posed is: does environmental heterogeneity created by small mammals influence seedling survival and growth? The specific questions addressed are: (1) Does seedling survival, growth, and nutrient uptake vary when grown on mounds, off‐mound soils, and artificially created mounds?; (2) What is the influence of the microbial and litter components of mound soils on seedling survival?; and (3) In communities where animal disturbances create environmental heterogeneity and may impact seedling establishment, is it possible to artificially create mounds that could serve a similar function? Results show that characteristics of mound soils increase seedling survival, shoot and root biomass, root length, number of tillers, mycorrhizal infection, and nutrient uptake more in plants grown on mounds than off mounds. Both the microbial and litter components of mound soils are essential components of this effect. Artificial mounds generated from soils associated with the herbaceous community were more similar to intact rabbit mounds than artificial mounds generated from soils associated with the oaks. The results indicate that rabbits produce rich patches (both nutrient and microbial) favorable to the growth of seedlings of the dominant bunchgrass, and point to the potential importance of rabbit disturbances in shaping the dynamics of this plant community. Thus, rabbit‐generated disturbances produce environmental heterogeneity in the sand shinnery oak community, similar to that produced by harvester ants in this community as shown by an earlier study. Small animal activity that results in soil displacement, and influences soil characteristics, may indirectly contribute to the persistence of certain plant species within a community. Thus, disturbances may well operate in semiarid communities to produce nutrient and microbe rich microsites which may function to maintain diversity.