bluuebunny/crossref_metadata_2025 huggingface dataset:
Extended criteria for organ acceptance. Strategies for achieving organ safety and for increasing organ pool
Authors: López‐Navidad Antonio , Caballero Francisco
Published: July 2003

Abstract: The terms extended donor or expanded donor mean changes in donor acceptability criteria. In almost all cases, the negative connotations of these terms cannot be justified. Factors considered to affect donor or organ acceptability have changed with time, after showing that they did not negatively affect graft or patient survival per se or when the adequate measures had been adopted.

There is no age limit to be an organ donor. Kidney and liver transplantation from donors older than 65 years can have excellent graft and patient actuarial survival and graft function. Using these donors can be from an epidemiological point of view the most important factor to esablish the final number of cadaveric liver and kidney transplantations. Organs with broad structural parenchyma lesion with preserved functional reserve and organs with reversible functional impairment can be safely transplanted. Bacterial and fungal donor infection with the adequate antibiotic treatment of donor and/or recipient prevents infection in the latter. The organs, including the liver, from donors with infection by the hepatitis B and C viruses can be safely transplanted to recipients with infection by the same viruses, respectively.

Poisoned donors and non‐heart‐beating donors, grafts from transplant recipients, reuse of grafts, domino transplant and splitting of one liver for two recipients can be an important and safe source of organs for transplantation.
C4d deposition in the glomeruli and peritubular capillaries associated with transplant glomerulopathy
Authors: Horita S , Nitta K , Kawashima M , Honda K , Onitsuka S , Tokumoto T , Tanabe K , Toma H , Nihei H , Yamaguchi Y
Published: July 2003

Abstract:  Transplant glomerulopathy (TGP) is a unique disease entity with characteristic pathological findings. Although ultrastructural studies for TGP have been performed, histogenesis of TGP is not fully understood. The present study was designed to investigate the relation of complement fragment C4d to the histogenesis of TGP. Nine cases of isolated TGP were randomly selected. A commercially available monoclonal antibody against complement fragment C4d was used in allograft biopsies. To evaluate the extent and severity of deposition of the C4d complement in the glomerular and peritubular capillaries, indirect immunofluoresce method was performed on frozen sections. Intense deposition of C4d in the glomerular basement membrane and peritubular capillaries was found in association with morphological appearance of TGP. Peritubular capillaries were affected in all the patients, showing splitting and multilayering of peritubular capillary basement membrane. These changes, which diffusely affect most capillaries, and their severity pattern were quite similar in each patient. In early stages of all patients with cellular rejection, C4d was not detected in the glomerular and peritubular capillaries. In addition, no C4d deposition was detected in all zero‐hour biopsies without diagnostic abnormality. These findings suggest that C4d deposition in the glomerular and peritubular capillaries might be associated with the pathogenesis of TGP in renal transplantation.
Evaluation of the mechanical characteristics of the implant–abutment complex of a reduced‐diameter morse‐taper implant
Authors: Akça Kıvanç , Çehreli Murat Cavit , İplikçioğlu Haldun
Published: July 2003

Abstract: The purpose of this study was to evaluate the mechanical characteristics of the implant–abutment connection of a reduced‐diameter ITI® dental implant. A finite element model of a ∅ 3.3 mm×10 mm ITI® solid‐screw implant and a 6° solid abutment 4 mm in height was constructed, and the implant–abutment complex was embedded vertically in the center of a ∅ 1.5 cm×1.5 cm acrylic cylinder. Static vertical and oblique loads of 300 N were applied in separate load cases. The contact area was defined between the implant–abutment connection and nonlinear finite element stress analysis was performed. The magnitude and distribution of Von Mises stresses and displacement characteristics were evaluated. In vertical loading, Von Mises stresses concentrated around the implant–abutment connection at the stem of the screw and around the implant collar. Oblique loading resulted in a 2‐fold increase in stresses at the implant collar, which was close to the yield strength of titanium. Displacement values under both loading conditions were negligible. We conclude that, in a reduced‐diameter ITI® dental implant, vertical and oblique loads are resisted mainly by the implant–abutment joint at the screw level and by the implant collar. The neck of this implant is a potential zone for fracture when subjected to high bending forces. The reduced‐diameter ITI® dental implant might benefit from reinforcement of this region.
Anterior loop of the mental nerve: a morphological and radiographic study
Authors: Kuzmanovic Dusan V , Payne Alan GT , Kieser Jules A , Dias George J
Published: July 2003

Abstract: Treatment planning for dental implant patients is often complicated by the unknown extent of the anterior loop of the mental neurovascular bundle. The aim of this study was to determine the correlation between the visual interpretation of the panoramic radiographs and the anatomical dissection findings in a cadaveric sample. Panoramic radiographs of the 22 randomly selected coronally sectioned human head specimens were taken using the Scanora® (Soridex, Orinon Corporation Ltd, Helsinki, Finland) radiographic unit jaw panorama (Programme 001, magnification 1.3) and dental panorama (Programme 003, magnification 1.7) and interpreted by two calibrated observers. Bilateral anatomical dissection was then performed on all specimens. The anterior loop of the mental canal was only identified in six panoramic radiographs (27%) (range 0.5–3 mm). There was a significant positive correlation between both observers of the radiographs and between the two radiographic programmes used. Anatomical measurements of the anterior loop of the mental neurovascular bundle revealed its presence in eight dissected specimens (range 0.11–3.31 mm; mean 1.20, ± 0.90). Fifty percent of the radiographically observed anterior loops of the mental canal were misinterpreted by observers with both radiographic programmes and 62% of the anatomically identified loops were not observed radiographically. Clinicians should not rely on panoramic radiographs for identifying the anterior loop of the mental nerve during implant treatment planning. However, a safe guideline of 4 mm, from the most anterior point of the mental foramen, is recommended for implant treatment planning, on the basis of our anatomical findings.
Implant surface preparation in the surgical treatment of experimental peri‐implantitis with autogenous bone graft and ePTFE membrane in cynomolgus monkeys
Authors: Schou Søren , Holmstrup Palle , Jørgensen Torben , Skovgaard Lene Theil , Stoltze Kaj , Hjørting‐Hansen Erik , Wenzel Ann
Published: July 2003

Abstract: The aim of the present investigation was to assess the effect of four implant surface preparation methods used in the surgical treatment of experimental peri‐implantitis with autogenous bone graft and expanded polytetrafluoroethylene (ePTFE) membrane. The methods were air‐powder abrasive unit+citric acid, air‐powder abrasive unit, gauze soaked in saline+citric acid, and gauze soaked alternately in chlorhexidine and saline. A total of 64 implants with a titanium plasma‐sprayed (TPS) surface was placed in eight cynomolgus monkeys (Macaca fascicularis). After a 3‐month period with plaque control, experimental peri‐implantitis was induced. A bone loss of 4–6 mm was established after 9–17 months and plaque control was re‐implemented. The peri‐implantitis defects were surgically exposed, granulation tissue was removed, and each implant surface was prepared by one of the above‐mentioned procedures. The defects were then filled with autogenous bone graft particles and covered by an ePTFE membrane. The animals were sacrificed after 6 months. Evaluation by clinical parameters, radiography including quantitative digital subtraction radiography, histology, and stereology did not reveal significant differences between the methods. Almost total bone regeneration and considerable re‐osseointegration were obtained irrespective of the method applied. A mean bone‐to‐implant contact of 39–46% was observed within the defects. Therefore, the present study of implants with a TPS surface in cynomolgus monkeys indicates that the simplest method involving gauze soaked alternately in chlorhexidine and saline should be the preferred implant surface preparation method in the surgical treatment of peri‐implantitis involving autogenous bone graft and ePTFE membrane.
Genetic polymorphisms of the interleukin‐1 gene and early marginal bone loss around endosseous dental implants
Authors: Shimpuku Hitomi , Nosaka Yasuhiro , Kawamura Tatsuya , Tachi Yoichi , Shinohara Mitsuko , Ohura Kiyoshi
Published: July 2003

Abstract: Dental implant surgery commonly proceeds in two stages. It is generally accepted that bone loss around implants does not occur at stage‐II surgery because implants do not receive mechanical loading. However, early marginal bone loss around implants occasionally does occur during the healing period. Genetic polymorphisms in the interleukin‐1 (IL‐1) gene have been reported to be important for bone homeostasis and susceptibility to bone disease. We therefore investigated whether the idiopathic early marginal bone loss around implants is related to polymorphisms in the IL‐1 gene. We performed a case‐control study. Patients demonstrating marginal bone loss around implants at stage‐II surgery were designated as the ‘marginal bone loss (+)’ group and those without bone loss as the ‘marginal bone loss (–)’ group. Polymorphisms of the IL‐1α and IL‐1β genes (IL‐1A−889, IL‐1B−511 and IL‐1B+3954) were detected by restriction fragment length polymorphism using NcoI, AvaI and TaqI after polymerase chain reactions. A total of 251 implants were placed in 39 patients. Marginal bone loss was observed in 36 implants. The patients with IL‐1B−511 2/2 genotype exhibited a significantly higher occurrence of marginal bone loss than those with IL‐1B−511 1/1 or 1/2 genotypes (OR=5.63; 95% CI=1.20–26.42; P=0.033). Multiple logistic regression analyses showed a markedly increased odds ratio (OR=10.86; 95% CI=1.64–71.90) in IL‐1B−511 2/2 genotype carriers, while ORs of the other risk factors for bone loss, such as age, smoking status, post‐menopausal women and bone quality, remained between 0.44 and 6.20. There was no significant difference in the distributions of the IL‐1B+3954 and IL‐1 A−889 genotypes between cases and controls. These data suggest that the IL‐1B−511 2/2 genotype has a significant association with the incidence of early marginal bone loss around endosseous implants.
Autogenous bone graft and ePTFE membrane in the treatment of peri‐implantitis. I. Clinical and radiographic observations in cynomolgus monkeys
Authors: Schou Søren , Holmstrup Palle , Jørgensen Torben , Stoltze Kaj , Hjørting‐Hansen Erik , Wenzel Ann
Published: July 2003

Abstract: The purpose of the study was to examine the effect of autogenous bone graft particles and expanded polytetrafluoroethylene (ePTFE) membrane in the treatment of peri‐implantitis. The treatment outcome was evaluated by clinical and radiographic methods including quantitative digital subtraction radiography. A total of 64 implants with a titanium plasma‐sprayed (TPS) surface was inserted in eight cynomolgus monkeys (Macaca fascicularis). After a 3‐month healing period with plaque control, experimental peri‐implantitis characterized by a bone loss of 4–6 mm was established during 14–22 months. Plaque control was then re‐implemented and surgical treatment involving autogenous bone+membrane (B+M), autogenous bone (B), membrane (M), or a conventional flap procedure alone (control) (C) was performed. The animals were killed 6 months after treatment. Healthy peri‐implant tissue was established irrespective of the applied surgical procedure. A mean bone gain of 4.7 mm was identified around implants treated with B+M, while, respectively, 4.0, 3.0, and 1.9 mm were recorded within the B, M, and C groups. Quantitative digital subtraction radiography confirmed considerable bone gain within defects treated with autogenous bone with or without membrane coverage. The bone gain, especially for defects treated with B+M, seemed to be almost to the level before development of peri‐implantitis. By contrast, 38 and 25% of the defect was on average characterized by bone gain when, respectively, M or C was used alone. The present study of implants with a TPS surface in cynomolgus monkeys thus demonstrates considerable bone regeneration after treatment of experimental peri‐implantitis with autogenous bone graft particles with or without ePTFE membrane coverage. Further stereologic and histologic evaluation of the treatment outcome is necessary before final conclusions about the effect of autogenous bone graft and ePTFE membrane can be made.
High frequency of simultaneous sensitivity to Disperse Orange 3 in patients with positive patch tests to para‐phenylenediamine
Authors: Goon Anthony T.‐J. , Gilmour Nicola J. , Basketter David A. , White Ian R. , Rycroft Richard J. G. , Mcfadden John P.
Published: July 2003

Cross‐sensitization between para‐phenylenediamine (PPD) and Disperse Orange 3 (DO3), among other textile dyes, has frequently been reported. We evaluated the frequency of simultaneous patch test reactions to PPD and a range of textile dyes. Retrospectively, we studied 128 patients who were patch test positive to PPD and who had also been tested to textile dyes. The dyes that most commonly also reacted were DO3 (46·1%) followed by Disperse Yellow 3 (21·9%). 80% of 55 patients who had a + + or stronger reaction to PPD also reacted to DO3. Dyes that were least likely also to react were Bismarck Brown (0%), Naphthol AS (1·06%), Disperse Yellow 9 (1·06%), Disperse Blue 3 (1·56%) and Disperse Red 11 (2·13%). We interpreted the simultaneous patch test reactions to PPD and DO3 as due either to cross‐sensitivity proper, or to metabolic conversion of textile dyes in the skin to PPD.
Computer‐related skin diseases
Authors: Wintzen Marjolein , Van Zuuren Esther J.
Published: July 2003

The use of computers has increased vastly, occupationally as well as for private use, and in the last decade, a number of reports have been published in which skin problems are ascribed to the (intensive) use of computers. Not only irritant or mechanically induced contact dermatitis has been reported but also allergic contact dermatitis. As this appears to be a new group of occupational dermatoses, we present a brief overview of these cases, and aetiologic factors are discussed.
Clinical and immunologic features of systemic contact dermatitis from ingestion of Rhus (Toxicodendron)
Authors: Oh Seok‐Hun , Haw Choong‐Rim , Lee Mu‐Hyoung
Published: July 2003

Oral or parenteral exposure to certain contact allergens may elicit an eczematous skin reaction in sensitized individuals. This phenomenon has been called systemic contact dermatitis (SCD) and is relatively rare when compared with classical contact dermatitis. We reviewed and analysed the clinical and immunologic features of 42 patients with SCD caused by ingestion of Rhus (Toxicodendron), 24 males and 18 females, average age 44 years (range 24–72). Several of such patients (33%) had a known history of allergy to lacquer. The patients developed skin lesions such as generalized maculopapular eruptions (50%), erythroderma (29%), vesiculobullous lesions (14%) and erythema multiform (EM)‐like lesions (7%). Many patients (57%) developed leucocytosis with neutrophilia (74%). In some patients (5%), abnormalities of liver function developed. We also analysed lymphocyte subsets in the peripheral blood of 12 patients. The lymphocyte subsets studied were T cells (CD3), B cells (CD19), natural killer (NK) cells (CD3–CD16+/CD56+), helper/inducer cells (CD4), cytotoxic/suppressor cells (CD8) and helper/suppressor ratio (CD4/CD8). The lymphocyte subsets of all 12 patients studied were within the normal range. Moreover, there were no differences between patients with a history of allergy to lacquer and those without a history of allergy to lacquer. Therefore, rather than an immunologic response, the skin eruption seems to be caused by a toxic reaction because of Rhus.
Occupational allergic contact dermatitis in a company manufacturing boards coated with isocyanate lacquer
Authors: Frick Malin , Isaksson Marléne , Björkner Bert , Hindsén Monica , Pontén Ann , Bruze Magnus
Published: July 2003

Over a short period of time, there was an outbreak of work‐related skin lesions among workers at a company producing flooring laminate boards, after the introduction of a water‐repellent lacquer based on diphenylmethane‐4,4′‐diisocyanate (MDI). In 5 workers, patch testing was performed with a standard series, an isocyanate series and work‐environmental products when indicated. 3 of the workers were tested with the lacquer, and contact allergy was found with concurrent reactions to 4,4′‐diaminodiphenylmethane (MDA). 1 of the 3 workers also showed a simultaneous reaction to MDI, whereas 1 showed a positive reaction to dicyclohexylmethane‐4,4′‐diisocyanate (HMDI). Of the 2 individuals not tested with the lacquer, 1 reacted to both MDI and MDA, whereas the other reacted to a soap used at work. In 3 of 4 cases, the isocyanate reactions appeared after D3. Occupational contact with isocyanates should not exclusively be focused upon respiratory hazards, as this report shows that skin contamination probably increases the risk of developing contact allergy to isocyanates and isocyanate‐related substances. When aiming at diagnosing contact allergy to isocyanates, it is desirable to perform a late reading, as positive reactions appear late. MDA appears to be a good marker for isocyanate hypersensitivity.
Allergic contact dermatitis in venous leg ulcer patients
Authors: Tavadia S. , Bianchi J. , Dawe R. S. , McEvoy M. , Wiggins E. , Hamill E. , Urcelay M. , Strong A. M. M. , Douglas W. S.
Published: July 2003

Our aim was to determine the frequency and nature of contact sensitivity in venous leg ulcer patients in Lanarkshire. We performed patch testing with the European standard series, antimicrobials and medicaments on 200 patients referred to our leg ulcer clinics. Positive patch tests were found in 136 (68%) patients. Multiple allergies occurred in 102 (51%). The most frequent allergen groups were fragrances (30·5%), antimicrobials (19·5%), topical excipients (19·5%), rubber accelerators (13·5%) and topical corticosteroids (8%). We also found a high prevalence of positive patch tests to Intrasite® gel (9·5%) and Hioxyl® cream (8·5%), medicaments which are commonly used to treat leg ulcers in our area. Contact sensitivity is common in venous leg ulcer patients and has important implications for patient management. The allergens involved vary depending on local nursing practice. We suggest that all venous leg ulcer patients be patch tested with a locally relevant patch test series.
Comparative evaluation of Type 1 latex hypersensitivity in patients with chronic urticaria, rubber factory workers and healthy control subjects
Authors: Piskin Gamze , Akyol Aynur , Uzar Hatice , Tulek Necla , Boyvat Ayse , Gurgey Erbak
Published: July 2003

Latex hypersensitivity manifests itself most commonly with contact urticaria. In this study, we investigated the frequency of latex hypersensitivity as a possible aetiological factor in patients with chronic urticaria (CU) and compared latex hypersensitivity of CU patients (n = 50) with that of rubber factory workers (n = 50) and healthy controls (n = 50). Prick test with latex and fruit extracts and determination of latex‐specific immunoglobulin E (IgE) were performed. As a risk factor, contact dermatitis due to rubber additives was tested by patch test. Latex hypersensitivity was detected in 14% of CU patients, 12% of rubber factory workers and 12% of healthy controls (P > 0·05). Positive patch test with rubber additives was detected in 6% of CU and 4% of rubber factory workers. 3 of 7 CU patients had sensitivity to fruits in addition to latex hypersensitivity. In 1 patient with CU, the clinical complaints were found to be related to latex hypersensitivity. These findings suggest that the frequency of latex hypersensitivity in CU patients is no higher than that in healthy individuals. However, CU patients should be carefully asked about latex allergy, as we demonstrated that 1 of the CU patients had undiagnosed symptomatic latex allergy.
An audit of the value of patch testing and its effect on quality of life
Authors: Woo P. N. , Hay I. C. , Ormerod A. D.
Published: July 2003

We have assessed the value of patch testing from the patient's perspective and examined the impact of patch testing on their quality of life (QoL). 140 patients were recruited over 5 months. 2 questionnaires were designed to investigate the patient's views on patch testing. The 1st questionnaire was completed at the final visit to the clinic and the 2nd was posted 6 weeks later. The Dermatology Life Quality Index (DLQI) questionnaire was completed on both occasions. There was a significant improvement of the DLQI score in all patch‐tested subjects (P = 0·003). Patients with involvement of the trunk had worse QoL. At the 4‐day visit, 77 patients (55%) expressed the opinion that patch testing had been helpful. 6 weeks later, 71 patients replied. 47 patients were diagnosed as having allergic contact dermatitis: 87% of them found that patch testing had been useful, 91% were able to avoid the allergen(s) and 57% reported improvement/clearing in their skin condition. 58% of the 24 patients with negative results also found that patch testing had been beneficial. Overall, patient perception was that they understood verbal information (92%) better than written information (76%). Patch testing is beneficial to patients, leading to improved QoL. Patient perception was that they understood verbal advice better than written information.
Sezary syndrome: cutaneous immunoperoxidase double‐labeling technique demonstrates CD4/CD8 ratio non‐specificity
Authors: Balfour Erika M. , Glusac Earl J. , Heald Peter , Talley Lori L. , Smoller Bruce R.
Published: July 2003

Background:  Sezary syndrome (SS) is an erythrodermic cutaneous T‐cell lymphoma with a leukemic component. Biopsies from these patients may suggest erythrodermic mycosis fungoides or SS but most often are not diagnostic. Additional methods are therefore usually needed to diagnose SS. These include a peripheral blood morphological assessment, flow cytometry, and gene rearrangement studies. The Cutaneous Lymphoma Study Group of the European Organization for Research and Treatment of Cancer has proposed criteria for the diagnosis of SS based on peripheral blood analysis. These include an increased T‐cell count with a CD4/CD8 ratio of ≥10, in conjunction with evidence of a T‐cell clone in the blood (Willemze et al., Blood 1997; 90: 354–371).

Methods:  We have conducted a study designed to obtain CD4/CD8 ratios by immunoperoxidase staining of skin biopsies, as opposed to flow cytometry. Fourteen biopsies from eight patients with SS and 14 control biopsies were evaluated for CD4/CD8 ratio via double immunostaining.

Results:  A CD4/CD8 ratio of >10 : 1 was seen in 85% of SS biopsies and 43% of controls with horseradish peroxidase used as the CD4 antibody. With alkaline phosphotase used as the CD4 antibody, 54% of SS biopsies and 21% of control biopsies exhibited a >10 : 1 ratio. We demonstrate that double‐labeling immunoperoxidase staining with antibodies to CD4 and CD8 on skin biopsies is not specific for SS. By comparing the CD4/CD8 ratios from skin biopsies in Sezary cases with those from biopsies in inflammatory dermatoses cases, we conclude that flow cytometry remains the most specific method for determining the CD4/CD8 ratios in patients with cutaneous eruptions. Although immunohistochemistry would be useful for laboratories with limited access to flow cytometry, we dismiss such a use, as CD4/CD8 ratios ≥10 were also found in 21–43% of non‐Sezary cases examined.

Conclusions:  We conclude that a CD4/CD8 ratio >10 : 1 on skin biopsy is not sufficiently specific to support a diagnosis of SS.
The reliability of long‐term storage of direct immunofluorescent staining slides at room temperature
Authors: Dikicioglu Emel , Meteoglu Ibrahim , Okyay Pinar , Culhaci Nil , Kacar Furuzan
Published: July 2003

Background:  Long‐term preservation of immunofluorescence is important for re‐examinations. We investigated whether the storage of direct immunofluorescent (DIF)‐positive slides at room temperature was reliable in daily practice.

Methods:  One hundred and twenty‐five DIF‐positive slides from the skin of 52 patients were evaluated. Sections were examined for the presence of immunoglobulin A (IgA), IgG, IgM, C3, and fibrinogen using fluorescein isothiocyanate‐conjugated antisera and mounted with a ready‐to‐use permanent mounting medium containing an antifading reagent and sodium azide (DAKO, Glostrup, Denmark, S3023). The slides were stored at room temperature for 16–24 months. Changes in diagnostic pattern, fluorescence intensity, and the form and location of accumulation of immunoreactants and technical deformation were investigated.

Results:  Over the entire observation period, 49.6% of the slides faded away; the median length of survival was 16 months. Before 12 months, the survival rate of slides was 92.0%, whereas after 20 months it was 28.0%. In the early faded slides, which faded away before 16 months following the first examination, C3 and IgA were the most frequently observed immunoreactants. The technical deformations did not prevent the diagnosis.

Conclusions:   The preservation of fluorescence in DIF‐positive slides using mounting media with an antifading reagent is possible for 2 years at room temperature. However, in daily practice, storage for longer than 11 months prevents a reliable diagnosis.
Cutaneous B‐cell lymphoma with loss of CD20 immunoreactivity after rituximab therapy
Authors: Clarke Loren E. , Bayerl Michael G. , Ehmann W. Christopher , Helm Klaus F.
Published: July 2003

Background:  Antibodies to the B‐cell‐specific antigen CD20 are widely used for immunohistochemical identification of B‐cell lymphomas, approximately 95% of which are strongly CD20‐positive.

Methods:  We report a 51‐year‐old male with a CD20‐positive systemic B‐cell lymphoma who developed a CD20‐negative relapse with secondary cutaneous involvement after therapy with the anti‐CD20 monoclonal antibody rituximab (Rituxan).

Results:  Biopsy of a skin nodule demonstrated an atypical lymphocytic infiltrate that was negative for CD20, CD3, lysozyme, and myeloperoxidase, but strongly positive for CD45rb (LCA) and the B‐cell marker CD79a.

Conclusions:  We conclude that loss of CD20 expression in cutaneous B‐cell lymphoma (both primary and secondary) is important to recognize, that immunohistochemistry for CD79a, another widely expressed B‐cell marker, is useful in the identification of CD20‐negative B cells in such cases, and that loss of CD20 expression may become more common, as use of rituximab is expected to increase.
Hypertrophic lupus erythematosus: a clinicopathological study of 14 cases
Authors: Daldon Patrícia Érica Christofoletti , De Souza Elemir Macedo , Cintra Maria Letícia
Published: July 2003

Background:  Hypertrophic lupus erythematosus (HLE) is a distinct and rare subset of lupus erythematosus (LE). It is characterized by verrucous lesions, chronic in its course, and resistant to treatment. The purpose of this study was to identify clinical and histological characteristics of HLE.

Methods:  We review our experience with 14 cases of HLE identified in a group of 220 patients with different forms of LE, at the UNICAMP Hospital, between 1976 and 2002.

Results:  All patients presented verrucous plaques concomitantly with discoid lesions. The most common sites of involvement were the face and the arms. Histology of HLE lesions revealed pseudoepitheliomatous hyperplasia engulfing elastotic material. Elastic fibers were seen in migration throughout the epidermis. Classic features of LE were noted in all cases. Three of the patients developed hyperkeratotic papules with central keratinous plug on their arms at the previous LE sites. These lesions resemble clinically and histopathologically keratoacanthomas. In one patient, HLE lesion progressed to squamous cell carcinoma (SCC), 26 years after the onset of the disease.

Conclusions:  Transepithelial elimination of the elastotic material may be a feature of HLE. Some HLE lesions may present as keratoacanthoma, but classical features of LE aid the correct diagnosis. SCC may arise on a long‐standing HLE lesion; therefore HLE requires clinical and histopathological follow up.
Eruptive melanotic macules and papules associated with adenocarcinoma
Authors: Busam Klaus J. , Sachs Dana L. , Coit Daniel G. , Halpern Allan , Hwu Wen‐Jen
Published: July 2003

Background:  Malignancies may be associated with paraneoplastic cutaneous manifestations, including pigmentary disorders.

Methods:  The clinical findings were reviewed. Skin and tumor tissue samples were examined by routine histology, immunohistochemistry, and in one case also by electron microscopy.

Results:  Two patients developed diffuse melanotic macules and papules associated with visceral adenocarcinoma. One patient was a 64‐year‐old man with advanced carcinoma of the distal esophagus. The other was a 62‐year‐old man with metastatic pulmonary adenocarcinoma. The detection of the primary tumor in both patients was preceded by the rapid onset of melanotic macules and papules in the anogenital region and in one patient also around both nipples. The pigmented lesions were histologically characterized by a lentiginous melanocytic proliferation of large and heavily pigmented melanocytes associated with hyperpigmentation of adjacent keratinocytes. Both patients had been misdiagnosed as having epidermotropic metastatic malignant melanoma. None of them had prior, concurrent, or subsequent cutaneous or extracutaneous invasive melanoma. Both patients died of metastatic adenocarcinoma.

Conclusion:  Eruptive melanotic macules and papules represent an under‐recognized paraneoplastic syndrome. The cases illustrate a diagnostic pitfall for clinicians and pathologists unaware of this phenomenon.
The sebaceous nevus as part of the Schimmelpenning–Feuerstein–Mims Syndrome – an obvious phacomatosis first documented in 1927
Authors: Warnke P. H. , Hauschild A. , Schimmelpenning G. W. , Terheyden H. , Sherry E. , Springer I. N.
Published: July 2003

The sebaceous nevus is a common nevus and can be easily diagnosed because of its typical rough fatty surface due to its amount of sebaceous glands. In some rare cases, the sebaceous nevus is part of a genetic disorder, the Schimmelpenning–Feuerstein–Mims (SFM) syndrome. If the SFM syndrome is suspected, further investigation is necessary, because multiple organ involvement is highly likely. We suggest that diagnosis of the SFM syndrome is simple, considering the special linear arrangement of sebaceous nevi in cases of SFM syndrome.
Identification of human papillomavirus in keratoacanthomas
Authors: Forslund Ola , DeAngelis Paula M. , Beigi Marzieh , Schjølberg Aasa R. , Clausen Ole Petter F.
Published: July 2003

Background:  Keratoacanthomas are benign, clinically distinct skin tumors that may infiltrate and show cellular atypia. A viral etiology has been suggested, and the aim was to search for human papillomavirus (HPV) in keratoacanthomas.

Methods:  From 21 immunosuppressed organ transplant recipients and 11 non‐immunosuppressed patients, 72 fresh biopsies with diagnosis of keratoacanthomas were analyzed. For detection of cutaneous and genital HPV DNA, single‐tube nested ‘hanging droplet’ polymerase chain reaction (PCR) and another PCR (GP5+ and 6+) were used, respectively.

Results:  Among 21 immunosuppressed patients, 71% (15/21) harbored HPV DNA at least in one sample. Of the keratoacanthoma lesions, 55% (33/60) were HPV DNA positive. Fourteen samples from eight immunosuppressed patients contained HPV types 5, 9, 10, 14, 19, 20, 21, 38, 49, 80, putative HPV types as HPVvs20‐4, HPVvs75, and HPVvs92 and FA16.1, FA23.2, FA37, FA75, and FA81. Among 11 non‐immunosuppressed patients, 36% (4/11) harbored HPV DNA at least in one sample, and 33% (4/12) of their keratoacanthomas were HPV DNA positive. In total, HPV DNA was detected in 51% (37/72) of the keratoacanthomas.

Conclusions:  By the use of PCR, cutaneous HPV DNA was detected in 51% (37/72) of the keratoacanthomas. No predominating HPV type or genital HPV type was identified. The role of HPV in keratoacanthomas remains thus elusive.
Epithelioid cell histiocytoma – histogenetic and kinetics analysis of dermal microvascular unit dendritic cell subpopulations
Authors: Silverman Jeffrey S. , Glusac Earl J.
Published: July 2003

Background:  Epithelioid cell histiocytoma (ECH), also known as epithelioid fibrous histiocytoma, is a peculiar dermal tumor, which can mimic melanocytic, vascular, epithelial, or other histiocytic lesions. Thought to arise from dermal dendrocytes, most ECH contain approximately 50% FXIIIa+ histiocytic dendrocytes, but not all lesional cells express FXIIIa. A putative fibroblastic component has not been characterized.

Methods:  We analyzed the differentiation and cell kinetics of dermal microvascular unit cells in 12 previously reported ECH using antibodies to FXIIIa, CD68 (KP1), CD34, CD117, CD31, smooth muscle actin, collagen type 1 aminopropeptide, and MIB‐1, using single and double immunostains.

Results:  In ECH, many variably sized CD34/CD31+ tumor vessels with actin+ myopericytes were surrounded by epithelioid‐to‐dendritic cells of three types. About 5–80% were dendritic histiocytes that expressed FXIIIa but not CD31 or KP1. Fibroblasts, in some cases showing mild nuclear pleomorphism, were usually collagen type 1+, but CD34 and actin– in 11/12 cases. One ‘early’ ECH had 40% CD34+ epithelioid cells, admixed with 50% FXIIIa+ histiocytes. Most ECH had about 2–20% KP1+, CD117+ mast cells. Mast cell numbers increased with FXIIIa+ histiocyte numbers and the intensity of FXIIIa expression. MIB‐1/FXIIIa double‐labeling showed only rare cycling histiocytes, with numerous cycling fibroblasts and endothelial cells.

Conclusions:  Our findings support the impression that ECH is a vascular fibrous histiocytoma. The constituent cells appear to arise from the activation of resident microvascular CD34+ dermal fibroblasts and the accumulation of FXIIIa+ dendritic stromal assembly histiocytes. The CD34+ cells appear to differentiate toward collagenous fibrocytes in association with histiocytes and mast cells in forming collagenous stroma and vessels. ECH is a tumor composed of all requisite cell types consistent with the origin from the dermal microvascular unit.
Keratin profile of intraepidermal cells in Paget's disease, extramammary Paget's disease, and pagetoid squamous cell carcinoma in situ
Authors: Lau Jacob , Kohler Sabine
Published: July 2003

Background:  Although the histopathologic differential diagnosis of pagetoid neoplasms is broad, unique histopathologic identifiers and clinical correlation can often identify the process. However, in the case of mammary Paget's disease (MPD) or extramammary Paget's disease (EPD) without an obvious underlying malignancy, distinction from pagetoid squamous cell carcinoma in situ (PSCCIS) can be challenging. Our goal was to better define the immunohistochemical staining patterns of these three entities in the hope of determining distinctive staining patterns.

Methods:  We evaluated nine cases of PSCCIS, five cases of MPD, and 10 cases of EPD with the immunohistochemical antibodies CAM 5.2 and CK 5/6. In addition, only PSCCIS was stained with CK 7, as the staining patterns of CK 7 in MPD and EPD are well known from prior studies.

Results:  CAM 5.2 diffusely stained all cases of MPD and EPD and failed to stain any case of PSCCIS. Furthermore, CK 7 only focally stained two of the 10 cases of PSCCIS. CK 5/6 was difficult to interpret due to the high functional background staining of the normal keratinocytes in the epidermis.

Conclusions:  Based on these results, our data supports the use of CAM 5.2 and CK 7 immunoperoxidase markers in differentiating between difficult cases of PSCCIS and MPD or EPD. An antibody panel consisting of S‐100, CAM 5.2, and CK 7 will aid in the accurate diagnosis of almost all pagetoid neoplasms of the breast or genital skin.
p53 alterations in porokeratosis
Authors: Arranz‐Salas Isabel , Sanz‐Trelles Andres , Ojeda Dolores Bautista
Published: July 2003

Background:  Porokeratosis (PK) is a group of cutaneous entities characterized by disordered epidermal keratinization and by a predisposition to develop malignant transformation. The molecular mechanism of this carcinogenesis remains unclear, but p53 has been proposed as a mediator of this process. p53 overexpression, detected by immunohistochemistry, has frequently been reported in PK, and p53 mutations are direct results of ultraviolet (UV) skin exposure and are directly involved in most common skin cancers.

Methods:  Eleven cases of Mibelli‐type PK, one of them associated with a squamous cell carcinoma, were reviewed. Formalin‐fixed, paraffin‐embedded archival tissue from these cases was immunostained for p53 and used for DNA extraction for the analysis of p53 mutations by polymerase chain reaction and single‐strand conformation polymorphism.

Results:  Increased p53 expression was confirmed in all cases. Most of them showed a discontinuous labeling, often stronger at the base of the cornoid lamella. No relation with sun exposure was observed. Finally, no p53 mutations were found at the gene levels more frequently damaged in human cancers called ‘hot spots’.

Conclusions:  p53 alterations can be involved in the pathogenesis of the PK and the carcinogenesis arising in some of the lesions. Since p53 gene inactivation in human cancer is related to mutation and/or loss, the absence of genetic damage could indicate that p53 alterations are only at the protein level, leading to an abnormal cell‐cycle control. UV exposure does not seem to play a main role in the process.
Cutaneous pseudolymphoma in association with molluscum contagiosum in an elderly patient
Authors: Moreno‐Ramírez D. , García‐Escudero A. , Ríos‐Martín J. J. , Herrera‐Saval A. , Camacho F.
Published: July 2003

Background:  Molluscum contagiosum (MC) is a common cutaneous infection, which has been reported in association with cutaneous pseudolymphoma in few cases.

Methods:  A 72‐year‐old woman with a nodule arising on the external canthus was reviewed. The lesion was surgically removed, and the histopathological study demonstrated an epidermal invagination filled by molluscum bodies and a diffuse infiltrate comprising atypical lymphocytes.

Results:  Immunohistochemical stains disclosed predominance of T cells with positive CD30 labeling. Polymerase chain reaction failed to demonstrate clonal rearrangement of the T‐cell receptor.

Conclusion:  After ruling out systemic involvement, the patient was followed up for 2 years with no evidence of recurrence. We report this case to the best of our knowledge and discuss the literature about atypical clinical and histological presentations of MC.
Transplantable melanomas in gerbils (meriones unguiculatus). II: melanogenesis
Authors: Plonka Przemyslaw M. , Slominski Andrzej T. , Pajak Stanislawa , Urbanska Krystyna
Published: July 2003

Abstract: We characterized the melanogenic apparatus in a family of transplantable gerbil melanomas (melanotic and amelanotic) using a combination of biophysical, ultrastructural and biochemical methods. Melanotic melanomas produced pure eumelanin but in vesiculo‐globular melanosomes (‘pheomelanosomes’); the eumelanosomes, characteristically ellipsoidal in shape with fibrillar or fibrillo‐lamelar matrix, were never noticed. Melanotic melanomas also had significant tyrosinase activity and Zn, Pb/S, Ca and P content; all higher than in the amelanotic variants. The amelanotic variant, which was devoid of melanin pigment and melanosomes, had clearly detectable tyrosinase activity (albeit at 20% of that in the melanotic variant). Thus, with these multidirectional approaches we demonstrate that pure eumelanin can be synthesized in organelles ultrastructurally defined as pheomelanosomes, but a defect in the formation of melanosomes can prevent in vivo melanin synthesis despite the presence of detectable tyrosinase activity. We conclude that this melanoma system provides an excellent experimental model for the study of molecular components determining pheo‐ and/or eumelanogenesis. The information generated can be used for defining the roles of melanogenesis and of tyrosinase expression in the regulation of melanoma behavior and the effect of their modification on the course of the disease.
Immunofluorescence analysis of the basement membrane zone components in human anagen hair follicles
Authors: Joubeh Sohaila , Mori Osamu , Owaribe Katsushi , Hashimoto Takashi
Published: July 2003

Abstract: The ultrastructure and constituent components of the basement membrane zone (BMZ) of the interfollicular epidermis have been well characterized. However, little is known about the junctions between dermal papilla and the surrounding epithelial cells of the hair bulb, as well as those junctions between connective tissues and epithelial cells outside the hair follicle. In the present study, immunofluorescence was used to determine the expression of various BMZ components, particularly plectin, BP230, BP180, α6β4 integrin, laminin 5 and type VII collagen, in anagen hair follicles from human scalp. All the BMZ components examined showed essentially the same immunofluorescence staining pattern. Specifically, staining of the upper portion of the hair follicle demonstrated expression of all BMZ components with a labeling intensity similar to that found in the interfollicular epidermis. Staining in the lower portion of the hair follicle, however, was markedly different: all the BMZ components showed a gradual decrease in staining intensity. Particularly, outside the hair bulb, the linear staining was diminished and even discontinuous in some areas. Finally, between dermal papilla and epithelial cells inside the hair bulb, there was a strong immunoreactivity for all the BMZ components except for BP230, which was completely negative. The present study also confirmed a previous reported ultrastructural finding that hemidesmosomes are not apparent in the hair bulb's exterior BMZ nor in the dermal papilla junctions. Instead, peculiar cloudy materials were seen in both the lamina densa and the adjacent epithelium outside the hair bulb. Taken together, the diminished expression of all the BMZ components outside the hair bulb, as well as the complete absence of BP230 at the dermal papilla junction, seem to be responsible for the incomplete ultrastructure of hemidesmosomes in these regions. Furthermore, the results in the present study led us to speculate that the expression of BMZ components inside and outside the hair bulb are markedly decreased in the transient regions of the hair follicle as compared with their expression in the permanent region, signified by the upper portion of the hair follicle. When the hair follicle moves upward in catagen or downward in anagen, the complete structure of the hemidesmosome may stabilize the upper portion to the surrounding connective tissues, while the incomplete hemidesmosome may facilitate the movement of the transient region.
Intermittent foot shock stress prolongs the telogen stage in the hair cycle of mice
Authors: Aoki Eri , Shibasaki Tamotsu , Kawana Seiji
Published: July 2003

Abstract: Stress significantly influences skin diseases and cutaneous functions. Recently, interactions between stress and skin conditions have been studied in animal models using various systemic stressors. Here, we studied the effect of intermittent foot shock stress on the hair cycle of C57BL/6 mice. After a 2‐week period of intermittent foot shock stress, we examined the changes in the depilation‐synchronized hair cycle macroscopically and histologically and we also measured the plasma levels of corticosterone. We found that foot shock stress prolonged the telogen stage and delayed the subsequent anagen induction in the hair cycle. The distribution patterns of corticotrophin releasing factor or corticotrophin releasing factor receptor positive cells in the skin of stressed or of control mice were identical with those in the ordinal hair cycle. It is noteworthy that corticotrophin releasing factor positive keratinocytes were observed in the telogen follicles of the stressed mice but were negative in the telogen follicles of the non‐stressed mice in this study. Plasma corticosterone levels were significantly higher in the stressed group than in the control group. These results suggest that increased levels of plasma corticosterone may be involved in the mechanism underlying the stress‐induced delay of the hair cycle.
Desmosomes exhibit site‐specific features in human palm skin
Authors: Wan Hong , Dopping‐Hepenstal Patricia J. C. , Gratian Matthew J. , Stone Michael G. , McGrath John A. , Eady Robin A. J.
Published: July 2003

Abstract: Hereditary skin disorders resulting from desmosome gene pathology may preferentially involve the palms and soles. Why this is so is not clear. Moreover, even in normal control skin it is unknown whether there are differences in desmosome number, size or structural organization in palmoplantar sites compared with skin from other body regions. Therefore, we sought evidence for such differences by examining desmosome expression in relation to epidermal differentiation in both epidermis and cultured keratinocytes from normal human palm and breast skin samples. Confocal microscopy of skin biopsy material showed relative differences in the expression profiles of several desmosomal proteins (desmogleins, desmocollins, desmoplakin, plakoglobin and plakophilin 1) between the two sites. Western blotting revealed a higher expression level of all five proteins in palm compared with breastcultured keratinocytes. Staining for the differentiation‐associated component, involucrin, suggested an earlier onset of synthesis of this protein in palm epidermis, and a suspension‐induced differentiation assay showed that involucrin synthesis began earlier in palm keratinocytes than in breast cells. At 4–8 h, the number of involucrin‐positive cells in palm keratinocytes was almost twice that in breast. Morphometric analysis showed that, overall, desmosomes were larger but of similar population density in the palm compared with breast skin. These findings demonstrate differences in desmosome structure and protein expression between the two sites, possibly reflecting the needs of palms and soles to withstand constant mechanical stress. They may also help to explain the preferential involvement of this region in certain hereditary disorders (palmoplantar keratodermas), associated with mutations in desmoplakin or desmoglein 1.