bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital mucoid cyst: the ganglion type
Authors: Hernández‐Lugo Ana Marcela , Domínguez‐Cherit Judith , Vega‐Memije María Elisa
Published: March 2003

A 43‐year‐old woman presented with a soft, smooth, cystic, slightly erythematous, dome‐shaped nodule, 6 × 8 mm in diameter, located on the dorsum of the middle finger of the right hand, between the proximal fold and the distal interphalangeal joint, lateral to the midline ( Fig. 1). The nail of the affected finger showed longitudinal grooving and mild distal transverse overcurvature. The lesion had been present for 3 months and was tender upon pressure.

Digital mucoid cyst, lateral to the midline of the third finger, causing nail deformity

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Clinical examination revealed early signs of osteoarthritis and Heberden’s nodes on the distal interphalangeal joints of both hands. Previous treatment included the intake of nonsteroidal anti‐inflammatory drugs (NSAIDs) indicated by a rheumatologist. An X‐ray of the right hand showed decreased joint spaces between the second and third phalanges of the middle finger.

Diagnosis of a digital mucoid cyst (with nail deformity secondary to the former) was made. Surgical excision was performed. During surgery, a pedicle connecting the cyst to the joint capsule was clearly observed and two satellite lesions were also found ( Fig. 2). The cyst and its satellite lesion, including the communicating tract, were totally removed.

(A) direct link of the cyst to the distal interphalangeal joint during surgery is clearly observed

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The histopathologic study showed large cystic spaces containing mucin (colloidal iron stain) which were lined in some areas by synovial membrane ( Fig. 3). The histopathologic report was compatible with a digital mucoid cyst of the ganglion type.

Large cystic spaces containing mucin lined, in some areas, by synovial membrane (×100, original magnification)

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Six months after excision, no recurrence has been detected, and the nail plate deformities have improved.
Unilateral transient forehead paralysis following injury to the temporal branch of the facial nerve
Authors: Flynn Timothy Corcoran , Emmanouil Panagiota , Limmer Bradley
Published: March 2003

Background Cutaneous surgery in the temporal region of the forehead can lead to injury to the superficial temporal branch of the facial nerve. A flattened forehead and with ipsilateral forehead paralysis can occur with damage to this nerve.

Methods A case is presented of transient forehead paralysis resulting from Mohs’ micrographic surgery with reconstruction of the defect. The paralysis resolved over a period of fifteen months.

Results The anatomy of the nerve makes it susceptible to injury during cutaneous surgery. The area of danger is the area superior to the zygomatic arch and lateral to the lateral eyebrow where the nerve is closest to the skin.

Conclusions Restoration of motor function usually occurs without intervention, but may take several months. Should motor function not recur, nerve grafting of a repair of the ptotic brow may be needed. The anatomy of the nerve is reviewed and brow lifting options are discussed.
‘Airborne’ contact dermatitis due to Leica immersion oil
Authors: Géraut Christian , Tripodi Dominique
Published: March 2003

Background Contact dermatitis has often been described in healthcare staff, resulting essentially from the use of natural rubber latex gloves, antiseptics, and especially aldehydes. This study reports an unusual cause of contact dermatitis in laboratory technicians.

Materials and methods Four patients working in the bacteriology departments of three different hospitals were seen for airborne contact dermatitis. All were patch tested for specific plastics and glues.

Results For all patients, positive patch reactions were obtained with classic epoxy resins, such as diglycidylether of bisphenol, as well as with new types, such as diglycidylether of bisphenol F and an epoxyacrylate resin.

Conclusions Although phenols and ether handled by the laboratory technicians and an epoxy mastic applied during floor repair were initially suspected, an immersion oil used in light microscopy proved to be the real cause of the dermatitis. To our knowledge, these are the first reported cases due to this type of contact.
Epidemiology of pemphigus in Sofia, Bulgaria. A 16‐year retrospective study (1980–1995)
Authors: Tsankov Nikolai , Vassileva Snejina , Kamarashev Jivko , Kazandjieva Jana , Kuzeva Vassilka
Published: March 2003

Background Pemphigus is a disease showing an uneven geographical distribution. In Bulgaria pemphigus has always represented a substantial part of diagnosed bullous diseases, but previous epidemiological data are incomplete. Our purpose was to evaluate retrospectively the incidence and prevalence of pemphigus in the district of Sofia (the capital of Bulgaria; population 1 200 000) for a sixteen‐year period.

Methods The files of all the newly registered patients with pemphigus in the City Hospital of Dermatology in Sofia during the period Jan 1 1980 to Dec 31 1995, were collected and analysed with regard to personal statistics, ethnic origin, profession, history of the disease including age and season of onset, symptoms, clinical diagnosis, severity, laboratory findings, associated illnesses, therapy, and cure rate. Special attention was paid to smoking, alcohol abuse, and the presence of triggering factors such as emotional stress, drug intake, underlying diseases, neoplasias, or others.

Results During the 16‐year period studied, 74 newly diagnosed cases of pemphigus occurred in the district of Sofia, giving a prevalence of 0.38 per 100 000 inhabitants and a mean incidence of 0.47/100 000/year for the overall population and 0.51/100 000/year for the population aged above 20 years. The most common clinical variant is pemphigus vulgaris, frequently occurring in the fifth–sixth decades. The vast majority of the patients are workers or professionals.

Conclusions The results of the present retrospective study reveal a relatively high prevalence and incidence of pemphigus in Bulgaria, compared to that encountered in other countries. Our data is similar to that reported from Greece. Whether the Balkan Peninsula represents a focus of population groups with high susceptibility to pemphigus is a problem which could be highlighted by further epidemiological studies in this geographic area.
In vitro tannin acantholysis
Authors: Brenner Sarah , Ruocco Vincenzo , Ruocco Eleonora , Russo Adolfo , Tur Ethel , Luongo Vincenza , Lombardi Maria Luisa
Published: March 2003

Abstract

Background  Exogenous factors, such as certain drugs, may be involved in the induction of pemphigus. Other offenders sharing a similar chemical composition to these drugs may also play a role. Tannins with their considerable biologic activity were suggested as possible factors. To substantiate the role of tannins in the pathomechanism of pemphigus, the present study examined the acantholytic potential of tannins in vitro.

Methods  Normal human breast skin from patients without any bullous disease was cultured for 3 days in the presence of tannic acid at concentrations of 0.02, 0.05, 0.1, 0.25, 0.5, 1.0, and 2.0 m
m. The effect of the tannic acid was microscopically examined in a blind fashion by three independent investigators.

Results  In addition to the cytotoxic effect, tannic acid caused marked acantholytic changes, with a clear suprabasal cleavage and intraepidermal acantholytic cells. The acantholytic changes were the most constant and specific effects. They were constantly observed at 1.0 and 2.0 m
m, whereas lower concentrations showed changes only in some of the explants. The concentrations needed to exert this effect were notably low. There was a remarkable variability among the subjects who had provided the explants.

Conclusions  The results suggest a possible role of tannin in the disease process of pemphigus. The tannin acantholytic potential was much greater than the potential of known acantholytic drugs, such as penicillamine and captopril. The interindividual variability in susceptibility to acantholysis may explain the variability in the individual potential for developing pemphigus.
Does immune serum globulin confer protection against skin diseases?
Authors: Mimouni Daniel , Gdalevich Michael , Mimouni Francis B. , Grotto Itamar , Eldad Arieh , Shpilberg Ofer
Published: March 2003

Abstract

Background Following a case of serologically proven hepatitis A in a food‐handling worker serving several military bases in the same vicinity, the entire military population was vaccinated with immune serum globulin (ISG).

Objective To evaluate the effectiveness of ISG in preventing skin disease.

Methods The data for this study were drawn from the military archives of the Medical Corps. The population of the bases was followed for a period of 3 months after immunization. Rates of selected skin diseases were compared with those of a nearby base during the same period, and with those in the population of the same bases a year earlier.

Results The rates of several skin diseases (bacterial skin infections, dermatitis and eczema, fungal infections, acne, warts, nail disorders, and nonspecific skin diseases) among the vaccinated population were significantly lower when compared to the historical control group and to the contemporary control group of the nearby base.

Conclusions ISG provides a protecting effect for skin diseases, especially those of infectious origin.
Helicobacter pylori and idiopathic chronic urticaria
Authors: Daudén Esteban , Jiménez‐Alonso Isabel , García‐Díez Amaro
Published: March 2003

Background Different studies have shown a high prevalence of Helicobacter pylori (HP) infection in patients with chronic urticaria (CU), and occasional remission of the skin lesions after eradication therapy. Recent investigations, however, have failed to find a significant relationship between the two conditions. We designed a case–control study to assess the prevalence of HP infection and the effect of bacterium eradication on the outcome of the skin disease in patients affected by CU. The literature is reviewed.

Methods Twenty‐five patients diagnosed with CU were included. Information about their medical history and a complete laboratory investigation ruled out other diseases or situations suspected to cause CU. Twenty‐five healthy volunteers from a census‐based, randomized sample were used as controls. HP infection was assessed by the 13C‐urea breath test (UBT). Eradication therapy included oral amoxicillin, omeprazole, and clarithromycin for 1 week.

Results The high prevalence of HP infection (68%) and mean titer of UBT (24.13) in our patients with idiopathic CU do not differ from the general population. Marked differences were observed in the mean age of the CU patients with positive UBT (45.52 years) vs. those without HP infection (35.25 years). After eradication therapy, only one patient showed a complete remission of urticaria and two showed a partial remission.

Conclusions Our results support a lack of relationship between HP infection and the course of idiopathic CU.
Application of computerized image analysis in pigmentary skin diseases
Authors: Lee Eun‐So , Kim Jie‐Hoon , Im Sungbin , Lee Kyi Beom , Sohn Seonghyang , Kang Won Hyoung
Published: March 2003

Abstract

Background  Melanocyte number and the amount of melanin pigment are related to diagnosis and treatment of pigmentary skin diseases. Various histologic methods are used, such as Fontana‐Masson stain for melanin pigment or immunohistochemical stain for melanocytes. Recently, computerized image analysis has been applied to many fields to avoid interobserver bias. In this study, we applied a computerized image analysis to assess the melanin content and melanocyte density of human epidermis.

Methods  We evaluated the skin biopsy specimens (paraffin blocks) from normal human skin (33 ± 6.6, n = 11) and diseased skins; vitiligo (32 ± 10.0, n = 8), melasma (35 ± 8.6, n = 11), and lentigo senilis (40 ± 7.2, n = 11) (mean age ± SD). Each specimen was stained with Fontana–Masson for melanin pigments and immunohistochemical method for melanocytes. Quantitative analysis of melanin pigment and melanocyte number (density) were investigated through two methods: (1) two dermatologists measured the visual scales; and (2) computerized image analysis was used to measure melanin content indices (MCI). The data were evaluated using one‐way
anova.

Results  The visual scale of the Fontana–Masson stain was the highest for lentigo senilis (3.8 ± 0.40), followed by melasma (2.6 ± 0.67), normal skin (1.8 ± 0.60) and vitiligo (0) (P < 0.05). These findings were consistent with objective measurements made by computerized image analysis. MCI values were 120.3 ± 20.74 for lentigo senilis, 81.1 ± 19.27 for melasma, 45.5 ± 16.92 for normal skin, and 0.3 ± 0.30 for vitiligo in decreasing order (P < 0.05). MC/1E (melanocyte number per 1 mm epidermis) was about two fold larger in lentigo senilis (18.1 ± 8.92) than melasma (9.7 ± 2.40) or normal skin (9.3 ± 2.67) (P < 0.05). MC/1B (melanocyte number per 1 mm basal layer) was about 1.5 fold higher in lentigo senilis (13.5 ± 4.17), compared to normal skin (9.0 ± 3.55) (P < 0.05). Melasma showed increased melanocyte numbers compared to normal skin, but it was not statistically significant (P > 0.05).

Conclusion  We believe this computerized image analysis could be useful tool for diagnosis and comparison of interval changes in pigmentary diseases like melasma or lentigo senilis by quantifying melanin pigments or melanocytes in skin biopsy specimens.
Pemphigus in South Africa
Authors: Aboobaker Jamila , Morar Nilesh , Ramdial Pratistadevi K. , Hammond Michael G.
Published: March 2003

Abstract

Background  Pemphigus is an autoimmune disease characterized by intraepidermal blistering. We describe the demography, prevalence, clinical features, response to treatment, and human leukocyte antigen (HLA) characteristics of pemphigus in Kwa‐Zulu Natal, South Africa.

Methods  All patients with pemphigus were prospectively recruited over 12 years from January 1987 to December 1999. The demography, clinical features, histology, and immunofluorescence (IF) were recorded. In a subset of patients, HLA tests were performed.

Results  One hundred and twelve patients had pemphigus. Pemphigus foliaceus (PF) was the commonest variant seen (62 patients) and 80% of these patients were black. The mean age was 43 years (12–93 years) and the male to female ratio was 1 : 1.4. Fifty patients had pemphigus vulgaris (PV), of whom 82% were Indian. The mean age of presentation of PV was 48 years (21–82 years). The male to female ratio was 1 : 1.7. There was no mucosal involvement in PF. PV patients had painful oral lesions. The mortality rate was 14% in the total sample (six in PV and two in PF). HLA‐B8 was positive in 41% of patients with PF (P < 0.001).

Conclusions  PF occurs more commonly in black people, while most cases in Indians present with the PV subtype. Pemphigus patients present with severe and extensive disease, and PV patients share features in common with patients from their land of origin (India), suggesting a genetic link.
Cutaneous T‐cell lymphoma treated with electron beam irradiation in Indian patients
Authors: Parida Dillip K. , Verma Kaushal K. , Chander Subhash , Joshi R. C. , Rath Goura K.
Published: March 2003

Abstract

Background  Cutaneous T‐cell lymphoma (CTCL) is a rare occurrence in India. Total skin electron irradiation (TSEI) is a well‐accepted therapeutic modality for the treatment of CTCL throughout the world. The aim of this study was to retrospectively analyze the treatment outcome of TSEI in Indian patients with CTCL and to determine the different parameters affecting the disease‐free survival in these patients.

Methods  Fourteen male patients between 27 and 82 years of age with CTCL (duration of disease, 4 months to 2 years) were treated with TSEI between 1985 and 1998. Seven patients had early stage disease, while the other seven had advanced disease. Two patients had lymph node involvement at the time of presentation. The TSEI was performed according to the Stanford technique delivering a total dose in the range 8–36 Gy.

Results  Of the 14 patients, 10 showed complete remission following TSEI. The total follow‐up period was 4–110 months (median, 52 months). Five patients were disease free at the end of 5 years. Two patients died due to rapid progression of the disease, while the cutaneous lesions relapsed in three patients after 2–27 months and one patient developed visceral metastasis.

Conclusions  TSEI was an effective therapeutic modality for the treatment of CTCL in this group of patients, both as a curative and palliative measure, although the long‐term prognosis is poor.
Personal and practice‐related characteristics of a subsample of US women dermatologists: data from the Women Physicians' Health Study
Authors: Frank Erica ,   MPH, Singh Sareeta R.
Published: March 2003

Abstract

Background  The number of women dermatologists has increased dramatically over the past few decades. Despite this, there have been few studies examining the personal or professional characteristics of women dermatologists practicing in the USA.

Methods  A representative random sample of active, part‐time, professionally inactive, and retired US women physicians, aged 30–70 years, was studied; this article compares data from the 95 responding dermatologists with data from 4350 other respondents.

Results  Women dermatologists were more likely to be US born, white, and married to a physician than were other women physicians; they were similar to other women physicians in age, marital status, children, amount of stress at home, political self‐characterization, and personal health behavior. Women dermatologists were more likely to be board certified and to practice in solo or two‐person practices than were other women physicians. They had fewer nights on call, were less likely to state that they worked too much, reported less stress at work, were more satisfied with their careers, and reported higher household incomes. With the decided exception of skin cancer prevention and screening, they were unlikely to have considerable training, confidence, or interest in routine prevention‐related screening or counseling for patients.

Conclusions  Women dermatologists are unlikely to be part of a minority group, likely to be married to another physician, and likely to have a high household income. They report reasonable work stress and high career satisfaction. Given these findings, it is not surprising that only 10% would consider changing their specialty were they to relive their lives.
Anhidrotic ectodermal dysplasia with eruptive vellus hair cysts
Authors: Köse Osman , Tastan Halis Bülent , Deveci Salih , Gür Ali Riza
Published: March 2003

A 21‐year‐old white man complained of heat intolerance, absence of sweating, and papular lesions on the forehead. Facial features included a saddle nose, prominent supraorbital edge, and frontal bossing. The scalp hair was scanty, fine, and brittle. Eyelashes and eyebrows were also thin. Subungual hyperkeratosis and dystrophic changes were observed on the finger and toe nails. Hypodontic teeth were detected on oral examination. He was otherwise healthy. Biochemical and hematologic analyses were also normal. Cutaneous examination revealed smooth and dry skin. Multiple, 4–5 mm, brown–black, comedo‐like, soft papules were observed on the forehead (Fig. 1). A biopsy specimen from a papule on the forehead revealed cystic structures lined by squamous epithelium and containing laminated keratinous material and scattered obliquely and transversely cut vellus hairs (Fig. 2). Topical application of 0.1% tretinoin for 2 months produced no clinical improvement.

Scanty and fine scalp hair, prominent supraorbital edge and frontal bossing on the face, and brown–black comedo‐like soft papules (arrows) on the forehead

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Luminal vellus hairs and laminated keratinous material (hematoxylin and eosin, × 200)

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Nitric oxide and endothelin‐1,2 in actinic keratosis and basal cell carcinoma: changes in nitric oxide/endothelin ratio
Authors: Vural Pervin , Erzengin Dilek , Canbaz Mukaddes , Selçuki Dilek
Published: March 2003

Abstract

Background  Nitric oxide (NO) is an inorganic free radical gas which has cytostatic/cytotoxic actions in tumoral tissues, including gynecologic, breast, and colon cancer. Nitric oxide is also a multifunctional signaling molecule active in many cells of the body, including endothelial cells, macrophages, monocytes, hepatocytes, mast cells, osteoblasts, and astrocytes. Endothelin‐1 (ET‐1) is a 21‐amino acid peptide that stimulates the proliferation of vascular smooth muscle cells, fibroblasts, and keratinocytes, and plays a role in the expression of proto‐oncogenes (c‐myc, c‐fos), which precedes cell proliferation. Similar to NO, ET is secreted by different cell types, including macrophages, monocytes, hepatocytes, endothelial cells, vascular smooth muscle cells, and various tumor cells. Elevated ET‐1 levels are observed in pulmonary, hepatocellular, and prostate cancers. Actinic keratosis (AK) and basal cell carcinoma (BCC) are common skin tumors with accentuated hyperkeratinization, hyperpigmentation, and keratinocyte proliferation.

Aim  To investigate plasma NOx (nitrite/nitrate –‐ the end products of NO metabolism), ET, and the NOx/ET ratio in patients with AK and BCC in comparison with healthy controls.

Methods  NOx, ET, and the NOx/ET ratio were measured in 13 patients with AK, 12 patients with BCC, and in 16 healthy controls.

Results  Data analysis indicated a significant increase in plasma NOx, ET, and NOx/ET values in BCC patients in comparison with controls (P < 0.001, P < 0.05 and P < 0.001, respectively). Plasma ET levels in AK were also increased in comparison with controls (P < 0.001). When the two study groups (AK and BCC) were compared, a significant increase (P < 0.001) in the NOx/ET ratio in BCC was found.

Conclusions  The increased plasma ET and NOx levels in AK and, especially, BCC are probably the result of and/or reason for the accentuated hyperkeratinization, hyperpigmentation, and keratinocyte proliferation. The increased production of ET and NO by keratinocytes may function as growth and cytotoxic factors and potential mitogens, and may accelerate further proliferation of these skin tumors. In addition, the increased NOx/ET ratio probably reflects a disturbed equilibrium between these two substances, leading to cell damage and tumor promotion and proliferation.
Cutaneous sinus tract of dental origin
Authors: Güleç Ayse Tülin , Seçkin Deniz , Bulut Şule , Sarfakoğlu Evren
Published: March 2003

A 47‐year‐old woman presented with a nodular lesion on her face that had been discharging pus intermittently for 7 months. She could not recall any previous trauma to the site. Dermatologic examination revealed a nontender, erythematous, nodular, draining lesion on the patient's chin (Fig. 1). Dental examination showed poor oral hygiene and severe chronic periodontitis, but no acute infection. Radiography demonstrated diffuse periapical radiolucency associated with the right central mandibular incisor (Fig. 2). The patient was diagnosed with chronic apical periodontitis. Because it was too late for her oral condition to be corrected with endodontic treatment, the tooth was extracted and the scar on her chin was revised later.

A cutaneous draining sinus of dental origin presenting as an erythematous nodule on the patient's chin

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A periapical radiograph demonstrating periapical radiolucency surrounding the lower right central incisor (tooth no. 25)

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Cutaneous involvement of dermatomyositis can respond to Dapsone therapy
Authors: Cohen Jack B.
Published: March 2003

Background Dapsone (4,4‐diaminodiphenylsulfone) is a sulfone antibiotic used in the treatment of leprosy, but dermatologists more commonly utilize its anti‐inflammatory properties particularly directed against leukocytes to treat various bullous disorders, erythema nodosum, pyoderma gangrenosum, Sweet’s syndrome, cutaneous vasculitis, and cutaneous forms of lupus erythematosus. The cutaneous manifestations of dermatomyositis are often resistant to antimalarial and immunosuppressive therapies.

Methods Two patients with cutaneous dermatomyositis unresponsive to combination therapy with prednisone, hydroxychloroquine, quinacrine, and immunosuppressive medications had Dapsone added to their therapy.

Results Both patients showed rapid improvement with the addition of Dapsone. Each had an exacerbation of their cutaneous dermatomyositis on Dapsone with withdrawal and subsequent improvement when the Dapsone was reinstituted.

Conclusions Dapsone therapy for cutaneous dermatomyositis may have a wider role in treatment for these patients refractory to prednisone and antimalarial therapy.
Perianal actinomycetoma experience of 20 cases
Authors: Chávez Guadalupe , Estrada Roberto , Bonifaz Alexandro
Published: March 2003

Background Actinomycetoma is a chronic infection resulting from aerobic Actinomycetes. The major agents are Nocardia brasiliensis, Actinomadura madurae, and Streptomyces somaliensis. The most frequent topographies are the lower and upper limbs. The prognosis of this disease is determined by several factors, such as etiologic agent, clinical topography, and depth of disease (degree of involvement, visceral, and bone affection). The purpose of this paper was to present our experience with actinomycetoma of the perianal region.

Methods This study comprises 20 cases of perianal actinomycetoma, all of which were clinically and microbiologically proven by direct examinations, cultures, and biopsies. Clinical responses to the two principal treatment regimes used [combination of trimethoprim‐sulfamethoxazole (TMS/SMX) and diaminodiphenylsulfone (DDS) or amikacine plus TMS/SMX] are reported.

Results Most of the cases were male (17/20, 85%), the mean age was 42.1 years, and the farmers predominated (90%). The principal etiologic agent isolated was N. brasiliensis (85%).

Conclusions Perianal actinomycetoma is a rare entity. Differential diagnosis with anal sinuses, hydroadenitis, and cutaneous tuberculosis must be made in endemic areas by performing mycologic tests and biopsies. Treatment depends on the etiologic agent involved and the patient's condition.
Nevoid hyperkeratosis of the nipple and/or areola: a report of two cases and a review of the literature
Authors: Krishnan Ravi S. , Angel Tiffany A. , Roark Tom R. , Hsu Sylvia
Published: March 2003

Nevoid hyperkeratosis of the nipple and/or areola is a rare and idiopathic disorder with fewer than 50 cases reported in the literature. We report two cases, discuss the clinical and histological findings, and review the literature pertaining to its pathogenesis and therapy. It is hoped that, through this report, nevoid hyperkeratosis of the nipple and/or areola becomes a more recognizable and reported entity, thereby stimulating future studies regarding its pathogenesis and therapy.
Cutaneous findings associated with chronic natural killer cell lymphocytosis
Authors: Vanness Erin R. , Davis Mark D. P. , Tefferi Ayalew
Published: March 2003

Background Chronic Natural Killer Cell Lymphocytosis (CNKL) is a recently described rare proliferative disorder. We noted an association of cutaneous disorders with CNKL in our clinical experience.

Methods We reviewed the medical records of all known patients with CNKL at our institution.

Results Five of 14 patients (36%) with CNKL had associated chronic cutaneous disease: two had livedoid vasculopathy; one, urticarial vasculitis; one, peripheral T‐cell lymphoma; and one had complex recurrent aphthous stomatitis. In each case, except the one with lymphoma, the cutaneous disease was present before CNKL was diagnosed and CNKL persisted for the duration of the cutaneous disease. All five patients had increased numbers of large granular lymphocytes on a peripheral blood smear and three or four in the bone marrow (one patient did not undergo bone marrow biopsy).

Conclusions Although CNKL and the reported skin diseases have occurred in the same patients, a causal link cannot yet be established. With CNKL, dermatologists must recognize associated cutaneous diseases, monitor patients for systemic disorders and cytopenias, and appropriately refer patients to a hematologist.
Evidence‐based medicine in practice: limiting or facilitating patient choice?
Authors: Rogers Wendy A
Published: March 2003

Facilitating patient choice is an important element in respecting the autonomy of patients. Evidence‐based medicine has the potential to contribute to this process by the provision of high quality research‐based information, for use by patients and clinicians. In this paper, I analyse the processes of evidence‐based medicine in order to identify the ways in which patient choice is affected by decisions made in the development and use of evidence‐based guidelines. I argue that despite the potential contribution, the current methods and techniques of guideline production limit rather than facilitate patient choice.
Determination of stereochemistry stability coefficients of amino acid side‐chains in an amphipathic α‐helix
Authors: Chen Y. , Mant C. T. , Hodges R. S.
Published: March 2003

Abstract:  We describe here a systematic study to determine the effect on secondary structure of d‐amino acid substitutions in the nonpolar face of an amphipathic α‐helical peptide. The helix‐destabilizing ability of 19 d‐amino acid residues in an amphipathic α‐helical model peptide was evaluated by reversed‐phase HPLC and CD spectroscopy. l‐Amino acid and d‐amino acid residues show a wide range of helix‐destabilizing effects relative to Gly, as evidenced in melting temperatures (ΔTm) ranging from −8.5°C to 30.5°C for the l‐amino acids and −9.5°C to 9.0°C for the d‐amino acids. Helix stereochemistry stability coefficients defined as the difference in Tm values for the l‐ and d‐amino acid substitutions [(ΔTm′ = TmL and TmD)] ranging from 1°C to 34.5°C. HPLC retention times [ΔtR(XL−XD)] also had values ranging from −0.52 to 7.31 min at pH 7.0. The helix‐destabilizing ability of a specific d‐amino acid is highly dependent on its side‐chain, with no clear relationship to the helical propensity of its corresponding l‐enantiomers. In both CD and reversed‐phase HPLC studies, d‐amino acids with β‐branched side‐chains destabilize α‐helical structure to the greatest extent. A series of helix stability coefficients was subsequently determined, which should prove valuable both for protein structure‐activity studies and de novo design of novel biologically active peptides.
Assortative mating across a hybrid zone in Chorthippus parallelus (Orthoptera: Acrididae)
Authors: Ritchie Michael G. , Butlin Roger K. , Hewitt Godfrey M.
Published: March 2003

Two subspecies of the grasshopper Chorthippus parallelus meet and form a hybrid zone in the Pyrenees. Both strong hybrid dysfunction and a behavioural difference occur, which would seem to make the zone a suitable candidate for speciation by reinforcement. One of the classic ways of looking for this is to test for increased levels of assortative mating between populations from close to the region of contact. Here we show that, with virgin insects, such assortment decreases as one approaches the centre of the zone in C. parallelus. The pattern is different upon remating, with non‐virgins showing a pattern more like that predicted by reinforcement. Overall there is little evidence for reinforcement. We argue that other tests of the model may be more appropriate for stable hybrid zones.
Lack of seasonal changes in mitochondrial DNA variability of a Drosophila subobscura population
Authors: González Ana , Carrió Rafael , Fernández‐Pedrosa Victoria , Moya Andrés
Published: March 2003

Restriction site analysis of mtDNA of 550 isofemale lines corresponding to different seasonal samples of a single geographic population of Drosophila subobscura was carried out. The distribution pattern of haplotypes was similar to that observed for the entire range of the species on the European continent: two haplotypes were equally and highly frequent, and a set of sporadic haplotypes were almost never present in more than one seasonal sampling. No statistically significant evidence was found for between‐population heterogeneity across time, and the mean within‐population variation was similar to other mtDNA restriction site analyses previously reported for D. subobscura populations. These observations could be interpreted in terms of the neutral mutation hypothesis where the entire population has not yet reached an equilibrium. The causes of this non‐equilibrium are most likely periodic winter bottlenecks, phenomena that particularly affect the distribution of mtDNA haplotypes across time.
A comparison between allozyme data and phenotypic distances from defensive secretion in Oreina leaf‐beetles (Chrysomelinae)
Authors: Rowell‐Rahier Martine , Pasteels Jacques M.
Published: March 2003

The genetic relationships between five Oreina species (Chrysomelidae, Coleoptera) were studied. Of these species, four (O. bifrons, O. gloriosa, O. speciosa, O. variabilis) feed on Apiaceae and secrete mixtures of autogenous cardenolides from defensive glands, whilst the other (O. speciosissima) feeds on Asteraceae and is able both to produce cardenolides and to sequester pyrrolizidines N‐oxides (PAs). A dendrogram based on the different mixtures of cardenolides produced by the different species agreed with these genetic relationships. In other words, cardenolide mixtures are good taxonomic markers, since the clustering method based on chemical defense produces a branching pattern similar to that based on genetic relationships.
Population divergence and morphometric integration in the greenfinch (Carduelis chloris) – evolution against the trajectory of least resistance?
Authors: Merilä  , Björklund
Published: March 2003

Theory predicts that genetic and phenotypic correlations among traits may direct the process of short-term evolution by limiting the directions of variation available to natural selection to act on. We studied correlations between 14 skeletal traits in 10 geographically distinct and relatively young greenfinch (Carduelis chloris) populations to unravel whether the divergence among populations has occurred into directions predicted by the within-population correlations (cf. drift/correlated responses models), or whether it is better explained by ‘adaptive’ models, which predict no necessary association between within- and among-population correlations (allometries). We found that the within-population character correlations (or covariances) did not predict character divergence between populations. This was because the first eigenvector of the among-population correlation/covariance matrix, summarizing the major dimension of divergence, was a bipolar body:beak dimension, and distinct from the (≈ isometric) first eigenvector of within-population matrix. Hence, as the divergence among greenfinch populations cannot be satisfactorily accommodated by drift/correlated response models, an adaptive basis for divergence is suggested. The second major axis of within-population variation was a classical ‘group size’ factor revealing that beak size was more or less free to vary independently of body size. Consequently, even if the divergence among populations cannot be simply accommodated to expectations of drift and correlated response models, it is striking that the most pronounced size-independent (nonallometric) changes had occurred along the second largest dimension of variance. This could mean that selection pressures which shape integration within populations are the same as those that cause divergence among populations. A relaxed beak:body integration could also occur as a result of species level selection favouring taxa in which independent evolution of beak and body is made possible.
Mate search and aggregation behaviour in the Galician hybrid zone of Littorina saxatilis
Authors: Erlandsson J. , Kostylev V. , Rolán-Alvarez E.
Published: March 2003

In Galician rocky shores two ecotypes of the snail L. saxatilis can be found in sympatry. A ridged and banded ecotype (RB-morph) and a smooth and unbanded ecotype (SU-morph) overlap in midshore with the production of some hybrids. The distinct morphs mate assortatively and there is evidence of a partial reproductive barrier between them. This sexual isolation is caused by a nonrandom microdistribution and mate choice behaviour. Mucus trail-following, movement rate and aggregation behaviour were studied to determine their roles in the mating behaviour and sexual isolation of this species. Morph-specific mucus trail-following could not, in our experiments, explain either of these two processes. The reasons for the aggregation of morphs were investigated by Monte Carlo simulations of data from natural populations, which showed that size aggregation (refuge sizes fit different sized morphs differently) could explain only about 36% of the morph aggregation in adult snails. In the laboratory, morph aggregation was still present, and simulations suggested that size aggregation was the possible explanation. Thus, morph aggregation in Galician L. saxatilis has to be explained also by other causes in addition to size aggregation. These may be a combination of contrasting preferences for barnacle and mussel patches in the two morphs, and possibly longer copulation and pair formation time with similar sized snails of the same morph. Thus aggregation behaviour, but not trail-following, contributes to incipient reproductive isolation and perhaps sympatric speciation in Galician L. saxatilis populations.
Ecology and evolution of extravagant feather ornaments
Authors: Cuervo J. J. , Møller A. P.
Published: March 2003

The ancestral conditions that permit the evolution of extravagant secondary sexual characters are of considerable theoretical and empirical interest because they allow identification of necessary ecological conditions, but also allow empirical tests of models of female mate preferences. We investigated the ancestral and derived state of a range of ecological and evolutionary variables that might have been implicated in the evolution of secondary sexual characters. Extravagant feather ornaments have evolved independently at least 70 times in birds, and the context of these evolutionary events was investigated statistically. The acquisition of feather ornaments was significantly associated with a change in social mating system from monogamy to polygyny or lekking. This association is consistent with the Fisherian mechanism of sexual selection. However, very often also the acquisition of feather ornaments occurred without change in mating system. Therefore, ornamentation can develop for reasons other than polygyny. We did not find any indication of male parental care, kind of food, foraging mode, coloniality, nest site, migration or body mass being significantly associated with a change in the state of ornamentation.
Rate of deleterious mutation and the distribution of its effects on fitness in vesicular stomatitis virus
Authors: Elena  , Moya
Published: March 2003

Despite their importance, the parameters describing the spontaneous deleterious mutation process have not been well described in many organisms. If mutations are important for the evolution of every living organism, their importance becomes critical in the case of RNA-based viruses, in which the frequency of mutation is orders of magnitude larger than in DNA-based organisms. The present work reports minimum estimates of the deleterious mutation rate, as well as the characterization of the distribution of deleterious mutational effects on the total fitness of the vesicular stomatitis virus (VSV). The estimates are based on mutation-accumulation experiments in which selection against deleterious mutations was minimized by recurrently imposing genetic bottlenecks of size one. The estimated deleterious mutation rate was 1.2 mutations per genome and generation, with a mean fitness effect of –0.39% per generation. At the end of the mutation-accumulation experiment, the average reduction in fitness was 38% and the distribution of accumulated deleterious effects was, on average, left-skewed. The magnitude of the skewness depends on the initial fitness of the clone analysed. The implications of our findings for the evolutionary biology of RNA viruses are discussed.
Optimal timing of first reproduction in parasitic nematodes
Authors: Gemmill  , Skorping  , Read
Published: March 2003

The time between infection and the onset of reproduction (maturation time) is a key determinant of body size, fecundity and generation time in parasitic nematodes. An optimality model for maturation time is developed centred on prematurational growth, the duration of which has opposing consequences for fecundity and for survival to reproductive age. The maturation time favoured by natural selection is found to be inversely proportional to prematurational mortality rate. The product of maturation time and mortality rate is predicted to be an invariant number equal to the allometric slope linking daily fecundity to maturation time. Predictions are tested using comparative data on mammalian gastrointestinal nematode taxa. Half the cross-species variation in prepatent period (the time from infection until propagules are shed from the host) is accounted for by this adaptive trade-off hypothesis, even though many biological details are not explicitly modelled. These results are discussed in the light of previous studies and in the context of general models of life history evolution.
Pollinator behaviour and the evolution of Louisiana iris hybrid zones
Authors: Wesselingh  , Arnold
Published: March 2003

Pollinator preference may influence the origin and dynamics of plant hybrid zones. Natural hybrid populations between the red-flowered Iris fulva and the blue-flowered Iris brevicaulis are found in southern Louisiana. The genetic structure of these populations reflects a lack of intermediate genotypes. We observed pollinator behaviour in an experimental array with five plants each of I. fulva, I. brevicaulis, their F1, and the first backcross generation in each direction, to obtain data on flower type preferences and transitions between flower types. The most abundant visitors were Ruby-throated Hummingbirds (Archilochus colubris) and workers of the bumblebee Bombus pennsylvanicus. Hummingbirds visited I. fulva twice as often as I. brevicaulis and visited hybrids at intermediate frequencies. Bumblebee workers preferred the purple-flowered F1s and visited plants of I. fulva and the backcross to I. fulva more often than I. brevicaulis and its backcross. Overall, F1 flowers were visited most frequently. Both hummingbirds and bumblebees visited nearest neighbours in almost 80% of the interplant movements. This meant that a majority of movements were between different flower types, rather than between plants of the same type. Findings from the present study suggest that pollinator preference is not a major causal factor for the lack of intermediate genotypes in natural iris hybrid populations. Instead, pollinator behaviour in our array promoted mixed mating between flower types belonging to different pollination syndromes. However, owing to predominant nearest-neighbour visitation, the spatial distribution of parental and hybrid genotypes (in concert with pollinator behaviour) will have a strong influence on mating patterns and thus the genotypic structure and evolution of Louisiana iris hybrid zones.
High-prevalence male-killing Wolbachia in the butterfly Acraea encedana
Authors: Jiggins  , Hurst  , Dolman  , Majerus
Published: March 2003

Inherited bacteria which kill males during early development are widely distributed throughout the insects, but have been little studied outside of a single family of beetles, the Coccinellidae. We have investigated a male-killing bacterium discovered in the butterfly Acraea encedana. This bacterium belongs to the genus Wolbachia and is identical in wsp gene sequence to a male-killer in the closely related butterfly A. encedon, suggesting that it has either recently moved between host species or was inherited from a common ancestor of the butterflies. The prevalence of Wolbachia is remarkably high, 95% of females are infected and only 6% of wild caught butterflies are male. Measurements of the vertical transmission efficiency were used to calculate that this high prevalence is the result of infected females producing at least 1.79 times the number of surviving daughters as uninfected females (lower confidence limit is 1.25).
Mass-dependent reproductive strategies in wild bighorn ewes: a quantitative genetic approach
Authors: RÉale  , Festa-Bianchet
Published: March 2003

In the Ram Mountain bighorn sheep (Ovis canadensis) population, ewes differing by more than 30% in body mass weaned lambs with an average mass difference of only 3%. Variability in adult body mass was partly due to additive genetic effects, but inheritance of weaning mass was weak. Maternal effects could obscure genetic effects in the phenotypic expression of weaning mass, particularly if they reflected strategies of maternal expenditure that varied according to ewe mass. We performed a quantitative genetic analysis to assess genetic and environmental influences on ewe mass and on maternal expenditure. We used the mean daughters/mother regression method and Derivative Free Restricted Maximum Likelihood models to estimate heritability (h2) of ewe mass and indices of maternal expenditure. We found additive genetic effects on phenotypic variation in maternal mass, in lamb mass at weaning (absolute maternal expenditure) and in weaning mass relative to maternal mass at weaning (relative maternal expenditure). Heritability suggests that maternal expenditure has the potential to evolve. The genetic correlation of ewe mass and absolute maternal expenditure was weak, while ewe mass and relative maternal expenditure were strongly negatively correlated. These results suggest additive genetic effects on mass-dependent reproductive strategies in bighorn ewes. Mass-dependent reproductive strategies could affect lamb survival and phenotypic variation in adult mass. As population density increased and reproduction became costlier, small females reduced maternal expenditure more than large females. Constraints on reproductive strategy imposed by variations in resource availability are therefore likely to differ according to ewe mass. A general trend for a decrease in maternal expenditure relative to maternal size in mammals suggests that size-dependent negative maternal effects may be common.
Temporal and microspatial variation in the intensities of natural and sexual selection in the yellow dung fly Scathophaga stercoraria
Authors: Jann P. , Blanckenhorn W. U. , Ward P. I.
Published: March 2003

Studies of phenotypic selection in natural populations often concentrate only on short time periods and do not quantify selection intensities. We quantified temporal and microspatial variation in the intensities of natural and sexual selection for body size in the yellow dung fly over 2 years. Female fecundity selection intensity remained approximately constant over the season with an overall mean ± SE of 0.187 ± 0.014. Selection intensity for male reproductive success, defined as eggs obtained by mating males, did not differ from zero, indicating there was no assortative mating by size. Sexual selection intensity for male mating success favouring large males was variable but overall strong in the two years (0.499 ± 0.053 and 0.510 ± 0.051). As theoretically expected for male–male competition, sexual selection intensity increased with competitor density and reached an asymptote at about 250 males per pat; it also decreased with time in spring and increased again in autumn as a function of density. Small males had the best chance of obtaining a female at very low male densities. Greater selection intensity for large size in males than females is consistent with, and might be responsible for, the observed sexual size dimorphism in this species, as males are larger. The seasonal pattern of mean male body size (smallest at the beginning and end of the season) most likely reflects mere environmental (primarily temperature) influences on phenotypic size.