bluuebunny/crossref_metadata_2025 huggingface dataset:
Osteoporosis Education Programs: Changing Knowledge and Behaviors
Authors: Sedlak Carol A , Doheny Margaret O , Jones Susan L
Published: March 2003

Osteoporosis is an age related metabolic disease that primarily affects women and causes bone demineralization that results in fractures. Early identification of risk factors for osteoporosis and development of prevention programs is needed to halt the increasing incidence of the disease. Public health nurses (PHNs), with their emphasis on primary, secondary, and tertiary prevention with individuals and families, are in a unique position to protect the health of these vulnerable populations who are at risk for osteoporosis. This article describes the implementation and program evaluation of three osteoporosis prevention educational programs that use three levels of intensity of design. Each design is based upon the learning needs of the targeted audience. The goals of each program were to increase knowledge of osteoporosis, increase health beliefs, and increase the frequency of osteoporosis preventing behaviors. Theoretical aspects from adult learning and the Health Belief Model (HBM) were used to develop the programs. For the program evaluation, participants completed evaluation instruments before and 3 weeks after participating in an osteoporosis health education program. Participants in all programs had significantly higher levels of knowledge after completing the programs; however, overall, there was no change in health beliefs or behaviors. Implications of these findings are discussed.
Geographical Mapping of Unmarried Teen Births and Selected Sociodemographic Variables
Authors: Blake Barbara J , Bentov Leora
Published: March 2003

Texas is one of five states in the United States in which teen pregnancies exceed 70 per 1,000 females aged 15 to 17 years. The purpose of this retrospective exploratory study was to analyze and map sociodemographic variables associated with unmarried teen childbirth. It was hypothesized that selected sociodemographic variables would be related to the unmarried teen birthrates. Correlational analysis was employed to ascertain the relationship between the sociodemographic variables and the unmarried teen birthrates for 81 zip codes in Dallas County, Texas. The births occurred between January 1, 1995 and December 31, 1996. Geographic Information System (GIS) software illustrated the spatial distribution of the unmarried teen birthrates in conjunction with sociodemographic variables extracted from the 1990 U.S. Census Bureau. The results indicate that unmarried teen births are positively related to low socioeconomic status, single‐parent family households, and minority populations. Mapping supports the quantitative relationships between the variables. Maps can be used to identify communities where teens most vulnerable to unmarried pregnancy and childbirth reside and provide policy makers with explicit information about their constituents so that they can develop and implement population‐specific interventions.
Mentoring Benefits and Issues for Public Health Nurses
Authors: Smith Linda S , McAllister Lydia E , Crawford Carol Snype
Published: March 2003

New public health nurses (PHNs) move from novice to expert status with enormous expectations from their organization, their peers, and themselves. These expectations lead to stress that may be beyond the level of endurance. Mentoring is an important answer to this problem. Mentoring is the greatest gift PHNs can give to each other, especially for PHNs who self‐identified themselves as minority cultural group members. This article describes definitions, roles, benefits, and responsibilities of mentors and mentees and includes mentoring concerns, current and proposed mentoring programs, and mentoring issues for gender and race. Organizational mentoring programs can be created that will facilitate the development of mentoring relationships. These programs help experienced PHNs bridge the gap between the theory and reality of nursing for themselves and inexperienced colleagues.
Asian Indian Women: Knowledge, Attitudes and Behaviors Toward Breast Cancer Early Detection
Authors: Sadler Georgia Robins , Dhanjal Sharanjeet Kaur , Shah Neeta Bhatia , Shah Rina Bihari , Ko Celine , Anghel Mihai , Harshburger Ryan
Published: March 2003

Education programs have been developed to promote adherence to recommended breast cancer screening guidelines. Few studies have assessed the degree to which ethnic subgroups are perceiving and acting on the proffered information. Such assessment is vital to the creation of efficient public health interventions. This paper describes the reported breast cancer knowledge, attitudes, and screening behaviors of 194 American Asian Indian women. While monthly breast self exam adherence was low, only 40.7%, 61.3% of women 40 and older, and 70% of women 50 and older, reported having had a mammogram within the past 12 months. These rates for annual mammography screening are high relative to many other ethnic groups. While the results are encouraging, the respondents may not be representative of all Asian Indian women. The majority of these women reported that their breast cancer knowledge is inadequate. They were willing to be called upon to share with others any knowledge they gained. There is a clear opportunity for public health nurses to provide Asian Indian women with a more comprehensive understanding of breast health and disease. Those women can then share their health knowledge with other women within their ethnic group.
Nothing is Going to Stop Me Now: Obstacles Perceived by Low‐Income Women as They Become Self‐Sufficient
Authors: Brown Sandra Godman , Barbosa Gail
Published: March 2003

As low‐income women struggle to become self‐sufficient, they encounter many obstacles. The literature identifies physical and mental health problems, inadequate childcare, inadequate occupational skills, lack of transportation, criminal histories, and limited educational abilities as major barriers to be overcome in this transition. Qualitative data collected from low‐income women attending Innovative Alternatives for Women, an occupational skills and health information training center which was developed and implemented by a nurse, refutes several of the previously identified obstacles. Inadequate childcare and transportation were not seen as barriers to success by the program participants, but were viewed as socially acceptable reasons for not working. Eight obstacles were identified by the program participants as being the real reasons for their lack of success. The identified obstacles included the following: lack of self‐esteem, especially relating to school; “bad” relationships with men; lack of support from family and friends; limited life options; lack of training for nonwelfare recipients; lack of quality programs; criminal histories; and fear of success.
Antecedents of Adherence to Antituberculosis Therapy
Authors: McDonnell Marcia , Turner Joan , Weaver Michael T.
Published: March 2003

This correlational study identified antecedents of adherence to antituberculosis (anti‐TB) therapy in a convenience sample of 62 English‐speaking adults. From a demographic perspective, the study sample was similar to the referent population of TB patients in Georgia. A variety of parametric analyses revealed the following: The mean self‐reported adherence score was 92.6% (SD= 3.3). Higher levels of self‐reported adherence were associated with an annual income of $11,000 or more, education beyond high school, no current alcohol use, perceived support and absence of barriers to medication taking, strong intentions to adhere, and a high capacity for self‐care. Those six variables accounted for 28% of adherence variance, F(6, 44) of 4.3, p= 0.0017. Additionally, belief in the usefulness and benefit of the medications was strongly correlated with intentions to adhere (r= 0.83, p < 0.001), and interpersonal aspects of care was significantly correlated with perceptions of medication utility (r= 0.65, p < 0.001), supports/barriers (r= 0.44, p < 0.001), intentions (r= 0.69, p < 0.001), and self‐care (r=–0.42, p < 0.01). Persons who were diagnosed with both TB and human immunodeficiency virus (HIV) reported significantly lower adherence.
Smoking Patterns Among Ninth‐Grade Adolescents in the Pitkäranta District (Russia) and in Eastern Finland
Authors: Kemppainen Ulla , Tossavainen Kerttu , Vartiainen Erkki , Pantelejev Vladimir , Puska Pekka
Published: March 2003

This study describes how ninth‐grade adolescents' smoking behavior in the Pitkäranta district (Russia) differs from their eastern Finland counterparts. Cross‐sectional data from the second North Karelia Youth Study and the Pitkäranta Youth Study were used. Subjects were all (n=385) ninth‐grade students in 10 comprehensive schools in Pitkäranta and all (n=2098) students of the same age in 24 comprehensive schools in eastern Finland. Students were asked about their smoking status, intentions to smoke, smoking situations, acquisition of tobacco products, and opportunity to smoke in the school area. The results showed very large differences in the smoking prevalence between Pitkäranta and eastern Finland. For boys, the prevalence of daily smoking was 29% and 19% in Pitkäranta and eastern Finland, respectively. The differences in girls were adverse: 7% and 21% of girls in Pitkäranta and eastern Finland, respectively, were daily smokers. However, as many as one third of the nonsmoking girls in Pitkäranta stated that they may experiment or start smoking later. Boys in Pitkäranta had vaguer attitudes about remaining nonsmokers than boys in eastern Finland. This situation anticipates worsening of the smoking epidemic in Pitkäranta and requires an effective prevention policy and cooperation between different groups in society.
Sexual Risk Taking Among Taiwanese Youth
Authors: Yeh Chao‐Hsing
Published: March 2003

The purpose of this grounded theory study was to understand sexual risk‐taking behavior among Taiwanese youth. Thirty‐six participants were purposively selected for two to three semistructured, in‐depth individual interviews. The constant comparative method and coding process were used for data analysis. The core category of preserving the fantasy of romantic innocence emerged from the initial data analysis to explain how and why young people engage in sexual risk taking. Accordingly, the subcategories of suppressing carnal knowledge and being swept away by love were developed. Suppressing carnal knowledge consisted of keeping silent, having an inadequate sexual education, and having stereotypical thinking and was identified as an explanation as to why young people cannot relate knowledge to actual practice. Being swept away by love included a false knowledge of one's sexual partner, shifting levels of intimacy, and nonacceptance of one's own sexuality. This conceptualization emphasizes the reasons why young people engage in sexual risk taking; that is, cultural reluctance to discuss sexuality openly. The implication of this theorizing is that interventions to reduce sexual risk taking should be done on an individual basis and should consider one's developmental context in order to increase one's skills in effectively discussing sex and sexuality.
Evaluation of a Clinic‐Based Parent Education Program to Reduce the Risk of Infant and Toddler Maltreatment
Authors: Huebner Colleen E.
Published: March 2003

Community‐based parent education programs are a common component of service plans for abusive and potentially abusive parents. Despite their widespread use, few studies have evaluated the effect of such programs to change actual parenting behavior even though this is a key intervention goal. The purpose of this study was to evaluate whether a relatively brief and inexpensive clinic‐based education program could benefit parents of infants and toddlers by alleviating parental stress and improving parent–child interaction. Participants were 199parents of children 1 through 36 months of age who were at risk for parenting problems and child maltreatment due to serious life stress including poverty, low social support, personal histories of childhood maltreatment, and substance abuse. Program effects were evaluated in terms of improvement in self‐reported parenting stress and observed parent–child interaction. Positive effects were documented for the group as a whole and within each of three subgroups: two community samples and a group of mothers and children in residential drug treatment. Additional analyses illustrated a dose–response relationship between program attendance and magnitude of gain in observed parenting skills.
Women's Efficiency in Decision Making and Their Perception of Their Status in the Family
Authors: Erci Behice
Published: March 2003

Abstract  This study is descriptive in nature. Three hundred ten women who applied to the Maternal–Child Health and Family Planning Center in Erzurum, Turkey, between June 1 and August 30, 2001 were included in this study. Data were collected through the inquiry form, which was prepared to determine women's efficiency in decision making, their perception of their status within the family, and their demographic characteristics.

Women's decision‐making rate was lower than that of men, except for selecting clothes. Couples' joint decision‐making rate was high on personal matters but low on official matters. The women's educational level affected their decision making in the family. The majority of the women perceived themselves as wives sharing everything within the family. Women's perception of their positions in the family was related to their status and decision making. The results can be used in primary care practice for women's health promotion. The sample in this study reflects only one area of Turkey.
Adult Day Care: Northern Perspectives
Authors: Ritchie Linda
Published: March 2003

Abstract  This qualitative study explores older adults', caregivers', and nurses' perceptions regarding adult day care (ADC). The study took place in two small towns and one small city in the northern interior region of British Columbia, Canada, with the intent to develop ADC programs that reflect the needs of older persons and their caregivers. The 32 participants contributed their perceptions in focus groups and individual interviews. The interviews, in this descriptive/exploratory study, were audiotaped, transcribed verbatim, and analyzed using inductive, qualitative techniques. The participants acknowledged ADC services as essential to the health and well‐being of older adults and their caregivers. The major themes that emerged were need for respite; aging in place; ADC programming; program characteristics; staff knowledge, skills, and attitudes; and northern perspectives. The study participants identified a number of possible reasons for underuse of ADC programming in the north. This study provides information that can facilitate the grounding of ADC policy within the clients' perspectives and a northern context. The participants' thoughts also highlight areas of policy that have broad applicability to the provision of services to the elderly in any setting.
Giant Congenital Melanocytic Nevus with Underlying Hypoplasia of the Subcutaneous Fat
Authors: Caradona Stephanie A. , Skidmore Robert , Gupta Anu , Bush Charles H. , Ford Michael J.
Published: March 2003

Abstract: A 17‐week‐old boy with a giant congenital melanocytic nevus (GCMN) of the left lower extremity was noted to have a reduction in circumference of the left lower extremity relative to the contralateral side. The skin overlying the GCMN was persistently warm when compared with the surrounding and contralateral skin. Comparative plain radiography, ultrasonography, and magnetic resonance imaging showed fat hypoplasia of the left lower extremity, with bone and muscle appearing unaffected. The possible role of cytokines produced by the nevus in fat hypoplasia in GCMN is discussed.
Idiopathic Localized Unilateral Hyperhidrosis in a Child
Authors: Ghali Fred E. , Fine Jo‐David
Published: March 2003

Abstract: Idiopathic unilateral circumscribed hyperhidrosis is an extremely rare form of increased sweat production that occurs within a sharply demarcated area on the face or upper extremities of otherwise healthy patients. There are no associated neurovascular or metabolic abnormalities. We report idiopathic localized unilateral hyperhidrosis on the upper extremity of a healthy 4‐year‐old girl.
Bilateral En Coup de Sabre—A Rare Entity
Authors: Rai Ranju , Handa Sanjeev , Gupta Somesh , Kumar Bhushan
Published: March 2003

Abstract: Linear scleroderma involving the frontal or frontoparietal region of the scalp (with or without associated facial hemiatrophy) is called “en coup de sabre” (like the stroke of a sabre). We report a case which to the best of our knowledge is only the fifth instance of this subset of localized morphea occurring in a bilateral distribution. We believe that the rarity of this presentation warrants a report.
Benign Cephalic Histiocytosis with Diabetes Insipidus
Authors: Weston William L. , Travers Sharon H. , Mierau Gary W. , Heasley Diane , Fitzpatrick James
Published: March 2003

Abstract: Benign cephalic histiocytosis is a rare skin condition consisting of small tan papules on the face and upper trunk that is believed not to be associated with internal organ involvement. The infiltrating histiocytes are not Langerhans' cells (LCs). We report a 5‐year‐old girl who presented with diabetes insipidus 1 year after developing multiple small brown asymptomatic skin papules. Histologic examination revealed a non‐LC histiocytic proliferation in the dermis without epidermal invasion. She had infiltration of the pituitary stalk on brain imaging. Diabetes insipidus has heretofore been associated with LC histiocytosis and xanthoma disseminatum but not benign cephalic histiocytosis.
Papillon–Lefèvre Syndrome with Pyogenic Hepatic Abscess: A Rare Association
Authors: Khandpur Sujay , Reddy Belum Siva Nagi
Published: March 2003

Abstract: Papillon–Lefèvre syndrome in a 14‐year‐old boy presenting with palmoplantar keratoderma, periodontosis, recurrent pyogenic infections of the skin, and hepatic abscesses is reported for its rarity and unusual manifestations. The patient showed a dramatic response to acitretin therapy.
Erythema Nodosum Induced by Kerion Celsi of the Scalp
Authors: Calista Donato , Schianchi Sandra , Morri Massimo
Published: March 2003

Abstract: A 5‐year‐old girl presented with a 2‐week history of a sharply demarcated, inflammatory, granulomatous lesion on the right side of her scalp. Shortly afterward, painful, subcutaneous nodules developed on her shins and thighs. Trichophyton mentagrophytes was isolated from the scalp lesion and a diagnosis of erythema nodosum induced by kerion of the scalp was made. The patient was started on oral therapy with 18 mg/kg/day griseofulvin, associated with topical crystal violet. Her erythema nodosum regressed in 10 days, while the kerion healed 6 weeks later, leaving residual scarring alopecia. Erythema nodosum represents a reaction pattern to a wide variety of inflammatory stimuli. The interest of this case lies in the unusual association of kerion erythema nodosum, of which only nine cases have been reported in the international literature.
Guttate Psoriasis Following Kawasaki Disease
Authors: Garty B. , Mosseri R. , Finkelstein Y.
Published: March 2003

Guttate psoriasis developed in a 3.5‐year‐old boy during the course of Kawasaki disease (KD). The pathogenesis of this unusual complication may be production of superantigens, which is also considered to be a cause of KD.
Treatment of Human Papilloma Virus in a 6‐Month‐Old Infant with Imiquimod 5% Cream
Authors: Schaen Lori , Mercurio Mary Gail
Published: March 2003

A healthy female infant was diagnosed with genital warts at six months of age. She was the product of an uncomplicated vaginal delivery to a mother who was diagnosed with genital warts during the pregnancy, but did not undergo any treatment. The infant’s warts were clinically resolved following a three week course of 5% imiquimod cream, an immunomodulating agent that has been demonstrated to be a potent inducer of several cytokines promoting an antiviral cell‐mediated immune response.
Infantile Perianal Protrusion: 13 New Cases
Authors: Patrizi Annalisa , Raone Beatrice , Neri Iria , D'Antuono Antonietta
Published: March 2003

We report 13 girls, ages 4 months–5 years, affected by an infantile perianal protrusion located on the midline anterior to the anus in 8 patients and posteriorly in 3. A past personal history of constipation existed in six patients and anal fissures in three patients. In one of the five patients with recurrent anogenital erythema, a punch biopsy specimen revealed the histopathologic signs of lichen sclerosus et atrophicus (LS&A). In another two patients, infantile perianal protrusion was associated with clinical signs of genital LS&A. None of our patients had spontaneous reduction of infantile perianal protrusion during the follow‐up period.
Neurocutaneous Melanosis in Association with the Dandy–Walker Complex, Complicated by Melanoma: Report of a Case and Literature Review
Authors: Mena‐Cedillos Carlos Alfredo , Valencia‐Herrera Adriana M. , Arroyo‐Pineda Alma Iris , Salgado‐Jiménez M. Angeles , Espinoza‐Montero Rubén , Martínez‐Avalos Armando Bernardo , Perales‐Arroyo Antonio
Published: March 2003

Abstract:Neurocutaneous melanosis is a rare congenital neurocutaneous syndrome in which benign and malignant melanocytic tumors of the leptomeninges with large or numerous congenital melanocytic nevi develop. The Dandy–Walker malformation occurs as a broad posterior fossa with high insertion of the tentorium, hypoplasia or aplasia of the cerebellar vermis, and cystic dilation of the fourth ventricle communicating with the posterior fossa. Association of these entities is very unusual and only 10 previous reports were found in the literature. Our patient had multiple, medium‐size to small melanocytic nevi present since birth. At 5 years of age the patient has intracranial pressure secondary to hydrocephalus. A diagnosis of Dandy–Walker malformation and suspected neurocutaneous melanosis was established after a skull computed tomography (CT) scan. Three months later the patient developed a right frontal tumor shown on the CT scan. The histologic finding was nevomelanocytic infiltration with strong pleomorphism. The tumor grew rapidly, producing neurogenic shock and death. The postmortem report indicated malignant melanoma.
Pityriasis Rotunda in Childhood
Authors: Ena P. , Cerimele D.
Published: March 2003

Abstract: Pityriasis rotunda is a rare disease characterized by round or oval patches, localized mainly on the trunk, arms, and legs. The patches are usually lighter than the surrounding skin, but sometimes may be darker, and are covered by fine, adherent scales. Two types of pityriasis rotunda have been described. Type I has been observed mainly in oriental and black patients older than 60 years of age, and is often associated with systemic disease or malignancy. Type II has been observed in white patients younger than 40 years of age, is often familial, and has never been observed in association with malignancy or internal disease. On Sardinia, a cluster of patients with type II pityriasis rotunda has been described. From 1981 until 1998, 51 cases of this disease have been observed in the Department of Dermatology, University of Sassari; 32 of them were children. The great prevalence of pityriasis rotunda on Sardinia, an island which until 40 years ago had limited contact with the Italian mainland, and the presence of a large number of familial cases suggest that type II pityriasis rotunda should be considered a genetically determined disease. The trend toward spontaneous resolution after the age of 20 years suggests that pityriasis rotunda should be considered a genodermatosis with a temporary phenotypic expression.
Prevalence of Skin Conditions in Primary School Children in Turkey: Differences Based on Socioeconomic Factors
Authors: İnanir Işil , Şahin M. Turhan , Gündüz Kamer , Dinç Gönül , Türel Aylin , Öztürkcan Serap
Published: March 2003

Abstract: Skin diseases are associated with environmental factors and a public health approach is particularly important. We determined the prevalence of skin conditions and associated socioeconomic factors in primary school children in Turkey. A questionnaire for determining the socioeconomic level and a complete dermatologic examination were performed in 785 children in two primary schools in different socioeconomic areas of suburban and central Manisa, Turkey. The study included 345 (43.9%) girls and 440 (56.1%) boys with a mean age of 9.25 ± 1.55 (range 6–14 years). Infectious skin diseases were frequently observed: pediculosis capitis in 74 children (9.4%), scabies in 17 (2.2%), viral skin diseases in 30 (3.8%), and fungal infections in 6 (0.7%). The other common conditions were melanocytic nevi (14.4%), keratosis pilaris (12.5%), pityriasis alba (12%), xerosis (11.8%), and atopic dermatitis (6.8%). Pediculosis capitis, acne, and dandruff were more common in girls. The rate of infections, atopic dermatitis, xerosis, and pityriasis alba were significantly higher in the school children with poor socioeconomic conditions. Improvement in socioeconomic conditions along with education may be needed to decrease the prevalence of some of these skin disorders in order to decrease costs related to treatment.
A Clinical Study of Childhood Alopecia Areata in Singapore
Authors: Tan Eileen , Tay Yong‐Kwang , Giam Yoke‐Chin
Published: March 2003

Abstract: Alopecia areata (AA) is a common cause of nonscarring alopecia. The aim of this epidemiologic study is to review the clinical characteristics and treatment of childhood alopecia areata in a mixed ethnic population. The study population consisted of a total of 392 children seen over a 4‐year period with AA diagnosed before the age of 16 years. The female:male ratio was 1:1.4. There were 309 Chinese (78.8%), 51 Malays (13.0%), and 32 Indians (8.2%). The mean age at the time of diagnosis was 11.2 years. The majority of patients (71.7%) had alopecia of less than 6‐months duration and 6% had previous episodes of AA. Females appeared to have more severe involvement. A familial history of AA was observed in 33 patients (8.4%). Associated atopy was found in 26.6% of patients and in 32.3% of their first‐degree relatives. Other associations such as vitiligo or Down syndrome were rare. For limited AA, topical and/or intralesional corticosteroid was the first‐line treatment used and squaric acid dibutyl ester was the choice of treatment for patients with extensive involvement. The profile of the poor respondents to therapy included young age of onset, past history of AA, Down syndrome, and extensive involvement.
Ectrodactyly‐Ectodermal Dysplasia‐Clefting Syndrome (EEC): Report of a Case with Perioral Papillomatosis
Authors: Fernandes Bárbara , Ruas Evelina , Machado Álvaro , Figueiredo Américo
Published: March 2003

Abstract: We report a 13‐year‐old boy with ectodermal dysplasia, ectrodactyly, and syndactyly, hypospadias, photophobia, conductive hearing loss, and perioral papillomatosis. His father had ectrodactyly and hypotrichosis. The clinical picture suggested ectrodactyly‐ectodermal dysplasia‐clefting (EEC) syndrome. The presence of perioral papillomatosis, classically seen in Goltz syndrome, has been reported only once before in EEC syndrome.
Netherton Syndrome Associated with Idiopathic Congenital Hemihypertrophy
Authors: Yerebakan Özlem , Uğuz Ayşen , Keser İbrahim , Lüleci Güven , Çiftçioğlu Mehmet Akif , Başaran Erdal , Alpsoy Erkan
Published: March 2003

Abstract: Netherton syndrome is a rare genodermatosis comprised of anichthyosiform dermatitis, hair shaft defects, and atopic features. Other problems associated with Netherton syndrome are delayed growth and development, immune abnormalities, recurrent infections, and intermittent aminoaciduria. We describe an 18‐month‐old girl with Netherton syndrome who had idiopathic congenital hemihypertrophy on her right side with contralateral benign nephromegaly in addition to the characteristic clinical signs of the syndrome. To our knowledge, this is the first case of Netherton syndrome associated with idiopathic congenital hemihypertrophy to be reported.
Sensitization to Para‐Phenylenediamine from a Streetside Temporary Tattoo
Authors: Marcoux Danielle , Couture‐Trudel Pierre‐Marc , Riboulet‐Delmas Gisèle , Sasseville Denis
Published: March 2003

Abstract: “Temporary” henna tattoos (skin painting or pseudotattooing) are in vogue among American and European youngsters, particularly when vacationing. A 17‐year‐old girl presented with a severe contact dermatitis of her scalp and face after having dyed her hair with a permanent oxidative hair dye. She denied previous use of oxidative hair dye. Eight months earlier she had a “temporary” henna tattoo applied on her shoulder by a transient artist in downtown Montreal and developed an acute, erythematous, edematous eruption that resolved with residual, prolonged hyperpigmentation. As henna tattooing is a lengthy and tedious procedure, para‐phenylenediamine (PPD) may be added to the mixture to accelerate the process, to darken, and to give more precision to the design. This short‐lived fad can have longer‐term sequelae then expected, ranging from postinflammatory hyperpigmentation of the tattoo site to permanent sensitization to PPD and related compounds.
Lichen Planus in the Lines of Blaschko
Authors: Kabbash Christina , Laude Teresita A. , Weinberg Jeffrey M. , Silverberg Nanette B.
Published: March 2003

Abstract: We describe three adolescents with eruptive linear lesions of the back, abdomen, and extremities distributed along the lines of Blaschko. Clinically one of these lesions resembled an epidermal nevus in its morphology and distribution. A biopsy specimen demonstrated the typical histology of lichen planus (LP). There have been fewer than 20 reported cases of childhood linear LP. Our patients demonstrate that linear LP sometimes may closely resemble an epidermal nevus and may auger the onset of more generalized LP or more involvement along the lines of Blaschko, that is, “Blaschkoian” disease. Previous studies have referred to this variant as zosteriform. Our cases are the fourth, fifth, and sixth cases of childhood LP reported to occur along the lines of Blaschko. Based on the clinical findings in our patients and a review of the English‐language literature, we believe that linear LP is usually distributed along the lines of Blaschko and should be renamed lichen planus, Blaschko subtype.
Neu–Laxova Syndrome: A Case Report
Authors: Hickey Patrick , Piantanida Elizabeth , Lentz‐Kapua Sarah , Kenner Julie
Published: March 2003

Abstract: Neu–Laxova syndrome is a rare congenital disorder characterized by microcephaly, limb contactures, lissencephaly and ichthyosis. A case of Neu–Laxova syndrome is presented, with a discussion of clinical manifestations, complications, and therapeutic interventions.
Apheresis and the Thrombotic Thrombocytopenic Purpura Syndrome: Current Advances in Diagnosis, Pathophysiology, and Management
Authors: Brailey Lisa Louise , Brecher Mark E. , Bandarenko Nicholas
Published: March 2003

Endeavors to optimize the management of thrombotic thrombocytopenic purpura (TTP) syndrome and improve mortality and relapse rates are hindered by its poorly understood pathophysiology. Variability in the application of therapeutic plasma exchange (TPE), including replacement fluid strategies, desirable endpoints in the platelet count, serum lactate dehydrogenase concentration, and the use of a TPE taper, limit comparisons among published studies. The diversity of adjunctive therapies such as antiplatelet agents, steroids, and splenectomy further clouds comparisons. Recent progress in the diagnosis, pathophysiology, and management of TTP syndrome are summarized. The possible role of occult infection and newly emerging associations such as ticlopidine therapy are discussed. Advances in possible pathogenic mechanisms, the rationale for different replacement fluids including the recently licensed solvent‐detergent treated plasma, and progress in the apheresis management of TTP syndrome are presented.
Immunoadsorption in Guillain‐Barré Syndrome and Myasthenia Gravis
Authors: Haupt W.F. , Rosenow F. , van der Ven C. , Birkmann C.
Published: March 2003

Elimination of circulating antibodies by hemapheresis is an empirical treatment concept in various neuroimmunological diseases. Plasma exchange (PE) has been shown to be superior to symptomatic treatment in Guillain‐Barré syndrome (GBS) in two large multicenter studies. It is also effective in myasthenia gravis (MG), although no comparative studies have been performed. Immunoadsorption (IA) using polyvinyl alcohol gel columns to which phenylalanin (IM‐PH) or tryptophan (IM‐TR) are covalently bound is an alternative to PE, and seems to have equal efficacy and comparable side effects. This method also obviates the need for replacement of plasma with human albumin or plasma. We compared the treatment results of 11 patients with GBS treated by PE to those of 13 patients treated by IA using an IM‐TR column. Here, we found no statistically significant differences with regard to efficacy and clinical or procedural complications. From these data we conclude that immunoadsorption can be used as an equal alternative to PE. A large multicenter study comparing PE, intravenous immunoglobulins (IVIG), and the combination of both in the treatment of GBS revealed no significant difference between the 3 treatment groups. In MG, only 2 small studies have been performed using IA, and no studies comparing PE or other treatments to IA have been conducted. Both investigations of IA therapy demonstrated a marked reduction in the acetylcholine receptor (AchR) antibodies and a sustained improvement of the clinical signs. These results therefore show that IA is an effective treatment for myasthenia gravis.
Therapeutic Apheresis for Cancer Related Hemolytic Uremic Syndrome
Authors: Kaplan Andre A.
Published: March 2003

Abstract: Hemolytic uremic syndrome (HUS) can be seen as a result of disseminated cancer, as a consequence of chemotherapy, or in association with bone marrow transplantation (BMT). Further distinction can be made when the clinical presentation is that of an acute, fulminant course with rapidly progressive renal failure or that of a sub‐acute form with a slow progression of renal involvement. Each of the different etiologies (cancer, chemotherapy, or BMT) and each of the two basic clinical presentations has its own prognosis. There are no randomized, controlled studies to elucidate the role of therapeutic apheresis for cancer‐related HUS. Hemolytic uremic syndrome related to disseminated cancer is most often a terminal event and is not commonly treated with apheresis procedures, although there are anecdotal reports that plasma exchange may be beneficial. Chemotherapy and drug‐related HUS have a prognosis that is strongly dependent on the severity of the presentation, but even in the most severe cases may respond to either immunoadsorption or plasma exchange with fresh frozen plasma (FFP). Finally, BMT‐related HUS has a poor prognosis but may respond to immunoadsorption, plasma exchange, or a combination of the two.
Granulocytapheresis as a Possible Cancer Treatment
Authors: Tabuchi Takafumi , Ubukata Hideyuki , Sato Shigenori , Nakata Ichiro , Goto Yoshihisa , Watanabe Yoshinori , Hashimoto Takashi , Mizuta Toshinobu , Adachi Masakazu , Soma Tetsuo
Published: March 2003

Abstract: Guest Editor's Introduction: The granulocyte removal column was developed by Japan Immunoresearch Laboratories Co. based upon the hypothesis that the normalization of granulocyte‐to‐lymphocyte ratio would be beneficial for the treatment of cancer since the ratio is increased due to the cancer leukocytosis. The column consists of cellulose acetate beads with a diameter of 2 mm, which removes granulocytes and monocytes from blood with no significant changes in the number of lymphocytes or platelets. The clinical results for cancer treatment was less impressive than the animal experiments. Subsequently, however, the G‐1 Column was found very useful for the treatment of inflammatory bowel disease and rhumatoid arthritis. This paper describes the clinical application for cancer treatment, and was printed in Anticancer Research, vol. 15, page 985–990 (1995). This paper was reprinted here with permission.

We assessed the effect of granulocyte apheresis in patients exhibiting increased granulocyte‐to‐lymphocyte ratio in order to overcome granulocytosis occurring in the terminal stages of malignancies. 17 patients with post‐operative recurrent metastatic tumors including 6 gastric, 3 colonic, 2 rectal, 1 esophageal and 5 breast cancers were selected. The granulocytapheresis was performed by extracorporeal vein‐to‐vein circulation equipped with an apheresis column filled with cellulose acetate beads. Each week the patients underwent one or two sessions of treatment that lasted 30 to 50 minutes per session at a flow rate of 30 to 50 ml/min. 15 sessions formed 1 therapeutic cycle. The effect of granulocytapheresis resulted in partial response (PR) in 4 cases, no change (NC) in 7 cases and partial disease (PD) in 6 cases. The performance status showed 30% remission. None of the patients exhibited significant side effects. Since the treatment demonstrated anti‐tumor effects, granulocytapheresis may be applied during combined cancer treatments.
Current Topics on Cryofiltration Technologies
Authors: Siami Ghodrat A. , Siami Flora S.
Published: March 2003

Abstract: In the last 40 years, therapeutic plasmapheresis techniques have been improving considerably. These include cryofiltration technologies providing novel ways of removing large amounts of cryoproteins from plasma. The concept of cryofiltration involves exposure of plasma to below core (37°C) and room temperatures (25°C) without freezing. It was initially used to treat diseases such as cryoglobulinemia with systemic vasculitis, rheumatoid arthritis, systemic lupus erythematosus, and ABO‐incompatible transplants. There are 2 basic types of cryofiltration. The first method removes cryoproteins, namely cryoglobulins that precipitate at 4°C. Several filters have been used for this procedure like the AP06M (Asahi Medical, Tokyo, Japan) with a 0.2 μm pore size, a 0.65 m2 surface area, and a cellulose diacetate (CDA) membrane. It has been used in the United States and Japan for treatment of rheumatoid arthritis and cryoglobulinemia. A major disadvantage was frequent filter plugging, which was cumbersome and it is no longer used in the United States. The G3 cryofilter (Gelman Sciences, Ann Arbor, MI, U.S.A.) with a 3 μm pore size was tried in vitro but proved inadequate by design. Currently in our institution, the cryoglobulin filter (Pall Medical, Ann Arbor, MI, U.S.A.) is used with a 4.3 μm pore size, a 0.135 m2 surface area, and an acrylic copolymer pleat membrane. We performed over 1,200 procedures in 40 patients in the last 8 years. The second type of cryofiltration removes cryogel, which is an agglutination complex of fibrinogen, fibronectin, fibrin split products, and cold insoluble proteins with a heparin core, at temperatures between 2 and 10°C. The AP06M, the AC1740 (Asahi Medical) with a 0.02 μm pore size, a 1.70 m2 surface area, and a CDA membrane, and the Evaflux‐4A (Kuraray Company, Osaka, Japan) with a 0.03 μm pore size, a 2 m2 surface area, and an ethylene vinyl alcohol membrane are used to remove cryogel to treat ABO‐incompatible transplants as well as rheumatoid arthritis and other previously mentioned diseases. This article will discuss each cryofiltration treatment modality.
High‐Efficiency DALI Apheresis Using 1,250 ml Adsorbers in a Hypercholesterolemic Obese Patient: A Case Report
Authors: Bosch T. , Lennertz A. , Samtleben W.
Published: March 2003

Abstract: Direct adsorption of lipoproteins (DALI) apheresis is the first method for direct adsorption of lipoproteins from whole blood and is therefore an easy and rapid procedure. The majority of patients reaches >60% acute low‐density lipoprotein cholesterol (LDL‐C) reduction using either the DALI 750 or 1000 configuration. However, in patients with extremely high LDL‐C levels or very large blood volumes, these configurations may lead to suboptimal results. The current study was performed to test the safety and efficacy of DALI 1250. In a severely obese patient (185 cm, 133 kg, blood volume 7.2 L, LDL‐C 239 mg/dl), 11 L of blood (1.53‐fold patient blood volume) was processed at a flow rate of 80 ml/min in 2.5 h; a combined heparin‐plus‐citrate anticoagulation regimen was used. Commercially available DALI 1250 and DALI hardware and disposables were manufactured by Fresenius HemoCare Adsorber Technology, St. Wendel, Germany. Twenty weekly sessions were performed. Clinically and technically, the apheresis sessions were completely uneventful. As compared to DALI 1000 (n = 4 sessions), the reduction rates by DALI 1250 (n = 20) improved for LDL‐C (from 52% to 66%), lipoprotein (a) (Lp[a]) (53% vs. 66%), and fibrinogen (11% vs. 16%). There was a slight increase in high‐density lipoprotein cholesterol (HDL‐C) loss (20% vs. 24%). Moreover, the absolute amount of LDL‐C removed per session increased from 5.06 g to 5.94 g. Laboratory safety parameters remained within the normal range, the anticoagulation was well controlled, and the pressure gradients over the adsorber remained constant. In this case report, DALI 1250 was perfectly safe and significantly increased the efficacy of LDL‐C and Lp(a) elimination compared to standard DALI. Thus, this high‐efficiency version of DALI may be used in patients with extremely high LDL‐C levels and/or large blood volumes.
Therapeutic Plasma Exchange in the Intensive Care Setting
Authors: Samtleben W. , Mistry‐Burchardi N. , Hartmann B. , Lennertz A. , Bosch T.
Published: March 2003

Abstract: The potential to treat life‐threatening conditions with therapeutic plasma exchange (TPE) is limited to a few situations. In severe pulmonary hemorrhage as a complication of several immune disorders (e.g., antiglomerular basement membrane antibody disease, Wegener's granulomatosus, lupus erythematosus), TPE should only be considered after conventional measures (mostly pulses of methylprednisolone) have been applied. Idiopathic familial and nonfamilial thrombotic thrombocytopenic purpura as well as the subset of the hemolytic uremic syndrome not associated with diarrhea are clear indications for TPE using fresh frozen plasma as replacement fluid. Patients with myasthenic crisis will also benefit from TPE and will improve within 1 day. Acute pancreatitis as a complication of the chylomicronemia syndrome has a poor prognosis and should be treated with TPE without any delay. In the case of drug overdose or intoxication, the efficiency of TPE to remove the offending drug is usually overestimated. In this situation, TPE is useful only when the plasma protein binding of the substance is high (>80%) and the volume of distribution is low (<0.2 L/kg body weight). TPE is not without risks and hazards (e.g., vascular access, bleeding, allergy), which should also be considered when discussing this extracorporeal therapy in otherwise refractory clinical conditions.
Double Filtration Plasmapheresis for the Treatment of Bullous Pemphigoid: A Three Case Report
Authors: Kitabata Yukiko , Sakurane Mikihisa , Orita Hikari , Kamimura Motohiro , Siizaki Kazuhiro , Narukawa Nobuhiko , Kaketaka Akio , Abe Takaya , Kobata Hirotugu , Akizawa Tadao
Published: March 2003

Abstract: Bullous pemphigoid (BP) is an autoimmune disease caused by an antidermal basal lamina antibody. In recent years double filtration plasmapheresis (DFPP) has been reported to be an effective therapy for BP. We experienced 3 cases of BP treated by DFPP. DFPP resulted in an improvement in clinical symptoms and remission allowing a decrease in the required dose of corticosteroid. DFPP was found to be an effective treatment for all 3 patients without noticeable adverse events resulting from DFPP. From these results it is concluded that DFPP is worth considering as an option as treatment for BP patients who were unresponsive to conventional steroid therapy, those in whom corticosteroids should be reduced or discontinued because of complications such as diabetes mellitus and/or osteoporosis.
Successful Delivery in a Pregnant Woman with Lupus Anticoagulant Positive Systemic Lupus Erythematosus Treated with Double Filtration Plasmapheresis
Authors: Takeshita Y. , Turumi Y. , Touma S. , Takagi N.
Published: March 2003

Abstract: The case was a 29 year old female who has suffered from systemic lupus erythematosus (SLE) since 15 years of age. The activity of SLE was low, and she took prednisolone orally. Her first pregnancy failed after 14 weeks. In the second pregnancy, she had thrombocytopenia, prolonged activated partial thromboplastin time (APTT), positive lupus anticoagulant (LAC) and thus was diagnosed with antiphospholipid antibody syndrome (APS). Combination therapy with steroids and aspirin was started, and she underwent treatment of double filtration plasmapheresis (DFPP) in the early stage of pregnancy. Her platelet count increased, and the value of APTT has normalized with DFPP treatment. She delivered successfully on the 32nd week of pregnancy. We think that DFPP is an effective and safe treatment in patients with an LAC positive pregnancy.
Two Cases of Refractory Endocrine Ophthalmopathy Successfully Treated with Extracorporeal Immunoadsorption
Authors: Prophet Heinrich , Matic Goran B. , Winkler Roland E. , Tiess Michael , Schneidewind Jana‐Marie , Hebestreit Gabriele , Michelsen Ann , Ramlow Wolfgang
Published: March 2003

Abstract: Endocrine ophthalmopathy (EO) is a severe disease entity that is characterized by retrobulbar swelling due to accumulation of glycosaminoglycans on an autoimmune basis. This disorder can lead to the loss of vision and often is resistant to conventional therapy. There is a relation to Graves' hyperthyroidism, but probably no close association. Two patients with severe EO that was resistant to usual therapeutic approaches including steroids and radiological and surgical measures underwent a 20 session course of intensive immunoadsorption therapy (Plasmaselect/Therasorb Anti‐IgG) with a mean 2‐ to 3‐fold plasma volume treated. After the first sessions, both patients voiced an impressive relief of their major symptoms, which was confirmed by ophthalmological investigation. Throughout the time of therapy until present, these patients have remained at their respective levels of improvement. We consider immunoadsorption an effective therapeutic opportunity in severe EO resistant to conventional treatment.
A Case of Nephrotic Syndrome Due to Lupus Nephritis Which Was Controlled with Low‐Density Lipoprotein Apheresis
Authors: Kamijo Yuji , Kaneko Yoko , Ichikawa Toru , Kobayashi Nobuhiko , Koyama Takayuki , Kakegawa Tetsuji , Kamijo Hiroshi , Kono Keiichi , Minami Satoshi , Tanaka Naoki , Arakura Hideo , Hirata Masayuki , Higuchi Makoto , Kiyosawa Kendo , Hora Kazuhiko
Published: March 2003

Abstract: Our report discusses a 29 year old female patient with nephrotic syndrome due to lupus nephritis, biopsy‐proven World Health Organization classification Types IVb and V that was controlled with low‐density lipoprotein (LDL) apheresis. She was initially treated with steroid therapy, including methylprednisolone pulse therapy, and the serological activity of her systemic lupus erythematosus was suppressed. However, her nephrotic state, accompanied by severe hyperlipidemia, persisted despite the steroid therapy. Since we could not obtain her consent to administer immunosuppressants such as cyclophosphamide, we tried to treat her using LDL apheresis (LDL‐A). We found that her urine protein excretion, hyperlipidemia, hypoalbuminemia, and renal function improved following the initiation of LDL‐A. This suggests that LDL‐A may be an effective therapy for nephrotic syndrome due to lupus nephritis through short‐term amelioration of hyperlipidemia.