bluuebunny/crossref_metadata_2025 huggingface dataset:
Microtextures of opaque inclusions: their use as indicators for hiatuses during garnet porphyroblast growth
Authors: Spiess  , Bertolo  , Borghi  , Chinellato  , Tinor Centi
Published: March 2003

Within an analysed garnet porphyroblast, opaque inclusions imaged with the backscatter facility of a scanning electron microscope show different microtextures depending on their position within the porphyroblast. Three different zones can been distinguished: Zone 1 contains a Ti‐rich magnetite that has decomposed to a symplectite of fine and narrowly spaced exsolution lamellae of ilmenite and magnetite. Zone 2 shows a Ti‐rich magnetite symplectite with thicker and more widely spaced exsolution lamellae of ilmenite and magnetite. Within zone 3, Ti‐rich magnetite symplectite has totally been replaced by recrystallized magnetite crystals bordered by a thin ilmenite rim. Similar microtextures within ulvöspinel‐rich magnetite have elsewhere shown to be the result of an increase in oxidation and rate of diffusion. During metamorphism of metapelites, such an increase can be reasonably envisaged because of dehydration reactions progressing during rising temperatures, and this has occurred during the overgrowth of the three different microtextures by the garnet porphyroblast. Because the microtextures are homogeneous within the three different zones, it is deduced that the oxidation reaction rate of the opaque inclusions was substantially lower than the garnet growth rate. As a consequence, hiatuses in the garnet growth history must have occurred between the evolution from one microtexture to the next. A comparison between the inclusion trail geometry and the microtextural zone boundaries shows a perfect coincidence between these and the sites where inclusion trails become strongly deflected and truncated. This correlation confirms that, in the studied case, sharp microstructural boundaries (as truncation zones or deflection zones) coincide with growth hiatuses. The study therefore highlights the potential use of opaque inclusions to confirm or reject the occurrence of growth hiatuses within garnet porphyroblasts, especially in cases where discontinuities in the inclusion trail patterns are otherwise arbitrarily associated with growth hiatuses.
Fluid generation, vein formation and the degree of fluid–rock interaction during decompression of high‐pressure terranes: the Schistes Lustrés, Alpine Corsica, France
Authors: Cartwright I. , Buick I. S.
Published: March 2003

Centimetre‐ to decimetre‐wide quartz+calcite veins in schistes lustrés from Alpine Corsica were formed during exhumation at 30–40 Ma following blueschist facies metamorphism. The δ18O and δ13C values of the veins overlap those of the host schistes lustrés, and the δ18O values of the veins are much higher than those of other rocks on Corsica. These data suggest that the vein‐forming fluids were derived from the schistes lustrés. Fluids were probably generated by reactions that broke down carpholite, lawsonite, chlorite and white mica at 300–350 °C during decompression between c. 1400 and 800 MPa. However, the δ18O values of the veins are locally several per mil higher than expected given those of their host rocks. The magnitude of oxygen isotope disequilibrium between the veins and the host rock is inversely proportional to the δ18O value of the host rock. Additionally, calcite in some schists is in isotopic equilibrium with calcite in adjacent veins, but not with the silicate fraction of the schists. Locally, the schists are calcite bearing only within 1–20 cm of the veins. The vein‐forming fluids may have been preferentially derived from calcite‐bearing, high‐δ18O rocks that are common within the schistes lustrés and that locally contain abundant (>15%) veins. If the fluids were unable to completely isotopically equilibrate with the rocks, due to relatively rapid flow at moderate temperatures or being confined to fractures, they could form veins with higher δ18O values than those of the surrounding rocks. Alteration of the host rocks was probably inhibited by isolation of the fluid in ‘quartz‐armoured’ veins. Overall, the veins represent a metre‐ to hectometre‐scale fluid‐flow system confined to within the schistes lustrés unit, with little input from external sources. This fluid‐flow system is one of several that operated in the western Alps during exhumation following high‐pressure metamorphism.
Isograds and P–T evolution in the eastern Lepontine Alps (Graubünden, Switzerland)
Authors: Nagel T. , De Capitani C. , Frey M.
Published: March 2003

Reactions producing Al‐rich index minerals in the south‐eastern part of the Lepontine Dome (Central Alps, Switzerland) are investigated using mineral distribution maps, microstructural observations and equilibrium phase diagrams. The apparent staurolite mineral zone boundary corresponds to the paragonite breakdown reaction Pg + Grt + Qtz = Pl + Al2O3 + W. Equilibrium phase diagrams show that most natural metapelites do not contain staurolite or alumosilicates as long as univalent cations are predominantly accommodated in white mica. For a wide range of metapelitic compositions the paragonite breakdown releases sufficient Al for the formation of these minerals. Rare occurrences of staurolite and kyanite, north of the formerly mapped mineral zone boundaries, coexist with paragonite and are restricted to extremely Al‐rich bulk compositions. The stable branch of the kyanite‐forming paragonite breakdown reaction above 660 °C yields an additional mapable isograd. The second set of Al‐releasing reactions is biotite‐producing phengite breakdown. However, these reactions are less suitable to produce well defined reaction isograds in the field as they are more continuous and their progress is strongly dependent on bulk composition. Well developed fibrolite in metapelites does not appear until staurolite starts to breakdown. We conclude that amphibolite facies conditions in the study area were attained by decompression, without substantial heating at low pressures.
Fluid inclusions as microchemical systems: evidence and modelling of fluid–host interactions in plagioclase
Authors: Kleinefeld B. , Bakker R. J.
Published: March 2003

Dense, CO2‐rich fluid inclusions hosted by plagioclases, An45 to An54, of the O.‐v.‐Gruber‐ Anorthosite body, central Dronning Maud Land, East Antarctica, contain varying amounts of small calcite, paragonite and pyrophyllite crystals detected by Raman microspectroscopy. These crystals are reaction products that have formed during cooling of the host and the original CO2‐rich H2O‐bearing enclosed fluid. Variable amounts of these reaction products illustrates that the reaction did not take place uniformly in all fluid inclusions, possibly due to differences in kinetics as caused by differences in shape and size, or due to compositional variation in the originally trapped fluid. The reaction albite + 2anorthite + 2H2O + 2CO2 = pyrophyllite + paragonite + 2calcite was thermodynamically modelled with consideration of different original fluid compositions. Although free H2O is not detectable in most fluid inclusions, the occurrence of OH‐bearing sheet silicates indicates that the original fluid was not pure CO2, but contained significant amounts of H2O. Compared to an actual fluid inclusion it is obvious, that volume estimations of solid phases can be used as a starting point to reverse the retrograde reaction and recalculate the compositional and volumetrical properties of the original fluid. Isochores for an unmodified inclusion can thus be reconstructed, leading to a more realistic estimation of P–T conditions during earlier metamorphic stages or fluid capturing.
Non‐dialytic Treatment of Acute Hyperkalemia in the Dialysis Patient
Authors: Emmett Michael
Published: March 2003

Acute hyperkalemia occurs commonly amongst patients with chronic renal failure and is especially common in noncompliant individuals. These patients often present to the emergency room with weakness. This editorial addresses the issue of non‐dialytic treatment of hyperkalemia. Is emergency dialysis indicated in every case? In my opinion, acute dialysis can often be delayed until the hospital's dialysis unit opens for “regular working hours.”
Routine Serologic Testing for Hepatitis C Virus Infection Should Be Instituted Among Dialysis Patients
Authors: Natov Svetlozar N. , Pereira Brian J. G.
Published: March 2003

Since the cloning of hepatitis C virus (HCV), a number of serologic and virologic tests for detecting infections with this virus have been made available for clinical practice. This led to the recognition of HCV as a major health hazard in hemodialysis (HD) centers. Yet the nephrology community has not been offered explicit recommendations about routine serologic testing for HCV of dialysis patients and consequently has remained unclear and divided about the utility of this testing. This review presents evidence in support of instituting routine serologic testing for HCV among dialysis patients. It concludes that because of the peculiar features of HCV infection in HD patients, serologic testing for HCV is the only means for unequivocal diagnosis of hepatitis C and an irreplaceable instrument for monitoring the incidence and the prevalence of the infection in this population. Serologic surveillance for HCV infection is crucial for identifying the association of new cases of HCV infection with potential risk factors for HCV transmission, particularly nosocomial, that can be modified in a way to prevent further dissemination of the virus. Data collected from routine serologic testing for HCV will undoubtedly improve our understanding of the epidemiology of HCV in the dialysis population and will provide a strong foundation for developing preventive measures and infection control strategies that are highly effective in controlling HCV infection. Routine serologic testing for HCV is also of direct benefit to the individual patient since establishing the HCV serologic status of each patient is important for optimizing patient care.
Reconsidering the Importance of Long‐Term Low‐Level Aluminum Exposure in Renal Failure Patients
Authors: Cannata‐Andía Jorge B.
Published: March 2003

Aluminum toxicity is widely considered a problem of the past. However, low‐level aluminum exposure and low but abnormal body burdens of aluminum are common. Aluminon, the routinely used histochemical stain for aluminum in bone, has a low sensitivity. The role of aluminum in renal osteodystrophy needs to be reassessed using more sensitive techniques. Low‐level aluminum exposure also may result in subtle neurological dysfunction, another area that needs further investigation.
Pathological Aspects of β2‐Microglobulin Amyloidosis
Authors: Jadoul Michel , Garbar Christian , Van Ypersele de Strihou Charles
Published: March 2003

Histology remains the gold standard to diagnose β2‐microglobulin amyloidosis (Aβ2M). Two diagnostic criteria are required: positive Congo red staining with typical birefringence under polarized light and immunostaining of amyloid deposits with a labeled anti‐β2M antibody. Aβ2M is preferentially located in the joints. Small deposits are also found in various organs, mainly the heart and gastrointestinal tract. Pathologic studies have demonstrated a high prevalence of articular Aβ2M early in the course of hemodialysis and peritoneal dialysis, antedating clinical manifestations by several years. The stages of β2M amyloid formation have been delineated: β2M amyloid deposits first on the surface of the cartilage, in the absence of macrophages (stage 1), and subsequently involves capsules and synovia (stage 2), with eventual recruitment of macrophages around large β2M amyloid deposits (stage 3). Clinical manifestations are likely associated with the inflammation observed in stage 3. The factors triggering the fibrillar precipitation of β2M remain unknown. Macrophages do not play a role: their presence is the consequence rather than the cause of β2M amyloid deposits. Several substances coprecipitated with β2M amyloid have been incriminated: highly sulfated glycosaminoglycans such as chondroitin or keratan sulfate, antiproteases such as α2‐macroglobulin, and apolipoprotein E. As yet, no definitive conclusion has been reached.
Imaging in the Dialysis Patient: Imaging in Dialysis Spondyloarthropathy
Authors: Theodorou Daphne J. , Theodorou Stavroula J. , Resnick Donald
Published: March 2003

Destructive spondyloarthropathy has recently been described in patients who undergo maintenance hemodialysis for chronic renal disease. The condition most frequently involves the lower segment of the cervical spine, although the craniocervical junction also may be affected. Although the pathogenesis of destructive spondyloarthropathy remains unclear, the disorder is thought to relate to a hemodialysis‐associated amyloidosis. It appears that the disease correlates with the duration of hemodialysis, although it has been reported in patients with chronic renal insufficiency not associated with hemodialysis. Radiographic features simulate those of an infectious process, encompassing a range of abnormalities from superficial erosions to large bony defects. Computed tomography (CT) images reveal osteolytic areas, with bone sclerosis of adjacent vertebral endplates, and minimal osteophytosis. The intervertebral spaces appear narrow or obliterated. On magnetic resonance imaging (MRI), the disorder may show the imaging characteristics of spondylodiskitis. The absence of high signal intensity on T2‐weighted images generally helps to eliminate the diagnosis of an infection. With progression of the disease, collapse of a vertebral body and spinal instability may occur. Severe complications of destructive spondyloarthropathy in long‐term dialysis patients may include spinal cord compromise, necessitating surgical decompression, with or without spinal stabilization.
Automated Peritoneal Dialysis Symposium: APD Prescription: Achieving the Adequacy Goals
Authors: Dell'Aquila Roberto , Rodighiero Maria Pia , Bordoni Valeria , D'Intini Vincente , Ronco Claudio
Published: March 2003

In the last few years, automated peritoneal dialysis (APD) has undergone considerable improvements due to technological developments. The definition of a minimal dose of peritoneal dialysis (PD) has not yet been completely assessed. Appropriate use of APD requires an evaluation of dialytic efficiency in terms of dialytic indexes and their targets. Many dialytic treatment modalities have been performed in order to achieve adequacy targets. Some aspects have to be taken into consideration to reach the optimal dialytic dose: optimizing mass transfer in correlation with intraperitoneal volumes, prescribing tailored treatment modalities according to different characteristics of peritoneal membranes and individual patient needs, and performing more biocompatible treatments using different glucose profiling and alternative physiologic PD fluids. New high‐flow techniques such as continuous flow PD can ensure better urea and creatinine clearances and ultrafiltration rates, leading to a higher utilization of the APD modality.
Prostate Specific Antigen Levels: Effect of Sexual Activity
Authors: McNaughton Collins Mary , Kleinman Ken , Barry Michael J. , Meigs James B. , Yurgalevitch Susan M. , McKinlay John B.
Published: March 2003

Background: To determine whether six lifestyle factors (dietary fat, smoking, sleep, alcohol consumption, physical, and sexual activities) are associated with non‐prostate cancer‐related, elevated prostate specific antigen (PSA) levels.

Methods: PSA levels were measured on frozen serum that was collected at baseline (time T1, 1987–1989) and at follow‐up (time T2, 1995–1996) in the Massachusetts Male Aging Study, a population‐based random sample survey of 1709 men aged 39–70 years old. Men with a PSA level >4.0 ng/ml at time T2 were offered a biopsy. Excluding men who had ever had a diagnosis of prostate cancer (N = 82) left 892 men with both time T1 and time T2 PSA measurements. Lifestyle factors assessed at time T1 were used for the analysis.

Results: Of 866 men who had a time T1 PSA <4.0 ng/mL, 56 (6%) had a PSA level >4.0 ng/ml at time T2. In logistic regression models predicting crossing the threshold of 4.0 ng/ml, sexual activity was a significant predictor, but other lifestyle factors were not. Relative to little or no sexual activity, the age‐adjusted odds ratio for sex 1–3 times/month was 4.18 (95% confidence interval (CI) = 1.4–12.3), and for sex ≥4 times/month was 2.54 (95% CI = 0.9–6.9).

Conclusions: Men who were more sexually active at time T1 were at higher risk of a falsely elevated PSA level >4.0 ng/ml at time T2. Although interim knowledge about lifestyle is lacking, this finding may reflect the effect of ejaculation on serum PSA. Other lifestyle factors had no effect on time T2 PSA levels.
Alternative Measures of Resource Consumption in Home Care Episodes
Authors: Madigan Elizabeth A , Fortinsky Richard H
Published: March 2003

Expected changes in home health care reimbursement will require a shift in focus from a visit‐based unit to some other yet‐to‐be‐defined unit of resource consumption. Little research has been done to understand other measures of resource consumption, however, especially those examining disciplinary differences. The purpose of this study was to provide empirical evidence on other measures of resource consumption as a way to frame discussions on alternative measures. Information is presented from a study of 102 home health care patients from 10 agencies in Ohio who completed an episode of care and remained at home. While the mean time per visit was similar for all disciplines (46 to 55 minutes), there were differences in the number of visits provided by various disciplines (home care aide services had the highest mean number of visits with 11.8). The mean cost per day for all services was $43.80 while the mean cost per episode was $1,160. Recommendations for further research include similar examinations using a more rigorous sampling methodology and including disparate populations of patients.
Community Based and Community Focused: Nursing Education in Community Health
Authors: Feenstra Cheryl
Published: March 2003

Nurses have always cared for individuals, families, groups, and communities in their practice. Recently there has been an increase in the focus on nurses working outside of the hospital, primarily in community‐based settings that focus on individuals and families. There is also increasing emphasis on community‐focused nursing care with the community as the client. In some nursing programs, nurse educators have tried to adjust to this change by increasing the amount of time that nursing students spend in the community. The focus of this experience ranges from individuals to populations. This article describes a one‐semester community health course in a baccalaureate nursing program that gives students both theoretical and practical knowledge in caring for individuals, families, groups, and communities. This allows for practice and understanding of both community‐based and community‐focused nursing care.
A Comparison of Two Models of Health‐Promoting Lifestyle in Rural Elderly Taiwanese Women
Authors: Wang Hsiu‐Hung
Published: March 2003

The purposes of this study were to: (1) examine the relations among age, marital status, social class, perceived health, self‐care agency, health‐promoting lifestyle, and well‐being in two groups of rural elderly Taiwanese women and (2) validate and compare two models using the two age groups of rural elderly Taiwanese women. Based on the conceptualizations of the major study variables in Orem's self‐care model (1995), Pender's health promotion model (1987), and other scholars' ideas (Hartweg, 1990; Simmons, 1990), a theoretical model of health‐promoting lifestyle was proposed for this study. A survey‐interview method was used for data collection. Two groups of elderly women were recruited for data analysis: 168 in the younger group and 116 in the older group. The mean age was 64.66 in the younger group and 75.59 in the older group. Two models of health‐promoting lifestyle were tested with a path analysis, using the Linear Structural Relations 8 (LISREL 8) program. The resultant models yielded χ2 of 13.69 with 9 degrees of freedom (p= 0.13) in the younger group and χ2 of 15.76 with 10 degrees of freedom (p= 0.11) in the older group. Other fit indices also indicate the two models fit the data well. Community nurses can assess, identify, and use effective interventions for rural elderly women on a basis of the resulting models.
Predictors of Initiation of Early Sex in Black and White Adolescent Females
Authors: Felton Gwen M. , Bartoces Monina
Published: March 2003

This study examined the extent to which problem solving, self‐image, and other health‐related factors predict age at first intercourse among Black and White adolescent females. The volunteer sample was 16 to 19 years old; 52% were Black (n=105), and 48% (n=97) were White. Adolescents were recruited from family planning clinics throughout South Carolina. Stratified analyses identified race as a modifier of the relationship between problem solving and time of first intercourse (early or delayed). Logistic regression revealed three predictors of early age at first intercourse in Black girls, but only one predictor in White girls. There were no race differentials in either age or the proportion of girls initiating early intercourse. However, Black girls who had less problem solving skill than their peers were five times more likely to have early intercourse, three times more likely to practice fewer health‐promoting behaviors, and seven times more likely to have 10 or fewer years of education. Early intercourse was significantly associated with unprotected first intercourse. Our findings suggest that interventions may need to be tailored for different risk groups within Black populations of adolescent girls.
Blue Rubber Bleb Nevus (Bean Syndrome): Evolution of Four Cases and Clinical Response to Pharmacologic Agents
Authors: Boente Maria del C. , Cordisco Maria R. , Frontini Maria del V. , Asial Raúl A.
Published: March 2003

Blue rubber bleb nevus (BRBN) syndrome is a rare disorder characterized by distinctive cutaneous and gastrointestinal vascular malformations. The latter may lead to bleeding complications. We followed four affected children for at least 5 years. The evolution of their disease and the value of pharmacologic agents (steroids, interferon) in the management of some of these patients are discussed.
Calcipotriol in Vitiligo: A Preliminary Study
Authors: Parsad D. , Saini R. , Nagpal R.
Published: March 2003

Abstract: A large variety of therapeutic agents have been tried for the treatment of vitiligo, but psoralens continue to be the main treatment. Twenty‐one patients age 5 to 17 years with vitiligo were enrolled in this study. The children were advised to apply calcipotriol 50 μg/g in the evening and expose themselves to sunlight the next day for 10 to 15 minutes. The patients were followed at 3‐week intervals. Initial repigmentation occurred in the majority of children after 6 to 12 weeks of treatment. Marked to complete repigmentation was seen in 10 of 18 patients. Four patients showed moderate improvement while the remaining four patients showed minimal or no improvement. No patient developed new lesions. The repigmentation was cosmetically excellent in the majority of children. All patients tolerated the calcipotriol well except for three patients who complained of mild irritation on application. All of the laboratory investigations, including serum calcium levels remained normal. The rationale for this study originated from recent advances in the understanding of vitiligo at the molecular level. Furthermore, development of hyperpigmentation in patients with psoriasis receiving treatment with PUVA and calcipotriol has been observed. Our results are encouraging and offer a new and potentially efficacious treatment for this pigmentation disorder in children.
Hypopigmented Mycosis Fungoides in Childhood and Adolescence
Authors: Neuhaus Isaac M. , Ramos‐Caro Francisco A. , Hassanein Ashraf M.
Published: March 2003

Abstract: We present a case of purely hypopigmented mycosis fungoides of 8‐years duration in an 18‐year‐old woman who responded readily to psoralen plus ultraviolet A (PUVA) treatment. The literature pertaining to hypopigmented mycosis fungoides is reviewed.
Oral Treatment of Crusted Scabies with Ivermectin: Report of Two Cases
Authors: Cestari S. C. P. , Petri V. , Rotta O. , Alchorne M. M. A.
Published: March 2003

Abstract: Oral treatment with ivermectin of crusted (Norwegian) scabies in two immunosuppressed patients is reported. There was resolution of symptoms and signs of the cutaneous parasitosis on administration of 18–36 mg ivermectin (total doses) in 2‐ and 3‐week periods of treatment, with remission periods of 3 and 4 months, respectively.
Congenital Linear Steatocystoma Multiplex of the Nose
Authors: Park Young Min , Cho Sang Hyun , Kang Hoon
Published: March 2003

Abstract: We describe a case of steatocystoma multiplex with an unusual clinical manifestation. A 5‐year‐old girl had 8 papulonodular lesions arranged in a linear fashion on the left side of the nose. These had been present at birth. Histologically the lesions showed the typical features of steatocystoma multiplex. There was no family history of similar lesions. This is the second case of linear steatocystoma multiplex, a rare variant of steatocystoma multiplex.
Characteristics of Vitiligo in Korean Children
Authors: Cho Soyun , Kang Hyung‐Chul , Hahm Jeong‐Hee
Published: March 2003

Abstract: Eighty Korean children (ages 8 months–12 years) with clinical and/or histopathologic diagnoses of vitiligo were evaluated; 39 boys and 41 girls. The mean age at first visit was 7.9 years and the mean age at onset was 5.6 years. The most common site of onset was the head/neck area (58.8%), followed by the trunk and lower limbs. The children were compared with a control group of 422 adults with vitiligo. Children comprised 16% of the total vitiligo patients and adults comprised 84%. A family history of vitiligo was found in 11 (13.8%) children, compared to 10.7% in the adult group; poliosis in 20 (25.0%); halo nevi in 2 (2.5%), compared to 4.0% in the adult group; combined autoimmune and endocrine diseases in 1 (1.3%), compared to 7.6% in the adult group; and segmental vitiligo in 26 (32.5%), compared to 13.0% in the adult group. The combined diseases were significantly less often found in children than adults (p < 0.01), and segmental vitiligo was significantly more often associated with children (p < 0.0001). Our study did not show a higher prevalence of vitiligo in girls as reported in other studies, which may indicate racial differences. Of the total 502 patients, only 1 patient with segmental vitiligo had halo nevi. Sixty‐four percent of the children with vitiligo responded to treatment, compared to 57% of the adults.
Nickel Contact Hypersensitivity in Children
Authors: Silverberg Nanette B. , Licht Jonah , Friedler Suzanne , Sethi Shika , Laude Teresita A.
Published: March 2003

Nickel allergic contact dermatitis is the most prevalent allergy in North America, with an incidence of 14.3%. It is on the rise from 10 years ago, when the incidence was 10%. This has been presumed to represent an increased exposure to nickel in the environment—especially in costume jewelry and belt buckles. We examined a group of 30 pediatric patients who had either a personal history of umbilical or wrist dermatitis, or a family history of nickel allergic contact dermatitis. All of these patients had a positive patch test to nickel sulfate 5%. Moreover, 50% of patients had an id reaction; all of these patients had positive patch tests that were papular in nature, similar to their papular id reaction. We posit that the presence of a positive family history may be a positive predictor of nickel allergic contact dermatitis, requiring nickel avoidance, especially in atopic children. Based on the high level of positive reactions in patients with umbilical dermatitis and an id reaction, patch testing to nickel in these patients is most likely to yield a useful result. Knowledge of reactivity to nickel would then allow parents and patients to initiate nickel avoidance earlier in life.
Erythrokeratodermia Variabilis with Erythema Gyratum Repens‐Like Lesions
Authors: Landau Marina , Cohen‐Bar‐Dayan Meirav , Hohl Daniel , Ophir Joseph , Wolf Charles R. , Gat Andrea , Mevorah Barukh
Published: March 2003

Abstract: A large pedigree with erythrokeratodermia variabilis (EKV) and erythema gyratum repens‐like lesions is described. Clinical, laboratory, and histologic findings of this family are presented. The differential diagnoses of the following dermatoses with an erythematous and a hyperkeratotic component are discussed: erythrokeratodermia variabilis (Mendes da Costa), progressive symmetric erythrokeratoderma (Gottron), loricrin keratoderma, erythrokeratoderma en cocardes (Degos), Netherton syndrome, keratitis‐ichthyosis‐deafness (KID) syndrome, erythrokeratolysis hiemalis (Oudtshoorn disease), and nonbullous congenital ichthyosiform erythroderma.
A 13‐Year‐Old Girl with Recessive Dystrophic Epidermolysis Bullosa Presenting with Squamous Cell Carcinoma
Authors: Ayman Taliha , Yerebakan Özlem , Çiftçioǧlu Mehmet Akif , Alpsoy Erkan
Published: March 2003

Abstract:  Recessive dystrophic epidermolysis bullosa (RDEB) is an uncommon and severely disabling genetic disorder characterized by trauma‐induced blisters, intractable skin ulcers, scarring, milia, and nail dystrophy. Patients with RDEB have an increased tendency for fast‐growing and early metastasizing squamous cell carcinoma (SCC). We report here a 13‐year‐old girl with RDEB who developed a large SCC on the left knee. At 6 months of evolution it was resected and covered with an autologous skin graft. To our knowledge, this is the youngest patient with RDEB complicated by SCC to be reported, and therefore may serve to emphasize the importance of vigilance in surveying RDEB patients for SCC.
Neonatal Primary Cutaneous Aspergillosis: Case Report and Review of the Literature
Authors: Woodruff Christy A. , Hebert Adelaide A.
Published: March 2003

Abstract:  Neonatal primary cutaneous aspergillosis usually presents as an erythematous plaque with pustules that evolve into an eschar. Immunocompromised patients and premature neonates are at risk of developing this disease. Early diagnosis and treatment are critical in preventing progression to a systemic illness. We report a preterm neonate with primary cutaneous aspergillosis and discuss the etiologies, presentations, and treatments for this illness.
Fibroblastic Rheumatism: Case Report and Review of the Literature
Authors: Lee Joyce M. , Sundel Robert P. , Liang Marilyn G.
Published: March 2003

Abstract: A previously healthy 7‐year‐old boy presented with polyarthritis and skin lesions. Multiple, skin‐ to pink‐colored, firm papules were noted on the periungual areas, hands, feet, and nose. There was swelling of the proximal interphalangeal joints, wrists, elbows, ankles, and knees. A skin biopsy specimen revealed dermal fibrosis and interspersed histiocytes and lymphocytes. These findings were consistent with fibroblastic rheumatism, a condition characterized by cutaneous nodules and a symmetric polyarthritis. He was treated with methotrexate and corticosteroids with improvement in the symptoms of his arthritis and skin lesions. This early treatment was beneficial in our patient.
Therapeutic Plasma Exchange in Patients with Chylomicronemia Syndrome Complicated by Acute Pancreatitis
Authors: Lennertz  , Parhofer  , Samtleben  , Bosch
Published: March 2003

Chylomicronemia syndrome (CMS) is a rare disorder characterized by the presence of chylomicrons in the fasting state causing a milky appearance of plasma, eruptive xanthomas, and hepatosplenomegaly; an acute and potentially life threatening complication is severe acute pancreatitis. The underlying defects are inborn errors of metabolism such as deficiencies of lipoprotein lipase (LPL) or apoprotein C‐II (apo C‐II) as well as familial hypertriglyceridemia. Moreover, CMS can be precipitated when mild hypertriglyceridemia is exacerbated by additional factors such diabetes mellitus, ethanol abuse, or pregnancy. The purpose of the present study was to retrospectively analyze the results of therapeutic plasma exchange (TPE) in 5 patients transferred to our hospital for severe acute pancreatitis due to chylomicronemia syndrome. In a total of 7 TPE sessions, on average 3,286 ± 247 ml of plasma (i.e., about 1 patient plasma volume) were treated per session. Triglyceride (TG) levels were decreased from 4,972 ± 2,469 mg/dl on admission to 1,614 ± 1,276 mg/dl (−70%) after the TPE sessions, and a further decrease was achieved by conservative treatment. Part of the TG reducing effect of the treatment was probably due to heparin induced lipolysis. Acute pancreatitis was resolved in all cases, and 1 pregnant patient delivered without problems at term. In summary, 1 or 2 TPE sessions sufficed to substantially decrease the bulk of triglycerides in acutely exacerbated chylomicronemia syndrome causing a rapid resolution of acute severe pancreatitis.
Therapeutic Plasma Exchange in Patients Suffering from Thrombotic Microangiopathy after Allogeneic Bone Marrow Transplantation
Authors: Bosch  , Buhmann  , Lennertz  , Samtleben  , Kolb
Published: March 2003

Thrombotic microangiopathy (TM) is a potentially fatal complication of allogeneic bone marrow transplantation (BMT). The underlying pathophysiology is thought to be generalized endothelial cell damage caused by several factors including conditioning treatment, cyclosporin A (CsA,) or graft versus host disease (GVHD). In the present retrospective study, 6 patients suffering from Grade 2 BMT‐TM at a mean of 62 days post BMT were treated by 3–15 daily sessions of therapeutic plasma exchange (TPE). In most sessions, cryosupernatant (CSN) of plasma, in some fresh frozen plasma (FFP) was used as the substitution fluid. All patients suffered from acute graft versus host disease (aGVHD) of the skin, which was treated by CsA. CsA was withdrawn in all patients. TPE caused a response in 4 of 6 patients evidenced by a decrease to Grade 0 (n = 3) or 1 (n = 1) BMT‐TM. Only 1 patient had mild renal insufficiency which did not improve during TPE. While all patients were dependent on platelet transfusions at baseline, the platelet counts improved in 2 of 6 patients after the TPE course. One patient did not show any response to TPE with FFP, and his disease improved only after CSN was introduced as substitution fluid (Grade 0). Four patients were still alive 175–495 days post BMT, and 2 patients died about 2–3 weeks after the end of the TPE course, 1 from cachexia and 1 from systemic aspergillosis. In summary, in this pilot study, TPE positively influenced BMT‐TM, especially if CSN was used as the substitution fluid.
Effects of Losartan on Low‐Density Lipoprotein Apheresis
Authors: Kojima Shunichi , Yoshitomi Yuji , Saotome Masao , Tanaka Kyo‐e , Shida Mikio , Kuramochi Morio
Published: March 2003

Abstract:The negative charges of dextran sulfate cellulose (DSC) used for low‐density lipoprotein (LDL) apheresis activate the intrinsic coagulation pathway, accompanied by bradykinin production. This study was undertaken to see whether an antagonist of angiotensin receptor (AT1), losartan, could be safely used in a patient treated by DSC‐LDL apheresis. Losartan (50 mg/day) was given to a patient with coronary heart disease who had been treated by DSC‐LDL apheresis and had experienced an anaphylactoid reaction by administration of an angiotensin converting enzyme inhibitor. The effects of losartan on blood pressures and humoral factors were examined by comparing these parameters between apheresis with and without losartan. Blood pressures and plasma levels of bradykinin, renin, and aldosterone were measured before and at 1,000, 2,000, and 3,000 ml of plasma treatment. Bradykinin levels during LDL apheresis tended to be higher with losartan than without losartan (without versus with, 529 ± 121 [n = 4, mean ± SE] pg/ml vs. 1,058 ± 49 at the 2,000 ml stage, p < 0.01). The rise of plasma renin activity with losartan (221 ± 26% at the 3,000 ml stage) was significantly greater than that without losartan (144 ± 2.4%). Mean blood pressure decreased by 7% during apheresis with losartan, but blood pressure reduction was not accompanied by any complaints. These results suggest that AT1receptor antagonists are safely used in patients treated by DSC‐LDL apheresis.
Therapeutic Apheresis Application Using Membrane Plasma Fractionation Technology: Present Scope and Limitations
Authors: Sueoka Akinori
Published: March 2003

Abstract: Membrane technologies have been applied for therapeutic apheresis, such as plasma separation and plasma fractionation. Membrane used for plasma fractionation has a microporous structure with pore sizes in the range of 0.01–0.04 μm. A membrane plasma fractionator is utilized for the second filter in the double filtration plasmapheresis (DFPP) system and is applied for treatment of various diseases.This article summarizes the present scope and limitation of membrane plasma fractionation.
Therapeutic Cryogel Removal in Autoimmune Disease: What is Cryogel?
Authors: Nosé Y. , Horiuchi T. , Malchesky P.S. , Smith J.W. , Matsubara S. , Abe Y.
Published: March 2003

Guest Editor's Introduction:This paper was presented as a keynote address of the 2nd congress of the Japanese Society for Therapeutic Plasmapheresis on June 5, 1982. It was printed inTherapeutic Plasmapheresis II(ed) T. Oda, and published by F.K. Schattauer Verlag, Stuggart, Germany in 1982 on pages 15–25. In this paper, attempts were made to clarify the formation of the cryogel, composition of cryogel, and cryogel and its temperature dependence by cryofiltration procedures. Clinical effects of cryogel removal or cryofiltration procedures were described from macromolecular changes, pre and post procedures, and the clinical effects of rheumatoid arthritis patients were assessed from these macromolecular kinetics. Basically, cryogel is a fibrinogen‐heparin‐fibronection complex and contains various types of pathological macromolecules.

Abstract:Cryofiltration is the on‐line technique of plasma treatment consisting of plasma cooling and its membrane filtration. In cryofiltration, cryogel is formed and removed by the cryofilter. The formation of cryogel on‐line at temperatures near 4°C and the removal of cryogel by the membrane filter has been shown to produce positive clinical results in the treatment of rheumatoid arthritis and other autoimmune diseases. Cryogel as generated in cryofiltration is distinct from cryoprecipitate (cryoprotein, cryoglobulin) as isolated by classical laboratory tests or those substances removed by off‐line techniques as cryopheresis and cryoglobulinpheresis. Cryogel is formed under conditions of relatively fast cooling (10–20 minutes) and is removed during membrane filtration of the plasma. Cryogel concentrates the pathological molecules, and therefore, is selective for their removal. Clinical and in vitro studies of cryofiltration indicate the primary importance that temperature has on the bulk properties of the solution and the filtration process. While clinical studies to date have been carried out at 4°C, cryogel can form at temperatures below 37°C.  In general we can remove more cryogel from pathological plasma than from normal plasma.  Mechanisms involved in the formation of cryogel are complex and involve multiple plasma solutes. Cold‐induced precipitation of macromolecules from plasma is most likely due to the interaction of heparin, fibronectin (cold insoluble globulin), and fibrin/fibrinogen under cooling conditions. Plasma subjected to the cooling procedures contains sufficient amounts of heparin to produce heparin‐fibrinogen complex. This complex acts as a nucleus for cryogel formation and the binding of macromolecular weight plasma solutes which are then trapped on the cryofilter.
Treatment of Systemic Inflammatory Response Syndrome by Push‐Pull Powdered Sorbent Pheresis: A Phase 1 Clinical Trial
Authors: Ash Stephen R , Steczko Janusz , Levy Howard , Blake Donald E , Carr David J
Published: March 2003

Abstract: An FDA‐approved Phase 1 feasibility study was performed in two centers to determine the safety of the BioLogic‐DTPF (detoxifier/plasma filter) system for the treatment of patients with systemic inflammatory response syndrome (SIRS). This device combines hemodiabsorption (dialysis of blood against powdered sorbents with the BioLogic‐DT system) with push‐pull sorbent‐based pheresis (the PF add‐on module). Eight adult ICU patients with both SIRS and multiple organ failure participated in the study. One 6 h treatment was planned for each patient with powdered charcoal as sorbent for 4 patients and a combination of charcoal/silica in the PF sorbent bag for 4 patients. The treatments appeared to have no negative effects in 7 patients, but 1 patient died during treatment due to progressive cardiac failure. Sepsis was resolved in 5 of the 8 patients. However, there were only 2 long‐term survivors of the group. The addition of the PF module should improve the chemical function of the BioLogic‐DT by allowing removal of protein‐bound toxins such as cytokines. The selected patients tolerated treatment by the DTPF system well, but proof of benefit of the device remains to be proven in a Phase 2 clinical trial with randomized controls.
Consistent Lowering of Clotting Factors for the Treatment of Acute Cardiovascular Syndromes and Hypercoagulability: A Different Pathophysiological Approach
Authors: Jaeger B.R. , Goehring P. , Schirmer J. , Uhrig S. , Lohse P. , Kreuzer E. , Reichart B. , Seidel D.
Published: March 2003

Abstract:Hypercoagulability is a key contributor to acute cardiovascular syndromes and to various microcirculatory disorders. The use of heparin‐mediated extracorporeal low‐density lipoprotein/fibrinogen precipitation (HELP) apheresis makes a controlled, immediately effective reduction of clotting factors possible, and induces subsequent positive effects on plasma viscosity, erythrocyte aggregation, and microcirculation. Oxygen supply to an ischemic artery can thus be increased without hemodilution, qualifying the HELP system as a possible therapeutic tool in the treatment of acute cardiovascular syndromes and microcirculatory disorders.
Antibody Elimination by Apheresis in Living Donor Liver Transplant Recipients
Authors: Kawagishi Naoki , Ohkohchi Nobuhiro , Fujimori Keisei , Orii Takashi , Koyamada Nozomi , Kikuchi Hiroyuki , Sekiguchi Satoshi , Tsukamoto Shigeki , Sato Toshinobu , Satomi Susumu
Published: March 2003

Abstract: In the present study, we investigated retrospectively the indications and the efficacy of the elimination of preexisting antiallogeneic antibodies in liver transplant recipients. Three patients who were ABO blood type incompatible were subjected to plasmapheresis and double filtration plasmapheresis before the living donor liver transplantation (LDLTx), and the titers decreased to less than 8. After transplantation, plasmapheresis was also performed in 3 cases, and continuous hemodiafiltration in 1 case, and in 2 out of these 3 patients acute rejection was recognized. Two patients who were crossmatch positive were subjected to plasmapheresis before transplantation, and the T warm titers were reduced to less than Score 2. These 2 patients had no acute rejections after transplantation. We conclude that in liver transplant patients apheresis is effective to prevent acute rejection induced by preexisting anti‐A and/or anti‐B antibodies and anti‐donor specific antibodies before transplantation, but it is not effective in a patient with accelerated humoral rejection occurring after transplantation.
Rapid and Persistent Reduction of Proteinuria Following Plasma Exchange in a Case of Steroid‐Resistant Focal Segmental Glomerulosclerosis
Authors: Ishii Eriko , Ando Yasuhiro , Tamba Kaichiro , Masunaga Yoshinori , Kusano Eiji , Asano Yasushi
Published: March 2003

Abstract: We report on the case of a 45 year old male with focal segmental glomerulosclerosis (FSGS) in whom steroid‐resistant proteinuria was reduced rapidly by plasma exchange. In 1994, he was admitted to our hospital because of massive proteinuria of several years' duration. Renal biopsy confirmed the diagnosis of FSGS. Proteinuria was suppressed partially with the use of dipyridamole. Though oral prednisolone (PSL, 30 mg/day) was effective initially, relapse occurred during PSL tapering. Doses of PSL up to 30 mg/day or additional mizoribine were ineffective. The patient was readmitted for a trial of plasma exchange in April 2000. Four sessions of plasma exchange with albumin replacement over 2 weeks immediately reduced the proteinuria from 3.2 g/day to 0.6 g/day without any change in medication. After discharge, proteinuria remained suppressed for more than 6 months despite a reduction of PSL dose to 15 mg. The rapid and long lasting effect of plasma exchange in the present case argues for the role of a putative circulatory factor in the pathogenesis of proteinuria in FSGS.
Improvements in Artery Occlusion by Low‐Density Lipoprotein Apheresis in a Patient with Peripheral Arterial Disease
Authors: Kamimura Motohiro , Matsuo Masaki , Miyahara Takashi , Kimura Karue , Matsumoto Kimiyo , Nakaya Tsuyoshi , Abe Tomiya , Akizawa Tadao
Published: March 2003

Abstract: Peripheral arterial disease (PAD; arteriosclerosis obliterans) shows ischemic symptoms along the peripheral arteries due to reduced blood flow, and the number of patients with PAD is increasing. Several papers have reported on the clinical effect of low‐density lipoprotein apheresis (LDL‐A) on PAD, but there has been no report so far on the improvement of total peripheral artery stenosis by LDL‐A. We report on the clinical course of a female PAD patient with intractable decubitus in her heel due to the complete occlusion of anterior tibial artery who was treated by a series of LDL‐A sessions. The complete occlusion of the anterior tibial artery improved as seen on angiography, and the decubitus in her heel also markedly improved after LDL‐A therapy. This report supports the clinical benefit of LDL‐A for the treatment of PAD.
Burning Prairie to Restore Butterfly Habitat: A Modeling Approach to Management Tradeoffs for the Fender's Blue
Authors: Schultz Cheryl B. , Crone Elizabeth E.
Published: March 2003

Designing strategies to manage rare species’ habitats may involve tradeoffs that include negative short‐term impacts to achieve positive long‐term success. In managing grasslands, fire is a powerful tool to control invasive weeds and stimulate native plant growth, but it may decimate the invertebrate fauna. To rank potential burn strategies for Icaricia icarioides fenderi (Fender's blue butterfly) habitat, we present an empirically based mathematical model. Parameter estimates are based on experiments conducted by Wilson and Clark from 1994 to 1997. Potential strategies include combinations of times between burn (1, 2, 3, 4, or 5 years) and fractions of a habitat to burn in each fire (1/8, 1/4, 1/3, or 1/2), as well as a strategy of never burning. Burning one‐third of the habitat every year maximizes the average annual population growth rate, but, based on maximum likelihood parameter estimates, 8 of 21 strategies led to 95% of simulated butterfly populations persisting for 100 years. In simulations based on the parameters’ lower confidence limits, however, there were some cases in which no strategies led to populations persisting 100 years. In this uncertainty analysis—the effect of changes in parameters based on our confidence in them—we also investigated the rank order of the strategies. This uncertainty analysis indicated that the rank order of burning strategies is most sensitive to our confidence in rates of habitat change after a burn (number of “good” years after a fire and time for habitat to return to pre‐burn conditions). Surprisingly, however, the rank order of strategies changes little over a wide range of butterfly demographic rates. Better knowledge of rates of habitat change after a burn would improve our ability to make management decisions substantially more than better knowledge of the butterfly's vital rates.