bluuebunny/crossref_metadata_2025 huggingface dataset:
Age‐Specific Reference Ranges for Prostate Specific Antigen in Young Men: Retrospective Study from the National Defense University
Authors: Hartzell Joshua D. , Kao Tzu‐Cheg , Holland John C. , Holt Stephen R. , Moul Judd W.
Published: March 2003

Objectives: While controversial, the use of prostate specific antigen (PSA) testing is common and may reduce the morbidity and mortality associated with prostate cancer. The use of age‐specific reference ranges (ASRRs) has been suggested to increase the sensitivity of the PSA test in younger men. The objective of this study was to determine the normal age‐specific reference ranges for a large group of clinically cancer‐free men and to compare these findings with similar studies.

Materials and Methods: A retrospective chart review of PSA values was conducted on 1199 students from the National Defense University, Fort McNair, Washington, DC, who were matriculating between 1994 and July 1999. The AsXYM system using MEIA technology with monoclonal antibodies from Abbott laboratories was used to determine the PSA values. The mean, median, 95th percentile, 99th percentile, and range were calculated for each decade.

Results: A total of 1123 students between the ages of 30 and 59 were included in the study (1105 with PSA levels ≤ 4.0 ng/ml). The largest number of students (67.4%) fell in the 40–49‐year‐old group. The median PSA level was 0.74 ng/ml. There was a significant correlation between age and PSA level for the 40–59‐year‐old age group (r = 0.06, p = 0.044). There was no significant correlation between age and PSA for the 40–49‐year‐old age group (r = 0.048, p = 0.192). The median PSA value and the 95th percentile increased from 0.7 and 2.3, respectively, in the 40–49‐year‐old age group to 0.8 and 2.7, respectively, in the 50–59‐year‐old age group.

Conclusions: The results of this study indicate that PSA values in young men are quite low. The 95th percentile of PSA levels for men in their 40s and 50s was 2.3 and 2.7 ng/ml, respectively, which is significantly lower than the traditional normal value of 4.0 ng/ml. Although further prospective studies are needed, our data suggest that a lower PSA value threshold of 2.0 to 2.5 ng/ml for younger men is reasonable to dictate further evaluation.
Associate and Baccalaureate Degree Final Semester Students' Perceptions of Self‐Efficacy Concerning Community Health Nursing Competencies
Authors: Rosen Linda Moore
Published: March 2003

A quantitative study was undertaken to examine whether final semester associate degree nursing (ADN) and baccalaureate degree nursing (BSN) students who experienced community health nursing content perceived themselves as self‐efficacious to work as community health nurses (CHNs) with individuals, families, and communities. Additionally, the study examined the variance of perceived self‐efficacy (PSE) accounted for by antecedent variables, performance accomplishments (PA), vicarious experience (VE), verbal persuasion (VP), and emotional arousal (EA). Questionnaires were mailed to faculty liaisons from 34 randomly selected National League for Nursing (NLN)‐accredited schools in the United States. Statistical analysis revealed that the ADN and BSN final semester students perceived themselves to be equally self‐efficacious to work with individuals and families. Significant differences were found, however, between the ADN and BSN students on PSE to work with communities. PA and VE explained 15% of the PSE variance suggesting that actual and VE contributes positively to a students' PSE to work as a CHN.
Scores on the Nursing Child Assessment Teaching Scale for Father–Toddler Dyads
Authors: Harrison Margaret J. , Magill‐Evans Joyce , Sadoway Delmarie
Published: March 2003

Fathers of 49 Canadian children (ages 13 to 24 months) were observed interacting with their child at home using the Nursing Child Assessment Teaching Scale (NCATS). Consensus ratings from two observers were used in the analysis. Compared with the NCATS reference data for 164 mothers of similar ethnicity and marital status with similar‐aged children, mothers were more responsive than fathers in the interactions. Mothers had significantly higher scores on the overall Total NCATS score, on the Total Parent score, and on the Parent Contingency score than the fathers. In contrast, children were more responsive to fathers than mothers. Children interacting with their fathers had significantly higher Total Child scores and higher Child Contingency scores than those interacting with their mothers. Maternal and paternal age and education were not correlated to scores on the NCATS. Implications for practitioners are discussed and the results are compared to a study of mothers and fathers interacting with children ages 2 to 12 months old in which the observations were measured by the NCATS. Results suggest that NCATS cutoff scores used to identify mothers in need of intervention should be used with caution for father–toddler interactions.
Home‐Screen: A Short Scale to Measure Fall Risk in the Home
Authors: Johnson Maree , Cusick Anne , Chang Sungwon
Published: March 2003

Community nurses are often the health professionals with whom older Australians living at home have most contact. The home environment has been identified to have a number of hazards associated with falls in older people. The Home‐screen scale was specifically designed as a nurse‐administered instrument to identify environmental and behavioral risks that alert nurses to the need for action to reduce fall risks in the home. A 14‐item scale was administered to 1,165 older people receiving community nursing services. Psychometric investigation confirmed a 10‐item scale with construct validity and internal consistency (α= 0.86, n= 989), explaining 60% of the construct of home safety (safe home environment and safe home behaviors). In addition, differences in mean scores were found in clients able and unable to transfer independently (t= 4.5 [df= 323.1]p < 0.001 [Group 1: M= 82.14, SD= 15.56; Group 2: M= 75.54, SD= 20.83, n= 989]). Similarly, an association existed between clients with low scores on the Home‐screen scale and the perceived need for home modification. A score of 74 on this scale has been identified as a critical point for potential client injury. The use of this scale, both as an initial screening instrument and as a monitoring tool for community nurses working with older people, is recommended.
Starting from a Blank Page: Discovering and Creating Community Health Nursing in Post‐Soviet Latvia
Authors: Kalnins Irene
Published: March 2003

Nurses discovering the practice and creating the tradition of community health nursing without mentors or forerunners have to learn from the practice itself and from each other. Data in the phenomenologic study of 17 Latvian community health nurses (CHNs) consisted of group and individual interviews and observation of practice with families. The focus of this article is the situated practice of nurses in the new role of primary care CHN, revealed through clinical stories that give voice to nurses in a particular historical and social context. The stories of the nurses in this article provide evidence of a growing ability to practice from a health promotion/prevention focus and engage with families and neighborhoods. The practice is still developing, and at this point nurses are not drawing on experience with families to identify and care for vulnerable populations.
Promoting Clinical Practice Knowledge in an Age of Taxonomies and Protocols
Authors: SmithBattle Lee , Diekemper Margaret
Published: March 2003

The proliferation of classification schemes, practice guidelines, and critical pathways expresses our modern faith in theoretical reasoning and scientific evidence. This mode of knowing is almost universally championed for providing the evidence that will guide and advance nursing practice. The nature and complexity of clinical expertise, however, are misconstrued with the quest to standardize nursing practice. After distinguishing between theoretical and clinical reasoning, several narratives from two interpretive studies of public health nursing practice will illustrate how clinical practice resists theoretical understanding and must be more fully articulated if clinical and ethical reasoning is to be preserved and strengthened.
A Win–Win Model for an Academic Nursing Center: Community Partnership Faculty Practice
Authors: Shiber Stella , D'Lugoff Marion
Published: March 2003

A number of schools of nursing have established community nursing centers to provide faculty practice sites, student learning experiences, and a service to the community, most often to a poor underserved population. The current literature concludes that these centers provide a quality clinical service and improve access to health care, and they also provide an avenue for research, training, and faculty practice. Acquiring necessary financial support and the ability to achieve financial independence appear to be the most common difficulties for these centers. Most of the current literature includes an examination of issues relating to funding. The model presented in this article focuses on organizational variables that include both the center and its placement in relationship to other functions and programs in the school and a broadening of the meaning of fiscal responsibility to include an awareness of the broad spectrum of benefits that the community nursing center brings to the entire school. Efforts to coordinate and integrate the needs and functions of several groups are described. Establishing goals and priorities that simultaneously meet the needs of all or most of these groups has been an important outcome. The activities of the center have become an integral part of the everyday life of the school. Achieving financial independence and being fiscally aware and responsible is not the same thing.
The Advent of High‐Tech Home Care in Germany
Authors: Ewers Michael
Published: March 2003

The purpose of this conceptual paper is to examine the current situation in which high‐tech home care is going to materialize in Germany in the beginning of the new millennium. It will be shown that there have been long‐standing efforts to bring about a corresponding expansion of home care as can be observed in other countries (e.g., United States). It is apparent, however, that these efforts are still crowned by only modest success. This especially applies to high‐tech home care. The introduction of this special form of care is turning out to be a complicated process on a collision course with a great number of obstacles due to the peculiarities of Germany's health care system. If the nursing options related to high‐tech home care are to be opened up and put into practice in the future, numerous prerequisites for their development will first have to be created. From a public health nursing viewpoint the three most pressing issues on the list of priorities relevant to high‐tech home care are to: (1) increase awareness of the problems associated with this special form of care; (2) eliminate the present information deficits in society; and (3) initiate a debate in Germany about possibilities and limitations of technology‐intensive home care, building on international exchange of experiences and ideas.
The Roles of Contemporary Mexican American Women in Domestic Health Work
Authors: Mendelson Cindy
Published: March 2003

Abstract Domestic health work is defined as the day‐to‐day household activities, which are often invisible, that create the backbone of healthy environments and healthy individuals. This article describes the roles of a sample of contemporary Mexican American women in domestic health work. Using an ethnographic design, 13 moderately to highly acculturated women were interviewed to determine their roles in domestic health work. Women's roles fell into two broad categories: being a parent and caring for the family. The findings from this research highlight the burden and conflict of multiple roles in this sample and provide insight into the processes by which contemporary Mexican American women maintain culturally defined roles that they feel are important. It also addresses the burdens that they feel are culturally unnecessary. This research has significance for nurses working in the context of the community and the household in that it explicates women's roles in domestic health work and points to the need for community‐based nurses to be aware of the many voices of Mexican American women.
Southern Women's Response to a Walking Intervention
Authors: Nies Mary A. , Reisenberg Catherine E. , Chruscial Heather L. , Artibee Kay
Published: March 2003

Abstract  The need to change the sedentary habits of many American adults is well recognized. Middle‐aged women are an important target group for increased physical activity because of certain health risks such as osteoporosis. In the current study, 31 women between the ages of 30 and 60 from high‐ and low‐income groups (high‐income >$50,000; low‐income <$50,000 per year) took part in a physical activity intervention. The goal was to increase walking activity to a minimum of 90 min per week. Each woman received 16 telephone calls over a 6‐month period in which she was asked to reflect upon the benefits of walking, goal setting, restructuring plans, social support, exercise efficacy, relapse prevention, and maintenance. Content analysis revealed a number of themes emerging from intervention conversations. There were differences between races in walking location and walking partners. Furthermore, there were differences between income groups in beliefs about the benefits of walking and social support. Overall, the intervention appeared to provide a basis for women to develop a walking routine. The women were able to reflect upon their walking routine and attempts to begin a walking routine and to identify how each component of the intervention affected their individual daily routine.
Older Women and Exercise: Theory of Planned Behavior Beliefs
Authors: Conn Vicki S. , Tripp‐Reimer Toni , Maas Meridean L.
Published: March 2003

Abstract Despite well‐documented benefits of exercise, aging women remain largely sedentary. Further understanding of beliefs associated with exercise could result in more‐effective public health interventions to increase exercise in this vulnerable population. This study examined the relationships between theory of planned behavior constructs and exercise behavior and exercise intention in older women. Constructs from the theory of planned behavior (behavioral beliefs, perceived control beliefs, and normative beliefs) were examined in a sample of 225 women aged 65 and older. Exercise was measured with the Baecke Physical Activity Scale. All women were interviewed, to prevent literacy and vision problems from hampering participation. Significant predictors of exercise behavior were perceived control beliefs and behavioral beliefs. Significant predictors of exercise intentions were perceived control beliefs, behavioral beliefs, and normative beliefs. Specific belief items predicting exercise behavior were that exercise is good for health and that exercise is difficult because of tiredness, as well as the lack of commitment and time. These findings provide partial support for the application of the theory of planned behavior to exercise in older women. The findings suggest that interventions should focus on increasing women's confidence that they can overcome barriers to exercise.
Urticaria and Hidden Salicylates
Authors: Wright A. L. , Minford A.
Published: March 2003

Abstract: A 23‐month‐old girl had a chronic urticaria resistant to antihistamine therapy. She was found to be using large quantities of a topical salicylate preparation which was being regularly applied to her pacifier. Once this habit was stopped, her urticaria cleared and has not recurred.
Multiple Eruptive Milia in a 15‐year‐old Boy
Authors: Cairns Michael L. , Knable Alfred L.
Published: March 2003

We present a 15‐year‐old boy with periorbital idiopathic multiple eruptive milia. He represents the youngest case to date of this unusual dermatosis.
Treatment of Linear IgA Bullous Dermatosis of Childhood with Colchicine
Authors: Ang Por , Tay Yong‐Kwang
Published: March 2003

Linear IgA bullous dermatosis of childhood is the most common immunobullous disorder of childhood. First‐line treatment includes dapsone or sulfapyridine. We report a child with linear IgA dermatosis who was treated successfully with colchicine after developing hemolytic anemia from dapsone. We recommend colchicine as an alternative therapy for linear IgA dermatosis of childhood in patients in whom first‐line treatment is contraindicated or who fail first‐line treatment or develop side effects from it.
Junctional Epidermolysis Bullosa with Pyloric Stenosis Presenting with Electron Microscopic Findings Suggestive of Epidermolysis Bullosa Simplex
Authors: Wasel Norman , Idikio Halliday , Lees Gordon , Krol Alfons , Lin Andrew N.
Published: March 2003

Abstract: We present an infant girl who was born with pyloric stenosis and epidermolysis bullosa (EB). Electron microscopy of a skin biopsy specimen showed findings suggestive of EB simplex, but immunofluorescence (IF) mapping of the same specimen established the diagnosis of junctional EB. Because electron microscopy findings may sometimes be misleading, an EB patient with pyloric stenosis and electron microscopy findings suggestive of EB simplex should have a biopsy specimen examined by immunofluorescence mapping, which may confirm that the patient in fact has junctional EB.
Papules and Pustules of the Elbows and Knees: An Uncommon Clinical Sign of Dermatomyositis in Oriental Children
Authors: Lister Robert K. , Cooper E. S. , Paige David G.
Published: March 2003

Abstract: We report two children with dermatomyositis in whom the initial manifestation was a papular eruption on the extensor surfaces of the elbows and knees. In each there was a follicular component to the eruption and one child had pustular lesions. The extensor eruption predated the onset of muscle weakness by 1 year in the first child and by 2 years in the second. Both children had Vietnamese parents. There is some evidence in the literature that Oriental patients may be predisposed to this type of eruption.
Neonatal Urticaria Due to Prostaglandin E1
Authors: Carter Eric L. , Garzon Maria C.
Published: March 2003

Abstract: Prostaglandin E1 is commonly used in the management of cyanotic congenital heart disease. While cutaneous flushing and peripheral edema are well recognized side effects of prostaglandin E1 therapy, other cutaneous effects have not been described in the dermatologic literature. We report a neonate with transposition of the great vessels who developed urticaria during treatment with prostaglandin E1.
KID Syndrome Associated with Features of Ichthyosis Hystrix
Authors: Nousari Hossein C. , Kimyai‐Asadi Arash , Pinto Jose Luna
Published: March 2003

Abstract: Keratitis‐ichthyosis‐deafness (KID) syndrome is a congenital ectodermal disorder causing erythrokeratoderma, vascularizing keratitis, and neurosensory deafness. Ichthyosis hystrix is a rare cutaneous disease characterized by well‐demarcated, spiky, verrucous, linear plaques that is believed to be a clinical and pathologic chimera of two autosomal dominant diseases: epidermal nevus and epidermolytic hyperkeratosis. We present a patient with the classic triad of KID syndrome with clinical and histologic features of ichthyosis hystrix. This case demonstrates that KID syndrome comprises a spectrum of ectodermal disorders which may include diseases such as hystrix ichthyosis and deafness (HID) syndrome.
Precalcaneal Congenital Fibrolipomatous Hamartoma: A Report of Four Cases
Authors: Ortega‐Monzó Carmen , Molina‐Gallardo Inmaculada , Monteagudo‐Castro Carlos , Cardá‐Batalla Carmen , Pinazo‐Canales Isabel , Smith‐Ferres Victoria , Calduch‐Rodríguez Luis , Jordá‐Cuevas Esperanza
Published: March 2003

Abstract: Four infants had soft, skin‐colored nodules in the midline plantar region of the heels since birth. The lesions were asymptomatic, bilateral, and symmetric, and measured approximately 1 cm in diameter. Their size increased in proportion to the growth of the child. In three infants the lesions persisted at 1 year of age, while in the fourth they remained at age 12 years. The nodules were not associated with any other disease or abnormality. A review of the literature revealed only one Argentinean series comprising four cases, and two communications at international pediatric congresses by French and American authors who reported five and three cases, respectively. We describe four additional cases of precalcaneal congenital fibrolipomatous hamartoma and comment on their histopathologic and ultrastructural characteristics.
Tuberous Xanthomas in Sitosterolemia
Authors: Alam Murad , Garzon Maria C. , Salen Gerald , Starc Thomas J.
Published: March 2003

Abstract: Sitosterolemia is an autosomal recessive lipid disorder in which plasma plant sterol levels are extremely elevated and cholesterol levels are often elevated but may be normal. Clinically sitosterolemia is characterized by xanthomas, premature vascular disease, and arthritis. Adolescent boys and girls with sitosterolemia are susceptible to fatal cardiac events. Dermatologists may have a vital role in the diagnosis of this rare but serious condition because early detection and treatment are important in preventing the associated atherosclerotic heart disease. We present a 7‐year‐old girl with sitosterolemia and tuberous xanthomas.
The Conjunctivitis of Solar (Actinic) Prurigo
Authors: Magaña Mario , Mendez Yira , Rodriguez Abelardo , Mascott Manuel
Published: March 2003

Abstract: Solar (actinic) prurigo (SP) is an abnormal reaction to sunlight that affects mostly the Indian and mestizo populations of America, and is well known in Canada and the United States. It is quite common in Mexico, Central, and South America, although rare in Europe. It usually starts in childhood in both sexes and in about 30–50% of cases involves the oral and ocular mucosa. In this study we present the clinical and histopathologic conjunctival findings in 11 of 105 children with SP. Clinically the most important features were photophobia, some degree of pterygium, and pinguecula, hyperemia, Trantas' dots, hyaline exudate, and follicles. Histopathologically the changes were epithelial, such as epidermoid metaplasia and absence of goblet cells, and stromal changes, which were the most diagnostically relevant. These consisted of lymphocytic inflammatory infiltrates, usually with eosinophils, melanosis, and solar elastosis. We believe this constellation of criteria will be useful for a better characterization of SP.
Infantile McCune–Albright Syndrome
Authors: Davies Justin H. , Barton John S. , Gregory John W. , Mills Caroline
Published: March 2003

McCune–Albright syndrome is a rare disorder caused by an activating mutation of the α subunit of the Gs protein and is characterized by multiple hormonal abnormalities, fibrous dysplasia of bone, and cutaneous pigmentation. We report a 10‐week‐old infant with McCune–Albright syndrome. He presented with failure to thrive, cardiorespiratory distress, and pigmented macules on his face, trunk, and limbs. Following the clinical diagnosis of McCune–Albright syndrome, he was subsequently shown to have hypercortisolism and hyperthyroidism.
Clotrimazole/Betamethasone Diproprionate: A Review of Costs and Complications in the Treatment of Common Cutaneous Fungal Infections
Authors: Greenberg H. L. , Shwayder Tor A. , Bieszk Nella , Fivenson David P.
Published: March 2003

The use of antifungal/corticosteroid combinations as topical therapy for dermatophytoses has been criticized as being less effective, more expensive, and the cause of more adverse cutaneous reactions than antifungal monotherapy. The combination of clotrimazole and betamethasone diproprionate (Lotrisone) is a mix of an azole antifungal and a high‐potency corticosteroid, and is one of the most widely prescribed of these combinations. Our objective was to describe the beneficial and deleterious effects of Lotrisone in the treatment of common cutaneous fungal infections and its relative cost‐effectiveness. We did a literature review documenting clinical trial data and adverse reactions to Lotrisone and collected a cost analysis of topical antifungal prescribing data over a 2‐month period from a large midwestern staff‐model health maintenance organization (HMO). Lotrisone is approved by the U.S. Food and Drug Administration (FDA) for the treatment of tinea pedis, tinea cruris, and tinea corporis in adults and children more than 12 years of age. Treatment is limited to 2 weeks in the groin area and 4 weeks on the feet. The most concerning adverse effects of Lotrisone were reported in children and included treatment failure, striae distensae, hirsuitism, and growth retardation. This combination was also reported to have decreased efficacy in clearing candidal and Trichophyton infections as compared to single‐agent antifungals. Lotrisone was considerably more expensive than clotrimazole alone and was found to account for more than 50% of topical antifungal expenditures as prescribed by primary care physicians, but only 7% of topical antifungals prescribed by dermatologists. We found that Lotrisone was shown to have the potential to induce many steroid‐related side effects and to be less cost effective than antifungal monotherapy. This combination should be used judiciously in the treatment of cutaneous fungal infections and may not be appropriate for use in children.
Skin Physiology of the Neonate and Young Infant: A Prospective Study of Functional Skin Parameters During Early Infancy
Authors: Hoeger Peter H. , Enzmann Christine C.
Published: March 2003

Abstract: Although neonatal and adult epidermis are similar with respect to thickness and lipid composition, skin development is not complete at birth. Previous studies indicate that the skin undergoes a process of adaptation and maturation postnatally. Postnatal skin physiology has not yet been evaluated comprehensively in a prospective study. We assessed skin function parameters prospectively in a cohort of 202 healthy term neonates (98 boys) of Caucasian descent. Measurements were performed at 3 days, 4 weeks, and 12 weeks of age and at four different body sites (frontal area, cheek, volar forearm, and gluteal surface). The following parameters were assessed: skin surface pH, corneal layer hydration (capacitance), epidermal desquamation, and surface roughness. Data were presented in box and whisker plots. Our results were as follows. Surface pH decreased by 0.3–1.1 units (p < 0.001), while desquamation increased significantly during the observation period (p < 0.001), but only on the facial areas. There was a significant increase in stratum corneum hydration (p < 0.001) which was paralleled by decreasing skin roughness, indicating smoothing of the skin surface (p < 0.001). No significant differences were found between male and female infants. These findings reflect significant cutaneous adaptation processes, particularly during the neonatal period. Reference values for functional skin parameters may be helpful in delineating normal from pathologic skin conditions such as ichthyosis or atopic dermatitis at an early stage when intervention might help to prevent exacerbations. The usefulness of these reference values will have to be evaluated in clinical practice.
Acrokeratoelastoidosis
Authors: Hu Weimin , Cook Thomas F. , Vicki Gary J. , Glaser Dee Anna
Published: March 2003

Abstract: Acrokeratoelastoidosis of Costa is a rare papular palmoplantar keratosis characterized by small round‐oval to rhomboid‐shaped, yellowish papules most commonly localized to the palmar surface of the hands and sometimes also found on plantar surfaces of the feet. Both autosomal dominant and sporadic forms of the disease have been reported. Histologically acrokeratoelastoidosis is marked by hyperkeratosis and epidermal hypertrophy. Specific stains for elastic tissue reveal characteristic fragmentation and rarefaction of elastic fibers. We report a sporadic case of acrokeratoelastoidosis in a 13‐year‐old girl and review the etiology, differential diagnosis, and treatment of this disorder.
Incontinentia Pigmenti Presenting as Seizures
Authors: Hubert Jason N. , Callen Jeffrey P.
Published: March 2003

Abstract: Incontinentia pigmenti is a rare disorder that may affect many systems including the skin, central nervous system, bone, and eyes. We describe a 13‐day‐old girl who developed seizures on day 1 of life and was placed on antiseizure medication. On approximately day 4 of life, she developed a vesicular rash on her trunk and extremities. The pediatric team prescribed intravenous acyclovir and diphenhydramine cream. These were used without improvement. At dermatology consultation, linear and swirled vesicular lesions were seen. A skin biopsy specimen revealed eosinophils within intraepidermal vesicles consistent with a diagnoses of incontinentia pigmenti. This case of incontinentia pigmenti is of interest in that the initial symptom was a seizure disorder.
Hydrazine‐Conjugated Cellulose for Adsorption of Glycated Proteins
Authors: Kojima Shunichi , Ogino Eiji , Tani Nobutaka
Published: March 2003

Glycated proteins and advanced glycation endproducts are postulated to play an important role in the development of complications due to diabetes mellitus or renal failure. The purpose of this study was to assess the ability of hydrazine‐conjugated cellulose to adsorb glycated albumin. The samples used for adsorption test were artificially glycated albumin or the serum from patients with diabetes mellitus. The hydrazine‐conjugated cellulose adsorbed more than 20% of the albumin glycated artificially over 77 days. The serum concentrations of glycated albumin in patients with diabetes mellitus (39.6 ± 2.5% (mean ± SEM), n = 14) were not decreased by incubation with cellulose alone (postincubation level, 39.7 ± 2.5%) whereas they were significantly (p < 0.0001) reduced to 38.0 ± 2.4% after incubation with hydrazine‐conjugated cellulose. There was a significant correlation (r = 0.75, p < 0.01) between the preincubation levels of glycated albumin and the degree of adsorption. The hydrazine‐conjugated cellulose has a higher affinity for albumin with greater glycation.
Therapeutic Apheresis for Renal Disorders
Authors: Kaplan Andre A.
Published: March 2003

Many primary renal diseases are associated with either antibody deposition within the glomerulus or an antibody associated autoimmunity, as may be seen with certain vasculitidies. Other immunoglobulins may be nephrotoxic or glomerulopathic; such may be the case with myeloma related light chains or cryoglobulins. Given the rapid removal of immunoglobulins by therapeutic plasma exchange, this modality has been considered an appealing management option in the treatment of these autoimmune related renal diseases. Although not classically considered as autoimmune diseases, thrombotic thrombocytopenic purpura and hemolytic uremic syndrome are related syndromes which often involve the kidneys. In many cases therapeutic plasma exchange has been found to be a useful treatment modality for these microangiopathic hemolytic anemias. This paper will provide a concise review of the renal indications for therapeutic plasma exchange.
Changes of Plasma Fibronectin in Patients Treated with Cryofiltration for an Extended Period
Authors: Yonekawa Motoki , Kawamura Akio , Kukita Kazutaka , Meguro Jun‐ichi , Tanaka Mitsuko , Tamaki Tohru
Published: March 2003

Abstract: The purpose of this study was to evaluate correlations between extra domain A fibronectin (EDA[+]FN) in plasma and the clinical course in cryofiltration for an extended period. Two patients with systemic lupus erythematosus (SLE), 1 with aortitis syndrome, 1 with ankylosis spondylitis, 1 with polymyositis, 1 with rheumatoid arthritis, and 1 with chronic rejection of a kidney graft, were regularly treated with cryofiltration for more than 3 years. The average level of EDA(+)FN in each year did not show significant change in clinically stable patients with aortitis syndrome, polymyositis, and SLE. In the patient with ankylosis spondylitis, the average level of EDA(+)FN in each year elevated, so cryofiltration was performed frequently. On the other hand, cryofiltration could not attenuate the progression in the juvenile rheumatoid arthritis patient. In the patient with chronic rejection of a kidney graft, kidney function without hemodialysis could be prolonged for 33 months by cryofiltration. The average level of EDA(+)FN elevated as the graft function got worse. Changes of average level of EDA(+)FN in plasma corresponded with changes in the clinical courses of patients with autoimmune disease and chronic rejection of a kidney graft. The EDA(+)FN level might give prognostic information and determine the interval of cryofiltration.
Study of Filtration Characteristics of EVAL Secondary Filters in Plasma Diseases
Authors: Sueoka A. , Miyahara T. , Takakura K. , Ueda Y.
Published: March 2003

INTRODUCTION Guest Editor's Introduction: This paper was presented at the fourth congress of the Japanese Society for Therapeutic Plasmapheresis in Tokyo, Japan, on June 2, 1984. The paper was printed in Therapeutic Plasmapheresis (proceedings of the fourth congress), edited by T. Oda and published by Schattauer, Stuggart, in 1985, p. 45–49. This paper provides the first technical description of plasma fractionators for cascade filtration. EVAL (ethylenevinyl alcohol copolymer) hollow fibers of different porosities (four types) were utilized for various macromolecular separations. Two types of EVAL secondary filters are described in this article. Successful cascade filtrations were expected to be performed with these filters.
New Flow‐Through Centrifuge Without Rotating Seals Applied to Plasmapheresis
Authors: Ito Yoichiro , Suaudeau Jacques , Bowman Robert L.
Published: March 2003

Abstract: Guest Editor's Introduction: Most of the continuous flow centrifuge devices utilized a rotary seal, typically consisting of a pair of discoid structures, one of which moves with the rotor while the other remains stationary. Although the rotary seals had been satisfactorily used in various techniques such as countercurrent elutriation and field‐flow fractionation, when applied for blood processing, a sealless structure is more preferable to prevent cellular damage. This paper was concerned with the first flow‐through centrifuge without rotating seals, and describes the principle and basic designs of a sealless continuous flow centrifuge. This paper was printed in Science vol. 189, page 999–1000 (1975), and reprinted here with permission.
Principles of Blood Separation and Component Extraction in a Disposable Continuous‐Flow Single‐Stage Channel
Authors: Hester Jeane , Kellogg Robert M. , Mulzet Alfred P. , Kruger Victor R. , McCredie Kenneth B. , Freireich Emil
Published: March 2003

Abstract: Guest Editor's Introduction: By 1977, the NCI/IBM 2990 and the Amico Celltrifuge, a conceptually similar instrument that had an identical centrifuge bowl, were being used worldwide. However, a major technical problem remained in that the blood path was still not completely disposable. To overcome this drawback, IBM 2977 was developed. The centrifuge bowl was changed from an axial flow separator to a circumferential flow geometry. The IBM 2997 single‐stage channel instrument was first introduced and followed by the dual‐stage channel instrument to obtain platelet concentrate with minimum lymphocyte contamination. This paper describes the basic design, operation conditions, and collection performance of the single‐stage channel IBM 2977. This paper was printed in Blood, vol 54, page 254–268 (1979) and reprinted here with permission.

A single‐stage disposable channel and seal that provides for leukocyte and granulocyte collection by continuous‐flow cell separation (CFCS) has been designed by the IBM Corporation. This paper describes (1) the separation characteristics of whole blood as it responds to varying gravitational (G) forces and flow rates through the channel;
(2) the mechanism by which the buffy coat accumulates and is extracted;
(3) the efficiency of extraction;
(4) those donor and procedural variables that contribute to the final yield;
(5) posttransfusion increment response in patients; and
(6) the functional integrity of the cells collected.
Immunoadsorption of Immunoglobulins Alters Intracytoplasmic Type 1 and Type 2 T Cell Cytokine Production in Patients with Refractory Autoimmune Diseases
Authors: Hehmke Bernd , Salzsieder Eckhard , Matic Goran B. , Winkler Roland E. , Tiess Michael , Ramlow Wolfgang
Published: March 2003

Abstract: Intracellular cytokine staining and flow cytometry were used to investigate whether immunoadsorption (IA) of immunoglobulins alters intracytoplasmic cytokine production in CD4+ and CD8+ T cells from the blood of patients with refractory rheumatoid arthritis (n = 7), membrane proliferative glomerulonephritis (n = 1), and Goodpasture's syndrome (n = 1). Four patients (Group 1) showed severely depressed production of TNF‐α, IL‐2, IFN‐γ, and IL‐4 by CD4+ and CD8+ T cells and responded to 3 IA sessions with significant increases in CD4+TNF‐α+, CD4+IL‐2+, and CD8+IL‐2+ T cells. Also, a tendency toward increased percentage levels of CD4+ T cells producing IFN‐γ or IL‐4 and of CD8+ T cells producing either TNF‐α or IFN‐γ was seen, but due to the small number of patients investigated, these differences did not attain statistic significance. Group 2 (n = 5) showed unimpaired intracellular cytokine levels and responded to IA with a heterogeneous pattern of changes in TNF‐α, IL‐2, IFN‐γ, and IL‐4 production, but these alterations were smaller than those in Group 1. The present findings indicate that the extracorporeal removal of immunoglobulins by anti‐IgG or protein A adsorber columns has an impact on T cell immunity and suggest that modulating effects on cellular immune system function are involved in the mode of action of IA.
Beneficial Effect of Aggressive Low‐Density Lipoprotein Apheresis in a Familial Hypercholesterolemic Patient with Severe Diabetic Scleredema
Authors: Koga Nobuhiko
Published: March 2003

Abstract: We present a 59‐year‐old woman with severe diabetic scleredema (DS) associated with heterozygous familial hypercholesterolemia (FH). She had been treated with drugs to lower blood glucose, with insulin for diabetes mellitus (DM), and with low‐density lipoprotein (LDL) apheresis therapy monthly or every 2 weeks in addition to drugs to lower serum lipids for FH. However, her scleredema had not improved. After we had tried weekly LDL apheresis therapy for a period of 3 years to treat her hyperlipidemia, the levels of her serum lipids were reduced to normal ranges, and scleredema in her nape improved. We also demonstrated the histopathological improvement in dermis of her cervical skin. We conclude that weekly LDL apheresis therapy is effective for diabetic scleredema that is resistant to conventional treatments.
The Severity of Hyperdynamic Circulation May Predict the Effects of Direct Hemoperfusion with the Adsorbent Column Using Polymyxin B‐Immobilized Fiber in Patients with Gram‐Negative Septic Shock
Authors: Uriu Kohei , Osajima Akihiko , Kamochi Masayuki , Watanabe Hiroyuki , Aibara Keiji , Kaizu Kazo
Published: March 2003

Abstract: It has been reported that direct hemoperfusion with the adsorbent column using polymyxin B‐immobilized fiber (DHP with PMX‐F column) ameliorates hyperdynamic circulation in septic shock and improves survival rate. However, the clinical characteristics of patients with an improvement of septic shock after DHP with PMX‐F column have not been evaluated. To clarify this issue, the clinical profiles of 46 patients who were suggested to have gram‐negative septic shock and treated using DHP with PMX‐F column were analyzed retrospectively. Of 46 patients, 31 were diagnosed with gram‐negative septic shock (G group). Mean arterial pressure (MAP) just before DHP with PMX‐F column was not different between the G and the non‐G group. As compared with the non‐G group, the G group had a higher cardiac index (CI) and a lower systemic vascular resistance (SVR). Significant increases in MAP and SVR with a significant decrease in CI were observed after DHP with PMX‐F column in the G group. In the non‐G group, MAP was significantly increased after the DHP therapy, but systemic hemodynamics were unchanged. Patients in the G group who fulfilled the following criteria were considered as the effective group: MAP was elevated more than 10 mm Hg or 125% of the basal MAP and/or the dose of vasopressors was reduced after DHP with PMX‐F column. Twenty‐one patients (67.8%) were in the effective group. In comparison with the effective group, the noneffective group was characterized by a significant increase in CI before DHP with PMX‐F column. All patients with a CI less than 6 L/min/m2 were in the effective group. These data suggest that DHP with PMX‐F column was useful for patients with Gram‐negative septic shock who did not have severe hyperdynamic circulation.
Donor Leukocyte Infusion for Japanese Patients with Relapsed Leukemia After Allogeneic Bone Marrow Transplantation: Indications and Dose Escalation
Authors: Shiobara Shintaro , Nakao Shinji , Ueda Mikio , Yamazaki Hirohito , Takahashi Satoshi , Asano Shigetaka , Yabe Hiromasa , Kato Shunichi , Imoto Shion , Maruta Atsuo , Yoshida Takashi , Gondo Hisashi , Morishima Yasuo , Kodera Yoshihisa
Published: March 2003

Abstract: To clarify the role of dose escalation of donor leukocyte infusion (DLI) in the treatment of relapsed leukemia after allogeneic bone marrow transplant (BMT), data from 100 patients were collected from 46 facilities in Japan and analyzed with respect to indications and infused cell dose. Complete remission (CR) was achieved in 11 of 12 (91%) patients with relapsed chronic myelogenous leukemia (CML) in the chronic phase, 3 of 11 (27%) with CML in the acute phase, 8 of 21 (38%) with acute myelogenous leukemia (AML), 6 of 23 (25%) with acute lymphoblastic leukemia (ALL), and 5 of 11 (45%) with myelodysplastic syndrome (MDS). The probability of remaining in CR at 3 years was 82% in CML patients in the chronic phase, but 0% in those with CML in the acute phase, 7% in those with AML, 0% with ALL, and 33% with MDS. Acute graft‐versus‐host disease (GVHD) (≥2) developed in 31 of 89 (34%) patients with human leukocyte antigen identical related donors and was fatal for 7 (7%). A leukocyte dose of 1 × 107/kg of recipient body weight with CML in the chronic phase, 3 × 107/kg of recipient body weight with MDS, and 1 × 108/kg of recipient body weight with acute leukemia appeared to be optimal as an initial dose of DLI. However, the minimal dose of leukocyte developing fatal GVHD was 7 × 107/kg of recipient body weight. These suggest that a relatively small dose of DLI ranging from 1 × 107/kg to 5 × 107/kg of recipient body weight should be administered initially then the infused escalating dose 2 or 3 months later in patients with CML in the chronic phase and MDS. However, a large number of leukocytes around 1 × 108/kg are needed to induce graft versus leukemia effects in patients with acute leukemia despite a 7% fatality in GVHD.
Myocardial Infarction njury Is Relatively Common at Presentation of Acute Thrombotic Thrombocytopenic Purpura: The Indiana University Experience
Authors: McCarthy Leo J. , Danielson Constance F.M. , Skipworth Elaine M. , Peters Shelley L. , Miraglia Charles C. , Antony Asok C.
Published: March 2003

Abstract: Although widespread vascular thrombosis is common in thrombotic thrombocytopenic purpura (TTP), there have been no prospective studies on the extent of injury to specific organs. Following successful resuscitation and plasma exchange of an index patient with widespread organ dysfunction, cardiogenic shock, and elevated cardiac troponin‐I levels, we prospectively studied and identified 2 more individuals (of 10 consecutive patients) with evidence of myocardial injury/infarction at presentation of acute TTP. These data suggest that cardiac troponin‐I measurements should be considered during initial evaluation of all patients with acute TTP.
Dextran Sulfate (Selesorb) Plasma Apheresis Improves Vascular Changes in Systemic Lupus Erythematosus
Authors: Braun Norbert , Jünger Michael , Klein Reinhild , Gutenberger Sylvia , Guagnin Michael , Risler Teut
Published: March 2003

Abstract: Apheresis has been effective as rescue therapy in patients with severe, therapy‐resistant, systemic lupus erythematosus (SLE). Its benefit in patients with less severe but therapy‐resistant SLE is not known. Dextran sulfate apheresis was applied as a rescue therapy for therapy‐resistant vasculitic skin lesions in a 30 year old female patient with a 9 year history of SLE in combination with antiphospholipid syndrome and Raynaud's phenomenon. Partial remission was achieved after 9 immunoadsorption sessions, as documented by marked improvement of skin lesions and an increase of capillary density in the nailfold area. Further improvement was noted with maintenance therapy using mycophenolate mofetil. Dextran sulfate apheresis can be applied safely in patients with moderate therapy‐resistant SLE disease activity when severe immunodeficiency and cytotoxic adverse effects should be avoided.
Time‐Course of Iodine Elimination by Hemodialysis in Patients with Renal Failure after Angiography
Authors: Shinoda Toshio , Hata Toshihiko , Nakajima Ken‐ichi , Yoshimoto Hiroshi , Niwa Akihiro
Published: March 2003

Abstract: The study was designed to examine the time‐course of iodine elimination by hemodialysis to determine a desirable duration for dialysis after angiography to prevent contrast media nephropathy (CMN) in patients with renal failure. Reduction rates of iodine by hemodialysis (DRR) of 1 to 3 h and the renal elimination of iodine (RER) for 20 h after hemodialysis were prospectively examined in 8 chronic renal failure (CRF) patients. The mean DRR was 46.6% at 1 h, 65.2% at 2 h, and 75.1% at 3 h, and the mean RER was 49.4% in the CRF patients. Renal function significantly deteriorated in 2 CRF patients after angiography. Plasma iodine was eliminated by more than 80% after 2 h of hemodialysis following angiography, and the subsequent renal elimination in patients with mild‐to‐moderate renal failure was also examined. There is no need of prophylactic hemodialysis to prevent CMN for these patients when they have no additional risk factors such as a high dose of contrast medium, diabetes mellitus, or severe heart failure. However, 2 h of hemodialysis is desirable immediately after angiography for patients with moderate renal failure and one additional risk factor, and three hours or more of hemodialysis is also desirable for patients with severe renal failure, and for those with moderate renal failure having two or more additional risk factors.