bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology, course and disease burden of chronic hepatitis B virus infection. HEPNET study for chronic hepatitis B: a multicentre Greek study
Authors: Raptopoulou M. , Papatheodoridis G. , Antoniou A. , Ketikoglou J. , Tzourmakliotis D. , Vasiliadis T. , Manolaki N. , Nikolopoulou G. , Manesis E. , Pierroutsakos I.
Published: October 2008

Summary.  Hepatitis B virus infection (HBV) has been recognized as a major health problem worldwide. Greece belongs to the intermediate endemicity countries with a trend of decreasing prevalence of HBV infection during the last decade. However, the recent massive immigration to our country may have led to alterations of HBV epidemiology. In this study, we evaluated the epidemiological features of HBV infection in a sample of 3480 patients followed up during the years 1997–2006. Immigrants mainly from Albania represented the 18.6% of the total study population and 56.6% of children. The majority of the patients had no family history of HBV infection (67.3%) or of acute hepatitis (95.4%), no known source of infection (64.6%), with intrafamilial spread accounting for 16.9% of the HBV transmission in adults and 33.9% in children. HBeAg(‐) hepatitis B was the predominant form of hepatitis (92.1%) among the Greek patients in contrast to the immigrants where 16.6% were HBeAg(+). Liver cirrhosis was diagnosed in 8.8% of the total population and 0.9% had hepatocellular carcinoma. A high proportion of children were HBeAg(+) (62%), 55% from immigrant families, 25.2% were infected in the perinatal period and had no evidence of disease complications. In conclusion our results showed (a) a changing pattern in the epidemiology of HBV infection in Greece due to the significant number of HBeAg(+) patients, especially among children and (b) a considerable number of patients although aware of their infection, present with advanced disease.
Improvingblood‐borne viral diagnosis; clinical audit of the uptake of dried blood spot testing offered by a substance misuse service
Authors: Craine N. , Parry J. , O’Toole J. , D’Arcy S. , Lyons M.
Published: October 2008

Summary.  The diagnosis of blood‐borne viral infection amongst drug injectors in Wales is limited by a poor uptake of diagnostic testing; recent research suggests that dried blood spot (DBS) sample collection, rather than venepuncture, may improve diagnostic rates. We carried out an audit of the uptake of DBS testing for hepatitis C, hepatitis B and HIV amongst drug injectors attending a substance misuse service (SMS) in the first year of DBS testing being routinely offered to clients (1 May 2007 to 30 April 2008) and compared the uptake to venepuncture testing of SMS clients in the previous year. Uptake of DBS testing for hepatitis C, hepatitis B and HIV was almost six times greater than the uptake of venepuncture testing amongst clients of the SMS in the previous year. The data are consistent with the hypothesis that DBS testing can increase the uptake of blood‐borne viral testing amongst current and ex‐drug injectors. We accept that part of the almost sixfold increase in diagnostic testing observed in the first year of DBS testing may be due to an increase in awareness amongst drug injectors of testing opportunities and a prioritization of testing by the SMS. Nonetheless the dramatic increase in uptake demonstrates that DBS testing is acceptable to drug injectors and should be subject to more rigorous trials to evaluate its potential impact on diagnosis.
Association of respiratory tract infection symptoms and air humidity with meningococcal carriage in Burkina Faso
Authors: Mueller Judith E. , Yaro Seydou , Madec Yoann , Somda Paulin K. , Idohou Régina S. , Njanpop Lafourcade Berthe‐Marie , Drabo Aly , Tarnagda Zekiba , Sangaré Lassana , Traoré Yves , Fontanet Arnaud , Gessner Bradford D.
Published: October 2008

Objectives  To evaluate risk factors for meningococcal carriage and carriage acquisition in the African meningitis belt, comparing epidemic serogroup A (NmA) to non‐epidemic serogroups.

Methods  During the non‐epidemic meningitis season of 2003, pharyngeal swabs were taken at five monthly visits in a representative population sample (N = 488) of Bobo‐Dioulasso, Burkina Faso (age 4–29 years) and analysed by culture. Standardized questionnaires were administered. In 2006, a similar study was performed in 624 individuals (age 1–39 years) during an NmA meningitis epidemic. We evaluated serogroup‐specific risk factors for carriage, carriage acquisition and clearance using multivariate logistic and Poisson regression, and a Cox proportional hazard model.

Results  The prevalence of NmA carriage (current or recent pharyngitis or rhinitis) was 16% (31%) vs. 0% (9%) in the epidemic vs. the hyperendemic setting. During the epidemic situation, NmA carriage was significantly associated with recent sore throat (adjusted odds ratio (OR), 3.41) and current rhinitis (OR 2.65). During the non‐epidemic meningitis season in 2003, air humidity (20–39% and ≥40%, compared to <20%) during the month before swabbing was significantly and positively associated with carriage acquisition of non‐groupable meningococci (OR 2.18 and 1.55) and inversely with carriage clearance (hazard ratio 0.61 and 0.27, respectively).

Conclusion  Respiratory tract infections may increase meningococcal carriage, and thus contribute to epidemic risk, in addition to seasonality in the meningitis belt. Humid climate may favour carriage of unencapsulated meningococci. These findings may help identifying interventions against epidemic and hyperendemic meningococcal meningitis due to non‐vaccine serogroups.
The association of allergic symptoms with sensitization to inhalant allergens in childhood
Authors: Govaere Elke , Van Gysel Dirk , Verhamme Katia M. C. , Doli Erenik , De Baets Frans
Published: October 2008

Although it is generally agreed that sensitization is an important risk factor for allergic diseases, the extent to which sensitization accounts for allergic symptoms in children is controversial. As part of the Aalst Allergy Study, this cross‐sectional study investigated the prevalence of allergic symptoms and their association with sensitization in an unselected population of Flemish children aged 3.4–14.8 yr. Skin prick testing with the most common aeroallergens was performed and allergic symptoms were documented by a parental questionnaire. In the children older than 6 yr, a significant association of current wheezing, current dyspnea, airway hyperreactivity, rhinoconjunctivitis, and current eczema with sensitization was found, while in the pre‐school children these associations were less pronounced. The association with sensitization was strongest for rhinoconjunctivitis and current respiratory symptoms – the association was less striking for children with current eczema. The impact of a positive family history of allergy on the association with sensitization was more important for eczema than for the other analyzed allergic symptoms. Persistent and late‐onset wheezers were significantly more likely than non‐wheezers and transient early wheezers to be associated with sensitization and a personal history of rhinoconjunctivitis. Late‐onset wheezing was associated with a positive family history of allergy, while transient early wheezing was associated with day‐care attendance. An association with eczema was found for all three childhood wheezing phenotypes. The association of allergic symptoms with sensitization is significant in the older but less pronounced in pre‐school children and is more pronounced for current allergic symptoms. Diagnosis and disease definition of allergy symptoms remains difficult at pre‐school age. The influence of a positive family history of allergy on the association of the respective allergic symptoms with sensitization was most important for eczema. Our data confirm the atopic characteristics of the different wheeze phenotypes.
Cytokine profiles in 1‐yr‐old very low‐birth‐weight infants after enteral glutamine supplementation in the neonatal period
Authors: Van Zwol Annelies , Van Den Berg Anemone , Nieuwenhuis Edward E. S. , Twisk Jos W. R. , Fetter Willem P. F. , Van Elburg Ruurd M.
Published: October 2008

In a previous study, we found that glutamine‐enriched enteral nutrition in 102 very low‐birth‐weight (VLBW) infants decreased both the incidence of serious neonatal infections and atopic dermatitis during the first year of life. The aims of this follow‐up study were to determine whether these beneficial effects are attended by changes in Th1 and Th2 cytokine profiles at age 1 yr. Furthermore, we studied changes in cytokine profiles during the first year of life in these VLBW infants. In total, 89 infants were eligible for the follow‐up study (12 died, 1 exclusion due to a chromosomal abnormality). Th1 (IFN‐γ, TNF‐ α and IL‐2) and Th2 cytokine (IL‐10, IL‐5, and IL‐4) profiles following in vitro whole blood stimulation were measured at 1 yr. Cytokine profiles were measured in 59/89 (66%) infants. Glutamine‐enriched enteral nutrition in neonatal period did not influence cytokine profiles at 1 yr. Cytokine profiles were not different in infants with and without allergic or infectious diseases. The beneficial effect of glutamine‐enriched enteral nutrition on the incidence of serious neonatal infections and atopic dermatitis during the first year of life is not related to changes in the Th1 and Th2 cytokine profiles. Both Th1 and Th2 cytokine profiles increased during the first year of life in this cohort of VLBW infants.
The comparison of cetirizine, levocetirizine and placebo for the treatment of childhood perennial allergic rhinitis
Authors: Lee Chih‐Fang , Sun Hai‐Lun , Lu Ko‐Hsiu , Ku Min‐Sho , Lue Ko‐Huang
Published: October 2008

Cetirizine (Zyrtec) is a potent and long‐acting second‐generation histamine H1‐ receptor antagonist for the treatment of allergic disease, such as allergic rhinitis and chronic idiopathic urticaria, in adult and child. It is a racemic mixture of levocetirizine (Xyzal) and dextrocetirizine. The purpose of this present study was to compare the efficacy of cetirizine, levocetirizine and placebo for the treatment of pediatric perennial allergic rhinitis. 74 perennial allergic rhinitis patients, aged 6 to 12 years old, assigned to 1 of 3 treatment groups for 12 weeks randomly. The effects of the three agents were compared with the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and Total Symptom Score (TSS) by diary. Nasal peak expiratory flow rate (nPEFR) and laboratory examinations including serum immunoglobulin E level, eosinophil cationic protein (ECP), blood eosinophil counts and eosinophil percentage in a nasal smear were evaluated among the three groups. The results revealed that both cetirizine and levocetirizine improved TSS in comparison with the placebo group, and ceterizine appeared to be more efficacious than levocetirizine at week 8 and week 12. The PRQLQ score showed significant decreased both in cetirizine and levocetirizine group, but there was no statistic significant difference between both groups. The eosinophil proportion in a nasal smear significantly decreased among the cetirizine in comparison with the placebo group but there was no statistic significant in levocetirizine groups. Both cetirizine and levocetirizine showed significant improvement in nPEFR in comparison with the placebo group, and ceterizine appeared to be more efficacious than levocetirizine. The 12‐week treatment program showed that cetirizine was more effectious than levocetirizine.
Microparticles in stored red blood cells: an approach using flow cytometry and proteomic tools
Authors: Rubin O. , Crettaz D. , Canellini G. , Tissot J.‐D. , Lion N.
Published: October 2008

Background and Objectives  Microparticles (MPs) are small phospholipid vesicles of less than 1 µm, shed in blood flow by various cell types. These MPs are involved in several biological processes and diseases. MPs have also been detected in blood products; however, their role in transfused patients is unknown. The purpose of this study was to characterize those MPs in blood bank conditions.

Materials and Methods  Qualitative and quantitative experiments using flow cytometry or proteomic techniques were performed on MPs derived from erythrocytes concentrates. In order to count MPs, they were either isolated by various centrifugation procedures or counted directly in erythrocyte concentrates.

Results  A 20‐fold increase after 50 days of storage at 4°C was observed (from 3370 ± 1180 MPs/µl at day 5 to 64 850 ± 37 800 MPs/µl at day 50). Proteomic analysis revealed changes of protein expression comparing MPs to erythrocyte membranes. Finally, the expression of Rh blood group antigens was shown on MPs generated during erythrocyte storage.

Conclusions  Our work provides evidence that storage of red blood cell is associated with the generation of MPs characterized by particular proteomic profiles. These results contribute to fundamental knowledge of transfused blood products.
Morphological variation of Aechmea distichantha (Bromeliaceae) in a Chaco forest: habitat and size‐related effects
Authors: Cavallero L. , López D. , Barberis I. M.
Published: October 2008

Plants show different morphologies when growing in different habitats, but they also vary in their morphology with plant size. We examined differences in sun‐ and shade‐grown plants of the bromeliad Aechmea distichantha with respect to relationships between plant size and variables related to plant architecture, biomass allocation and tank water dynamics. We selected vegetative plants from the understorey and from forest edges of a Chaco forest, encompassing the whole size range of this bromeliad. Plant biomass was positively correlated with most architectural variables and negatively correlated with most biomass allocation variables. Understorey plants were taller and had larger diameters, whereas sun plants had more leaves, larger sheath area, sheath biomass and sheath mass fraction. All tank water‐related variables were positively correlated with plant biomass. Understorey plants had a greater projected leaf area, whereas sun plants had higher water content and evaporative area. Plasticity indices were higher for water‐related than for allocation variables. In conclusion, there were architectural and biomass allocation differences between sun‐ and shade‐grown plants along a size gradient, which, in turn, affected tank water‐related variables.
Nutrient dynamics in a tritrophic system of ants, aphids and beans
Authors: Schumacher E. , Platner C.
Published: October 2008

The interactions between ants (Lasius niger), aphids (Aphis fabae) and plants (Phaseolus vulgaris) were studied in a laboratory experiment with the following treatments: application of N‐fertilizer for plants, supply of mealworms or sugar solution or their combination as alternative food sources for ants. Three main questions were studied: (1) Do ants reduce tending to honeydew‐producing aphids when an alternative sugar or protein resource was available? (2) Is aphid predation/protein consumption by ants higher when additional carbon is offered to maintain the carbon/protein balance? (3) Does fertilizer treatment propagate in the food web? For the experimental analysis stable isotope techniques were applied. δ15N served as a marker for the pathway from plants to higher trophic levels. Low δ15N‐value of fertilizer spread from plant shoots to aphids and ants. To trace which sugar‐/protein source was consumed by ants, the different13C/12C‐ratios of C3‐ and C4‐plants were used with aphids feeding on C3‐plant material, while mealworm food and sugar solution originated from C4‐plant material. Fertilizer application had no effect on biomasses of plants, consumers or microflora. Ant biomass was significantly higher when additional sugar solution was offered. Higher contents of13C indicated a high incorporation rate of additional sugar. Additional protein had no effect on colony biomass and no increasing predation on aphids could be observed when carbon was in excess. However, due to the lack of queens and newly produced larvae, protein requirements of experimental colonies were lower than in natural systems. Ants positively affected aphid populations, but reduced tending, whilst having access to an alternative sugar resource. When sugar/protein was offered to ants, the host plant had an increased root/shoot ratio. This indicates that decreasing aboveground activity of ants could lead to reduced plant growth of aphid‐infested plants, presumably due to higher fungal attack on shoots.
Morphological and Apoptotic Comparison of Primordial and Primary Follicles in Cryopreserved Human Ovarian Tissue
Authors: Wang LH , Mullen SF , Li Y , Zhong JQ , Crister JK , Chen ZJ
Published: October 2008

Contents

There are few reports which were designed to compare the survival rate of human primary follicles with primordial follicles after cryopreservation. This study was designed to evaluate whether such a difference occurs. Human ovarian biopsies were cryopreserved using dimethylsulphoxide/sucrose as the cryoprotectants. Fresh and cryopreserved ovarian samples were evaluated for viability differences between the two types of follicles using the endpoints of histology, ultrastructure and DNA fragmentation. In comparison with fresh ovarian tissue (83.9% ± 10.0%), the percentage of morphologically normal primordial follicles was not significantly different in cryopreserved tissue (73.9% ± 17.2%). However, a lower percentage of primary follicles with normal morphology was seen in the cryopreserved group (43.3% ± 25.7% vs 74.8% ± 19.4% for the fresh group). Transmission electron microscopy revealed that the cryopreservation did not appear to affect the structural integrity of primordial follicles; however, varying ultrastructural damage to the cytoplasm was observed in the majority of the cryopreserved primary follicles. Using a DNA fragmentation assay, the percentage of apoptotic primordial and primary follicles in the unfrozen (26.3% and 20%) and frozen (23.3% and 25%) ovarian tissue was similar. A higher proportion of primary follicles, compared to primordial follicles, suffer histological damage after slow freezing.
European Eel Sperm Diluent for Short‐term Storage
Authors: Peñaranda DS , Pérez L , Gallego V , Barrera R , Jover M , Asturiano JF
Published: October 2008

Contents

The sperm of European eel shows a high density and the time of spermatozoa motility is very short after activation with sea water. These characteristics make difficult the sperm handling and its quality assessment. Several diluents were previously described for the Japanese eel obtaining over 3 weeks’ conservation times under refrigeration, but they rendered bad results in the European species. In the present study, several diluents were developed taking as basis the P1 medium, and using different dilution ratios (1 : 50, 1 : 100) and two pH (6.5, 8.5). The effect of the addition of bovine serum albumin (BSA, 2% w/v) was also evaluated. At 24 h, undiluted samples already showed significant lower motility and viability than sperm samples diluted in the different media. The results for diluents with pH 6.5 and 8.5 were different. Spermatozoa diluted in media at pH 6.5 cannot be activated at 24 h, while samples diluted in the diluents with pH 8.5 and added with BSA did not show significant differences with respect to the fresh sperm motility until 48 h. The viability (percentage of alive cells) did not show differences until 1 week, independent of the dilution ratio. After 1 week, the motility was approximately 30% in the media containing BSA, which presented no differences for head size of the spermatozoa (perimeter and area) until 72 h and 1 week, respectively. In conclusion, the combination of one medium having similar physico‐chemical characteristics to the seminal plasma, including pH 8.5, and supplemented with BSA can be used in different dilution ratios for the sperm’s short‐term storage, preserving its motility capacity.
Pregnancy Rates in Angus Cross Beef Cows Bred at Observed Oestrus With or Without Second GnRH Administration in Fixed‐Time Progesterone‐Supplemented Ovsynch and CO‐Synch Protocols
Authors: Kasimanickam R , Hall JB , Currin JF , Inman B , Rudolph JS , Whittier WD
Published: October 2008

Contents

Crossbred cows (n = 1073) from five locations had oestrous cycles synchronized with 100 μg of GnRH IM and insertion of controlled internal drug release device (CIDR) on Day 0 followed by 25 mg of PGF2α IM and CIDR removal on Day 7. Kamar® patches were placed on all cows at CIDR removal. Cows were observed three times daily for oestrus after PGF2α administration. In the Ovsynch‐CIDR group, cows detected in oestrus (n = 193) within 48 h after PGF2α were inseminated using the AM–PM rule. Among these cows, 80 received and 113 did not receive a second GnRH at 48 h after PGF2α. Cows (n = 345) not detected in oestrus received a second GnRH at 48 h after PGF2α on Day 9, and fixed‐time AI 16 h after the GnRH on Day 10. In the CO‐Synch‐CIDR group, cows detected in oestrus (n = 224) within 48 h after PGF2α were inseminated using the AM–PM rule. Among these cows, 79 received and 145 did not receive a second GnRH at 64 h after PGF2α. Cows (n = 311) not detected in oestrus received a second GnRH on Day 10 at the time of AI, 64 h after PGF2α. The AI pregnancy rates were not different between the Ovsynch‐CIDR and CO‐Synch‐CIDR groups (p = 0.48). There were no differences in the AI pregnancy rates for cows inseminated at a fixed time (p = 0.26) or at detected oestrus (p = 0.79) between the treatment groups. Among cows inseminated in oestrus, there were no differences in the AI pregnancy rates between cows that received or did not receive the second GnRH (p = 0.47). In conclusion, acceptable AI pregnancy rates can be achieved with or without inclusion of oestrus detection in the Ovsynch‐CIDR and CO‐Synch‐CIDR protocols. Among cows detected in oestrus, cows that received a second GnRH yielded similar pregnancy rates when compared with cows that did not receive the second GnRH.
Evaluating statistics in clinical trials: Making the unintelligible intelligible
Authors: Gilmore Stephen J
Published: October 2008

Medical practitioners should be familiar with the basic principles of statistical testing and analysis, as the critical evaluation of clinical trials is an essential component to the effective practise of evidence‐based medicine. Practitioners also need to be able to identify unethical trial design. The aim of this review is to facilitate an understanding of inferential methodology by introducing some of the basic principles involved in the critical analysis of trial design and interpretation.
Therapy‐related leukaemia cutis: A review
Authors: Weinel Sarah , Malone Janine , Jain Dharamvir , Callen Jeffrey P
Published: October 2008

Leukaemia cutis following chemotherapy for a malignancy is a multifactorial process that is dependent on the chemotherapeutic agent used, the dosing regimen, and the cumulative dose as well as potential contributing therapies such as radiation and possibly even haematopoeitic support from granulocyte colony stimulating factor. In the right combination and in a patient with a conducive milieu of epigenetic factors, leukaemia can develop as a treatment complication. Leukaemia cutis is the specific infiltration of the skin by leukaemic cells and occurs most commonly when the underlying leukaemia is an acute myeloid leukaemia. Although it is well reviewed in the literature as a result of primary leukaemia, leukaemia cutis has only very rarely been reported in association with therapy‐induced leukaemia. This article reviews the factors that contribute to therapy‐related leukaemia and the development of leukaemia cutis.
Meyerson's naevus: A clinical and histopathological study of 11 cases
Authors: Cook‐Norris Robert H , Zic John A , Boyd Alan S
Published: October 2008

We undertook a clinical and histopathological analysis of patients presenting with Meyerson's naevi. Eleven patients with the characteristic histological features of a Meyerson's naevus were identified over a 5‐year period. Diagnostic criteria included epidermal spongiosis and a dermal inflammatory infiltrate associated with a banal junctional or compound naevus. Cases were excluded if naevus cells showed moderate to severe atypia or regression. Patients were contacted by phone and interviewed regarding their lesions. The most common clinical appearance was a solitary, pruritic, erythematous eruption encircling a pre‐existing pigmented naevus. The trunk and proximal upper extremities were preferentially affected. Only one clinician listed Meyerson's naevus in the clinical differential diagnosis. All cases demonstrated a pigmented junctional or compound naevus with epidermal spongiosis, parakeratosis and a perivascular lymphohistiocytic inflammatory infiltrate with scattered eosinophils. The inflammatory infiltrate consisted almost exclusively of CD3+ lymphocytes, the majority of which were CD4+. However, a substantial number were CD8+. In all patients, the lesions cleared with excision or spontaneously, without recurrence or progression to melanoma. The aetiology of this entity remains unclear and most clinicians are unlikely to be familiar with it.
Treatment of lentigo maligna with total circumferential margin control using vertical and horizontal permanent sections: A retrospective study
Authors: R Lee Michael , J Ryman William
Published: October 2008

This retrospective study assesses the long‐term cure rate for the treatment of lentigo maligna using total circumferential margin control with vertical and horizontal permanent sections using life‐table analysis. A cohort of 31 patients in Sydney with lentigo maligna treated with total circumferential margin control with vertical and horizontal permanent sections over a 6‐year period were followed up. Follow up to determine recurrence was obtained by direct examination, by contact with the referring dermatologist, general practitioner, or by telephone interview with the patient's relative if the patient was deceased. Following our total circumferential margin control technique, of the 16 primary tumours, only one recurred (a cure rate of 94%). Of the 15 recurrent tumours, two had recurred. The mean follow‐up time in this study was 42 months (range 12–89 months). Kaplan–Meier analysis estimated that at 5 years, 87% of patients would be free from disease (95% confidence interval 70–100%). Seventy‐five per cent of the population can be expected to be disease‐free for 6 years (lower 95% confidence limit 4 years). We describe the use of total circumferential margin control with vertical and horizontal permanent sections for the treatment of lentigo maligna that we believe is simple, effective and reproducible.
Melanization in basal cell carcinomas: Microscopic characterization of clinically pigmented and non‐pigmented tumours
Authors: Tan Wee‐Ping , Tan Audrey Wei‐Hsia , Ee Hock‐Leong , Kumarasinghe Prasad , Tan Suat‐Hoon
Published: October 2008

Clinical and microscopic pigmentation may affect the treatment outcomes in basal cell carcinoma. However, there have not been any in‐depth histopathological comparisons between clinically pigmented and non‐pigmented basal cell carcinomas with regards to microscopic melanization. The aims of our study were to determine the proportion of pigmented basal cell carcinomas presenting to the National Skin Centre in Singapore, to characterize the histological pattern of melanization and to perform a semi‐quantitative analysis of the degree of microscopic melanization of the tumours. Patients with clinical features and histologically confirmed basal cell carcinomas were recruited. Demographic data and clinical characteristics were recorded and basal cell carcinoma sections were examined for histological subtype and pattern of melanization. Twenty‐five Chinese patients with 30 basal cell carcinomas were recruited. Three of the five clinically non‐pigmented and all of the clinically pigmented basal cell carcinomas had microscopic evidence of melanization. Microscopic melanization in clinically non‐pigmented basal cell carcinomas was present only focally or in the centre of the tumour mass. Both groups of basal cell carcinomas may be colonized by melanocytes. Two morphological types of melanocytes, a dendritic and round cell type, were identified. Future research is required to evaluate if the degree of microscopic melanization influences the treatment outcome of basal cell carcinomas.
Annular lesions in Kawasaki disease: A cause of confusion
Authors: Ming Andrew , Wargon Orli
Published: October 2008

We present three cases of Kawasaki disease in which an annular eruption was the predominant cutaneous finding. The provisional diagnosis was Stevens–Johnson syndrome. However, the annular lesions were not typical of Stevens–Johnson syndrome: the lips were crusted without mucosal ulceration and the conjunctivitis was non‐purulent without corneal erosions. Dermatologists are often involved in the initial assessment of this multisystem disease and should be aware of the variety of cutaneous manifestations, as rapid treatment is known to decrease morbidity and mortality.
Basal cell carcinoma of the vulva: A report of four cases
Authors: DeAmbrosis Kathryn , Nicklin James , Yong‐Gee Simon
Published: October 2008

Four cases of vulval basal cell carcinoma were identified in multiparous females aged 46–78 years. Symptoms included discomfort and pruritus ranging from 6 weeks to 4 years in duration. Such symptoms occurred in the context of a pink vulval plaque. The non‐specific symptoms, in the context of the particular anatomical site, led to late presentation. Subsequent treatment in all cases involved wide local excision following incisional biopsy. No recurrence has been documented after a minimum follow‐up period of 12 months.
Hyperpigmentation, nail dystrophy and alopecia with generalised intestinal polyposis: Cronkhite–Canada syndrome
Authors: Ho Vincent , Banney Leith , Falhammar Henrik
Published: October 2008

A 62‐year‐old Malaysian woman presented with a constellation of skin signs including alopecia, hyperpigmentation and nail dystrophy. On questioning, a history of diarrhoea, taste disturbance and weight loss was found. The onset of these changes coincided with the administration of thyroxine prescribed for a benign multinodular goitre. Hormonal investigations showed no abnormality and no underlying malignancy was found. Investigation of the diarrhoea showed a protein‐losing enteropathy with generalized intestinal polyposis and non‐specific histology. A diagnosis of Cronkhite–Canada syndrome was made. Treatment with prednisone and nutritional support has been partially effective.
Leprosy: Recognizing red flags
Authors: Pearce Victoria , Horton Jeremy J
Published: October 2008

A 28‐year‐old man from the Philippines presented with multiple papules and plaques symmetrically distributed on the arms and legs. This was associated with worsening paraesthesia of the hands and feet. A right common peroneal nerve decompression had been performed 2 years earlier. He was diagnosed with multibacillary leprosy on skin biopsy and subsequently treated with oral rifampicin, clofazamine and dapsone.
Complex regional pain syndrome after dermatological surgery
Authors: Kumar Sandeep , Mackay Catherine , O'Callaghan James , De'Ambrosis Brian
Published: October 2008

We report a case of complex regional pain syndrome developing in a 57‐year‐old woman after minor skin surgery in the sole of her right foot. This was diagnosed and treated in its early phase with sympathetic blockade using guanethedine with complete recovery of symptoms.
Dermal vacuoles in two biopsies of psoriasis
Authors: Ayva Sebnem , Erkek Emel , Atasoy Pinar
Published: October 2008

Two patients presented with cutaneous lesions clinically typical of psoriasis. The first case was a 38‐year‐old man and the second was a 51‐year‐old woman. To confirm the diagnosis, 4‐mm punch biopsy samples were obtained from both patients from the lesions on the knees. Histology in both cases was in favour of psoriasis and also revealed empty vacuoles in the papillary dermis, concentrated at sites of intense lymphocyte infiltration. The empty vacuoles resembled true fat cells or fat globules. They did not reveal positive immunostaining with CD34 antigen, suggesting that they were not lined by endothelial cells. Final histological diagnosis was psoriasis associated with dermal vacuolization.
Prolidase deficiency: The use of topical proline for treatment of leg ulcers
Authors: Dunn Rebecca , Dolianitis Con
Published: October 2008

A 41‐year‐old man with prolidase deficiency has had chronic leg ulcers and recurrent cellulitis for most of his life. Until recently he had been hospitalized at least annually for this and suffered significant morbidity as a result. Since commencing topical 5% proline in white soft paraffin ointment to treat the leg ulcers, there has been marked improvement in the ulcers and decreased frequency of hospitalizations for cellulitis. This lends further support to the use of topical proline in the treatment of patients with skin ulcers secondary to prolidase deficiency.
Fatal delayed presentation of primary melanoma of the penis
Authors: Tritton Sara M , Shumack Stephen , Fischer Gayle
Published: October 2008

A 60‐year‐old man presented with a 3‐week history of lethargy, anorexia, breathlessness at rest, nausea and vomiting. He had a 5‐year history of an undisclosed, enlarging, pigmented mass on his penis. He refused biopsy of this lesion. Fine‐needle aspirate of an enlarged inguinal lymph node histologically confirmed a diagnosis of melanoma and widespread metastases were demonstrated by radiological imaging. The patient succumbed to disease within 8 days of diagnosis. Primary penile melanoma, albeit rare, is an important and sensitive dermatological problem, often leading to delayed presentation.
C‐reactive protein and other predictors of poor outcome in patients hospitalized with exacerbations of chronic obstructive pulmonary disease
Authors: RUIZ‐GONZÁLEZ Agustín , LACASTA Daniel , IBARZ Mercedes , MARTÍNEZ‐ALONSO Montserrat , FALGUERA Miquel , PORCEL José M.
Published: October 2008

Background and objective:  CRP is elevated in patients with acute exacerbations of COPD (AECOPD), but there is little information on whether this biomarker can help to identify adverse short‐term clinical outcomes.

Methods:  A 6‐month prospective study of all patients with AECOPD requiring hospital admission. Clinical, laboratory (including plasma CRP levels at admission) and functional data were recorded. The outcome variable (the adverse outcome) consisted of: (i) death in hospital or within 15 days of discharge, (ii) transfer to the intensive care unit, or (iii) development of acute heart failure during hospitalization.

Results:  Data from 147 patients with a total of 160 admissions were recorded. During follow up, 38 (23.7%) adverse outcomes were observed, including 13 (8.8%) and 8 (5.4%) patients who died during hospitalization or within 15 days of discharge, respectively. CRP at a level of 50 mg/L was related to an adverse outcome (OR 4.9, 95% CI: 1.92–12.6, P < 0.01), although by itself it was neither sensitive nor specific (area under the receiver operating characteristic curve (AUC) 0.69, 95% CI: 0.60–0.77). However, a risk score derived from the combination of CRP with other variables, such as ‘current smoker’, ‘at least two comorbidities’ and ‘confusion,’ at admission showed good predictive ability to identify an adverse outcome (AUC of 0.80, 95% CI: 0.72–0.88).

Conclusions:  Plasma CRP in combination with other variables obtained at admission may assist identification of high‐risk patients with AECOPD.
Serum pro‐hepcidin levels in term and preterm newborns with sepsis
Authors: Yapakçı Ece , Tarcan Aylin , Çelik Banu , Özbek Namık , Gürakan Berkan
Published: October 2008

Background:  An iron regulatory peptide hormone, hepcidin, is also part of the innate immune system and is strongly induced during infections and inflammation. The aim of the present study was to determine serum levels of the 60 aa pro‐hormone form of hepcidin (pro‐hepcidin) in full‐term and preterm newborns with sepsis and to determine the possible relationships between pro‐hepcidin levels and serum iron and complete blood count parameters.

Methods:  Fifteen preterm newborns with sepsis, 17 healthy preterm, six full‐term newborns with sepsis and 16 healthy full‐term newborns were included the study. Blood samples were collected from patients with sepsis at the time of clinical diagnosis. Each blood sample was analyzed for complete blood count, serum iron and ferritin concentrations, iron‐binding capacity, and pro‐hepcidin level.

Results:  The mean serum pro‐hepcidin level (mean ± SD) in preterm neonates with sepsis and in healthy preterm newborns was 565.4 ± 519.5 ng/mL and 279.8 ± 227.6 ng/mL, respectively (P < 0.05). The mean serum pro‐hepcidin level in full‐term newborns with sepsis and in healthy full‐term neonates was 981.4 ± 415.4 ng/mL and 482 ± 371.9 ng/mL, respectively (P < 0.05). Although the mean serum ferritin levels in the two groups with sepsis were higher when compared with the healthy groups, the difference was not statistically significant in full‐term newborns. No statistically significant correlations were found between serum pro‐hepcidin levels and any other parameters in each group.

Conclusions:  Serum pro‐hepcidin levels were higher in newborns with sepsis (either premature or full‐term) than they were in healthy newborns at the time of clinical diagnosis.
Is thrombocytopenia suggestive of organism‐specific response in neonatal sepsis?
Authors: Manzoni Paolo , Mostert Michael , Galletto Paolo , Gastaldo Luca , Gallo Elena , Agriesti Giovanni , Farina Daniele
Published: October 2008

Background:  It is controversial whether thrombocytopenia is suggestive of one (or more) causative agents of neonatal sepsis: a low platelet count has been related in turn to Gram‐positive, Gram‐negative or fungal sepsis.

Methods:  A retrospective, cohort study on 514 very low‐birthweight (VLBW) neonates admitted over a 9 year period to a large tertiary neonatal intensive care unit (NICU) in Italy was carried out. Through database search, data on platelet counts, sepsis, clinical course, and microbiological culture were collected and analyzed. Statistical analysis was performed to look for significant association between thrombocytopenia and sepsis caused by different (Gram‐positive, Gram‐negative or fungal) organisms.

Results:  Sepsis diagnosed on microbiological criteria occurred in 197 of 514 VLBW neonates (38.3%), and thrombocytopenia (at least one finding of platelet count <80 000/mm3) was detected in 34 (17.2%) of the 197 septic infants. Thrombocytopenia occurred in 10 of 51 neonates with fungal sepsis (19.6%), and in 24 of 146 with bacterial sepsis (16.4%; P = 0.37). The difference was not significant when clustering for sepsis caused by Gram‐positive (nine thrombocytopenic of 51 with Gram‐positive sepsis, 17.6%; P = 0.40) and Gram‐negative organisms (15/95, 15.7%; P = 0.22), or when considering only coagulase‐negative Staphylococcus sepsis (6/37, 16.2%; P = 0.25).

Conclusions:  In contrast with previous reports, thrombocytopenia might not be an organism‐specific marker of sepsis. Caution should be maintained in relating a low platelet count to any infectious agent (or group of agents) in preterm VLBW neonates.
Intravenous luteinizing hormone‐releasing hormone has no effect on serum N‐terminal pro‐brain natriuretic peptide in children and adolescents
Authors: Norozi Kambiz , Binder Lutz , Brack Christoph , Potthoff Ludger , Hess Georg , Wessel Armin
Published: October 2008

Background:  Little is known about the acute effects of i.v. luteinizing hormone‐releasing hormone (LHRH) on the heart function, therefore the aim of the present study was to measure N‐terminal pro‐brain natriuretic peptide (N‐BNP) in children, who underwent a diagnostic work up for short stature or delayed puberty.

Methods:  N‐BNP was measured in 52 children before and after administration of LHRH. Serum N‐BNP obtained from 255 healthy children and adolescents (aged birth–18.3 years) served as a reference.

Results:  There was no significant difference between baseline N‐BNP of children who underwent the LHRH diagnostic test and their healthy peers. There was no significant serum N‐BNP level change before or after administration of LHRH (59 ± 36 pg/mL vs 58 ± 34 pg/mL). N‐BNP fell from 399 ± 425 pg/mL in newborns and reached 44 ± 36 pg/mL in children aged 12–18 years.

Conclusion:  Short stature or delayed puberty had no effect on heart function determined by serum N‐BNP; i.v. LHRH does not acutely influence the level of serum N‐BNP.
Congenital cardiac malformations in neonates with apparently isolated gastrointestinal malformations
Authors: Olgun Hasim , Karacan Mehmet , Caner Ibrahim , Oral Akgun , Ceviz Naci
Published: October 2008

Background:  The association of congenital cardiac malformations (CCM) with malformations of the gastrointestinal tract/abdominal wall is known. Nevertheless, the data presently available are derived from patient populations that include some special conditions known to be associated with a high rate of CCM. The aim of the present study was therefore to determine the incidence of cardiac malformations among neonates with apparently isolated malformations of the gastrointestinal tract/abdominal wall.

Methods:  A total of 201 neonates with apparently isolated gastrointestinal malformations were screened on echocardiography.

Result:  Thirty‐six (17.9%) of the neonates were diagnosed as having a CCM. When the four most frequent gastrointestinal malformations were evaluated, a CCM was diagnosed in 11/69 (15.9%) with anal atresia, in 9/38 (23.7%) with tracheoesophageal fistula/esophageal atresia, in 2/25 (8%) with diaphragmatic hernia and in 5/17 (29.4%) with intestinal atresia. In 11 of 36 patients (30.6%) with CCM, the cardiac problems were hemodynamically significant, requiring anti‐congestive and/or surgical treatment.

Conclusion:  A significant number of neonates with apparently isolated gastrointestinal malformations had CCM. Because almost all patients with malformations of the gastrointestinal tract/abdominal wall require early surgical intervention, they should be evaluated on echocardiography to investigate CCM at the earliest opportunity.
Three‐dimensional 26‐core biopsy‐based patient selection criteria for nerve‐sparing radical prostatectomy
Authors: Numao Noboru , Kawakami Satoru , Yonese Junji , Koga Fumitaka , Saito Kazutaka , Fujii Yasuhisa , Ishikawa Yuichi , Fukui Iwao , Kihara Kazunori
Published: October 2008

Objectives:  Most of the previously reported patient selection criteria for nerve‐sparing radical prostatectomy were based on conventional sextant biopsy, and those based on extended biopsy have been scarcely investigated. In the current study, we developed patient selection criteria for nerve‐sparing RP based on the three‐dimensional 26‐core (3D26) biopsy‐derived variables.

Methods:  We evaluated 202 non‐nerve‐spared sides in 109 consecutive patients in whom prostate cancer was diagnosed by the 3D26 biopsy and who underwent RP without neoadjuvant treatment. Associations of clinical and pathological variables with side‐specific posterolateral extraprostatic extension (SS‐PL‐EPE) were analyzed. Subgroup analysis using transperineal 14‐core (TP14) and transrectal 12‐core (TR12) biopsies as representative subsets of the 3D26 biopsy was also performed.

Results:  Maximum cancer length in positive cores ≥5 mm and biopsy Gleason score ≥4 + 3 were independent and were significant risk factors of SS‐PL‐EPE in the 3D26 cohort at multivariate analysis. In the prostatic side with none, one, and two risk factors, the incidences of SS‐PL‐EPE were 0, 14 and 52% in the 3D26 cohort, 3.4,15 and 57% in the TP14 cohort and 2.6, 20 and 61% in the TR12 cohort, respectively.

Conclusions:  We developed simple patient selection criteria for nerve‐sparing RP. According to our criteria, the nerve‐sparing side can be selected in the majority of patients who undergo the 3D26, TP14 or TR12 biopsy with a less‐than‐4% risk of SS‐PL‐EPE.
Effects of a novel β3‐adrenoceptor agonist, AJ‐9677, on relaxation of the detrusor muscle: Anin vitrostudy
Authors: Otsuka Atsushi , Shinbo Hitoshi , Hasebe Ko , Matsumoto Rikiya , Ozono Seiichiro
Published: October 2008

Objectives: To examine the relaxant effects of AJ‐9677, a novel β3‐adrenoceptor agonist, on the isolated rat, monkey and human detrusor muscle.

Methods: The isolated detrusor strips of rats, monkeys and humans were mounted in organ baths containing Krebs solution. By the cumulative addition of β‐adrenoceptor agonists (isoproterenol, AJ‐9677, CL 316,243 and salbutamol in rats; isoproterenol, AJ‐9677 and CL 316,243 in monkeys and humans), concentration–relaxation curves were obtained. The maximal relaxation responses and pEC50values were calculated. In rats, concentration–relaxation curves to isoproterenol and AJ‐9677 were obtained in the presence and absence of propranolol or SR 59230A.

Results: Isoproterenol, AJ‐9677, CL 316,243 and salbutamol induced concentration‐dependent relaxation in rats. The rank order of their relaxing potency in the rat detrusor muscle was AJ‐9677 > isoproterenol > CL 316,243 > salbutamol. Isoproterenol and AJ‐9677 also produced a concentration‐dependent relaxation with high potency in monkeys and humans, whilst CL 316,243 had low relaxing potency. According to the antagonist studies in rats, propranolol and SR 59230A caused a rightward shift of the concentration–relaxation curves to isoproterenol or AJ‐9677, respectively.

Conclusions: AJ‐9677 has a high relaxant potency on the rat, monkey and human detrusor smooth muscle, and it may have the potential to treat overactive bladder.
Hand‐assisted laparoscopic radical cystectomy and extracorporeal urinary diversion: Experience with 31 cases
Authors: Wang Sheng‐zheng , Chen Ling‐wu , Chen Wei , Zhang Yong‐hai
Published: October 2008

Objectives:  To report our techniques and experience with hand‐assisted laparoscopic radical cystectomy and extracorporeal urinary diversion for bladder cancer.

Methods:  Between May 2004 and November 2007, 31 patients (mean age 61.3 years, range 40–79) underwent hand‐assisted laparoscopic radical cystectomy with extracorporeal urinary diversion for bladder cancer. Five patients had previously undergone abdominal surgeries. Data were collected with respect to patient demographics, perioperative outcomes and short‐term oncological follow up.

Results:  Twenty‐four patients underwent an ileal conduit and seven patients underwent an orthotopic neobladder. Mean operative time was 365.7 min (range 245 to 530). Estimated blood loss was 250.9 cc (range 100 to 500), with a transfusion rate of 9.7%. Oral liquids were resumed at 4.3 days and the mean hospital stay was 19.7 days. There were no intraoperative complications. Postoperative early complications (within 30 days of surgery) occurred in six patients (19.4%). Two wound infections, one urinary leak, one wound dehiscence, one bowel obstruction and one alimentary tract hemorrhage were all treated conservatively. Late complications occurred in three patients (two parastomal hernias and one ureteroenteric stricture). With a mean follow up of 18 months, 27 patients had no evidence of disease. One patient died because of cancer and one died for unrelated causes. One was alive with local recurrences and one with lung metastasis.

Conclusions:  Hand‐assisted laparoscopic radical cystectomy is a safe, reproducible and minimally invasive option for bladder cancer patients.