bluuebunny/crossref_metadata_2025 huggingface dataset:
Buckling of Columns Subjected to a Central Force Produced by a Tensioned String
Authors: Sugiyama Yoshihiko , Masuyoshi Ikko
Published: July 2003

The paper is concerned with a new buckling problem of columns subjected to a central force produced by the tension of a string. The central force can be characterized by having a movable center fixed on the deformed axis of a column at its intermediate position. Equilibrium equations of the column, together with the boundary conditions and the conditions of continuity, lead to the characteristic determinant. The characteristic determinant yields the buckling load, and then the buckling mode. If the intermediate center is set at the midspan of the column, the characteristic equation yields a double root. The double root makes buckling mode indeterminate. This fact is an interesting aspect of the present buckling problem. The imperfection method is applied to discuss a possible buckling mode. Experiment of the column was conducted to check the theoretical prediction. The theoretical buckling load and the corresponding buckling modes are compared with the experimental results to find a good agreement between the theory and the experiment.
Effect of Vertical Ground Motions on Horizontal Response of Structures
Authors: Ambraseys N. N. , Douglas J.
Published: July 2003

Single-degree-of-freedom (SDOF) elastic models are commonly used for gaining an understanding of the response of structures to earthquake ground motions. The standard SDOF model used does not account for the effect of gravity or the combined effect of horizontal and vertical excitations on horizontal response. The purpose of this paper is to review previous work on this topic and to investigate a series of SDOF models that do incorporate these effects and to compare their response to the response of the standard model using 186 strong-motion records of near-field earthquake ground motions. It is found that for most realistic SDOF models and most earthquake ground motions the effect of vertical excitation on horizontal response is small.
Activity-based Knowledge Management Systems
Authors: Hasan H. , Gould E.
Published: July 2003

This paper explores the design of computer-based systems that support the management of organisational knowledge. The information systems notions of databases and information architectures are extended to the search for a meaningful conceptual structure by which collective knowledge can be supported by existing information technologies. An "architecture" is presented where the key unit of analysis is human activity as proposed by the cultural–historical activity theory. This architecture has the richness of the activity theory philosophy and yet addresses the issues of practical implementation from both the technical and organisational perspectives. The paper articulates the architecture and also reports on a study where its effectiveness was evaluation by a target group. An implementation of the architecture is also introduced.
Knowledge Exchange Protocols: A Second Study
Authors: Herschel Richard , Nemati Hamid , Steiger David
Published: July 2003

In the knowledge management domain, the conversion of tacit knowledge to explicit knowledge is critical because it is a prerequisite to the knowledge amplification process wherein knowledge becomes part of an organization's knowledge network. Moreover, this process is strategically important because it enhances an organization's ability to create new knowledge that is inevitably expressed through the organization's capabilities, products, and services. The conversion of tacit to explicit knowledge is particularly relevant to information technology (IT), because IT can only partially facilitate tacit knowledge management, while it offers a substantial number of techniques to support the management and sharing of explicit knowledge. In this paper, knowledge exchange protocols are examined as a vehicle for improving the tacit-to-explicit knowledge conversion process. In a second experiment testing the use of knowledge exchange protocols, initial findings are confirmed: while structure may significantly improve the tacit-to-explicit knowledge conversion process, it also matters how the structure is employed in this process.
Biliary Excretion of Phenolphthalein Sulfate in Rats
Authors: Tanaka Hiroyuki , Sano Naoyo , Takikawa Hajime
Published: July 2003

Glucuronide and glutathione conjugates have been reported to be substrates of multidrug resistance protein 2 (Mrp2), whereas sulfates of nonbile acid organic anions have never been reported as substrates of Mrp2. To further examine the substrate specificity of Mrp2, we examined the effects of bile acid sulfates on the biliary excretion of phenolphthalein sulfate in rats. The biliary excretion of phenolphthalein sulfate was markedly delayed in Eisai hyperbilirubinemic rats, an Mrp2-deficient strain, and was markedly inhibited by taurolithocholate-3-sulfate. The biliary excretion of leukotriene C4 metabolites and sulfobromophthalein was inhibited by phenolphthalein sulfate infusion to some extent. These findings suggest that phenolphthalein sulfate is a unique sulfated nonbile acid organic anion which is a substrate of Mrp2.
Anxiolytic Effects of Acute Morphine Can Be Modulated by Nitric Oxide Systems
Authors: Shin Im-Chul , Kim Hyoung-Chun , Swanson Jeffrey , Hong Jin-Tae , Oh Ki-Wan
Published: July 2003

This study was performed to investigate whether nitric oxide (NO) precursor (L-arginine), NO donor (S-nitroso-N-acetylpenicillamine, SNAP) and NO synthase inhibitors [NG-nitro-L-arginine-methylester (L-NAME) and NG-nitro-L-arginine (L-NOARG)] modulate morphine-induced anxiolytic effects in the plus-maze. L-Arginine (100, 200 and 300 mg kg–1, i.p.) and SNAP (4, 8 and 10 mg kg–1, i.p.) reduced the anxiolytic effect of morphine (20 mg kg–1, s.c.). L-NAME (10, 20 and 40 mg/kg, i.p.) and L-NOARG (10, 15 and 20 mg kg–1, i.p.) enhanced the anxiolytic effects of morphine (20 mg kg–1, s.c.). On the other hand, L-arginine and SNAP increased the morphine-induced locomotor activity. L-NAME decreased the morphine-induced locomotor activity, but L-NOARG did not modify the morphine-induced locomotor activity. Therefore, these results suggest that the anxiolytic effects of morphine can be modulated by NO systems.
The Cornell University Experience
Authors: Chervenak Frank A. , McCullough Laurence B.
Published: July 2003

The authors provide an account of their 20-year-old history of collaborative research and publication at Cornell University on ethics in fetal diagnosis and therapy. This research first developed and applied a conceptual framework for ethics in maternal-fetal medicine based on the concept of the fetus as a patient. The basic elements of this framework are described, as well as their application to fetal diagnosis and fetal therapy. Related topics, including obstetrics and gynecology, clinical medicine, managed care, and the ethical dimensions of medical leadership, are also briefly described.
Etiology and Outcome of Fetal Echogenic Bowel
Authors: Kesrouani Assaad K. , Guibourdenche Jean , Muller Françoise , Denamur Eric , Vuillard Edith , Garel Catherine , Delezoide Anne Lise , Eydoux Patrice , Tachdjian Gerard , Lebon Pierre , de Lagausie Pascal , Sibony Olivier , Bauman Clarisse , Oury Jean-François , Luton Dominique
Published: July 2003

Objective: To assess the frequency of certain etiologies in fetal echogenic bowel and the related pregnancy outcome. Study Design: A retrospective study including 215 cases. Ultrasound findings included bowel abnormality, malformations, growth retardation and Doppler abnormalities. Amniocentesis was performed in 196 cases to screen for abnormalities in karyotype, cystic fibrosis gene and infection. The color of amniotic fluid and a history of first-trimester bleeding were also noted. Outcome according to different etiologies was reported. Results: 112 cases (57%) had a known etiology, which included chromosomal abnormality (7%), infection (4%), cystic fibrosis (1.5%), bowel abnormality (3%), bleeding or stained amniotic fluid (11%), Doppler abnormality (14%), malformation (16%) and miscellaneous (0.5%). Pregnancy was terminated in 39 cases and fetal demise complicated one third of the cases (13) of severe growth retardation. Conclusion: Fetal echogenic bowel should be investigated and a careful follow-up is necessary if there is associated Doppler perturbation or growth retardation.
A Case of Fetal Subdural Hematoma at 31 Weeks of Gestation in a Woman on Warfarin Therapy after Cabrol’s Operation
Authors: Matsuda Yoshio , Hashiguchi Kazunari , Akizawa Yoshika , Saito Rie , Ohta Hiroaki
Published: July 2003

The case of a complicated pregnancy of a woman who had undergone Cabrol’s operation, and whose baby suffered from subdural hematoma is presented. Although the outcome of this case was not so severe, we would like to inform about the risk to both the mother and her fetus as a result of serious complications.
Evolution of the Amniotic Sac and Extracelomic Space as Seen by Early Ultrasound Examination
Authors: Santolaya-Forgas Joaquin , De Leon-Luis Juan , D’Ancona Roberto Levy , Morgan Jeffrey , Kauffman Robert P.
Published: July 2003

Objective: Amniotic sac and extracelomic space changes occurring from 5 to 14 weeks of pregnancy were observed with transvaginal ultrasound to gain new insights into their normal relationships during this time period. Study Design: Ninety-seven women from 5 to 15 weeks’ gestation were enrolled in the study. Gestational age was determined by measuring embryonic crown-rump length. The embryo, amniotic sac, and gestational sac areas were measured using the best-fitted computer-generated elliptical view. The embryonic heart rate was measured using the M-mode function of the ultrasound equipment. Associations were determined using the least-squares method and Pearson’s correlation coefficient. Results: Mean (range) gestational age calculated from CRL was 9.6 (5.3–14.6) weeks, embryonic heart rate 153 (100–188) beats per minute, embryonic surface 699.6 (5–2,199) mm2, amniotic sac surface 1,383 (5–5,335) mm2 and gestational sac surface was 1,517 (110–5,335) mm2. Significant correlations between gestational sac surface, amniotic sac surface, embryonic surface, heart rate and gestational age were noted (p < 0.01). Changes in the amniotic sac surface correlated with embryonic surface but not with heart rate even when multiple regression analysis was attempted. Conclusion: These data describe the normal relationships between the embryonic, amniotic sac, extracelomic space, and gestational sac surface, suggesting that increases in embryonic surface area is a determining factor for early expansion of the amniotic sac at these gestational ages.
Congenital Craniopharyngioma: A Role for Imaging in the Prenatal Diagnosis and Treatment of an Uncommon Tumor
Authors: Kolen E.R. , Horvai A. , Perry V. , Gupta N.
Published: July 2003

Ultrasonography and magnetic resonance imaging performed upon a male fetus at 32 and 36 weeks gestation, respectively, revealed a large suprasellar mass. A male newborn, delivered at 37 weeks, required ventilatory assistance at birth and subsequently developed myoclonic seizures, hypertension, and bradycardia. The intracranial mass was felt to be inoperable and the patient expired shortly after support was withdrawn. Autopsy results were consistent with a congenital craniopharyngioma. We discuss the differential diagnosis for this mass lesion based on prenatal imaging as well as distinguishing features on imaging studies that may aid in the prenatal diagnosis and treatment of this benign tumor.
Spectral Analysis of Fetal Heart Rate Variability in Fetuses with Supraventricular Extrasystoles
Authors: Troeger Carolyn , Schaub Andreas F. , Bernasconi Paolo , Hösli Irene , Holzgreve Wolfgang
Published: July 2003

Objective: Fetal heart rate (FHR) variability is an important indicator of fetal well-being. In fetal tachyarrhythmias, however, visual analysis of FHR variability is limited. We therefore applied power spectral analysis of FHR to evaluate the fetal state. Methods: Fetal R-R intervals were detected by means of an external ECG in 3 fetuses with supraventricular extrasystoles after cardiac malformations had been excluded by fetal echocardiography. Using an autoregressive model, power spectral densities were calculated from 20 consecutive 256-beat segments for the following frequency bands: <0.03 Hz (very low frequency), 0.03–0.069 Hz (low frequency; LF), 0.07–0.129 Hz (mid-frequency) and 0.13–1.0 Hz (high frequency; HF). Results: The FHR variability in fetal supraventricular extrasystoles mainly resulted from the HF component (63.91 ± 6.97%). The sympatho-vagal balance (LF/HF) was decreased in the tracings with extrasystoles (0.13). Conclusion: The analysis of FHR variability in fetal supraventricular extrasystoles revealed an imbalance between sympathetic and parasympathetic regulation.
Assessment of Quality of Life in Pharmacological Treatment of Atrial Fibrillation
Authors: Engelmann Mads D.M. , Godtfredsen John
Published: July 2003

Atrial fibrillation (AF) is the most common arrhythmia resulting in hospital admission. The mainstay of treatment for AF is pharmacological control with the aim of reducing symptoms, preventing complications and improving quality of life (QoL). However, the quality of QoL research in AF is suboptimal, and the impact of pharmacologic treatment on QoL is far from established. In the present review, basic definitions and instruments used in QoL research are introduced and the methodological problems in some of the more recent studies on QoL in AF are emphasized. Among these are heterogeneity of study groups, small sample size, lack of a control group and the use of nonvalidated QoL instruments. Finally, a set of eight criteria to be fulfilled when planning future studies on QoL in AF is proposed, criteria that hopefully may act as an inspiration for investigators planning future studies on QoL in pharmacologic treatment of AF.
Nuclear Cardiology Core Laboratory: State of the Art
Authors: Simões Marcus V. , Neverve Jodi , Schwaiger Markus , Nekolla Stephan G.
Published: July 2003

Considering the low mortality rate related to cardiovascular diseases achieved by the currently available therapeutic options, proving the superiority of a new drug/intervention over standard treatment using mortality as the end point requires the inclusion of several thousands of patients in a prospective randomized clinical trial. The high costs involved in such trials represent a severe limitation for the development of new therapeutic strategies. At the same time, however, there is increasing acceptance that cardiac functional parameters, changes in which are directly related to the beneficial effect of an intervention, can be used as surrogate end points in small-sample size pilot-phase studies. This study design has been shown to be advantageous not only regarding cost-saving aspects but also for providing objective evaluation of the beneficial effect of a new treatment. In addition, the design helps in establishing the number of patients to be included in the definitive trial as well as determining the best dosage to be used. This review describes the available information supporting the use of nuclear cardiology imaging to reliably assess multiple cardiac function parameters constituting adequate surrogate end points for the assessment of therapeutic effects in several cardiovascular diseases. In addition, the technical aspects, feasibility and clear advantages of the use of nuclear cardiology core laboratories for centralized imaging processing/analysis in the context of multicenter clinical trials are also presented.
Effect of Local Antifungal Treatment on Nasal Polyposis
Authors: Ricchetti Alma , Landis Basile N. , Giger Roland , Zheng Chungkuan , Lacroix Jean-Silvain
Published: July 2003

Nasal polyposis (NP) is considered as the ultimate stage of chronic rhinosinusitis. The exact pathogenesis of NP is unknown, but recent studies have suggested that allergic fungal rhinosinusitis could be involved in the development of NP. The aim of the present study was to evaluate the effects on NP of an intranasal administration of a fungicide suspension. One hundred and fifteen consecutive patients suffering from NP over 6 months were included. Patients in group I (n = 75) performed nasal lavages with 20 ml of a 1‰ amphotericin B suspension in each nostril, twice a day, during 4 weeks. Patients in group II (n = 40) used the same amphotericin B suspension as a nasal spray twice a day (total volume 800 µl) for 4 weeks. All patients continued their saline nasal lavages and their treatment with a conventional topical corticosteroid spray (400 µl/day). After antifungal nasal lavages, total disappearance of NP was observed in 29 patients (39%). Following fungicide nasal spray, total disappearance of NP was found in 17 patients (43%). In patients who had had previous endoscopic sinus surgery, total disappearance of NP was seen in 48 and 64% of patients from groups I and II, respectively. The beneficial effects of nasal lavage versus nasal spray with a fungicidal suspension are similar. Hyperreactivity to fungal organisms could be one of the mechanisms underlying the development of NP. However, a direct effect of amphotericin B suspension on the integrity of the cell membranes of the polyp epithelium could not be excluded.
Aetiological Considerations on Chronic Sinusitis and Therapeutic Consequences
Authors: Passàli D. , Passàli G.C. , Damiani V. , Passàli F.M. , Bellussi L.
Published: July 2003

The therapeutic rationale of acute or chronic rhinosinusal inflammatory disease must necessarily be based on the correct identification of the microbiological agents involved in causing the sinus affection. In our experience, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the germs responsible for most of the acute forms found in our country, in adults and children alike. In 1997, the FDA approved the use of antibiotics such as amoxicillin/clavulanic acid, clarithromycin, cefuroxime axetil, loracarbef and levofloxacin for acute forms. According to our experience, the administration of amoxicillin/clavulanic acid would appear to be particularly effective, also in the relapse of chronic forms. Regarding the duration of antibiotic treatment, consensus is practically unanimous. In acute rhinosinusitis, the therapy should be given for at least 10 days at full dosage. The duration of treatment may be extended up to 14 days at the physician’s discretion in the more serious cases of infection and in the case of debilitated patients. In the chronic forms, the common literature indicates a therapy targeted at eradication of coagulase-positive and coagulase-negative staphylococci and anaerobes having a duration of less than 5 weeks. In our opinion, chronic histological modifications of the sinoidal mucosa represent conditions of risk for the appearance of acute episodes, which should necessarily be treated with medical therapy. When the acute episodes recur with incessant regularity, leading to important problems and causing a decrease in quality of life, then functional surgery should be considered.
The Dizziness Maze
Authors: Belal Aziz
Published: July 2003

Dizziness is still one of the perplexing diagnostic mazes in medicine. To go through the maze, a road map for the diagnosis of the dizzy patient is outlined. In this map, navigation along 5 different routes, i.e. diagnostic questions, leads to 10 different destinations, i.e. clinical presentations of dizziness. Each destination has its own anatomical diagnosis, etiological diagnosis and line of suggested diagnostic tests. This road map ensures reaching a rational diagnosis in over 90% of dizzy patients without wasting the physician’s time or ordering unnecessary costly tests for the patient.
The Efficacy of Cryosurgery Combined with Laser Surgery in the Treatment of Perennial Allergic Rhinitis
Authors: Furukawa Masayuki , Kakimoto Shingo , Himeno Chiemi , Yamashita Toshio
Published: July 2003

A combined treatment of laser surgery to the inferior turbinate and transnasal cryodegeneration of the vidian nerve using endoscopy were evaluated. The study consisted of 79 patients with perennial allergic rhinitis caused by house dust. All were refractory to conservative treatment, including allergic desensitization. The CO2 laser surgery was repeated once a week for 3 weeks. After the third laser surgery, the area that was endoscopically estimated to be the sphenopalatine foramen was frozen over the mucous membrane by an extrafine pointed cryoprobe. The subjective results 6 months after the operation are promising, and no major complications were noted. The combined treatment of laser and cryosurgery using endoscopy is a minor surgical procedure with high efficacy and minimal postoperative morbidity. More cases and a longer follow-up are necessary to provide long-term results.
New Approaches to the Treatment of Sjögren’s Syndrome: Soon beyond Symptomatic Relief?
Authors: Steinfeld Serge , Simonart Thierry
Published: July 2003

Sjögren’s syndrome (SS) is a common autoimmune disease characterized by destruction and dysfunction of the salivary and lachrymal glands. Systemic manifestations occur in almost one third of patients with SS. Treatment of SS has been long considered as disappointing, being mainly restricted to local management with artificial tears and oral lubricants or to the use of immunosuppression-based therapies for systemic disease. Better knowledge of the pathogenesis of SS, including the role of retroviruses and cytokines and the discovery of aquaporins, provides new perspectives for the local and systemic management of this disease. Our goal is to focus on these recent therapeutic progresses.
Alteration and Significance of Heparin-Binding Epidermal-Growth-Factor-Like Growth Factor in Psoriatic Epidermis
Authors: Zheng Yan , Peng Zhenhui , Wang Yili , Tan Shengshun , Xi Yanping , Wang Guorong
Published: July 2003

Background: Heparin-binding epidermal-growth-factor-like growth factor (HB-EGF) has proved to be a mitogen of keratinocytes, which may be involved in the pathogenesis of inflammatory diseases, but its mechanism in psoriasis remains unknown. Objective: To investigate the alteration of HB-EGF in the epidermis of active psoriasis vulgaris. Methods: The expression of HB-EGF in normal skin tissues, uninvolved tissues and psoriatic lesions was detected by in situ hybridization and immunohistochemistry. Results: HB-EGF mRNA and protein were located in the basal layer of normal epidermis (10/10, 100.00%), with nearly no expression in the suprabasal layers (1/10, 10.00%); the expression of HB-EGF was located not only in the basal layer (21/21, 100.00%), but was also seen as focal overexpression in the suprabasal layers of uninvolved epidermis (20/21, 95.24%) and the marginal part of psoriatic lesions (18/21, 85.71%), while nearly no expression of HB-EGF was found in the central part of psoriatic lesions (1/21, 4.76%). Conclusion: HB-EGF may play an important role in the early pathogenesis of psoriasis.
Dermatological and Ophthalmological Sequels in Toxic Epidermal Necrolysis
Authors: Magina S. , Lisboa C. , Leal V. , Palmares J. , Mesquita-Guimarães J.
Published: July 2003

Background: Toxic epidermal necrolysis (TEN) is a rare, drug-induced disease characterized by epidermal detachment and mucosal involvement. After an acute period, potentially disabling cutaneous and ocular sequels may appear. Although long-term complications are not rare, only few outcome studies are published. Objective: To evaluate the incidence of dermatological and ophthalmological sequels following TEN, to describe its clinical aspects and correlation with acute involvement. Patients and Methods: Eight patients surviving to TEN were submitted to dermatological and ophthalmological observation ranging from 0.5 to 8 years after hospitalization. Cutaneous and ocular involvement, during the acute phase, was retrospectively analysed. Results: Dermatological sequels were observed in 6 patients (75%) corresponding to those with more extensive skin involvement in the acute phase. The most frequent complications were cutaneous dyschromia (62.5%) and nail dystrophies (37.5%). Six patients (75%) had ocular complications with tarsal conjunctiva keratinization in 5 (62.5%) and keratoconjunctivitis sicca in 4 of them (50%). Trichiasis, corneal neovascularization and symblepharon were observed in 1 case. There was no correlation between the severity of acute ocular involvement and long-term complications. Conclusion: Following TEN, most patients have dermatological and ophthalmological sequels that persist for several years.
Comparative Testing of Liposomal and Aqueous Formulations of Povidone-Iodine for Their Angioirritative Potential at the Chorioallantoic Membrane of ex ovo Cultivated Chick Embryos
Authors: Wutzler P. , Sauerbrei A. , Härtl A. , Reimer K.
Published: July 2003

Background: Due to its excellent microbicidal activity, povidone-iodine (PVP-I) is used for local anti-infective treatment, especially for wound antisepsis of the skin. Previous studies have shown that liposomal PVP-I formulations are less cytotoxic and that a special liposomal PVP-I hydrogel provides wound healing efficacy. Objective: In the present study, the angiotoxic activity of the liposomal and the aqueous PVP-I formulations were comparatively tested at the chorioallantoic membrane (CAM) of chick embryos. Methods: Test preparations were administered onto the CAM of ex ovo cultivated chick embryos. At different time intervals, the local irritation of the blood vessels was examined microscopically and assigned to a score of vascular injury. Results: Angioirritative reactions of the CAM were manifest as coagulation, vascular congestion and hemorrhages. The liposomal formulations containing 0.1, 0.5 or 1% PVP-I were found to be significantly less angiotoxic than the corresponding aqueous formulations. Conclusion: The angioirritative potential of PVP-I is significantly reduced by its liposomal encapsulation.
Cellular Phone Dermatitis with Chromate Allergy
Authors: Seishima Mariko , Oyama Zuiei , Oda Makiko
Published: July 2003

Background: A patient with allergic contact dermatitis caused by hexavalent chromium plating on a cellular phone has already been reported. Objectives: This study described the clinical characteristics and results of patch tests in 8 patients with contact dermatitis possibly caused by handling a cellular phone. Patients: The 8 patients were 4 males and 4 females aged from 14 to 54 years. They each noticed skin eruptions after 9–25 days of using a cellular phone. All patients had erythema, and 7 had papules on the hemilateral auricle or in the preauricular region. Three of 8 patients had a history of metal allergy. Chromate, aluminium and acrylnitrile-butadiene-styrene copolymer were used as plating on the cellular phones used by these patients. Methods: Closed patch tests and photopatch tests were performed using metal standard antigens. Results: The patch test was positive for 0.5, 0.1 and 0.05% potassium dichromate in all 8 patients. The photopatch test showed the same results. One patient was positive for 2% cobalt chloride and one for 5% nickel sulfate. Conclusion: It is important to consider the possibility of contact dermatitis due to a cellular phone, possibly caused by chromate, when the patients have erythema and papules on the hemilateral auricle or in the preauricular region.
IL-4 Expression by Neutrophils in Psoriasis Lesional Skin upon High-Dose UVB Exposure
Authors: Piskin Gamze , Tursen Umit , Bos Jan D. , Teunissen Marcel B.M.
Published: July 2003

Background: Upon a single high dose of UVB irradiation of psoriatic lesional skin, IFN-γ expression is decreased, whereas IL-4 expression is enhanced. A similar type 1 to type 2 shift was found in dermal T cells derived from irradiated lesional skin as compared to unexposed lesional psoriatic skin. We have found recently that the IL-4 protein detected in situ upon UVB exposure of normal skin was not associated with T cells but with infiltrating neutrophils. Objective: To determine which cell types express IL-4 in psoriatic skin after UVB irradiation. Methods: Skin biopsies were obtained from healthy controls and psoriasis patients before and after local UVB exposure. Double immunohistochemical stainings were performed to determine the identity of IL-4-expressing cells. Results: In the irradiated skin of both healthy controls and patients, IL-4-positive cells coexpressed elastase and CD15, but not CD3. Conclusion: IL-4-expressing cells found in psoriatic skin after a single high-dose UVB exposure appeared to be neutrophils.
Basal Cell Carcinomas in Association with Basaloid Follicular Hamartoma
Authors: Yoshida Y. , Urabe K. , Mashino T. , Duan H. , Kiryu H. , Masuda T. , Koga T. , Furue M.
Published: July 2003

We describe a unique case of various types of basal cell carcinoma (BCC) associated with basaloid follicular hamartoma (BFH) in a 56-year-old female patient. The lesion consisted of a dark brown and elastic soft nodule and papules within the area of a birthmark on the neck. The lesion was surgically excised. Histological examination of the nodular region revealed aggregations of neoplastic basaloid cells. We diagnosed the nodule as BCC with a racemiform or reticular pattern. In addition, a specimen taken from brownish black papules within the birthmark was found to be composed of anastomosing cords of basaloid cells accompanied by infundibular cystic structures. These features were consistent with an infundibulocystic BCC. In contrast, specimens from a hamartomatous plaque showed distinctive branching strands of basaloid cells that are suggestive of BFH. Therefore, our findings indicate that several types of BCC may develop within a BFH.
Lichen striatus in Adults or ‘Adult Blaschkitis’?
Authors: Hofer Thomas
Published: July 2003

Background: Lichen striatus (LS) is a well-known acquired linear inflammatory dermatosis. In 1990, Grosshans and Marot introduced the term ‘adult blaschkitis’ (AB), describing an eruption similar to LS occurring in an adult (adult LS). Does there really exist a new entity or a need for a new naming? Objective and Methods: Two new cases of adult LS are described and the data from 16 earlier cases (12 AB and 4 adult LS) are reviewed. Results: The analysis of 18 adult patients with an acquired inflammatory blaschkolinear eruption reveals that females are affected two times as frequently as males. The mean age at onset is 44 years, the mean duration until spontaneous cure 8.7 months. Relapses occur in 27.7%. In 78%, the eruption is localized on the trunk, in 55% on the arms and in 50% on the legs. Multilinearity is found in 100% if the eruption is on the trunk, and 61.5% if it is on the limbs. Neither clinical nor morphological differences exist between AB and adult LS. Conclusion: There are no convincing characteristics which justify creating a new name or even a new entity. AB may be the same as LS, a well-known acquired linear inflammatory dermatosis, which – as has been shown now – does not occur so rarely in adults. However, the etiology of this entity remains obscure.
Anaphylaxis to the Carbohydrate Carboxymethylcellulose in Parenteral Corticosteroid Preparations
Authors: Bigliardi P.L. , Izakovic J. , Weber J.M. , Bircher A.J.
Published: July 2003

Background: Carboxymethylcellulose is a carbohydrate widely used as additive in tablets, cosmetics, some injectable hormone formulations, food (as E466) and as active principle in hydrocolloid dressings. Anaphylaxis to carboxymethylcellulose in parenteral corticosteroid preparations has previously been reported. Typically, skin tests were positive in such cases, occasionally specific IgE or histamine release have been demonstrated. Case Report: We report on 3 patients who suffered from anaphylactic symptoms after local injection of corticosteroid preparations. Intracutaneous skin tests with carboxymethylcellulose were positive; in 2, sulfidoleukotriene release could be measured in the cellular antigen stimulation test (CAST®). Specific IgE could not be identified. Oral provocation tests with typical doses of carboxymethylcellulose as found in food and tablets were negative. Conclusion: In patients with anaphylaxis to parenteral administration of carboxymethylcellulose, small amounts are tolerated by the oral route. Skin tests and CAST are useful diagnostic tools.
Decreased CD44 Expression and Stromal Hyaluronate Accumulation in Myxoid Dermatofibroma
Authors: Çalıkoglu Emel , Chavaz Pierre , Saurat Jean-Hilaire , Kaya Gürkan
Published: July 2003

Background: Dermatofibroma (DF) is a common benign histiocytic tumor, which has several clinicopathological variants. Myxoid DF is one of these variants, which is characterized by a stromal mucin deposition. CD44 is a polymorphic transmembrane glycoprotein and the principal cell surface receptor of hyaluronate (HA), the major component of the extracellular matrix. In a recent study, we have observed an abnormal accumulation of HA in the superficial dermis of transgenic mice with a keratinocyte-specific CD44 expression defect. We have also shown that HA was accumulated in large amounts in the superficial dermis of lichen sclerosus et atrophicus (LSA) lesions and that the epidermal CD44 expression of LSA skin was significantly decreased or lost. In an another study, we have suggested that a decrease in CD44 expression in follicular epithelial proliferations might be correlated with an abnormal HA accumulation in perifollicular solitary cutaneous myxoma. Recently we have also demonstrated that classical DF lesions displayed a strong CD44 expression in tumor cells and a weak HA positivity in tumor stroma whereas CD44 expression was significantly reduced or absent in dermatofibrosarcoma lesions and the tumor stroma showed strong HA staining. Objective and Methods: Here we present 3 cases of myxoid DF, in which we explored the nature of the mucinous material in myxoid stroma by colloidal iron and hyaluronic acid binding protein stainings, as well as the expression of CD44 in the tumor cells by immunohistochemistry. Results: We show that HA is accumulated in the stroma of all myxoid DF lesions with a significant decrease in CD44 expression in the tumor cells. Conclusion: Our results suggest that a decrease in CD44 expression in the tumor cells may result in stromal myxoid changes characterized by an abnormal HA accumulation in myxoid DF.
Imiquimod Induces Complete Clearance of a PUVA-Resistant Plaque in Mycosis fungoides
Authors: Dummer Reinhard , Urosevic Mirjana , Kempf Werner , Kazakov Dmitry , Burg Günter
Published: July 2003

Imiquimod is a topical immune response modifier that binds to Toll-like receptors 7 and 8 and induces α-interferon. We locally applied imiquimod 5% cream (Aldara®) daily for 2 weeks on a PUVA- and retinoid-resistant plaque on the face of a patient with mycosis fungoides. The diagnosis was based on clinical appearance, histology and molecular studies. Most of the disease manifestations showed a clear remission during PUVA therapy combined with low-dose retinoids. However, the plaque on the face was PUVA resistant. Local imiquimod treatment resulted in the complete clearance of the plaque. The patient has now been in complete remission for 12 months.
Monitoring Hyperhydration during High-Dose Chemotherapy: Body Weight or Fluid Balance?
Authors: Mank A. , Semin-Goossens A. , v.d. Lelie J. , Bakker P. , Vos R.
Published: July 2003

Body weight and fluid input/output are usually monitored for checking fluid balance in case of intravenous hyperhydration during nephrotoxic chemotherapy. The reliability of measuring fluid input/output is uncertain. Moreover, this measurement is redundant, complex, labour-intensive and represents an occupational hazard for nurses and other health-care workers handling fluids or body excreta. In a prospective cohort study, we determined the concordance between body weight and fluid intake/output. We also examined the clinical consequences with respect to the safety of selecting only body weight measurement as a parameter for fluid overload. A total of 591 combined observations of fluid balances and body weights were collected. We observed a higher increase in body weight than in fluid balance. The Pearson correlation between fluid balance and body weight was relatively low (r = 0.28). With regard to the safety of measuring body weight only, we found 4 cases (0.6%) who might not have received furosemide if the fluid input/output had not been measured, without clinical consequences, however. After standardization, body weight can safely be used as the only parameter for monitoring fluid retention in case of hyperhydration during chemotherapy.
Mixed Chimerism of Erythro- and Megakaryopoiesis following Allogeneic Bone Marrow Transplantation
Authors: Thiele J. , Wickenhauser C. , Kvasnicka H.M. , Varus E. , Schneider C. , Müller H. , Beelen D.W.
Published: July 2003

Until now, studies on mixed chimerism (MCh) after allogeneic bone marrow transplantation (BMT) have predominantly focused on the B- and T-lymphocyte population, but not on distinct myeloid cell lineages like nucleated erythroid precursors and megakaryocytes. To evaluate the lineage-restricted MCh more explicitly in 10 patients with chronic myelogenous leukemia (CML), a quantitative analysis was performed on bone marrow biopsies following a sex-mismatched host/donor constellation. Techniques included immunophenotyping (antiglycophorin C, CD61) for the identification of erythro- and megakaryopoiesis and a simultaneously conducted genotyping with x- and y-chromosome-specific DNA probes. Normal bone marrow and specimens taken before BMT served as controls. Contrasting a total gender-dependent sex-typing in the latter samples in the early and late posttransplant period (up to 586 days), 3–9% erythroid precursors and about 16% megakaryocytes revealed a host-type origin. This significantly higher number of host megakaryocytes is explained by their polyploidy generating an increased probability to detect positive signals at a certain section level of the corresponding biopsies. A striking conversion of MCh to a recipient cell type was found in leukemic relapse with a more than 90% host-derived erythroid and megakaryocytic cell population in 4 patients approximately 643 days after BMT.
Intermediate-Dose Cyclophosphamide and Granulocyte Colony-Stimulating Factor Is a Valid Alternative to High-Dose Cyclophosphamide for Mobilizing Peripheral Blood CD34+ Cells in Patients with Multiple Myeloma
Authors: Petrucci Maria Teresa , Avvisati Giuseppe , La Verde Giacinto , De Fabritiis Paolo , Ribersani Michela , Palumbo Giovanna , De Felice Lidia , Rusignuolo Alessandra , Simone Francesca , Meloni Giovanna , Mandelli Franco
Published: July 2003

Peripheral blood stem cells (PBSC) are widely used in the setting of dose-intensive chemotherapies in patients with multiple myeloma (MM). Although the granulocyte colony-stimulating factor (G-CSF), following chemotherapy or not, is considered the standard growth factor for mobilizing PBSC, the optimal chemotherapeutic regimen still remains to be defined. Cyclophosphamide (CTX) is an effective drug in the treatment of MM which is capable of mobilizing PBSC if followed by growth factors, even though administration of high-dose CTX (7 g/m2) results in severe toxicity requiring hospitalization and increasing costs. We have retrospectively analyzed the results obtained in 38 newly diagnosed MM patients treated with 1.2 g/m2 CTX on days 1 and 3 combined with 40 mg dexamethasone daily for 4 days. The results were compared with those obtained in 25 newly diagnosed MM patients treated with 7 g/m2 CTX. A higher number of CD34+ cells/kg was collected during the first leukapheresis and a statistically significant lower consumption of G-CSF was observed following two doses of 1.2 g/m2 CTX compared to the 7 g/m2 CTX dose. The possibility of treating patients with day-hospital regimens, with a satisfactory yield of hematopoietic cells harvested, may have relevant economic implications for treatment strategies in MM patients.
Alcohol, Drugs and the Family: Results from a Long-Running Research Programme within the UK
Authors: Velleman Richard , Templeton Lorna
Published: July 2003

This article will outline the main strands of the UK-based Alcohol, Drugs and the Family (ADF) research programme. This programme has examined the impact of substance misuse problems on children, spouses, and families, both in the UK and elsewhere, especially in urban Mexico City and in Australia amongst both urban and rural Aborigine populations. This article will outline the main theoretical perspective that we have developed from this work (the stress-strain-coping-support model). It will outline some of the key findings of this programme, and address some of the key universals that we have observed across various cultures. It will end by describing current research, including the testing of brief interventions being delivered through primary care to family members to enable them to cope better with the problems which family substance misuse causes.
Parenting Beliefs and Practices of Opiate-Addicted Parents: Concealment and Taboo
Authors: Hogan Diane M.
Published: July 2003

The lifestyle associated with opiate dependence, including drug taking, the buying and selling of drugs, and contact with other drug users, carries potential risks for the safety and well-being of children of drug-using parents. Based on a qualitative interview study conducted with 50 opiate-dependent parents in Dublin, Ireland, the parenting beliefs and practices in relation to children’s exposure to drugs and the associated lifestyle are described. Parents saw their lifestyle as potentially risky for their children and their families. The most common strategy adopted by parents was to conceal their drug-related activities and maintain a strict family taboo about these activities. Intervention programmes should be offered to support effective family communication about parental drug dependence.
Maternal Smoking and Smoking in Adolescents: A Prospective Community Study of Adolescents and Their Mothers
Authors: Lieb Roselind , Schreier Andrea , Pfister Hildegard , Wittchen Hans-Ulrich
Published: July 2003

The associations between maternal smoking and nicotine dependence and patterns of smoking and nicotine dependence in offspring were examined in a large community-based sample of adolescents. Data were derived from baseline and 4-year follow-up assessments of 938 respondents aged 14–17 years at the outset of the Early Developmental Stages of Psychopathology (EDSP) study, a prospective-longitudinal community study of adolescents and young adults and their parents respectively. Smoking and nicotine dependence in respondents were assessed using the Munich Composite International Diagnostic Interview (DSM-IV algorithms). Diagnostic information about smoking behavior in mothers was collected by independent direct diagnostic interviews with the mothers. In comparison to children of non- or occasionally smoking mothers, children of regularly smoking and nicotine-dependent mothers had higher probabilities of using tobacco as well as of developing nicotine dependence. For all ages under consideration, survival analyses revealed a higher cumulative lifetime risk of regular smoking and nicotine dependence among these children. Maternal smoking during pregnancy seems to represent an additional risk for these outcomes in children, specifically with regard to the risk of developing nicotine dependence. Associations were comparable for sons and daughters. Our findings show that maternal smoking predicts escalation of smoking, development of nicotine dependence, and stability of smoking behavior in children. Implications for specific intervention and prevention efforts are discussed.
Use of Cocaine by Secondary School Students in Northern Spain
Authors: Sáiz P.A. , G-Portilla M.P. , Paredes B. , Delgado J. , Martínez S. , Bascarán M.T. , Bobes J.
Published: July 2003

Aim: To describe the prevalence of cocaine and other drug use in secondary school students in Oviedo (Asturias, Northern Spain) and determine the personality features and levels of sensation seeking in cocaine users. Methods: 2,862 secondary school students (mean age ± SD = 15.87 ± 1.48 years; 50.6% males) were interviewed during the 1998–1999 academic year. For evaluation, the World Health Organization questionnaire for drug consumption, the Eysenck Personality Questionnaire (EPQ) for adults and the Zuckerman Sensation Seeking Scale were used. Results: The prevalence of lifetime, previous year and previous month cocaine use among secondary school students was 6.1, 4.9 and 2.7%, respectively. Cocaine ranked sixth among illicit drugs ever used by this population. Once individuals had used cocaine for the first time, they were likely to use it again (44.8% of those who had ever used cocaine reported that they had done so in the previous month). Compared to students who had never used cocaine (but who may have used other substances), cocaine users had a more extensive drug abuse history. Students who had used cocaine at some point during their lifetime scored significantly higher on the EPQ psychoticism subscale and reported higher levels of sensation seeking. Conclusions: There is a significant rate of cocaine consumption amongst secondary school students of both sexes. Cocaine users are polyconsumers of other substances, both legal and illicit. Those who consume cocaine have a different psychological profile, characterized by high sensation seeking and high levels of psychoticism.
Treatment of Drug Addiction in Traumatised Refugees
Authors: Brune Michael , Haasen Christian , Yagdiran Oktay , Bustos Enrique
Published: July 2003

The comorbidity of post-traumatic stress disorder (PTSD) and drug addiction is quite often overlooked in refugees. However, the simultaneous treatment of both disorders is of elemental importance for a positive outcome in addicted and traumatised refugees. Furthermore, mutual misinterpretations of habits, behaviours and reactions through negligence of the distinct sociocultural context of patient and clinician often leads to unfavourable developments. These observations are exemplified in this case report.
Endoscopic Removal of Knotted Urethral Catheter: A Point of Technique
Authors: Dogra P.N. , Nabi G. , Goel R.
Published: July 2003

Urethral catheter knotting is a rare complication of the simple and widely practiced clean intermittent self-catheterization. We report the endoscopic retrieval of a retained knotted feeding tube in a 12-year-old child. Various factors leading to such a rare complication and a new minimal invasive technique are described. To the best of our knowledge this technique has not been previously reported in the medical literature.