bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparative Study of Intraperitoneal Carboplatin versus Intravenous Carboplatin with Intravenous Cyclophosphamide in Both Arms as Initial Chemotherapy for Stage III Ovarian Cancer
Authors: Polyzos A. , Tsavaris N. , Kosmas C. , Giannikos L. , Katsikas M. , Kalahanis N. , Karatzas G. , Christodoulou K. , Giannakopoulos K. , Stamatiadis D. , Katsilambros N.
Published: April 2003

Cisplatin (C) or carboplatin (CBP) plus cyclophosphamide (CTX) was until recently considered standard chemotherapy for advanced ovarian cancer (OC). Attempts to maximize platinum and its analog activity against OC include its administration directly into the peritoneal cavity. In the past we have shown that intraperitoneal (IP) CBP administration is a safe and effective treatment for OC [Polyzos et al: Proc Am Assoc Cancer Res 1990;31: 1120]. In the present study we aimed to compare the effectiveness and toxicity of CBP administration either intravenously (IV) or IP plus CTX IV. Since 1990, 90 evaluable patients with stage III OC were prospectively randomized to receive CBP 350 mg/m2 IV or IP plus CTX 600 mg/m2 IV (in both groups) every 3–4 weeks for six courses. The randomization incorporated stratification according to performance status and the amount of residual tumor (maximum diameter ≤2 or >2 cm). Clinical assessment was performed with abdominal CT and serum CA-125. Responses were observed in 33/46 = 72% (95/CI 56.5–84.0) of the IV group and in 33/44 = 75% (95/CI 59.7–86.8) of the IP group with 48 and 45% clinical complete responses, respectively. Times to progression were 19 months (8–62+) for the IV group and 18 (6–72+) for the IP group. Median survivals were: 25 months (6–80+) and 26 months (6–72+), respectively. Significantly more patients in the IV group than in the IP group had grade 3 or higher leukopenia (p < 0.01) and grade 3 thrombocytopenia (p < 0.09). Morbidity due to infectious complications in the IP group was minimal. It seems that IP CBP is equally effective to IV administration in terms of response and survival with less myelotoxicity. The favorable results on survival demonstrated in studies with IP C administration in patients with small volume disease [Alberts et al: N Engl J Med 1996;335:1950–1965] could not be repeated in the present study applying CBP in patients with variable tumor size and a relatively small number of patients. The likelihood that patients with large volume disease would benefit from a regional approach compared to systemic administration is small and this explains the inability to detect a difference between the two arms.
Gestational Age and Origin of Human Milk Influence Total Lipid and Fatty Acid Contents
Authors: Rueda Ricardo , Ramírez María , García-Salmerón José Luis , Maldonado José , Gil Angel
Published: April 2003

The human milk composition may be influenced by several factors, such as gestational age or genetic characteristics and dietary habits of different populations. To analyze the total lipid and fatty acid contents of human milk, we have conducted two studies, one on mothers who had delivered preterm and term newborns and another on mothers from two different sociocultural backgrounds (Spain and Panama). The total lipid content (g/100 g wet weight) was significantly higher in term (2.76 ± 0.66; mean ± SD) than in preterm mature milk (1.06 ± 0.4). The relative amount of 18:1n-9 was significantly higher in preterm than in term milk for transitional and mature milk, whereas that for the colostrum followed the opposite trend. Concerning the comparison between milk from mothers born in different countries, the relative contents of each of the fatty acids 16:0, 16:1n-7, 18:2n-6, 18:3n-3, and 22:5n-3 were higher in Panamanian than in Spanish milk, whereas the mean percentages of saturated fatty acids <14:0, of 16:1n-9, and of 18:1n-9 were higher in Spanish than in Panamanian milk. Statistically significant differences were found during the three periods of lactation considered for almost all the fatty acids mentioned above, especially for 18:1n-9 and 18:3n-3. Although the potential biological significance of the changes in oleic acid content between preterm and term milk remains unclear, differences in fatty acid content between Spanish and Panamanian milk reflect the different composition of the diet among women from these countries.
The Hemodialysis Access: Preferences and Concerns of Patients, Dialysis Nurses and Technicians, and Physicians
Authors: Bay William H. , van Cleef Sheri , Owens Matthew
Published: April 2003

One hundred twenty-eight hemodialysis patients and 64 medical personnel consisting of dialysis nurses and technicians, hemodialysis access surgeons and nephrologists were surveyed about their preferences and concerns in regard to the hemodialysis vascular access. The access preferred by physicians was the A-V fistula in the lower arm. In contrast, the access preferred by dialysis nurses and technicians was the polytetrafluoroethylene (PTFE) graft in the lower arm. Patients desired a superficial access in the forearm which was easy to cannulate, had minimal effect on their appearance, provided quick hemostasis after dialysis and enabled arm comfort during dialysis. Physicians felt the most significant concerns about the access were thrombosis and infection. Nurses and technicians ranked difficult cannulation and insufficient access blood flows that prohibited dialysis adequacy as their major problems. For patients the most common problem was pain during needle insertion. This survey concluded that the A-V fistula remains the access of choice. However, appropriate maturation of the fistula must occur before needle insertion is attempted. An immature fistula is difficult to cannulate, has fragile veins resulting in blood leakage around the needle infiltrating the subcutaneous tissues and has inadequate blood flows for successful dialysis. Patients who are introduced to dialysis with inadequate access function or access failure from either an A-V fistula or a PTFE graft have increased morbidity, inadequate dialysis and enhanced anxiety about dialysis treatments. To increase the success and acceptance of A-V fistulas in hemodialysis patients it is incumbent upon the nephrologist to protect the future access arm from damage to the vasculature and to allow for fistula maturation before cannulation. Surgical protocols must improve the appropriate selection of a fistula or PTFE graft for various age groups and disease categories. Better patient preparation and selection of the proper access type for each patient will enhance early access function and subsequent access survival.
Prescription of Twice-Weekly Hemodialysis in the USA
Authors: Hanson Julie A. , Hulbert-Shearon Tempie E. , Ojo Akinlolu O. , Port Friedrich K. , Wolfe Robert A. , Agodoa Lawrence Y.C. , Daugirdas John T.
Published: April 2003

Background/Aims: The purpose of this study was to investigate the frequency and characteristics of two hemodialysis sessions/week, to identify factors which influence or predict this prescription, and to examine the outcomes of patients receiving hemodialysis two times/week as compared to the more common treatment of three times/week. Methods: Data from a national sample of 15,067 adult hemodialysis patients were utilized to compare twice-weekly with thrice-weekly therapy by logistic regression. Results: Patients treated less than one year were more likely to be treated twice-weekly (6.1%) than patients on dialysis for one year or more (2.7%) (AOR = 1.49, p = 0.002). Treatment schedules also varied significantly by geographic region. Factors predictive of twice-weekly hemodialysis (p < 0.05) were older age, Caucasian race, female gender, higher serum albumin, lower serum creatinine levels, and lower body mass index. A higher estimated renal function at the start of ESRD was also predictive of a twice-weekly schedule among incident patients (AOR = 1.05, p = 0.05). In addition, Cox-adjusted survival analysis indicated a lower mortality risk (RR = 0.76, p = 0.02) for twice-weekly hemodialysis compared to thrice-weekly among prevalent patients. For incident patients, however, the results were not significant when adjusted for GFR at ESRD onset (RR = 0.85, p = 0.31). Conclusion: Geographic differences in prescribed treatment remained unexplained by measured characteristics. The survival advantage associated with twice-weekly hemodialysis is likely to be related to patient selection and greater residual renal function.
Effects of L-Carnitine Supplementation on Cardiac Morbidity in Hemodialyzed Patients
Authors: Matsumoto Yoshihiro , Sato Motoyoshi , Ohashi Hiroshige , Araki Hajime , Tadokoro Mitsunobu , Osumi Yukio , Ito Hiroyasu , Morita Hiroyuki , Amano Izumi
Published: April 2003

Cardiac diseases are well known among patients on maintenance hemodialysis (HD), and carnitine deficiency may be an important factor in cardiac morbidity. We studied the effects of low-dose L-carnitine treatment (500 mg/day) on chest symptoms (dyspnea on exertion, chest pain, palpitation), cardiac function, and left ventricular (LV) mass in 9 HD patients with reduced ejection fraction (EF). After 6 months of L-carnitine treatment, most patients had at least some improvement in chest symptoms, while LVEF was increased and LV mass was decreased. Carnitine fractions increased and reached plateaus at 2–3 times the baseline levels. These results suggest that prolonged low-dose L-carnitine treatment can improve the cardiac morbidity by restoring decreased carnitine tissue levels and impaired oxidation of FFA.
Early Elevation of Cochlear Reactive Oxygen Species following Noise Exposure
Authors: Ohlemiller Kevin K. , Wright James S. , Dugan Laura L.
Published: April 2003

Reactive oxygen species (ROS) have been implicated in a growing number of neurological disease states, from acute traumatic injury to neurodegenerative conditions such as Alzheimer’s disease. Considerable evidence suggests that ROS also mediate ototoxicant- and noise-induced cochlear injury, although most of this evidence is indirect. To obtain real-time assessment of noise-induced cochlear ROS production in vivo, we adapted a technique which uses the oxidation of salicylate to 2,3-dihydroxybenzoic acid as a probe for the generation of hydroxyl radical. In a companion paper we described the development and characterization of this method in cochlear ischemia-reperfusion. In the present paper we use this method to demonstrate early elevations in ROS production following acute noise exposure. C57BL/6J mice were exposed for 1 h to intense broad-band noise sufficient to cause permanent threshold shift (PTS), as verified by auditory brainstem responses. Comparison of noise-exposed animals with unexposed controls indicated that ROS levels increase nearly 4-fold in the period 1–2 h following exposure and do not decline over that time. Our ROS measures extend previous results indicating that noise-induced PTS is associated with elevated cochlear ROS production and ROS-mediated injury. Persistent cochlear ROS elevation following noise exposure suggests a sustained process of oxidative stress which might be amenable to intervention with chronic antioxidant therapy.
Systematic Monitor Disinfection Is Effective in Limiting HCV Spread in Hemodialysis
Authors: Aucella Filippo , Vigilante Mimmo , Valente Giuseppe Lucio , Stallone Carmine
Published: April 2003

Background: Patients on chronic hemodialysis are at high risk of HCV infection due to nosocomial transmission. The strict adhesion to universal precautions is the first step in prevention, but other simple tools such as systematic monitor disinfection and the use of separate machines for anti-HCV-positive patients need to be evaluated. Methods: A 5-year prospective study was carried out in 4 dialysis centers enrolling 135 patients. General precautions were adopted, but anti-HCV-positive patients were not isolated. In period A, lasting 24 months, monitor disinfection was performed after each dialysis session with sodium hypochlorite; peracetic acid was also used 3 times a week. In period B, lasting 36 months, 3 dialysis units (77 patients) prolonged the same preventive protocol of period A, while another unit (58 patients) also adopted the use of separate machines for anti-HCV-positive subjects. A third-generation ELISA anti-HCV test was performed every 2 months throughout the study. Results: Anti-HCV antibodies were initially detected in 43 patients (31.8%), prevalence rate ranging from 25 to 39.4%. One seroconversion occurred in period A, with an overall seroconversion rate of 0.54%/year. Also in period B one seroconversion occurred (unit 2), seroconversion rate of 0.36%/year. Therefore the mean seroconversion rate throughout the 5 years was 0.43%/year. Conclusion: Systematic monitor disinfection may be a simple and quite effective tool to avoid nosocomial transmission of HCV infection in the hemodialysis setting. In our opinion its use is mandatory. The use of separate machines for anti-HCV-positive patients seems unnecessary.
Frequency and Clinical Correlates of Occlusive Lesions of Cerebral Arteries in Japanese Patients without Stroke
Authors: Uehara Toshiyuki , Tabuchi Masayasu , Mori Etsuro
Published: April 2003

To determine the frequency and clinical correlates of intra- and extracranial arterial occlusive lesions in a stroke-free population, we studied cerebral arteries in 156 subjects with no evidence of stroke who presented at a neurologic clinic with concerns about a possible stroke (104 males ranging in age from 37 to 83 years, with a mean age of 63.0) by using MR angiographies (MRAs). According to a validated rating scheme of MRAs for occlusive lesions, the degree of stenoses in the cervical portion of the carotid artery and of the intracranial arteries including the intracranial portion of the internal carotid artery, the middle cerebral artery stem, and the basilar artery were evaluated. Stenoses (>25% narrowing in diameter) were found in 18 patients (11.5%) in the cervical carotid artery, and in 23 patients (14.7%) in the intracranial arteries. Multiple logistic regression analysis showed that age and hyperlipidemia were significant and independent predictors for cervical carotid artery stenoses, and that age and hypertension were predictors for intracranial artery stenoses. Our data based on this special cohort of stroke-free patients suggested that the risk factors for extra- and intracranial artery lesions were different, and that MRA is possibly efficient in those patients in whom cerebral artery occlusive lesions may be suspected, e.g. in hyperlipidemic or hypertensive elderly. Larger population-based studies are needed to confirm these results.
Prevalence of Symptomatic Intracranial Aneurysm and Ischaemic Stroke in Pseudoxanthoma Elasticum
Authors: vandenBerg JanS.P. , Hennekam Raoul C.M. , Cruysberg Jan R.M. , Steijlen Peter M. , Swart Jaap , Tijmes Nel , Limburg Martien
Published: April 2003

Background: Pseudoxanthoma elasticum (PXE) is an heritable connective tissue disorder with clinical manifestations of the ocular, dermal, and cardiovascular system. The purpose of this study was to investigate the prevalence of symptomatic intracranial aneurysms (IAs) and ischaemic stroke (IS) in PXE. Methods: The records of 100 patients with PXE were retrieved. All patients were contacted and data on complications were collected. The literature was reviewed regarding PXE, ISs, and IAs. Results: No patient with PXE had a symptomatic IA as presenting symptom. One patient presented with an IS. During follow-up of 94 of the 100 patients (mean follow-up 17.1 years, range 1–49 years), none presented a symptomatic IA (3,168 retrospective patient observation years and 1,602 prospective patient observation years). Upper gastrointestinal haemorrhage during follow-up occurred in 17 patients, in 1 patient during aspirin use. One patient has IS as presenting symptom and a recurrence during follow-up, and 7 patients had IS during follow-up. All were caused by small-vessel disease. The relative risk of IS in PXE under 65 years compared with the general population was 3.6 (95% confidence interval 3.3–4.0). Conclusions: On the basis of the currently available data, an association between symptomatic IAs and PXE is unlikely. However, the incidence of IS, due to small-vessel disease, was increased. Antiplatelet therapy in patients with PXE may lead to a high incidence of upper gastrointestinal haemorrhages.
Use of Transverse Microradiography to Quantify Mineral Loss by Erosion in Bovine Enamel
Authors: Amaechi B.T. , Higham S.M. , Edgar W.  M.
Published: April 2003

The aim of the present study was to develop transverse microradiography (TMR) in order to quantitatively assess the influence of artificial saliva and orange juice on the erosion of bovine enamel. Bovine incisors were sectioned sagittally into two equal halves. Each half was coated with acid-resistant nail varnish except for a rectangular enamel window on the labial surface of the tooth. While both halves of each tooth were immersed in pure orange juice 6 times daily for a period of 5 min at each occasion making a total of 30 min per day, one half was stored in artificial saliva and the other half in deionized distilled water between exposures to orange juice and for the remaining 12 h overnight, for 24 days making a total of 12 h of exposure to orange juice. Sections bearing intact and eroded enamel surfaces were cut from each specimen and ground to 80 μm thickness, and TMR of the sections was made. Mineral loss was quantified from the microradiographs using two-step image analysis. Mineral loss was significantly greater in those specimens cycled in orange juice and de-ionized distilled water. TMR was used successfully to quantify the mineral loss by erosion in vitro, and it is envisaged that it will be useful for specimens used in intra-oral appliances during in situ trials. Artificial saliva saturated with respect to calcium and phosphate salts can possibly remineralize an erosive lesion and may reduce the degree of erosion.
Influence of in vivo Formed Salivary Pellicle on Enamel Erosion
Authors: Hannig M. , Balz M.
Published: April 2003

This study assessed the protective effect of the salivary pellicle formed in vivo during 24 h or 7 days against demineralization of bovine enamel caused by citric acid. In addition, the influence of acid treatment on the behavior of the pellicle was investigated. Enamel specimens with and without in vivo pellicles were immersed in citric acid (0.1, 1.0%) over 30, 60, and 300 s, and processed for scanning (SEM) and transmission electron microscopy (TEM), as well as for measurement of surface microhardness (SMH). Specimens coated with the in vivo formed pellicles revealed less extensive erosive demineralization of the enamel surface compared to uncovered enamel specimens. SEM analysis and SMH results did not indicate distinct differences between erosive surface alterations on enamel slabs covered with 24–hour pellicles and on those covered with 7–day pellicles. TEM analysis showed that the pellicle layer was dissolved in part from the enamel surface due to acid exposure. However, pellicle residues could be detected by TEM in all specimens, even after 5–min exposure to 1.0% citric acid. It is concluded that the in vivo salivary pellicle can resist the acidic action to some extent and provides protection to the underlying enamel surface against erosive destruction caused by short–term action of citric acid.
A Functional Outcome Swallowing Scale for Staging Oropharyngeal Dysphagia
Authors: Salassa John
Published: April 2003

Objective: To develop a simple and straightforward functional outcome swallowing scale (FOSS) for patients with oropharyngeal dysphagia to determine the severity of the disorder and the effectiveness of therapy or outcome. Design: Five years ago, the author developed a dysphagia staging scale based on personal experience and a review of the English literature. This scale was shared with colleagues from the specialties of otolaryngology, speech pathology, neurology, and gastroenterology, both within and outside the author’s institution. Minor modifications have been made. The scale has been used in clinical management and retrospective studies. Setting: Patients were seen in a multispecialty, tertiary care, academic center. Patients: The patient population included the full spectrum of oropharyngeal dysphagia in adults, but was weighted heavily toward aging patients and patients with head and neck cancer, neurologic disorders, gastroesophageal conditions, and psychiatric problems. Results: The stages are as follows: stage 0 = normal function and asymptomatic; stage I = normal function but with episodic or daily symptoms of dysphagia; stage II = compensated abnormal function manifested by significant dietary modifications or prolonged mealtime (without weight loss or aspiration); stage III = decompensated abnormal function with weight loss of 10% or less of body weight over 6 months due to dysphagia, or daily cough, gagging, or aspiration during meals; stage IV = severely decompensated abnormal function with weight loss of more than 10% of body weight over 6 months due to dysphagia, or severe aspiration with bronchopulmonary complications, nonoral feeding recommended for most of nutrition, and stage V = nonoral feeding for all nutrition. Conclusions: The FOSS was successful for staging various adult patients with dysphagia into clinically useful, overall performance categories. It has been applied successfully to retrospective outcome studies and to clinical management by clinicians from different specialties.
Reduced Levels of a Specific Myelin-Associated Oligodendrocytic Basic Protein Isoform in shiverer Myelin
Authors: Montague Paul , Kirkham Douglas , McCallion Andrew S. , Davies R.Wayne , Kennedy Peter G.E. , Klugmann Matthias , Nave Klaus-Armin , Griffiths Ian R.
Published: April 2003

Myelin-associated oligodendrocytic basic protein (MOBP) and myelin basic protein (MBP) share many structural similarities. MOBP is synthesised by mature oligodendrocytes and localised at the major dense line (MDL), suggesting a role in the myelin compaction process. The shiverer mouse, a deletion mutant of the myelin basic protein (Mbp) gene, has poorly compacted myelin with essentially no MDL. In this study we compare the developmental expression of the Mobp gene in wild-type and shiverer mice. The significant finding is that one of the two abundant MOBP isoforms, the ∼20-kD species, is poorly incorporated into shiverer myelin. The absence is specific to shiverer and is not a feature of dysmyelinating mutants with an abnormal intraperiod line. Our data suggest that incorporation of this MOBP isoform into shiverer myelin may be influenced by the presence of MBP or be a consequence of a disrupted MDL.
13C MR Spectroscopy Study of Lactate as Substrate for Rat Brain
Authors: Qu Hong , Håberg Asta , Haraldseth Olav , Unsgård Geirmund , Sonnewald Ursula
Published: April 2003

In order to address the question whether lactate in blood can serve as a precursor for cerebral metabolites, fully awake rats were injected intravenously with [U-13C]lactate or [U-13C]glucose followed 15 min later by decapitation. Incorporation of label from [U-13C]glucose was seen mainly in glutamate, GABA, glutamine, aspartate, alanine and lactate. More label was found in glutamate than glutamine, underscoring the predominantly neuronal metabolism of pyruvate from [U-13C]glucose. It was estimated that the neuronal metabolism of acetyl CoA from glucose accounts for at least 66% and the glial for no more than 34% of the total glucose consumption. When [U-13C]lactate was the precursor, label incorporation was similar to that observed from [U-13C]glucose, but much reduced. Plasma analysis revealed the presence of approximately equal amounts of [1,2,3-13C]- and [1,2-13C]glucose, showing gluconeogenesis from [U-13C]lactate. It was thus possible that the labeling seen in the cerebral amino acids originated from labeled glucose, not [U-13C]lactate. However, the presence of significantly more label in [U-13C]- than in [2,3-13C]alanine demonstrated that [U-13C]lactate did indeed cross the blood-brain barrier, and was metabolized further in the brain. Furthermore, contributions from pyruvate carboxylase (glial enzyme) were detectable in glutamine, glutamate and GABA, and were comparatively more pronounced in the glucose group. This indicated that relatively more pyruvate from lactate than glucose was metabolized in neurons. Surprisingly, the same amount of lactate was synthesized via the tricarboxylic acid cycle in both groups, indicating transfer of neurotransmitters from the neuronal to the astrocytic compartment, as previous studies have shown that this lactate is synthesized primarily in astrocytes. Taking into consideration that astrocytes take up glutamate more avidly than GABA, it is conceivable that neuronal lactate metabolism was more prominent in glutamatergic neurons.
Mechanisms of Androgen Induction of Sebocyte Differentiation
Authors: Rosenfield R.L. , Deplewski D. , Kentsis A. , Ciletti N.
Published: April 2003

It has been difficult to induce the expected sebocyte differentiation in vitro with dihydrotestosterone (DHT). We reasoned that our culture system lacks differentiating factors, and peroxisome proliferator-activated receptors (PPARs) were the prime candidates. We tested PPAR activators informative about diverse PPAR subtypes, with and without DHT (10–6 M): BRL-49653 (10–6 M, PPAR-γ), WY-14643 (10–6 M, PPAR-α), and linoleic acid (LIN, 10–4 M, PPAR-d). Treatments were added in serum-free medium to cultures of rat preputial sebocytes. Control, DHT, BRL and BRL + DHT treatments caused 11, 25, 66 and 80%, respectively, of preputial cell colonies to differentiate into lipid-forming colonies (LFCs) (p <0.001). WY induced 20% and LIN over 95% LFC formation. PPAR-γ mRNA was identified in preputial sebocytes by the RNase protection assay. These data suggest that differentiation of sebocytes is transduced by PPARs and have implications for the development of new treatments for acne.
Persistent Milia, Steatocystoma multiplex and Eruptive Vellus Hair Cysts: Variable Expression of Multiple Pilosebaceous Cysts within an Affected Family
Authors: Patrizi A. , Neri I. , Guerrini V. , Costa A.M. , Passarini B.
Published: April 2003

Background: Steatocystoma multiplex (SM) and eruptive vellus hair cysts (EVHC) are conditions characterized by numerous cutaneous cysts with a clinical resemblance, such as age of onset, location, appearance of the lesions and mode of inheritance, but with distinctive histologic features. Recently, some authors have proposed that the two conditions are variants of one entity originating in the pilosebaceous duct, while others suggest that SM and EVHC are two distinct entities, on the basis of the different expression of keratins. Milia are small round cysts, commonly involving the face. In 1994, Menni and Piccinno reported the first association, in a family, between persistent infantile milia in a 9-month-old girl and SM in the father. The authors hypothesized a relationship between these two conditions. Objective: We describe a family in which the mother showed cystic lesions and milia and her 4-year-old son and her 18-month-old daughter presented persistant infantile milia. Methods: In addition to the clinical and genetic documentation, a biopsy was performed in the son and two biopsies in the mother. Results: The histologic examination of one of the son’s milium-like papules showed in the superficial dermis a small cyst typical of a milium. In serial sections it was possible to see a connection with a vellus hair follicle by an epithelial pedicle. The histologic examination of one of the mother’s papules on the forehead showed a large round cystic structure with histologic features of EVHC. Close to the cyst wall, serial sections showed flattened sebaceous gland lobules. The histologic findings of the second biopsy taken from the chest showed the typical features of a steatocystoma. Conclusions: The relationship between milia, SM and EVHC is discussed; the three diseases should be considered as subtypes of multiple pilosebaceous cysts that may all present overlapping histologic features. The different level of the pilosebaceous duct where the cyst originates should explain the different clinical manifestations.
Ecstasy Pimples – A New Facial Dermatosis
Authors: Wollina U. , Kammler H.-J. , Hesselbarth N. , Mock B. , Bosseckert H.
Published: April 2003

Ecstasy (XTC) has become a popular drug in the rave, dance and techno scene. Several severe disorders due to drug addiction have been described but no dermatological symptoms. We report on 2 patients (20-year-old female, 21-year-old male) with medical problems after taking XTC. Both developed a facial rash with reddish pimples after oral intake of XTC. The distribution resembled either periorificial dermatosis or acneiform rash without white- or blackheads. The lesions cleared without specific treatment. We suggest that XTC pimples represent an acneiform dermatosis in young people taking designer drugs. Though the dermatosis itself seems to be mild, it may be a cutaneous marker for drug abuse.
Nummular Eczema: An Addition of Senile Xerosis and Unique Cutaneous Reactivities to Environmental Aeroallergens
Authors: Aoyama Hiroaki , Tanaka Misako , Hara Masahiro , Tabata Nobuko , Tagami Hachiro
Published: April 2003

Background: The pathogenesis of nummular eczema (NE) is still unknown. It often develops on the lower legs of elderly individuals with xerotic changes during the winter months. Such winter exacerbation is also observed in atopic dermatitis, in which there is a high incidence of cutaneous immune reactivities against environmental aeroallergens. Objective: Because of the total lack of information about skin reactivities in NE patients, we performed immunological as well as functional studies in their uninvolved skin. Method: Prick tests and chamber scarification patch tests for representative aeroallergens were conducted on the flexor surface of the forearm in 26 NE patients, in 21 age-matched elderly persons without NE and in 43 healthy young controls. Results: We found that the elderly subjects, regardless of their background, showed a significantly higher immediate skin reactivity to Candida albicans than the young controls. In contrast, patch testing revealed that, unlike the age-matched elderly subjects who showed a decrease in incidence of positive patch test reations, the NE patients retained delayed contact sensitivity at a level comparable to that of the young healthy controls. They showed a significantly higher percentage of positive patch test reactions to Dermatophagoides farinae allergen (46%) and house dust allergen (35%) than the age-matched controls. Moreover, they also showed a significantly higher percentage of delayed hypersensitive reactions to C. albicans allergen (85%) than the age-matched controls (48%). Noninvasive functional assessment of the stratum corneum (SC) in unaffected skin areas of the lower legs in 8 NE patients demonstrated that, though the water barrier function of the SC was comparable to that of the age-matched controls, they showed a significantly lower hydration state of the SC than the age-matched controls. Conclusion: The xerotic skin of elderly individuals facilitates the development of cracking and fissuring of the skin surface in dry and cold winter. Such damage in the SC is sometimes aggravated by inadvertent scratching due to pruritus, allowing skin permeation of various environmental allergens. They may induce eczematous changes in those with preserved adequate delayed hypersensitivity despite their advanced age.
Two Cases of Pilomatrixoma in Turner’s Syndrome
Authors: Noguchi H. , Kayashima K. , Nishiyama S. , Ono T.
Published: April 2003

Multiple and familial cases of pilomatrixomas have been reported in myotonic dystrophy. We report 2 cases of pilomatrixoma in Turner’s syndrome. Between 5 and 19 years of age, 1 patient developed 6 pilomatrixomas including atypical occurrences on the chest and the posterior aspect of the leg. This is the first report of multiple pilomatrixomas in Turner’s syndrome.
Tropical-Wood-Induced Bullous Erythema multiforme
Authors: Shimizu Satoko , Chen Ko-Ron , Pratchyapruit Walai-Orn , Shimizu Hiroshi
Published: April 2003

We report a case of bullous erythema multiforme caused by an exotic wood, pao ferro (Machaerium scleroxylon). A 25-year-old female, a luthier (guitar maker) who often handles a variety of woods, developed bullous erythema multiforme. A patch test confirmed a positive reaction to one of the exotic woods, pao ferro. A subsequent accidental short contact with pao ferro 5 months following the first incidence induced a similar exudative erythema. Exotic woods such as pao ferro should be added to the list of contact allergens that can induce bullous erythema multiforme.
Rupture of the Hydatid Disease of the Liver into the Biliary Tracts
Authors: Paksoy Melih , Karahasanoglu Tayfun , Carkman Sinan , Giray Serdar , Senturk Hakan , Ozcelik Faik , Erguney Sabri
Published: April 2003

Background: To analyze the diagnosis and the surgical treatment of intrabiliary ruptured hydatid disease of the liver. Methods: Between 1990 and 1995, 263 patients with hydatid cysts of the liver underwent surgery in a university hospital. Twenty-five (9.43%) patients with intrabiliary rupture of hepatic hydatid cyst were retrospectively reviewed. Results: Diagnosis was principally made using ultrasonography and computed tomography scanning and was confirmed by the findings of other tests. In 12 patients (48%) partial cystectomy with primary closure; 5 patients (20%) partial cystectomy with drainage; 5 patients (20%) cystotomy with drainage; 3 patients (12%) left hepatic resection (atypic, segmentary or lobar) was performed. Omentoplasty was performed in 6 patients. The common bile duct was explored in all patients and it was drained by a T-tube in 22 patients, and by a choledochoduodenostomy in 3 others. The average postoperative hospitalization time was 8.3 and 22.5 days in patients treated with choledochoduodenostomy and T-tube drainage respectively. Cholecystectomy was performed in 18 patients. Complications were seen in 4 patients (16%) with 1 pleural effusion and 3 wound infections. There was only 1 death (4%) due to duodenal peptic ulcus perforation with intrabiliary ruptured hydatid cyst. Conclusion: This study indicates that T-tube drainage and choledochoduodenostomy in intrabiliary ruptured hydatid cysts are effective procedures with low morbidity and mortality rates.
Improved Survival with Resectionafter Transcatheter ArterialChemoembolization (TACE) for Unresectable Hepatocellular Carcinoma
Authors: Fan Jia , Tang Zhao-You , Yu Ye-Qin , Wu Zhi-Quan , Ma Zeng-Chen , Zhou Xin-Da , Zhou Jian , Qiu Shuang-Jian , Lu Ji-Zhen
Published: April 2003

Aim: This retrospective study was undertaken to analyze the outcome of hepatic resection in hepatocellular carcinomas (HCCs) that shrunk after transcatheter hepatic arterial chemoembolization (TACE) in 65 patients with unresectable HCCs between June 1987 and September 1996. Materials and Methods: Among these 65 patients, the median diameter of the tumor was 9.9 cm (5.6–20.0) prior to the first TACE, after 1–6 times of TACE (median 3) the median tumor diameter reduced to 3.7 cm (1.9–12.5) prior to resection. The duration between the last TACE treatment and sequential resection varied from 1 to 9 months (median 2.5). Serum α-fetoprotein (AFP) levels were abnormal in 39 out of the 65 patients. In AFP producing HCCs, the AFP level returned to normal (≤20 µg/l) in 14 out of 39 patients (35.9%). Hepatic segmentectomy, multiple hepatic segmentectomy or partial hepatic resection were performed in 61 patients, right hemihepatectomy in 1, left trisegmentectomy in 2, and left hemihepatectomy in 1. Results: Tumor necrosis ranged from 40 to 100% and pathologically and complete tumor necrosis occurred in 11 patients (16.9%). Of 14 patients with AFP levels decreased to normal, 10 still had microscopic living tumor foci. The 1-, 3- and 5-year survival rates of the 65 patients were 80.0, 65.0 and 56.0% respectively. Conclusion: TACE treatment can provide a chance of tumor resection for those patients with initially judged unresectable HCCs, and liver resection should be performed when the tumor has shrunk to be resectable, even when the AFP level has returned to normal.
Standard Kausch-Whipple Pancreatoduodenectomy
Authors: Jones Lucie , Russell Chris , Mosca Franco , Boggi Ugo , Sutton Robert , Slavin John , Hartley Mark , Neoptolemos John P.
Published: April 2003

Despite the increasing number of clinical trials in pancreatic cancer there are no widely accepted definitions of different types of resection for pancreatic cancer. An agreed definition of the standard Kausch-Whipple pancreatoduodenectomy was derived by a group of international experts at a meeting in Castelfranco Veneto, Italy, in May 1998. The lymph node groups to be removed en bloc with the pancreatoduodenectomy and described using the Japanese Pancreas Society classification were as follows: 13a and 13b; 17a and 17b; 12b1, 12b2 and 12c; and 14a and 14b. Limited segmental major venous resection and adjacent organ resection, if required, may be included as part of a standard pancreatoduodenectomy. The pylorus-preserving procedure also may be included as part of standard resection, but not for tumours of the anterior-superior part of the head of the pancreas. Wider adoption of the definition of standard Kausch-Whipple resection will enable a more objective comparative analysis of the radicality of resection between institutions and permit a more coherant analysis on the type of surgery undertaken in multicentre adjuvant studies.
Laparotomic vs. Laparoscopic Rectopexy in Complete Rectal Prolapse
Authors: Boccasanta Paolo , Venturi Marco , Reitano Maria Carmela , Salamina Giovanni , Rosati Riccardo , Montorsi Marco , Fichera Giuseppe , Strinna Mario , Peracchia Alberto
Published: April 2003

Aim: The aim of this study was to compare the functional and clinical results of laparotomic and laparoscopic rectopexy in 2 homogeneous groups of patients with complete rectal prolapse and fecal incontinence. Methods: Between January 1989 and December 1997, twenty-three patients underwent abdominal rectopexy. Thirteen patients (group A, 12 females and 1 male, mean age 57.3, range 22–76 years), and 10 patients (group B, 10 females, mean age 52.3, range 26–70 years) were submitted respectively to either Wells laparotomic or laparoscopic rectopexy by the same surgical team using the same surgical technique and materials. Before the operation a detailed clinical history was collected, and the patients were studied by inspection and digital examination of the anorectum, proctosigmoidoscopy, pancolonic transit time, dynamic defecography, anorectal manometry and anal electromyography. After the operation all patients underwent perineal physiotherapy, external electric stimulation, and perineal biofeedback. Mean follow-up was 37.1 (range 6–90) months in group A and 25.7 (range 6–49) months in group B. Values were compared by χ2, Mann-Whitney U, and Wilcoxon tests as appropriate. Differences were considered significant at p < 0.05. Results: In both groups dyschezia and fecal incontinence improved significantly (p < 0.05) after the operation. The basal pressure of the anal sphincter, squeezing pressure and rectoanal reflex improved without significance, and anal-perineal pain was not significantly reduced. In group B the postoperative hospital stay was lower than in group A, with a reduction in costs. Conclusion: Laparoscopic Wells rectopexy has the same clinical and functional results as laparotomic rectopexy, but with a shorter postoperative hospital stay and lower costs.
L-Methadone and D,L-Methadonein Methadone Maintenance Treatment: A Comparison of Therapeutic Effectiveness and Plasma Concentrations
Authors: de Vos Jan W. , Ufkes Jan G.R. , Kaplan Charles D. , Tursch Marcus , Krause Joachim K.A. , van Wilgenburg Henk , Woodcock Barry G. , Staib A. Horst
Published: April 2003

The clinical effectiveness of l-methadone maintenance treatment (LMMT) carried out using d,l-methadone or l-methadone have been compared with ambulatory heroin-dependent subjects. A total of 40 heroin-dependent subjects, previously maintained on l-methadone in Frankfurt am Main, were divided into two groups under randomised double-blind conditions and received either an equivalent dose of l-methadone as d,l-methadone or remained on the previous l-methadone treatment. Requests for a change in the dose of d,l-methadone and l-methadone were recorded, urine samples for determination of illicit drug use were collected and the individual level of opiate craving was determined over a 22-day observation period. There was no significant difference between the two groups in the number requests for a dose change (dose increase <10%). However, there was a significant increase in heroin use in the group which continued to receive l-methadone. Although there was less variability in opiate craving in the group receiving d,l-methadone, the mean intensity of opiate craving did not differ between the two groups. The mean l-methadone dose:l-methadone plasma concentration ratio, an index of the bioavailability of l-methadone in individual subjects, showed no significant change when the treatment was changed to d,l-methadone. The mean d-methadone:l-methadone plasma concentration ratio was 1.17. There was no significant difference between these ratios for day 15 and day 22. The mean l-methadone:EDDP plasma concentration ratio in the l-methadone group was 22.2 and the d,l-methadone:EDDP plasma concentration ratio was 18.4 . The plasma EDDP concentration in the d,l-methadone group increased 3-fold after starting treatment with d,l-methadone. These findings suggest that d,l-methadone can be used in methadone maintenance treatment of heroin-dependent subjects but that further studies are required to evaluate pharmacokinetic interactions between methadone enantiomers.
Protein Displays of the Human T Cell Receptor Alpha, Beta, Gamma and Delta Variable and Joining Regions
Authors: Folch Géraldine , Scaviner Dominique , Contet Valérie , Lefranc Marie-Paule
Published: April 2003

‘Protein Displays of the Human T Cell Receptor Alpha, Beta, Gamma and Delta Variable and Joining Regions’, the 13th report of the ‘IMGT Locus in Focus’ section, comprises 8 figures: (1) ‘Protein display of the human TRA V-REGIONs’; (2) ‘Protein display of the human TRB V-REGIONs’; (3) ‘Protein display of the human TRG V-REGIONs’; (4) ‘Protein display of the human TRD V-REGIONs’; (5) ‘Protein display of the human TRA J-REGIONs’; (6) ‘Protein display of the human TRB J- REGIONs’; (7) ‘Protein display of the human TRG J-REGIONs’; (8) ‘Protein display of the human TRD J-REGIONs’, and 4 tables entitled: (1) ‘FR-IMGT and CDR-IMGT length of the human TRAV genes’; (2) ‘FR-IMGT and CDR-IMGT length of the human TRBV genes’; (3) ‘FR-IMGT and CDR-IMGT length of the human TRGV genes’; (4) ‘FR-IMGT and CDR-IMGT length of the human TRDV genes’. These figures and tables are available at the IMGT Marie-Paule page from IMGT, the international ImMunoGeneTics database (http:// imgt.cines.fr:8104) created by Marie-Paule Lefranc, Université Montpellier II, CNRS, Montpellier, France.
Voice Problems at Work: A Challenge for Occupational Safety and Health Arrangement
Authors: Vilkman Erkki
Published: April 2003

In modern societies about one third of the labor force are working in professions in which voice is the primary tool. Voice problems are common in general, but they are even more common in professions in which there is heavy vocal loading, i.e. professions that do not only require prolonged voice use, but also involve extra loading factors such as background noise, long speaking distance, poor room acoustics, lack of adequate equipment like voice amplifiers etc. School and kindergarten teachers can be considered to represent professions with heavy vocal loading. The occupational safety and health arrangements of voice and speech professionals are poorly developed as compared to many other professions. However, the existing legislation could be used to support efforts to improve the working conditions of this large but heterogeneous group.
Prevalence and Etiology of Linear Enamel Hypoplasia in Monkeys and Apes from Asia and Africa
Authors: Guatelli-Steinberg Debbie , Skinner Mark
Published: April 2003

Ninety-seven specimens of sympatric monkeys and apes from East Malaysia and 115 monkeys and apes from West Africa are examined in order to evaluate the magnitude and nature of the great ape-monkey linear enamel hypoplasia (LEH) ‘dichotomy’. This study demonstrates that great apes from both regions have a higher incidence of LEH and repetitive LEH than do gibbons and monkeys. However, the authors find that the dichotomy is not as clear-cut as previous research suggests, since some monkey samples exhibit high LEH frequencies. The authors evaluate the potential influence of great ape-monkey differences in crown height on this dichotomy. They show that canine crown height variation is weakly associated with LEH variation. Differences between monkeys and great apes in their crown formation spans and in their experience of environmental stress may be more likely causes of the dichotomy.
Characterization of IgE–Reactive Autoantigens in Atopic Dermatitis
Authors: Seiberler Susanne , Natter Susanne , Hufnagl Peter , Binder Bernd R. , Valenta Rudolf
Published: April 2003

Previously we reported that patients with severe forms of atopy (e.g. atopic dermatitis, AD) frequently display IgE reactivity against autoantigens. Here we investigated the effects of periodate treatment and reducing versus nonreducing conditions on IgE recognition of nitrocellulose–blotted human cell extracts. IgE and IgG subclass reactivities of AD patients to blotted human cellular extracts as well as to ELISA plate–bound purified endogenous (myosin, histones) antigens and an environmental allergen (timothy grass pollen allergen, Phl p 5) were compared. Serum samples were collected over a period of 12 months from 3 autoreactive AD patients with pollen allergy and tested for IgE reactivity to nitrocellulose–blotted human epithelial and endothelial cell extracts as well as to birch and timothy grass pollen allergens. Results obtained indicate that (1) IgE autoantibodies may be directed primarily against protein and not carbohydrate epitopes, (2) reducing conditions seem to expose or better extract epitopes recognized by IgE autoantibodies, (3) IgE and IgG1–4 autoantibody responses were poorly associated and (4) IgE responses to autoallergens may reflect skin manifestations and may be boosted by seasonal exposure to pollen allergens. Our results thus indicate that IgE autoreactivity may represent a true form of autoimmunity directed against partly denatured peptide epitopes which may be boosted by exogenous allergen contact.