bluuebunny/crossref_metadata_2025 huggingface dataset:
NOISE TRANSFORMATION IN NONLINEAR SYSTEM WITH INTENSITY DEPENDENT PHASE ROTATION
Authors: ZVEREV V. V.
Published: December 2003

The statistical behavior of a nonlinear system described by a mapping with phase rotation is studied. We use the Kolmogorov–Chapman equations for the multi-time probability distribution functions for investigation of dynamics under the external noise perturbations. We find a stationary solution in the long-time limit as a power series around a state with complete phase randomization ("phase mixing"). The Ornstein–Uhlenbeck and Kubo–Andersen models of noise statistics are considered; the conditions of convergence of the power expansions are established.
ON THE ABSOLUTE REGULARITY OF LINEAR RANDOM DYNAMICAL SYSTEMS
Authors: DUC LUU HOANG
Published: December 2003

We introduce a concept of absolute regularity of linear random dynamical systems (RDS) that is stronger than Lyapunov regularity. We prove that a linear RDS that satisfies the integrability conditions of the multiplicative ergodic theorem of Oseledets is not merely Lyapunov regular but absolutely regular.
Brain Size Scaling and Body Composition in Mammals
Authors: Schoenemann P. Thomas
Published: December 2003

Brain size scales with body size across large groups of animals, but exactly why this should be the case has not been resolved. It is generally assumed that body size is a general proxy for some more important or specific underlying variable, such as metabolic resources available, surface area of the body, or total muscle mass (which is more extensively innervated than is, e.g., adipose tissue). The present study tests whether brain size in mammals scales more closely with muscle mass (and other components of lean body mass) than with total fat. Felsenstein’s independent comparisons method was used to control for phylogenetic effects on body composition in organ weight data taken from a previously published comparative sample of 39 species in 8 different orders of mammals, all collected and processed by the same researchers. The analysis shows that the size of the central nervous system (CNS) is more closely associated with components of fat-free weight than it is to fat weight. These results suggest a possible explanation for why metabolic resources and brain size both share the same general relationship with body size across mammals. They also suggest that some measure of lean body mass is a more appropriate scaling parameter for comparing brain size across species than is overall body weight.
Temporal Dynamics of Degenerative and Regenerative Events Associated with Cerebral Ischemia in Aged Rats
Authors: Badan I. , Platt D. , Kessler C. , Popa-Wagner A.
Published: December 2003

Background and Purpose: The age-related decline in plasticity of the brain may be one factor underlying the poor functional recovery after stroke. In the present work we tested the hypothesis that the attenuation of neural plasticity could be the result of an age-related reduction in the upregulation of factors promoting brain plasticity (microtubule-associated protein 1B [MAP1B], β-amyloid precursor protein [βAPP]), and an age-related increase in glial reactivity and the accumulation of Aβ, a proteolytic cleavage product of βAPP with neurotoxic properties. Methods: Focal cerebral ischemia was produced by reversible occlusion of the right middle cerebral artery in 3- and 20-month-old male Sprague-Dawley rats. The functional outcome was assessed in neurobehavioral tests 3, 7, 14 and 28 days after surgery. At the indicated time points, brains were removed and immunostained for glial cells. Aβ, as well as the markers of brain plasticity, βAPP and MAP1B. Results: Histologically, in young rats there was a gradual activation of both microglia and astrocytes that peaked by days 14–28 with the formation of a glial scar. In contrast, aged rats showed an accelerated astrocytic and microglial reaction that peaked in the first week after stroke. The expression patterns of a growth-associated phenotype of βAPP as well as with MAP1B accumulation in varicosities along axons in cortical areas affected by stroke peaked between days 14 and 28 in young animals. In aged rats their expression was both delayed (28 days) and reduced. In addition the carboxy terminal fragment of βAPP steadily accumulated over time and reached a maximum by day 14 in aged rats as compared to 28 days in young rats. Conclusions: These results suggest that a temporally anomalous gliotic reaction to cerebral ischemia in aged rats in conjunction with a late and limited upregulation of neuronal plasticity proteins as well as a diminished neurogenesis potential lead to the prevalence of scar tissue that impedes functional recovery from stroke.
An Electrophysiological Study of the Deep Peroneal Sensory Nerve
Authors: Lo Y.L. , Leoh T.H. , Dan Y.F. , Tan Y.E. , Nurjannah S. , Fook-Chong S.
Published: December 2003

The electrodiagnosis of peripheral neuropathy is often based on nerve conduction abnormalities in sensory nerves of the lower extremities. We performed nerve conduction studies of the deep peroneal sensory nerve prospectively in 63 limbs of 38 normal subjects. The sensory amplitudes showed a decreasing trend with increasing age. 21% of subjects had absent sensory potentials, especially those in the older age groups. This was seen in contrast with superficial peroneal and sural potentials, which were universally present. Although the deep peroneal sensory nerve is located in the distal lower limb, it should be used with caution in evaluating peripheral neuropathy, in view of the frequent occurrence of absent potentials even in asymptomatic normal subjects.
Oral Fluoride Retention in Saliva following Toothbrushing with Child and Adult Dentifrices with and without Water Rinsing
Authors: Issa A.I. , Toumba K.J.
Published: December 2003

Ten healthy adult volunteers were recruited to participate in this double-blind randomised 18-leg crossover designed study. The subjects either rinsed their mouth with 10 ml de-ionised distilled water for 10 s or just spat out once after 1-min brushing with one of nine different toothpastes: NaF (500, 1,000 and 1,450 ppm F), SMFP (525, 1,000, 1,450 ppm F), AmF (250, 1,400 ppm F) or fluoride-free dentifrice. Samples of whole mixed unstimulated saliva were collected at different time intervals. The results showed that the use of the AmF toothpaste (1,400 ppm F) resulted in the highest fluoride content of saliva without water rinsing after 120 min (0.52 ppm F, CI 0.23, 0.81). Two hours after brushing with fluoride toothpaste containing AmF and NaF, the salivary fluoride levels were still higher than baseline levels.
Demineralization of Dentin by Streptococcus mutans Biofilms Grown in the Constant Depth Film Fermentor
Authors: Deng D.M. , ten Cate J.M.
Published: December 2003

To develop a bacterial demineralization model, we grew Streptococcus mutans biofilms in a constant depth film fermentor (CDFF) and studied the effects of sucrose pulsing frequency (SPF) in time on dentin demineralization. S. mutans biofilms were grown in dentin specimens with grooves and on dentin surface specimens for 20 days. During the experiments, 2% sucrose was pulsed either 4 or 8 times per day for periods of 30 min. Diluted brain-heart infusion medium containing 25 mM PIPES buffer and 1.5 mM CaCl2 was pulsed as the alternative growth medium. Specimens with intact biofilms were taken out on days 5, 12 and 20. The model was assessed by viable counts of the biofilm, mineral loss and lesion depth in the dentin specimens (by transversal microradiography) and pH measurements in the groove (by pH microelectrode). The results showed that biofilms formed on the dentin surface specimens were constant in viable counts for the low SPF, while this parameter tended to increase with time under the high SPF. Lesions with intact surfaces were formed and the lesion size increased significantly over time and increased significantly with increasing SPF. Typical Stephan curves were found after sucrose pulsing. The pH inside the groove returned to neutral under low SPF, but remained below 6.5 under high SPF. With the CDFF S. mutans biofilm model, lesions can be created in dentin within reasonable experimental time periods, as a result of the presence of a biofilm and in response to carbohydrate challenges.
Enhanced External Counterpulsation as Initial Revascularization Treatment for Angina Refractory to Medical Therapy
Authors: Fitzgerald C.P. , Lawson W.E. , Hui J.C.K. , Kennard E.D.
Published: December 2003

Enhanced external counterpulsation (EECP) is effective in patients with angina refractory to medical therapy or revascularization. However, as a noninvasive treatment it should perhaps be considered the first-line treatment with invasive revascularization reserved for EECP failures or high-risk patients. The International EECP Patient Registry was used to analyze a cohort of patients with prior percutaneous coronary intervention (PCI) and/or coronary artery bypass graft (CABG) (n = 4,454) compared with a group of patients (PUMPERS) who were candidates for PCI and/or CABG and chose EECP as their initial revascularization treatment (n = 215). The PUMPERS responded to treatment with EECP with decreased anginal episodes and nitroglycerin use and with improvement in their Canadian Cardiovascular Society functional class, similarly to previously revascularized patients. Treatment with EECP resulted in sustained, and often progressive, reduction in angina over the succeeding 6 months. Given the findings of this study, it is interesting to speculate on the possibility of using EECP as the primary revascularization intervention after medical therapy proves unsatisfactory.
Metabolic Disturbances in Shock, and the Role of ATP-MgCl2 and Sex Steroids
Authors: Jarrar Doraid , Wang Ping , Chaudry Irshad H.
Published: December 2003

Hemorrhage following accidental injuries is a common cause of death in the industrialized world. Moreover, the impact of elective surgery and solid organ transplantation sometimes results in low flow conditions similar to those seen following hemorrhagic shock. A shortage in O2 availability, or hypoxia, leads to sequential changes in cell metabolism and morphology, including inflammatory responses and the expression of hypoxia-inducible transcription factor-1, which controls the cellular adaptation to hypoxia. These endogenous adaptive responses show that O2 deprivation is not an unforeseen event for cells. The purpose of this review article is to discuss the pathophysiologic principles of shock and the metabolic alterations that cells undergo during low flow conditions. Moreover, the rationale for therapeutic intervention by administering ATP-MgCl2 and sex steroids following shock and trauma will also be discussed.
Prevalence of Metabolic Syndrome among Hypertensive Patients Attending a Primary Care Clinic in Kuwait
Authors: Sorkhou E.I. , Al-Qallaf B. , Al-Namash H.A. , Ben-Nakhi A. , Al-Batish M.M. , Habiba S.A.
Published: December 2003

Objective: To determine the prevalence of metabolic syndrome among hypertensive patients using the criteria of the National Cholesterol Education Program’s Adult Treatment Panel III in a primary care health center in Kuwait. Subjects and Methods: A population of 250 Kuwaiti hypertensive patients (129 males and 121 females) over the age of 40 were screened for metabolic syndrome by determining body mass index (BMI), waist circumference, levels of fasting plasma glucose and fasting plasma lipids (serum triglycerides, total cholesterol and high-density lipoprotein cholesterol). The study was carried out in the Mishref Family Practice Health Center, Kuwait, from January to July 2001. Results: The total number of patients who met the criteria for metabolic syndrome was 85 (34%), 55% of them were males and 45% females. Prevalence of the syndrome was 28.2% among 40- to 55-year-olds and 41.9% in those above the age of 55 years. Among the 250 hypertensive patients, type II diabetes mellitus was found in 52.8% (54% males and 46% females), impaired fasting glucose in 8% (70% males and 30% females), high plasma triglycerides in 44.8% (53% males and 47% females) and low high-density lipoprotein cholesterol in 63.2% (54% males and 46% females). Obesity measured as BMI = 30 kg/m2 was noted in 46% (43% males and 57% females) and increased waist circumference in 58% (44% males and 56% females). Conclusion: The prevalence of metabolic syndrome is high among hypertensives attending primary health care centers in Kuwait.
Is There a Need for Doppler Vascular Examination for the Diagnosis of Varicose Vein? A Prospective Study
Authors: Safar Hussein , Shawa Naèl , Al-Ali Jasem , Al-Nassar Mohammad , Dashti Hussein , Asfar Sami
Published: December 2003

Objective: To compare the validity of a careful clinical examination with venous Doppler studies in the management of patients presenting with varicose veins. Subjects and Methods: Ninety-five consecutive patients presenting with varicose veins from September 1998 to August 1999 were included in this study. Of the 95 patients, 52 were males and 43 females. Eighty-four were expatriate laborers and 11 Kuwaiti nationals. Seventy-one were active workers under the age of 30. All of the patients underwent a full clinical examination for varicose veins, and a management plan was developed for each patient prior to Doppler venous study. The results of the Doppler studies were then compared with the clinical examination results, and the management plan was changed, if necessary, based on the Doppler results. Results: Both clinical and Doppler examinations were equally effective in diagnosing primary varicose vein and identifying sites of venous incompetence. A family history for varicose veins was found in 21% and standing for a long period of time was a risk factor in 51% patients. The most common symptoms were pain and heaviness. Doppler study findings were useful in changing the management plan of 14 (15%) patients, 6 with recurrent varicose vein and 8 obese patients with chronic venous insufficiency. The majority of the patients (n = 82) benefited from surgery and were free of symptoms. Conclusion: This prospective study demonstrated that detailed clinical examination was sufficient to diagnose most patients suffering from primary varicose veins. Doppler vascular studies were useful in changing the treatment modality for those presenting with recurrent varicose vein or obese patients with signs and symptoms of chronic venous insufficiency with no clinically clear varicosity.
Aseptic Leptomeningitis in Systemic Lupus erythematosus
Authors: Coşkun Özlem , Atasoy H. Tuğrul , Tunç Tuğba , Yildiz Hülya , İnan Levent E.
Published: December 2003

Objective: Systemic lupus erythematosus (SLE) with leptomeningeal involvement is a rare condition. We report a case in a 17-year-old woman. Clinical Presentation and Intervention: The patient was admitted to hospital with the complaints of vertigo, nausea, vomiting, headache, diplopia, ptosis on the left and weakness of the left leg. A diagnosis of SLE was established, with diffuse leptomeningeal involvement demonstrated by cranial magnetic resonance imaging. When treated with steroids, the clinical problems resolved almost completely. Conclusions: Although rare, leptomeningeal involvement can complicate SLE. Cranial magnetic imaging can demonstrate tissue involvement. The condition responds to steroid therapy.
Factors Affecting the Formation of a Skin Reservoir for Topically Applied Solutes
Authors: Roberts M.S. , Cross S.E. , Anissimov Y.G.
Published: December 2003

The reservoir function of the skin is an important determinant of the duration of action of a topical solute. The reservoir can exist in the stratum corneum, in the viable avascular tissue (viable epidermis and supracapillary dermis) and in the dermis. A steroid reservoir in the stratum corneum has been demonstrated by the reactivation of a vasoconstrictor effect by occlusion or application of a placebo cream to the skin some time after the original topical application of steroid. Other solutes have also been reported to show a reservoir effect in the skin after topical application. A simple compartmental model is used to understand why reactivation of vasoconstriction some time after a topical steroid application shows dependency on time, topical solute concentration and the product used to cause reactivation. The model is also used to show which solutes are likely to show a reservoir effect and could be potentially affected by desquamation, especially when the turnover of the skin is abnormally rapid. A similar form of the model can be used to understand the promotion of reservoir function in the viable tissue and in the dermis in terms of effective removal by blood perfusing the tissues.
Analysis of Epidermal Lipids of the Healthy Human Skin: Factors Affecting the Design of a Control Population
Authors: De Paepe K. , Weerheim A. , Houben E. , Roseeuw D. , Ponec M. , Rogiers V.
Published: December 2003

The intervariability of studies on the lipids of human epidermis and stratum corneum is high because of the different origin of the skin samples and the variety of extraction methods used. In the present work, a high-performance thin-layer chromatographic technique has been used to study the parameters age, sex, and anatomical site for their effects on the lipid profiles recovered from healthy epidermal skin biopsy specimens. It was found that sex-related differences were seen at the level of the total ceramide concentration. Observed decreases in lipid concentration, due to ageing, depended on the anatomical site. Therefore, these variables should be controlled in a reproducible and standardized way in order to be able to study the direct relationship between skin condition and barrier lipid composition. Only when this relation is established, results of topical treatment can be scientifically evaluated.
Enhancement of Wound Healing by Shikonin Analogue 93/637 in Normal and Impaired Healing
Authors: Mani H. , Sidhu G.S. , Singh A.K. , Gaddipati J. , Banaudha K.K. , Raj K. , Maheshwari R.K.
Published: December 2003

Wound healing is a complicated biological process, which involves interactions of multiple cell types, various growth factors, their mediators and the extracellular matrix proteins. In this study, we evaluated the effects of shikonin analogue 93/637 (SA), derived from the plant Arnebia nobilis, on normal and hydrocortisone-induced impaired healing in full thickness cutaneous punch wounds in rats. SA (0.1%) was applied topically daily as an ointment in polyethylene glycol base on wounds. SA treatment significantly accelerated healing of wounds, as measured by wound contraction compared to controls in hydrocortisone-impaired animals. SA treatment promoted formation of granulation tissue including cell migration and neovascularization, collagenization and reepithelialization. The expression of basic fibroblast growth factor (bFGF) was higher as revealed by immunohistochemistry in treated wounds compared to controls. However, the expression of transforming growth factor-β1 was not affected by SA treatment. Since bFGF is known to accelerate wound healing, the increased expression of bFGF by SA may be partly responsible for the enhancement of wound healing. These studies suggest that SA could be further studied for clinical use to enhance wound healing.
Improved Preparation and Preservation of Human Keratoplasty Lenticules
Authors: Salvalaio Gianni , Fasolo Adriano , Bruni Alessandro , Frigo Anna Chiara , Favaro Elisa , Ponzin Diego
Published: December 2003

Purpose: To improve the preparation of lenticules from human cornea and to obtain their preservation without loss of viable keratocytes. Methods: The epithelium was manually removed after bathing the surface of the cornea with a solution of trypsin and EDTA. Lenticules were prepared by microkeratome resection and viable keratocytes were visualized by staining with thiazolyl blue (MTT). Results: The pretreatment with trypsin-EDTA allowed the removal of the epithelium without damage to the keratocytes and the stroma. When these lenticules were incubated in Optisol-GS for 7 days at 4°C, they showed a limited thickness increase and a preservation of keratocyte viability. Conclusion: This procedure allows the preparation of lenticules with viable keratocytes that can be preserved in the cold for at least 1 week.
Outcome and Safety of Extracorporeal Shock Wave Lithotripsy as First-Line Therapy of Lower Pole Nephrolithiasis
Authors: Riedler Ildiko , Trummer Harald , Hebel Peter , Hubmer Gerhart
Published: December 2003

Introduction: The aim of this study is to assess the efficiency of extracorporeal shock wave lithotripsy (ESWL) as initial therapy for isolated lower pole kidney stones smaller than 20 mm. Patients and Methods: During a 24-month period 116 patients with previously untreated single stones under 20 mm in diameter were treated with a Dornier lithotripter S. They were analyzed with regard to stone site and size, number of ESWL sessions, auxiliary measures, retreatment rates, complications and the time taken for stone clearance. Results: 76 patients (65.5%) became stone free, 50 of them (43.1%) within 3 months after ESWL. Depending on stone size the stone-free rates were 67.1% for patients with a stone diameter of <10 mm (59 of 88 patients), and 60.7% for stone diameters between 10 and 20 mm (17 of 28 patients). Complications during and after treatment were rare, i.e. the necessity of ureteral stent insertion due to colic (n = 10), endoscopic stone removal (n = 2), acute pyelonephritis (n = 1), stonestreet (n = 1) and 1 case of hematoma not requiring intervention. The recurrence rate during follow-up (13.2–36.9, mean 25.0 months) was low: 16 patients (13.8%) had recurrent or persistent stones, and 74 patients (63.8%) had no evidence of urolithiasis. Conclusions: ESWL is a safe and efficient first-line therapy for treatment of isolated small lower pole kidney stones with acceptable stone-free rates, low morbidity, few complications and a low stone recurrence rate.
Results of Extracorporeal Shock Wave Lithotripsy with a New Electrohydraulic Shock Wave Generator
Authors: Gronau Eckart , Pannek Jürgen , Böhme Matthias , Senge Theodor
Published: December 2003

Objective: Since 1999, the lithotriptor LDM® (Philips, Germany) is used routinely for treatment of urinary stones in our department. We evaluated the complication rate and treatment success of extracorporeal stone treatment with the new lithotriptor. Material and Methods: We performed a prospective, two-step clinical study: (1) Complication rate: From January to May 1999, 312 consecutive treatments in 225 patients (136 male, 89 female) were evaluated. (2) Success rate: From February to April 2000, 88 consecutive patients (61 male, 27 female) with 113 concrements were evaluated. Results: (1) Complication rate: Overall complication rate was 10%. Most of them were minor complications. Most significant complications were subcapsular renal hematomas, which were detected by routinely performed renal ultrasound in 1%. (2) Success rate: After single treatment, overall success rate was 87%. 15 of 16 in situ treated ureteral stones (94%) were sufficiently disintegrated by a single treatment. Disintegration rates after single treatment were 93.6% for renal stones smaller than 1 cm and 86% for renal stones 1–2 cm, respectively. Conclusions: Stone therapy by SWL with the new lithotriptor LDM is a highly effective therapy of renal and ureteral stones and has a low complication rate.
Adrenalectomy: Defining Its Role in the Surgical Treatment of Renal Cell Carcinoma
Authors: De Sio Marco , Autorino Riccardo , Di Lorenzo Giuseppe , Damiano Rocco , Cosentino Luca , De Placido Sabino , D’Armiento Massimo
Published: December 2003

Objectives: With the recent widespread use of modern imaging techniques, the frequency of small low-stage renal cell carcinomas (RCC) has grown considerably, giving rise to more conservative surgical approaches. We evaluated the characteristics of adrenal involvement and the accuracy of computerized tomography (CT) in the diagnosis of RCC, defining the real need for adrenalectomy during surgical treatment. Methods: The medical records of 201 patients undergoing radical nephrectomy and ipsilateral adrenalectomy for localized or advanced RCC, from 1996 to 2002, were analyzed, retrospectively. We considered 76 with stage T1–2 disease and 125 with T3–4N0–1M0–1 disease. In all cases a blinded review of the preoperative abdominal CT was performed. Histopathology records of the surgical specimens were examined to determine the accuracy of the CT in identifying adrenal involvement by RCC. Results: The overall incidence of adrenal metastasis was 4.4%. The mean renal tumor size in patients with adrenal involvement was 7.8 cm. The tumor stage correlated with a probability of adrenal spread (p < 0.05), with T1–2 tumors accounting for 1.3% of cases only. The adrenal gland was diagnosed as abnormal on preoperative CT in 21 patients (10.4%). CT scan demonstrated 88.8% sensitivity, 92.1% specificity, 99.4% negative predictive value and 34.7% positive predictive value for adrenal involvement by RCC. Conclusions: Adrenal involvement is not likely in patients with localized early stage RCC and adrenalectomy can be omitted in such cases, particularly when CT is negative. However, in selected patients with large high-risk tumors, radical nephrectomy, including removal of the ipsilateral adrenal gland, should be performed.
Varicoceles in Adolescents and Young Adults after Surgery for Hepatosplenic Schistosomiasis
Authors: Brandt Frederico Teixeira , Albuquerque Carla Daisy Costa , Brandt Carlos Teixeira , Lorenzato Felipe Rinald , Leal Cláudio Ribeiro , Barbosa Carolina Duarte , Nóbrega Leonor Viana
Published: December 2003

Introduction: This case-control study aimed at evaluating testicular volume, pubertal and genital development, and incidence of varicoceles in adolescents and young adults after surgery for hepatosplenic schistosomiasis associated with bleeding oesophageal varices. Patients and Methods: The study involved 26 young males with schistosomiasis who were submitted to splenectomy, left gastric vein ligature, and auto-implantation of splenic tissue in the major omentum during childhood. The mean follow-up period was 4 years after surgery. The control group included 15 healthy volunteers from a school in the same region where the cases lived. They were randomly selected, matched by age and epidemiological characteristics, and had schistosomiasis ruled out. All participants underwent thorough clinical and ultrasound examinations. Special attention was paid to sexual characteristics, testicular ultrasonography, and Doppler flowmetry of spermatic veins. Results and Conclusions: The patients with schistosomiasis had significant deficits in pubertal and genital development and in testicular volume, especially the left one, and a high incidence of varicoceles (61.5%) without a straight association with testicular atrophy.
Comparative Clinical and Electrometric Assessments of the Impact of Surfactants on Forearm Skin
Authors: Uhoda Emmanuelle , Paye Marc , Piérard Gérald E.
Published: December 2003

Surfactant-based skin care products can induce minimal to severer alterations of the human stratum corneum (SC). These changes can be conveniently assessed using electrometric devices. Four different surfactant-based solutions were applied to the forearms of 10 healthy volunteers following a soap chamber test method. The 2-day patch testing was followed by a 2-week follow-up. Clinical and instrumental assessments were performed at 7 time points. Data generated by the Corneometer® CM820, the Dermalab Moisture Module® and the Nova Dermal Phase Meter® (DPM) 9003 were compared. The significant differences between the product aggressiveness to the SC were similarly disclosed by the Corneometer and the Dermalab Moisture Module. The ranking of product aggressiveness given by the 3 devices 5 days after patch removal was similar to that given by the clinical assessment of erythema. A high level of correlation was found between the values yielded by the immediate and continuous mode assessments using the Dermalab Moisture Module with the pin probe, while the correlation was weaker with the Nova DPM. This finding may be related to the fact that the Nova DPM is influenced by the accumulation of the transepidermal water loss in the continuous mode assessment while there is no significant occlusion effect of the Dermalab Moisture pin probe that is more representative of the initial level of SC hydration. In conclusion, the Corneometer and the Dermalab Moisture Module respond similarly to changes in the SC content. This finding is different from some previous reports.
Is Androgenetic Alopecia a Photoaggravated Dermatosis?
Authors: Trüeb Ralph M.
Published: December 2003

Progressive thinning of the scalp hair in androgenetic alopecia (AGA) results in a gradual decline in natural protection of the scalp from ultraviolet radiation (UVR). A number of pathologic conditions of the scalp are evidently related to UVR, particularly photosensitive diseases and disorders of the chronically photodamaged bald scalp. The most important chronic effects of UVR are photocarcinogenesis and solar elastosis. Besides these, erosive pustular dermatosis and ‘red scalp’ are distinct disorders peculiar to the balding scalp. While the consequences of sustained UVR on the unprotected scalp are well appreciated, the effects of UVR on hair loss have widely been ignored. However, clinical observations and theoretical considerations suggest that UVR may have negative effects: acute telogen effluvium from UVR has been described, and the production of porphyrins by Propionibacterium sp. in the pilosebaceous duct, with photoactivation of porphyrins leading to oxidative tissue injury, has been implicated in follicular microinflammation. Alternatively, keratinocytes themselves may respond to physicochemical stress from UVR, besides irritants and pollutants, by producing radical oxygen species and nitric oxide and by releasing proinflammatory cytokines, eventually leading to injury of the putative site of follicular stem cells in the superficial portion of the hair follicle. Since all of these processes involved in hair loss share the common feature that they are induced or exacerbated by exposure to sunlight, it is proposed that AGA is a photoaggravated dermatosis that requires photoprotection.
Review of the Chronology of Clinical Manifestations in 60 Patients with Behçet’s Disease
Authors: Alpsoy Erkan , Donmez Levent , Bacanli Ali , Apaydin Cemil , Butun Bulent
Published: December 2003

Background: The natural course of Behçet’s disease is not fully known. Objective: The aim of the present study was to determine the occurrence of the symptoms retrospectively in chronologic order in patients with Behçet’s disease, diagnosed according to the criteria of the International Study Group for Behçet’s Disease. Methods: A total of 60 consecutive patients (29 male and 31 female; aged 35.87 ± 9.84 years) were involved in the study. The symptoms of the disease were retrospectively recorded in the time order of the manifestations per patient. Results: Oral ulcer was the most commonly observed onset manifestation (51 of 60 patients: 85%), followed by genital ulcer (13 of 60 patients: 21.7%) and articular symptoms (10 of 60 patients: 16.7%). The duration between the oral ulcer and the fulfilment of diagnostic criteria was calculated to be 3.77 ± 4.43 years. The same duration was 2.50 ± 4.74 and 2.11 ± 3.44 years for genital ulcer and articular symptoms, respectively. The duration between the time point of fulfilment of diagnostic criteria and the diagnosis (2.83 ± 2.3 years) was found to be longer in female patients (3.2 ± 2.5 years). The duration was also longer in patients having only mucocutaneous lesions (3.18 ± 2.5 years) than in patients having serious organ involvement such as eye disease (1.63 ± 0.7 years; p < 0.05). Conclusion: Our study indicates that oral ulcer is the onset manifestation in the majority of the patients and the disease is often diagnosed with a delay of several years after the appearance of the onset sign.
Flow-Cytometric DNA Analysis in Cutaneous Fibrohistiocytic Tumors
Authors: Okita Hiroshi , Ohtsuka Tsutomu , Yamazaki Soji
Published: December 2003

Background: Fibrohistiocytic tumors are rare skin tumors. There are many kinds of fibrohistiocytic tumors. It is often difficult to differentiate dermatofibrosarcoma protuberans (DFSP) and malignant fibrous histiocytoma (MFH) from dermatofibroma (DF) and other benign tumors. Objective: In this study, the possible usefulness of DNA ploidy for the differentiation was studied. Methods: Five MFH, 9 DFSP, 3 DF, 2 lipofibromas and 2 scars were studied for DNA ploidy using a flow cytometer. Results: All the 7 benign tumors showed a diploid pattern. Of 14 malignant fibrohistiocytic tumors, 8 cases (57.1%) showed an aneuploid and 6 a diploid pattern. Two of 5 MFH (40.0%) and 6 of 9 DFSP (66.7%) showed an aneuploid pattern. These results showed that fibrohistiocytic tumors with an aneuploid pattern are malignant, though those with a diploid pattern may be benign or malignant. Conclusion: Analysis of DNA ploidy using flow cytometry was concluded to be useful for the differentiation of malignant fibrohistiocytic tumors from benign ones.
Erythema multiforme-Like Drug Eruption with Oral Involvement after Intake of Leflunomide
Authors: Fischer Tobias W. , Bauer Heike I. , Graefe Tim , Barta Ute , Elsner Peter
Published: December 2003

Leflunomide is an antirheumatic agent of the type of a ‘disease-modifying antirheumatic drug’. In rare cases, severe skin reactions up to the extreme expression of toxic epidermal necrolysis have been observed. A female patient with rheumatoid arthritis had been treated with systemic steroids and methotrexate for 2 years. Five weeks prior to admission to our hospital methotrexate was replaced by leflunomide. Three weeks after initiation of leflunomide therapy a progressive generalized erythema with blistering formation occurred accompanied by increase of body temperature, chills and erosive lesions on the lips and oral mucosa. The palmar and plantar surfaces revealed edema, erythema and pulpitis with epidermolysis. On histologic examination necrotic keratinocytes and epidermal spongiosis were observed. After administration of high-dose prednisolone and topical treatment the patient recovered within 14 days. This is one of the few cases of severe drug reaction after intake of leflunomide. Therefore, the indication of this relatively new drug should be considered carefully.
Acquired Perforating Dermatosis in a Patient with Poland Syndrome
Authors: Fistarol Susanna K. , Itin Peter H.
Published: December 2003

Acquired perforating dermatosis (APD) is characterized by umbilicated 1- to 10-mm-measuring papulonodules with a central adherent oystershell-like keratotic plug, typically on the dorsa of the hands, forearms and over the knees. APD is associated with systemic diseases, especially diabetes mellitus and/or renal failure. Histologically the lesions show transepidermal elimination of altered dermal components into a cup-shaped epidermal depression. We present a 69-year-old man with coexisting APD and Poland syndrome (PS), an association not yet described. PS (OMIM 173800) is a rare congenital anomaly consisting of unilateral partial or total absence of the greater pectoralis muscle and ipsilateral symbrachydactyly. Most cases of PS are sporadic as it was in our case. Our patient had, in addition, an untreated diabetic condition, hyperuricaemia, dilated cardiomyopathy and a very recent pulmonary embolism. He responded to therapy with allopurinol.
Sex-Related Hearing Impairment in Wolfram Syndrome Patients Identified by Inactivating WFS1 Mutations
Authors: Pennings Ronald J.E. , Huygen Patrick L.M. , van den Ouweland Jody M.W. , Cryns Kim , Dikkeschei Lambert D. , van Camp Guy , Cremers Cor W.R.J.
Published: December 2003

This study examined the audiovestibular profile of 11 Wolfram syndrome patients (4 males, 7 females) from 7 families, with identified WFS1 mutations, and the audiometric profile of 17 related heterozygous carriers of WFS1 mutations. Patients with Wolfram syndrome showed a downsloping audiogram and progressive hearing impairment. None of the carriers had sensorineural hearing loss. Two patients with missense (non-inactivating) mutations in WFS1 had normal hearing and mild symptoms of Wolfram syndrome and were excluded from the analyses. Of the identified patients with inactivating WFS1 mutations, 5 female patients were significantly more hearing impaired than four male patients (p < 0.05). Female patients showed hearing impairment progressing by 1.5–2.0 dB HL per year for the low frequencies and 4.0–4.5 dB HL per year for the mid and high frequencies. The age of onset (90% phoneme recognition score) was 21 years and the onset level 78 dB HL. The deterioration rate was 4.0% per year and the deterioration gradient 1.4% per dB HL. One of the 6 examined patients had vestibular areflexia.
Dichlorodiphenyltrichloroethane Specifically Depletes Dopaminergic Neurons in Primary Cell Culture
Authors: Leung K.W. , Chan Y.S. , Yung K.K.L.
Published: December 2003

Toxicity of dichlorodiphenyltrichloroethane (DDT) to dopaminergic neurons in primary cell culture was investigated in the present study. Developing neurons from the substantia nigra of neonatal rats were cultured. After treatments with different concentrations of DDT (5– 12.5 µM), specific cell death of tyrosine-hydroxylase-immunoreactive dopaminergic neurons was observed in the culture by flow cytometric analysis. More than 60% of dopaminergic neurons were depleted after treatments with 10 and 12.5 µM of DDT. In addition, significant reductions of intensity levels of tyrosine hydroxylase immunofluorescence were observed in dopaminergic neurons after DDT treatments even at low concentrations of DDT. The present findings indicate that dopaminergic neurons are more susceptible to DDT toxicity than other types of neurons in the primary cell culture. Moreover, it is shown that the synthesis of dopamine in dopaminergic neurons is also depressed. Previous studies have demonstrated that perinatal exposure of DDT causes neurons to be more susceptible to neurotoxic damages in later adult life. The present findings thus provide evidence that dopaminergic neurons that are undergoing growth and development are targets of DDT neurotoxic effects. Exposure to DDT from contaminated environments is therefore a potential risk of onset of Parkinson’s disease.
Expression of the G-Protein-Coupled Receptor Endothelial Differentiation Gene-2 in the Developing Human Forebrain with Reference to Myelination
Authors: Briese Michael , Ulfig Norbert
Published: December 2003

The G-protein-coupled receptor endothelial differentiation gene-2 (Edg-2) is localized to oligodendrocytes in the postnatal mouse and rat brain. Its spatial and temporal expression pattern has been shown to closely parallel the progress of myelination. Here we have investigated immunohistochemically the distribution of this receptor in 10 fetal forebrains ranging from 24 to 28 weeks of gestation, which roughly corresponds to the onset of myelin formation in the human forebrain. At 24 weeks of gestation, Edg-2-immunoreactive cells are detected around the anterior commissure and in the putamen, globus pallidus, medial medullary lamina and subthalamic nucleus. In these areas, cells positive for Edg-2 regularly possess one or two rather thick processes which may divide into branchlets at their endings. Double-labelling demonstrates that Edg-2 distribution correlates with the appearance of myelin sheaths in the globus pallidus and medial medullary lamina. It precedes myelination in the internal capsule and within the subthalamic nucleus. Additionally, Edg-2-positive cells are found within as well as in the vicinity of the ganglionic eminence in the form of densely packed columnar cell clusters oriented towards the striatum and globus pallidus. This finding indicates an early expression in presumably migrating oligodendrocyte progenitor cells, which may originate in the ganglionic eminence. Together, our results demonstrate that in the human fetal forebrain, the receptor Edg-2 might be involved in oligodendrocyte development. As an oligodendrocyte marker, Edg-2 might be used to assess the pathological alterations occurring in white matter injury and in other disturbances affecting oligodendrocyte development and function.
Polymorphonuclear Elastase in the Early Diagnosis of Complicated Pyogenic Pleural Effusions
Authors: Alemán Carmen , Alegre José , Segura Rosa M. , Armadans Lluís , Suriñach Josep M. , Varela Encarna , Soriano Teresa , Recio Jesús , Fernández de Sevilla Tomás
Published: December 2003

Background: Polymorphonuclear elastase (PMN-E) is a neutrophilic marker that has been implicated in acute inflammatory responses. Objectives: To evaluate the accuracy of PMN-E in the diagnosis of complicated pyogenic effusions. Patients and Method: We studied 536 patients with pleural effusion of various etiologies. There were 125 pyogenic bacterial effusions (42 typical parapneumonic, 17 borderline complicated parapneumonic and 66 complicated parapneumonic or empyema), 83 tuberculous, 91 malignant, 42 paramalignant, 95 transudates, 28 miscellaneous and 72 effusions of unknown origin. Classic markers (pH, glucose, proteins, adenosine deaminase, LDH, leukocytes and differential count) and the PMN-E level were quantified in pleural fluid. The accuracy of PMN-E as an early marker in the diagnosis of complicated pyogenic infectious effusions was evaluated among pleural effusions that were not diagnosed with classic biochemical markers, radiological findings or Gram stain. Since results of pleural fluid culture and cytological examination are generally available after a 48-hour delay, they were not included as early markers in the initial diagnosis of pleural effusions. Results: Early diagnosis of complicated pyogenic bacterial effusions was achieved in only 48 of 66 cases with classic markers. Among those that were not diagnosed with these parameters, a pleural PMN-E value >3,500 µg/l discriminated between complicated and noncomplicated pyogenic bacterial effusions with a sensitivity of 67% and a specificity of 97%. Conclusions: PMN-E is useful in the early diagnosis and management of complicated pyogenic infectious effusions, which may be delayed with classic markers.
Organizing Pneumonia Presenting as a Solitary Nodular Shadow on a Chest Radiograph
Authors: Watanabe Kentaro , Harada Taishi , Yoshida Minoru , Shirakusa Takayuki , Iwasaki Akinori , Yoneda Satoshi , Kikuchi Masahiro
Published: December 2003

Background: The role of infection as a cause of focal organizing pneumonia (OP) is not fully understood. Objectives: This study aimed to determine the clinical, radiological and pathological characteristics of patients with OP presenting a solitary nodular shadow on a chest radiograph. Methods: Fourteen patients who presented with a solitary nodular shadow on a chest radiograph, pathologically diagnosed as OP after surgical resection, were allocated into two groups according to the histological findings. The first had OP with aggregates of neutrophils in airways and/or pulmonary parenchyma with or without necrosis or destruction of lung architecture (group 1: OP with neutrophilic infiltration; n = 10). The second consisted of patients with OP presenting neither neutrophilic infiltration, necrosis nor destruction of lung architecture (group 2: OP without neutrophilic infiltration; n = 4). Results: Cough, sputum, and chest pain were the common symptoms in both groups of patients. Computed tomography (CT) revealed that all nodules in both groups were located in the peripheral lung parenchyma and had irregular margins, and their shapes varied from round to wedge-shaped. Haemophilus influenzae was isolated from sputum or transbronchial aspirates from 3 patients in group 1. Conclusions: The specimens resected from patients with focal OP mostly show small aggregates of neutrophils. However, the dominant histological feature is OP and neutrophilic infiltration, suggesting infection was a minor histological component in all cases. Clinical symptoms and chest CT findings did not clearly distinguish these two groups of patients. It is thus reasonable to place these OPs in the same category and to treat them in the same way. Surgical excision appears to be the only method for a precise diagnosis.
Acute Respiratory Distress Syndrome Induced by Rifampicin with High Levels of Neutrophil and Eosinophil Products in Bronchoalveolar Lavage Fluid
Authors: Ashitani Jun-ichi , Yanagi Shigehisa , Arimura Yasuji , Sano Arisa , Mukae Hiroshi
Published: December 2003

We reported a case with acute respiratory distress syndrome (ARDS) caused by rifampicin during therapy for pulmonary tuberculosis. A high level of eosinophil cationic protein in bronchoalveolar lavage fluid (BALF) was detected as well as interleukin-8 and neutrophil elastase. Based on these results together with the positive result of the drug lymphocyte-stimulating test, we concluded that rifampicin was the causative drug leading to ARDS. Corticosteroid therapy resulted in clinical improvement and resolution of the pulmonary infiltrates on the chest radiograph without the recurrence of pulmonary tuberculosis.
High-Dose Therapy and Autologous Stem Cell Transplantation in Relapsed and Refractory Hodgkin’s Disease: Outcome Based on a Prognostic Model
Authors: Qazilbash Muzaffar H. , Devetten Marcel P. , Abraham Jame , Lynch Joseph P. , Beall Charles L. , Auber Miklos , Weisenborn Robin , Bunner Pam , Ericson Solveig G.
Published: December 2003

We evaluated the results of high-dose therapy (HDT) and autologous hematopoietic stem cell transplantation (ASCT) in patients with relapsed or primary refractory Hodgkin’s disease (HD), using a previously reported prognostic model based on the presence of three poor prognostic factors at the start of salvage therapy/preparative regimen: B symptoms, extranodal disease and the duration of last complete response of less than 1 year. Based on this model, the patients were divided into low-risk and high-risk groups. Between 1993 and 2001, 24 patients with HD were treated with HDT and ASCT. Eighteen of the 24 patients had 0–1 risk factors (low-risk group) and 6 patients had 2–3 risk factors (high-risk group). Using Kaplan-Meier analysis, after a median follow-up of 40.5 months, the progression-free survival (PFS) was 48%, and the overall survival (OS) was 55%. PFS in the low-risk group was 56%, and in the high-risk group 17% (p < 0.001). OS in the low-risk group was 68% and in the high-risk group it was 18% (p < 0.001). The 100-day transplant-related mortality for the entire group was 16%. Our results are comparable to those reported in previous clinical trials for patients with refractory and relapsed HD treated with HDT and ASCT. The use of a prognostic model appears useful for predicting the outcome of HDT and ASCT for HD patients, and may play an important role in choosing the appropriate therapy for these patients.
Granulocytic Sarcoma of the Pancreas
Authors: Servin-Abad Luis , Caldera Humberto , Cardenas Rafael , Casillas Javier
Published: December 2003

Granulocytic sarcoma is an extramedullary collection of myeloblasts. Granulocytic sarcomas usually arise during the course of acute myeloid leukemia, although they also occur infrequently in chronic myeloid leukemia and other myeloproliferative disorders. We are reporting a very unusual presentation of granulocytic sarcoma in a patient with poorly differentiated (FAB type M2) acute myeloid leukemia. The patient was in complete remission from leukemia when he presented obstructive jaundice due to a pancreatic mass consisting of myeloblasts. A literature search identified only five previously reported cases of granulocytic sarcoma of the pancreas. Those cases are also reviewed here with emphasis on their clinical characteristics, diagnostic approaches, and management of this interesting and challenging entity.