bluuebunny/crossref_metadata_2025 huggingface dataset:
The medical‐care cost burden of obesity
Authors: Thompson David , Wolf Anne M.
Published: March 2003

Recent years have seen a dramatic rise in the prevalence of obesity in many countries, stimulating interest in the health and economic consequences of this phenomenon. In this article, we provide a systematic review of the literature on the medical‐care cost burden of obesity. Relevant studies were identified using a computerized search of the medical literature for English‐language articles published between 1990 and 2001. The 18 studies that met all criteria for inclusion in the review can be classified as modelling or database studies and further distinguished as cross‐sectional or longitudinal in nature. The majority of studies that have been conducted are cross‐sectional modelling studies, including 10 studies reporting the burden of obesity to national health systems. These suggest that obesity accounts for 5.5–7.0% of national health expenditures in the United States and 2.0–3.5% in other countries for which estimates have been reported. Other studies highlight the burden of obesity from other perspectives, including employers and health plans, as well as the impact of obesity on future disease risks and associated medical‐care costs. Despite various methodological limitations, discussed herein, this body of research leads to the inescapable conclusion that obesity exacts an immense economic toll in various countries throughout the world.
Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship
Authors: Deurenberg P. , Deurenberg‐Yap M. , Guricci S.
Published: March 2003

The objective was to study the relationship between body mass index (BMI) and body fat per cent (BF%) in different population groups of Asians. The study design was a literature overview with special attention to recent Asian data. Specific information is provided on Indonesians (Malays and Chinese ancestry), Singaporean Chinese, Malays and Indians, and Hong Kong Chinese. The BMI was calculated from weight and height and the BF% was determined by deuterium oxide dilution, a chemical‐for‐compartment model, or dual‐energy X‐ray absorptiometry. All Asian populations studied had a higher BF% at a lower BMI compared to Caucasians. Generally, for the same BMI their BF% was 3–5% points higher compared to Caucasians. For the same BF% their BMI was 3–4 units lower compared to Caucasians. The high BF% at low BMI can be partly explained by differences in body build, i.e. differences in trunk‐to‐leg‐length ratio and differences in slenderness. Differences in muscularity may also contribute to the different BF%/BMI relationship. Hence, the relationship between BF% and BMI is ethnic‐specific. For comparisons of obesity prevalence between ethnic groups, universal BMI cut‐off points are not appropriate.
Elevated body fat percentage and cardiovascular risks at low body mass index levels among Singaporean Chinese, Malays and Indians
Authors: Deurenberg‐Yap M. , Chew S. K. , Deurenberg P.
Published: March 2003

The aim of this study was to investigate the relationship between body mass index (BMI) and body fat percentage (BF%) in Singaporean Chinese, Malays and Indians, and to determine the risk for selected comorbidities at various BMI categories and abdominal fat distributions, as assessed by waist circumference (WC). The study was a cross‐sectional (population) design. In total, 4723 subjects participated in the National Health Survey of 1998 in which the risks were investigated. A selected subsample of 291 subjects participated in a detailed body composition study, where weight, height and WC were measured, as were blood pressure, total and high‐density lipoprotein (HDL) cholesterol, serum triglycerides and fasting glucose. In the subsample, BF% was determined by means of a chemical four‐compartment model. At any given BF% the BMI of Singaporeans was about 3 kg m−2 lower than that of Caucasians. There were slight differences in the BF%/BMI relationship between the three ethnic groups. For all the ethnic groups, it was found that at low categories of BMI (between 22 and 24 kg m−2) and WC (between 75 and 80 cm for women and between 80 and 85 cm for men), the absolute risks for having at least one of the aforementioned risk factors were high, ranging from 41 to 81%. At these same categories the relative risks were significantly higher compared to the reference category, odds ratios ranging from 1.97–4.38. These categories of BMI and WC were all far below the cut‐off values of BMI and WC as currently recommended by the World Health Organization (WHO). The data from the current study, which includes evidence that not only risk factors, but also BF% are elevated at low BMI values, presents a strong case for lowering the BMI cut‐off value for overweight and obesity among Singaporeans, from 25 kg m−2 and 30 kg m−2 to 23 kg m−2 and 27 kg m−2, respectively.
Energy balance and pollution by organochlorines and polychlorinated biphenyls
Authors: Pelletier C. , Imbeault P. , Tremblay A.
Published: March 2003

Organochlorines are fat‐soluble chemical compounds resistant to degradation, so they are stored in the adipose tissue of practically every organism on the planet, including humans. Accumulation of these compounds in the body seems to be related to fat mass, obese individuals having a higher plasma organochlorine concentration than lean subjects. During body weight loss, lipid mobilization and a decrease in fat mass result in increased concentrations of organochlorines in plasma and adipose tissue. Organochlorines may have adverse health effects. For example, they have been associated with altered immune and thyroid functions and with some types of cancer. As these compounds may reach their target organs whilst in the circulation, their increase in plasma during weight loss might be associated with some physiological changes occurring during weight loss. Relationships have indeed been reported among weight loss‐induced increase in plasma organochlorine concentration and decreased triiodothyronine (T3) concentration, resting metabolic rate, and skeletal muscle markers for fat oxidation. Although further studies are needed to assess the causality of these relationships, they raise concern about some potential undesirable effects of weight loss. Indeed, the effects of organochlorines on energy balance could complicate body weight loss and even favour weight regain. These notions lend support for weight‐loss strategies favouring a moderate weight loss, which would reduce risks for cardiovascular diseases, diabetes and hypertension, without resulting in a substantial release of organochlorines.
New Concepts in the Pathogenesis, Diagnosis, Prognostic Factors and Clinical Presentation of Chronic Lymphocytic Leukemia
Authors: Hallek Michael
Published: March 2003

Chronic lymphocytic leukemia of the B‐cell type CLL) is the most frequent leukemia in the Western hemisphere. Recent advances in the understanding of the pathogenesis of this disease have enabled the identification of genetically defined subgroups, which show a distinct clinical behavior. Moreover, the pathogenic mechanisms that underlie the severe disturbances of the immune system, which represent a hallmark of CLL, are beginning to be unraveled. This review summarizes the different clinical aspects which are benefiting from this increased knowledge of the immunology, molecular and cell biology of CLL.
The Inherited Bone Marrow Failure Syndromes: Fanconi Anemia, Dyskeratosis Congenita and Diamond‐Blackfan Anemia
Authors: Dokal Inderjeet
Published: March 2003

The inherited bone marrow (BM) failure syndromes, Fanconi anemia (FA), dyskeratosis congenita (DC) and Diamond–Blackfan anemia (DBA), are genetic disorders in which patients develop BM failure at a high frequency, usually in association with a number of somatic abnormalities. The recent identification of four FA genes (FANCA, FANCC, FANCF, FANCG), one DC gene (DKC1) and one DBA gene (RPS19) has confirmed their genetic heterogeneity and has provided new methods of diagnosis; this is particularly useful where clinical presentation is atypical, as in the Hoyeraal–Hreidarsson syndrome, a severe variant of X‐linked DC. Recent data suggest that the FA proteins function in a novel cell pathway which has an important role in maintaining genomic stability; the DKC1 encoded nucleolar protein, dyskerin, is predicted to have an important role in ribosomal RNA (rRNA) processing and the RPS19 protein is a structural ribosomal protein. These syndromes therefore provide important information about novel cell pathways which may lead to a better understanding of normal hematopoiesis and of the poorly understood idiopathic aplastic anemia (AA). In turn, this may lead to new treatments, not only for FA, DC and DBA, but also for some types of idiopathic AA.
Paroxysmal Nocturnal Hemoglobinuria— the Selection of a Clone
Authors: Hillmen Peter , Richards Stephen
Published: March 2003

The understanding of the clinical features and the pathophysiology of paroxysmal nocturnal hemoglobinuria (PNH) has advanced considerably over the last decade or so. All cases of PNH appear to be associated with aplastic anemia or, occasionally, with another bone marrow failure syndrome, such as myelodysplastic syndrome. This observation led to the development of the theory that, in order to develop PNH, two events are required: (1) the evolution of a hematopoietic clone which is deficient in glycosylphosphatidylinositol (GPI)‐linked proteins by virtue of an acquired mutation of the pig‐a gene; and
(2) selection against the normal residual stem cells without selection against the GPI‐deficient clone. There is now overwhelming evidence that this dual pathogenesis theory for the development of PNH is correct, but the mechanism of selection in favor of the PNH clone remains unclear. The advances in the understanding of PNH are described in detail, with an emphasis placed on the implications that these observations have on the treatment and diagnosis of PNH. In addition, the potential implications of these findings on the classification and treatment of other bone marrow failure syndromes are discussed, as well as the lessons learnt in relation to normal hematopoiesis and cell biology.
The Etiology of Acquired Aplastic Anemia
Authors: Young Neal S.
Published: March 2003

Historically, diverse clinical associations of aplastic anemia with benzene, radiation, medical drug exposure, pregnancy, viral infections and other hematologic diseases have suggested a complex etiology. However, the modern observation that the majority of patients recover with immunosuppressive drug treatment has implicated an immune pathophysiology. The abnormal immune response has been characterized as TH1/TC1, with measurable cytotoxic T‐cell activation and excessive production of interferon‐γ, tumor necrosis factor and interleukin‐2. The result of this aberrant immune response is to induce programmed cell death in hematopoietic target cells through the Fas pathway, resulting in the destruction of a very high proportion of early progenitor and probably also stem cells. While the sequence and character of initiating events have remained elusive, a role for exogenous antigens may be inferred from preceding hepatitis or a convincing history of suspect pharmaceutic drug use; endogenous antigens have been inferred from the strong association of bone marrow hypocellularity with myelodysplasia and deficient marrow function with paroxysmal nocturnal hemoglobinuria. In addition to exposure, host susceptibility factors must influence the aberrant immune response and a few histocompatibility antigens have been linked to aplastic anemia. Early interruption of the process of immune‐mediated hematopoietic cell destruction, as well as preservation of residual marrow cells from continuing subclinical destruction by T cells, are the goals of advanced approaches to immunosuppressive therapy.
REVISITATIONOFTHECLINICALINDICATIONSFORTHETRANSFUSIONOFPLATELETCONCENTRATES
Authors: Rebulla Paolo
Published: March 2003

Platelet transfusion is indicated when the expected benefits of increasing the number of functional platelets in the patient’s circulation outweigh the potential risks generated by exposing the patient to allogeneic, manipulated and stored blood products such as platelet concentrates. Although reassuring evidence has been collected indicating that current risks associated with blood transfusion are lower than those of several voluntary and involuntary human activities, balancing benefits and risks of platelet transfusion may not be easy in a proportion of patients and in a number of conditions. To facilitate this task, guidelines have been developed, with particular attention to cancer patients. As witnessed by the most recent guidelines, over the last few years there has been a progressive, although not absolute, consensus on: (i) the routine use of platelets as a tool to prevent hemorrhage in oncohematology (the so called ‘prophylactic approach’) as opposed to limiting platelet transfusion to actual bleeding episodes (the so‐called ‘therapeutic approach’) and (ii) lowering the trigger for prophylactic platelet transfusion in stable oncohematology recipients from 20×109to 10×109platelets/L. This has been accompanied by a reduction of platelet use per oncohematology patient of about 20%, an important outcome in view of the progressive increase of platelet demand due to more aggressive therapy in cancer patients. In selected clinical conditions, specific triggers ranging from 30×109to 100×109platelets/L have been recommended, with higher values when surgical procedures are required for the patient’s treatment. Indications and trigger values proposed in the guidelines must be considered within the context of careful clinical evaluation of each patient, with a clear appreciation of the power of discrimination of automated platelet counters at low counts, and of the quality and local availability of platelet products for emergency.
ACUTE MYELOID LEUKEMIA: TREATMENT OVER 60
Authors: Büchner Thomas , Hiddemann Wolfgang , Berdel Wolfgang , Wörmann Bernhard , Schoch Claudia , Löffler Helmut , Haferlach Torsten , Schumacher Andrea , Staib Peter , Balleisen Leopold , Grüneisen Andreas , Rasche Herbert , Aul Carlo , Heyll Axel , Lengfelder Eva , Ludwig Wolf‐Dieter , Maschmeyer Georg , Eimermacher Hartmut , Karow Jochen , Frickhofen Norbert , Hirschmann Wolf‐Dietrich , Sauerland Maria‐Cristina ,   Achim Heinecke for the German AML Co‐operative Group
Published: March 2003

Undertreatment of older patients with acute myeloid leukemia (AML) can explain, in part, their inferior outcome when compared to that of younger patients. In agreement with the benefit seen by patients under age 60 from high‐dose cytosine arabinoside (Ara‐C), there are dose effects in the over 60s, in particular for daunorubicin, in induction treatment and for the duration of postremission treatment. The use of these effects can partly overcome the mostly unfavorable disease biology in older age AML, as expressed by the absence of favorable and the over‐representation of adverse chromosomal abnormalities as well as the expression of drug resistance. We recommend an adequate dosage of 60 mg/m2 daunorubicin on 3 days in combination with standard dose Ara‐C and 6‐thioguanine given for induction and consolidation, and followed by a prolonged monthly maintenance chemotherapy for at least 1 year's duration. Further improvements in supportive care may help to deliver additional antileukemic cytotoxicity. As a novel approach, nonmyeloablative preparative regimens may open up the possibility of allogeneic transplantation for older patients with AML. Other new options like multidrug resistance modulators, antibody targeted therapies and molecular targeting are under clinical investigation. A questionnaire study in patients with AML showed that, according to patients’ self‐assessment, intensive and prolonged treatment did not result in a diminished quality of life. This finding did not vary by age, under or over 60 years. As the median age in this disease is more than 60 years, the adequate management of AML in older patients remains the major challenge.
THE BIOLOGY AND CYTOGENETICSOF MULTIPLE MYELOMA
Authors: Ho P. Joy , Campbell Lynda J. , Gibson John , Brown Ross , Joshua Douglas
Published: March 2003

Despite the advances in our knowledge of myeloma cell biology, our understanding of myeloma pathogenesis is still incomplete. In this review, we present a summary of the cellular and molecular aspects of B‐cell development and immunoglobulin (Ig) gene rearrangement which have been important in defining the characteristics of the myeloma plasma cell (MPC). The PMC has undergone variable gene recombination, somatic hypermutation and isotype switching, and is therefore at a postgerminal center stage of development. The finding of preswitch clonal cells and isotype variants have raised interesting questions about the cell of origin of myeloma, for which no conclusive data is as yet available. However much information has been obtained about the chromosomal and genetic aberrations in myeloma, including monosomy 13, Ig heavy chain (IgH) switch region translocations, numerical abnormalities and a multitude of heterogeneous changes. A variety of techniques have been developed to overcome the insensitivity of conventional karyotyping, utilizing molecular cytogenetic strategies ranging from the delineation of precise loci by fluorescent in situ hybridization, a more “global” assessment of the genome by multicolor spectral karyotyping, to the quantitation of chromosomal material of specific origin by comparative genomic hybridization. Whether the abnormalities detected represent oncogenic insults, are involved in disease progression or are simply “by‐products” of genetic instability is still unclear. For IgH translocations, the role of candidate genes such as Cyclin D1 and FGFR3 has been studied extensively by quantitating their expression and assessment of their oncogenicity (e.g. for FGFR3) in animal models. The significance of other aberrations such as c‐myc, ras and p53 has also been investigated. With the advent of oligonucleotide microarrays, the expression of thousands of genes can be efficiently examined. So far, this approach seems promising in defining subgroups of different disease behavior, and may highlight specific genes and molecular mechanisms which are important in myeloma pathogenesis.
Factors predictive of disease progression and death in AIDS‐related Kaposi's sarcoma
Authors: Spano J‐P , Salhi Y , Costagliola D , Rozenbaum W , Girard P‐M
Published: March 2003

Background The natural history of Kaposi's sarcoma (KS) is poorly documented. We attempted to identify factors predictive of progression and survival in HIV‐infected patients with KS and CD4+cell counts greater than 100/μL.

Patients and Methods We studied retrospectively 78 HIV‐infected patients diagnosed as having KS between 1989 and 1995. The following variables were assessed as potential predictors of progression and death, in a Cox proportional hazards model: age, sex, ethnic group, transmission group, site of the first KS lesions, duration of KS, concomitant opportunistic infections or malignancies, antiretroviral drug therapy (excluding protease inhibitors), antiherpes treatments, neutrophil counts, CD4+and CD8+cell counts, plasma HIV load, p24 antigenaemia, β2‐microglobulinaemia and immunoglobin A and G serum levels.

Results During a median follow‐up of 22 months (3–81 months), KS progressed in 66 of the 78 patients. The median survival time after progression was 68 months (9–126 months). Multivariate analysis identified only visceral KS, a high neutrophil count and a high serum immunoglobulin (Ig) level as independent predictors of progression (P < 0.05). Previous and concomitant opportunistic diseases (P = 0.003) and low CD4+cell counts (P = 0.013) were independently associated with shorter survival; in contrast KS therapy did not independently influence survival.

Conclusion Progression of KS is predicted by markers of KS severity, while overall survival is best predicted by markers of immunodeficiency (opportunistic diseases and the CD4+cell count).
Assessing the cost‐effectiveness of HAART for adults with HIV in England
Authors: Miners Ah , Sabin Ca , Trueman P , Youle M , Mocroft A , Johnson M , Beck Ej
Published: March 2003

1

Royal Free Centre for HIV Medicine, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK,

2

NPMS‐HHC, St. Stephen's Centre, Chelsea and Westminster Hospital, London, UK,

3

Global Health Outcomes, Glaxo Wellcome R and D, Greenford, Middlesex, UK,

4

Royal Free Centre for HIV Medicine, Department of Thoracic Medicine, Royal Free Hospital, London, UK and Joint Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada

Objective  To assess the cost‐effectiveness of highly active antiretroviral therapy (HAART) compared with two nucleoside reverse transcriptase inhibitors (NRTIs) for HIV infected individuals.

Design  Different data sources on the clinical effects and costs of treatments were combined using a Markov model.

Setting  English HIV treatment centres.

Perspective

UK public finance.

Interventions  HAART – dual NRTI therapy plus a protease inhibitor or a non‐nucleoside reverse transcriptase inhibitor – vs. dual NRTI therapy.

Participants  Hypothetical cohorts of 1000 individuals infected with HIV.

Outcome measures

Projected life expectancy, cost‐effectiveness in UK£ per life‐year saved and per quality‐adjusted life‐years (QALYs) saved.

Results  Assuming a 2‐year additional treatment effect of therapy with HAART produced incremental cost‐effectiveness ratios of £14 602 per life‐year saved and £17 698 per QALY saved.

Conclusions  The results were sensitive to a number of assumptions including the cost of HAART and the discount rate, but they suggest that the use of HAART in England is at least moderately cost‐effective compared with treatment with two NRTIs alone.
Therapeutic vaccination (p24‐VLP) of patients with advanced HIV‐1 infection in the pre‐HAART era does not alter CD4 cell decline
Authors: Smith D , Gow I , Colebunders R , Weller I , Tchamouroff S , Weber J , Boag F , Hales G , Adams S , Patou G , Cooper DA ,   for the 006 Study Group
Published: March 2003

Summary In a randomized placebo controlled trial 304 HIV infected patients with CD4 cell counts below 350 cells/µL received therapeutic vaccination with: alum placebo (Group I, n = 102), p24‐VLP 500 µg (Group II, n = 101) or p24‐VLP 1000 µg (Group III, n = 101) p24‐VLP monthly for six months. Over one year the average change in CD4 cell count did not differ significantly between groups (–32, –40 and –52 cells per μL respectively). There was also no difference between groups in progression to CDC catagory B or C events, or in adverse events. Therapeutic vaccination with p24‐VLP does not affect CD4 cell decline in patients with advanced HIV infection.
Cohort study of metastatic melanoma patients in the Dermatology Institute of Florence 1990/1997
Authors: Moretti S , Carli P , Biggeri A , Volpi V , Pimpinelli N
Published: March 2003

Background

Chemotherapy and immunotherapy are treatments currently employed in advanced melanoma, but responses obtained are poor, and metastatic melanoma patients with visceral localization rarely survive for more than 6 months. Thus, different therapeutic regimens are used in metastatic melanoma and no standardized therapy exists so far.

Methods

We report a retrospective survival study involving 80 patients with metastatic melanoma who were treated either with chemotherapy [dacarbazine (DTIC) alone or DTIC in monotherapeutic or polychemotherapeutic regimen] or immunochemotherapy [interferon (IFN)‐α at low doses added to chemotherapy]. Survival of patients was statistically evaluated in an actuarial curve taking into account as predictive variables sex, age, marital status, site of primary tumour, histological type, Clark level, sites of metastases, and the different therapeutic regimens (i.e. DTIC alone, DTIC plus IFN‐α, or others, with or without IFN‐α).

Results

Site of primary melanoma, histological type, Clark level and therapy regimen appeared to exhibit a prognostic significance in survival; when a multivariate analysis was performed to obtain a mutual adjustment of survival values for each variable, only the therapeutic regimen was found to be significant as an independent prognostic variable. Patients treated with immunochemotherapy, i.e. DTIC plus IFN‐α, showed a probability of dying of 0.41 (95% confidence interval 0.2–0.8) compared with patients treated with DTIC alone.

Conclusions

In our study immunochemotherapy, comprised of DTIC plus IFN‐α at low doses, was associated with a significantly longer survival of patients, in comparison with chemotherapy comprised of only DTIC.
Dendritic cells and their role in skin‐induced immune responses
Authors: Holíková Z , Hercogová J , Plzák J , Smetana K
Published: March 2003

This article gives a brief review on dendritic cells (DC) with regard to their origin, life cycle and functions. The regulation of immune responses by DC functioning as antigen‐presenting cells is discussed. Special attention is given to epidermal DC, e.g. Langerhans cells. The perspectives of DC‐based therapy are also mentioned.
Multiple linear eccrine spiradenomas with eyelid involvement
Authors: Gupta S , Radotra BD , Kaur I , Handa S , Kumar B
Published: March 2003

Eccrine spiradenoma is an uncommon tumour of the sweat gland and usually occurs as a solitary small painful nodule. Very rarely, it may present as multiple tumours arranged in a linear/zosteriform fashion. We present the case of a 23‐year‐old female who had multiple spiradenomas arranged linearly from the midline of forehead to the left corner of the mouth and a few lesions also on the margin of the left eyelid. The lesions were probably along the Blaschko’s lines. Tumours were excised surgically in stages. Literature search revealed only 13 reported cases of linear/zosteriform/naevoid multiple spiradenomas and only four cases of solitary spiradenoma of the eyelid. The review of reported cases suggests that arrangement of tumours in a linear/zosteriform pattern is an important diagnostic clue for multiple (naevoid) spiradenomas.
Linear IgA dermatosis presenting with erythema annulare centrifugum lesions: report of three cases in adults
Authors: Dippel E , Orfanos CE , Zouboulis CHC
Published: March 2003

Linear IgA dermatosis presented with erythema annulare centrifugum lesions in three elderly women. Search for underlying malignancy revealed low‐grade B‐cell lymphoma in one case. In addition to subepidermal blistering, histology showed a typical mixed infiltrate of granulocytes and eosinophils and, occasionally, papillar microabsesses in one case. In the two other subjects, characteristic subepidermal lining with granulocytes was observed. Immunofluorescence studies confirmed the diagnosis, while autoantibodies characteristic for dermatitis herpetiformis were absent. To our knowledge this is the second report of adult linear IgA dermatosis in association with erythema annulare centrifugum lesions. Our observations concord with several other reports of figurate erythema associated with autoimmune blistering disease and other immune disorders. Common antibody‐related immunological mechanisms indicate that the two distinct clinical pictures are probably stages of the same pathogenic entity.
Electron microscopic evidence of persistent chlamydial infection following treatment
Authors: Bragina EY , Gomberg MA , Dmitriev GA
Published: March 2003

Chlamydia trachomatis infections of the female and male genital tracts are often asymptomatic and, thus, tend to become persistent. In the persistent state the typical Chlamydia life cycle is arrested and standard antibiotic regimens do not always eradicate this infection. We sought to relate treatment failures in men and women with persistent chlamydial genital tract infections to electron microscopic evidence of chlamydial persistence and with atypical morphological forms of the organism. Of 16 patients with chlamydial persistence following azithromycin treatment, morphological variants of this organism were observed by electron microscopy from one endocervical sample and one male urethral sample. We document the presence of intracellular inclusions containing only reticulate bodies, extracellular monomembrane and polymembrane phagosomes containing elementary bodies and reticulate bodies with abnormal outer membranes in the process of dividing extracellularly. These observations parallel previous in vitro studies of chlamydial persistence under adverse conditions. This capacity of C. trachomatis to undergo atypical morphological alterations in vivo may contribute to its persistence and relative resistance to antibiotics.
Botulinum toxin A for palmar hyperhidrosis
Authors: Wollina U , Karamfilov T
Published: March 2003

ObjectiveWe evaluated the efficacy and safety of intracutaneous injections of botulinum toxin A on severe palmar hyperhidrosis.

MethodsTen patients with recalcitrant palmar hyperhidrosis were treated with intercutaneous injections of botulinum toxin A (Botox; 200 U for each hand). Patients were followed up to 23 months (mean ± SD: 12.1 ± 6.2 months).

ResultsBotulinum toxin significantly reduced abnormal sweating within 1 week in 100% of the patients. In six patients with a follow‐up of 12 months or more the antisudorific effect lasted 12.3 ± 5.5 months. The longest response duration was 22 months. Repeated treatment was performed in five patients with unchanged clinical efficacy. The only side‐effect was tolerable pain from the intracutaneous injections in patients where a nerve block was not performed.

ConclusionsBotulinum toxin A (200 U Botox per palm) was able to induce long‐term remission in palmar hyperhidrosis without significant acute and long‐term side‐effects. Strictly intracutaneous injection of small volumes is recommended. So far, response to repeated treatments did not show evidence of neutralizing antibody induction.
The Laugier–Hunziker syndrome
Authors: Lenane P , Sullivan DO , Keane CO , Loughlin SO
Published: March 2003

Laugier and Hunziker described a syndrome consisting of asymptomatic benign areas of hyperpigmentation affecting the lips, buccal mucosa and, in 50%, the fingernails. We report a 67‐year‐old woman with the clinical features of Laugier–Hunziker syndrome in association with vulval pigmentation. Histology, immunohistochemistry and electron microscopy from the various areas of pigmentation on the body confirmed the benign nature of the pigmentation. We review potential causes of oral and genital pigmentation, and suggest an expansion of the original syndrome described by Laugier and Hunziker to include more widespread areas of benign hyperpigmentation, which may associated.
Tacrolimus: a review of its use for the management of dermatoses
Authors: Gupta AK , Adamiak A , Chow M
Published: March 2003

The newly developed immunomodulator tacrolimus (FK506) is the first of a new class of agents that have enormous potential to change the way that dermatoses are treated and managed. Tacrolimus has been found to be active in a topical formulation with the latter exerting its effects by acting on the signal transduction pathways inside T cells and inhibiting gene transcription. The result is decreased responsiveness of T cells to antigens. Percutaneous absorption of tacrolimus is higher in diseased skin as opposed to healthy skin and, therefore, the drug will be taken in at progressively lower quantities as lesions heal. There is limited systemic absorption of tacrolimus over the course of therapy. The most extensive experience with tacrolimus has been in treating atopic dermatitis. In numerous trials, tacrolimus ointment 0.03–0.3% has shown to be effective in reducing the symptoms and severity of atopic dermatitis in adults and the paediatric population. Furthermore, there have been no significant toxic effects associated with topical therapy with tacrolimus. The most common complaint is that of local irritation after applying the ointment. This is generally transient and the patient is able to continue with therapy. The other dermatoses where tacrolimus has been used include contact dermatitis, psoriasis and pyoderma gangrenosum.
Dexamethasone pulse therapy in pemphigus
Authors: Tóth Gg , Van De Meer Jb , Jonkman Mf
Published: March 2003

Pulse therapy with high‐dose glucocorticoids was introduced 20 years ago as a treatment modality for autoimmune disease and transplant rejection. The most popular dermatological indication for pulse therapy is severe pemphigus. We reviewed the sequelae of 14 patients with pemphigus who were treated by pulse therapy. Seven of them reached complete remission, although three of them needed a new pulse course due to disease flare‐up. Adverse events were minor and confined to 60% of all patients: temporary facial flushing during pulse administration, sleep disturbances during the first night after pulse administration, and mood changes occurred during the week of pulse therapy. The study showed the possibility of oral instead of an intravenous route of dexamethasone pulse administration, which makes double‐blind placebo‐controlled trials ethically feasible. Fifty per cent of the patients reached complete remission. This retrospective study does not allow claims on the steroid‐sparing effect.
Scleroderma ‘en coup de sabre’ and progressive facial hemiatrophy. Is it possible to differentiate them?
Authors: Orozco‐Covarrubias L , Guzmán‐Meza A , Ridaura‐Sanz C , Carrasco Daza D , Sosa‐De‐Martinez C , Ruiz‐Maldonado R
Published: March 2003

The aim was to be able to evaluate the diagnosis of two diseases by a consensus of clinical opinion used in the Department of Dermatology of the National Institute of Paediatrics in Mexico City. To differentiate between scleroderma ‘en coup de sabre’ (SCS) and progressive facial hemiatrophy (PFH), colour slides of 13 patients diagnosed as SCS and nine as PFH were examined by two dermatologists and microscopic slides by two pathologists. In both cases, the slides were randomly presented and no clinical information was given. The clinical and histopathological findings were statistically compared with two‐tailed tests and α = 0.05. κ coefficients were obtained to evaluate the concordance between dermatologists, pathologists, and in terms of the consensus diagnosis. The usefulness of photographic assessment is limited by the inability to palpate the consistency of lesions. The most important clinical feature that differentiated both conditions was cutaneous sclerosis present in eight of 13 patients with SCS and in none of the PFH patients (P < 0.005). Other clinical features more frequently found in SCS were cutaneous hyperpigmentation and alopecia. The more frequent clinical features in PFH were total hemifacial involvement and ocular changes. Statistically significant histopathological features were: connective tissue fibrosis present in all cases with SCS and two of nine patients with PFH (P < 0.0002); adnexal atrophy present in 11 of 13 patients with SCS, and in three of nine with PFH (P < 0.02), and mononuclear cell infiltrates in all patients with SCS cf. six with PFH (P < 0.05). Our results suggest that in most cases it is possible to differentiate SCS from PFH based on clinicopathological findings.
Alternative treatment of psoriasis with balneotherapy using Leopoldine spa water
Authors: Tsoureli‐Nikita E , Menchini G , Ghersetich I , Hercogova J
Published: March 2003

Background Leopoldine spa water is a hypotonic water rich in sulphate that has been used occasionally for balneological treatments in psoriatics. We evaluated the anti‐inflammatory effects of this salso‐sulphate water on the skin of subjects with psoriasis.

Patients and methods We selected 10 volunteer subjects (23–58 years old), who presented symmetrical, bilateral psoriasis involving at least 40% of the body surface. All the subjects were subjected to the following treatment schedule: (i) immersion of both arms in water twice a day [the right arm was immersed in Leopoldine spa water at its natural source temperature (27.2 °C) for 30 min, and the left arm was immersed in double‐distilled water for 30 min at a constant temperature of 27 °C]; (ii) both arms were exposed to the sun for 60 min after each immersion; and (iii) vaseline containing moisturizing creams were applied liberally. The treatment was continued for 4 weeks and was well tolerated by all subjects. Response to treatment was assessed by means of the modified Psoriasis Area and Severity Index (PASI). Six of the 10 subjects volunteered to undergo a cutaneous biopsy of lesional skin both before and 4 weeks after treatment to allow for assessment of modifications of the cutaneous infiltrate in the areas treated.

Results At the end of 4 weeks the average pretreatment PASI score of the left arms was 5.72 (range 4–9.6) while the right arms had a mean PASI of 5.56 (range of 3.2–9). At the end of the study the average PASI score was 0.78 for the arms treated with Leopoldine spa water and 2.83 for the arms treated with double‐distilled water. The mean PASI improvement score for the Leopoldine spa water treated arms was 85.9% while the double‐distilled water treated arms showed a PASI improvement score of 50.5%. An immunohistological study showed significant differences between the cutaneous samples taken 4 weeks after treatment and those taken before treatment with Leopoldine spa water. There were significant decreases in the numbers of epidermal CD4+ and CD8+ T lymphocytes and CD1a+ Langerhans cells (microscopic field at × 22 objective), as well as a decrease in the epidermal keratinocyte expression of intercellular adhesion molecule‐1 and interleukin‐8 and the dermal expression of CD4+ and CD8+ T lymphocytes.

Conclusions These data show the potential anti‐inflammatory effects of Leopoldine mineral waters on human skin affected by psoriasis.
Assessment of depression in subjects with psoriasis vulgaris and lichen planus
Authors: Akay A , Pekcanlar A , Bozdag KE , Altintas L , Karaman A
Published: March 2003

Aim The aim of this study was to investigate the frequency of depressive symptoms in psoriasis vulgaris and lichen planus and to evaluate the relationship between the Beck depression scores and the Psoriasis Area and Severity Index (PASI) scores of subjects with psoriasis vulgaris.

Subjects The study involved 120 subjects attending the dermatology clinic of Izmir Ataturk Training Hospital (Izmir, Turkey) and comprised 50 subjects with psoriasis vulgaris, 30 with lichen planus and 40 healthy control subjects.

Results Subjects with psoriasis vulgaris, lichen planus and controls had depression scores of 58%, 53% and 20%, respectively. The Beck depression scores of patients with psoriasis vulgaris were significantly higher than those of the control group. The PASI scores showed a correlation with Beck depression scores. Smoking and drinking were very common in subjects with psoriasis vulgaris. There was no correlation between the duration of illness and depressive symptoms.

Conclusions This study confirms the importance of depressive symptoms in two common dermatological diseases. It is important to recognize this association as it affects both clinical outlook and response to treatment.
Psychological features of androgenetic alopecia1
Authors: Camacho FM , García‐Hernández MJ
Published: March 2003

Objective To evaluate the psychological features of subjects with male (MAGA) and female androgenetic alopecia (FAGA).

Methods We performed a retrospective study of 100 patients with FAGA and the same number of patients with MAGA based on the features registered in the personal history of individuals who attended our Trichology Unit (Hospital Universitario Virgen Macarena, Sevilla, Spain) from January 1993 to January 1995.

Results Depression was more frequent in FAGA than in MAGA (55:3), but anxiety (78:41) and aggressiveness or hostility were more frequent in MAGA than in FAGA (22:3), and three men were considered anxious and depressive. Treatment resulted in improvement in 89% of FAGA and 76% of MAGA, and the subjects continued attending with periodic check‐ups. There were requests for surgical treatment by 3% of FAGA and 12% of MAGA, and 6% of FAGA and 12% of MAGA did not return for follow‐up consultation. All of the MAGA showed aggressiveness and lack of willingness to follow the correct treatment.

Conclusions In general, AGA patients tend to have elusive personalities and, although the individuals may go to the trichology centre accompanied they preferred to present alone to the desk or at least to the trichological examination room, except for subjects with depression who would often not agree to the physician removing hairs for the trichogram. Most subjects accepted the prescribed medical or surgical treatment, but several phoned before the second treatment session because the results of the first session were not as good as they had expected. The drop‐out rate was higher in men (1 in 2), who were probably subjects showing aggressiveness.
Mycosis fungoides presenting as Ofuji's papuloerythroderma
Authors: Hur J , Seong J‐Y , Choi T‐S , Jang J‐G , Jang M‐S , Suh K‐S , Kim S‐T
Published: March 2003

We report three patients presented with clinical features of Ofuji's papuloerythroderma (pruritic erythematous papules and extensive erythema sparing all skin folds), however, showing histopathological findings of mycosis fungoides (Pautrier's microabscess, haloed lymphocytes, disproportionate epidermotropism, and wiry collagen bundles). One case was associated with plaque stage of mycosis fungoides and follicular mucinosis. T‐cell receptor (TCR) gene rearrangement analysis in the lesional skin tissue demonstrated rearrangement of the gamma chain in all cases. HTLV‐1 serology was negative for two patients who conducted HTLV‐1 test. We think that Ofuji's papuloerythroderma might be a variant of early mycosis fungoides rather than secondary skin manifestations to certain cutaneous inflammatory diseases.
Skin necrosis from extravasation of Vinorelbine*
Authors: Moreno de Vega MJ , Dauden E , Abajo P , Bartolome B , Fraga J , Garcia‐Diez A
Published: March 2003

Skin necrosis from intravenous infiltration of soft tissue is a rare but potentially devastating complication of intravenous therapy. Vinca alkaloids are among the intravenous drugs with the highest destructive power.

We report two cases of skin necrosis from accidental extravasation of vinorelbine, a semisynthetic analogue of vinblastine, rarely described as being responsible for this event. Histopathologic study showed separation of the dermis from necrotic epidermis, associated with cytologic atypia, in both patients, and focal necrosis of eccrine glands in one of them.

We consider that intravenous infusions of vinorelbine should be performed using the preventive measures and care applied for other chemotherapeutic agents with high potential for induction of skin necrosis due to extravasation.
Extracorporeal photochemotherapy in the treatment of eosinophilic fasciitis
Authors: Romano C , Rubegni P , De Aloe G , Stanghellini E , D’Ascenzo G , Andreassi L , Fimiani M
Published: March 2003

Background Eosinophilic fasciitis (EF) is a rare connective tissue disorder characterized clinically by symmetrical swelling, induration and thickening of the skin and histologically by thickening of the fascia with chronic inflammatory infiltrate containing eosinophils. The disease is classified in the spectrum morphea/systemic sclerosis and treated with systemic steroids and other immunosuppressant drugs.

Objective The purpose of this study was to use extracorporeal photochemotherapy (ECP) in patients with EF to evaluate the effectiveness of this therapy.

Subjects and methods Three patients affected by EF were treated with ECP because they failed to respond or with contraindications to immunosuppressant treatment. The patients underwent ECP with a UVAR XTS apparatus. Subjects were treated on two consecutive days at 2‐week intervals for the first 3 months and thereafter every 4 weeks on the basis of clinical response. The patients were assessed before therapy and then monthly by means of a clinical score. Changes in affected areas were evaluated at predetermined points by computerized skin elastometry (Cutometer SEM 474).

Result After 1 year of therapy we found considerable improvement of clinical parameters in two cases. There was less striking improvement in the other case. These clinical results were confirmed by the elastometry measurements. All patients reported improved quality of life, which enabled a reduction in the dose of immunosuppressants.

Conclusion ECP emerged as a safe and effective therapy in association with low doses of immunosuppressants in our three patients. A randomized comparative multicentre study between ECP as single therapy and ECP plus immunosuppressants and conventional therapies is required to firmly establish photopheresis as a possible basic treatment to combine with conventional therapies for EF.
Leg ulcer in Klinefelter's syndrome
Authors: Igawa K , Nishioka K
Published: March 2003

Hypostatic ulceration of the legs is relatively uncommon in men. Recently, the hypothesis that recurrent ulceration in men may be associated with chromosomal abnormalities such as Klinefelter's syndrome is gradually being accepted. Herein, we describe a patient with Klinefelter's syndrome complicated by recurrent leg ulcers, in whom immunological disorders such as positive antinuclear factor, antiphospholipid antibodies and cryoglobulins without venous insufficiencies were demonstrated. Interestingly, these abnormalities of immune functions were normalized after the androgen replacement therapy for Klinefelter's syndrome, and his leg ulcers immediately recovered.
Ethics, an emerging subdiscipline of obstetric ultrasound, and its relevance to the routine obstetric scan
Authors: Chervenak F. A. , McCullough L. B.
Published: March 2003

Ethics is an emerging subdiscipline of obstetric ultrasound because there are clinical dimensions of obstetric ultrasound that only ethics can identify and address. These dimensions concern the ethical obligations of physicians to their patients. Ethics is defined as the disciplined study of morality. Two fundamental principles of ethics are described, beneficence and respect for autonomy. How ethics can bring to light clinical dimensions of obstetric ultrasound that are insufficiently appreciated is illustrated with the example of the routine use of obstetric ultrasound in the second trimester. The authors conclude that prenatal informed consent for sonogram should be an integral part of obstetric care in countries, such as the United States, in which routine ultrasound is not endorsed. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology
Conservative treatment of ectopic pregnancies using a single echo‐guided injection of methotrexate into the gestational sac
Authors: Venezia R. , Zangara C. , Comparetto G. , Cittadini E.
Published: March 2003

The authors describe the possibility of the conservative treatment of five early ectopic pregnancies. A single injection of methotrexate into the tubal gestational sac was performed under vaginal ultrasound guidance. In all five cases, a clear ectopic gestational sac could be visualized. The pregnancies dated from the 5th to the 7th week of amenorrhea. Strict ultrasound follow‐up following injection showed a gradual reduction in the size of the tubal gestational sac. At the same time, plasma β‐hCG gradually decreased to zero after a maximum time period of 25 days. Subsequent hysterosalpingography performed on all of the women demonstrated bilateral normal patent tubes.

It is concluded that, in selected patients, transvaginal injection provides an alternative relatively non‐invasive approach to the management of ectopic pregnancy. It is proposed that the adoption of a policy of earlier diagnosis and treatment may lead to a reduction in the incidence of some tubal causes of infertility. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology