bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Hypopigmented Sarcoidosis with 8‐Methoxypsoralen and Long Wave Ultraviolet Light
Authors: Patterson Jmes W. , Fitzwater James E.
Published: March 2008

ABSTRACT: A patient with hypopigmented sarcoidosis involving the face was treated with topical 8‐methoxypsoralen and long wave ultraviolet light. Satisfactory repigmentation occurred within eight months of tri‐weekly therapy. Electron microscopic study of involved, untreated skin showed abnormalities of melanocytes, including cytoplasmic vacuolization and the presence of melanosome complexes. Treated skin showed sparsity of melanosomes within the central portions of some melanocytes and large numbers of melanosomes within melanocytic dendrites. The clinical and ultrastructural findings suggest the possibility of toxic damage to melanocytes, perhaps with abnormalities of melanosome transfer, in lesions of hypopigmented sarcoidosis. These abnormalities appear to be responsive to psoralen‐UVA therapy.
Nickel Allergy in a Female Twin Population
Authors: Menné Torkil , Holm N. V.
Published: March 2008

The genetic predisposition of nickel allergy was evaluated in 1,546 Danish female twins horn between 1906 and 1930. The twins were investigated primarily via a mailed questionnaire and were asked if they noticed redness, itching, or dermatitis when they came in contact with metal clasps or costume jewelry. The material was divided into two equal parts corresponding to the western and eastern parts of Denmark. The majority of the possible positives in the eastern part were examined and patch tested.
Book Reviews
Authors: BEERMAN HERMAN
Published: March 2008

Book reviews in this article:

MICROBIOLOGY. Abraham I. Braude.

CLINICAL DERMATOLOGY (DIAGNOSIS AND THERAPY OF COMMON SKIN DISEASES). P. Vasarinsh.

THE MANAGEMENT AND PREVENTION OF PRESSURE SORES. Anthony Barton and Mary Barton.

PRESSURE ULCERS—PRINCIPLES AND TECHNIQUES OE MANAGEMENT. Mark B. Constantian, M.D., Editor.
Thesis Review
Authors: MAIBACH HOWARD I.
Published: March 2008

Thesis review in this article:

ALLERGIC CONTACT DERMATITIS DUE TO INGREDIENTS USED IN TOPICALLY APPLIED PHARMACEUTICAL PRODUCTS AND COSMETICS. A. Dooms‐Goossens, M.D.
A New Treatment for Cutaneous Candidiasis: Sulconazole Nitrate Cream 1%
Authors: Tanenbaum Lewis , Anderson Caroline , Rosenberg Martin , Dorr Albert
Published: March 2008

Sulconazole nitrate cream 1 %, a new topical imidazole compound with a broad antifungal activity was compared to its vehicle and to miconazole nitrate cream 2% in two double‐blind parallel studies involving 96 patients with cutaneous candidiasis. Once daily application of sulconazole was as effective as twice daily application of miconazole and produced KOH and culture cures in 100% and 88% of patients, respectively. No systemic adverse reactions were reported. One vehicle‐treated patient developed itching: six sulconazole‐ and three miconazole‐treated patients developed erythema and/or pruritus, which was mild and transient. Sulconazole used bid was significantly superior to its vehicle and produced KOH and culture cures in 100% of patients.
Topical Treatment of Hidradenitis Suppurativa with Clindamycin
Authors: Clemmensen Ole J.
Published: March 2008

Thirty patients with recurrent suppurative hidradenitis entered a double blind trial to evaluate the effect of topical clindamycin against placebo in hidradenitis. Twenty seven patients concluded the 3 months' treatment. The overall effect of clindamycin treatment based on patients' assessments, number of abscesses, inflammatory nodules and pustules was significantly better than placebo at each monthly evaluation (P < 0.01). When each parameter was evaluated separately, clindamycin was significantly superior to placebo except for inflammatory nodules and abscesses on the second and third months' evaluation. No side effects were recorded and the treatment was easy to administer. Topical clindamycin may be helpful prior to radical surgery or spontaneous remission.
Incontinentia Pigmenti in Nigerians
Authors: Olumide Yetunde , Danesi Musiapha , McMoli Theo
Published: March 2008

Three cases of incontinentia pigmenti were seen among Nigerian children who had had previously unreported occurrences of non‐development of Broca's speech area, signs suggestive of heterozygote albinism.
Pseudoscleroderma and Phenylketonuria
Authors: Guillet G. Y. , Dore N. , Hehunstre J. P. , Maleville J. , Battin J.
Published: March 2008

An infant girl with partial phenylketonuria developed pseudoscleroderma. After six years of follow up, both the neurologic and cutaneous conditions improved under a phenylalanine restricted diet. The probable roles of phenylalanine, tryptophan, tyrosine, and their metabolites may cause both conditions through possible transient hypersensitivity of cutaneous and muscular tissues.
The Use of Podophyllin in the Treatment of Keratoacanthoma
Authors: Cipollaro Vincent A.
Published: March 2008

Keratoacanthoma can be treated successfully with podophyllin, which has been used in cutaneous tumors for well over a century and has been in use for a much longer time. Podophyllin is useful alone, with cautery and curettage, or with radiotherapy.
Book Reviews
Authors: BEERMAN HERMAN
Published: March 2008

Book reviews in this article:

ALLERGIC CONTACT DERMATITIS TO SIMPLE CHEMICALS. Gilles Dupuis and Claude Benezra.

MODERN GENETIC CONCEPTS AND TECHNIQUES IN THE STUDY OF PARASITES. Frank Michal, editor.

AN ATLAS OF SKIN BIOPSY. Raghunath P. Misra and I. Daniel Sanusi.

NEONATAL SKIN. Howard I. Maibach and Edward K. Boisits.

STEDMAN'S ILLUSTRATED MEDICAL DICTIONARY (38 Authors). Naomi M. Kanof

COMMON SKIN DISORDERS: A MANUAL FOR PHYSICIANS AND PATIENTS. Ernst Epstein, M.D. Clifton
The Morphologic Events of Blister Formation in Porphyria Cutanea Tarda
Authors: Caputo R. , Berti E. , Gasparini G. , Monti M.
Published: March 2008

In porphyria cutanea tarda (PCI), the submicro‐scopic event causing the formation of spontaneous blisters is the appearance of membrane‐limited vacuoles in the superficial dermis. These vacuoles are apparently formed through iytolysis of dermal cells and swelling of the pseudopodia of the basal cells protruding into the dermis, probably as a consequence of photochemically‐induced lysosomal damage. The number and size of these vacuoles progressively increase near the cleavage area of the blisters, where their limiting membranes merge and break, giving rise to the cavity of the blister, which is formed under the basal lamina. The presence of coated vesicles along the limiting membranes as well as inside the vacuoles suggests their involvement in the transport of fluids from the damaged vessels, thus contributing In the progressive volume increase of vacuoles themselves.
Histopathology of Vitiliginous Skin
Authors: Gokhale B. B. , Mehta L. N.
Published: March 2008

ABSTRACT: A histological study of 74 vitiligo cases revealed imflammatory and degenerative changes in the epidermis, papillation, blood vessels, sweat glands and ducts, sebeceous glands cind hair follicles, dermis (connective tissue), and dermal nerves and nerve endings.
Clinical Electrophysiologic Assessment of Ulnar Nerve Transposition in Tuberculoid Leprosy
Authors: Amer Mohamed A. , Gawish Hassan H. A. , Hawala Abd El Samed I. El , Amer Samih A. , Amer Kawther
Published: March 2008

Ulnar nerve transposition was accomplished in 24 tuberculoid leprotic patients, making a total of 27 operations. Results were assessed clinically and electrophysiologically, pre‐ and postoperatively. and compared with a control group of 30 patients. Excellent results were obtained in early cases with minimal electromyographic changes. Late cases did not improve after surgery.
Book Reviews
Authors: Beerman Herman
Published: March 2008

Book reviews in this aticle:

DR. FULTON'S STEP‐BY‐STEP PROGRAM FOR CLEARING ACNE FINALLY… AN ACNE TREATMENT THAT WORKS! James E. Fulton, Jr. and Elizabeth Black.

OCCUPATIONAL SKIN DISEASES. Robert M. Adams.

PRECIS DE PHYSIOLOGIE CUTANEE. Jean Meynadier.

MANSON'S TROPICAL DISEASES. P. E. C. Manson‐Bahr, F.I.C. Apted.

MEDIEVAL MEDICUS. Edward J. Kealey.

DIFFERENTIAL DIAGNOSIS IN DERMATOPATHOLOGY. A. Bernard Ackerman, John Niven, Jane M. Grant‐Kels.

SKIN SURGERY, FIFTH EDITION. Ervin Epstein, M.D., and Ervin Epstein, Jr., M.D.
Tinea Capitis in Philadelphia
Authors: Shockman Joel , Urbach Fredtrick
Published: March 2008

From 1962 to 1979, there was a dramatic change in tinea capitis infections in children In the Philadelphia area. This has been primarily due to the virtual disappearance of tinea capitis due to Microsporum organisms. This dramatic change in a common, highly infectious childhood disease is most likely due to a sudden change in hair styles, particularly in black boys, which prevents infectious spores from reaching the scalp
Localized Cutaneous Sporotrichosis
Authors: Sperling Leonard C. , Read Sandra I.
Published: March 2008

Localized sporotrichosis can present a difficult diagnostic problem. It mimics many other skin diseases, some of which are far more common. Often the skin biopsy is not helpful. The disease tends to be chronic, requiring specific therapy with potassium iodide.
A Comparison of Miconazole Nitrate and Selenium Disulfide as Anti‐dandruff Agents
Authors: Sheth Rekha A.
Published: March 2008

ABSTRACT: The anti‐dandruff efficacy of two shampoos containing 2% miconazole nitrate and 2.5% selenium disulfide was compared in 15 subjects and eight subjects, respectively. The antifungal drug, miconazole nitrate, was found to possess anti‐dandruff activity similar to selenium sulfide, a cytostatic compound. For evaluation, techniques of clinical grading and the corneocyte count were used and the latter was found inaccurate. Instead, clinical assessment by grading the severity, supplemented by cytodiagnosis by smear examination was found more helpful. The latter helps to evaluate both the altered pathophysiologic and microbial factors operating in a given case of dandruff, which is a symptom complex brought about by multiple etiologic factors.
Epidemiology of an Outbreak of Erythema Infectiosum in Tokyo
Authors: Hidano A. , Ogihara Y. , Oryu F. , Ishihara F. , Horie T.
Published: March 2008

ABSTRACT: Endemic outbreaks of erythema infectiosum were observed in various areas of Japan from 1977 to 1981. Even in a limited district of Tokyo, we recorded 395 cases until June 1981. so this might be the largest epidemic in Japan. Most cases occurred from January to June. The peak incidence was at the age of 7 years and the average age was 8.9 years. The outbreak also occurred among our hospital nurses, but no severe case was observed in hospitalized patients. Furthermore, the symptoms in adults were as mild as in children, suggesting the little participation of immunity in this disease. By epidemiologic survey, erythema infectiosum was distinct from rubella.
Extracutaneous Sporotrichosis
Authors: Friedman Stephen J. , Doyle John A.
Published: March 2008

ABSTRACT: The typical infection with Sporothrix schenckii is characterized by superficial cutaneous nodules occurring along the lines of lymphatic drainage of the limbs. Review of the medical records at the Mayo Clinic from 1937 to the present disclosed 58 patients with sporotrichosis. Eleven patients had evidence of extracutaneous infection. Eight of the patients were men whose ages ranged from 25 to 71 years; the ages of the three women were 54, 64, and 67. Seven patients had predominantly joint involvement, with the knee and wrist joints being most often infected. Other sites of infection included the mandible and ethmoid sinuses. Three patients had disseminated systemic infection, and one patient died within a year of the initial diagnosis. Nine patients had been in good health before the infection, although five patients were taking systemic corticosteroids before their infection was diagnosed. Therapies included supersaturated potassium iodide, am‐photericin B. and 2‐hydroxystilbamidine isethionate. Although most commonly seen as a cutaneous disease, sporotrichosis is a potentially disseminated infection with life‐threatening consequences.
Papillon‐Lefèvre Syndrome
Authors: Landow R. Kenneth , Cheung Herman , Bauer Marjorie
Published: March 2008

ABSTRACT: A patient, with Papillon‐Lefevre syndrome, presented with a premature loss of both deciduous and permanent teeth and hyperkeratosis palmaris et plantaris. Other abnormalities Such as psoriasiform hyperkeratosis. calcification of the falx, and frequent infections can be seen. Although no etiologic factor is known for this aberration, an autosomal recessive inheritance is established. Treatment usually consists of dental hygiene only since dermatologic therapy is usually unrewarding. A new finding resulted when fibroblasts from involved gingiva were compared with either uninvolved gingiva or controlled gingiva. The protein and collagen synthesis of the involved tissue was about twice that of the latter two groups.
Nonsuture Surgery Under Microscopic Control for Basal Cell Carcinoma
Authors: Tapia Arturo , Saiz Antonio
Published: March 2008

ABSTRACT: Nonsuture surgery under microscopic control consists of conservative surgical excision of the tumor leaving the wound open and allowing it to granulate. Using fresh tissue technique, the lesion is cut in multiple horizontal sections from the depth up and examined under the microscope. In this form, a simple office procedure, removal is complete with minimum destruction of normal tissue. Cosmetic results are excellent.
Photochemotherapy and Alopecia Areata
Authors: Amer Mohamed A. , Garf Ahmed El
Published: March 2008

ABSTRACT: Four of ten patients with alopecia areata (plaque and totalis types) showed some regrowth of hair after PUVA therapy using a light box with peak emission 365 nm. Because PUVA may have long term side effects, this therapy should be reserved for patients resistant to other treatments.
Dermatomycoses in Indonesia
Authors: Harahap Marwali , Nasution Mansur A.
Published: March 2008

ABSTRACT: A review of mycologic surveys and case reports indicates the unique occurrence of deep and superficial fungus infections of the skin as encountered in Indonesia, confirming that each country has its own pathogenic mycologic flora. Such diseases as phycomycosis, histoplasmosis, mycetoma, chromomycosis, cryptococcosis, and dermatophytosis are common.
Cutaneous T‐Cell Lymphoma First Presenting at the Tumor Stage
Authors: Schewach‐Millet Miriam , Azizi Esther , Semah David , Bubis Jose J. , Chaitchuk Samario
Published: March 2008

ABSTRACT: Cutaneous T cell lymphoma first presenting at the tumor stage is described in three patients, including one with the rarely reported granulomatous mycosis fungoides. The rapid progression and resistance to the currently available treatment modalities seem to characterize this unique form of lymphoma.
Pigmented Cosmetic Dermatitis
Authors: Nakayama Hideo , Matsuo Shizuno , Hayakawa Kazuto , Takhashi Keiko , Shigematsu Takeshi , Ota Seihachi
Published: March 2008

Pigmented cosmetic dermatitis1–4 is a new name for melanosis faciei feminase designated after the mechanisim and causative allergens of this pigmentary disorder were greatly clarified. In Japan, a large number of pigmented cosmetic dermatitis patients were noted in the 1960s and 1970s; however, the number of patients has decreased remarkably since 1978, when major cosmetic companies began to eliminate strong contact sensitizers from their products. This review is concerned with the way this pigmentary disorder was overcome through the use of patch testing and allergen control.
Familial Lichen Amyloidosis
Authors: Ozaki Motoaki
Published: March 2008

ABSTRACT: In japan, two cases of familial lichen amyloidosis were found in a mother and her son, who had a history of cutaneous amyloidosis in 11 adults of three family generations. HLA types in both patients were rather common ones among Japanese people. Topical application of dimethyl sulfoxide was effective in the mother but not in the son. Familial cutaneous amyloidosis (FCA) is a rare disease in japan although nonfamilial‐type is not uncommon. Possible parameters of FCA are disc ussed. The author recommends using “FCA” without “primary” as the name of the disease.
Cutaneous Leishmaniasis in Al‐Hassa, Saudi Arabia
Authors: Al‐Cindan Youssef , Abdul‐Aziz Othman , Kubba Raj
Published: March 2008

ABSTRACT: Cutaneous leishmaniasis of the classical noduloulcerative variety is endemic in Al‐Hassa, Saudi Arabia. In a clinical study in which 56 Saudi patients and 66 non‐Saudi patients were examined, it was found that the Saudi patients were considerably younger and had significantly milder disease compared with the non‐Saudi patients.
Topical Aluminum Sulfate for Fire Ant Stings
Authors: Bruce Suzanne , Tschen Edward H. , Smith Edgar B.
Published: March 2008

ABSTRACT: Topical aluminum sulfate was not effective in relieving pain and stinging from the imported fire ant, contrary to a previous uncontrolled study.
The Biochemical Diagnosis of the Porphyrias
Authors: Disler Peter B. , Blekkenhorst Gerry H. , Eales Lennox
Published: March 2008

The aim of diagnosis is the characterization of a patient's disease so that the optimal therapy may be instituted. The precision of the diagnosis depends on the knowledge available and the sensitivity of the techniques used to exploit that knowledge, and major methodological advances in recent years have provided the scientific investigator with an extensive array of sophisticated techniques. The choice of which test is best for the diagnosis of a particular disease is particularly difficult when dealing with the disorders of porphyrin metabolism as simple, cheap tests are available to identify a patient as “porphyric.” This diagnosis is not sufficient, however, as the term “porphyria” encompasses a number of different disorders, each a manifestation of deficient enzyme activity at different stages in the heme biosynthetic pathway. While all are characterized by excessive production, accumulation, and excretion of porphyrins and porphyrin precursors, the pattern thereof is specific for each particular type of porphyria and each is a discrete clinical entity demanding a different therapeutic approach. It thus cannot be over emphasized that the porphyric patient's disease must be meticulously defined and when simple tests are insufficient for this, sophisticated techniques should be employed, preferably in laboratories committed to porphyrin study. Before discussing the best way to make a diagnosis, however, it is clearly important to define the terms used.
Behold, the Gatekeeper Cometh
Authors: Weary Peyton E.
Published: March 2008

The insidious intrusions of arbitrary restrictive patterns of health care delivev that limit direct access of patients to specialist care were once largely confined in this country to voluntary health maintenance organization‐independent practice association (HMO‐IPA) systems and the military service. In 1981, 87% of surveyed HMOs and IPAs restricted patient access to specialist care to some extent. Such limitation is now becoming more widespread through the creation of primary‐care networks, case management, and experimental programs under Medicaid. Limitation of direct access to specialists will impact substantially on the practice patterns and quality of dermatologic care, because primary care physicians and physician extenders who will control the referral system often will attempt to treat skin conditions even though they frequently misdiagnose the condition. Further, as is often the case, referrals to specialists often will be limited to one visit only, with no opportunity for the specialist to establish a satisfying doctor‐patient relationship or to evaluate the effectiveness of treatment. The following is an analysis of this phenomenon and an assessment of what has been accomplished or remains to be done to combat this trend.
Human Leukocyte Antigen in Genodermatosis
Authors: Amer Mohamed , Afifi Nawal , Iskander Irene , Diab Nagwa
Published: March 2008

ABSTRACT: Tissue typing performed on the lymphocytes of 41 Patients, including: 23 patients with ichthyosis (15 of autosomal dominant and 8 of the x‐linded variety; 8 patients with tuberous sclerosis (epiloia); and 10 patients with acroder‐matitis enteropathica (AEP). In adddition, tissue typing was performed for a control group of 80 healthy unrelated subjects of the same ethnic origin as the patients. A significant increase of A2 antigen or its crossreacting antigen A28 was detected among the three diseases studied. A significant increase of HLA‐A2 antigen was found in autosomal dominant ichthyosis, while the x‐linked variety showed significant association with HLA‐Cw2. A significant association with HLA‐A28 antigen was noticed in both epiloia and AEP. The suggested mechanisms of such association may be refferred to as incidental genetic linkage with mutants causing disease or deficiency.
Increased Cuaneous Fobrinolytic Activity in a Acse of Aquagenic Pruritus
Authors: Lotti Torello , Cappugi Pietro , Lattari Paolo , Panconesi Emiliano
Published: March 2008

ABSTRACT: Cutaneous fibrinolytic activity was found to be increased in a patient with aquagenic pruritus both before and after contact with water. This could explain the lack of wheal formation in this affection, which is characterized by increased histamine release.
Clinical Study on Syphilis in Abu Dhabi with Special Stress on the Unusual Presentation of the Disease
Authors: El Shiemy S. , Farid M. , Saliam T. H. , Al‐Jamal M. J.
Published: March 2008

ABSTRACT: Seventy‐nine cases of syphilis were the material of this study. Unusual presentations of primary syphilis were found in 42.5% of cases; explanations are given for these findings. Other aspects of the unusual presentations of the disease were studied with special stress on the occurrence of itching in the course of secondary syphilis. The authors emphasize that pruritis as a presenting symptom in the presence of skin lesion suggestive of syphilis should not blind the physician to the possibility that Treponema pallidum may be the etiologic agent.
Pemphigus Vegetans
Authors: Razzaque Ahmed A. , Blose Douglas A.
Published: March 2008

ABSTRACT: Two cases of pemphigus vegetans are presented, one of the Neumann type and one of the Hallopeau type. The differences between the two subsets are clinical presentation and course. Patients with the Hallopeau type often have a relatively benign disease, require lower doses of systemic corticosteroids, and usually have a prolonged remission. Patients with the Neumann type have a course similar to pemphigus vulgaris, need higher doses of systemic corticosteriods, and have relapses and remissions. The histologic findings in the vegetating lesions are similar in both types. The immunopathologic features of both types are indistinguishable and similar to pemphigus vulgaris. IgM staining of eosinophilic microabscesses was observed in one case.
Allopurinol‐induced Toxic Epidermal Necrolysis
Authors: Dan Michael , Jedwab Medina , Peled Michal , Shibolet Shlomo
Published: March 2008

ABSTRACT: An erythematous eruption with itching developed in an 84‐year‐old man 4 days after therapy with allopurinol was initiated. The diagnosis of toxic epidermal necrolysis, suspected when separation of the epidermis was noted, was confirmed by skin biopsy. This is the third reported case that can be attributed exclusively to allopurinol and the first patient who did not die.
Potassium influences on yield and quality production for maize, wheat, soybean and cotton
Authors: Pettigrew William T.
Published: March 2008

Potassium is one of the principle plant nutrients underpinning crop yield production and quality determination. While involved in many physiological processes, potassium’s impact on water relations, photosynthesis, assimilate transport and enzyme activation can have direct consequences on crop productivity. Potassium deficiency can lead to a reduction in both the number of leaves produced and the size of individual leaves. Coupling this reduced amount of photosynthetic source material with a reduction in the photosynthetic rate per unit leaf area, and the result is an overall reduction in the amount of photosynthetic assimilates available for growth. The production of less photosynthetic assimilates and reduced assimilate transport out of the leaves to the developing fruit greatly contributes to the negative consequences that deficiencies of potassium have on yield and quality production. Goals aimed toward increasing crop productivity and improved quality dictate either increased potassium supply or more efficient use of potassium. Developing plants that more efficiently use potassium might be a worthwhile goal for geneticists.
The Effects of Foliar Application of Ascorbic Acid (Vitamin C) on Antioxidant Enzymes Activities, Lipid Peroxidation and Proline Accumulation of Canola (Brassica napus L.) under Conditions of Salt Stress
Authors: Dolatabadian A. , Sanavy S. A. M. M. , Chashmi N. A.
Published: March 2008

The effects of salt stress on protein (PROT) content, lipid peroxidation, proline accumulation, chlorophyll (Chl) content, and superoxide dismutase (SOD; EC 1.15.1.1), catalase (EC 1.11.1.6) and peroxidase (EC 1.11.1.7) activity were studied in the leaves and roots of canola (Brassica napus L. cv. Okapi). Four weeks after sowing (at the V4 stage), plants were exposed to salt stress by the application of NaCl solution (200 mm) for 6 days daily, After 6 days followed by foliar application of ascorbic acid (AsA) solution (25 mm). The activity of all the antioxidant enzymes assayed (except SOD in the roots) was increased significantly in the plants under conditions of salt stress. The application of AsA decreased enzyme activity in the leaves, but it had no effect on enzyme activity in the roots. The total PROT content of the leaves and roots decreased under the conditions of high salinity. AsA treatment of plants under salt stress increased the total PROT content significantly in both leaves and roots. Measurement of the malondialdehyde content of leaves and roots showed that lipid peroxidation was increased by interaction with damaging reactive oxygen species during salt stress, and that application of AsA reduced lipid peroxidation only in the leaves. The Chl content was also affected by salt stress. There was significant difference between the controls and salt‐stress treatments in Chl content. The results of the present study indicate that usage of AsA reduces the harmful effects of salinity and increases resistance to salinity in canola plant.
Lukumbat marawana: A changing pattern of drug use by youth in a remote Aboriginal community
Authors: Senior Kate , Chenhall Richard
Published: March 2008

Objective:  To examine marijuana use by youth in a remote Aboriginal community in Northern Australia over a 5‐year period.

Design:  Participant observation, structured and unstructured interviews.

Setting:  Remote Indigenous Australian community.

Participants:  Young Aboriginal people and adult community members.

Main outcome measure:  Emergent themes of the attitudes towards marijuana use among remote Indigenous residents are reported.

Results:  Restrictions in the availability of alcohol and petrol have led to increased use of marijuana with serious social and community consequences.

Conclusions:  Efforts to control licit substances, such as alcohol, in remote communities need to be addressed in the context of understanding of the dynamics of alcohol and drug use in totality as well as interventions that address underlying structural and social inequalities.
Physical activity behaviours of adults in the Greater Green Triangle region of rural Australia
Authors: Vaughan Clare , Kilkkinen Annamari , Philpot Benjamin , Brooks Joanne , Schoo Adrian , Laatikainen Tiina , Chapman Anna , Janus Edward D. , Dunbar James A.
Published: March 2008

Objective:  To assess physical activity (PA) behaviours of adults in rural Australia.

Design and setting:  Three cross‐sectional surveys in the Greater Green Triangle area covering the south‐east of South Australia (Limestone Coast), and south‐west (Corangamite Shire) and north‐west (Wimmera) of Victoria during 2004–2006.

Participants:  A total of 1546 persons, aged 25– 74 years, randomly selected from the electoral roll.

Main outcome measures:  Overall PA, leisure‐time PA, occupational PA, active commuting and moderate‐to‐vigorous PA.

Results:  Approximately 80% of participants, more women than men, engaged in 30 minutes or more of daily PA. Only 30% (95% CI 26.3, 33.0) of men and 21% (95% CI 18.3, 23.9) of women did moderate‐to‐vigorous PA for at least 20–30 minutes four or more times a week. In leisure time, most participants were moderately active; almost one‐fifth were inactive and another fifth highly active. Two‐thirds of men engaged in high‐level occupational PA, compared with one‐sixth of women. Only 30% of participants actively commuted to work. There was a tendency for a positive association between income level and leisure‐time PA.

Conclusions:  One‐fifth of adults in rural Australia were inactive. While there was a high prevalence of participants who engaged in daily PA, few did so at moderate‐to‐vigorous intensity to achieve health benefits. As occupational PA is difficult to change, improvements in levels of PA are more likely during leisure‐time and for some people by engaging in commuting PA.
An evaluation of a community pharmacy‐based rural asthma management service
Authors: Saini Bandana , Filipovska Julija , Bosnic‐Anticevich Sinthia , Taylor Susan , Krass Ines , Armour Carol
Published: March 2008

Objective:  To compare the effect of a pharmacist‐delivered rural asthma management service (RAMS) on health outcomes for people with asthma in a rural/regional area with ‘standard care’ delivered through community pharmacies.

Design:  A parallel group controlled repeated measures study.

Setting:  Community pharmacies in Central West New South Wales.

Intervention:  Standardised protocols and resources based on national asthma management guidelines, delivered by specially trained community pharmacists. Patients visited the pharmacy at baseline and 1, 3 and 6 months after baseline in the intervention group and at baseline plus 6 months after baseline in the control group.

Participants:  The intervention pharmacists (n = 12) were trained to deliver the RAMS model, while control pharmacists (n = 8) provided standard asthma care to their recruited patients. Fifty‐one and 39 patients were recruited by intervention and control pharmacists.

Main outcome measure:  Asthma severity score which was a composite score based on recency, frequency and severity of asthma symptoms, and asthma history.

Results:  Data compared at the final visit between groups indicated that the RAMS patient group demonstrated a significant reduction in the asthma severity scores (7.9 ± 2.6 versus 10.4 ± 2.6, P < 0.001); a reduction in the risk of non‐adherence to medication scores (1.6 ± 0.7 versus 2.3 ± 1.1, P < 0.001); and an increase in the proportion of patients owning a written action plan (50% versus 23%, P = 0.04).

Conclusions:  These results indicated that the community pharmacy‐based RAMS model can improve asthma outcomes for patients in rural settings, and similar models for asthma and other chronic diseases should be tested rigorously and adopted in rural primary care practice.
Survival rates according to the Cancer of the Liver Italian Program scores of 345 hepatocellular carcinoma patients after multimodality treatments during a 10‐year period in a retrospective study
Authors: Yamagiwa Kentaro , Shiraki Katsuya , Yamakado Koichiro , Mizuno Shugo , Hori Tomohide , Yagi Shinichiro , Hamada Takashi , Iida Taku , Nakamura Ikuo , Fujii Koji , Usui Masanobu , Isaji Shuji , Ito Keiichi , Tagawa Shinsei , Takeda Kan , Yokoi Hajime , Noguchi Takashi
Published: March 2008

Background and Aim:  The Cancer of the Liver Italian Program (CLIP) score has been demonstrated to have superior prognostic ability in hepatocellular carcinoma (HCC) patients worldwide, but there has never been sufficient assessment of the efficacy of treatment modalities according to the CLIP score. This retrospective cohort study of HCC patients was conducted to assess the efficacy of treatment modalities according to the CLIP score.

Methods:  We compared the efficacy of hepatic resection (HR) (n = 101), radiofrequency ablation with prior transcatheter arterial chemoembolization (RFA + TACE) (n = 115), percutaneous ethanol injection with prior TACE (PEI + TACE) (n = 43), and TACE (n = 86) as a primary treatment in terms of survival among 345 patients treated at Mie University Hospital between 1995 and 2004, according to CLIP score.

Results:  The overall survival rates in the RFA + TACE group were significantly higher in the patients with CLIP scores of 1, 2, and 3 or more (5‐year, 70.9%; 3‐year, 73.7%; and 3‐year, 100%, respectively), but they were not significantly different from the 5‐year survival rates of the HR group with a CLIP score of 0 (83.7%). Among the patients with a CLIP score of 0, a significantly higher disease‐free survival rate (5‐year: 33.7%) was obtained in the HR subgroup (n = 35) than in the RFA + TACE subgroup (n = 35), both of which were followed since 2000, but morbidity (21.8%) was highest in the HR group.

Conclusion:  RFA + TACE is concluded to be a safe treatment modality with better overall survival (5‐year, > 60%) in HCC patients regardless of their CLIP score.
Asia–Pacific consensus guidelines on gastric cancer prevention
Authors: Fock Kwong Ming , Talley Nick , Moayyedi Paul , Hunt Richard , Azuma Takeshi , Sugano Kentaro , Xiao Shu Dong , Lam Shiu Kum , Goh Khean Lee , Chiba Tsutomu , Uemura Naomi , Kim Jae G , Kim Nayoung , Ang Tiing Leong , Mahachai Varocha , Mitchell Hazel , Rani Abdul Aziz , Liou Jyh Ming , Vilaichone Ratha‐korn , Sollano Jose
Published: March 2008

Background and Aim:  Gastric cancer is a major health burden in the Asia–Pacific region but consensus on prevention strategies has been lacking. We aimed to critically evaluate strategies for preventing gastric cancer.

Methods:  A multidisciplinary group developed consensus statements using a Delphi approach. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded.

Results:  Helicobacter pylori infection is a necessary but not sufficient causal factor for non‐cardia gastric adenocarcinoma. A high intake of salt is strongly associated with gastric cancer. Fresh fruits and vegetables are protective but the use of vitamins and other dietary supplements does not prevent gastric cancer. Host–bacterial interaction in H. pylori infection results in different patterns of gastritis and differences in gastric acid secretion which determine disease outcome. A positive family history of gastric cancer is an important risk factor. Low serum pepsinogens reflect gastric atrophy and may be useful as a marker to identify populations at high risk for gastric cancer. H. pylori screening and treatment is a recommended gastric cancer risk reduction strategy in high‐risk populations. H. pylori screening and treatment is most effective before atrophic gastritis has developed. It does not exclude the existing practice of gastric cancer surveillance in high‐risk populations. In populations at low risk for gastric cancer, H. pylori screening is not recommended. First‐line treatment of H. pylori infection should be in accordance with national treatment guidelines.

Conclusion:  A strategy of H. pylori screening and eradication in high‐risk populations will probably reduce gastric cancer incidence, and based on current evidence is recommended by consensus.
Marine reserve effects on fishery profit
Authors: White Crow , Kendall Bruce E. , Gaines Steven , Siegel David A. , Costello Christopher
Published: March 2008

Some studies suggest that fishery yields can be higher with reserves than under conventional management. However, the economic performance of fisheries depends on economic profit, not fish yield. The predictions of higher yields with reserves rely on intensive fishing pressures between reserves; the exorbitant costs of harvesting low‐density populations erode profits. We incorporated this effect into a bioeconomic model to evaluate the economic performance of reserve‐based management. Our results indicate that reserves can still benefit fisheries, even those targeting species that are expensive to harvest. However, in contrast to studies focused on yield, only a moderate proportion of the coast in reserves (with moderate harvest pressures outside reserves) is required to maximize profit. Furthermore, reserve area and harvest intensity can be traded off with little impact on profits, allowing for management flexibility while still providing higher profit than attainable under conventional management.
Non‐surgical management of multicystic dysplastic kidney
Authors: Cambio Angelo J. , Evans Christopher P. , Kurzrock Eric A.
Published: March 2008

OBJECTIVES

To better define the outcome and association of multicystic dysplastic kidney (MCDK) with hypertension, vesico‐ureteric reflux (VUR), infection and cancer, as there is no consensus on the management of patients born with MCDK. The risk of cancer has dictated the surgical management of the disease in the past.

METHODS

The Medline database was searched for articles published between 1965 and 2006 and written in the English language, and containing the keywords ‘multicystic dysplastic kidney’.

RESULTS

The inclusion criteria were met by 105 reports that were subsequently analysed. Of MCDK, 60% regress or involute within 3 years. About 25% of patients will have VUR into the contralateral kidney, of which 90% is grade ≤3. The risk of urinary tract infection appears to be associated with VUR or coexistent abnormalities rather than the MCDK. The risk of hypertension is no greater than that in the general population and nephrectomy is usually not curative. The overall risk of Wilms’ tumour developing in a MCDK is <1 in 2000. All reported Wilms’ tumours were identified before 4 years of age and 70% presented as a palpable mass.

CONCLUSIONS

Published reports support the non‐surgical management of MCDK. Common practice has been to remove palpable or growing MCDKs, although these represent a very small fraction of MCDKs. In theory, ultrasonographic surveillance until 4 years old might allow the earlier detection of a Wilms’ tumour, and decrease the intensity of chemotherapy and improve prognosis. Previous reports do not prove or disprove this concept, and the appropriate frequency of surveillance is not evident.
The effect of surgical volume, age and comorbidities on 30‐day mortality after radical prostatectomy: a population‐based analysis of 9208 consecutive cases
Authors: Walz Jochen , Montorsi Francesco , Jeldres Claudio , Suardi Nazareno , Shariat Shahrokh F. , Perrotte Paul , Arjane Philippe , Graefen Markus , Pharand Daniel , Karakiewicz Pierre I.
Published: March 2008

OBJECTIVES

To examine the effect of surgical volume (SV) on 30‐day mortality after radical prostatectomy (RP; reportedly 0.1–0.6% and influenced by age and comorbidities) and to explore the most informative SV, age and comorbidity thresholds to distinguish between high‐ and low‐risk men.

PATIENTS AND METHODS

Between 1989 and 2000, 9208 consecutive patients were treated with RP. The effects on 30‐day mortality of (either continuously coded or categorized) patient age, comorbidities (Charlson Comorbidity Index, CCI) and SV were tested in multivariable logistic regression models. The models were corrected for overfit bias using 200 bootstrap re‐samples and were displayed graphically as nomograms.

RESULTS

The overall 30‐day mortality was 0.52%; being younger (<69 years, 0.3% vs 1.0% 30‐day mortality otherwise, P < 0.001), lower CCI (0, 0.2% vs 0.8% otherwise, P < 0.001) and higher SV (>27 RPs, 0.07 vs 0.6% otherwise, P = 0.049) had a protective effect and represented independent predictors of 30‐day mortality. After correction for overfit bias, their combined input was 72.3% accurate in predicting 30‐day mortality, vs 67.1% (P < 0.001) when the same variables were used in continuously coded (uncategorized) format. A model‐derived probability threshold of ≤0.1% resulted in a 99.9% negative predictive value.

CONCLUSIONS

SV is an important determinant of 30‐day mortality. Categorized age, CCI and SV are more useful and more accurate for predicting 30‐day mortality than continuously coded variables. The combination of young age (<69 years), a CCI of 0 and high SV (>27 RPs) can accurately identify patients at negligible risk of 30‐day mortality.
Evaluation of an orthotopic rat bladder urothelial cell carcinoma model by cystoscopy
Authors: Hendricksen Kees , Molkenboer‐Kuenen Janneke , Oosterwijk Egbert , Hulsbergen‐van de Kaa Christina A. , Witjes J. Alfred
Published: March 2008

OBJECTIVES

To enable preclinical testing of intravesical therapies against non‐muscle‐invasive bladder cancer (NMIBC) in an orthotopic rat bladder tumour model, augmented by the use of serial cystoscopy for in vivo tumour assessment and follow‐up.

MATERIALS AND METHODS

Fischer F344 rats had a 16‐G transurethral cannula placed. The bladder mucosa was conditioned with an acid rinse, followed by a 1‐h instillation of 1.5 × 106 AY‐27 rat bladder urothelial cell carcinoma (UCC) cells (day 0). Cystoscopy (1 mm) was done on day 0 (control) and at 3, 4, 5, 6, 7, 10, 13 and 17 days. At the scheduled times the rats were killed after cystectomy (four at each time) for histopathological examination of the bladder.

RESULTS

Overall, tumour establishment was >80%, with predominantly carcinoma in situ preceding or concomitant with invasive tumour growth. All tumours were formed at 3–5 days, and remained non‐muscle‐invasive up to 5 days. From 6 days, tumours progressed to muscle‐invasive disease in 40% of the rats. Visibility at cystoscopy was excellent and tumours were apparent in >90% of rats from 5 days on, with a specificity and sensitivity of >90%. Cystoscopy could not distinguish NMIBC from muscle‐invasive disease.

CONCLUSIONS

This is a reliable model of orthotopic rat bladder UCC, with early high‐grade NMIBC growth, immediately followed by muscle‐invasive growth, i.e. the recommended time to start intravesical therapy would be 5 days after tumour cell inoculation. Tumour growth can easily be monitored by cystoscopy, but cannot be used to distinguish NMIBC from muscle‐invasive bladder cancer.
Factors affecting erectile function after radical retropubic prostatectomy: results from 1620 consecutive patients
Authors: Ayyathurai Rajinikanth , Manoharan Murugesan , Nieder Alan M. , Kava Bruce , Soloway Mark S.
Published: March 2008

OBJECTIVE

To report the return of erectile function in 1620 consecutive men after radical retropubic prostatectomy (RRP), chosen by half of men diagnosed with clinically localized prostate cancer, and the goal of which is to completely excise the tumour while preserving continence and erectile function.

PATIENTS AND METHODS

From January 1992 to October 2006, one surgeon performed RRP with a nerve‐sparing technique where feasible. Men with erectile dysfunction before surgery, salvage RRPs, those not having a nerve‐sparing procedure, neoadjuvant or adjuvant therapy within 6 months of RRP and a follow‐up of <6 months were excluded from the analyses. Erectile function was evaluated by the surgeon when possible or by an annual questionnaire. Potency was defined as erectile function sufficient for intercourse with or without a phosphodiesterase‐5 inhibitor.

RESULTS

Of 619 men who had a bilateral and of 178 who had a unilateral nerve‐sparing RRP, 72% and 53%, respectively, were potent. When stratifying by age groups (≤49, 50–59, 60–69 and ≥70 years) potency rates were 86%, 76%, 58% and 37%, respectively. Potency was more common after bilateral than unilateral nerve‐sparing RRP in all age groups (P < 0.001). Age, bilateral nerve‐sparing (odds ratio 2.9) and surgeon experience were associated with potency in a multivariate analysis.

CONCLUSION

Careful patient selection and meticulous surgical technique are essential to achieve the right balance between cancer control and morbidity. The patient’s age, nerve‐sparing RRP and the surgeon’s experience were the significant predictors of return of potency after RRP.
Total reconstruction of the vesico‐urethral junction
Authors: Tewari Ashutosh , Jhaveri Jay , Rao Sandhya , Yadav Rajiv , Bartsch Georg , Te Alexis , Ioffe Edward , Pineda Miguel , Mudaliar Senthil , Nguyen Lang , Libertino John , Vaughan Darracott
Published: March 2008

OBJECTIVE

We describe a novel technique of total vesico‐urethral reconstruction, which combines the tactics of previous surgeons, and compare the outcome of our innovative changes for return to early continence with prostatectomies with no or partial reconstruction of the vesico‐urethral junction.

PATIENTS AND METHODS

Between 1 January 2005 and 5 June 2007 a cohort of 700 patients undergoing robotic radical prostatectomy were prospectively evaluated. Patients in 2005 (214) served as a control group, they received no additional methods to provide support to the vesico‐urethral junction; a standard anastomosis was made. Patients in 2006 (304) received an anterior reconstruction only, to provide additional vesico‐urethral anastomotic support. Patients in 2007 (182) received the total reconstructive procedure, which included an anterior reconstruction and posterior reconstruction. Outcome data were collected using standardized health‐related quality‐of‐life measures, which included the Expanded Prostate Cancer Index Composite survey, International Prostate Symptom Score, International Index of Erectile Function, and then re‐verified by telephone interview with a standardized questionnaire. The follow‐up intervals were 1, 6, 12, 24 and 52 weeks. Continence was defined as no pad usage or one small liner used for security purposes only. Baseline variables were also collected.

RESULTS

The percentage of patients who had achieved continence in the control group were: 13%, 35%, 50%, 62% and 82% at the 1‐, 6‐, 12‐, 24‐ and 52‐week follow‐up, respectively. The percentage of patients who had achieved continence in the anterior reconstruction group were 27%, 59%, 77%, 86%, and 91%, respectively. The total reconstruction group had continence rates of 38%, 83%, 91%, and 97% at 1, 6, 12, and 24 weeks, respectively. At all the follow‐up intervals the continence rate was significantly less in the control group than in the anterior reconstruction group and the total reconstruction group (P < 0.01).

CONCLUSIONS

The total reconstruction procedure is a safe and effective way to achieve an early return to continence. No adverse effects have been observed because of its employment and our data validates that it does provide a statistically significant early return to continence compared with no reconstructive efforts or with only anterior reconstructive efforts.