bluuebunny/crossref_metadata_2025 huggingface dataset:
Cytokine Production, Lymphocyte Proliferation and T-Cell Receptor Vβ Expression in Primary Peripheral Blood Mononuclear Cell Cultures from Nickel-Allergic Individuals
Authors: Cederbrant K. , Anderson C. , Andersson T. , Marcusson-Ståhl M. , Hultman P.
Published: January 2004

Background: Clinical history and patch test constitute the two cornerstones in the diagnosis of nickel (Ni) allergy. Due to technical and interpretative limits of the patch test, the in vitro lymphocyte transformation test (LTT) has been developed for confirming contact allergy; however, most studies show an overlap in lymphocyte proliferation between Ni-allergic and nonallergic subjects using the LTT. The aim of this study was to see if the secretion of cytokines, especially interleukin (IL)-10 and IL-17, or the use of T-cell receptor (TCR) Vβ families in Ni-stimulated primary peripheral blood mononuclear cell (PBMC) cultures might be more useful for discriminating between allergic and nonallergic subjects. Methods: Ni2+-stimulated primary PBMC cultures derived from female subjects diagnosed as Ni-allergic (n = 5) or nonallergic (n = 5) on the basis of a positive or negative patch test were assessed for cell proliferation by tritiated thymidine incorporation and for production of interferon-γ, IL-4, IL-10 and IL-17 in the culture supernatant by ELISA. The immunophenotype and TCR-Vβ family affiliation of the Ni2+-induced lymphoblasts were determined by flow cytometry. Results: Lymphocytes from Ni-allergic individuals challenged with a high and a low concentration of Ni showed significantly higher cell proliferation than lymphocytes from nonallergic individuals, but all subjects showed a positive LTT result (stimulation index >2). We found a significantly higher release of IL-10 in Ni2+-treated cultures from Ni-allergic compared with nonallergic subjects that provided better separation between individuals in the two groups than did lymphocyte proliferation. The proliferating lymphoblasts were predominantly CD4+, and in 2 of the 5 Ni-allergic subjects, but in none of the 5 nonallergic subjects, the CD4+ lymphoblasts showed a dominance of TCR-Vβ17. Conclusions: Determination of IL-10 production in primary PBMC cultures is a potentially promising in vitro method for discrimination of Ni allergy in females, as compared with cell proliferation.
The Drumbeat of Renal Failure: Symbiosis of Prevention and Renal Replacement Therapy
Authors: Dirks John H.
Published: January 2004

The global population of patients with end-stage renal disease is rising rapidly, especially in developing countries. The possibility and economic burden of renal replacement therapy will be greatly challenged in the next decade as the prevalence of diabetes and hypertension rises. The establishment of effective prevention and intervention measures creates a means by which the increasing burden of renal replacement therapy can be reduced.
Monocyte Apoptosis in Uremia Is Normalized with Continuous Blood Purification Modalities
Authors: D’Intini Vincenzo , Bordoni Valeria , Bolgan Irene , Bonello Monica , Brendolan Alessandra , Crepaldi Carlo , Gastaldon Fiorella , Levin Nathan W. , Bellomo Rinaldo , Ronco Claudio
Published: January 2004

Uremia is associated with a state of immune dysfunction. Dysregulation of homeostasis may be directly related to abnormal apoptosis regulation in uremia, which is crucial for the maintenance of the biological system. We demonstrated that plasma from three groups of uremic subjects, i.e. hemodialysis (HD) patients, peritoneal dialysis (PD) patients and patients with predialysis chronic renal failure (CRF), has different apoptotic potential on U937 monocytes. The plasma of HD and CRF subjects when incubated with U937 cells induced higher levels of apoptosis compared with that of PD and control subjects (HD 26.08 ± 11.39, CRF 24.87 ± 9.07, PD 12.13 ± 4.51, controls 11.69 ± 4.02). Furthermore, the phagocytic ability of U937 cells incubated with the various plasma demonstrated an impaired response in the HD and CRF subjects (HD 27.56 ± 6.67, CRF 30.24 ± 9.08, PD 36.55 ± 9.80, controls 40.04 ± 6.98). These results suggest that continuous blood purification, such as in PD, may have advantages over intermittent therapies in removing uremic apoptotic molecules and potentially maintaining biological function and homeostasis.
International Care Models for Chronic Kidney Disease: Methods and Economics – United States
Authors: Crooks Peter
Published: January 2004

In the United States, there is a major chronic kidney disease (CKD) problem with over 8 million adults having stage 3 or 4 CKD. There is good medical evidence that many of these patients can benefit from focused interventions. And while there are strong theoretical reasons to believe these interventions are cost-effective, there are little published data to back up this assertion. However, despite the lack of financial data proving cost-effectiveness and against the background of a disorganized health care system in the US, some models of CKD care are being employed. At the present time, the most comprehensive models of care in the US are emerging in vertically integrated health care programs. Other models of care are developing in the setting of managed care health plans that employ CKD disease management programs, either developed internally or in partnership with renal disease management companies.
Atherosclerosis in Dialyzed Patients
Authors: Ritz Eberhard
Published: January 2004

In the recent HEMO study, the most common cause of death in dialyzed patients was ischemic heart disease. In Europe there are regional differences, but the mortality due to cardiovascular disease is also very high. The long-lasting controversy whether the high incidence and prevalence of atherosclerotic manifestations (particularly ischemic heart disease) may be explained by known risk factors, or non-traditional risk factors are also involved seems to be partially solved with the increasing evidence that the latter hypothesis is true. Thus, together with classic risk factors such as hypertension, dyslipidemia and diabetes, other situations such as microinflammation, increased concentration of asymmetrical dimethyl-L-arginine, disturbed phosphate metabolism and anemia may represent important risk factors for accelerated atherosclerosis in dialyzed patients.
Calcimimetics versus Vitamin D: What Are Their Relative Roles?
Authors: Drüeke Tilman B.
Published: January 2004

A strict control of secondary hyperparathyroidism in patients with chronic kidney disease (CKD) is indicated to avoid serious complications linked to osteitis fibrosa and other parathyroid-hormone (PTH)-related bodily disturbances. However, such a control is often achieved only at the price of unacceptably high plasma calcium and phosphorus levels and the risk of soft tissue calcification, even when using the novel, so-called ‘non-hypercalcemic’ vitamin D analogs. The advent of a new class of drugs, the calcimimetics, should allow a more adequate control of the disturbed calcium-phosphorus metabolism in CKD patients. In my opinion, the calcimimetics will not replace currently used medications but will be a valuable supplement to presently available treatment options for this major complication in patients with renal failure.
Renal Cell Therapy in the Treatment of Patients with Acute and Chronic Renal Failure
Authors: Humes H. David , Weitzel William F. , Fissell William H.
Published: January 2004

Hemodialysis and hemofiltration have been important technologies in saving the lives of patients with acute (ARF) and chronic renal failure by clearing small solutes from plasma and thereby preventing death from acidemia, hyperkalemia, volume overload, and uremia. These therapeutic approaches, however, are still suboptimal, as patients with ARF have mortality rates exceeding 50%, and patients with end-stage renal disease (ESRD) have, on average, a life expectancy of 4–5 years. The preeminent cause of death in patients with ARF is the development of sepsis or the systemic inflammatory response syndrome with resulting systemic vasodilation, hypotension, ischemic injury to solid organs, multi-organ failure, and death. This vasodilation is due to persistent and excessive pro-inflammation. Similarly, the reduced survival times of patients with ESRD on chronic dialysis have been associated with a persistent and chronic systemic pro-inflammatory state. We have hypothesized that the loss of renal tubule cell mass acutely in acute tubule necrosis and chronically in ESRD results in an immunologically dysregulated state leading to excessive pro-inflammation. The replacement of renal tubule cell function may thus change the current dismal prognosis of patients with these disorders. In this regard, this report presents the first patient ever treated with a bioartificial kidney consisting of a synthetic hemofilter in series with a renal tubule assist device (RAD) containing approximately 109 human renal tubule cells. This treatment in a critically ill patient with multi-organ failure and ARF in the intensive care unit was associated temporally with improved cardiovascular parameters and enhanced native kidney function. Multiple systemic plasma cytokine levels and gene expression profiles of peripheral white blood cells were also temporally changed with cell therapy. Clinical trials in patients suffering from either ARF or ESRD are currently ongoing to evaluate the influence of the RAD on the inflammatory response in these groups of patients.
Non-Specialist Ultrasound Measuring of Access Flow: New Technology
Authors: Vilkomerson David , Chilipka Tom , Nazarov Andrey , Kuhlmann Martin , Levin Nathan W.
Published: January 2004

A new ultrasound instrument has been developed, using vector Doppler and embedded machine intelligence, to enable measurement of access flow rates by non-specialists. Ultrasound measurement of access flow can be performed with the patient off the dialysis machine, avoiding the hemodynamic changes that may affect indicator-dilution methods. A research version of the instrument was tested on flow phantoms simulating graft flow, and showed accuracy better than 5%. A non-specialist measured flow in the access grafts of 7 consenting dialysis patients; the instrument showed flows commensurate with indicator-dilution-measured flows, but with less variability. Measurements were made in less than 5 min per patient. The cost per measurement is calculated to be significantly less than that of present methods of measuring flow. The new instrument may become a useful tool for monitoring flow in accesses to extend their life.
Dialysis without Membranes: How and Why?
Authors: Leonard Edward F. , West Alan C. , Shapley Nina C. , Larsen Mona U.
Published: January 2004

Dialysis between two flowing, miscible fluids without an intervening membrane enhances both the transport rate and biocompatibility. Unfortunately, it also presents serious challenges, including the loss of pressure as a driving force for volume transport, the need for sterile dialysate in greater quantity than in conventional dialysis, the possibility of unacceptable protein loss, and even the possibility of blood cell loss. This paper quantifies these advantages and disadvantages, and evaluate the means by which the latter might be surmounted. Preliminary data are provided to show that stable flows of one fluid sheathing another, miscible fluid are achievable and that molecular exchange between the fluids is orderly and in qualitative agreement with the theory. Extension of the concept to other blood purification tasks, especially in the treatment of liver failure and various macromolecular separations, is also discussed. In conclusion, membraneless separations will require a secondary process and a recycle stream. Under these conditions, its advantages can be preserved and its disadvantages controlled.
Polymorphism of Immunomodulatory Cytokine Genes: Implications in Acute Renal Failure
Authors: Jaber Bertrand L. , Liangos Orfeas , Pereira Brian J.G. , Balakrishnan Vaidyanathapuram S.
Published: January 2004

Experimental studies have incriminated cytokines and other immunoregulatory molecules as important mediators of tissue injury in acute renal failure (ARF). The relative importance of genetic factors, e.g. polymorphisms involving cytokine genes, in influencing susceptibility to and severity of ARF is unknown. This review summarizes the existing experimental and clinical studies supporting the role of inflammation in ARF, and critically examines human studies that have examined polymorphism of two critical cytokine genes, tumor necrosis factor-α and interleukin-10, as potential determinants of susceptibility to and severity of acute infectious and inflammatory diseases. Conclusions are drawn on the application of genetic epidemiology to the field of ARF and the rationale for further research on the role of genetic markers in ARF.
When Good Water Goes Bad: How It Happens, Clinical Consequences and Possible Solutions
Authors: Lonnemann Gerhard
Published: January 2004

Dialysis fluid produced by state-of-the-art water preparation and distribution is contaminated with gram-negative bacteria and cytokine-inducing substances (CIS) derived from these microorganisms. The presence of a biofilm increases the risk of continuous contamination of dialysis fluid. Depending on the type of dialyzer membrane (cellulosic vs. synthetic) and the mode of dialysis (low flux vs. high flux with backfiltration), CIS may penetrate intact dialyzer membranes, induce cytokine production in the patient’s blood and contribute to chronic inflammation associated with long-term hemodialysis therapy. Measures to improve the microbiological quality of dialysis fluid are: (1) the awareness of the problem and regular testing of dialysate samples using adequate methods; (2) disinfection of the entire water preparation and distribution system on a regular basis, replacement of biofilm-containing tubings, and (3) installation of ultrafilters in the dialysate circuit in particular when high-flux hemodialysis modalities are performed.
Diabetes and Chronic Kidney Disease: Tragedy and Challenge
Authors: Chua Dave Y. , Bakris George L.
Published: January 2004

Management of hypertension in diabetic nephropathy is challenging and generally requires a minimum of three different and complementary antihypertensive agents to achieve the recently recommended blood pressure (BP) goal of <130/80 mm Hg in order to reduce cardiovascular (CV) risk and preserve kidney function. Commonly used antihypertensive combinations include an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, agents that have compelling indications for use in diabetic renal disease, added to a diuretic, generally a thiazide-type agent. If additional therapy is required, either a beta-blocker or calcium antagonist may be added. Beta-blockers are particularly effective in people with a high sympathetic drive, i.e. high pulse rates, to lower BP and reduce CV risk while reducing proteinuria and slowing decline of kidney function. In light of this information, it is disturbing that a recent analysis of the NHANES III database indicates that only about 11% of people with diabetic kidney disease have achieved the target BP of <130/80 mm Hg. Recent data from Denmark demonstrate that focusing on total CV risk reduction among people with diabetes, including achievement of recommended BP and lipid goals along with the use of aspirin, exercise and a proper diet, can reduce the absolute risk of a CV event by 20% over less intensive treatment.
Chronic Kidney Disease and Sudden Death: Strategies for Prevention
Authors: McCullough Peter A. , Sandberg Keisha R.
Published: January 2004

The association between chronic kidney disease and cardiovascular death is accounted for, in part, by higher rates of serious arrhythmias. Research shows an independent relationship between worsened renal function and atrial fibrillation, heart block, ventricular tachycardia, ventricular fibrillation, and asystole. These higher rates also associate with underlying structural heart disease including left ventricular hypertrophy, cardiac fibrosis, valvular disease, and left ventricular systolic and diastolic dysfunction. In addition, chronic intermittent ischemia is implicated in the arrhythmias observed during hemodialysis. The superimposed conditions of acidosis and fluxes in both potassium and magnesium also contribute to higher rates of arrhythmias. Baseline estimated glomerular filtration rate is linked to worsened outcomes and increased defibrillation thresholds in patients receiving implantable cardioverter defibrillators. Preventive strategies include meticulous management of electrolytes, baseline treatment for cardiovascular disease, and when indicated, implantable cardioverter defibrillators. Future research into the mechanisms and prevention of sudden cardiac death in patients with chronic kidney disease is warranted.
Ultrafiltration in Patients with Hypervolemia and Congestive Heart Failure
Authors: Ronco C. , Ricci Z. , Brendolan Alessandra , Bellomo R. , Bedogni F.
Published: January 2004

Fluid overload may occur in patients with myocardial dysfunction and different clinical problems. Myocoardial dysfunction may be a consequence of heart dilatation with reduced contractility, ventricular stiffness with diastolic dysfunction or the consequence of myocardial injury or circulating myocardial depressant factors as seen in sepsis. In all cases, cardiac support can be achieved by the optimization of fluid balance, the reduction in organ edema and the restoration of desirable levels of pre- and afterload. Several reports have shown that myocardial elastance can improve after hemofiltration with restoration of adequate fluid balance. In such conditions, continuous extracorporeal therapy may result in remarkable cardiovascular stability with maintenance of hemodynamic parameters, including mean arterial pressure, heart rate and systemic vascular resistance. Such stability, which is achieved through the slow continuous ultrafiltration and continuous refilling of the intravascular volume from the interstitium, enables the stability of the circulating blood volume and the preservation of organ perfusion. This is also crucial for renal recovery during acute renal failure.
DOPPS Estimates of Patient Life Years Attributable to Modifiable Hemodialysis Practices in the United States
Authors: Port Friedrich K. , Pisoni Ronald L. , Bragg-Gresham Jennifer L. , Satayathum Sudtida S. , Young Eric W. , Wolfe Robert A. , Held Philip J.
Published: January 2004

Data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) allow estimation of the percentage of patients outside published hemodialysis guidelines and their associated mortality risk. We estimated the number of life years that could be gained from adherence to four of these guidelines and two other modifiable practices, i.e. dialysis dose, phosphate control, improved anemia, partial correction of serum albumin, reduced interdialytic weight gain and less use of catheters for vascular access. We extrapolated DOPPS data on these practices and guidelines to the US hemodialysis population for a 5-year projected period. Of the practices we examined, the highest relative risk of mortality was associated with having albumin <3.5 g/dl (relative risk = 1.38, p < 0.0001); 20.5% of the patients in the study fell outside the target range. The adjusted sum of the patient years attributable to all six practice patterns was 143,617; a more conservative estimate, modeling life years potentially gained by bringing half of all patients outside targets within them, is 69,367. The magnitude of potential savings in life years should encourage greater adherence to guidelines and practices that are significantly associated with better survival.
Effects of Acute Wound Environment on Neonatal Rat Dermal Multipotent Cells
Authors: Shi Chunmeng , Cheng Tianmin
Published: January 2004

Dermal multipotent cells (DMCs) with the capacity to differentiate to osteocytes, chondrocytes, adipocytes and neurons were isolated from the dermis of newborn Wistar rats by their adherence to culture plastic dishes.After labeling with a fluorescent nuclear marker, 4′,6-diamidino-2-phenylindole, neonatal DMCs were implanted into minced skin. The labeled cells were found in the regenerative skin 2 weeks after implantation. Topical transplantation of DMC suspension on full-thickness excision wounds made on the back of female rats enhanced the initial rate of contraction. Wound fluid collected using polyvinyl alcohol sponges from the incisions on the dorsa of adult rats on day 3 postwounding was used in the experiments. A methylthiazolyldiphenyl tetrazolium bromide assay showed that wound fluid with concentrations from 5 to 30% induced an increase in the number of cultured DMCs. The wound model of a monolayer of cells indicated that 10% wound fluid accelerated the migration rate of DMCs to fill in defects made in the layer of cultured cells. A colorimetric analysis also indicated that 10% wound fluid increased the hydroxyproline content in cultured cells. In conclusion, DMCs have been isolated from newborn rat dermis by their adherence to culture plastic dishes, and acute wound environment in the early stage promotes the viability, migration and collagen synthesis of these cells.
Fourier Transform Infrared Spectroscopy Application to Vascular Biology: Comparative Analysis of Human Internal Mammary Artery and Saphenous Vein Wall
Authors: Renò F. , Sabbatini M. , Bosetti M. , Laroche G. , Mantovani D. , Cannas M.
Published: January 2004

Saphenous vein (SV) and internal mammary artery (IMA) are used for aorto-coronary bypass grafting. IMA is considered to be the graft of choice for coronary revascularization having a long-term patency compared to SV. The aim of this study is to investigate the structure of vascular wall using a new technical approach. We analysed the chemical composition of vessel wall layers (total lipid, lipid ester and protein) of 25 vascular segments (19 SV and 6 IMA) using Fourier transform infrared spectroscopy (FTIR). FTIR analysis showed that in intima layer lipid ester and protein concentration (expressed as arbitrary units) was significantly higher in SV (lipid ester = 0.020 ± 0.002; protein = 0.449 ± 0.022) than in IMA (lipid ester = 0.014 ± 0.002; protein = 0.342 ± 0.032). Moreover, the percentage of lipid ester on total lipid was significantly higher in SV (intima = 54.7 ± 2.9%; media = 78.4 ± 4.9%; adventitia = 83.9 ± 8.3%) wall layers compared to IMA ones (intima = 37.3 ± 4.9%; media = 45.4 ± 3.8; adventitia = 57.1 ± 4.8). These data suggest that a different chemical composition of wall layers could also be responsible for the morphological modifications observed in SV after grafting.
Orbital Passage of Pterygopalatine Ganglion Efferents to Paranasal Sinuses and Nasal Mucosa in Man
Authors: Ruskell Gordon L.
Published: January 2004

Parasympathetic nerves of pterygopalatine ganglion origin are considered to enter the orbit and distribute to the nasal mucosa with the anterior ethmoidal nerve. As their distribution has never been demonstrated the present study was undertaken to seek evidence of their passage and to identify their relationship with the ethmoidal nerves. The soft tissues of the pterygopalatine fossa and orbit from sixteen sides of twelve cadavers were removed in one piece and either dissected or cut coronally into slabs and prepared histologically using montages of thin resin-embedded sections at intervals suitable for nerve path tracing. Several of the rami orbitales passing mediodorsally from the ganglion enter the orbit apically, branch and enter the posterior ethmoidal foramen terminating in the lining of the paranasal sinuses and others advance to enter the anterior ethmoidal canal to reach the nasal mucosa. No junctions were made with ethmoidal nerves within the orbit or the canal. Failure of surgical lesions of the anterior ethmoidal nerve as a treatment for vasomotor rhinitis may be attributed to the sparing of the separate parasympathetic nerves. Appropriate chemical lesions, on the other hand, could ensure destruction of isolated parasympathetic nerves while limiting damage to the larger anterior ethmoidal nerve.
Takayasu’s Disease with Cutaneous Involvement
Authors: Pascual-López Marta , Hernández-Núñez Almudena , Aragüés-Montañés Maximiliano , Daudén Esteban , Fraga Javier , García-Díez Amaro
Published: January 2004

Takayasu’s arteritis (TA) is a chronic inflammatory and fibrosing arteriopathy that can also involve cutaneous vessels. The disease typically presents with a prepulseless phase that overlaps or is followed by the characteristic pulseless stage. In both phases of TA, cutaneous manifestations may be present. Lesions considered to be ‘specifically’ associated with TA have been described most frequently simulating erythema nodosum, erythema induratum and pyoderma gangrenosum. We report 2 Caucasian patients with TA and nodular cutaneous lesions. Nine skin biopsies from these patients were studied. A necrotizing vasculitis was present in 5 biopsies. We review those patients with TA and well-documented cutaneous manifestations in the English literature, with special interest in nodular lesions, the most frequent cutaneous manifestation of TA in Caucasian patients. Biopsies from lesions with similar morphology frequently show different histological findings.
Automated Extraction and Description of Dark Areas in Surface Microscopy Melanocytic Lesion Images
Authors: Pellacani Giovanni , Grana Costantino , Cucchiara Rita , Seidenari Stefania
Published: January 2004

Background: Identification of dark areas inside a melanocytic lesion (ML) is of great importance for melanoma diagnosis, both during clinical examination and employing programs for automated image analysis. Objective: The aim of our study was to compare two different methods for the automated identification and description of dark areas in epiluminescence microscopy images of MLs and to evaluate their diagnostic capability. Methods: Two methods for the automated extraction of ‘absolute’ (ADAs) and ‘relative’ dark areas (RDAs) and a set of parameters for their description were developed and tested on 339 images of MLs acquired by means of a polarized-light videomicroscope. Results: Significant differences in dark area distribution between melanomas and nevi were observed employing both methods, permitting a good discrimination of MLs (diagnostic accuracy = 74.6 and 71.2% for ADAs and RDAs, respectively). Conclusions: Both methods for the automated identification of dark areas are useful for melanoma diagnosis and can be implemented in programs for image analysis.
Three-Point Checklist of Dermoscopy
Authors: Soyer H. Peter , Argenziano Giuseppe , Zalaudek Iris , Corona Rosamaria , Sera Francesco , Talamini Renato , Barbato Filomena , Baroni Adone , Cicale Lorenza , Di Stefani Alessandro , Farro Pietro , Rossiello Luigi , Ruocco Eleonora , Chimenti Sergio
Published: January 2004

Background: Dermoscopy used by experts has been demonstrated to improve the diagnostic accuracy for melanoma. However, little is known about the diagnostic validity of dermoscopy when used by nonexperts. Objective: To evaluate the diagnostic performance of nonexperts using a new 3-point checklist based on a simplified dermoscopic pattern analysis. Methods: Clinical and dermoscopic images of 231 clinically equivocal and histopathologically proven pigmented skin lesions were examined by 6 nonexperts and 1 expert in dermoscopy. For each lesion the nonexperts assessed 3 dermoscopic criteria (asymmetry, atypical network and blue-white structures) constituting the 3-point method. In addition, all examiners made an overall diagnosis by using standard pattern analysis of dermoscopy. Results: Asymmetry, atypical network and blue-white structures were shown to be reproducible dermoscopic criteria, with a kappa value ranging from 0.52 to 0.55. When making the overall diagnosis, the expert had 89.6% sensitivity for malignant lesions (tested on 68 melanomas and 9 pigmented basal cell carcinomas), compared to 69.7% sensitivity achieved by the nonexperts. Remarkably, the sensitivity of the nonexperts using the 3-point checklist reached 96.3%. The specificity of the expert using overall diagnosis was 94.2% compared to 82.8 and 32.8% achieved by the nonexperts using overall diagnosis and 3-point checklist, respectively. Conclusion: The 3-point checklist is a valid and reproducible dermoscopic algorithm with high sensitivity for the diagnosis of melanoma in the hands of non-experts. Thus it may be applied as a screening procedure for the early detection of melanoma.
Teaching Effects of Dermatological Consultations on Nondermatologists in the Field of Internal Medicine
Authors: Antic Milos , Conen Dieter , Itin Peter H.
Published: January 2004

Background: Scarce data exist concerning dermatological consultations within departments of internal medicine. To date, no survey has been carried out in Switzerland to elucidate this issue. The aim of this study was to analyze the spectrum of skin diseases internists are confronted with and to study their diagnostic accuracy in cutaneous diseases. In addition, we wanted to evaluate the motivation for dermatologists to cooperate closely with internists. Patients and Methods: The study included patients with dermatological problems treated at the Department of Internal Medicine at the Kantonsspital Aarau, Switzerland. All patients had been referred to the Department of Dermatology for examination between 1999 and 2001. Patient data were analyzed demographically, by referral modus, diagnoses and therapy. To evaluate the knowledge of internists and dermatologists in cutaneous medicine, 15 clinical slides of common dermatoses with a patient history were shown and asked for diagnostic suggestions to 32 internists of the Kantonsspital Aarau and to 13 dermatologists of the University Hospital Basel, Switzerland. Results: 1,290 patients were referred to the Department of Dermatology. 1,737 dermatological diagnoses were made including 348 different dermatoses. Eczema was the single most common diagnosis (12.6%), followed by actinic and bowenoid precancerosis (6.2%), drug eruption (4.2%), verrucae (4%) and mycosis (3.8%). The top ten diagnoses accounted for 41.7% of all skin-related diagnoses. Infection-related dermatoses were most common (20.5%) followed by different types of eczema (12.6%), malignant cutaneous tumors and malignant visceral conditions (11.2%). Local therapy was prescribed in 64.2% and systemic therapy in 22.6% of the patients. 15.9% did not receive specific therapy because the consultation request was only a diagnostic one. 146 skin biopsies were performed (11.3%). Systemic diseases with cutaneous manifestations accounted for 15.7%. In general, these conditions were not commonly seen by dermatologists in daily practice. The internists recognized 51.1% of the cutaneous manifestations during examination and 49% when presented with slides. Conclusions: Internists are confronted with a different spectrum of cutaneous diseases compared with dermatologists. Due to the broad spectrum of skin diseases, it is a challenging task for internists to recognize dermatoses. Our study elucidates that patients, internists and dermatologists may profit from a close cooperation.
Study Design and Preliminary Results from the Pilot Phase of the PraKtis Study: Self-Reported Diagnoses of Selected Skin Diseases in a Representative Sample of the Italian Population
Authors: Naldi Luigi , Colombo Paolo , Placchesi Elena Benedetti , Piccitto Roberto , Chatenoud Liliane , La Vecchia Carlo
Published: January 2004

Background: Few data are available on the prevalence of common skin disorders like actinic keratoses in the general population. Such data are mostly needed to better define health needs and to organize medical services. The Prevalence of Actinic Keratoses in the Italian Population Study (PraKtis) was designed to estimate the point prevalence of actinic keratoses and related disorders, e.g. photoaging, in a representative sample of the Italian population. Within the study, information on the history of relevant dermatological diagnoses was also collected. Methods: The study was conducted in collaboration with DOXA, the Italian branch of the Gallup International Association. A representative sample of people aged 45 years or older was selected by picking them from the electoral rolls according to a stratified random sampling design involving a replacement procedure. A total of 180 interviewers specifically trained to collect data on skin diseases and to take photographs of representative lesions on the face and upper limbs, contacted and interviewed the sampled subjects and performed a face-to-face computer-assisted interview. A final sample of about 12,000 subjects was foreseen. Results: The pilot phase of the study was conducted between January 1 and June 30, 2003. A total of 3,660 subjects were recruited and interviewed. Overall, an estimated 37% of Italian people reported having ever undergone a dermatological consultation in the past. An estimated 29% reported having ever received a specific dermatological diagnosis by a physician. The frequency of specifically enquired diagnoses, weighted according to the distribution of the Italian population, was as follows: atopic dermatitis 4.7%, other eczematous dermatitides 4.3%, urticaria 4.3%, psoriasis 3.1%, skin tumors 1.6%, vitiligo 0.7% and actinic keratoses 0.3%. Conclusion: Skin diseases are frequently reported. The prevalence of actinic keratoses according to self-reported diagnoses was lower than expected based on prevalence data obtained by directly examining people. These discrepancies may be due to underreporting and/or unawareness of lesions by affected people. More precise estimates will be obtained by direct examination of sampled people.
Interferon Alpha as Adjuvant Postsurgical Treatment of Melanoma: A Meta-Analysis
Authors: Pirard Delphine , Heenen Michel , Melot Christian , Vereecken Pierre
Published: January 2004

Background: The literature on the benefit of α-interferon (IFN-α) as adjuvant postsurgical treatment of melanoma reports discordant results. Objective: With the published data so far, we performed a meta-analysis in order to evaluate the effect of IFN-α on the relapse rate (RR) and the overall survival (OS). Methods: Published randomised trials were identified by Medline search. Stage IV melanoma was not considered. Results: Nine published studies were included, with a total of 2,880 patients. Both the per protocol and the intention-to-treat analysis show that IFN-α significantly decreased the RR (OR = 0.74; 95% CI = 0.64–0.86). Subgroup analyses show that, for all stages, high and low doses decreased the RR (OR = 0.71, 95% CI = 0.54–0.92, and OR = 0.76, 95% CI = 0.63–0.91, respectively). No difference has been evidenced on OS. Conclusions: High and low doses of IFN-α significantly decrease the RR, but the OS does not seem to be improved.
Caterpillar Dermatitis in Two Siblings due to the Larvae of Thaumetopoea processionea L., the Oak Processionary Caterpillar
Authors: Maier Harald , Spiegel Wolfgang , Kinaciyan Tamar , Hönigsmann Herbert
Published: January 2004

Two siblings, 16 months and 5 years of age, came into contact with the urticating hairs (setae) of oak processionary caterpillars, the larvae of Thaumetopoea processionea L., when the family moved to a suburb of Vienna, where mass gradation of T. processionea had started the year before. The setae were being spread by the wind from an infested oak tree in the neighbourhood. Both children repeatedly suffered bouts of dermatitis during the 10 weeks of the larval development. Owing to the fact that T. processionea often infests oak trees, whether isolated or at the edges of forests, there is a high likelihood of people being affected. Children frequently explore their surroundings and are at an even greater risk of developing lepidopterism. Caterpillar dermatitis should therefore be taken into consideration in the differential diagnosis of a pruritic rash in infants from regions with caterpillar-infested trees, especially during the larval development of T. processionea.
Total Hepatectomy Model in Pigs: Revised Method for Vascular Reconstruction Using a Rigid Vascular Prosthesis
Authors: Sosef M.N. , van Gulik T.M.
Published: January 2004

Total hepatectomy in animals provides an irreversible model of acute liver failure. Vascular reconstruction in this model of acute liver failure was modified and characterized for the use of assessment of liver support systems. Pigs underwent total hepatectomy and a rigid three-way transparent polyethylene vascular conduit was used to replace the retrohepatic caval vein and to shunt the portal venous blood to the caval vein. Placement of the vascular conduit in conjunction with excision of the liver was completed in 10–22 min without the need of a temporary veno-venous bypass. A survival study conducted in 5 animals showed a mean survival time of 46 ± 6 h. Baseline and 4 h postoperative hemoglobin levels were not different, and plasma ammonia levels rose to more than 30-fold of baseline values. All animals died of cardiac arrhythmias and irreversible shock. Total hepatectomy in the pig using a three-way portal-venous conduit is a reliable and well-reproducible animal model of acute liver failure for evaluation of liver assist devices.
Suppression of Postoperative Systemic Inflammatory Response Syndrome with Clarithromycin following Lung Cancer Surgery
Authors: Hirata T. , Ogawa E. , Takenaka K. , Kawashita F.
Published: January 2004

We examined whether clarithromycin (CAM), a 14-membered macrolide, can control the postoperative systemic inflammatory response syndrome that occurs following lung cancer surgery. In the control group (n = 16), prophylactic antibiotics (flomoxef) were administered for 4–7 days following surgery. In the CAM group (n = 10), 400 mg/day of CAM were administered orally for 14 days prior to surgery and for 7 days following surgery, in addition to the postoperative administration of flomoxef. The incidence and duration of the systemic inflammatory response syndrome in the CAM group (30%, 0.3 days) were significantly lower than those in the control group (81%, 1.6 days). There were no significant differences between the control and CAM groups in both the amount and frequency of nonsteroidal anti-inflammatory drugs following surgery. In conclusion, our study suggests that CAM may suppress the postoperative systemic inflammatory response syndrome in lung cancer patients.
Value of Energy Substrates in HTK and UW to Protect Human Liver Endothelial Cells against Ischemia and Reperfusion Injury
Authors: Janßen Hermann , Janßen Petra H.E. , Broelsch Christoph E.
Published: January 2004

Adenosine 5′-triphosphate (ATP) depletion is a major cause of cellular injury during ischemia and reperfusion in organ transplantation. Therefore, histidine-tryptophan-ketoglutarate solution (HTK; α-ketoglutarate) and University of Wisconsin solution (UW; adenosine) were supplied with energy substrates to achieve graft viability. Nevertheless, their efficacy for maintaining the ATP level, particularly in human liver endothelial cells, was uncertain. Furthermore, it is of interest whether a high ATP level is beneficial in human liver endothelial cell viability. We used human liver endothelial cells between the 3rd and 6th passages in a cell culture model. Human liver endothelial cells were exposed to hypothermic preservation (4°C) in HTK and UW for 2, 6, 12, 24 and 48 h with subsequent reperfusion of 6 h. ATP and lactate dehydrogenase (LDH) were measured after each interval. In comparison to HTK, UW demonstrates a statistically significantly higher level of ATP after each interval of ischemia (p < 0.001) and reperfusion (p < 0.002). Additionally, UW-preserved human liver endothelial cells exceed the ATP level of the warm control during all intervals of ischemia. The loss of cell viability (LDH) was statistically significantly higher after ischemia (p < 0.01) and reperfusion (p < 0.01) in HTK than in UW except after the interval of 48 h. In conclusion, adenosine was more effective than α-ketoglutarate in maintaining a high ATP level in human liver endothelial cells after ischemia and reperfusion. Different pathways of energy substrate utilization were a contributing factor. The beneficial effect of the higher ATP level caused by adenosine to human liver endothelial cell viability was limited to 24 h of ischemia. Beyond this ischemia time we could not prove a favorable impact of adenosine on human liver endothelial cells.
Effects of Combined Nutritional Therapy on Acute Necrotizing Pancreatitis in Rats in the Early Phase of the Disease
Authors: Alhan E. , Kaklıkkaya N. , Deger O. , Erçin C.
Published: January 2004

The aim of this study was to investigate the influence of a small amount of enteral nutrition along with parenteral nutrition on acute necrotizing pancreatitis (ANP) induced by glycodeoxycholic acid in rats in the early phase of disease. The induction of ANP resulted in a significant increase in mortality rate, intestinal permeability, bacterial infection in the pancreas and extrapancreatic organs, pancreatic necrosis and serum activity of urea and amylase, and a significant decrease in concentrations of calcium, protein and albumin. But no difference was observed between the pancreatitis groups. Significant hyperglycemia and increased liver transaminase activity were observed in rats treated with combined nutritional therapy (CNT). CNT did not improve the course of acute pancreatitis, intestinal permeability, bacterial translocation, or reduce the extent of acinar cell injury in ANP and is therefore unlikely to be of benefit in patients with pancreatitis in the early period.
Interleukin-10 Suppresses Proliferation and Remodeling of Extracellular Matrix of Cultured Human Skin Fibroblasts
Authors: Moroguchi A. , Ishimura K. , Okano K. , Wakabayashi H. , Maeba T. , Maeta H.
Published: January 2004

When we previously examined the participation of local expression of interleukin-10 (IL-10) and tumor necrosis factor-α (TNFα) in wound healing of an intestinal anastomosis under septic conditions in mice, we found that IL-10 and TNFα expressions were markedly enhanced around the anastomosis and that wound healing was impaired in this animal model. The purpose of the present study was to investigate the combined effect of IL-10 on proliferation and remodeling of the extracellular matrix (ECM) of cultured human skin fibroblasts. Human skin fibroblasts were cultured for 48 h with IL-10 and/or TNFα at various concentrations, then the proliferation rates were determined using the MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay. The concentration of transforming growth factor-β1 (TGFβ1) in cell culture supernatants was measured by enzyme-linked immunosorbent assay, and type I collagen protein and matrix metalloproteinase-I (MMP-I) were detected by indirect immunofluorescence in cultured cells incubated for 48 h with 10 ng/ml of IL-10 and/or 10 ng/ml of TNFα. IL-10 itself had no effect on fibroblast proliferation, but reduced TNFα-induced fibroblast proliferation. The concentration of TGFβ1 in cell culture supernatants was significantly lower in the presence of TNFα and IL-10 than in the presence of TNFα alone. Immunolabeling of fibroblasts for type I collagen protein was decreased in cells incubated with IL-10 and/or TNFα compared to controls. MMP-I immunolabeling was increased in cells incubated with IL-10, IL-10 and TNFα compared to control and cells incubated with TNFα. It is suggested that IL-10 is an inhibitory factor for the remodeling of the ECM during wound healing.
New Therapeutic Approaches in Pulmonary Embolism
Authors: Schellong Sebastian M. , Schmidt Benjamin A.
Published: January 2004

Pulmonary embolism as a part of venous thromboembolic disease has a broad spectrum of clinical presentations from minimal disease to life-threatening right heart failure. Therapy has to be guided by the risk associated with the individual clinical state of the patient. As long as hemodynamics are entirely stable, anticoagulation is given in order to prevent early or late recurrence, thereby allowing for endogeneous thrombolysis and recovery. In hemodynamically instable patients, i.e. patients under cardiopulmonary resuscitation or in shock, there is the need for a rapid reduction of thrombus mass in order to restore right ventricular function. Systemic thrombolysis is the most feasible modality to reduce the thrombus burden of the pulmonary circulation in the short term. For hemodynamically stable patients with right ventricular dysfunction as assessed by echocardiography, there is still some controversy as to whether thrombolysis improves the long-term outcome. At the least, thrombolysis may positively modify the short-term course of acute disease in patients with an extremely low risk of bleeding. When the acute phase has been overcome, secondary prophylaxis with vitamin K antagonists has to be given. The duration of secondary prophylaxis requires an individual assessment of both the risk of recurrence and the risk of bleeding. In the near future, new anticoagulant drugs such as direct thrombin and factor Xa inhibitors will offer new treatment modalities for the acute phase as well as for secondary prophylaxis.
Serum Soluble Fas in Patients with Schistosomal Cor pulmonale
Authors: Salama Mai , El-Kholy Gamal , Abd El-Haleem Soheir , Elzamarany Enas , Abou Freikha Mohamed , Elwan Nadia , El-Masry Magdy , Al-Bacil Amr , Elhendy Abdou
Published: January 2004

Background: Schistosomal cor pulmonale is considered an important pathological condition in endemic areas. Few recent studies have reported the role of apoptosis in pulmonary hypertension. Objectives: The aim of this study was to assess serum levels of soluble Fas (sFas), an inhibitor of apoptosis, in patients with schistosomal cor pulmonale as compared to patients with cor pulmonale due to chronic obstructive pulmonary disease (COPD) and normal subjects. Methods: Serum sFas was assessed in 15 men with schistosomal cor pulmonale (age 32 ± 10 years), 15 men with chronic cor pulmonale secondary to COPD and 20 healthy men, matched for age. Results: Serum levels of sFas were significantly higher in patients with schistosomal cor pulmonale (74 ± 80 U/ml) than in patients with cor pulmonale due to COPD (15 ± 10 U/ml) and normal subjects (19 ± 11 U/ml, p < 0.001 in both). In patients with schistosomal cor pulmonale, sFas was significantly higher in patients with mean pulmonary artery pressure >30 mm Hg as compared to patients with pressure ≤30 mm Hg (109 ± 97 vs. 34 ± 20 U/ml, p = 0.01). There was a significant correlation between serum sFas and the mean pulmonary artery pressure in patients with bilharzial cor pulmonale (r = 0.4, p < 0.01), but not in patients with COPD (r = 0.1, p = NS). Conclusions: Serum sFas levels are elevated in patients with schistosomal cor pulmonale and they are related to the severity of pulmonary hypertension. These findings suggest a role of apoptosis in schistosomal cor pulmonale.