bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving Hemodialysis Patient Outcomes: A Step‐By‐Step Approach
Authors: Sehgal Ashwini R.
Published: March 2003

Hemodialysis patient outcomes are often suboptimal, with one‐sixth of patients receiving an inadequate dialysis dose, one‐fourth using catheters for vascular access, and more than one‐half being malnourished. This review describes a four‐step approach for improving dialysis patient outcomes. First, select an outcome to improve. This can be a global outcome such as mortality, morbidity, quality of life, or health care costs or an intermediate outcome (such as dialysis dose) that has a demonstrated link with a global outcome. Second, determine barriers to optimal outcomes. Both patient factors (such as noncompliance) and provider factors (such as the process of care) may act as barriers. Third, intervene on specific barriers. Interventions may involve providing medical or surgical treatment, changing patient or provider behavior, or modifying the system of care. Fourth, disseminate the intervention to other settings. “Early adopters” (those who quickly adopt an innovation) and “opinion leaders” (well‐respected local physicians) are especially influential in determining the rate of dissemination. By using this approach, physicians can move from helping an individual patient to improving the outcomes of many patients.
National Surveillance of Dialysis‐Associated Diseases in the United States, 2000
Authors: Tokars Jerome I. , Frank Mark , Alter Miriam J. , Arduino Matthew J.
Published: March 2003

In December 2000, all U.S. dialysis centers were surveyed regarding selected patient care practices and dialysis‐associated diseases. The results were compared with similar surveys conducted in previous years. During 1997–2000, the percentage of patients vaccinated against hepatitis B virus infection increased from 47% to 58% and the percentage of staff vaccinated increased from 87% to 88%. In 2000, an estimated 64% of patients were vaccinated for influenza and 27% for pneumococcal pneumonia. In 2000, routine testing for antibody to hepatitis C virus (anti‐HCV) was performed on staff at 40% of centers and on patients at 58% of centers; anti‐HCV was found in 1.7% of staff and 8.4% of patients. During 1995–2000, the percentage of patients who received dialysis through central catheters increased from 13% to 24%; this trend is worrisome because infections and antimicrobial use are higher in patients receiving dialysis through catheters. However, during the same period the percentage of patients receiving dialysis through fistulas increased from 22% to 28%. In 2000, 25% of catheters were used for new patients awaiting an implanted access, 28% for established patients with a failed access awaiting a new implanted access, 41% as an access of last resort, and 6% for other reasons, including patient preference. The percentage of centers reporting one or more patients infected or colonized with vancomycin‐resistant enterococcus (VRE) increased from 11.5% in 1995 to 32.7% in 2000.
Imaging in the Dialysis Patient: The Role of Vascular Radiology in Hemodialysis Access
Authors: Chalmers Nicholas
Published: March 2003

The article summarizes the role of vascular radiology in the imaging and salvage of hemodialysis fistulas and in the placement and maintenance of tunneled dialysis access catheters.
Peritoneal Dialysis in Anuric Patients: Concerns and Cautions
Authors: Van Biesen Wim , Vanholder Raymond , Veys Nic , Lameire Norbert
Published: March 2003

Most recent studies have found an equivalent survival for patients on peritoneal dialysis (PD) and hemodialysis (HD); evidence even suggests that PD might be the preferred modality during the first 3–4 years of renal replacement therapy. This is probably related to the continuous and minimally invasive character of PD as compared to HD, resulting in better preservation of residual renal function (RRF) and less cardiovascular strain. On the other hand, blood pressure control, fluid balance, and adequacy targets may be difficult to obtain in long‐term PD patients. The question arises whether PD is a feasible option in anuric patients. It is clear that the answer depends on the body size and the peritoneal membrane transport characteristics of the patient, so that PD will be feasible in some anuric patients, whereas in others it will not be. Evaluation of the peritoneal transport characteristics and adaptation of the PD prescription is warranted. A constant evaluation of the fluid balance, nutritional, and cardiovascular status is needed. This article reviews the physiologic insights and clinical evidence necessary for a good PD prescription in anuric patients.
Fellows' Forum in Dialysis edited by Mark A. Perazella: Cardiac Troponins: Utility in Renal Insufficiency and End‐Stage Renal Disease
Authors: Watnick Suzanne , Perazella Mark A.
Published: March 2003

Currently available serum markers of cardiac injury in patients with renal insufficiency suffer from impaired sensitivity and specificity. Cardiac troponins (cTnI, cTnT) are relatively new diagnostic markers of myocardial injury and have gained widespread application in the non‐renal‐failure population to diagnose myocardial infarction. Over the past few years the specificity and sensitivity of cardiac troponins for diagnosing acute myocardial infarction in patients with renal dysfunction have been examined. Most data indicate that cardiac troponin I has an excellent specificity, but until more studies are available this marker should be consdiered a useful but imperfect serum marker of an acute coronary syndrome in patients with underlying renal dysfunction.
Do Calcium Channel Blockers Adversely Affect Hormonal Treatment of Prostate Cancer Through an Inhibition of Apoptosis?
Authors: Buchholz Thomas A. , Eng Tony Y. , Martin Douglas D. , Powell Curt R. , Johnstone Peter A. S. , Allen Pamela
Published: March 2003

Background: Hormonal therapy of prostate cancer is mediated, in part, through apoptosis. This process is dependent on intracellular calcium influx. This study investigates whether the use of calcium channel blockers inhibits this process and thereby negatively impacts hormonal therapy.

Methods: Records from patients dying from metastatic prostate cancer in three medical centers were reviewed. The date of diagnosis, date of metastatic disease, date of death, Gleason sum, type of hormone therapy, and calcium channel blocker used were recorded.

Results: Of the 180 patients, 26 were on a calcium channel blocker at the time of their hormonal therapy. The length of survival from the time of hormone therapy to death in these patients did not differ from the 154 patients not on a calcium channel blocker (respective median survival time of 819 days versus 730 days, p = 0.913—log rank test of the survival curves). Similarly, there were no differences in length of survival from the date of diagnosis between the two groups. Other analyzed factors (type of hormone therapy, Gleason score, and interval between diagnosis and metastatic disease) also did not affect length of survival from the time of hormonal treatment or time of diagnosis.

Conclusion: We found no evidence that calcium channel blockers inhibit the therapeutic efficacy of hormonal treatment for metastatic prostate cancer.
Prostate Apoptosis in Response to Castration in Wild‐Type and Nerve Growth Factor‐Induced Gene A‐Deficient Mice
Authors: Naughton Cathy K. , Tourtellotte Warren G. , Smith Deborah S. , Milbrandt Jeffrey
Published: March 2003

Objective: Nerve growth factor‐induced gene A (NGFIA) is a transcription factor implicated in androgen deprivation‐induced apoptosis in an androgen‐sensitive prostate cell line (
1,
2). The objective of our study was to investigate the role of NGFIA in prostate apoptosis in response to androgen ablation in a mouse animal model lacking the gene.

Materials and Methods: Wild‐type mice (n = 56) and NGFIA‐deficient mice (“knock‐out”) (n = 16) were surgically castrated. The animals were killed at 0 (noncastrated controls), 1, 3, 5, 7, 10, 14, and 21 days after castration, and the prostates were harvested. Tissue sections were stained for morphologic analysis and quantification of apoptosis using a terminal deoxynucleotidyl transferase biotinylated deoxyuridine triphosphate nick‐end labeling (TUNEL) strategy. Apoptosis was quantitatively measured by counting the number of TUNEL‐positive cells/100 epithelial cells by light microscopy. The percentage of apoptosis was compared for wild‐type mice versus NGFIA‐deficient mice after castration at the defined time points.

Results: We found a statistically significant increase in the mean percentage of prostate cell apoptosis within 7–21 days after castration in both wild‐type and NGFIA‐deficient mice (p < 0.05). However, there was no statistically significant difference in the mean percentage of apoptotic prostate cells between wild‐type and NGFIA‐deficient mice 1–5 or 7–21 days after castration (p > 0.05).

Conclusion: NGFIA does not seem to play a critical role in prostate apoptosis induced by androgen ablation in this mouse model.
Meningeal Carcinomatosis in Metastatic Prostate Cancer: A Case Report
Authors: Reed Eddie , Matthews Douglas , Dyer Valerie , Figg William D.
Published: March 2003

Leptomeningeal involvement of metastatic prostate cancer is a rare clinical entity. We report such a case, along with a summary of three previous cases where detailed clinical information is available. Seven additional cases (for a total of 10 cases) have been reported previously in the literature. It seems that this syndrome is associated with changes in mentation, specifically without cranial nerve findings on physical exam. The physician should be alerted to the possibility of this clinical circumstance in metastatic prostate cancer patients with altered mental status.
Testicular Metastasis from Adenocarcinoma of the Prostate: Review of Literature and Report of Two Cases
Authors: Berkmen Ferhat , Ayyıldız Ali , Ardıçoğlu Arslan
Published: March 2003

Tumor metastases to the testes, excluding lymphomas and leukemias, are extremely uncommon. In the literature there have been reports of 236 different cancer metastases to the testis. The most common origin is the prostate in 76 (32%) cases. We report two additional cases of testicular metastases from adenocarcinoma of the prostate. Immunohistochemical analysis of prostate specific antigen indicated that the metastatic cancer was of prostatic origin.
Preoperative Detection of Locally Advanced Prostate Cancer by Using Transrectal Ultrasound‐Guided Staging Prostate Biopsy
Authors: Zisman Amnon , Herbert Merdad , Strauss Simon , Manor Hana , Liebovici Dan , Lindner Arie
Published: March 2003

Treatment for cure is reserved for patients with organ‐confined prostate cancer. The clinical staging of prostate cancer lacks accuracy regarding local extension. The results of a transrectal ultrasound‐guided staging biopsy (TGSB), performed in addition to routine sextant biopsies (RSBs) of the prostate, is defined as being positive when tumor cells are shown to invade extraprostatic loci and, thus, would certainly differentiate between organ‐confined and locally advanced disease. Seventy‐seven RSB + TGSB procedures were compared to 223 routine sextant prostate TRGBs. Prostate cancer (CaP) was detected in 24 patients (31%) and 60 patients (27%), respectively. In four RSB + TGSB procedures, local extension of CaP was depicted, and as a result radical prostatectomy was withheld. In six of seven patients undergoing radical prostatectomy (86%), the specimen analysis result was in agreement with the results of the preoperative TGSB. There were no extra complications associated with the performance of staging biopsies. We conclude that TGSB is safe and efficacious and that it should be performed in candidates for radical prostatectomy.
An Innovative Tool for Predicting the Pathologic Stage of Prostate Cancer
Authors: Martorana Giuseppe , Bertaccini Allesandro , Viaggi Stefano , Belleli Rossella
Published: March 2003

Objective: To develop a practical tool for predicting the pathologic stage in prostate cancer.

Materials and Methods: Two hundred fifty patients who had had radical prostatectomy were selected from an Italian longitudinal observational study on prostate cancer. Inclusion criteria for selection were the following: a preoperative prostate specific antigen (PSA) value <50 ng/ml; a clinical stage less than or equal to stage T3c (TNM 1992); the availability of the bioptic Gleason score; and the availability of a pathologic specimen obtained during the radical prostatectomy. Pathologic stages were categorized into five levels according to the increasing severity of the illness. Multivariate logistic regression on polythomous ordinal response was performed to obtain a predictive model of disease progression. A set of parallel scale nomographs then was constructed to transfer the predictive model into a new tool, called the “Uro‐gramma,” that is able to simplify the practical use of the traditional nomograms.

Results: The Gleason score was the factor that influenced the probability of pathologic stage progression the most; PSA and clinical stage were the second and third most significant factors, respectively. Two‐way and three‐way interactions were tested and were not found to be significant. The confounding effects of age and neoadjuvant hormonal therapy also were tested, and they had no significant influence on the response variable. A logistic regression algorithm then was used to produce a set of nomographs (the Uro‐gramma) for the prediction of different pathologic stages using the Gleason score, PSA level, and clinical stage of disease.

Conclusion: The predictive model obtained from this Italian study will help physicians and patients in therapeutic decision making. The Uro‐gramma provides a new and easier instrument with respect to previous nomograms and multidimensional tables for pathologic stage prediction.
County Drought Relief: A Public Health Nurse's Problem
Authors: Wharton Anne L.
Published: March 2003

Editor's Note— Last winter was more than usually full of traumas, natural and unnatural. Regardless of where one lives, natural events can devastate whole geographic regions. Hurricanes, floods, mudslides, earthquakes, tornadoes, and droughts, leave in their wake ruined homes, power outages, and crop failures. All too frequently, these natural disasters cause people to die, as well. Communities are forced under such circumstances to regroup and rebuild. It is in these activities that we may sometimes learn from disaster, as individuals reach out to one another to meet temporary needs. The power of collective action is demonstrated in stories told by public health nurses who witnessed and participated in disaster recovery.

For the second in the series of three reprints highlighting nursing following natural disasters earlier in this century, I have selected the account of a public health nurse who worked in rural Virginia in the winter of 1931 following a drought that left many residents of the region destitute. It was orginally published in Public Health Nursing in August 1931. From a late twentieth century perspective, her particularism and her choice of family to portray to her readers may grate on us a bit. Yet the enduring themes of effective public health work—case‐finding, grassroots involvement, and collaboration—resound from one end of the century to the other.
A Case Study on Expanding the Concept of Caring from Individuals to Communities
Authors: Smith‐Campbell Betty
Published: March 2003

Caring has been described as the essence of nursing and some theorists assert that caring occurs only on the interpersonal level. The purpose of this paper is to illustrate caring beyond the individual to communities. Patterns of caring explicated from a case study were matched with concepts of caring defined in the literature. The concepts of caring were modified through a reevaluation of caring based on the findings from a community case study. Findings suggest concepts of caring as (1) a moral imperative, (2) an affect, (3) a personal interaction, and (4) an action, can be found at the community level. Modification of the original patterns of caring included broadening the concepts to include community interaction and preparatory caring action.
A Survey of Home Nursing Services in Taiwan
Authors: Shyu Yea‐Ing Lotus , Liao Mei‐Nan , Shao Jung‐Hua , Yang Chia‐Ling
Published: March 2003

This study investigated the current situation of home nursing services in Taiwan. A total of 93 home nursing agencies (response rate of 75%) responded to a mail survey. The majority of the agencies (63%) had been established within the last 3 years before the survey, were hospital‐based (90%), and had less than 60 (89.3%) average total number of visits per month per nurse. Most of the home care nurses had taken home care nursing training courses and had at least 2 years of clinical experience. Half of the agencies provided care for patients on a respirator, and 28% provided in‐home hospice care. Almost a third of the agencies performed poorly in the areas of supply management, supervision of home visits, and quality monitoring and improvement mechanisms. Several suggestions for the development of home nursing services in Taiwan are made.
Cudahy High School Survey and Focus Groups: Assessment of the Needs of a Teen Population. A Community–Campus Collaboration
Authors: Doerr Bridget T. , Wantuch Carol
Published: March 2003

Collaboration between local public health agencies and university schools of nursing can be advantageous to both parties. Students need opportunities to learn aggregate‐based care; health officers need community partnerships that expand their potential to accomplish core functions. This article offers a case study to illustrate a collaborative relationship. A high school survey and a plan for teen services were the focus of the joint endeavor. With guidance from faculty, students offered labor and expertise; the agency offered a real world laboratory for learning.
Gender Differences for the Predictors of Depression in Young Adults with Genital Herpes
Authors: Dibble Suzanne L , Swanson Janice M
Published: March 2003

Genital herpes is a chronic, stigmatizing, sexually transmitted disease (STD), which is increasing despite efforts to control its spread. Depression is commonly reported among people diagnosed with genital herpes and differences in depression by gender have been reported. Therefore, the purpose of this study was to identify gender differences in the predictors of depression in young adults with genital herpes by secondary analyses of baseline data from a randomized clinical trial (RCT). For the RCT, young adults (193 females, 59 males) with genital herpes were recruited from newspaper advertisements. Participants completed questionnaires measuring illness burden, attitudes toward herpes, stress symptoms, mood states, depression, self‐concealment, self‐disclosure, substance use, and demographics. Univariate analyses and multiple regression techniques were used to identify variables predictive of depression in this sample. In women, increased anger, decreased vigor, increased confusion, a negative attitude toward herpes, self‐concealment, and stress symptoms from genital herpes predicted more depression (R2= 0.63). In men, increased depression was predicted by increased anger, a negative attitude toward herpes, and a decreased willingness to share personal information with a stranger (R2= 0.51). Findings suggest that future psychoeducational interventions should address anger as a predictor of depression in this population. Gender‐specific interventions need to be developed in order to assist young adults who are living with genital herpes.
Community Development Through Faculty Practice in a Rural Nurse‐Managed Clinic
Authors: Krothe Joyce Splann , Flynn Beverly , Ray Dixie , Goodwin Sheilia
Published: March 2003

This article describes a community‐academic partnership that led to the development of a nurse‐managed clinic (NMC) in 1996 in a rural Indiana area designated by the state as a medically underserved area (MUA) and a health professional shortage area (HPSA). Application of the community development model in faculty practice is described in relation to the clinic. The project is ongoing; lessons learned to date, which have implications for others involved in faculty practice, are described.
Street Music or the Blues? The Lived Experience and Social Environment of Depression
Authors: Poslusny Susan M
Published: March 2003

Life's complexity is a haunting melody of continuously interacting variables … Professional practice in nursing seeks to promote symphonic interaction between man [sic] and environment … (
Rogers, 1970, pp. 41, 122). The purpose of this phenomenological study was to explore the lived experience of clinical depression for women in the context of their social relations and environment. Twelve ethnically diverse female friend dyads were interviewed and completed the Beck Depression Inventory (BDI). Seventeen of these women had experienced a major depression in the past or were in treatment for clinical depression at the time of the study. This depression was characterized by dissonance experienced in childhood abuse and incest, uncontrollable moods despite self‐medication, abusive or negligent therapy, failed social relationships in adulthood, and a lack of resources in the environment. In contrast, seven healthy women described their social environment as generally resonant and connected. Prevention of childhood abuse and racism, relief from economic hardships, early diagnosis, and safe, effective treatment are essential in helping women to survive clinical depression. Nurses in the community are in a unique position to affect this public health problem.
Health‐Promoting Behaviors of Elderly Korean Immigrants in the United States
Authors: Sohng Kyeong‐Yae , Sohng Sue , Yeom Hye‐A
Published: March 2003

The purpose of this study was to explore health‐promoting behaviors among elderly Korean immigrants, and to examine the relationships of their health‐promoting behaviors with self‐efficacy and perceived health status. One hundred ten elderly Korean immigrants residing in the United States were interviewed using a structured questionnaire. The mean score of health promoting behaviors of elderly Korean immigrants was 2.54 on the 5‐point Likert scale. Nutrition was the subdomain with the highest mean score (M=3.01) and exercise was the subdomain with the lowest mean score (M=1.92). Both self‐efficacy (r=0.49, p=0.01) and perceived health status (r=0.19, p=0.043) were significantly related to health‐promoting behaviors. Education (F=3.61, p=0.016) and economic status (F=3.01, p=0.034) were significantly associated with health‐promoting behaviors. This study showed poor practices of healthy lifestyles of elderly Korean immigrants. Low exercise scores indicated the need for community based exercise and health promotion programs for the elderly Korean immigrants population.
Psoriasis Associated with Human Immunodeficiency Virus in an Infant
Authors: McAleer Patricia , Chu Paul , White Soren M. , Don Philip C. , Bamji Mahrukh , Weinberg Jeffrey M.
Published: March 2003

Psoriasis is commonly reported in association with HIV in adults. A 3‐month‐old girl with HIV presented with a widespread eruption and was diagnosed with psoriasis. This is the first infant reported with psoriasis in association with HIV infection. The relationship between the two entities is discussed, as is the role of treatment with zidovudine.
Adverse Reaction to Prednisone in a Patient with Systemic Lupus Erythematosus
Authors: Lew D. Betty , Higgins Gloria C. , Skinner Robert B. , Snider Mark D. , Myers Linda K.
Published: March 2003

Oral corticosteroids are the main therapeutic choice for systemic lupus erythematosus (SLE). Adverse reactions to systemic corticosteroids rarely occur and the etiology is unclear in most cases. A 14‐year‐old girl with newly diagnosed SLE developed a pruritic bullous eruption while on prednisone. The patient had been treated successfully in the hospital with intravenous methylprednisolone. In preparation for discharge, the steroid preparation was changed to prednisone to which the patient reacted with a development of new crops of bullous lesions. Skin biopsy specimens of lesional areas showed a bullous eruption consistent with erythema multiforme. The patient underwent immediate and delayed hypersensitivity tests. Intradermal and patch tests to liquid prednisone were positive. The patient was discharged on oral methylprednisolone and has not had recurrence of the skin lesions. In conclusion, a case of prednisone sensitivity in a patient with SLE is presented here. An alternative preparation, methylprednisolone, was used to successfully treat her underlying condition.
The New Moms Project: Educating Mothers About Sun Protection in Newborn Nurseries
Authors: Geller Alan C. , Sayers Linda , Koh Howard K. , Miller Donald R. , Steinberg Benjes Lori , Crosier Wood Martha
Published: March 2003

Sun protection habits should begin early in life and be taught as part of routine preventive health care. Early teaching of parents aims to introduce an easily achieved means of sun protection with the goal of instilling these practices as habits in the parents and their young children. We developed a maternity nurse‐led intervention for 187 mothers at newborn nurseries in Falmouth, Massachusetts, combining educational material and personal discussions. One year after the intervention we successfully contacted 73% of the mothers. Nearly 90% recalled the informational program and equal numbers stated that receiving educational materials in the newborn nursery was timely. Nearly two‐thirds of mothers reported that this was the only sun protection information received from a provider in the past year.
A Sporadic Case of Congenital Hypotrichosis Simplex of the Scalp: Difficulties in Diagnosis and Classification
Authors: Cambiaghi Stefano , Barbareschi Mauro
Published: March 2003

Abstract: Hereditary hypotrichosis simplex of the scalp is a genotrichosis characterized by a hair defect limited to the scalp in the absence of other ectodermal or systemic abnormalities. Only large pedigrees consistent with autosomal dominant transmission have been described to date. In this article the clinical and scanning electron microscopy findings of a nonfamilial case of congenital scalp hypotrichosis simplex are reported. In some patients the diagnosis of sporadic hypotrichosis simplex of the scalp should be considered after ruling out all other possible causes of congenital and hereditary hypotrichosis.
Depilation in a 6‐Month‐Old with Hypertrichosis: A Case Report
Authors: Wendelin Daniel S. , Mallory George B. , Mallory Susan B.
Published: March 2003

Abstract: Hypertrichosis in the pediatric age group can be troubling to both patients and parents. There is no well‐established method for managing this problem in young children. We describe the successful use of a cream depilatory agent for removal of excess hair from the face and body of a 6‐month‐old girl. Excellent cosmetic results were obtained. The risks and benefits of the use of depilatory cream in young patients are analyzed. Other options for hair removal in children are also reviewed.
Angiokeratomas in Juvenile Dermatomyositis
Authors: Shannon Patrick L. , Ford Michael J.
Published: March 2003

Abstract: Juvenile dermatomyositis (JDM) is an uncommon disease that features muscle weakness, a characteristic rash, and vascular changes in skin, muscle, and other organs. We report a patient with JDM who developed multiple angiokeratomas, one of which was calcified. Electron microscopy of an angiokeratoma revealed altered connective tissue consistent with abnormal collagen. To our knowledge, angiokeratomas occurring in association with JDM have not been previously reported. Abnormal collagen distinguishes the angiokeratomas in our patient from those seen in other conditions. We propose that the angiokeratomas resulted from a progressive compensatory response to the obliterative angiopathy of JDM.
Evidence that AEC Syndrome and Bowen–Armstrong Syndrome Are Variable Expressions of the Same Disease
Authors: Zenteno  , Venegas  , Kofman‐Alfaro
Published: March 2003

Several clinical disorders combine ectodermal dysplasia (ED) and cleft lip and/or palate (CL/P). These conditions have been recognized as a group of diseases with a narrow phenotypic spectrum and multiple points of overlap. We report a patient with a clinical diagnosis of AEC syndrome (ankyloblepharon, ectodermal defects, and CL/P) who additionally has some features observed in a different ED‐CL/P disorder, Bowen–Armstrong syndrome. Because of this clinical overlap, we suggest that AEC syndrome and Bowen–Armstrong syndrome may be variable manifestations of the same pathologic entity.
Changes in Diapered and Nondiapered Infant Skin Over the First Month of Life
Authors: Visscher Marty O. , Chatterjee Ranjit , Munson Karen A. , Pickens William L. , Hoath Steven B.
Published: March 2003

Abstract: Time‐ and site‐dependent differences in epidermal barrier properties were investigated over the first 28 days of life in healthy term newborn infants. Diapered and nondiapered skin sites were contrasted to the volar forearm of adults (mothers). Thirty‐one term infants were evaluated in the hospital on postnatal day 1 and at home on days 4, 7, 14, 21, and 28 for a total of six visits. Measurements included baseline skin hydration, continuous capacitive reactance, peak water sorption, rate of water desorption, skin pH, skin temperature, and environmental conditions. Changes in epidermal barrier properties over the first 4 weeks of life included an increase in surface hydration, a decrease in transepidermal water movement under occlusion, a decrease in surface water desorption rate, and a decrease in surface pH. Diapered and nondiapered regions were indistinguishable at birth but exhibited differential behavior over the first 14 days, with the diapered region showing a higher pH and increased hydration. Maternal measurements remained constant throughout the period. We conclude that healthy newborn skin undergoes progressive changes in epidermal barrier properties over the first 28 days. Adult skin testing does not replicate newborn skin during the first month of life.
Coexistence of Disseminated Superficial Porokeratosis in Childhood with Congenital Linear Porokeratosis
Authors: Suh Dae Hun , Lee Hyoun Seung , Kim Sang Duck , Cho Kwang Hyun , Kim Kyu Han , Park Kyoung Chan
Published: March 2003

Abstract: Porokeratosis is a genodermatosis characterized by abnormal epidermal keratinization with the histologic finding of cornoid lamella. To date, five clinical variants have been identified. However, the coexistence of these variants in a single patient has been described only rarely. We report a 5‐year‐old girl with the simultaneous occurrence of porokeratotic lesions in linear and disseminated patterns. Linear lesions were detected at birth and the disseminated lesions developed at the age of 3 years. Histologically the lesions had cornoid lamella, which is typical of this condition.
Toxic Epidermal Necrolysis After the Use of High‐Dose Cytosine Arabinoside
Authors: Özkan Alp , Apak Hilmi , Celkan Tiraje , Yüksel Lebriz , Yildiz Inci
Published: March 2003

Abstract: We report a fatal case of toxic epidermal necrolysis (TEN) resulting from a high dose of cytosine arabinoside (ARA‐C). A 13‐year‐old girl with acute lymphocytic leukemia was treated according to the protocol of the BFM Group (BFM‐95, HRG). On the fifth day after administration of a high dose of ARA‐C (2 g/m2 intravenously every 12 hours), she developed bullous lesions on the hands and soles that disseminated, evolving to necrosis, sepsis, and death on the 22nd day. ARA‐C is frequently associated with dermatologic toxicity, but this is only the second case of toxic epidermal necrolysis described in connection with this drug.
The Successful Treatment of Diffuse Neonatal Hemangiomatosis with Flashlamp Pulsed Dye Laser
Authors: Endo Hideki , Kawada Akira , Aragane Yoshinori , Yamashita Yuji , Isogai Rieko , Yudate Tatsuo , Tezuka Tadashi
Published: March 2003

Abstract: Diffuse neonatal hemangiomatosis is a rare disease with the distinctive features of multiple hemangiomas of the skin and visceral organs. These lesions have been treated with systemic corticosteroids, interferon‐α, and their combination. We report a patient with diffuse neonatal hemangiomatosis who had multiple cutaneous and hepatic hemangiomas. Single therapy with the flashlamp pulsed dye laser was effective for cutaneous hemangiomas, whereas the hemangiomas of the liver remained stable and no liver dysfunction or hemorrhage has occurred so far, even with no treatment.
Pigmented Purpuric Eruptions of Childhood: A Series of Cases and Review of Literature
Authors: Tristani‐Firouzi Payam , Meadows Kappa P. , Vanderhooft Sheryll
Published: March 2003

Pigmented purpuric eruptions comprise a group of benign dermatoses that are characterized clinically by pinpoint petechiae and purpura on a hyperpigmented base and histologically by capillaritis. The etiology of this group of disorders is unknown, although aberrant cell‐mediated immunity has been proposed. Pigmented purpuric eruptions are well characterized in the pediatric population. In this case series we present three children with these disorders and review the clinical subtypes of pigmented purpuric eruptions that have been described in the literature.
Self‐Healing Generalized Infantile Myofibromatosis with Elevated Urinary bFGF
Authors: Léauté‐Labrèze C , Labarthe M P , Blanc J F , Sanyas P , Dosquet C , Taïeb A
Published: March 2003

We report a case of generalized infantile myofibromatosis with favorable outcome despite systemic involvement. Elevated urinary bFGF levels during the active phase of the disease suggested an angiogenic stimulation in the pathogenesis of myofibromatosis.
Isolation of Drug‐Resistant Tubercle Bacilli in Cutaneous Tuberculosis
Authors: Ramesh V. , Murlidhar Sumathi , Kumar Joginder , Srivastava Lakshmi
Published: March 2003

Cutaneous tuberculosis in a teenage boy that did not respond to conventional antitubercular therapy is described. Mycobacterium tuberculosis was recovered on culture and found to be resistant to rifampicin and isoniazid. Gradual regression of the lesions was observed after the addition of streptomycin and ethambutol. Later streptomycin was stopped and the boy was advised to continue ethambutol along with ofloxacin and thioacetazone until complete regression was achieved.
Rothmund‐Thomson Syndrome (Thomson‐Type) and Myelodysplasia
Authors: Pianigiani Elisa , De Aloe Giovambattista , Andreassi Andrea , Rubegni Pietro , Fimiani Michele
Published: March 2003

Rothmund–Thomson syndrome (RTS) is a genetic disease characterized by developmental abnormalities and poikilodermatous skin changes that appear in infancy. An association with myelodysplastic syndromes is rarely reported in RTS, even though impairment of immune function and recurrent infections are described in the literature. A case of Thomson‐type RTS in a 14‐year‐old girl with trilinear myelodysplasia is presented. The patient was kept under hematologic surveillance for myelodysplastic syndrome. Bone marrow transplantation was considered unnecessary at present.
High‐Magnification Videodermatoscopy: A New Noninvasive Diagnostic Tool for Scabies in Children
Authors: Lacarrubba Francesco , Musumeci Maria Letizia , Caltabiano Rosario , Impallomeni Raffaello , West Dennis P. , Micali Giuseppe
Published: March 2003

A study of 100 children suspected of having scabies was carried out using high‐magnification (HM) videodermatoscopy as the only diagnostic tool. HM videodermatoscopy reaches magnifications of up to 600× and allows a detailed inspection of the skin. Rapid and clear identification of mites, migration burrows, eggs, and feces was obtained in 62 of 100 patients. None of the 38 patients with negative findings showed any sign of infestation 2 weeks later. HM videodermatoscopy is rapid, effective, and sensitive, especially in those cases with nonspecific clinical features, and allows clear detection of diagnostic details usually not appreciable at lower magnifications. It has high specificity, with no chance of false‐positive results, and being noninvasive, it eliminates the risk of accidental infections. Finally, the most important advantage in children is its high compliance rate, as it does not cause pain or physical or psychological discomfort. It may be used for primary diagnosis as well as for posttherapeutic follow‐up and for screening of family members, thus reducing the risk of persistence and diffusion of the infestation.
Rothmund–Thomson Syndrome in Three Siblings and Development of Cutaneous Squamous Cell Carcinoma
Authors: Piquero‐Casals Jaime , Okubo Alexandre Y. , Nico Marcello Menta S
Published: March 2003

Abstract: Rothmund–Thomson syndrome (RTS) is a rare autosomal recessive genodermatosis. It is characterized by early onset of progressive poikiloderma and several other cutaneous and extracutaneous findings including alopecia, dystrophic teeth and nails, juvenile cataracts, short stature, hypogonadism, and bone defects. There are several reported cases of skin malignancies in RTS patients, indicating a possibly higher incidence of cutaneous and noncutaneous malignancies. We report three siblings with RTS who developed cutaneous squamous cell carcinoma (SCC).
Sulfur for Scabies Outbreaks in Orphanages
Authors: Pruksachatkunakorn Chulabhorn , Damrongsak Maliwan , Sinthupuan Sombat
Published: March 2003

Abstract:  Scabies outbreaks occurred in two large orphanages in Chiang Mai, Thailand. Since we were concerned about the availability, safety, and cost of scabicides in Thailand, sulfur in petrolatum was our choice for mass treatment of the children. We studied the efficacy of sulfur in children 2 months to 6 years of age. After the treatment, 47% and 71% of the 102 patients were cured in 2 weeks and 4 weeks, respectively. Only three preschool children developed a mild facial irritation after the first application. This agent is a safe and cheap choice for mass therapy.
Thyroid Function, Autoantibodies, and HLA Tissue Typing in Children with Alopecia Areata
Authors: Nanda Arti , Alsaleh Qasem A. , Al‐Hasawi Fowzia , Al‐Muzairai Ibrahim
Published: March 2003

Abstract: A total of 80 Kuwaiti children with alopecia areata (AA), without clinical evidence of thyroid disease, were screened for the presence of thyroid abnormalities, and 50 unrelated children with AA were tissue typed for human leukocyte antigen (HLA) class I and class II antigens. Thyroid abnormalities were detected in 14 children (17.5%). Among these, 11 children (14%) had thyroid autoantibodies. These observations highlight the significance of screening for thyroid abnormalities in children with chronic, recurrent, and/or extensive disease. The Kuwaiti children with AA were observed to have a significant association with HLA B21 (OR 18.850, 95% CI 4.404–80.677), B40 (OR 6.767, 95% CI 1.818–25.181), and HLA B12 (OR 4.833, 95% CI 1.198–19.505) antigens. These findings differed from those reported elsewhere.
Acitretin for Erythrokeratodermia Variabilis in a 9‐Year‐Old Girl
Authors: Graham‐Brown Robin A. C. , Chave Toby A.
Published: March 2003

Abstract: Erythrokeratodermia variabilis (EKV) is a rare genodermatosis with a unique phenotype. Treatment with oral synthetic retinoids is well documented in adults, but not in children. We report a 9‐year‐old girl with EKV who cleared rapidly following treatment with oral acitretin.
Skin Cancer Prevention Counseling and Clinical Practices of Pediatricians
Authors: Gritz Ellen R. , Tripp Mary K. , De Moor Carl A. , Eicher Susan A. , Mueller Nancy H. , Spedale Jeanne H.
Published: March 2003

Abstract: Little is known about pediatricians' counseling and clinical practices to reduce skin cancer risk among their patients. Thus our objectives were to characterize skin cancer preventive counseling and clinical practices in a sample of pediatricians and identify correlates of these practices. Physicians practicing general pediatrics in Harris County, Texas, received a mail survey that assessed their sun protection recommendations and skin cancer preventive counseling and clinical practices. Pediatrician, patient, and medical practice variables were assessed as correlates. Most (76%) pediatricians routinely recommended sunscreen; however, relatively few (24%) suggested reapplying it after prolonged periods outside. About half routinely recommended protective clothing (53%), shade (47%), or limiting midday sun exposure (46%). Even fewer pediatricians routinely discussed skin cancer risk factors, passed out sunscreen samples, made educational materials available, took a family history of skin cancer, or documented risk factors in a patient's chart. More than half reported that they routinely performed full‐body skin examinations during a first visit (65%) and annually (56%). Perceived barriers, perceived relevance of skin cancer prevention, and personal sun protection practices were important factors associated with professional practices in this sample. Interventions are needed to increase pediatricians' counseling and clinical practices to reduce skin cancer risk among patients.
Treatment of Aregeneratoric Anemia Following an ABO‐Incompatible Allogeneic Peripheral Blood Stem Cell Transplantation: A Case Report
Authors: Üstün Celalettin , Çelebi Harika , Arat Mutlu , Özcan Muhit , Dilek İmdat , Gürman Günhan , Demirer Taner , İlhan Osman , Keskin Remzi , Koç Haluk
Published: March 2003

Aregeneratoric anemia (AA) occurs rarely after ABO‐incompatible allogeneic peripheral blood stem cell transplantation (alloPBSCT), and its management is generally difficult. Here, we present a 31‐year‐old white man with myelodysplastic syndrome who developed AA after receiving stem cells from his human leukocyte antigen (HLA) identical, but ABO‐incompatible sibling. Because his anti‐A antibody titers were high, therapy with conventional doses of erythropoietin and prednisolone failed to treat the AA. Following 8 cycles of plasma exchange and higher doses of erythropoetin and prednisolone as well as danazol administration, anti‐A titers decreased, and his anemia improved significantly. In conclusion, to treat and obtain a low titer of antibodies in a patient with AA following an ABO‐incompatible alloPBSCT, higher doses of erythopoietin and corticosteroids associated with plasma exchange have to be used.
Critical Care Apheresis: Hepatic Failure
Authors: Wiles
Published: March 2003

Hepatic failure is a common feature of critical care. Most hepatic dysfunction in the ICU responds to medical management and metabolic support. The role of extracorporeal organ support in hepatic failure is not as well defined as it is in renal failure and pulmonary failure. Nevertheless, artificial organ support has been successful in the treatment of advanced liver failure. Hybrid bioartificial liver substitutes show great promise, especially as a bridge to liver transplant.
Preliminary Evaluation Study of a Prototype Hollow Fiber Membrane for the Continuous Membrane Autotransfusion System
Authors: Fukunaga Ken , Shimoyama Takashi , Sueoka Akinori , Nosé Yukihiko
Published: March 2003

A totally new autotransfusion system has been developed utilizing a hollow fiber membrane, based upon plasmapheresis technology. Prior to fabricating the system, it was essential to evaluate the basic performance characteristics of the filter, which was designed particularly for the new system. The objective of this study was to prove or disprove that such a system would be available using this filter. An in vitro study was conducted on the filter using bovine blood. The result of the study showed that the filter could process 2–20% of hematocrit blood at a flow rate greater than 250 ml/min of inlet blood continuously. Moreover, it could concentrate 5–20% hematocrit blood to hematocrit percentages greater than 40% by a single passage through the filter. These results seemed to prove that a rapid, continuous, and compact autotransfusion system could be developed using this filter.
Thrombotic Thrombocytopenic Purpura in a Patient with Rheumatoid Arthritis Treated by Plasmapheresis
Authors: Baz Elizabeth M. Kfoury , Mahfouz Rami A.R. , Masri Abdel Fattah M.
Published: March 2003

Abstract: Thrombotic thrombocytopenic purpura (TTP) is a multisystem disorder characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia, and neurologic symptoms. TTP is associated with many diseases and several therapeutic drugs. We report the rare case of a patient with rheumatoid arthritis who developed TTP that was not associated with drug therapy, 18 months after the onset of rheumatoid arthritis. She recovered from the TTP following daily sessions of therapeutic plasma exchange (TPE) with fresh frozen plasma replacement and glucocorticoid therapy. Recent pathogenic mechanisms are reviewed as they relate to von Willebrand factor. In this report of the rare association of TTP with rheumatoid arthritis, an immediate relationship is likely because both are of an immune nature. Awareness of the possible development of TTP in rheumatoid arthritis is important for early diagnosis and treatment.
Membrane Plasma Separation
Authors: Malchesky P.S. , Sueoka A. , Matsubara S. , Wojcicki J. , Nosé Y.
Published: March 2003

Guest Editor's Introduction: This paper was presented at the first plasmapheresis symposium organized by ISAO and the International Center for Artificial Organs and Transplantation on April 3, 1982, Cleveland, Ohio. This paper was printed in the proceedings of this symposium, Plasmapheresis: Therapeutic Applications and New Techniques, edited by Y Nosé and PS Malchesky, JW Smith, and RS Krakauer, Raven Press, New York, 1983, p. 81–92. This paper describes the basic concept of membrane plasma separation. Consideration necessary for the usage of membrane plasma separators are also specifically described. The importance of transmembrane pressures and their maintenance for the lowest possible levels is stressed for the effective hemolysis‐free membrane plasma separation.
A Simplified Centrifuge for the Separation and Processing of Blood Cells
Authors: Tullis James L. , Tinch Robert J. , Gibson John , Baudanza Phyllis
Published: March 2003

Guest Editor's Introduction: The practical use of the Cohn ADL Centrifuge was hindered by its cost and complexity. Therefore, Tullis, worked with Arthur D. Little, Inc. and one of its engineers, Allan Latham, to modify the Cohn centrifuge for use as a blood processor. Latham designed a disposable plastic bowl with a smaller face seal. Since fluids enter and leave from the top of this assembly, the bowl could be driven by standard blood bank centrifuges. The modified bowl, which became known as the Latham bowl, was used for washing and deglycerolizing previously frozen red cells. However, it eventually became apparent that the Latham bowl could be used to separate blood components from whole blood. This paper reprinted here with permission was printed in Transfusion vol. 7, page 232–242 (1967), and describes the basic designs of the Latham bowl.