bluuebunny/crossref_metadata_2025 huggingface dataset:
Shopping Center Wheelchair Accessibility: Ongoing Advocacy to Implement the Americans with Disabilities Act of 1990
Authors: McClain Linda
Published: March 2003

Although the regulations of the Americans with Disabilities Act (ADA) of 1990 were phased in by 1992, monitoring and enforcement continue to be problematic. This study of three large shopping centers in the Southwest included one mall that was opened in the mid‐1990s, and two malls that were constructed prior to the law (but have undergone recent renovations). Use of the ADA Accessibility Guidelines Checklist for Buildings and Facilities (
Architectural and Transportation Barriers Compliance Board [ATBCB], 1992) generated data which were analyzed descriptively to determine the frequency and percent compliance in: parking lots, entrances, ramps, elevators, telephones, restrooms, food courts, and 12 specific store‐types. No mall was fully compliant in any area, other than telephone specifications. In other areas, compliance ranged from 0% (ramp slopes in the newer mall) to many areas of 100% compliance (for example, outdoor curb ramps and food court seating spaces and aisles). The implications are that shoppers who are wheelchair mobile cannot count on complete compliance and cannot predict which physical architectural barriers they will find in shopping centers.
Missouri Rural Adolescent Pregnancy Project (MORAPP)
Authors: Anderson Norma E , Smiley Dolores V , Flick Louise H , Lewis Cecilia Y
Published: March 2003

The purpose of this study was to investigate the pregnancy outcomes and services available to adolescent women in Missouri, comparing rural and urban residents. A secondary analysis of a large public use data set obtained from the Missouri Department of Health was done for the 5‐year period 1992 to 1996. Data were collected by county, with each of the 114 counties of the state classified as rural or urban. The SAS program was used for analysis. Results demonstrated definite patterns of similarity and dissimilarity among the teen mothers based on residence, when age and race were controlled. There were over 54,000 births to adolescent mothers in the 5‐year study period. Among the outcomes of pregnancy studied were: abortion rates, inadequate weight gain, intrauterine growth retardation, and low‐birthweight (LBW) infants. Among the services available to the young mothers that were studied were fertility services, WIC (women, infants, and children supplemental nutrition) program, food stamps, and Medicaid coverage for pregnancy and infant care. The outcomes are probably generalizable to Midwestern, rural/urban states similar to Missouri.
The Art of Motivating Behavior Change: The Use of Motivational Interviewing to Promote Health
Authors: Shinitzky Harold E , Kub Joan
Published: March 2003

Health promotion and disease prevention have always been essential to public health nursing. With the changing health care system and an increased emphasis on cost‐containment, the role of the nurse is expanding even more into this arena. A challenge for public health nurses, then, is to motivate and facilitate health behavior change in working with individuals, families, and communities and designing programs based on theory. Leading causes of death continue to relate to health behaviors that require change. The purpose of this article is to integrate theory with practice by describing the Transtheoretical Model of Change as well as the principles of motivational interviewing that can be used in motivating behavioral change. A case scenario is presented to illustrate the use of the models with effective interviewing skills that can be used to enhance health. Implications for practice with an emphasis on providing an individually tailored matched intervention is stressed.
Living Arrangements and Health Status in Later Life: A Review of Recent Literature
Authors: Hays Judith C.
Published: March 2003

The living arrangements of older persons play a key role in their use of formal and informal care, as well as in their health and well‐being. Nurses engaged in primary care, discharge planning, and home care are strategically positioned to contribute to an optimal fit between older persons and their home environment. This article describes the demographic significance of late‐life living arrangements and proposes a model for organizing the complex web of factors associated with household composition and late‐life migration. The article then summarizes qualitative and quantitative evidence in support of the proposed model. Key areas for nursing research and strategies for applying available research are identified.
Factors Associated with Breast Self‐Examination Among Jordanian Women
Authors: Petro‐Nustus Wasileh , Mikhail Blanche I.
Published: March 2003

The purpose of this cross‐sectional, correlational, descriptive study was to investigate factors and beliefs that may be related to the practice of breast self‐examination (BSE) among a group of Jordanian women. The sample consisted of 519 women from two major universities in Jordan. About 36% of the sample were university employees and 64% were graduate and undergraduate students. Stratified random sampling was used to enroll the undergraduate students while graduate students and employees were selected by convenience sampling. The study instrument was an adapted version of Champion's Revised Health Belief Model Scale (CRHBMS). The results were analyzed using a chi‐square test and a stepwise multiple regression. The main findings indicate that although the majority of the sample population (67%) had heard/read about BSE, only a quarter of them reported that they had ever practiced BSE in the previous 12 months, and only 7% had performed it on a regular monthly basis. Confidence, motivation, susceptibility, and fewer barriers were variables that showed a positive association with BSE practice in the previous year, while benefits, susceptibility, and motivation influenced the intention to perform BSE in the future. Women's age, level of education, having heard or read about breast tumors, and personal history of breast tumors were also found to be significant predictors of BSE practice.
Cultural and Noncultural Predictors of Health Outcomes in Korean Daughter and Daughter‐in‐Law Caregivers
Authors: Kim Jin‐Sun , Lee Eun‐Hyun
Published: March 2003

Abstract  In Western cultures, adverse health effects resulting from providing care for impaired elders is well documented for family caregivers, but little is known about the health of Korean caregivers. This study examined the level of depression and physical health of 120 daughter and daughter‐in‐law caregivers who cared for cognitively or functionally impaired elderly in Korea. It was hypothesized that cultural factors would have a greater effect on caregivers' health outcomes than noncultural factors, but, contrary to this expectation, the effects of noncultural factors were found to outweigh those of cultural factors. Moreover, the caregivers in this study reported a relatively high level of depression, and more caregivers rated their own health as “poor” than did Western caregivers in previous studies.

Family caregiving for the impaired elderly is stressful and negatively affects Korean caregivers' health outcomes regardless of societal values such as filial piety and familism regarding parent care in Korea. Culturally acceptable and sensible support programs may be useful in sustaining long‐term care at home by Korean daughter and daughter‐in‐law caregivers. Further family caregiving studies in the Korean sociocultural context are recommended.
Childhood Immunobullous Disease Following a Second Organ Transplant
Authors: Morelli Joseph G. , Weston William L.
Published: March 2003

Immunobullous diseases are quite unusual in children. We report two children who developed immunobullous disease shortly after a second solid organ transplantation. One child had IgA pemphigus vegetans, the other bullous pemphigoid. We hypothesize that the repeat organ transplantation served as a “booster” immunization for autoantibody production. Both children developed their immunobullous condition while being treated with immunosuppressive drugs that are used to treat immunobullous disorders.
Treatment of Molluscum Contagiosum with Potassium Hydroxide: A Clinical Approach in 35 Children
Authors: Romiti Ricardo , Ribeiro Alessandra P. , Grinblat Beni M. , Rivitti Evandro A. , Romiti Ney
Published: March 2003

Potassium hydroxide (KOH) is a strong alkali that has long been known to digest proteins, lipids, and most other epithelial debris of skin scrapings to identify fungal infections. To our knowledge, KOH has never been used for the treatment of molluscum contagiosum (MC). We evaluated 35 children with MC for the clinical effectiveness of treatment with topical 10% KOH aqueous solution. The solution was applied by the parents of affected children, twice daily, on each MC lesion. The therapy was continued until all lesions underwent inflammation and superficial ulceration. Thirty‐two of 35 patients achieved complete clinical cure after a mean treatment period of 30 days. Three children discontinued treatment: two reported severe stinging of the lesions and refused further applications; the other, with giant MC lesions, developed a secondary infection with prolonged treatment. Therapy with KOH was found to be effective and safe in the treatment of MC in children.
Subcutaneous Fat Necrosis of the Newborn Associated with Anemia
Authors: Varan Birgül , Gürakan Berkan , Özbek Namik , Emir Suna
Published: March 2003

Abstract: Subcutaneous fat necrosis (SFN) of the newborn characteristically affects full‐term infants who have experienced perinatal distress, such as hypothermia, obstetric trauma, or asphyxia. We report a newborn who had pallor, deep breathing, and severe anemia immediately after birth. She developed SFN on the fourth postnatal day. Her condition improved after blood transfusions and the skin lesions resolved in 6 weeks. This appears to be the first report of SFN associated with anemia.
Factitial Cheilitis in an Adolescent
Authors: Calobrisi Stella D. , Baselga Eulalia , Miller Elizabeth Shinall , Esterly Nancy B.
Published: March 2003

A 14‐year‐old adolescent girl presented with a 2‐year history of an exquisitely tender, vegetating cheilitis. Because of this, she was unable to drink fluids and was repeatedly hospitalized for dehydration and pain management. Lip and skin biopsies, as well as multiple laboratory studies did not support a definitive diagnosis. After 2 years, a diagnosis of factitial cheilitis was finally established.
Simultaneous Onset of Alopecia Areata and Idiopathic Thrombocytopenic Purpura: A Potential Association?
Authors: Levin Robin M. , Travis Susan F. , Heymann Warren R.
Published: March 2003

Alopecia areata (AA) has been associated with a variety of autoimmune diseases. Immune thrombocytopenic purpura (ITP) is an autoimmune disease marked by isolated thrombocytopenia. We present a young girl with the simultaneous onset of AA and ITP. To the best of our knowledge, this association has not previously been reported. We hypothesize that ITP may be one of many autoimmune diseases associated with AA via antibodies that cross‐react between platelet membrane glycoproteins and follicular glycoproteins.
The Effects of Amoxicillin Therapy on Skin Flora in Infants
Authors: Brook Itzhak
Published: March 2003

Abstract: In order to determine the effect of amoxicillin therapy on the perineal skin microbial flora in infants, we took quantitative bacterial and fungal cultures of perineal and sternal areas from 25 infants treated with amoxicillin (40 mg/kg/day) for 10 days. Specimens were obtained prior to therapy, within 3 days of conclusion of therapy, and 14–16 days later. Immediately following therapy, a decline in the number of bacterial isolates occurred on both the perineum (89 to 47) and sternum (84 to 39). The greatest decline occurred in the number of anaerobic bacteria (mostly Peptostreptococcus spp. and Propionibacterium acnes). Other organisms that were less often isolated were aerobic streptococci and Staphylococcus epidermidis. The number of Candida albicans isolates increased from 3 to 11 (p < 0.05) on the perineum, and 1 to 7 (p < 0.025) on the sternum. Four of the infants developed diaper dermatitis. The density of C. albicans increased more than 14‐fold following amoxicillin therapy. Cultures done 14–16 days after cessation of therapy revealed an increase in the number of bacterial isolates on the perineum (47 to 72) and on the sternum (39 to 61) and a decline in recovery of C. albicans. This study demonstrates the effects of amoxicillin on the ecology of skin microbial flora in infants—a decrease in the number of bacterial isolates and an increase in recovery of C. albicans.
Disseminated BCG Infection Following Bone Marrow Transplantation for X‐Linked Severe Combined Immunodeficiency
Authors: McKenzie Rowena H. S. B. , Roux Paul
Published: March 2003

Abstract: An 8‐month‐old boy with X‐linked severe combined immunodeficiency (XSCID) developed disseminated bacille Calmette‐Guerin (BCG) infection following BCG vaccination at birth. He initially presented with an abscess at the site of BCG vaccination and was begun on three‐drug antituberculous treatment (rifampicin, isoniazid, and pyrazinimide). Dissemination was subclinical prior to a human leukocyte antigen (HLA)‐identical bone marrow transplant (BMT) from his sister, following which he presented with an acute erythroderma. A skin biopsy specimen revealed granulomas with epithelial histiocytes and giant cells in the reticular dermis, and numerous acid‐fast bacilli (AFB) were present on Ziehl–Nielsen stain. A diagnosis of disseminated BCG disease was made. Despite the addition of a fourth antituberculous agent, ethambutol, he did not recover and developed numerous skin abscesses over the following weeks. Examination of pus from these lesions demonstrated numerous AFB. Clarithromycin was added as a fifth antituberculous agent. Despite five‐drug antituberculous therapy and monthly intravenous immunoglobulin infusions, recurrent abscesses containing AFB developed intermittently until 7 months posttransplant. At follow‐up 1 year post‐BMT he showed good general physical improvement. All abscesses had healed with scarring, and no further skin lesions had occurred.
AEC Syndrome and CHAND Syndrome: Further Evidence of Clinical Overlapping in the Ectodermal Dysplasias
Authors: Bertola D. R. , Kim C. A. , Sugayama S. M. M. , Albano L. M. J. , Utagawa C. Y. , Gonzalez C. H.
Published: March 2003

Abstract: Among the ectodermal dysplasias, there are several examples of overlapping phenotypes in disorders that are considered distinct. We report a 5‐year‐old boy born to nonconsanguineous parents and presenting with ectodermal dysplasia, ankyloblepharon filiforme adnatum, and bilateral choanal atresia consistent with the diagnosis of AEC syndrome. We compare the findings in our patient with the previous reported cases and discuss the overlapping phenotype of this disorder with CHAND syndrome.
Macrodactyly: Report of Eight Cases and Review of the Literature
Authors: Krengel S. , Fustes‐Morales A. , Carrasco D. , Vázquez M. , Durán‐McKinster C. , Ruiz‐Maldonado R.
Published: March 2003

Abstract: Congenital enlargement of one or several digits of the hands or feet (macrodactyly) is a rare disorder. A considerable proportion of the patients with this condition are referred to dermatology departments. The majority of the cases reported in the literature represent hamartomas with combined hypertrophy of several, predominantly lipomatous, soft tissue components and overgrowth of bone. The differential diagnosis includes Klippel–Trenaunay–Weber syndrome, neurofibromatosis, Milroy disease, and Proteus syndrome. We describe eight cases of congenital macrodactyly, discuss the findings, and propose a simple clinicopathologic terminology.
Rubinstein–Taybi Syndrome with Epidermal Nevus: A Case Report
Authors: Schepis Carmelo , Greco Donatella , Siragusa Maddalena , Batolo Dario , Romano Corrado
Published: March 2003

Abstract: We describe an 8‐year‐old boy with Rubinstein–Taybi syndrome, a multiple congenital anomaly/mental retardation syndrome characterized by broad thumbs and great toes, peculiar facies, and mental retardation caused by mutations in the transcriptional coactivator CREB binding protein (CBP). He had on his right side yellowish papular lesions organized in narrow bands according to Blaschko lines, later confirmed by histology as an epidermal nevus. Epidermal nevus syndrome has been ruled out because the patient failed to meet the criteria for inclusion under this designation. This association may be coincidental.
Urticating Hashimoto–Pritzker Langerhans Cell Histiocytosis
Authors: Butler David F. , Ranatunge Bandula D. , Rapini Ronald P.
Published: March 2003

Abstract: Red‐brown papules developing during the neonatal period may present a diagnostic dilemma. The Darier sign has been a reliable feature in the diagnosis of mastocytosis. However, the cutaneous infiltrate of Hashimoto–Pritzker Langerhans cell histiocytosis (LCH) may contain a large number of mast cells, leading to confusion both clinically and histologically. We report an infant who developed red‐brown papules of Hashimoto–Pritzker LCH during the neonatal period and presented with a positive Darier sign and acute urticaria.
Cutis Marmorata Telangiectatica Congenita: Laser Doppler Fluxmetry Evidence for a Functional Nervous Defect
Authors: Bormann Gisela , Wohlrab Johannes , Fischer Matthias , Marsch Wolfgang Christian
Published: March 2003

Abstract: We report a 5‐month‐old infant with cutis marmorata telangiectatica congenita (CMTC) without associated abnormalities and unusual hemicorporal vascular markings. Laser Doppler fluxmetry of the involved skin, carried out for the first time, and the measurement of the transcutaneous partial pressure of oxygen indicate a functional disturbance, which may be the expression of an α‐adrenergic innervation deficit of the cutaneous terminal blood vessels.
Pyoderma Gangrenosum in Two Siblings: A Familial Predisposition
Authors: Khandpur Sujay , Mehta Surjit , Nagi Reddy Belum Siva
Published: March 2003

We report pyoderma gangrenosum in two siblings with onset during childhood and no associated systemic abnormalities. The patients were born of nonconsanguineous, healthy parents. Treatment with oral corticosteroids produced an excellent clinical response, followed by recurrence after cessation of therapy. Steroids were restarted in combination with dapsone to prevent further recurrence.
Scrofuloderma with Multiple Organ Involvement in a 5‐Year‐Old Child
Authors: Kaur Sukhjot , Thami Gurvinder P. , Kanwar Amrinder J. , Mohan Harsh
Published: March 2003

Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis seen in children in developing countries. We report a 5‐year‐old child with cutaneous tuberculosis with involvement of lymph nodes, lungs, and the musculoskeletal and central nervous systems, which was not clinically obvious. Antituberculous treatment led to marked clinical improvement. The importance of a thorough search for internal organ involvement in patients presenting with cutaneous tuberculosis is emphasized.
Acute Juvenile Pityriasis Rubra Pilaris: A Superantigen Mediated Disease?
Authors: Betlloch Isabel , Ramón Regina , Silvestre Juan‐Francisco , Carnero Lucía , Albares María‐Pilar , Bañuls José
Published: March 2003

Juvenile acute pityriasis rubra pilaris (JAPRP) is a form of pityriasis rubra pilaris (PRP) with particular clinical characteristics and course. It is usually preceded by an infectious condition. We report a boy, initially thought to have Kawasaki disease, and subsequently diagnosed as having JAPRP, who made a satisfactory recovery. In this case, prior antibiotic treatment made it impossible to show the presence of any microorganism. However, the clinical characteristics of these patients and the similarities with other disorders involving the skin that are mediated by superantigens led us to think that these antigens may be involved in the development of this disease. Also, in view of the obvious differences between JAPRP and the other PRP, we suggest that, in the future this disorder may be considered a separate entity as a reactive exanthem.
Multiple Agminated Spitz Nevi Arising on a Café Au Lait Macule: Review of the Literature with Contribution of Another Case
Authors: Böer A. , Wolter M. , Kneisel L. , Kaufmann R.
Published: March 2003

The majority of Spitz nevi are acquired solitary lesions. Multiple Spitz nevi are rare and may develop on hyperpigmented skin. We report a 16‐year‐old girl with multiple Spitz nevi arranged on a café au lait macule. Immunohistochemistry showed positivity for S‐100 and HMB‐45. Of interest, expression of Polo‐like kinase (PLK), a novel proliferation marker that recently proved to be positive in up to 98% of malignant melanoma cells, showed positivity in 40% of the nevus cells. The clinical development of multiple Spitz nevi is not yet clear, as they are preferentially excised. Reviewing 70 cases in the literature we found that multiple agminated Spitz nevi occur more frequently than reported previously. In about one‐third of these cases Spitz nevi arose on congenitally hyperpigmented skin.
Congenital Nevocytic Nevi: Follow‐Up of a Swedish Birth Register Sample Regarding Etiologic Factors, Discomfort, and Removal Rate
Authors: Berg Peter , Lindelöf Bernt
Published: March 2003

Abstract: Congenital nevi both small and large are frequently removed. We attempted to study the removal rate and etiologic aspects of congenital nevi as well as their psychosocial effects through the use of a quality test. A questionnaire sent to a sample population of individuals with congenital nevocytic nevi (n=192) collected from the Swedish Medical Birth Register (SMBR) was used as a test of the register's quality and for collecting information on rate of removal and etiologic factors. The quality test indicated that only 85.3% of the nevi listed in the SMBR were true congenital nevocytic nevi. Of all true congenital nevocytic nevi reported in the questionnaire, 39.8% had been removed and none of the rest had developed malignant melanoma. The median time for follow‐up was 14 years. The median age at removal of the nevi was 9.7 years. Eight percent of respondents believed that the skin lesion caused taunting and changed their social activities. No infection or illness during pregnancy was specifically related to the development of congenital nevi. In conclusion, the larger the nevi, the more frequently and earlier they are excised. With an excision rate of 40% of congenital nevocytic nevi, we found no malignant melanoma.
Dermatitis Herpetiformis: Should Direct Immunofluorescence Be the Only Diagnostic Criterion?
Authors: Sousa Lourdes , Bajanca Rui , Cabral José , Fiadeiro Teresa
Published: March 2003

Abstract: We describe a 7‐year‐old boy with dermatitis herpetiformis (DH) diagnosed on clinical and histologic evidence, negative direct immunofluorescence (DIF) findings for junctional IgA deposits in uninvolved skin, positive IgA endomysial and gliadin antibodies, and jejunal biopsy revealing a gluten‐sensitive enteropathy. Treatment with dapsone led to the disappearance of cutaneous lesions and pruritus within 48 hours. Demonstration of IgA immune deposits in the dermal papillae has been the only acceptable criterion for the diagnosis of dermatitis herpetiformis. However, considering several reports in the literature of DH with a negative DIF and our own case, we believe that in the absence of the characteristic DIF pattern, one needs the combination of clinical, histologic, and immunologic data to support the diagnosis of DH. We also discuss recent developments in the diagnosis of DH.
Stevens–Johnson Syndrome: A Diagnostic Challenge in the Absence of Skin Lesions
Authors: Vanfleteren Inge , Van Gysel Dirk , De Brandt Christiane
Published: March 2003

Abstract: We report a 14‐year‐old boy with Stevens–Johnson syndrome who presented with mucous membrane lesions but without skin lesions and discuss the differential diagnosis of oral mucous membrane lesions in childhood. Stevens–Johnson syndrome in children is most frequently caused by a Mycoplasma pneumoniae infection. The full clinical picture of Stevens–Johnson syndrome can be present before seroconversion of Mycoplasma antibodies is observed. One should keep in mind that one negative titer of Mycoplasma antibodies does not rule out M. pneumoniae infection.
A Case of Infantile Acne Due to Pityrosporum
Authors: Kang Sook‐Kyoung , Jee Min‐Sun , Choi Jee‐Ho , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung
Published: March 2003

Abstract: We report a case of infantile acne. The lesion on the forehead resembled infantile acne clinically, but histologically it contained yeasts of Pityrosporum. The lesion was treated with topical ketoconazole cream and improved. We suggest that Pityrosporum is associated with infantile acne.
Plasmapheresis and Paraproteinemia: Cryoprotein‐Induced Diseases, Monoclonal Gammopathy, Waldenström's Macroglobulinemia, Hyperviscosity Syndrome, Multiple Myeloma, Light Chain Disease, and Amyloidosis
Authors: Siami Ghodrat A. , Siami Flora S.
Published: March 2003

Therapeutic plasmapheresis has been in widespread use as either a primary or adjunctive therapy in the United States since the 1960s. There are several types of plasmapheresis procedures used to treat various diseases. Plasma exchange with a centrifugal plasma separator using replacement fluid such as human albumin solution is the most widely used method in the United States. Other forms of plasmapheresis include membrane plasma separation, membrane fractionation, cryofiltration apheresis, immunoadsorption, and chemical affinity column pheresis. Therapeutic plasmapheresis has been used for the treatment of paraproteinemia to remove harmful paraproteins. Paraproteinemia is a disease classification in which abnormal or large amounts of plasma proteins such as cryoproteins or immunoglobulins are produced. In most cases, plasmapheresis is used in combination with corticosteroids and immunosuppressive drugs to prevent production of abnormal proteins or to treat the underlying disease. Cryoprotein‐induced diseases, which include cryoglobulinemia, cryofibrinogenemia, and cold IgM antibody agglutinin with cryoglobulin properties, are a subclass of paraproteinemia. Other categories of paraproteinemia include monoclonal gammopathy, Waldenström's macroglobulinemia, hyperviscosity syndrome, multiple myeloma, light chain disease, and amyloidosis. Some of these diseases may be interrelated, and they may be associated with one another. In this review paper, we discuss the role of plasmapheresis in the specific classes of paraproteinemia in the United States, including our own experience.
New Artificial Liver Support System (Plasma Perfusion Detoxification) for Hepatic Coma
Authors: Yamazaki Z. , Fujimori Y. , Sanjo K. , Kojima Y. , Sugiura M. , Wada T. , Inoue N. , Sakai T. , Oda T. , Kominami N. , Fujisaki U. , Kataoka K.
Published: March 2003

Guest Editor's Introduction: This paper was originally presented by Z. Yamazaki at the first congress of the International Society for Artificial Organs on August 26, 1977. It was printed in Artificial Organs Vol. 2 (supp) 273–276, 1978, and reprinted here with permission. This is the first paper describing clinical application of a membrane plasma separator as a hepatic assist device. This plasma separator was a hollow fiber device developed by Asahi Medical, Inc., Japan. Mr. K. Kataoka, vice president of Asahi Medical, Inc. was responsible for the development of this plasma separator module. Dr. N. Inoue is the internist responsible for these patients. Thirteen patients with acute liver failure were treated by this apheresis system. Seven out of thirteen patients recovered; however, only three of them survived.
Background and Indications for Protein A‐Based Extracorporeal Immunoadsorption
Authors: Matic Goran , Bosch Thomas , Ramlow Wolfgang
Published: March 2003

Abstract: Protein A (SPA), a major cell wall component of Staphylococcus aureus, has occupied numerous investigators from its discovery in the late fifties. Its availability and avid binding to human immunoglobulins have led to extensive usage for diagnostic and research purposes. Today, SPA‐based extracorporeal immunoadsorption relies on two rather different systems, namely, SPA‐silica (Prosorba), and SPA‐Sepharose (Immunosorba). Both systems are approved by the Food and Drug Administration for the core indications of rheumatoid arthritis and idiopathic thrombocytopenic purpura (SPA‐silica) or hemophilia with inhibitors (SPA‐Sepharose). Off label indications include immune disorders with a conceivable connection between autoantibody titers and disease activity, like forms of glomerulonephritis, systemic lupus erythematodes, myasthenia, and the Guillain‐Barré syndrome as well as alloantibody formation in the context of e.g., transplantation. This review summarizes historical developments and important properties of SPA. Indications for extracorporeal therapy are discussed on the basis of available information and personal experience.
Plasmapheresis Affects T Helper Type‐1/T Helper Type‐2 Balance of Circulating Peripheral Lymphocytes
Authors: Goto Hirofumi , Matsuo Hidenori , Nakane Shunya , Izumoto Hajime , Fukudome Takayasu , Kambara Chiaki , Shibuya Noritoshi
Published: March 2003

Abstract: Plasmapheresis not only removes humoral factors, but may also modulate cellular immunity. We investigated whether plasmapheresis influenced T helper type‐1/T helper type‐2 (Th1/Th2) cytokine‐producing‐cell balance in 3 patients with neuroimmunological disease. The production of interferon‐γ (IFN‐γ), interleukin‐2 (IL‐2), and IL‐4 in the culture supernatant of peripheral blood mononuclear cells stimulated by anti‐CD3 and anti‐CD28 was assayed. In 2 of 3 patients, plasmapheresis (immunoadsorption or plasma exchange) reduced Th1/Th2 cytokine ratio. The results may suggest that plasmapheresis induces a shift of Th1/Th2 balance in peripheral blood.
Plasma Exchange for the Treatment of Human T‐Cell Lymphotropic Virus Type 1 Associated Myelopathy
Authors: Narukawa Nobuhiko , Shiizaki Kazuhiro , Kitabata Yukiko , Abe Takaya , Kobata Hirotsugu , Akizawa Tadao
Published: March 2003

Abstract: A 55‐year‐old man was admitted to our hospital because of myelopathy. He had a history of chronic renal failure due to polycystic kidney disease at the age of 39, being treated by hemodialysis for 9 years with several blood transfusions for the treatment of renal anemia. After cadaver renal transplantation at the age of 48, he discontinued hemodialysis. At 50 years of age, he had pulmonary tuberculosis and tuberculous arthritis of the left elbow joint. He has experienced difficulty in walking since he was 48 years old, with mild dysuria. Gait disturbance gradually aggravated after that, and urinary retention was observed. When he was 55 years old, being human T‐cell lymphotropic virus type‐1 (HTLV‐1)‐positive in the serum and cerebrospinal fluid, he was diagnosed as having HTLV‐1‐associated myelopathy (HAM). As active steroid therapy was unapplicable because of the history of pulmonary tuberculosis and immunosuppression for transplanted kidney, a series of plasma exchanges (PE) was performed with fresh frozen plasma as a replacement fluid. After PE, dyskinesia of the left leg and dysuria subjectively and objectively improved. These results suggest that PE seems to be one of the therapeutic tools for the treatment of HAM.
Cost‐Effectiveness of Prosorba Column Therapy for Rheumatoid Arthritis: A Framework for Analysis
Authors: Griffiths Robert I. , Slurzberg Jo Ellen F.
Published: March 2003

Abstract:Apheresis with the Prosorba column is safe and effective for treating refractory rheumatoid arthritis. It also is resource intensive. Economic evaluation of Prosorba column therapy could help promote efficient use of this technology. This article describes a framework and the data requirements for analyzing the cost‐effectiveness of Prosorba column therapy. Several factors are considered in developing the framework including the target patient population, treatment alternatives, and clinical, economic, and quality of life outcomes of alternative treatments. We propose decision modeling as the appropriate study design because it provides a flexible framework for combining and analyzing data from different sources including experimental and nonexperimental studies. The cost‐effectiveness of Prosorba column therapy will depend on the patient population in which it is used and the other treatment options still available to these patients. Offsets to the costs of providing Prosorba column therapy are likely to be largest in treatment‐refractory patients and when this therapy is compared to other expensive new agents such as etanercept.
Rheopheresis for Age‐Related Macular Degeneration: A Novel Indication for Therapeutic Apheresis in Ophthalmology
Authors: Klingel Reinhard , Fassbender Cordula , Fischer Ina , Hattenbach Lars , Gümbel Hermann , Pulido Jose , Koch Frank
Published: March 2003

Abstract: Age‐related macular degeneration (AMD) is the leading cause of visual impairment and blindness in the elderly. Successful therapy is not yet available for the majority of patients, especially not for patients with dry AMD. AMD at cellular and molecular levels is at least in part a microcirculatory disorder of the retina. Rheopheresis is a safe and effective modality of therapeutic apheresis to treat microcirculatory disorders and represents a novel treatment option for patients with dry AMD. Elimination of a defined spectrum of high molecular weight proteins from human plasma including pathophysiologically relevant risk factors for AMD such as fibrinogen, cholesterol, von Willebrand factor, and α2‐macroglobulin results in the reduction of blood and plasma viscosity as well as erythrocyte and thrombocyte aggregation. Pulses of lowering blood and plasma viscosity performed as a series of Rheopheresis treatments lead to rapid changes of blood flow, subsequently inducing sustained improvement of microcirculation and recovery of retinal function. Two controlled randomized clinical trials demonstrated the safety and efficacy of Rheopheresis for the treatment of AMD patients, especially for those with the dry form. Recently the interim analysis of the sham‐controlled, double blind, randomized multicenter Multicenter Investigation of Rheopheresis for AMD (MIRA‐I) trial confirmed these results. The framework of completed and still ongoing controlled clinical trials in combination with postcertification studies including the RheoNet registry represents a comprehensive quality management approach for this novel interdisciplinary therapy for AMD. The development and continuous update of guidelines for the precise indication of Rheopheresis for AMD follows the requirements of evidence‐based medicine.
Long‐Term Survivors with Artificial Liver Support in Fulminant Hepatic Failure
Authors: Nitta Masakazu , Hirasawa Hiroyuki , Oda Shigeto , Shiga Hidetoshi , Nakanishi Kazuya , Matsuda Kenichi , Nakamura Masataka , Yokohari Kennji , Hirano Takeshi , Hirayama Yoh , Moriguchi Takeshi , Watanabe Eizou
Published: March 2003

Abstract: Clinical ability of artificial liver support (ALS) has been improved greatly in recent years which has allowed us to encounter long‐term survivors with fulminant hepatic failure (FHF) whose liver function has been almost completely lost. This suggests that application of ALS in patients with FHF gains time while awaiting transplantation as well as time for functional recovery and regeneration of the liver graft following receipt of the graft with marginal function and/or size. Thus, ALS will contribute greatly to extending the indications for liver transplantation and increase the number of patients receiving and benefiting from this treatment. On the other hand, introduction of ALS prolongs the duration of intensive treatment which increases the risk of infection and increases medical costs. In addition, when to discontinue intensive treatment of patients whose level of consciousness is maintained only by ALS is controversial. Thus, further investigation will be needed to establish a consensus on indications for long‐term ALS in FHF.
Zooplankton Community Responses during Recovery from Acidification in Little Rock Lake, Wisconsin
Authors: Frost Thomas M. , Montz Pamela K. , Kratz Timothy K.
Published: March 2003

Follow‐up studies after whole‐ecosystem‐stress experiments can provide important insights into the recovery process itself and into basic ecosystem properties. We report here on zooplankton community recovery during the first 5 years following the experimental acidification of Little Rock Lake, Wisconsin, U.S.A. Acidity in the lake’s treatment basin returned quickly to near pre‐manipulation levels. Zooplankton population shifts, however, did not support our hypothesis that species that had increased in abundance with acidification would persist and resist the return of the pre‐manipulation community. The three species that had proliferated most dramatically under low pH conditions—Daphnia catawba, Tropocyclops extensus, and Keratella taurocephala, returned close to their originally low, pre‐acidification population levels during the early stages of acid recovery. Some species that had been reduced during low pH conditions, such as Diaptomus minutus and Daphnia dubia, did not recover to pre‐manipulation levels. Overall, the zooplankton community in the treatment basin exhibits little similarity to that in the reference basin, a condition quite different from that which had occurred prior to the imposition of acid stress.
Tracking Wetland Restoration: Do Mitigation Sites Follow Desired Trajectories?
Authors: Zedler Joy B. , Callaway John C.
Published: March 2003

Hypothetical models in the scientific literature suggest that ecosystem restoration and creation sites follow a smooth path of development (called a trajectory), rapidly matching natural reference sites (the target). Multi‐million‐dollar mitigation agreements have been based on the expectation that damages to habitat will be compensated within 5–10 years, and monitoring periods have been set accordingly. Our San Diego Bay study site, the Sweetwater Marsh National Wildlife Refuge, has one of the longest and most detailed records of habitat development at a mitigation site: data on soil organic matter, soil nitrogen, plant growth, and plant canopies for up to 10 years from a 12‐year‐old site. High interannual variation and lack of directional changes indicate little chance that targets will be reached in the near future. Other papers perpetuate the trajectory model, despite data that corroborate our findings. After reviewing “trajectory models” and presenting our comprehensive data for the first time, we suggest alternative management and mitigation policies.
Factors Affecting Revegetation of Carex lacustris and Carex stricta from Rhizomes
Authors: Yetka Leslie A. , Galatowitsch Susan M.
Published: March 2003

The revegetation of sedge meadows has been problematic because natural recolonization does not occur under many circumstances and because planted propagules often fail to reestablish successfully. In this study, detached rhizomes of Carex lacustris Willd. and Carex stricta Lam. were transplanted in both fall (September) and spring (May) into three experimental wetlands to determine the effects of both planting season and hydrology on survival and establishment. Each experimental wetland had the same mean water depth across 5% slopes, but one had a constant water depth (0.5 m) throughout the growing season, another fell from a mean depth of 0.75 m to 0.25 m, and a third rose from a mean depth of 0.25 m to 0.75 m. Initial rhizome survival, shoot growth, and soil characteristics were recorded over 2 years. Neither planting proved successful (6.9% versus 0.5%) for C. stricta, a tussock‐forming sedge. For C. lacustris, a sedge with spreading rhizomes, spring planting had greater rhizome survival (53.2% survival) than fall planting (0.7%). Since both species initiate new shoots in the fall, they are susceptible to transplant failure during this season. The highest survival rates (71–100%) and plant production (736.0 and 494.5 g/m2) for C. lacustris occurred near the water’s edge in both the constant and falling basins. In the rising basin, establishment and growth of this species was high at all water depths (71–96%; 399 g/m2). C. lacustris grew optimally at the same elevations where rhizome survival was greatest, suggesting that shoots are more sensitive to early‐season than late‐season water levels.
Nurse Plants, Mycorrhizae, and Plant Establishment in a Disturbed Area of the Sonoran Desert
Authors: Carrillo‐Garcia Á. , De La Luz J.‐L. León , Bashan Y. , Bethlenfalvay G. J.
Published: March 2003

Arbuscular‐mycorrhizal (AM) fungi stabilize the soil and enhance plant growth by alleviating nutrient and drought stress. Their contributions to agriculture are well known, but their role in desert ecosystems has received less attention. The AM status of perennial plants in disturbed and undisturbed plots were investigated in the Sonoran Desert near La Paz, Baja California Sur, Mexico to determine if AM fungi contribute to resource‐island stability and plant establishment. All perennial plants (46 species) in the study plots were AM, but root colonization varied widely (<10 to> 70%). Roots of plants that established in greatest numbers in plant‐free zones (colonizers) of disturbed areas were highly AM. Plants with trace (<10%) root colonization (cacti of the tribe Pachycereae: Pachycereus pringlei,Machaerocereus gummosus, andLemaireocereus thurberi;andAgave datilyo) established preferentially in association with nurse trees. The pachycereid cacti grew underProsopis articulataandA. datilyounderOlneya tesotacanopies. Of the nine species of trees and arborescent shrubs in the area, the mature (>20 yr) nurse‐legumesP. articulataandO. tesotasupported the largest number of under‐story plants. Younger plants had only occasional associates. AM propagule densities in plant‐free areas were lower than under plant canopies (40 vs. 280 propagules/kg soil). Occurrence of soil mounds (islands) under plants owing to soil deposition was related to the nature of the canopies and to the AM status of the roots. Island soils were enmeshed with AM‐fungal hyphae, especially in the upper layer (approximately 10 cm). Seedlings ofP. pringlei, growing in a screenhouse for six months in soil collected underP. articulata, had a biomass ten times greater than plants growing in bare‐area soil. The results are consistent with the proposition that AM fungi contributed to the plant‐soil system of our study area by: (1) helping to stabilize windborne soil that settles under dense plant canopies; (2) enhancing the establishment of colonizer plants in bare soils of disturbed areas; and (3) influencing plant associations through differences in the mycotrophic status of the associates.
Translocation of Herb‐Rich Grassland from a Site in Wales Prior to Opencast Coal Extraction
Authors: Good J. E. G. , Wallace H. L. , Stevens P. A. , Radford G. L.
Published: March 2003

Reinstatement of vegetation to a similar condition to that prior to disturbance is often required in industrial restoration schemes. Seeding with specially prepared seed mixes containing species suited to local soils is often the preferred option on grounds of practicality and cost. Turf translocation is more difficult and costly but, if successful, meets the reinstatement requirement more precisely. In a pilot study at a proposed opencast coal site in Wales, we compared the effectiveness of whole‐turf translocation of herb‐rich mesic grassland communities, with a less technically demanding and more cost‐effective technique involving spreading turf over twice the area at the receiver site and rotovating it into the underlying soil. The translocated whole turf and rotovated turf plots were cut annually and the vegetation removed to simulate grazing that had occurred prior to translocation. Both the whole‐turf and rotovated turf transplant techniques gave successful re‐establishment of 50% or more of the species originally present. After three years, the cover and species composition were similar in “whole‐turf” and “spread and rotovated” plots. This suggests that the “spread and rotovate” technique provides a satisfactory ecological alternative to whole‐turf translocation. However, plant communities changed, in some cases substantially, after translocation using either technique. Altered soil hydrology and nutrition combined with the substitution of cutting for grazing are probably the main causes of these changes.
Recovery of Bird Species in Minimally Restored Indonesian Tin Strip Mines
Authors: Passell Howard D.
Published: March 2003

Bird species richness and individual abundances were recorded in old, unrestored tin strip mine plots, in mined plots restored 1, 2, and 3 years before the study, and in adjacent, unmined, natural secondary forest plots on the 11,340‐km2Indonesian island of Bangka (2°S, 106°E). The objective was to assess the ecological recovery of unrestored and minimally restored mine plots compared with surrounding reference forest. Unrestored mines had not been mined or used for any other purpose for 14–30 years; plots in their first, second, and third year since restoration were old mines planted withAcacia mangium(Leguminosae) at a density of 400 trees/ha. Natural secondary forest plots 20 or more years since the last disturbance were immediately adjacent to both unrestored and restored plots. Bird surveys on 4‐ha plots were performed during the 1995 breeding season. A comparison of data from unrestored plots of widely varying ages showed no significant differences among them for species richness, diversity (Shannon–Wiener index, H′), or individual abundance, indicating that little natural bird community recovery had occurred over time in the plots. However, increases did occur in restored sites over only 3 years for both species richness (r 2=0.29, p=0.04) and diversity (r 2=0.45, p=0.009). All values for third‐year restored plots, however, were still significantly lower than corresponding values for adjacent natural secondary forest plots. The quick return of bird activity on the plots after minimal efforts at restoration supports the idea that simple, inexpensive restoration can be effective for “jump starting” degraded systems at large scales. Such a restoration strategy might be of particular value for degraded land in developing nations, where scientific, professional, and financial resources might be in short supply. Using this strategy, a small number of restoration professionals could mobilize the labor of many local people in many areas, serving to both improve ecological systems and to educate and engage local populations in restoration and conservation projects.