bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peroxisomes in Dermatology. Part II
Authors: Smith Kathleen J. , Dipreta Edward , Skelton Henry 
Published: July 2017

Background: Peroxisomes are small cellular organelles that were almost ignored for years because they were believed to play only a minor role in cellular functions. However, it is now known that peroxisomes play an important role in regulating cellular proliferation and differentiation as well as in the modulation of inflammatory mediators. In addition, peroxisomes have broad effects on the metabolism of lipids, hormones, and xenobiotics. Through their effects on lipid metabolism, peroxisomes also affect cellular membranes and adipocyte formation, as well as insulin sensitivity, and peroxisomes play a role in aging and tumorigenesis through their effects on oxidative stress. Objective: To review genetically determined peroxisomal disorders, especially those that particularly affect the skin, and some recent information on the specific genetic defects that lead to some of these disorders. In addition, we present some of the emerging knowledge of peroxisomal proliferator activator receptors (PPARs) and how ligands for these receptors modulate different peroxisomal functions. We also present information on how the discovery of PPARs, and the broad and diverse group of ligands that activate these members of the superfamily of nuclear binding transcription factors, has led to development of new drugs that modulate the function of peroxisomes. Conclusion: PPAR expression and ligand modulation within the skin have shown potential uses for these ligands in a number of inflammatory cutaneous disorders, including acne vulgaris, cutaneous disorders with barrier dysfunction, cutaneous effects of aging, and poor wound healing associated with altered signal transduction, as well as for side effects induced by the metabolic dysregulation of other drugs.
Epidermolysis Bullosa Acquisita Responsive to Dapsone Therapy
Authors: Hughes Amy P. , Callen Jeffrey P. 
Published: July 2017

Background: Epidermolysis bullosa acquisita (EBA) is a chronic subepidermal blistering disease that is frequently resistant to therapy. Objective: A 58-year-old man who had a one-year history of a bullous eruption involving the hands, forearms, trunk, scalp, and oral mucosa. Histopathology revealed a subepidermal bulla, and direct and indirect immunofluorescence studies were consistent with EBA. The patient failed respond to niacinamide and tetracycline and oral prednisone 40 mg per day. Methods: Complete control of his blistering was achieved within two months of initiating oral dapsone, 150 mg per day. Conclusion: Dapsone may be an effective agent for some patients with EBA.
An Unusual Case of Cutaneous Pancreatic Fat Necrosis
Authors: Agarwal Smita , Nelson Jennell E. , Stevens Seth R. , Gilliam Anita C. 
Published: July 2017

Background: Cutaneous pancreatic fat necrosis is a pathognomonic sign for pancreatic disease and usually presents as subcutaneous nodules in the pretibial region. Objective: A case of cutaneous pancreatic fat necrosis is presented in which the clinical presentation of diffuse erythema was unusual. This disease is discussed and its possible etiologies are reviewed. Methods: A MEDLINE search for cases of cutaneous pancreatic fat necrosis presenting as diffuse erythema without nodules was conducted. Results: Diffuse erythema is an unusual presentation of cutaneous pancreatic fat necrosis. Conclusion: This may be the first case of cutaneous pancreatic fat necrosis presenting as diffuse erythema.
Extragenital Bowenoid Papulosis Associated with Atypical Human Papillomavirus Genotypes
Authors: Papadopoulos Anthony J. , Schwartz Robert A. , Lefkowitz Aza , Tinkle Lily L. , Jänniger Camila K. , Lambert W. Clark 
Published: July 2017

Background: Bowenoid papulosis typically appears as grouped violaceous or red-brown papules in the genital or perianal regions and clinically resembles condylomata acuminata. Isolated extragenital bowenoid papulosis is rare and has been reported in only a few case reports. Objectives: A 51-year-old immunocompetent, healthy woman had two solitary papules on the elbow; a 41-year-old HIV-positive man had a solitary cutaneous plaque on the abdomen. No genital, periungual, or other extragenital sites of involvement were noted in either patient. The diagnosis was confirmed histologically in both cases. Lesional skin from the female patient was tested with the Digenehybrid HPV DNA assay and was positive for a mixture of low-risk HPV subtypes (6, 11, 42, 43, 44). Lesional skin from the male patient was tested with polymerase chain reaction (PCR). Consensus primers targeted for the HPV L1 region, which is a highly conserved sequence common to more than 20 HPV subtypes encoding a viral capsid protein, were used. PCR using the consensus primers was positive, but type-specific probes for HPV types 6, 11, 16, 18, 45, 31, 33, 35, and 39 were negative. Conclusions: To our knowledge, our male patient represents the first case of isolated bowenoid papulosis of the abdominal skin. Isolated upper-extremity bowenoid papulosis in our female patient is also a unique case in both location and involvement of low-risk HPV types (6, 11, 42, 43, 44), which have not been previously associated with extragenital bowenoid papulosis.
The Majority of Cutaneous Squamous Cell Carcinomas Arise in Actinic Keratoses
Authors: Czarnecki D. , Meehan C. J. , Bruce F. , Culjak G. 
Published: July 2017

Background: Retrospective studies have given conflicting results with respect to how many cutaneous squamous cell carcinomas (SCCs) arise in actinic keratoses (AK). Objective: This study was conducted to determine what percentage of SCCs arise in AKs and to obtain more information about two histological features of SCCs, namely, thickness and ulceration. Methods: A prospective study was done of all SCCs treated by the authors during one calendar year. Results: Two hundred eight patients with SCC were entered into the study. An AK was contiguous with an SCC in 72% of the cases. This was taken as evidence that the SCC arose in the AK. Men presented with thicker and more ulcerated SCCs than women, but these were not statistically significant: p = 0.06 for thickness and p = 0.07 for ulceration. Ulcerated SCCs were more likely to arise on the head and neck (p = 0.02), on patients who had multiple skin cancers ( p = 0.005), and on patients who had a family history of skin cancer ( p = 0.03). Conclusion: Actinic keratoses need to be removed before they turn into SCCs. The prognostic significance of ulceration of cutaneous SCCs needs to be determined.
The Use of Diphenylcyclopropenone in the Treatment of Recalcitrant Warts
Authors: Upitis Jennifer A. , Krol Alfons 
Published: July 2017

Background: The treatment of recalcitrant palmoplantar and periungual warts using topical immunotherapy with diphenylcyclopropenone (DPC) was reviewed retrospectively over a seven-year period. Methods: Two hundred eleven patients were sensitized during this time. The patients consisted of 90 males and 121 females and were between 5 and 78 years old. Twenty-three patients were lost to followup. Of the remaining, 4 were undergoing treatment at the time of evaluation, 1 patient failed sensitization, and 1 patient became pregnant. Four discontinued because of side effects, 3 because of financial reasons, and 18 patients discontinued treatment prior to completing the minimum required applications (defined as 6), producing a dropout rate of 12% (25/211). Three patients had additional treatment during the course of DPC and were not included in the study. The remaining 154 patients were classified as nonresponders or responders. Results: The responders consisted of 135 individuals (87.7%) that had complete clearance of warts. Reported adverse effects were local and included with pruritus (15.6%), with blistering (7.1%), and with eczematous reactions (14.2%). The majority of the patients tolerated the treatment very well. One patient developed local impetigo. Patients had an average of 5 treatments over a 6-month period. Conclusions: Topical immunotherapy using DPC is an effective treatment option for recalcitrant warts. It should be considered as first-line treatment for warts based on its high response rate, absence of scarring, and painless application.
Coma Blisters, Peripheral Neuropathy, and Amitriptyline Overdose: A Brief Report
Authors: Maguiness Sheilagh , Guenther Lyn , Shum David 
Published: July 2017

Background: Coma blisters are most commonly associated with barbiturate and benzodiazepine overdose; however, they have also been described in association with many other substances, including amitriptyline. Objective: To review the literature on the clinical manifestations of coma blisters in the setting of amitriptyline overdose. Methods: Case report and literature review. Results: Coma blisters in association with amitriptyline overdose have rarely been documented in the literature. Of the few reported cases, peripheral neuropathy has been present two (including our case report) out of four times. Conclusion: Amitriptyline is known to impair endothelial cell tight junction integrity. Thus, individuals with amitriptyline overdose may be predisposed to microvascular damage during the compression imposed from a comatose state. This may help to explain the tendency for patients to present with the interesting triad of coma, blisters, and neuropathy.
Histopathologic Features Seen with Radiation Recall or Enhancement Eruptions
Authors: Smith Kathleen J. , Germain Marguerite , Skelton Henry 
Published: July 2017

Background: Although a radiation recall or enhancement eruption has been associated with a number of chemotherapeutic drugs, the histologic features have rarely been described. Objective: Our goal was to define the histologic features of radiation recall and enhancement eruptions in order to better understand their pathogenesis. Methods: We present ten patients on chemotherapeutic agents who developed erythematous maculopapular to psoriasiform eruptions often with associated follicular pustules. These eruptions occurred at the sites of prior or concurrent radiation therapy. Results: The most common class of drugs inducing these reactions were antibiotic chemotherapeutic agents alone or in combination with other chemotherapeutic drugs. In addition to routine histology, in four patients immunohistochemical staining for p53 was performed at the sites of the eruptions after resolution and at noninvolved sites matched for ultraviolet radiation (UVR) exposure. Histologic features in patients receiving concurrent radiation therapy included epidermal dysplasia, keratinocytes showing features of necrosis, increased mitotic figures, and a mixed inflammatory infiltrate. At sites of prior radiation therapy, the biopsy specimens showed a similar spectrum of epidermal changes and, in some cases, psoriasiform dermatitis with clearing within cells in the upper layers of the epidermis. Additional dermal changes included dermal fibrosis, vasodilatation, and atypical fibroblasts. Moderate to marked solar elastosis was seen in the majority of biopsy specimens. Immunohistochemical studies after resolution showed only a modest increase in p53 staining in epidermal keratinocytes in 3 of 4 sites of recall and enhancement eruptions after resolution of the reactions compared to skin that was matched for similar UVR exposure. Conclusion: Cumulative direct DNA damage and oxidative stress are probably important in radiation recall and enhancement eruptions, and these changes may be modulated by underlying nutritional deficits. Cumulative p53 mutations may play some role but are probably not a major factor in these eruptions. Mitochondrial dysfunction, which is known to occur with prior and concurrent radiation and chemotherapy, may be important in these eruptions. In addition to improvements in general nutrition, topical or oral antioxidant therapy may be a potential therapy to avoid radiation enhancement and recall reactions.
Facial Lipoatrophy following Systemic Lupus Erythematosus
Authors: Dupéré Audrey , Poulin Yves 
Published: July 2017

Background: Acquired partial lipodystrophy is a rare disorder. An association with systemic lupus erythematosus has been reported. In these cases, an immunologic basis is suggested by the presence of C3 nephritic factor and hypocomplementemia. Objective: The following report presents the case of a woman who developed a rapid loss of facial subcutaneous fat a few months after complete spontaneous resolution of cutaneous lesions of lupus. Conclusion: Absence of C3NeF in this case suggests that other immunological factors may be involved in the pathogenesis.
Insights into the Passive Partitioning of Amino Acids and Codeine into Human Hair
Authors: Krueger Gerald G. , Pitcher Carla , Liimatta Andrew P. , Knapp Todd L. , Miller Kenneth J. , Wilkins Diana G. , Rollins Douglas E. 
Published: July 2017

Background: Cells that form hair are among the body's most rapidly dividing cells, with each daughter cell becoming part of the hair shaft as it differentiates and lengthens. It follows that hair might contain concentrations of xenobiotics (environmental chemicals, therapeutic drugs, illicit substances, etc.) reflective of the concentration in blood at the time of division and onset of differentiation of cells that give rise to hair. Objective: This study was designed to gain insight into the passive incorporation of xenobiotics into hair. Methods: This study focused on the parameters of the passive partitioning of three agents, two water-soluble amino acids (cysteine and glutamine) and codeine into hair. Undamaged black hair from various ethnic groups was incubated in solutions containing the three agents as a function of time and concentration. Hair was washed extensively; time and dose to steady state as well as partitioning coefficients were determined for each agent. Codeine washing with a pH gradient also was carried out. Results: Data show that the partitioning coefficient of the agents is linear but not stoichiometric. At low doses passive partitioning into hair is efficient, a 1 minute exposure leading to significant retention. Washing extensively with deionized water, the fluid used for passive partitioning of the test agent, will not reversibly extract all of the agent, regardless of race. Conclusion: Hair can effectively absorb and retain agents of the environment, and this retention occurs via mechanisms other than those inherent to an ion exchange column.
Basal Cell Carcinoma of the Periocular Region
Authors: Arlette John P. , Carruthers Alastair , Threlfall William J. , Warshawski Laurence M. 
Published: July 2017

Background: Basal cell carcinomas of the periocular area present a particular challenge because of the likelihood of damage to vital structures. Objective: More than 10-years experience of treating basal cell carcinomas by Mohs micrographic surgery was reviewed. Methods: Chart analysis of 233 periocular basal cell carcinomas was performed. All patients were contacted either in clinical follow-up or by telephone review. Results: Two hundred and thirty-three periocular basal cell carcinomas were analyzed out of a total of 3,192 basal cell carcinomas treated during this period (7.3%). Patients ranged in age from 17 to 102 years with a mean age of 58.8 years and a median of 59.0 years. Of the patients, 54.5% were female. Mohs micrographic surgery was the prime therapy in 177 patients (75.9%). Of the lesions, 48.5% occurred in the medial canthal area, 35.2% on the lower eyelid, 10.7% on the upper eyelid, and 5.6% on the lateral canthus. There was no significant difference between the left/right distribution in males and females. The average follow-up time was 34 months (standard deviation 26.38 months). A cumulative rate of no recurrence tabulated by modified life table analysis was 0.9864. Conclusion: This study further documents the problems associated with basal cell carcinoma of the periocular area as well as the value of Mohs micrographic surgery as treatment.
How Do Physicians React to New Knowledge: The Experience of Jonathan Hutchinson 1828–1913 with Comments on its Relevance Today
Authors: Jackson Robert 
Published: July 2017

Background: In the late 20th century, physicians are being challenged to absorb new knowledge at an ever-increasing pace. Objective: This article will review the acquisition of new knowledge by Sir Jonathan Hutchinson, a prominent Victorian surgeon in the 19th century. At that time, new knowledge was presented much more slowly. How well Hutchinson absorbed new knowledge will be outlined and, in the light of his background and training, what events were there that either helped or hindered this process. Conclusion: Assuming good physical and mental health, age and basic training are often important in how physicians react to new knowledge; the timing of the release of new knowledge also plays a role. Training in the basic attributes of scientific medicine as well as continuing medical education will help in the processing of new knowledge. One common response by physicians to the increasing load of new information is the narrowing of the individual's field of expertise.
Phytodermatitis
Authors: Sasseville Denis 
Published: July 2017

Background: Most dermatologists can recognize the classic patterns of presentation of plant contact dermatitis; however, few can recognize the offending plants or know the name and chemical structure of the allergens or irritants that they contain. Objective: Five basic clinical patterns of phytodermatitis are reviewed: 1) allergic phytodermatitis, 2) photophytodermatitis, 3) irritant contact dermatitis, 4) pharmacologic injury, and 5) mechanical injury. The plants responsible for each pattern are presented by families, according to current scientific taxonomy. The chemical structure of the offending substances is described, and principles of investigation, prevention, and treatment are outlined. Conclusions: Plant contact dermatitis remains an extremely vast and complex topic. Exotic plants and woods are now present in our gardens and homes. The newfound interest in aromatherapy, phytotherapy, and so-called “natural” therapies is the cause of a tremendous increase in exposure to plant products and extracts. This is responsible for the appearance of atypical patterns of plant contact dermatitis with which the practising dermatologist must become familiar.
Genomic analysis of 220 CTCLs identifies a novel recurrent gain-of-function alteration in RLTPR (p.Q575E)
Authors: Park Joonhee , Yang Jingyi , Wenzel Alexander T. , Ramachandran Akshaya , Lee Wung J. , Daniels Jay C. , Kim Juhyun , Martinez-Escala Estela , Amankulor Nduka , Pro Barbara , Guitart Joan , Mendillo Marc L. , Savas Jeffrey N. , Boggon Titus J. , Choi Jaehyuk 
Published: July 2017

Key Points
Genomic analysis of 220 CTCLs identifies 55 genes in lymphomagenesis, including 17 genes not previously implicated in CTCL. RLTPR (p.Q575E) is a novel gain-of-function mutation that potentiates T-cell receptor signaling via selective upregulation of the NF-κB pathway.
Techniques and Behaviors Associated with Exemplary Inpatient General Medicine Teaching: An Exploratory Qualitative Study
Authors: Houchens Nathan , Harrod Molly , Moody Stephanie , Fowler Karen E. , Saint Sanjay 
Published: July 2017

BACKGROUNDClinician educators face numerous obstacles to their joint mission of facilitating high‐quality learning while also delivering patient‐centered care. Such challenges necessitate increased attention to the work of exemplary clinician educators, their respective teaching approaches, and the experiences of their learners.OBJECTIVETo describe techniques and behaviors utilized by clinician educators to facilitate excellent teaching during inpatient general medicine rounds.DESIGNAn exploratory qualitative study of inpatient teaching conducted from 2014 to 2015.SETTINGInpatient general medicine wards in 11 US hospitals, including university‐affiliated hospitals and Veterans Affairs medical centers.PARTICIPANTSParticipants included 12 exemplary clinician educators, 57 of their current learners, and 26 of their former learners.MEASUREMENTSIn‐depth, semi‐structured interviews of exemplary clinician educators, focus group discussions with their current and former learners, and direct observations of clinical teaching during inpatient rounds.RESULTSInterview data, focus group data, and observational field notes were coded and categorized into broad, overlapping themes. Each theme elucidated a series of actions, behaviors, and approaches that exemplary clinician educators consistently demonstrated during inpatient rounds: (1) they fostered positive relationships with all team members by building rapport, which in turn created a safe learning environment; (2) they facilitated patient‐centered teaching points, modeled excellent clinical exam and communication techniques, and treated patients as partners in their care; and (3) they engaged in coaching and collaboration through facilitation of discussion, effective questioning strategies, and differentiation of learning among team members with varied experience levels.CONCLUSIONThis study identified consistent techniques and behaviors of excellent teaching during inpatient general medicine rounds.
Duplication of the Urinary Tract Occurring in One Family
Authors: Alatas Husein , Indiarto Soemarso , Alwi Usman 
Published: July 2017

Duplication of the urinary tract occurring in one family is reported. The penetration of this anomaly among them was not equal. The father had a bifid ureter on the right side. Among his children, one had right bifid pelvis and the other two bilateral double kidney. The smallest child had a non-functioning right upper kidney associated with an ureterocele causing trouble in micturition and recurrent infection. After surgical correction the symptoms disappeared.