bluuebunny/crossref_metadata_2025_split huggingface dataset:
Eosinophilic fasciitis: demographics, disease pattern and response to treatment: report of 12 cases and review of the literature
Authors: Bischoff Lindsay , Derk Chris T. 
Published: August 2010

AbstractBackground  Eosinophilic fasciitis is a rare scleroderma‐like illness. The clinical spectrum of the disease has evolved since its initial description.Methods  We identified all patients diagnosed with eosinophilic fasciitis over the past 10 years at our scleroderma clinic. Demographics, disease pattern, serologies, tissue pathology and reponse to treatment were all recorded.Results  Twelve patients with eosinophilic fasciitis were identified in our clinic over the past 10 years. The mean age at diagnosis was 49.8 ± 9.8 years, with nine female and three male patients. The first symptoms were noticed at an average of 8.8 ± 6.1 months before diagnosis. The mean initial absolute peripheral blood eosinophil count was 1188 ± 1059 cells/L. Two patients had a monoclonal gammopathy, and two had positive ANA titers. All patients received corticosteroids, 10 of whom received the equivalent dose of > 20 mg/day of prednisone for more than a month. Five patients received hydroxychloroquine, two received methotrexate, one received cyclosporine, one received topical tacrolimus, and one received sulfasalazine. At a mean follow up of 17.6 months (range 2–94 months), 8 patients had a good response to treatment, 2 patients had no effect, and 2 patients had a poor response to treatment.Conclusion  High dose corticosteroid treatment lasting longer than a month with or without an immunosuppressive agent helped most patients with eosinophilic fasciitis, best results seen in those patients who were initiated treatment early on after their first symptoms.
Xanthoma disseminatum in a black African woman
Authors: Yusuf Shehu M. , Mijinyawa Mohammed S. , Musa Baba M. , Mohammed Aminu Z. 
Published: August 2010

AbstractPurpose  To report a partial steroid response of xanthoma disseminatum in a black African woman.Design  Case report and literature review.Methods  Histopathologic study of cutaneous tumour and clinical follow‐up.Results  A 32‐year‐old black African woman with mucocutaneous xanthomatosis and dysphonia, which partially responded to treatment with steroids.Conclusions  Xanthoma dissseminatum is a rare condition for which there is no medical treatment. We reported the condition in a black African woman whose skin and CNS symptoms regressed remarkably within 22 weeks of steroid therapy.
Nail changes in pemphigus vulgaris
Authors: Habibi Mohammadali , Mortazavi Hossein , Shadianloo Shervin , Balighi Kamran , Ghodsi S. Zahra , Daneshpazhooh Maryam , Valikhani Mahin , Ghassabian Akhgar , Pooli Aydin H. , Chams‐Davatchi Cheyda 
Published: August 2010

AbstractBackground  The frequency and types of nail changes in pemphigus vulgaris (PV) are unclear.Aim  To determine the frequency and types of nail changes, and their correlation with the number of skin and periungual bullae.Methods  Seventy‐nine patients with PV, including 59 new patients and 20 patients in relapse, were entered into the study. Microscopic examination in potassium hydroxide and culture for fungus were performed on all clinically abnormal nails.Results  Twenty‐five (31.6%) of 79 patients showed nail changes, with paronychia (n = 8) and onychomadesis (n = 6) being the most common. One patient in relapse had onychomycosis. The frequency of nail changes in fingers affected by periungual bullae was significantly higher than in other fingers (P < 0.05). The number of nail changes was higher in patients with a larger number of skin bullae and in those with a longer duration of disease (P < 0.05).Conclusions  Nail changes in PV are common and related to the number of skin bullae and the presence of periungual bullae.
Effect of γδ T cell supernatant on human skin fibroblast proliferation and collagen production – Possible role of transforming growth factor‐β and basic fibroblast growth factor
Authors: Ohtsuka Tsutomu 
Published: August 2010

AbstractBackground  Perivascular mononuclear cell infiltration, vascular injury and diffuse interstitial fibrosis has been shown in systemic sclerosis (SSc).Objective  To study a role of cellular immune mechanism inducing fibroblast proliferation and collagen synthesis.Methods  The interaction of γδ T‐cell receptor bearing lymphocyte supernatant to human fibroblast proliferation and collagen synthesis was studied.Results  The fibroblasts added with γδ T cell supernatant showed increased proliferation compared with those without it and that added with αβ supernatant. The endothelial cells added with γδ T cell supernatants, however, showed significantly decreased proliferation compared with those without it and that added with αβ T cell supernatant. The fibroblasts added with endothelial cell supernatant showed increased proliferation compared with those without it. A doubling of collagen synthesis was observed when human skin fibroblasts were maintained in all of the supernatant. The collagen synthesis was inhibited by antitransforming growth factor‐β antibody and antibasic fibroblast growth factor antibody.Conclusion  γδ T–cell‐receptor bearing lymphocyte has proliferative and collagen synthesis activity to human skin fibroblasts, but suppressive to endothelial cells.
Mucocutaneous features of Chikungunya fever: a study from an outbreak in West Bengal, India
Authors: Bandyopadhyay Debabrata , Ghosh Sudip Kumar 
Published: August 2010

AbstractBackground  Chikungunya fever (CF) epidemic has recently re‐emerged in India on a large scale affecting many parts of the country. We have reviewed the mucocutaneous manifestations of the disease in a number of cases.Methods  Twenty six serologically proven cases of CF with rash from the district of 24‐Paraganas (North) in the eastern Indian state of West Bengal were subjected to detailed clinical study to investigate the chronology and evolution of mucocutaneous lesions, the type and distribution of the rash, and systemic changes.Result  Most patients were in their 3rd and 4th decade (23% each). Males and females were equally affected. Most patients developed the rash concomitantly with the onset or during the febrile illness, but 5 (19.2%) developed rash after defervescence. Most (57.7%) patients developed rash within the first 2 days of fever. The upper limb was the most common site of first appearance of lesions. Morbilliform eruption was the most common type of lesion noted, followed by scaling, macular erythema, intertrigo, hypermelanosis, xerosis, excoriated papules, urticaria and petechial spots. Cutaneous lesions were generally asymptomatic but 5 (19.2%) patients had intense pruritus. Mucosal lesions were found in 4 (15.4%) patients. Moderate to marked joint involvement was universal.Conclusion  CF exanthem may have varying morphology. Since the disease is spreading widely in different parts of the world, it should be considered in the differential diagnosis of any acute febrile arthropathy with rash.
An increased body mass index is no risk factor for postoperative nausea and vomiting
Authors: Kranke P. , Apfel C. C. , Papenfuss T. , Rauch S. , Löbmann U. , Rübsam B. , Greim C.‐A. , Roewer N. 
Published: August 2010

Background: An increased Body Mass Index (BMI) is almost always mentioned as a fundamental risk factor for postoperative nausea (PN), vomiting (PV) or both (PONV). However, multivariate analyses were unable to detect any correlation. Therefore, we asked whether an increased BMI is really a risk factor for PONV.Methods: For the systematic review, a search of electronic databases and a detailed manual search of reviews were carried out. For the analysis of the original data, 587 adult patients from a randomised controlled antiemetic trial (RCT) who underwent general anaesthesia were allocated to four weight groups: Underweight (BMI<20), Normal Weight (BMI 20–25), Overweight (BMI 25–30) and Obesity (BMI≥30).Results: Four publications with original data were found. Two described a positive relationship, although not clearly supported by the data. Despite this, most narrative reviews claimed a positive correlation between obesity and PONV by quoting again narrative reviews or misquoting originals. In the RCT, the calculated underlying risk profile for PONV was comparable between all groups. Incidences (95% confidence intervals) of PONV were 45.8% (34.0; 57.6), 41.7 (36.5; 46.9), 47.8 (38.4; 57.1) and 44.1 (31.0; 57.1), for the groups Underweight, Normal Weight, Overweight and Obesity, respectively (P=0.69). The incidences of PN and PV also did not differ with P=0.76 and P=0.36, respectively.Conclusion: Systematic search of the literature provides no evidence for a positive relationship. Furthermore, our data confirm that an increased BMI is not a risk factor for PONV. This negative finding is important as focussing on the relevant risk factors is needed to allow for an objective risk assessment of PONV (Note).
Intrathecal clonidine does not reduce post‐spinal shivering
Authors: Jeon Y. T. , Jeon Y. S. , Kim Y. C. , Bahk J. H. , Do S. H. , Lim Y. J. 
Published: August 2010

Background:  After general or epidural anesthesia, clonidine is known to be effective in suppressing established shivering. The aim of this study was to assess the preventive effect of intrathecal clonidine on post‐spinal shivering compared with intravenous (i.v.) clonidine.Methods:  One hundred and fifty patients scheduled for orthopedic surgery were randomly allocated into three groups to receive either 1 µg/kg clonidine i.v. (IV group) or the same volume of isotonic saline (control and IT groups) at 5 min before spinal anesthesia. Spinal anesthesia was performed with 12–15 mg hyperbaric bupivacaine 0.5% plus either 1 ml of saline (control and IV groups) or 150 µg clonidine (IT group). Shivering was evaluated for a period of 90 min and graded as none, mild, moderate, and severe.Results:  Twenty patients (40%) in the control group and 17 patients (34%) in the IT group showed shivering compared with four (8%) in the IV group. Patients with moderate‐to‐severe shivering were only seen in the control and IT group, and the maximal intensity of shivering was not different between the two groups. Patients in the IV group were significantly more sedated than the other groups.Conclusions:  The intrathecal administration of clonidine 150 µg fails to prevent post‐spinal shivering; by contrast, we have confirmed that i.v. clonidine 1 µg/kg is an effective method to prevent shivering in patients undergoing spinal anesthesia for orthopedic surgery.
Effect of pulmonary artery pressure on extravascular lung water in an experimental model of acute lung injury
Authors: Colmenero M. , Pérez Villares J. M. , Fernández Sacristán M. A. , Garcia Delgado M. , Fernández Mondéjar E. 
Published: August 2010

Background:  Lung edema can be influenced by hemodynamic changes in pulmonary circulation. The aim of this study was to evaluate, in an experimental model of acute lung injury, the effect on extravascular lung water (EVLW) of an increase in pulmonary artery pressure (Ppa) without changes in cardiac output and wedge pressure.Methods:  Lung edema was produced by an intravenous oleic acid infusion in mixed‐breed pigs weighing 25–31 kg, which, after 20 min, were randomly assigned to a control group (100% FiO2) (n = 6) or a high Ppa group (21% FiO2) (n = 7). An increase in pulmonary artery pressure of at least 40% over baseline was produced in the high Ppa group by alveolar hypoxia. Hemodynamic, ventilatory and gas exchange parameters were collected at regular intervals. Pulmonary, wedge and capillary pressures were measured with a pulmonary artery catheter and the occlusion technique. EVLW was calculated gravimetrically.Results:  At 240 min, both gravimetric‐measured EVLW and mean pulmonary artery pressures were significantly higher (P < 0.05) in high Ppa animals vs. controls (12.06 ± 4.21 vs. 7.98 ± 2.46 ml/kg and 39.0 ± 1.3 vs. 26.6 ± 4.7 mmHg, respectively). Cardiac output (6.8 ± 2.5 vs. 7.3 ± 1.3) and pulmonary wedge pressures (9.2 ± 1.7 vs. 9.4 ± 2.8 mmHg) were similar. A difference was detected in pulmonary capillary pressures [17.0 ± 3.3 (high Ppa) vs. 13.8 ± 2.7 mmHg (controls)] but did not reach statistical significance.Conclusions:  In this model, an increase in pulmonary artery pressure by alveolar hypoxia produces an increase in extravascular lung water, probably related to changes in pulmonary capillary pressures.
The effect of propofol on actin, ERK‐1/2 and GABAA receptor content in neurones
Authors: Oscarsson A. , Juhas M. , Sjölander A. , Eintrei C. 
Published: August 2010

Aim:  Interaction with the γ‐aminobutyric acid receptor (GABAAR) complex is recognized as an important component of the mechanism of many anaesthetic agents, including propofol. The aims of this study were to investigate the effect of propofol on GABAAR, to determine whether exposure of neurones to propofol influences the localization of GABAAR within the cell and to look for cytoskeletal changes that may be connected with activation, such as the mitogen‐activated protein kinase (MAPK) pathway.Methods:  Primary cortical cell cultures from rat, with and without pre‐incubation with the GABAAR antagonist bicuculline, were exposed to propofol. The cells were lysed and separated into membrane and cytosolic fractions. Immunoblot analyses of filamentous actin (F‐actin), the GABAAβ2‐subunit receptor and extracellular signal‐regulated kinase‐1/2 (ERK‐1/2) were performed.Results:  Propofol triggers an increase in GABAAR, actin content and ERK‐1/2 phosphorylation in the cytosolic fraction. In the membrane fraction, there is a decrease in GABAAβ2‐subunit content and an increase in both actin content and ERK‐1/2 phosphorylation. The GABAAR antagonist bicuculline blocks the propofol‐induced changes in F‐actin, ERK and GABAAβ2‐subunit content, and ERK‐1/2 phosphorylation.Conclusion:  We believe that propofol triggers a dose‐dependent internalization of the GABAAβ2‐subunit. The increase in internal GABAAβ2‐subunit content exhibits a close relationship to actin polymerization and to an increase in ERK‐1/2 activation. Actin contributes to the internalization sequestering of the GABAAβ2‐subunit.
Use of the bispectral index to predict a positive awareness reaction to laryngeal mask airway–Fastrach insertion and intubation
Authors: Kocaman Akbay B. , Demiraran Y. , Yalcin Sezen G. , Akcali G. , Somunkiran A. 
Published: August 2010

Aim:  To determine whether the bispectral index (BIS) can be monitored to predict and indicate an awareness reaction to laryngeal mask airway–Fastrach (LMA–Fastrach) insertion and intubation at BIS values between 40 and 60.Methods:  Fifty‐one American Society of Anesthesiologists’ (ASA) class I or II status patients aged over 20 years were included in this study. Midazolam 0.1 mg/kg was given for pre‐medication, 30 min before induction. For induction, a 0.1‐μg/kg bolus injection of remifentanil was followed by infusion, and propofol was administered until the eyelash reflex disappeared; the infusion rate was adjusted to maintain BIS values between 40 and 60. Loss of the eyelash reflex, loss of response to verbal commands, yawning and total propofol consumption were recorded. Patients were tested for awareness twice at 1‐min intervals using the isolated forearm technique. The test was considered to be positive if the patient squeezed a hand when asked; after muscle relaxation, the patient was intubated and the test was repeated. In the recovery room and ward, patients were asked whether they could recall this event.Results:  Seven patients tested positive: two following LMA–Fastrach insertion and the remaining five following intubation. None of the patients had recall.Conclusion:  Awareness during anaesthesia may occur at BIS levels that indicate adequate anaesthesia, but this is not associated with recall of the events later.
Pre‐treatment with hyperoxia before coronary artery bypass grafting – effects on myocardial injury and inflammatory response
Authors: Karu I. , Loit R. , Zilmer K. , Kairane C. , Paapstel A. , Zilmer M. , Starkopf J. 
Published: August 2010

Background:  In experimental studies, exposure to hyperoxia for a limited time before ischaemia induces a low‐grade systemic oxidative stress and evokes an (ischaemic) preconditioning‐like effect of the myocardium. We hypothesised that hyperoxia before cardioplegia could protect the myocardium against necrosis and stunning caused by ischaemia–reperfusion.Methods:  Forty patients undergoing coronary artery bypass grafting were randomly exposed to an oxygen fraction of 0.4 or >0.96 in inspired air on an average of 120 min before cardioplegia. Blood for troponin I, creatine kinase‐MB, lactate, glutathione and interleukin‐6 was sampled from arterial and coronary sinus cannulae during 20 min of reperfusion. Additional arterial samples were drawn 60 min after declamping and in the first post‐operative morning. The cardiac index and right and left ventricular stroke work indices were measured before sternotomy and up to 12 h post‐operatively.Results:  Troponin I, creatine kinase‐MB and lactate did not differ between the groups. Hyperoxic pre‐treatment had no impact on the post‐operative haemodynamic indices measured with the thermodilution pulmonary artery catheter. More oxidised glutathione was released in the hyperoxia group in the first minute of reperfusion (P = 0.015). Hyperoxic pre‐treatment abolished the myocardial release of interleukin‐6 during 20 min of reperfusion (P = 0.021 vs. controls). In the first post‐operative morning, interleukin‐6 was higher in the hyperoxia group [127.0 (86.0–140.0) vs. 85.2 pg/ml (66.6–94.5 pg/ml); P = 0.016].Conclusions:  Exposure to >96% oxygen before cardioplegia did not attenuate ischaemia–reperfusion injury of the heart in patients undergoing coronary artery bypass grafting. The only potentially beneficial effect observed was the decreased transmyocardial release of interleukin‐6.
Comparison of electrical velocimetry and thermodilution techniques for the measurement of cardiac output
Authors: Zoremba N. , Bickenbach J. , Krauss B. , Rossaint R. , Kuhlen R. , Schälte G. 
Published: August 2010

Aim:  To compare a new method of non‐invasive determination of cardiac output based on electrical velocimetry (EV‐CO) with invasive thermodilution methods.Methods:  Fifty critically ill patients were enrolled into the study. EV‐CO was compared with cardiac output measured by a pulmonary artery catheter (PA‐CO) in one group (n= 25) and by a femoral artery catheter (PiCCO‐CO) in a second group (n= 25), by simultaneous measurements. Standard electrocardiography electrodes were used for non‐invasive measurements, and EV‐CO was calculated using the Bernstein–Osypka equation. The invasive measurements of PA‐CO and PiCCO‐CO were made by the injection of iced 0.9% saline and the recording of thermodilution curves.Results:  The precision values of EV‐CO, PA‐CO and PiCCO‐CO measurements were ± 0.46 [95% confidence interval (95% CI), ± 0.06], ± 0.57 (95% CI, ± 0.09) and ± 0.48 l/min (95% CI, ± 0.08 l/min), respectively. The mean differences between EV‐CO and PA‐CO or PiCCO‐CO were –0.05 ± 0.71 and 0.22 ± 0.78 l/min, respectively. The lower and upper limits of agreement for the comparison of EV‐CO with PA‐CO were −1.47 and 1.37 l/min (95% CI, ± 0.25 l/min), respectively. In the comparison of EV‐CO and PiCCO‐CO, lower and upper limits of –1.34 and 1.78 l/min (95% CI, ± 0.27 l/min) were found. The percentage errors between EV‐CO and PA‐CO or PiCCO‐CO were 26.5% and 26.4%, respectively.Conclusions:  The values of cardiac output were statistically comparable between the groups. Therefore, electrical velocimetry is a suitable method to evaluate haemodynamic variables with clinically acceptable accuracy.
Decision making in a life‐threatening cerebral condition: a comparative study of the ethical reasoning of intensive care unit physicians and neurosurgeons
Authors: Rydvall A. , Bergenheim T. , Lynöe N. 
Published: August 2010

Aim:  To study the support for the arguments of neurosurgeons and intensive care unit (ICU) physicians for and against life‐sustaining treatment of critically ill patients, and whether neurosurgeons are less inclined to emphasize quality‐of‐life aspects than ICU physicians.Methods:  A postal questionnaire was sent to a random sample of ICU physicians in Sweden (n= 298) and all neurosurgeons in Sweden (n= 112). The respondents evaluated and prioritized different arguments for and against withholding neurosurgery, withdrawing life‐sustaining treatment and providing drugs which may hasten death.Results:  The response rate was 62.5% for neurosurgeons and 73.5% for ICU physicians. Quality‐of‐life aspects were stressed as an important argument by the majority of both neurosurgeons and ICU physicians (76.8% vs. 54.0%); however, significantly more neurosurgeons regarded this argument as the most important (P < 0.001). A minority in both groups, although more ICU physicians (P < 0.001), supported a patient’s previously expressed wish of not ending in a persistent vegetative state as the most important argument. As the case clinically progressed, a consensus regarding the arguments for decision making evolved.Conclusions:  No support was found for the hypothesis that ICU physicians care more about the quality of life of a severely ill patient. Indeed, significantly more neurosurgeons emphasized the quality‐of‐life aspects in this particular setting. Compared with neurosurgeons, significantly more ICU physicians considered the patient’s own wishes to be important.
Changes in heart rate variability may reflect sympatholysis during spinal anaesthesia
Authors: Hanss R. , Ohnesorge H. , Kaufmann M. , Gaupp R. , Ledowski T. , Steinfath M. , Scholz J. , Bein B. 
Published: August 2010

Background:  To investigate if changes in low‐to‐high frequency ratio (LF/HF), low frequency (LF) and high frequency (HF) heart rate variability reflect autonomic regulation during spinal anaesthesia (SA) in pregnant women scheduled for elective Caesarean section.Methods:  Prospective clinical trial. Systolic blood pressure (SBP) and heart rate variability were analysed at baseline, 5 min after SA and 15 min after SA. Patients were assigned by baseline LF/HF. Group LF/HF < 2.5 (n= 52) was compared to group LF/HF > 2.5 (n= 48). Non‐parametric tests for statistical analysis.Results:  Group LF/HF > 2.5 showed a significant decrease in LF/HF and LF as well as an increase in HF during SA (median, range): baseline LF/HF [4.0 (3.2/4.8)] decreased to 2.3 (1.3/3.4) at event 15 min after SA (P < 0.001). Baseline LF = 59(43/71)% decreased to 40 (27/55)% at event 15 min after SA (P < 0.05). Baseline HF = 15(13/22)% increased to 26(15/41)% at event 15 min after SA (P < 0.05). In contrast, group LF/HF < 2.5 demonstrated only moderate changes in LF/HF, LF and HF during SA. SBP decreased significantly in group LF/HF > 2.5 (median and range) lowest SBP group LF/HF > 2.5: 80 (50/127 mmHg vs. group LF/HF < 2.5: 109 (104/142) mmHg, P < 0.001. Decrease of SBP before and after SA was correlated with a decrease in LF/HF, LF, and HF, respectively: LF/HF – SBP: r= 0.30, r2= 0.09, P < 0.001; LF – SBP: r= 0.25, r2= 0.06, P < 0.05, HF, NS.Conclusions:  Changes in heart rate variability parameters in the course of SA may reflect a decrease in sympathetic activity and relative increase in parasympathetic activity as a result of the block. In the course of SA, the more pronounced the changes in heart rate variability were the more distinct the hypotension.