bluuebunny/crossref_metadata_2025_split huggingface dataset:
Annular lesions in Kawasaki disease: A cause of confusion
Authors: Ming Andrew , Wargon Orli 
Published: October 2008

SUMMARYWe present three cases of Kawasaki disease in which an annular eruption was the predominant cutaneous finding. The provisional diagnosis was Stevens–Johnson syndrome. However, the annular lesions were not typical of Stevens–Johnson syndrome: the lips were crusted without mucosal ulceration and the conjunctivitis was non‐purulent without corneal erosions. Dermatologists are often involved in the initial assessment of this multisystem disease and should be aware of the variety of cutaneous manifestations, as rapid treatment is known to decrease morbidity and mortality.
Basal cell carcinoma of the vulva: A report of four cases
Authors: DeAmbrosis Kathryn , Nicklin James , Yong‐Gee Simon 
Published: October 2008

SUMMARYFour cases of vulval basal cell carcinoma were identified in multiparous females aged 46–78 years. Symptoms included discomfort and pruritus ranging from 6 weeks to 4 years in duration. Such symptoms occurred in the context of a pink vulval plaque. The non‐specific symptoms, in the context of the particular anatomical site, led to late presentation. Subsequent treatment in all cases involved wide local excision following incisional biopsy. No recurrence has been documented after a minimum follow‐up period of 12 months.
Hyperpigmentation, nail dystrophy and alopecia with generalised intestinal polyposis: Cronkhite–Canada syndrome
Authors: Ho Vincent , Banney Leith , Falhammar Henrik 
Published: October 2008

SUMMARYA 62‐year‐old Malaysian woman presented with a constellation of skin signs including alopecia, hyperpigmentation and nail dystrophy. On questioning, a history of diarrhoea, taste disturbance and weight loss was found. The onset of these changes coincided with the administration of thyroxine prescribed for a benign multinodular goitre. Hormonal investigations showed no abnormality and no underlying malignancy was found. Investigation of the diarrhoea showed a protein‐losing enteropathy with generalized intestinal polyposis and non‐specific histology. A diagnosis of Cronkhite–Canada syndrome was made. Treatment with prednisone and nutritional support has been partially effective.
Leprosy: Recognizing red flags
Authors: Pearce Victoria , Horton Jeremy J 
Published: October 2008

SUMMARYA 28‐year‐old man from the Philippines presented with multiple papules and plaques symmetrically distributed on the arms and legs. This was associated with worsening paraesthesia of the hands and feet. A right common peroneal nerve decompression had been performed 2 years earlier. He was diagnosed with multibacillary leprosy on skin biopsy and subsequently treated with oral rifampicin, clofazamine and dapsone.
Complex regional pain syndrome after dermatological surgery
Authors: Kumar Sandeep , Mackay Catherine , O'Callaghan James , De'Ambrosis Brian 
Published: October 2008

SUMMARYWe report a case of complex regional pain syndrome developing in a 57‐year‐old woman after minor skin surgery in the sole of her right foot. This was diagnosed and treated in its early phase with sympathetic blockade using guanethedine with complete recovery of symptoms.
Dermal vacuoles in two biopsies of psoriasis
Authors: Ayva Sebnem , Erkek Emel , Atasoy Pinar 
Published: October 2008

SUMMARYTwo patients presented with cutaneous lesions clinically typical of psoriasis. The first case was a 38‐year‐old man and the second was a 51‐year‐old woman. To confirm the diagnosis, 4‐mm punch biopsy samples were obtained from both patients from the lesions on the knees. Histology in both cases was in favour of psoriasis and also revealed empty vacuoles in the papillary dermis, concentrated at sites of intense lymphocyte infiltration. The empty vacuoles resembled true fat cells or fat globules. They did not reveal positive immunostaining with CD34 antigen, suggesting that they were not lined by endothelial cells. Final histological diagnosis was psoriasis associated with dermal vacuolization.
Prolidase deficiency: The use of topical proline for treatment of leg ulcers
Authors: Dunn Rebecca , Dolianitis Con 
Published: October 2008

SUMMARYA 41‐year‐old man with prolidase deficiency has had chronic leg ulcers and recurrent cellulitis for most of his life. Until recently he had been hospitalized at least annually for this and suffered significant morbidity as a result. Since commencing topical 5% proline in white soft paraffin ointment to treat the leg ulcers, there has been marked improvement in the ulcers and decreased frequency of hospitalizations for cellulitis. This lends further support to the use of topical proline in the treatment of patients with skin ulcers secondary to prolidase deficiency.
Fatal delayed presentation of primary melanoma of the penis
Authors: Tritton Sara M , Shumack Stephen , Fischer Gayle 
Published: October 2008

SUMMARYA 60‐year‐old man presented with a 3‐week history of lethargy, anorexia, breathlessness at rest, nausea and vomiting. He had a 5‐year history of an undisclosed, enlarging, pigmented mass on his penis. He refused biopsy of this lesion. Fine‐needle aspirate of an enlarged inguinal lymph node histologically confirmed a diagnosis of melanoma and widespread metastases were demonstrated by radiological imaging. The patient succumbed to disease within 8 days of diagnosis. Primary penile melanoma, albeit rare, is an important and sensitive dermatological problem, often leading to delayed presentation.
C‐reactive protein and other predictors of poor outcome in patients hospitalized with exacerbations of chronic obstructive pulmonary disease
Authors: RUIZ‐GONZÁLEZ Agustín , LACASTA Daniel , IBARZ Mercedes , MARTÍNEZ‐ALONSO Montserrat , FALGUERA Miquel , PORCEL José M. 
Published: October 2008

Background and objective:  CRP is elevated in patients with acute exacerbations of COPD (AECOPD), but there is little information on whether this biomarker can help to identify adverse short‐term clinical outcomes.Methods:  A 6‐month prospective study of all patients with AECOPD requiring hospital admission. Clinical, laboratory (including plasma CRP levels at admission) and functional data were recorded. The outcome variable (the adverse outcome) consisted of: (i) death in hospital or within 15 days of discharge, (ii) transfer to the intensive care unit, or (iii) development of acute heart failure during hospitalization.Results:  Data from 147 patients with a total of 160 admissions were recorded. During follow up, 38 (23.7%) adverse outcomes were observed, including 13 (8.8%) and 8 (5.4%) patients who died during hospitalization or within 15 days of discharge, respectively. CRP at a level of 50 mg/L was related to an adverse outcome (OR 4.9, 95% CI: 1.92–12.6, P < 0.01), although by itself it was neither sensitive nor specific (area under the receiver operating characteristic curve (AUC) 0.69, 95% CI: 0.60–0.77). However, a risk score derived from the combination of CRP with other variables, such as ‘current smoker’, ‘at least two comorbidities’ and ‘confusion,’ at admission showed good predictive ability to identify an adverse outcome (AUC of 0.80, 95% CI: 0.72–0.88).Conclusions:  Plasma CRP in combination with other variables obtained at admission may assist identification of high‐risk patients with AECOPD.
Serum pro‐hepcidin levels in term and preterm newborns with sepsis
Authors: Yapakçı Ece , Tarcan Aylin , Çelik Banu , Özbek Namık , Gürakan Berkan 
Published: October 2008

AbstractBackground:  An iron regulatory peptide hormone, hepcidin, is also part of the innate immune system and is strongly induced during infections and inflammation. The aim of the present study was to determine serum levels of the 60 aa pro‐hormone form of hepcidin (pro‐hepcidin) in full‐term and preterm newborns with sepsis and to determine the possible relationships between pro‐hepcidin levels and serum iron and complete blood count parameters.Methods:  Fifteen preterm newborns with sepsis, 17 healthy preterm, six full‐term newborns with sepsis and 16 healthy full‐term newborns were included the study. Blood samples were collected from patients with sepsis at the time of clinical diagnosis. Each blood sample was analyzed for complete blood count, serum iron and ferritin concentrations, iron‐binding capacity, and pro‐hepcidin level.Results:  The mean serum pro‐hepcidin level (mean ± SD) in preterm neonates with sepsis and in healthy preterm newborns was 565.4 ± 519.5 ng/mL and 279.8 ± 227.6 ng/mL, respectively (P < 0.05). The mean serum pro‐hepcidin level in full‐term newborns with sepsis and in healthy full‐term neonates was 981.4 ± 415.4 ng/mL and 482 ± 371.9 ng/mL, respectively (P < 0.05). Although the mean serum ferritin levels in the two groups with sepsis were higher when compared with the healthy groups, the difference was not statistically significant in full‐term newborns. No statistically significant correlations were found between serum pro‐hepcidin levels and any other parameters in each group.Conclusions:  Serum pro‐hepcidin levels were higher in newborns with sepsis (either premature or full‐term) than they were in healthy newborns at the time of clinical diagnosis.
Is thrombocytopenia suggestive of organism‐specific response in neonatal sepsis?
Authors: Manzoni Paolo , Mostert Michael , Galletto Paolo , Gastaldo Luca , Gallo Elena , Agriesti Giovanni , Farina Daniele 
Published: October 2008

AbstractBackground:  It is controversial whether thrombocytopenia is suggestive of one (or more) causative agents of neonatal sepsis: a low platelet count has been related in turn to Gram‐positive, Gram‐negative or fungal sepsis.Methods:  A retrospective, cohort study on 514 very low‐birthweight (VLBW) neonates admitted over a 9 year period to a large tertiary neonatal intensive care unit (NICU) in Italy was carried out. Through database search, data on platelet counts, sepsis, clinical course, and microbiological culture were collected and analyzed. Statistical analysis was performed to look for significant association between thrombocytopenia and sepsis caused by different (Gram‐positive, Gram‐negative or fungal) organisms.Results:  Sepsis diagnosed on microbiological criteria occurred in 197 of 514 VLBW neonates (38.3%), and thrombocytopenia (at least one finding of platelet count <80 000/mm3) was detected in 34 (17.2%) of the 197 septic infants. Thrombocytopenia occurred in 10 of 51 neonates with fungal sepsis (19.6%), and in 24 of 146 with bacterial sepsis (16.4%; P = 0.37). The difference was not significant when clustering for sepsis caused by Gram‐positive (nine thrombocytopenic of 51 with Gram‐positive sepsis, 17.6%; P = 0.40) and Gram‐negative organisms (15/95, 15.7%; P = 0.22), or when considering only coagulase‐negative Staphylococcus sepsis (6/37, 16.2%; P = 0.25).Conclusions:  In contrast with previous reports, thrombocytopenia might not be an organism‐specific marker of sepsis. Caution should be maintained in relating a low platelet count to any infectious agent (or group of agents) in preterm VLBW neonates.
Intravenous luteinizing hormone‐releasing hormone has no effect on serum N‐terminal pro‐brain natriuretic peptide in children and adolescents
Authors: Norozi Kambiz , Binder Lutz , Brack Christoph , Potthoff Ludger , Hess Georg , Wessel Armin 
Published: October 2008

AbstractBackground:  Little is known about the acute effects of i.v. luteinizing hormone‐releasing hormone (LHRH) on the heart function, therefore the aim of the present study was to measure N‐terminal pro‐brain natriuretic peptide (N‐BNP) in children, who underwent a diagnostic work up for short stature or delayed puberty.Methods:  N‐BNP was measured in 52 children before and after administration of LHRH. Serum N‐BNP obtained from 255 healthy children and adolescents (aged birth–18.3 years) served as a reference.Results:  There was no significant difference between baseline N‐BNP of children who underwent the LHRH diagnostic test and their healthy peers. There was no significant serum N‐BNP level change before or after administration of LHRH (59 ± 36 pg/mL vs 58 ± 34 pg/mL). N‐BNP fell from 399 ± 425 pg/mL in newborns and reached 44 ± 36 pg/mL in children aged 12–18 years.Conclusion:  Short stature or delayed puberty had no effect on heart function determined by serum N‐BNP; i.v. LHRH does not acutely influence the level of serum N‐BNP.
Congenital cardiac malformations in neonates with apparently isolated gastrointestinal malformations
Authors: Olgun Hasim , Karacan Mehmet , Caner Ibrahim , Oral Akgun , Ceviz Naci 
Published: October 2008

AbstractBackground:  The association of congenital cardiac malformations (CCM) with malformations of the gastrointestinal tract/abdominal wall is known. Nevertheless, the data presently available are derived from patient populations that include some special conditions known to be associated with a high rate of CCM. The aim of the present study was therefore to determine the incidence of cardiac malformations among neonates with apparently isolated malformations of the gastrointestinal tract/abdominal wall.Methods:  A total of 201 neonates with apparently isolated gastrointestinal malformations were screened on echocardiography.Result:  Thirty‐six (17.9%) of the neonates were diagnosed as having a CCM. When the four most frequent gastrointestinal malformations were evaluated, a CCM was diagnosed in 11/69 (15.9%) with anal atresia, in 9/38 (23.7%) with tracheoesophageal fistula/esophageal atresia, in 2/25 (8%) with diaphragmatic hernia and in 5/17 (29.4%) with intestinal atresia. In 11 of 36 patients (30.6%) with CCM, the cardiac problems were hemodynamically significant, requiring anti‐congestive and/or surgical treatment.Conclusion:  A significant number of neonates with apparently isolated gastrointestinal malformations had CCM. Because almost all patients with malformations of the gastrointestinal tract/abdominal wall require early surgical intervention, they should be evaluated on echocardiography to investigate CCM at the earliest opportunity.
Three‐dimensional 26‐core biopsy‐based patient selection criteria for nerve‐sparing radical prostatectomy
Authors: Numao Noboru , Kawakami Satoru , Yonese Junji , Koga Fumitaka , Saito Kazutaka , Fujii Yasuhisa , Ishikawa Yuichi , Fukui Iwao , Kihara Kazunori 
Published: October 2008

Objectives:  Most of the previously reported patient selection criteria for nerve‐sparing radical prostatectomy were based on conventional sextant biopsy, and those based on extended biopsy have been scarcely investigated. In the current study, we developed patient selection criteria for nerve‐sparing RP based on the three‐dimensional 26‐core (3D26) biopsy‐derived variables.Methods:  We evaluated 202 non‐nerve‐spared sides in 109 consecutive patients in whom prostate cancer was diagnosed by the 3D26 biopsy and who underwent RP without neoadjuvant treatment. Associations of clinical and pathological variables with side‐specific posterolateral extraprostatic extension (SS‐PL‐EPE) were analyzed. Subgroup analysis using transperineal 14‐core (TP14) and transrectal 12‐core (TR12) biopsies as representative subsets of the 3D26 biopsy was also performed.Results:  Maximum cancer length in positive cores ≥5 mm and biopsy Gleason score ≥4 + 3 were independent and were significant risk factors of SS‐PL‐EPE in the 3D26 cohort at multivariate analysis. In the prostatic side with none, one, and two risk factors, the incidences of SS‐PL‐EPE were 0, 14 and 52% in the 3D26 cohort, 3.4,15 and 57% in the TP14 cohort and 2.6, 20 and 61% in the TR12 cohort, respectively.Conclusions:  We developed simple patient selection criteria for nerve‐sparing RP. According to our criteria, the nerve‐sparing side can be selected in the majority of patients who undergo the 3D26, TP14 or TR12 biopsy with a less‐than‐4% risk of SS‐PL‐EPE.
Effects of a novel β3‐adrenoceptor agonist, AJ‐9677, on relaxation of the detrusor muscle: Anin vitrostudy
Authors: Otsuka Atsushi , Shinbo Hitoshi , Hasebe Ko , Matsumoto Rikiya , Ozono Seiichiro 
Published: October 2008

Objectives: To examine the relaxant effects of AJ‐9677, a novel β3‐adrenoceptor agonist, on the isolated rat, monkey and human detrusor muscle.Methods: The isolated detrusor strips of rats, monkeys and humans were mounted in organ baths containing Krebs solution. By the cumulative addition of β‐adrenoceptor agonists (isoproterenol, AJ‐9677, CL 316,243 and salbutamol in rats; isoproterenol, AJ‐9677 and CL 316,243 in monkeys and humans), concentration–relaxation curves were obtained. The maximal relaxation responses and pEC50values were calculated. In rats, concentration–relaxation curves to isoproterenol and AJ‐9677 were obtained in the presence and absence of propranolol or SR 59230A.Results: Isoproterenol, AJ‐9677, CL 316,243 and salbutamol induced concentration‐dependent relaxation in rats. The rank order of their relaxing potency in the rat detrusor muscle was AJ‐9677 > isoproterenol > CL 316,243 > salbutamol. Isoproterenol and AJ‐9677 also produced a concentration‐dependent relaxation with high potency in monkeys and humans, whilst CL 316,243 had low relaxing potency. According to the antagonist studies in rats, propranolol and SR 59230A caused a rightward shift of the concentration–relaxation curves to isoproterenol or AJ‐9677, respectively.Conclusions: AJ‐9677 has a high relaxant potency on the rat, monkey and human detrusor smooth muscle, and it may have the potential to treat overactive bladder.
Hand‐assisted laparoscopic radical cystectomy and extracorporeal urinary diversion: Experience with 31 cases
Authors: Wang Sheng‐zheng , Chen Ling‐wu , Chen Wei , Zhang Yong‐hai 
Published: October 2008

Objectives:  To report our techniques and experience with hand‐assisted laparoscopic radical cystectomy and extracorporeal urinary diversion for bladder cancer.Methods:  Between May 2004 and November 2007, 31 patients (mean age 61.3 years, range 40–79) underwent hand‐assisted laparoscopic radical cystectomy with extracorporeal urinary diversion for bladder cancer. Five patients had previously undergone abdominal surgeries. Data were collected with respect to patient demographics, perioperative outcomes and short‐term oncological follow up.Results:  Twenty‐four patients underwent an ileal conduit and seven patients underwent an orthotopic neobladder. Mean operative time was 365.7 min (range 245 to 530). Estimated blood loss was 250.9 cc (range 100 to 500), with a transfusion rate of 9.7%. Oral liquids were resumed at 4.3 days and the mean hospital stay was 19.7 days. There were no intraoperative complications. Postoperative early complications (within 30 days of surgery) occurred in six patients (19.4%). Two wound infections, one urinary leak, one wound dehiscence, one bowel obstruction and one alimentary tract hemorrhage were all treated conservatively. Late complications occurred in three patients (two parastomal hernias and one ureteroenteric stricture). With a mean follow up of 18 months, 27 patients had no evidence of disease. One patient died because of cancer and one died for unrelated causes. One was alive with local recurrences and one with lung metastasis.Conclusions:  Hand‐assisted laparoscopic radical cystectomy is a safe, reproducible and minimally invasive option for bladder cancer patients.
Systemic inflammatory response syndrome after percutaneous nephrolithotomy: An assessment of risk factors
Authors: Chen Liang , Xu Qing‐Quan , Li Jian‐Xing , Xiong Liu‐Lin , Wang Xiao‐Feng , Huang Xiao‐Bo 
Published: October 2008

Objectives:  To analyze the risk factors for systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) and to quantitatively predict the probability of SIRS after PCNL.Methods:  Medical records on 209 patients who underwent PCNL were retrospectively analyzed. The χ2 test, the t‐test and a logistic regression model were used to identify key risk factors of SIRS after PCNL. A predictive equation was then formulated to assess the risk of SIRS according to the results from the logistic model. Subsequently, the accuracy of the equation by calculating sensitivity, specificity, overall correct percentage, and positive and negative predictive values was tested.Results:  The incidence of SIRS after PCNL was 23.4%. The key risk factors for SIRS following PCNL were: the number of tracts, receipt of a blood transfusion, stone size, and presence of pyelocaliectasis. Other factors added no independent risk to the development of SIRS. The calculated values for sensitivity, specificity, overall percentage correct, positive predictive value and negative predictive value were 44.9%, 95.0%, 83.3%, 73.3%, and 84.9%, respectively.Conclusions:  Number of tracts, receipt of a blood transfusion, stone size and presence of pyelocaliectasis are identified as the key risk factors for SIRS after PCNL. The predictive equation allows for an individualized and quantitative assessment of the probability of SIRS after PCNL.
Postoperative pain control for primary cleft lip repair in infants: is there an advantage in performing peripheral nerve blocks?
Authors: SIMION CARMEN , CORCORAN JULIA , IYER ADITYA , SURESH SANTHANAM 
Published: October 2008

SummaryBackground:  Primary cleft lip repair is performed in infants under 1 year of age. The efficacy of an infraorbital nerve block vs intravenous fentanyl was compared in our prospective, randomized controlled trial.Methods:  Forty‐six infants scheduled for primary cleft lip repair were prospectively randomized to one of two groups: group F that received 2 mcg·kg−1 of fentanyl intravenously and an infraorbital nerve block with 0.5 ml on each side of preservative‐free normal saline, and, group B that received bilateral infraorbital nerve blocks with 0.5 ml on each side of 0.25% bupivacaine and 2 ml of preservative‐free saline solution intravenously after induction of anesthesia but prior to surgical incision. Patients were observed by a blinded observer for (i) pain scores using neonatal infant pain score; (ii) need for rescue medication in the anesthesia care unit (PACU), in the short stay unit (SSU) and at home and (iii) feeding parameters including difficulty in feeding, time to first feeding and volume of feeds in the PACU, SSU and at home.Results:  There were no significant differences in pain scores between the two groups over time (P = 0.98); there were no differences between groups in the number of rescue medications in the PACU, in the SSU as well as at home; however, the time to first rescue medication was greater in the block group compared with the fentanyl group (P = 0.07). There were no significant differences in feeding volumes between groups in the PACU (P = 0.46), SSU (P = 0.57) and at home (P = 0.15). There were no differences in time to initiate feeding between the two groups (P = 0.81). However, there was difficulty with feeding in the block groups compared with the fentanyl group (P = 0.01).Conclusions:  The infraorbital nerve block can be effectively used for pain control in infants undergoing primary cleft lip repair. Although children undergoing a nerve block experienced minor difficulties in feeding, there were no differences in feeding volumes or other feeding parameters. This study has shed light into postoperative outcomes besides pain control on children undergoing cleft lip repairs.