bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of direct smear, culture and histology for the diagnosis of onychomycosis
Authors: Karimzadegan‐Nia Motahareh , Mir‐Amin‐Mohammadi Akram , Bouzari Navid , Firooz Alireza 
Published: January 2007

SUMMARYA sensitive and efficient diagnostic strategy is needed to confirm the clinical suspicion of onychomycosis. The purpose of this study was to compare the sensitivity of three most commonly used diagnostic methods for onychomycosis. Nail specimens of 96 patients with clinically suspected onychomycosis were evaluated using potassium hydroxide smear, culture and histology. A positive result of any of these tests was considered confirmatory for fungal infection and the sensitivity of each test as well as various combinations of them was calculated. The diagnosis of onychomycosis was confirmed in 47 patients (48.9%). Histology was the most sensitive single test for the diagnosis of onychomycosis, although its sensitivity (80.8%) was not statistically different from smear (76.5%). Both histology and smear were significantly more sensitive than culture (53.2%). The most sensitive combination of tests, smear plus histology, was 97.8% sensitive with 98% negative predictive value. In conclusion, direct smear combined with histological examination is the most sensitive diagnostic approach for onychomycosis.
Dermatologist and family practitioner practice patterns for occupational contact dermatitis
Authors: Holness D Linn , Tabassum Shehrina , Tarlo Susan M , Liss Gary M , Silverman Frances , Manno Michael 
Published: January 2007

SUMMARYMedical practitioners have a role in the recognition of occupational contact dermatitis. The longer the duration of symptoms before diagnosis, the poorer the outcome. Our objective was to understand practice patterns, barriers and needs for early diagnosis of occupational contact dermatitis. A survey to obtain information on practice patterns was developed based on the literature and interviews with dermatologists and family practitioners. The survey was sent to all dermatologists and a random sample of 600 family practitioners in Ontario. Fifty‐seven per cent of dermatologists and 9% of family practitioners report seeing more than 20 patients per year with occupational contact dermatitis. The majority of practitioners report taking a workplace exposure history. Barriers to taking a workplace exposure history include time constraints and lack of knowledge. Reasons for referral to specialists include a lack of expertise, testing facilities and knowledge about workers’ compensation, time constraints and inadequate re‐imbursement, whereas lack of access to specialists is a barrier for referral. Although most practitioners identify a need for further education, a low volume of patients and time constraints are key barriers to continuing education. Opportunities are identified to improve educational initiatives and health services delivery for occupational contact dermatitis, tailored to each practitioner group.
Clinical review of 202 patients with vulval lichen sclerosus: A possible association with psoriasis
Authors: Simpkin Susan , Oakley Amanda 
Published: January 2007

SUMMARYTwo hundred and two patients with clinically typical or biopsy‐confirmed vulval lichen sclerosus were reviewed either at consultation (75%) or by retrospectively examining their chart. At diagnosis, 79% were 50 years or older. Ninety‐six per cent complained of itching, pain and/or dyspareunia. Lichen sclerosus most often affected the labia minora and perineum but 50% had perianal and 13% had extragenital disease. Thirty‐five patients gave a history of psoriasis (17%), which affected the vulval area in 10. Thyroid disease was reported in 39 patients (19%), and 33 gave a family history of thyroid disease. Of those tested (142), 20% had elevated thyroid antibodies. Topical clobetasol propionate was very effective but at least intermittent treatment was required long term in 85%. At follow up, 101 of 185 patients (56%) were asymptomatic but 22 (12%) continued to have moderate‐to‐severe symptoms. Thyroid disease and psoriasis are common associated conditions.
Photo‐onycholysis due to indapamide
Authors: Rutherford Tim , Sinclair Rodney 
Published: January 2007

SUMMARYPhoto‐onycholysis due to indapamide presented in a 75‐year‐old woman who was being treated with the diuretic for hypertension. The onset of her photo‐onycholysis was delayed because of inadvertent photoprotection in the form of artificial nails and occurred in the absence of a generalized photosensitive eruption. Her nails returned to normal after withdrawal of the drug and application of opaque nail polish.
Fabry disease in a heterozygote presenting as hand ischaemia and painful acroparaesthesia
Authors: Martin Linda , Sturgess Allan , Sillence David , Murrell Dédée F 
Published: January 2007

SUMMARYA 48‐year‐old woman presented with acute unilateral ischaemia of the left hand. She had a background of chronic peripheral neuropathic pain, palpitations, anaemia and an episode of superficial thrombophlebitis. Physical examination revealed non‐blanching purple discoloration of her left fingers and her left thumb, index finger and thenar eminance appeared ischaemic. Digital subtraction angiography of the left hand demonstrated reduced flow. Skin punch biopsy histology was unremarkable. The diagnosis of Fabry disease was made on urine lipid profile analysis and confirmed by reduced peripheral blood leukocyte α‐galactosidase A activity.
Pure cutaneous Langerhans cell histiocytosis resembling varicella
Authors: Gönül Müzeyyen , Kılıç Arzu , Çakmak Seray K , Gül Ülker , Ünal Tuba 
Published: January 2007

SUMMARYA 5‐month‐old boy presented with multiple, pinkish‐yellow, umblicated, varicelliform vesicles on his trunk. The lesions first appeared on his scalp 2 months earlier. There was also an erythematous, moist and erosive eruption on both axillae, inguinal regions and intergluteal sulcus. He had been treated with topical antibacterial and antiviral therapies. Histopathological investigation of the lesions revealed the diagnosis of Langerhans cell histiocytosis. Systemic involvement was not detected, although detailed investigation was performed. We present our case because he had a varicelliform and intertriginous eruption but did not have internal organ and haematological involvement.
Digital nerve blocks: More gain with less pain
Authors: Scarff Catherine E , Scarff Christopher W 
Published: January 2007

SUMMARYDigital nerve blocks are commonly used and effective techniques for achieving anaesthesia of the digit for the purposes of enabling a variety of surgical procedures to be performed. Several techniques have been described including the traditional method, the metacarpal block and the transthecal approach. We favour the traditional technique, and describe a variation of the technique.
Contact dermatitis to a canine anti‐dandruff shampoo
Authors: Rademaker Marius , Barker Scott 
Published: January 2007

SUMMARYA 40‐year‐old teacher presented after her third episode of acute facial oedema within 4 months. Each episode occurred 1–2 days after visiting her mother’s house. Patch testing showed positive reactions to miconazole and econazole nitrate. The patient denied use of any antifungal creams, but it transpired that her mother’s dog was being shampooed weekly with an antifungal shampoo containing miconazole. No further episodes were recorded after discontinuing the antifungal shampoo.
Treatment of female pattern hair loss with a combination of spironolactone and minoxidil
Authors: Hoedemaker Carlijn , Van Egmond Sylvia , Sinclair Rodney 
Published: January 2007

SUMMARYA 53‐year‐old woman with clinical evidence of female pattern hair loss and histological evidence of androgenetic alopecia was initially treated with the oral antiandrogen spironolactone 200 mg daily. Serial scalp photography documented hair regrowth at 12 months; however, the hair regrowth plateaued, and at 24 months there had been no further improvement in hair density. Twice daily therapy with topical minoxidil 5% solution was then introduced and further regrowth documented, confirming the additive effect of combination therapy.
Facial Sweet’s syndrome mimicking rosacea fulminans
Authors: Anavekar Namrata S , Williams Richard , Chong Alvin H 
Published: January 2007

SUMMARYA 36‐year‐old man presented with a non‐pruritic, erythematous facial rash with peri‐oral and peri‐orbital sparing. The initial clinicopathological diagnosis was rosacea fulminans, which was treated with 25 mg oral prednisolone and cephalexin. The patient re‐presented 1 week later with exacerbation of his rash in addition to constitutional symptoms of fever and malaise. A further skin biopsy was taken and the marked neutrophilic infiltrate in the absence of vasculitis made the diagnosis of Sweet’s syndrome (acute febrile neutrophilic dermatosis). High‐dose prednisolone (50 mg daily), topical hydrocortisone cream and ichthammol in zinc ointment were commenced with rapid clinical improvement. This case highlights the importance of considering Sweet’s syndrome as a differential diagnosis when presented with a facial eruption.
Analysis of national database for TEM resected rectal cancer
Authors: Bach S. , Mortensen N. ,   the TEM Users Group
Published: January 2007

Objective:  Transanal endoscopic microsurgery (TEM) is a minimally invasive alternative to rectal resection for cancer. Patients benefit from rapid recovery, excellent function and stoma avoidance.Method:  The national TEM database has prospectively collated data from 21 centres since 1993. Details of preoperative evaluation, neoadjuvant therapy, technical aspects of surgery, postoperative complications, pathological staging, salvage, recurrence and survival have been recorded for 454 cases of rectal cancer, median follow up 35 months.Results:  Intention was curative in 69%, for compromise in 22% and palliative in 5%. The morbidity and mortality of TEM was 17.2% and 1.5%. Neoadjuvant radiotherapy was administered in 8% of cases. Pathological staging: pT0 (1.8%), pT1 (52.9%), pT2 (32.8%), pT3 (9.9%) and pTx (3.1%). Margin positivity (<1 mm) occurred in 20%; this was markedly stage dependent. 18% received adjuvant radiotherapy while 13% progressed to major surgery. 5 year disease free survival was 77% pT1, 74% pT2 and 35% pT3 with local recurrence rates of 20%, 25% and 59% respectively. Age (P = 0.01), tumour area (P = 0.02) and pT stage (P = 0.07) predicted for relapse (Cox regression model).Conclusion:  TEM offers a safe alternative to major surgery curing three quarters of patients with pT1 disease. Although classical surgery must remain the standard of care we envisage future studies of TEM combined with adjuvant therapy.
Total pelvic clearance for advanced pelvic malignancy
Authors: Leon R. , O’Dwyer S. T. , Wilson M. S. 
Published: January 2007

Objective:  Advanced pelvic tumours require multidisciplinary care in order to improve outcome.This is an audit of one specialist unit's experience.Method:  Consecutive patients referred from 2001 to 2005 for consideration of pelvic clearance were evaluated by retrospective review.Results:  Of 100 patients assessed, 55 were considered unsuitable for surgery. Exclusions included unresectable pelvic side‐wall disease (25), widespread disease (23) and severe co‐morbidity (7). Forty‐five patients were operated on; 22 had locally advanced disease, 14 had recurrence and nine had residual disease following previous surgery. The primary cancers were colorectal in 24, gynaecological in 10 and urogenital in 10; one patient had nonneoplastic disease. Preoperatively 39 (87%) had examination under anaesthetic (87%) and all had MR and CT imaging. Neoadjuvant radiotherapy and chemotherapy was given in 27 and 18 patients respectively. Following resection by a multi‐speciality team, surgery was considered curative in 40 (90%) of cases as judged by a histologically negative margin. All patients received level 2 care postoperatively with only two requiring level 3 care. There was no 30‐day mortality but there were 17 complications treated conservatively and five that required surgery.Conclusion:  Advanced pelvic tumours require careful multidisciplinary assessment and treatment. This study shows that this can be done safely with high levels of histological clearance of tumour.
Phylogeographic structure suggests multiple glacial refugia in northern Victoria Land for the endemic Antarctic springtailDesoria klovstadi(Collembola, Isotomidae)
Authors: Stevens Mark I. , Frati Francesco , McGaughran Angela , Spinsanti Giacomo , Hogg Ian D. 
Published: January 2007

We carried out a phylogeographic study using mtDNA (COII) for the endemic springtailDesoria klovstadi(formerlyIsotoma klovstadi) from northern Victoria Land, Antarctica. Low levels of sequence divergence (≤ 1.6%) across 26 unique haplotypes (from 69 individuals) were distributed according to geographic location. Cape Hallett and Daniell Peninsula contained the highest nucleotide (both > 0.004) and haplotype (both > 0.9) diversity with 10 (of 16) and 8 (of 12) unique haplotypes, respectively. All other populations (Football Saddle, Crater Cirque, Cape Jones) had lower diversity with 2–4 unique haplotypes. Across the 69 individuals from five populations there was only a single haplotype shared between two populations (Daniell Peninsula and Football Saddle). Furthermore, nested clade analyses revealed that some of the Daniell Peninsula haplotypes were more closely related to Football Saddle haplotypes than to any other population. Such discrete haplotype groupings suggest historical (rare) dispersal across the Pleistocene (1.8 mya−11 kya) and Holocene (11 kya–present), coupled with repeated extinction, range contraction and expansion events, and/or incomplete sampling across the species range. The nested clade analyses reveal that a common pattern of climatic and geological history over long‐term glacial habitat fragmentation has determined the geographic and haplotype distributions found forD. klovstadi.
Pelvi‐ureteric junction obstruction in children: the role of urinary transforming growth factor‐β1 and epidermal growth factor
Authors: Taha Mohamed A. , Shokeir Ahmed A. , Osman Hussein G. , Abd El‐Aziz Abd El‐Aziz F. , Farahat Sami E. 
Published: January 2007

In this section authors from Egypt describe the use of urinary TGFβ1 and epidermal growth factor in PUJ obstruction. In another paper, authors from London herald what they consider to be a new era in the management of end‐stage renal disease in children, presenting the technique of bilateral synchronous posterior prone retroperitoneoscopic nephrectomy with simultaneous peritoneal dialysis.OBJECTIVESTo investigate the role of transforming growth factor β1 (TGF‐β1) and epidermal growth factor (EGF) in voided urine for the diagnosis and follow‐up of children with pelvi‐ureteric junction obstruction (PUJO).PATIENTS, SUBJECTS AND METHODSThe study included 35 children with unilateral PUJO who had a pyeloplasty, and 30 healthy control children. Urine samples were obtained from the bladders of patients before surgery, and as voided samples at 1, 2, 3, 6, 9 and 12 months after surgery. Bladder urine samples were also collected from all 30 children in the control group. TGF‐β1 and EGF were then measured in all the urine samples.RESULTSThe level of bladder TGF‐β1 before surgery in the patients was significantly higher than that in the healthy control group. A threshold of 190 pg/mg creatinine gave a sensitivity of 100%, a specificity of 80%, a positive predictive value of 85.4%, negative predictive value of 100% and an overall accuracy of 90.8%. Compared with the value before surgery, urinary TGF‐β1 was significantly lower at 1 year after pyeloplasty. There was no significant difference between the level of EGF before surgery in the patients and that in the control group, and no significant difference in the level of EGF before and after surgery over the follow‐up.CONCLUSIONWe do not recommend using EGF levels in voided urine in the routine diagnosis of children with hydronephrosis. The urinary level of TGF‐β1 is a useful noninvasive tool for the long‐term follow‐up of children with PUJO treated by pyeloplasty. Further studies with various controls are required to confirm the diagnostic accuracy of TGF‐β1 in children with PUJO.
Differences and commonalities in the management of locally advanced prostate cancer: results from a survey of oncologists and urologists in the UK
Authors: Payne Heather A. , Gillatt David A. 
Published: January 2007

OBJECTIVETo determine the management practices used by UK oncologists and urologists for patients with locally advanced (non‐metastatic) prostate cancer.METHODSUsing a postal questionnaire, 155 practising specialist oncologists and urologists were surveyed in the UK. Their views were sought on a multidisciplinary approach to the management of locally advanced prostate cancer and their current management practices.RESULTSOver half of respondents recognized the need for both oncologists and urologists to take the lead in management decisions, but almost as many still expected the sole responsibility to lie within their own speciality. Radical radiotherapy (RT) was considered the current optimum treatment by most respondents, but 22% of urologists thought that radical prostatectomy is optimal. Most responders would use luteinizing hormone‐releasing hormone agonists as neoadjuvant and adjuvant to RT but there was significant variation in the favoured duration of treatment of these drugs, and in the dose of RT.CONCLUSIONThis survey suggests that there are still wide variations in the management practices for locally advanced prostate cancer in the UK, and between urologists and oncologists. Improved consensus guidelines are required.
The role of the urothelium in mediating bladder responses to isoprenaline
Authors: Murakami Shigetaka , Chapple Christopher R. , Akino Hironobu , Sellers Donna J. , Chess‐Williams Russell 
Published: January 2007

OBJECTIVESTo investigate whether the responses of the pig bladder to isoprenaline (a nonselective β‐adrenoceptor agonist) are influenced by the presence of an intact urothelium and whether any influence might be attributed to the release of nitric oxide (NO), since stimulation of β‐adrenoceptors induces a direct relaxation of detrusor smooth muscle and β‐adrenoceptors are also present on the urothelium.MATERIAL AND METHODSPaired (in the presence or absence of urothelium) longitudinal strips of pig bladder dome were set up in tissue baths and the developed tension recorded. Relaxation responses to isoprenaline were examined after pre‐contraction with carbachol. The inhibitory effects of isoprenaline were examined by comparing responses to carbachol in the absence and presence of isoprenaline. To examine a possible role for NO, similar experiments were performed in the presence of the NO synthase inhibitor NG‐nitro‐l‐arginine (L‐NNA).RESULTSIn the presence of the urothelium, both the potency (pEC50) and the maximum contractile responses to carbachol were depressed. In relaxation experiments, isoprenaline relaxed carbachol pre‐contracted tissues by ≈75%, and the potency and maximum relaxation were similar in the absence and presence of the urothelium. In the inhibition experiments, the presence of isoprenaline caused rightward parallel shifts of the concentration‐response curves to carbachol, but isoprenaline did not influence the maximum contractions. In the presence of the urothelium there was a greater shift with 0.1 µm isoprenaline than in denuded tissues. Incubation with L‐NNA did not affect the influence of the urothelium on responses to isoprenaline in any experimental group.CONCLUSIONSThe relaxation responses of the bladder to isoprenaline do not appear to involve the urothelium or NO release in vitro. However, contractile responses to carbachol were inhibited in the presence of an intact urothelium, and this might reflect the release of an inhibitory factor other than NO.
The long‐term results of transurethral vaporization of the prostate using plasmakinetic energy
Authors: Kaya Cevdet , Ilktac Abdullah , Gokmen Ersin , Ozturk Metin , Karaman Ihsan M. 
Published: January 2007

OBJECTIVETo assess the long‐term efficacy and the safety of plasmakinetic vaporization of prostate (PKVP, Gyrus Medical Ltd., Bucks, UK) against standard transurethral resection of the prostate (TURP) for symptomatic prostatic obstruction.PATIENTS AND METHODSOf 75 patients admitted to our clinic with symptomatic prostatic obstruction between 2001 and 2003, 40 who were randomized to undergo either TURP or PKVP, and who had returned for the follow‐up, were included in this study. All treated patients completed the 36‐months of follow‐up; 25 had had PKVP and 15 a standard TURP. After surgery the treatment outcome was evaluated using the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax) and long‐term complications of surgery.RESULTSThe two groups had similar baseline characteristics. The improvement in both groups was statistically significant for the IPSS and Qmax at 24 and 36 months vs the baseline values (P < 0.05). The mean (sd) IPSS decreased from 21 (3.4) to 7.1 (1.5) and 7.6 (1.4) after PKVP and from 22 (3.8) to 5.2 (1.1) and 5.7 (1.2) after TURP, at 24 and 36 months, respectively. The mean Qmax for the both groups increased significantly from baseline values at 2 and 3 years, respectively, at 20.8 (2.4) and 21.8 (3.1) mL/s after TURP, which was statistically significantly better than after PKVP, at 12.5 (2.1) and 14.4 (2.6) mL/s, respectively (P < 0.05). Although three patients (12%) in the PKVP group had TURP at 14, 20 and 36 months, respectively, for residual adenoma tissue, one patient had an additional operation after TURP. Bulbar urethral strictures occurred in one patient in each group, requiring internal optical urethrotomy. Erectile dysfunction was reported by three patients after PKVP (12%) and by two of 15 after TURP who were potent before surgery (P > 0.05). The retrograde ejaculation rates in patients with erectile function were similar in both groups (56% and nine of 15, respectively; P > 0.05). In the PKVP and TURP groups, 12 (48%) and nine of 15 patients were satisfied overall.CONCLUSIONSAlthough early results showed that PKVP was a good alternative technique among the minimally invasive methods for surgically managing prostatic obstruction, the clinical outcome of PKVP in the long term was not comparable to the results after TURP.