bluuebunny/crossref_metadata_2025_split huggingface dataset:
Melanoma associated with pseudoepitheliomatous hyperplasia: a case series and investigation into the role of epidermal growth factor receptor
Authors: Mott Ryan T. , Rosenberg Arlene , Livingston Sandra , Morgan Michael B. 
Published: March 2003

Background:  Pseudoepitheliomatous hyperplasia (PEH) is a reactive epithelial proliferation that occurs in response to underlying infectious, inflammatory, and neoplastic conditions. The histologic features of PEH may simulate squamous cell carcinoma and may obscure an underlying malignant process. The association of PEH with benign melanocytic nevi is well described in the literature. However, reports documenting the association of PEH with melanoma are rare.Methods:  We examined the demographic and histologic features in 13 cases of melanoma in association with PEH. In addition, we evaluated the possible pathogenic role of epidermal growth factor receptor (EGFR) using immunohistochemical methods.Results:  In each case, histologic examination revealed epidermal hyperplasia with irregular cords of well‐differentiated epithelial cells extending into the dermis and infiltrating the melanoma. Although overlap existed, two patterns of epidermal hyperplasia were noted. The majority of cases (69%) exhibited acanthosis, hyperkeratosis, papillomatosis, and irregular infiltrating epithelial cords with squamous eddies. The remaining cases demonstrated basaloid acanthosis, laminated orthokeratosis, and horn cysts. EGFR immunohistochemical studies revealed strong staining within the basal layer of the epithelium, with no discernible difference between the hyperplastic epithelium overlying the melanoma cells and adjacent normal skin. Immunostaining among the melanoma cells was absent to weak in each of the cases. All cases exhibited intense EGFR immunoreactivity in macrophages underlying the epidermal lesions.Conclusions:  Melanoma is capable of presenting in a variety of histologic guises, including a pattern with PEH. The etiology of PEH, as rarely seen in conjunction with melanoma, unlikely involves EGFR and remains to be elucidated.
CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy): a neurovascular disease diagnosed by ultrastructural examination of the skin
Authors: Kanitakis Jean , Thobois Stéphane , Claudy Alain , Broussolle Emmanuel 
Published: March 2003

Background: CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a recently recognized neurovascular disease due to mutations of the Notch3 gene, manifesting with strokes or stroke‐like episodes, major psychiatric symptoms and dementia. The diagnosis can be confirmed either by molecular analysis or by ultrastructural examination of the brain or more simply the skin.Methods:  The skin of a patient with a suspected diagnosis of CADASIL was studied by electron microscopy.Results: Characteristic granular osmiophilic material within the basement membrane surrounding pericytes and smooth muscle cells of small and medium‐sized vessels of the skin were found, confirming the diagnosis of CADASIL.Conclusions: CADASIL is an additional example of a neurologic disease that can be diagnosed thanks to electron microscopic examination of the skin. Dermatopathologists should be aware of these ultrastructural findings, all the more so since the disease could be more common than originally thought.
CD4+ T lymphocytopenia with disseminated HPV
Authors: Stetson Cloyce L. , Rapini Ronald P. , Tyring Stephen K. , Kimbrough Robert C. 
Published: March 2003

Background:  There have been several reports of HIV‐negative patients with chronic idiopathic CD4+ T lymphocytopenia, the diagnostic criteria for which are: depressed numbers of circulating T lymphocytes (less than 300/µl or less than 20%) on more than one occasion; no laboratory evidence of HIV‐1 or HIV‐2 infection; and the absence of any defined immunodeficiency or therapy associated with depressed levels of CD4+ T lymphocytes.Methods: We report a patient with disseminated human papillomavirus infection associated with idiopathic CD4+ T‐cell lymphocytopenia. A 50‐year‐old woman presented to the dermatology clinic with a 10‐year history of widespread verrucae involving the skin and the cervix.Results: Biopsy from the arm revealed a common wart. PCR analysis performed from the paraffin‐embedded block was strongly positive for HPV type 2. Other HPV types (including EV‐associated HPV 5, 8, 14, 15, 17) were not found. Further laboratory work up revealed T‐cell lymphocytopenia, with an absolute CD4 count of 21. HIV tests were repeatedly negative. She was treated with interferon A 8 million units SQ three times per week with partial improvement. The patient underwent a hysterectomy for cervical dysplasia and a vulvectomy for vulvar intraepithelial neoplasia. She developed small‐cell lung carcinoma and died.Conclusions: The diagnosis of idiopathic CD4+ T‐cell lymphocytopenia should be considered in any patient with widespread viral, fungal, or mycobacterial infection whose HIV test is negative, and appropriate evaluation of the absolute CD4+ counts should be performed.
Histomorphologic and immunophenotypic analysis of fibrofolliculomas and trichodiscomas in Birt–Hogg–Dube syndrome and sporadic disease
Authors: Collins Gary L. , Somach Stephen , Morgan Michael B. 
Published: March 2003

Background:  Fibrofolliculomas and trichodiscomas are benign dermal neoplasms that likely derive from the mantle of the hair follicle and can occur sporadically or in association with Birt–Hogg–Dube syndrome (BHDS). Little is known about the pathogenesis and immunophenotypic properties of these entities.Methods:  We investigated the histomorphologic and immnophenotypic properties of 15 fibrofolliculomas and trichodiscomas in two patients with BHDS and eight with sporadic disease.Results:  We found the following: (1) fibrofolliculomas and trichodiscomas occurring in the setting of BHDS show microscopically contiguous histomorphologic features as compared to those occurring sporadically; (2) the immunophenotypic characteristics of syndromic‐associated and sporadic types are identical and consist of (3) perifollicular vimentin (+), CD34 (+) and Factor XIII (–) spindle cells.Conclusions:  Despite subtle histomorphologic differences, trichodiscomas and fibrofolliculomas are immunophenotypically similar, and are thus likely derived from a similar histogenic precursor. Given the previously reported CD34 (+) immunophenotype of the hair mantle, our findings would support an origin of these lesions from the mantle of the hair follicle. The proliferation of CD34 (+) spindle cells seen in conjunction with these lesions should not be confused with other CD34 (+) dermal entities.
Keratinocyte dysplasia: an usual finding after transplantation or chemotherapy
Authors: Castaño Esther , Rodríguez‐Peralto Jose Luis , López‐Ríos Fernando , Gómez Carlos , Zimmermann Marta , Iglesias Díez Luis 
Published: March 2003

Background:  Keratinocyte dysplasia is a histologic abnormality that has rarely been described in the first weeks after chemotherapy or transplantation. The purpose of this study was to determine the prevalence of early keratinocyte dysplasia after chemotherapy or transplant and to analyze the relationship between dysplasia and chemotherapeutic agents, transplantation or development of acute graft vs. host disease (GvHD).Methods:  A computer search for transplant patients was performed in the Departments of Hematology, Oncology and Surgery. Only patients with a skin biopsy taken within the first days of transplantation or chemotherapeutic treatment were included in the analysis.Results:  Forty‐four patients were included, of these 19 were women and 25 were men. Thirty‐four (77.3%) of 44 biopsies showed keratinocyte dysplasia. This dysplasia was severe in 18 cases (40.9%). Cyclophosphamide was more likely to be associated with severe keratinocyte maturation disturbances (OR = 5.51) (p < 0.01) whereas cytarabine was associated with a lower risk (OR = 0.19) (p < 0.05).Conclusions:  Severe keratinocyte dysplasia is a usual histologic finding in patients who have received chemotherapy and/or transplantation (40.9%). Cyclophosphamide is the main chemotherapeutic agent significantly associated with a higher risk of severe dysplasia (OR = 5.51). Causes other than GvHD or preconditioning treatment may be involved in the keratinocyte dysplasia, as it can be also found in transplanted patients who have not received chemotherapy and/or have not developed GvHD.
Mucocutaneous pigmented macule as a result of zinc deposition
Authors: Greenberg J. E. , Lynn M. , Kirsner R. S. , Elgart G. W. , Hanly A. J. 
Published: March 2003

Background:  Mucocutaneous depositions of various metals such as silver, lead, gold, arsenic, mercury, iron, and bismuth have been previously published. Heavy metal deposition typically occurs in the setting of either prolonged topical application to intact skin, topical application to eroded or ulcerated skin, as a result of either parenteral administration, or due to penetrating traumatic exposure.Method:  We report a unique case of mucocutaneous pigmentation occurring in a snow skier after topical application of a zinc‐containing sunblock. Formalin‐fixed paraffin‐embedded tissue was utilized for electron microscopy.Result:  Backscatter electron imaging and energy dispersive spectroscopy revealed that the dominant metal present was zinc.Conclusions:  Mucocutaneous deposition of metals is enhanced by damage to the surface epithelium. Metal‐containing topical agents, although commonly used, may rarely result in a permanent pigmentary alteration. We believe similar cases of mucocutaneous deposition of zinc exist; however, as these may be currently misdiagnosed as amalgam tattoos, the true incidence of this disorder is presently undefined.
Medicaid Enrollment among Elderly Medicare Beneficiaries: Individual Determinants, Effects of State Policy, and Impact on Service Use
Authors: Pezzin Liliana E. , Kasper Judith D. 
Published: March 2003

Objective. To better understand factors associated with Medicaid enrollment among low‐income, community‐dwelling elderly persons and to examine the effect of Medicaid enrollment on the use of health care services by elderly persons, taking into account selection in program participation.Data Sources. 1996 Medicare Current Beneficiary Survey (MCBS) Access to Care and Cost and Use files.Methods. Individual‐level predictions of the probability of dual enrollment are obtained from equations that estimate jointly the residential status of Medicare beneficiaries (community versus institution) and the probability of Medicaid enrollment among community‐dwelling eligible beneficiaries. Predicted values are then substituted into the service use equations, which are estimated via two‐part models.Principal Findings. Less than half of all community‐dwelling elderly persons with incomes at or below 100 percent of the Federal Poverty Level (FPL) were enrolled in Medicaid in 1996. Once selective enrollment was accounted for, there was limited evidence of a dual enrollment effect on service use. Although there were no effects of state Medicaid policy variables on the probability that beneficiaries lived in the community (as opposed to nursing homes), the effects of state's Medicaid generosity in home and community‐based services had a sizeable and statistically significant effect on influencing the likelihood that eligible elderly persons enrolled in Medicaid.Conclusions. Our results provide compelling evidence that Medicaid participation can be influenced by state policy. The observation that „policy matters” provides new insights into how existing programs might reach a larger proportion of potentially eligible beneficiaries.
The Determinants of HMOs’ Contracting with Hospitals for Bypass Surgery
Authors: Gaskin Darrell J. , Escarce José J. , Schulman Kevin , Hadley Jack 
Published: March 2003

Objective. Selective contracting with health care providers is one of the mechanisms HMOs (Health Maintenance Organizations) use to lower health care costs for their enrollees. However, are HMOs compromising quality to lower costs? To address this and other questions we identify factors that influence HMOs’ selective contracting for coronary artery bypass surgery (CABG).Study Design. Using a logistic regression analysis, we estimated the effects of hospitals’ quality, costliness, and geographic convenience on HMOs’ decision to contract with a hospital for CABG services. We also estimated the impact of HMO characteristics and market characteristics on HMOs’ contracting decision.Data Sources. A 1997 survey of a nationally representative sample of 50 HMOs that could have potentially contracted with 447 hospitals.Principal Findings. About 44 percent of the HMO‐hospital pairs had a contract. We found that the probability of an HMO contracting with a hospital increased as hospital quality increased and decreased as distance increased. Hospital costliness had a negative but borderline significant (0.10<p<0.05) effect on the probability of a contract across all types of HMOs. However, this effect was much larger for IPA (Independent Practice Association)‐model HMOs than for either group/staff or network HMOs. An increase in HMO competition increased the probability of a contract while an increase in hospital competition decreased the probability of a contract. HMO penetration did not affect the probability of contracting. HMO characteristics also had significant effects on contracting decisions.Conclusions. The results suggest that HMOs value quality, geographic convenience, and costliness, and that the importance of quality and costliness vary with HMO. Greater HMO competition encourages broader hospital networks whereas greater hospital competition leads to more restrictive networks.
Understanding Coordination of Care from the Consumer's Perspective in a Regional Health System
Authors: Harrison Alexandra , Verhoef Marja 
Published: March 2003

Objective To understand and develop a model about the meaning of coordination to consumers who experienced a transition from acute care to home care.Study Design. A qualitative, exploratory study using Grounded Theory.Data Sources/Analysis. Thirty‐three consumers in the Calgary Regional Health Authority who had experienced the transition from an acute care hospital back into the community with home care support were interviewed. They were asked to describe their transition experience and what aspects of coordination were important to them. Interviews were recorded, transcribed, and analyzed using constant comparison. The coding and retrieval of information was facilitated by the computer software program Nud*ist.Principal Findings. The resulting model has four components: (1) the meaning of coordination to consumers; (2) aspects of health care system support that are important for coordination; (3) elements that prepared consumers to return home; and (4) the components of a successful transition experience. Consumers appeared to play a crucial role in spanning organizational boundaries by participating in the coordination of their own care.Conclusions. Consumers must be included in health care decisions as recipients of services and major players in the transition processes related to their care. Health care providers need to ensure that consumers are prepared to carry out their coordination role and managers need to foster a culture that values the consumer “voice” in organizational processes.
Managed Behavioral Health Care: An Instrument to Characterize Critical Elements of Public Sector Programs
Authors: Susan Ridgely M. , Giard Julienne , Shern David , Mulkern Virginia , Audrey Burnam M. 
Published: March 2003

Objective. To develop an instrument to characterize public sector managed behavioral health care arrangements to capture key differences between managed and „unmanaged” care and among managed care arrangements.Study Design. The instrument was developed by a multi‐institutional group of collaborators with participation of an expert panel. Included are six domains predicted to have an impact on access, service utilization, costs, and quality. The domains are: characteristics of the managed care plan, enrolled population, benefit design, payment and risk arrangements, composition of provider networks, and accountability. Data are collected at three levels: managed care organization, subcontractor, and network of service providers.Data Collection Methods. Data are collected through contract abstraction and key informant interviews. A multilevel coding scheme is used to organize the data into a matrix along key domains, which is then reviewed and verified by the key informants.Principal Findings This instrument can usefully differentiate between and among Medicaid fee‐for‐service programs and Medicaid managed care plans along key domains of interest. Beyond documenting basic features of the plans and providing contextual information, these data will support the refinement and testing of hypotheses about the impact of public sector managed care on access, quality, costs, and outcomes of care.Conclusions. If managed behavioral health care research is to advance beyond simple case study comparisons, a well‐conceptualized set of instruments is necessary.
Undergraduate education in endodontology at two European dental schools
Authors: Petersson Kerstin , Olsson Helena , Söderström Christina , Fouilloux Isabelle , Jegat Nadège , Lévy Gérard 
Published: March 2003

The aim of this study was to compare the courses in endodontics and to assess the treatment quality in the student clinics in two dental schools, in Malmö, Sweden and Paris, France. A further aim was to improve the curriculum development in Paris 5 and Malmö by testing student exchange programmes. The comparison was based on the guidelines for undergraduate education set up by the European Society of Endodontology (ESE) [Int. Endod. J. 25 (1992) 169] and on the criteria formulated by Qualtrough and Dummer [Int. Endod. J. 30 (1997) 234]. The latter criteria covered the following aspects: educational methods, the timing of endodontic teaching, pre‐clinical practical exercises, student assessment, recommended literature, clinical/practical procedures, the education of the staff and number of students per teacher. The quality guidelines for endodontic treatment set up by the ESE [Int. Endod. J. 27 (1994) 115] were used for the assessment of the quality of the treatment. The following aspects were covered: history, diagnosis and treatment planning, records, infection control, root‐canal treatment, assessment of endodontic treatment. The undergraduate education in endodontics was fundamentally similar in Paris 5 and Malmö. The main differences observed were related to:

Educational methods: In Malmö, problem‐based learning and in Paris 5, traditional.
Assessment of student performance. In Malmö, self‐assessment and in Paris 5, credits for clinical/practical procedures.
Clinical/practical procedures relating to infection control. Aseptic treatment regimens were more meticulously performed in Malmö than in Paris 5.
Assessment (follow‐up) of all endodontic treatments was a routine only in Malmö.
The role of activin a in the maternal systemic inflammatory response in preeclampsia
Authors: Sargent Ian L. , Tannetta Dionne S. , Muttukrishna Shanti , Redman Chris W.G. 
Published: March 2003

BACKGROUND:  The maternal syndrome of preeclampsia is associated with a systemic inflammatory response. Circulating levels of activin A are significantly elevated in preeclampsia. The aims of this study were to determine whether activation of trophoblast, peripheral blood mononuclear cells (PBMC) and endothelial cells by pro‐inflammatory cytokines is the cause of these high levels of activin A and to investigate its role in leucocyte activation and endothelial cell function.RESULTS:  Term villous cytotrophoblast and endothelial cells (HUVECS) secreted increased levels of activin A in response to TNF‐α and IL‐1. PBMC from nonpregnant, normal pregnant and preeclamptic women did not spontaneously release activin A, but LPS and TNF‐stimulated production, with higher levels in preeclampsia. Activin A had no effect on the expression of leucocyte activation markers but significantly reduced the secretion of TNF‐α by activated PBMC although this effect was less marked in pregnancy. Activin A significantly inhibited HUVEC proliferation in a dose dependent manner.CONCLUSIONS:  The high circulating levels of activin A in preeclampsia may result from the effects of the inflammatory response on trophoblast, PBMC and endothelial cells. Although activin A has anti‐inflammatory properties on nonpregnant cells, this effect is reduced in pregnancy. The raised levels of activin A may also cause endothelial cell dysfunction, thus exacerbating the maternal syndrome.
T and B Lymphocyte Subsets in Patients with Unexplained Recurrent Spontaneous Abortion: IVIG versus Placebo Treatment
Authors: Jablonowska Barbara , Palfi Miodrag , Matthiesen Leif , Selbing Anders , Kjellberg Svante , Ernerudh Jan 
Published: March 2003

Jablonowska B, Palfi M, Matthiesen L, Selbing A, Kjellberg S, Ernerudh J. T and B Lymphocyte subsets in patients with unexplained recurrent spontaneous abortion: IVIG versus placebo treatment. AJRI 2002; 48:312–318 © Blackwell Munksgaard, 2002PROBLEM: To investigate circulating lymphocyte subsets in women with recurrent spontaneous abortion (RSA) in relation to pregnancy outcome and to treatment with intravenous immunoglobulin (IVIG).METHOD OF STUDY: Forty‐one women with a history of unexplained RSA were examined during first trimester of pregnancy before IVIG or placebo treatment and after pregnancy. The results were compared with five healthy, non‐pregnant women and five women in the first trimester of normal pregnancy. Circulating lymphocyte subsets with focus on T‐cell subpopulations were determined by flow cytometry.RESULTS: The proportions of human leukocyte antigen (HLA)‐DR positive T cells (CD3+ HLA‐DR+), T‐killer/effector cells (CD8+ S6F1+) and B cells (CD19+) were increased, whereas the proportion of T‐suppressor/inducer cells (CD4+ CD45RA+) was decreased during first trimester pregnancy of RSA women compared with pregnant normal controls. T and B lymphocyte subsets did not correlate with pregnancy outcome on either IVIG or placebo group.CONCLUSIONS: In RSA patients, the immune system seems to be activated in contrast to the suppression noted in normal pregnancy.