bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prospective study of the use of cryosurgery for the treatment of actinic keratoses
Authors: Thai Keng‐Ee , Fergin Peter , Freeman Michael , Vinciullo Carl , Francis David , Spelman Lynda , Murrell Dedee , Anderson Chris , Weightman Warren , Reid Catherine , Watson Alan , Foley Peter 
Published: September 2004

AbstractBackground  Actinic keratoses are the most common actinic lesions on Caucasian skin. Cryosurgery with liquid nitrogen is commonly used to treat actinic keratoses, but there have been few studies examining the true rate of cure in everyday dermatologic practice.Aim  To determine prospectively the true efficacy of cryosurgery as a treatment for actinic keratoses in everyday dermatologic practice.Methods  A prospective, multicentered study (a subsidiary study of a photodynamic therapy trial) was performed. Patients with untreated actinic keratoses greater than 5 mm in diameter on the face and scalp were recruited. Eligible lesions received a single freeze–thaw cycle with liquid nitrogen given via a spray device and were reviewed 3 months thereafter. Each center used their preferred freeze time. The only treatment criterion was complete freezing of actinic keratoses and a 1‐mm rim of normal skin. Treated lesions were assessed as complete response or noncomplete response. The influence of the duration of freeze, cosmetic outcomes, and adverse events were examined.Results  Ninety adult patients from the community with 421 eligible actinic keratoses were recruited. The overall individual complete response rate was 67.2%[SEM = ±3.5%; 95% confidence interval (CI) = 60.4–74.1%]. Complete response was 39% for freeze times of less than 5 s, 69% for freeze times greater than 5 s, and 83% for freeze times greater than 20 s. Cosmetic outcomes were good to excellent in 94% of complete response lesions. The main adverse events were pain, stinging, and burning during treatment, and hypopigmentation after healing.Conclusions  Cryosurgery is an effective treatment for actinic keratoses. The true complete response rate is significantly lower than that previously reported. The freeze duration influences successful treatment. Adverse events are mild and well tolerated.
Pemphigus vulgaris with involvement of the cervix treated using thalidomide therapy
Authors: Cunha Paulo Rowilson , De Oliveira Josenildo Rodrigues , Salles Maria José , Jamora Jasmin , Bystryn Jean‐Claude 
Published: September 2004

A 55‐year‐old White woman was first seen in July 1995 with ulceration of the oral mucosa, including the gingiva, labial mucosa, gums, palate and tongue, as well as erosions and blisters on the trunk. A biopsy showed a suprabasal blister with acantholysis. Direct immunofluorescence was positive for intercellular deposits of IgG and C3, and indirect immunofluorescence was positive for intercellular antibodies at a titer of 160. The patient was diagnosed as having pemphigus vulgaris and treated with prednisone 1–1.5 mg/kg/day from 1995 until 1998, but no response was observed (the disease continued to be active with the formation of new lesions). The patient developed a number of steroid‐induced complications including diabetes, osteoporosis, Cushing syndrome, hypertension and high‐output cardiac failure, and required repeated hospitalization. In August 1998 she was started on azathioprine 100–150 mg/day and continued on prednisone 1 mg/kg/day. One year later, in August 1999, the disease was still active with new lesion formation and persistent oral erosions and dysphagia, despite persistent therapy with azathioprine 150 mg/day and prednisone 1 mg/kg/day.Because of the disease severity and the lack of a response to treatment, in October 1999 the patient was started on thalidomide therapy 100 mg/day (1.7 mg/kg/day) and continued the prednisone treatment at 1 mg/kg/day together with azathioprine 150 mg/day (2.7 mg/kg/day). There was a good response, with clearing of all oral lesions in 20 days. The prednisone dose was gradually reduced and was discontinued in May 2000; azathioprine was gradually reduced to 50 mg 3 times/week (0.35 mg/kg/day). Thalidomide was continued at a dose of 100 mg/day. The patient was in total clinical remission, being free of both old and new lesions, for the next 14 months, when the thalidomide treatment was discontinued as a result of side‐effects, including weakness in the legs and paresthesis of the fingers.After the discontinuance of treatment with thalidomide, severe lesions returned. Thalidomide was reintroduced, at 100 mg/day. After 2 months the patient entered total clinical remission and on the last occasion on which she was seen, in May 2003, was found to have remained clear of lesions. The patient continues to take thalidomide at 100 mg/day.
Itraconazole in the treatment of New World mucocutaneous leishmaniasis
Authors: Calvopina Manuel , Guevara Angel G. , Armijos Rodrigo X. , Hashiguchi Yoshihisa , Davidson Robert N. , Cooper Philip J. 
Published: September 2004

AbstractBackground  A well‐tolerated oral drug is required for the treatment of mucocutaneous leishmaniasis (MCL). Current parenteral treatment regimens with pentavalent antimonials are associated with marked toxicity and significant rates of relapse.Aim  To evaluate the efficacy and tolerability of high‐dose itraconazole for the treatment of MCL.Methods  An uncontrolled treatment study was performed in 13 Ecuadorian patients with MCL. Each patient received a daily dosage of 400 mg of itraconazole for a minimum of 3 months.Results  All 13 subjects responded to itraconazole during the first month of treatment, but by 12 months after treatment the complete resolution of MCL lesions was observed in only three (23%) subjects. No adverse effects of treatment were reported. Response to treatment was associated with a short evolution of the disease and mild to moderate disease severity.Conclusion  Prolonged and high‐dose treatment regimens with itraconazole are not effective for the treatment of the majority of patients with MCL.
The association of hepatitis A and Helicobacter pylori with sensitization to common allergens, asthma and hay fever in a population of young British adults
Authors: Jarvis D. , Luczynska C. , Chinn S. , Burney P. 
Published: September 2004

Background:  A negative association of oro‐faecally spread infection with serological markers of sensitization and allergic disease has been reported.Method:  Previous infection with hepatitis A and Helicobacter pylori was assessed in a community‐based sample of young British adults and associations with serum‐specific IgE to environmental allergens, asthma‐like symptoms and hay fever were examined.Results:  There was no association of previous infection with hepatitis A or H. pylori with wheeze or hay fever. There was no evidence of an association of infection with either agent and sensitization except for the isolated finding of a lower prevalence of sensitization to grass in those with IgG antibodies to H. pylori (OR 0.65, 95% CI 0.43–0.99). This association did not explain the negative association of family size with sensitization to grass.Conclusion:  In this population, there was no evidence that infection with hepatitis A or H. pylori was associated with lower levels of IgE sensitization, asthma or hay fever except for an isolated finding of a negative association of H. pylori infection with sensitization to grass.
Atopic disorders among Estonian schoolchildren in relation to tuberculin reactivity and the age at BCG vaccination
Authors: Annus T. , Montgomery S. M. , Riikjärv M.‐A. , Björkstén B. 
Published: September 2004

Background:  Published data about a relationship of atopic diseases to Bacillus Calmette‐Guérin (BCG) vaccination and tuberculin responses are inconsistent. Our aim was to determine this association in a country with a low prevalence of allergies.Methods:  A random sample of 10–11‐year‐old schoolchildren in Tallinn was studied by a parental questionnaire (n = 979) and skin‐prick tests (n = 643), according to the International Study of Asthma and Allergies in Childhood. Data about BCG vaccinations and tuberculin tests were obtained from school records (n = 723).Results:  The prevalence of allergic symptoms and atopy was similar in children vaccinated during the first month of life and later. Positive tuberculin responses (≥5 mm) were inversely related to symptoms of asthma [odds ratio (OR) 0.10 (95% confidence interval 0.00–0.68) for exercise‐induced wheezing; OR 0.37 (0.12–0.99) for night cough], and eczema [OR 0.53 (0.28–0.98)] but not to atopy. However, among BCG‐revaccinated children, atopy tended to be more common in tuberculin responders, and the atopic children were significantly more likely to have a positive tuberculin response after the revaccination than would be predicted by their first test.Conclusions:  We found no protective effect of early BCG vaccination against atopy in school age, although tuberculin responses and allergic symptoms were inversely related.
The basophil activation test in wasp venom allergy: sensitivity, specificity and monitoring specific immunotherapy
Authors: Erdmann S. M. , Sachs B. , Kwiecien R. , Moll‐Slodowy S. , Sauer I. , Merk H. F. 
Published: September 2004

Background:  As in vitro diagnosis of wasp venom sensitization by specific serum IgE has a sensitivity of only 60–80%, additional in vitro tests are desirable. Basophil activation is associated with the expression of CD63 and its measurement has been proposed as a novel in vitro test for immediate‐type allergy. Furthermore, to date, no in vitro test exists to monitor successful specific immunotherapy (SIT) with wasp venom. Therefore, the potentially harmful sting challenge is still recommended.Objective:  We compared the CD63‐based basophil activation test (BAT) in the diagnosis of wasp venom allergy with skin tests and measurement of specific IgE. Furthermore, we investigated whether BAT can predict the outcome of the sting challenge in patients on SIT.Methods:  Fifty patients with a systemic reaction caused by a wasp sting and 20 controls were studied. Intracutaneous tests were performed with wasp and bee venom in the suspected allergics. Specific IgE was determined by the CAP‐FEIA method and basophil activation by flow cytometry upon double staining with anti‐IgE/anti‐CD63 mAb. Twenty‐five patients were sting challenged 6 months after starting SIT and the BAT was repeated before challenge.Results:  Sensitivity of the intracutaneous tests, specific IgE and BAT was 100, 76, and 92%, respectively. Specificity of specific IgE and the BAT was 85 and 80%, respectively. The cut‐off for a positive BAT was 15% CD63+ basophils. There was a positive correlation between IgE reactivity to wasp venom and the number of CD63+ basophils (r = 0.65). Although no patient had a systemic reaction upon sting challenge, in most subjects basophil activation did not decrease when compared with the BAT before SIT.Conclusions:  Quantitation of basophil activation by CD63 expression is a valuable new in vitro method for diagnosis of allergy to hymenopteran venoms. The CD63‐based BAT is a helpful tool for the complementation of routine diagnostic tests such as specific IgE as it increases sensitivity of in vitro detection of sensitization. However, this in vitro method does not offer an alternative to the sting challenge in monitoring successful SIT.
Pseudoallergic reactions in chronic urticaria are associated with altered gastroduodenal permeability
Authors: Buhner S. , Reese I. , Kuehl F. , Lochs H. , Zuberbier T. 
Published: September 2004

Background:  In a subgroup of patients with chronic urticaria (CU) the disease is caused by pseudoallergic reactions to food. The aim of this study was to investigate whether disturbances of the gastrointestinal barrier function play a role in the pathomechanism of the disease.Methods:  In 55 patients with CU gastrointestinal permeability was measured with an in vivo triple‐sugar‐test before and after 24 days of a diet low in pseudoallergens. Sucrose served as marker for gastroduodenal permeability, lactulose/mannitol ratio for intestinal permeability.Results:  Basal gastroduodenal and intestinal permeability were significantly higher in patients with urticaria as compared to controls. In 29 of the 55 patients skin symptoms decreased or completely disappeared during the diet (responders). Compared to nonresponders (n = 26), responders had a significantly higher gastroduodenal permeability before treatment (0.36 ± 0.04 vs 0.15 ± 0.01% sucrose; P < 0.001), which decreased after the diet (0.17 ± 0.02; P < 0.001). The number of patients with Helicobacter pylori infections did not differ between the two groups.Conclusions:  The results indicate that in a subgroup of patients with CU and pseudoallergy an impaired gastroduodenal barrier function may be of pathophysiological importance. The underlying mechanisms seem to be independent of H. pylori infection.
Sputum eosinophil counts and eosinophil cationic protein levels in cough‐variant asthma and in classic asthma, and their relationships to airway hypersensitivity or maximal airway response to methacholine
Authors: Yoo Y. , Koh Y. Y. , Kang H. , Yu J. , Nah K. M. , Kim C. K. 
Published: September 2004

Background:  The aims of this study were to compare the degree of airway inflammation in cough‐variant asthma (CVA) with that in classic asthma (CA), and to examine the relationship between airway inflammation and airway hypersensitivity or maximal airway response to methacholine in both conditions.Methods:  Sputum was induced in 41 CVA patients, in 41 methacholine PC20‐matched CA patients, and in 20 healthy children. The sputum samples were analyzed for total and differential cell counts, and for eosinophilic cationic protein (ECP). A high‐dose methacholine challenge test was performed in CVA and CA patients to determine PC20 and maximal airway response.Results:  Sputum eosinophil percentages and ECP levels were significantly elevated in CVA and CA vs the control, but no significant differences were found between the two asthma groups. In the two asthma groups, neither sputum parameters correlated significantly with methacholine PC20. However, the absence of a maximal response plateau or its higher level, when present, was associated with increased eosinophil percentages and ECP levels in the CVA group.Conclusions:  The degree of eosinophilic inflammation may not be causally related to differences in presented asthma manifestations. The identification of a maximal response plateau and the level of this plateau in patients with CVA may provide information pertinent to airway eosinophilic inflammation.
Cardioprotective action of fentanyl in a model of central sympathetic overactivity in rabbits: antiarrhythmic and anti‐ischemic effects
Authors: Lessa M. A. , Rodrigues E. , TibiriÇá E. 
Published: September 2004

Background:  Sympathetic overactivity resulting from perioperative noxious stimuli elicits hyperdynamic cardiovascular responses that may lead to myocardial ischemia and/or ventricular arrhythmia, especially in patients presenting with coronary artery disease. In the present study we investigated the cardioprotective effects of clinically relevant doses of fentanyl in an experimental model of sympathetic overactivity associated with myocardial ischemia in anesthetized rabbits.Methods:  Central sympathetic stimulation was achieved through intracerebroventricular (i.c.v.) injection of L‐glutamate (10 µmol), with simultaneous inhibition of nitric oxide (NO) synthesis through i.v. administration of N(omega)‐nitro‐l‐arginine methyl ester (L‐NAME; 40 mg kg−1).Results:  L‐glutamate triggered ventricular arrhythmia and electrocardiographic alterations indicative of myocardial ischemia. The intravenous administration of fentanyl (5, 10 or 50 µg kg−1) reduced the incidence of ST‐segment shift (70, 20 and 10%, respectively, vs. 66.7% in controls) as well as of T‐wave inversion from 58.3% to 30, 20 and 10%, respectively. The total number of ventricular premature complexes per minute fell from 65.2 ± 16 in the control group to 6.8 ± 3, 3.5  ±  2 and 2.6 ± 1.5, respectively. The occurrence of ventricular tachycardia and bigeminy was completely abolished by fentanyl. Finally, the i.v. administration of fentanyl did not induce significant hemodynamic effects (except for dP/dtmax in the 50 µg kg−1‐dose).Conclusion:  Fentanyl elicits significant cardioprotective effects in a model of arrhythmia resulting from the association of central sympathetic overactivity with myocardial ischemia in rabbits, independently from its systemic hemodynamic actions.
Gas embolism: an exceptional complication of radial arterial catheterization
Authors: Dube L. , Soltner C. , Daenen S. , Lemarieé J. , Asfar P. , Alquier P. 
Published: September 2004

Background:  We report a rare complication of radial arterial catheterization in a 74‐year‐old man who had undergone retroperitoneal surgery for an infra‐renal aortic aneurysm. A right subclavian venous catheter and a right radial artery catheter were inserted for hemodynamic monitoring.Results:  The patient suddenly went into a coma, with dyspnea and bradycardia, 1 day postsurgery, as a result of a cerebral gas embolism produced by the accidental entry of pressurized air into the artery via the arterial catheter. Cerebral Magnetic Resonance Imaging revealed multiple, diffuse brain lesions. Six months later the patient still had a left hemiparesis and a cognitive deficit. He walks with assistance.Conclusion:  Misuse of an arterial catheter can lead to a severe gas embolism. The infusion system used to flush arterial catheters should be checked regularly to ensure it contains no gas.
Oleic acid lung injury: a morphometric analysis using computed tomography
Authors: Rylander C. , Högman M. , Perchiazzi G. , Magnusson A. , Hedenstierna G. 
Published: September 2004

Background:  The oleic acid‐induced lung injury (OAI) model is considered to represent the early phase of acute respiratory distress syndrome (ARDS). Its inherent properties are important for the design and the interpretation of interventional studies. The aim of this study was to describe the evolution of morphometric lung changes during OAI using computed tomography (CT) analysis. Furthermore, the effect of a temporary change in positive end‐expiratory pressure (PEEP) was evaluated.Methods:  Fifteen anaesthetized pigs were ventilated in volume‐controlled mode with a baseline PEEP of 5 cm  H2O. Helical CT scans were taken at baseline and 1 h after oleic acid injection. The PEEP was then either increased to 10 cm  H2O (n = 5), decreased to 0 cm  H2O (n = 5) or kept constant (n = 5) for 30 min. For the next 30 min, the baseline PEEP level was applied in all animals before the final CT scans 2 h after the induction of OAI. Dimensional and volumetric changes were determined from radiographical attenuation values.Results:  There was a major decrease in gas volume and an increase in tissue volume within the first hour. A net increase in total lung volume, with a larger transverse area but no displacement of the diaphragm, was manifest after 2 h. A minor increase in volume of non‐aerated lung, located to the caudal region, was observed during the second hour. The tidal volume was redistributed to the middle and apical regions. The temporary change in PEEP did not influence the morphological progress of OAI.Conclusion:  Decreased gas volume and increased tissue volume are the dominating morphometric characteristics of oleic acid lung injury, occurring mainly within the first hour. With these changes manifest, the course of injury is not affected by a limited period of moderately changed PEEP during the second hour. The net increase of total lung volume suggests a predominance of oedema formation over airway and alveolar collapse.
Electromyographic assessment of blink reflexes correlates with a clinical scale of depth of sedation/anaesthesia and BIS during propofol administration
Authors: Mourisse J. , Lerou J. , Zwarts M. , Booij L. 
Published: September 2004

Background:  General anaesthesia is characterized by loss of consciousness, amnesia and obtundation of reflex responses to noxious stimuli. Quantifying the blink reflex may reflect the depression of reflex arches induced by anaesthetics and thus being informative on the anaesthetic state.Methods:  The relation between the electrically evoked blink reflexes and the depth of sedation and anaesthesia induced with intravenous propofol was investigated. Twenty patients received propofol by target‐controlled infusion to create a stepwise deepening of sedation and anaesthesia. Depth of anaesthesia was assessed using the observer's assessment of anaesthesia and sedation (OAAS) scale, and by bispectral EEG analysis (BIS). Probit analysis was used to estimate the predicted propofol effect site concentrations producing unconsciousness, no response to noxious stimulation, and loss of blink reflex components.Results:  Latency of the first (R1) and second (R2) blink component increased, whereas duration and area decreased with increasing depth of sedation and anaesthesia. A reasonably strong correlation between OAAS and the areas of R1 and R2 components was found (Spearman's ρ = 0.92 and 0.89). The areas of R1 and R2 and the OAAS also correlated with BIS (Spearman's ρ = 0.91, 0.88 and 0.90). EC50 and EC95 for loss of R1 were 2.8 (95% CI: 2.5–3.2) µg/ml and 4.6 (95% CI: 4.1–5.5) µg/ml, respectively.Conclusions:  Our results suggest that the differential sensitivity of the components of the blink reflex could be useful in monitoring depth of sedation and light levels of anaesthesia during the administration of propofol. Both OAAS and BIS correlate similarly with the blink reflex components.
Presurgical intravenous parecoxib sodium and follow‐up oral valdecoxib for pain management after laparoscopic cholecystectomy surgery reduces opioid requirements and opioid‐related adverse effects
Authors: Gan T. J. , Joshi G. P. , Zhao S. Z. , Hanna D. B. , Cheung R. Y. , Chen C. 
Published: September 2004

Background:  Opioids are associated with numerous adverse effects. It is unclear if reduced postoperative opioid consumption lowers the incidence and severity of opioid‐related adverse effects. This analysis – from a multicenter, randomized, double‐blind trial – tested if the reduction of opioid consumption among patients who received intravenous preoperative parecoxib 40 mg, followed by oral valdecoxib 40 mg qd postoperatively, in Days 1–4 after outpatient laparoscopic cholecystectomy surgery, reduced opioid‐related symptoms.Methods:  Patients received intravenous fentanyl for pain before discharge, and oral acetaminophen 500 mg hydrocodone 5 mg q 4–6 h prn postdischarge for up to 7 days postsurgery. Patients also received intravenous parecoxib 40 mg administered 30–45 min preoperatively, and valdecoxib 40 mg qd up to Day 4 and prn Days 5–7 postsurgery, or placebo. Patients completed an opioid‐related Symptoms Distress Scale (SDS) questionnaire every 24 h for 7 days. Opioid use was converted to morphine‐equivalent doses (MEDs). Clinically meaningful events (CMEs) for 12 opioid‐related symptoms were assessed by three ordinal measures: frequency, severity, and bothersomeness. Reduction of CMEs on Day 1 and number of patient‐days with CMEs on Days 1–4 were examined.Results:  Cumulative MEDs on Day 0, Day 1, and Days 1–4 were significantly lower in the parecoxib/valdecoxib group compared with the placebo group (P < 0.001). At the end of Day 1, parecoxib/valdecoxib‐treated patients had significantly lower SDS scores (P < 0.02), a significantly reduced incidence of CMEs (P < 0.05), and significantly fewer patient‐days with CMEs in Days 1–4 than placebo patients (P < 0.05). Patients in the parecoxib/valdecoxib group were less likely to have CMEs for multiple symptoms than those in the placebo group (P < 0.001).Conclusions:  Treatment with parecoxib and valdecoxib significantly reduced the cumulative MED requirements, the incidence of opioid‐related adverse effects, and patient‐days with CMEs.