bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined basal cell carcinoma and Langerhans cell histiocytosis of the scrotum in a patient with occupational exposure to coal tar and dust
Authors: Izikson Leonid , Vanderpool John , Brodsky Gilbert , Mihm Martin C. , Zembowicz Artur 
Published: September 2004

The patient was a 77‐year‐old male former smoker, with history of several basal cell carcinomas (BCCs) in sun‐protected areas around the waistline, who presented with another small ulceration on the anterior right upper scrotum near the base of the penis. BCC was suspected clinically and the lesion was treated with cryosurgery. The tumor recurred, became raised, and began to bleed. On examination, it was found to be a 3 cm × 4 cm, raised, light and dark gray variegated lesion with fissures, crusted bloody scale, and necrosis. There were no other penile, testicular, or scrotal lesions or masses. There was no regional lymphadenopathy. An excisional biopsy was performed. It showed nodular BCC surrounded by a cellular proliferation of round histiocytic cells with convoluted, lobulated and reniform nuclei and abundant cytoplasm (Fig. 1). The histiocytic proliferation was associated with numerous eosinophils. Histological features and immunohistochemical phenotype, including expression of CD1a and S‐100 antigens by histiocytic cells, were all consistent with Langerhans cell histiocytosis. As expected, BCC expressed keratin.(a) Low magnification (×40) view of the scrotal tumor showing nodular basal cell carcinoma surrounded by a cellular zone of Langerhans cell proliferation. (b) Langerhans cells showed typical irregular reiniform nuclei with convoluted outlines and were associated with eosinophilic infiltrate (×400). In immunohistochemical studies, they expressed (c) S‐100 and (d) CD1A antigens (both ×400)imageThe patient had no history of exposure to ionizing radiation, chemotherapy, immunosuppressive medications, prior lymphoma or other malignancy. However, he spent 4 years on a ship loading coal into the furnace of a steam engine, during which he slept in adjacent quarters that were covered with coal dust. Additionally, he had a several‐year history of occupational skin exposure to machine oil, oil refinery waste, sulfur waste, hydraulic fluid, and asbestos. He also reported a history of nude sunbathing. His current medical problems include pleural asbestosis, poorly controlled type II diabetes, and congestive heart failure. His past dermatologic history includes intertrigo, onychomycosis, and an unknown skin lesion removed from the face 40 years ago. Recent clinical follow‐up and imaging studies, including chest X‐ray and bone scan, showed no evidence of visceral lesions, lytic bone lesions, or other signs of systemic involvement by Langerhans cell histiocytosis. The scrotal lesion was re‐excised and the patient remains disease‐free more than 1 year after the diagnosis.
The CD63 basophil activation test in Hymenoptera venom allergy: a prospective study
Authors: Sturm G. J. , Böhm E. , Trummer M. , Weiglhofer I. , Heinemann A. , Aberer W. 
Published: September 2004

Background:  The basophil activation test (BAT), which relies on flow cytometric quantitation of the allergen‐induced up‐regulation of the granule‐associated marker CD63 in peripheral blood basophils, has been suggested to be a useful approach in detecting responsiveness to allergens. The purpose of this study was to establish the usefulness of the BAT with regard to the clinical history and current diagnostic tools in Hymenoptera venom allergy using a prospective study design.Methods:  Fifty‐seven consecutive patients allergic to Hymenoptera venom as defined by a systemic reaction after an insect sting, and 30 age‐ and sex‐matched control subjects with a negative history were included. The degree and nature of sensitization was confirmed by skin testing, specific immunoglobulin E (IgE), serum tryptase levels and BAT. In the nonallergic control group only analysis of specific IgE and BAT were performed. Correlation of BAT, skin test and specific IgE, respectively, with the clinical history in the allergic group was termed as sensitivity and in the control group as specificity.Results:  Twenty one of 23 (91.3%) bee venom allergic patients and 29 of 34 (85.3%) patients allergic to wasp and hornet venom tested positive in BAT. The overall sensitivity of BAT, specific IgE and skin tests were 87.7, 91.2 and 93.0%, respectively. The overall specificities were 86.7% for BAT and 66.7% for specific IgE. No correlation between the severity of clinical symptoms and the magnitude of basophil activation was observed.Conclusion:  The BAT seems to be an appropriate method to identify patients allergic to bee or wasp venom with a comparable sensitivity to standard diagnostic regimens. The higher specificity of BAT as compared with specific IgE makes this test a useful tool in the diagnosis of Hymenoptera venom allergy.
Bronchial hyperresponsiveness in children with atopic rhinitis: a 7‐year follow‐up
Authors: Cibella F. , Cuttitta G. , La Grutta S. , Hopps M. R. , Passalacqua G. , Pajno G. B. , Bonsignore G. 
Published: September 2004

Background:  A high prevalence of bronchial hyperresponsiveness (BHR) was found in atopic subjects with rhinitis. Those subjects may be at higher risk for developing bronchial asthma. We evaluated, in a 7‐year follow‐up, BHR and atopy in a homogeneous population of nonasthmatic children with allergic rhinitis (AR), and their role in asthma development.Methods:  Twenty‐eight children (6–15 years) with AR were studied. At enrollment (T0), skin tests, total serum IgE assay, peak expiratory flow (PEF) monitoring and methacholine (Mch) bronchial challenge were performed. BHR was computed as the Mch dose causing a 20% forced expiratory volume (FEV)1 fall (PD20FEV1) and as dose–response slope (DRS). Subjects were reassessed after 7 years (T1) using the same criteria.Results:  At T0, 13 children (46%), showing a PD20FEV1 <1526 μg of Mch, had BHR (Mch+), although PEF variability (PEFv) was within normal limits. None of the children with negative methacholine test developed bronchial asthma after 7 years. Of the 13 Mch+, only two reported asthma symptoms after 7 years. No significant change was seen in the other parameters of atopy considered.Conclusion:  Children with allergic rhinitis present a high prevalence of BHR. Nevertheless, their PEFv is normal and the rate of asthma development low.
Cat allergen peptide immunotherapy reduces CD4+ T cell responses to cat allergen but does not alter suppression by CD4+ CD25+ T cells: a double‐blind placebo‐controlled study
Authors: Smith T. R. F. , Alexander C. , Kay A. B. , Larché M. , Robinson D. S. 
Published: September 2004

Background:  We have previously described both modification of allergen immunotherapy using peptide fragments, and reduced regulation of allergen stimulated T cells by CD4+ CD25+ T cells from allergic donors when compared with nonallergic controls. It has been suggested that allergen immunotherapy induces regulatory T cell activity: we hypothesized that allergen peptide immunotherapy might increase suppressive activity of CD4+ CD25+ T cells.Objective:  To examine cat allergen‐stimulated CD4 T cell responses and their suppression by CD4+ CD25+ T cells before and after cat allergen peptide immunotherapy in a double‐blind placebo‐controlled study.Methods:  Peripheral blood was obtained and stored before and after peptide immunotherapy or placebo treatment. CD4+ and CD4+ CD25+ were then isolated by immunomagnetic beads and cultured with allergen in vitro.Results:  Comparing cells from blood taken before with that after peptide immunotherapy there was a significant reduction in both proliferation and IL‐13 production by allergen‐stimulated CD4+ T cells, whereas no change was seen after placebo. CD4+ CD25+ T cells suppressed both proliferation and IL‐13 production by CD4+ CD25− T cells before and after therapy but peptide therapy was not associated with any change in suppressive activity of these cells.Conclusion:  Allergen peptide immunotherapy alters T cell response to allergen through mechanisms other than changes in CD4+ CD25+ T cell suppression.
Human mast cells express receptors for IL‐3, IL‐5 and GM‐CSF; a partial map of receptors on human mast cells cultured in vitro
Authors: Dahl C. , Hoffmann H. J. , Saito H. , Schiøtz P. O. 
Published: September 2004

Background:  Mast cells have long been recognized as the principal cell type that initiates the inflammatory response characteristic of acute allergic type 1 reactions. Our goal has been to further characterize maturation of progenitors to mast cells.Methods:  Mast cells were cultured from human cord blood derived CD133+ progenitors. Mast cell function was tested using histamine release. During differentiation mast cells surface marker expression was monitored by flow cytometry.Results:  CD133+ progenitors expressed the early haematopoietic and myeloid lineage markers CD34, CD117, CD13 and CD33. Mature mast cells expressed CD117, CD13 and CD33, and expression of the high affinity immunoglobulin E recpetor FcɛRI increased during culture. Cytokine receptors interleukin (IL)‐5R, IL‐3R, granulocyte‐macrophage‐colony stimulating factor (GM‐CSF)R and IL‐18R were expressed at high levels during maturation. Chemokine receptors CXCR4 and CXCR2 were highly expressed on both newly purified CD133+ cells and mature cells.Conclusion:  Human mast cells can be cultured from a CD34+/CD117+/CD13+/CD33+ progenitor cell population in cord blood that is tryptase and chymase negative. Developing and mature mast cells express a wide range of chemokine and cytokine receptors. We found high levels of expression of CD123, IL‐5R and GM‐CSF receptors, also found on eosinophils and basophils, and high levels of expression of the receptor for the inflammatory cytokine IL‐18.
Troponin T‐values provide long‐term prognosis in elderly patients undergoing non‐cardiac surgery
Authors: Oscarsson A. , Eintrei C. , Anskär S. , Engdahl O. , Fagerström L. , Blomqvist P. , Fredriksson M. , Swahn E. 
Published: September 2004

Background:  The aim of this study was to evaluate the significance of elevated postoperative Troponin T (TnT) levels in an elderly population undergoing non‐cardiac surgery.Methods:  Five hundred and forty‐six consecutive patients aged 70 years or older undergoing non‐cardiac surgery of >30‐min duration were enrolled in this prospective, observational study. A postoperative TnT measurement was obtained on the 5th to 7th postoperative day. Troponin T values greater than 0.02 ng ml−1 were considered positive. Patients were followed over a 1‐year period, and mortality and non‐fatal cardiac events (acute myocardial infarction and coronary interventions) were recorded.Results:  Troponin T concentrations greater than 0.02 ng ml−1 were detected in 53 of the study subjects (9.7%). Eleven per cent of the patients with elevated TnT had electrocardiographic or clinical signs of myocardial ischemia. One year after surgery, 17 (32%) of the patients with abnormal TnT concentrations had died. In a multivariate Cox regression analysis adjusting for baseline and perioperative data, a TnT value >0.02 ng ml−1 was an independent correlate of the mortality adjusted hazard ratio (HR): 14.9 (95% CI 3.7–60.3). Other independent predictors of death were tachycardia (HR, 14.9 95% CI 3.45–64.8), ASA 4 (HR, 8.1 95% CI 1.3–50.0), reoperation (HR, 6.4 95% CI 1.1–36.9), and use of diuretics (HR, 4.2 95% CI 1.3–13.8).Conclusion:  We conclude that elevated TnT levels in the postoperative period confer a 15‐fold increase in mortality during the first year after surgery. Our findings also provide evidence that silent myocardial ischemia is common in an elderly population. Routine perioperative surveillance for TnT might therefore be of use in detecting patients at an increased risk of mortality during the first postoperative year.
Propacetamol and diclofenac alone and in combination for analgesia after elective tonsillectomy
Authors: Hiller A. , Silvanto M. , Savolainen S. , Tarkkila P. 
Published: September 2004

Background:  Diclofenac and paracetamol have different mechanisms and sites of action. Therefore, we tested if their combination is more effective for analgesia after tonsillectomy than either drug alone with respect to rescue analgesic consumption and visual analog scale values.Methods:  The analgesic effects of intravenously administered propacetamol (injectable pro‐drug of paracetamol) and diclofenac or a combination on postoperative pain were compared in 71 adult elective tonsillectomy patients in a randomized, double‐blind study. After induction of anesthesia the patients received monotherapy with 2 g propacetamol (n = 25) or 75 mg diclofenac (n = 25), or a combined treatment with 2 g propacetamol and 75 mg diclofenac (n = 21) in physiologic saline as an infusion. Postoperatively the propacetamol dosage was repeated twice and diclofenac once on the ward. Oxycodone (0.03 mg kg−1) was used as a rescue analgesic by patient‐controlled analgesia.Results:  On average the patients needed oxycodone 15.3, 13.2 and 10.6 times in the propacetamol, diclofenac and combination groups, respectively (NS). A verbal rating scale and a visual analog scale were employed for assessing post‐tonsillectomy pain, nausea and patient satisfaction in all groups. No statistically significant differences were found between the groups. Twelve of the 25 (48%) patients having received propacetamol complained of pain at the cannulation site.Conclusion:  Combined treatment with propacetamol and diclofenac with the dosages used provided clinically only a minor advantage over monotherapy with propacetamol or diclofenac with respect to postoperative analgesia or the incidence of side‐effects in adult tonsillectomy patients.
Supplemental remifentanil during coronary artery bypass grafting is followed by a transient postoperative cardiac depression
Authors: Pleym H. , Stenseth R. , Wiseth R. , Karevold A. , Dale O. 
Published: September 2004

Background:  The pharmacokinetic properties of the short‐acting µ opioid receptor‐agonist remifentanil makes it possible to give cardiac surgical patients a deep intraoperative anesthesia without experiencing postoperative respiratory depression and a prolonged stay in the intensive care unit (ICU). However, previous investigations have shown that patients who received remifentanil required additional analgesia during the early postoperative period as compared to patients who received fentanyl. The aim of the present study therefore was to investigate the effects of supplementing remifentanil to a standard fentanyl‐based anesthesia in coronary artery bypass grafting (CABG).Methods:  The study was prospective, randomized, double‐blind, and placebo‐controlled. Twenty male patients aged 55–70 years were included. All patients received a standard fentanyl and isoflurane‐based anesthesia. In addition, the patients were randomized to receive either remifentanil 0.5 µg kg−1 min−1 or placebo during surgery. Hemodynamic recordings and measurements of blood glucose and plasma adrenaline and noradrenaline were performed intra‐ and postoperatively.Results:  Remifentanil reduced the hemodynamic and metabolic response to surgical stress compared to the standard fentanyl‐based anesthetic regimen. However, the patients in the remifentanil group had a lower cardiac output (CO), left ventricular stroke work index (LVSWI), and mixed venous oxygen saturation (SvO2), and a higher central venous pressure (CVP) than the patients in the placebo group during the early postoperative phase, indicating a postoperative cardiac depression in the remifentanil group.Conclusion:  In CABG, remifentanil reduces the hemodynamic and metabolic responses during surgery but seems to give a cardiac depression in the early postoperative phase.
Nitrous oxide diffusion into tracheal tube cuffs: comparison of five different tracheal tube cuffs
Authors: Dullenkopf A. , Gerber A. C. , Weiss M. 
Published: September 2004

Background:  The aim of this study was to investigate cuff compliance and cuff pressure during nitrous oxide exposure in the recently introduced Microcuff tracheal tube with a polyurethane cuff (Microcuff GmbH, Weinheim, Germany), and to compare it to conventional tracheal tubes with PVC cuffs.Methods:  In an in vitro set up, five cuffed tracheal tubes (ID 7.0 mm) from different manufacturers (Microcuff HVLP, Portex Profile Soft Seal, Mallinckrodt HiLo, Rüsch Super Safety Clear and Sheridan CF) were studied. Pressure–volume curves were assessed and changes of cuff pressure during exposure to nitrous oxide (for 60 min; 66% N2O in oxygen) were recorded without and with restriction of the cuff in a trachea model. Each experiment was performed four times using two exemplars of each tube twice. Sixty‐minute values of the Microcuff group were compared with the other groups using the Mann– Whitney test (P < 0.05).Results:  The Microcuff polyurethane cuff demonstrated an intermediate cuff compliance but the highest cuff pressure increase during nitrous oxide exposure under unrestricted conditions. When inflated within the artificial trachea its cuff compliance became the highest of all tested tracheal tubes. However, exposure to N2O, again led to a rapid increase in cuff pressure.Conclusion:  The ultra‐thin polyurethane tube cuff demonstrated higher permeability for nitrous oxide than conventional PVC cuffs and led to a rapid cuff pressure increase when exposed to N2O. Routinely checking of cuff‐pressure or filling the cuff with nitrous oxide are more important than the brand of tube used.
Effects of nitrous oxide on baroreflex gain and heart rate variability
Authors: Tanaka M. , Nishikawa T. 
Published: September 2004

Background:  Spontaneous baroreflex method allows continuous assessment of cardiovagal reflex function within resting blood pressure, but effects of nitrous oxide, per se, on the spontaneous baroreflex response remain unknown. This study was designed to determine the effects of nitrous oxide on spontaneous baroreflex gain and heart rate variability assessed by power spectral analysis in humans.Methods:  Electrocardiogram and non‐invasive blood pressure were monitored in 12 healthy volunteers before and during a 15‐min inhalation of 67% nitrous oxide in oxygen, while spontaneous respiration was maintained. Least‐square regression analysis relating R‐R interval and systolic blood pressure was performed to obtain spontaneous baroreflex gains. Heart rate variability was analyzed using fast Fourier transformation.Results:  Nitrous oxide did not significantly alter spontaneous baroreflex gains, which correlated well with high‐frequency power (0.15–0.4 Hz) of heart rate variability before and during nitrous oxide inhalation.Conclusion:  Our results indicate that (a) cardiovagal reflex response is not affected by nitrous oxide, per se, and (b) spontaneous baroreflex responses closely reflect beat‐to‐beat dynamic modulation of the cardiac cycle by the parasympathetic nervous system during inhalation of 67% nitrous oxide.
Predictable reduction of intracranial hypertension with hypertonic saline hydroxyethyl starch: a prospective clinical trial in critically ill patients with subarachnoid haemorrhage
Authors: Bentsen G. , Breivik H. , Lundar T. , Stubhaug A. 
Published: September 2004

Background:  After head trauma, hypertonic saline lowers intracranial pressure (ICP) and preserves or increases cerebral perfusion pressure (CPP). Hypertonic saline has not been studied in patients with increased ICP due to subarachnoid haemorrhage (SAH). The aim of this study was to evaluate the effects on elevated ICP and on CPP in patients critically ill from SAH.Methods:  Critically ill SAH‐patients needing urgent treatment for an elevated ICP, but otherwise stable, were included in this study. We infused 7.2% saline in 6% hydroxyethyl starch (HyperHAES® Fresenius Kabi AG, Bad Homburg v.d.h., Germany) 2 ml kg−1 during 20 min in 10 episodes of ICP > 20 mmHg in seven patients with SAH. Our primary outcome variables were changes in ICP and CPP during and for 3 h after this infusion.Results:  All interventions resulted in decreased ICP and elevation of CPP. The mean value for maximum ICP decrease in percent of baseline was 58% (range 43–83%, P = 0.002), which occurred at mean 40 min (range 25–90 min) after start of infusion. The mean percent peak increase in CPP was 26% (range 16–32%, P = 0.002). After 210 min, ICP was 35% lower than baseline (range 19–39%, P = 0.008). Serum sodium increase was mean 6.6 mmol l−1 (range 5–9 mmol l−1) 30 min after start of infusion.Conclusions:  7.2% saline in 6% hydroxyethyl starch is an effective and safe therapy for intracranial hypertension after SAH. We demonstrate that an infusion of 2 ml kg−1 during 20 min has a predictable and clinically significant beneficial effect on ICP and CPP. The effect was still present 3 h after end of infusion. Rebound ICP‐increase was not observed within 3 h.
Comparison of BIS and AAI as measures of anaesthetic drug effect during desflurane–remifentanil anaesthesia
Authors: Kreuer S. , Bruhn J. , Larsen R. , Bauer C. , Wilhelm W. 
Published: September 2004

Background:  Autoregressive modelling with exogenous input of the middle‐latency auditory evoked potential has been developed for monitoring of anaesthetic depth. This study was designed to investigate the dose–response relationship between endtidal desflurane concentrations and the Alaris Autoregressive Index (AAI, Alaris Medical, Hampshire, UK, version 1.4) or the bispectral index (Aspect Medical Systems, Newton, MA, USA, version XP).Methods:  Twenty‐one patients scheduled for radical prostatectomy were investigated. After premedication and induction of anaesthesia with propofol und remifentanil all patients received atracurium and a remifentanil background infusion at a constant rate of 0.1 µg kg−1 min−1. During dissection of the prostate, desflurane endtidal concentrations were varied between 3 and 9 vol%. Both AAI and BIS were determined and compared with the respective endtidal desflurane concentration.Results:  None of the patients showed a significant change of AAI values while changing the desflurane concentrations between 3 and 9 vol%. The dose–response of BIS values and desflurane concentrations was not uniform: two patients showed increasing BIS values with increasing desflurane concentrations, while in three patients BIS values remained unchanged. In 16 patients decreasing BIS values adequately reflected an increase in desflurane concentrations.Conclusion:  Changes of desflurane concentrations during deep anaesthesia were adequately displayed only in 16 of 21 cases by BIS but in none of the cases by AAI monitoring.
Total spinal anaesthesia as a complication of local anaesthetic test‐dose administration through an epidural catheter
Authors: Steffek M. , Owczuk R. , Szlyk‐Augustyn M. , Lasinska‐Kowara M. , Wujtewicz M. 
Published: September 2004

We describe a case of total spinal anaesthesia, which occurred after a 3‐ml lignocaine (20 mg ml−1) test dose was administered through an epidural catheter in a 79‐year‐old patient scheduled for gastrectomy under combined general and epidural anaesthesia.The surgery was postponed, and the patient required admission to the intensive therapy unit. Spinal MRI from the total spinal cord did not reveal any pathology. During the next 24 h the patient recovered and after 11 days was successfully operated on under general anaesthesia. No late complications followed. We presume that during placement, the epidural catheter had migrated to the spinal canal as a result of technical difficulties.Although controversial, we consider that administering a standard test dose of local anaesthetic via an epidural catheter is recommended, especially in high‐risk patients and when epidural space identification or catheter placement poses technical difficulties. A test dose of local anaesthetic does not fully prevent complications.