Sedimentation Rate (sedimentation + rate)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Sedimentation Rate

  • elevated erythrocyte sedimentation rate
  • erythrocyte sedimentation rate
  • high sedimentation rate

  • Selected Abstracts

    Impacts of rapid sea-level rise on mangrove deposit erosion: application of taraxerol and Rhizophora records,

    Jung-Hyun Kim
    Abstract We investigated a well-dated marine sediment core from the tropical SE Atlantic covering the last 25,kyr, applying taraxerol and Rhizophora pollen as organic geochemical and palynological proxies for mangrove, respectively. Taraxerol records are positively correlated with Rhizophora pollen records, showing an enhanced supply of mangrove materials into deep-sea environments during the last deglaciation (Termination I). Sedimentation rates peaked during Meltwater Pulses 1A and 1B, which were associated with the maxima of taraxerol and Rhizophora pollen. This study supports the view that mangrove input was dominantly controlled by erosion of mangrove-rich shelf sediments during the transgressions. Whether reworked materials were penecontemporaneous or from much older deposits formed during previous sea-level cycles is discussed. Copyright © 2005 John Wiley & Sons, Ltd. [source]

    Association of components of the metabolic syndrome with the appearance of aggregated red blood cells in the peripheral blood.

    An unfavorable hemorheological finding
    Abstract Background Components of the metabolic syndrome are associated with low-grade inflammation. This can be accompanied by the synthesis of sticky proteins and erythrocyte aggregation. Methods The degree of erythrocyte aggregation was evaluated by a simple slide test and image analysis along with other markers of the acute-phase response, including the white blood cell count (WBCC), erythrocyte sedimentation rate (ESR), fibrinogen and high sensitivity C-reactive protein (hs-CRP) concentrations. Patients were categorized in four groups according to the absence or presence of 1, 2 and 3 or more components of the metabolic syndrome. Results We examined a total of 1447 individuals (576 women and 871 men) who gave their informed consent for participation. A significant cardiovascular risk factors, age and hemoglobin adjusted correlation was noted between the degree of erythrocyte aggregation and the number of components of the metabolic syndrome (r = 0.17, p < 0.0005). This correlation was better than that observed for clottable fibrinogen (r = 0.13 p < 0.0005), for ESR (r = 0.11 p < 0.0005) or WBCC (r = 0.13 p < 0.0005). A somewhat better correlation was noted for hs-CRP (r = 0.26 p < 0.0005). Conclusions The multiplicity of components of the metabolic syndrome is associated with enhanced erythrocyte aggregation, probably related to the presence of multiple adhesive macromolecules in the peripheral blood. The enhanced aggregation might contribute to capillary slow flow, tissue deoxygenation as well as vasomotor tone changes in the presence of multiple components of this syndrome. Copyright © 2004 John Wiley & Sons, Ltd. [source]

    Rheological determinants of red blood cell aggregation in diabetic patients in relation to their metabolic control

    DIABETIC MEDICINE, Issue 2 2002
    K. Elishkevitz
    Abstract Aims To determine whether increased red blood cell adhesiveness/aggregation in diabetic patients is related to the extent of their metabolic control. Methods We measured erythrocyte adhesiveness/aggregation in a group of 85 adult patients with diabetes mellitus by using citrated venous whole blood and a simple slide test. The erythrocyte adhesiveness/aggregation was determined by measuring the size of the spaces that are formed between the aggregated erythrocytes. We divided the patients into those with either low or high erythrocyte adhesiveness/aggregation values. Results The erythrocyte adhesiveness/aggregation values of the two groups differed significantly in terms of their fibrinogen concentration, erythrocyte sedimentation rate, high sensitive C-reactive protein (CRP), total cholesterol and triglyceride concentrations. There was no difference between the two groups regarding the concentrations of HbA1c. Logistic regression was applied to construct a model to predict the belonging of a patient in the low or high erythrocyte adhesiveness/aggregation group. A linear regression was applied to construct a model to predict the erythrocyte adhesiveness/aggregation values. Both models turned out to include gender, age, fibrinogen, triglyceride, retinopathy, coronary artery disease and age and gender interaction. Neither HbA1c nor CRP entered the models. Conclusions The degree of erythrocyte adhesiveness/aggregation and several variables of the acute-phase response in patients with diabetes mellitus are not directly related to the degree of metabolic control as evaluated by means of HbA1c concentration. Diabetic patients might benefit from rheological or anti-inflammatory interventions regardless of their metabolic control. [source]

    The distribution and prevalence of sponges in relation to environmental gradients within a temperate sea lough: vertical cliff surfaces

    James J. Bell
    Abstract. The prevalence and distribution of sponges was surveyed on vertical cliff surfaces at Lough Hyne Marine Nature Reserve, Co. Cork, Ireland. The number of sponge species was recorded at 6-metre depth intervals at four sites within Lough Hyne, and at one site on the adjacent Atlantic coastline to examine differences in abundance and zonation patterns. Sites ranged from an exposed turbulent regime to sheltered, sedimented environments. Individual species showed different distributions and prevalence between sites and with increasing depth. Greatest differences were observed between the most- and least-disturbed sites. Distinct sponge zonation patterns were evident at all sites sampled. Twenty-five species were considered dominant at all five sites with the remaining 48 species considered rare. Only four of the 25 most-dominant species occurred at the site experiencing the most turbulent flow conditions, whereas 12 species were found at the site of unidirectional fast flow. At sites of moderate to slight water movement and high sedimentation, between 18 and 24 of the most dominant species were present. Encrusting forms constituted high proportions of sponge communities at all five sites sampled (although consisting of different species). At sites of turbulent and unidirectional fast flow massive forms also dominated whereas at the least turbulent sites, where sedimentation was high, arborescent sponges were abundant. Few species showed exclusive distribution to a single depth and site, but there was some degree of correlation between species distributions and abiotic factors such as sedimentation rate and flow regimes. Sponge distributions and densities are discussed with respect to the suitability of species' morphologies to particular environments, intra-specific and inter-specific competition and physiological adaptations that enable them to survive in different habitats. [source]

    The distribution and prevalence of sponges in relation to environmental gradients within a temperate sea lough: inclined cliff surfaces

    James J. Bell
    Abstract. Sponge communities on inclined cliff surfaces (40°) at Lough Hyne Marine Nature Reserve, Co. Cork, Ireland were sampled at five sites (four inside the lough and one on the adjacent Atlantic coast). Each site varied in sedimentation rate and flow regime. Sites ranged from turbulent (with negligible sedimentation) to very low flow (< 3 cm,1) and highly sedimented regimes. Sponge species showed variation between sites and depth. The greatest difference in sponge communities was observed between the most turbulent and most sedimented sites. The distinct zonation patterns, present at all sites, were most pronounced at the highly sedimented sites. Encrusting forms constituted a high proportion of the sponges at all sites. However encrusting species found at the turbulent site were different to those at the sedimented sites. Arborescent species were common, mainly at the sedimented sites within Lough Hyne. Distributions of sponge species are considered with respect to morphological adaptation, competition and physiological adaptation. The distributions of sponge species on inclined surfaces are also compared with those on vertical cliff faces. [source]

    Endothelial dysfunction in Buerger's disease and its relation to markers of inflammation

    M. Joras
    Abstract Background, Buerger's disease (BD) is a segmental occlusive vascular disease. The aim of this study was to detect functional changes in brachial artery and asymptomatic morphological changes in extra-cranial carotid arteries not affected by the disease process and to assess markers of inflammation and endothelial damage. Materials and methods, Fourteen patients in the remission phase of BD and the same number of age- and sex-matched healthy controls were included in the study. The capability of endothelium-dependent (flow-mediated) and endothelium-independent dilation of the brachial artery and intima-media thickness of the carotid arteries were measured using high-resolution ultrasound. Laboratory parameters of endogenous fibrinolytic activity, inflammation and endothelial dysfunction were also measured. Results, Patients with BD had a diminished capability of endothelium-dependent vasodilation and higher levels of some circulating markers of inflammation, such as leukocytes, C-reactive protein, intercellular adhesion molecule-1 and E-selectin. Intercellular adhesion molecule-1 levels were related to some of the inflammatory markers (sedimentation rate, C-reactive protein, ,2-globulins and fibrinogen), while E-selectin was correlated with decreased endogenous blood fibrinolytic activity. Endothelium-dependent vasodilation was in negative correlation with the relative share of neutrophil granulocytes. There were no significant differences in intima-media thickness between patients with BD and controls. Conclusions, Our study has expressed generalized functional arterial disorder in patients with BD not accompanied by any measurable morphological changes of the carotid arterial wall. Functional deterioration of brachial artery could be related to increased levels of various inflammatory markers , the process which is most probably the basic pathogenetic mechanism of the disease. [source]

    Investigations on the Structural Damage in Human Erythrocytes Exposed to Silver, Gold, and Platinum Nanoparticles

    P. V. Asharani
    Abstract Human erythrocytes or red blood cells (RBCs), which constitute 99% of blood cells, perform an important function of oxygen transport and can be exposed to nanoparticles (NPs) entering into the human body during therapeutical applications involving such NPs. Hence, the haemocompatibility of the Ag, Au, and Pt NPs on human RBCs is investigated. The parameters monitored include haemolysis, haemagglutination, erythrocyte sedimentation rate, membrane topography, and lipid peroxidation. The findings suggest that platinum and gold NPs are haemocompatible compared to Ag NPs. Erythrocytes exhibit significant lysis, haemagglutination, membrane damage, detrimental morphological variation, and cytoskeletal distortions following exposure to Ag NPs at a concentration of 100,µg,mL,1. Exposure of Ag+ to RBCs shows no lysis or deterioration, implying that the observed toxicity is solely due to NPs. The haemolyzed erythrocyte fraction has the ability to induce DNA damage in nucleated cells. Additionally, multiple pits and depressions are observed on RBC membrane following exposure to Ag NPs (50,µg,mL,1 onwards). Hence, it is apparent that Ag NPs exhibit toxicity on RBCs and on other cells that are exposed to NP-mediated haemolyzed fractions. [source]

    Effect of tick parasitism on the health status of a passerine bird

    FUNCTIONAL ECOLOGY, Issue 6 2008
    D. J. A. Heylen
    Summary 1Little information is available on the ecological interactions between ticks and their hosts under natural conditions, and particularly so for avian hosts. To understand this host,parasite interaction it is necessary to assess the physiological harm ticks can do to their host. 2We combined observational and experimental (field and laboratory) data to examine the effects of a common tick species with major economic importance, the sheep tick (Ixodes ricinus), on the health status of a common passerine bird, the great tit (Parus major). 3In the laboratory experiment a parallel group design was carried out in which the birds of the experimental group were infested with 3,10 nymphs, whereas the birds of the control group were kept free of ticks and received a sham treatment. Both groups were stratified according to age and sex. Health parameters were measured the day before and 3 days after infestation or sham treatment: haematocrit level, erythrocyte sedimentation rate, leucocyte concentration and general body condition (body mass corrected for body size). 4No effects of age were observed on any of the health parameters. The decrease in haematocrit level in the experimental group was significantly greater than in the control group. Moreover, infested males suffered more blood depletion than infested females. The increase in sedimentation rate was greater in the experimental group than in the control group. Surprisingly, no treatment effects were found on leucocyte concentrations, which may indicate immunoregulation by the ticks on components of the birds' cellular immune response. Also no difference in general body condition between the treatment groups was found. None of the infested birds died during infestation. 5Lower haematocrit levels in infested birds, but unaffected leucocyte concentrations and general body condition are confirmed by field data (experimental and observational) of adult birds during breeding season. 6Neither haematocrit level nor general body condition was associated with parasite intensity among infested birds, suggesting that immature Ixodes ricinus are not resource limited at high natural densities. Still, the measurable direct harm caused by sheep tick infestations calls for further study on its importance for the evolutionary ecology of passerine hosts. [source]

    Modelling the relationship between a pitcher plant (Sarracenia purpurea) and its phytotelma community: mutualism or parasitism?

    FUNCTIONAL ECOLOGY, Issue 4 2008
    N. Mouquet
    Summary 1To improve our understanding of the relationship between the pitcher plant (Sarracenia purpurea) and the phytotelma community inhabiting its leaves we built an exploratory, mechanistic model based on stochiometric constraints on carbon and nitrogen associated with prey decomposition. 2Our theoretical results suggest that the phytotelma community is acting as a mineralizing system producing nitrogen for the plant. This is confirmed by data collected in the field and in the literature, that show the amount of nitrogen produced by the decomposition of prey is sufficiently high to be considered as a major source of nitrogen for the plant. 3In our model, nitrogen yield is higher if the phytotelma community is restricted to bacteria alone than when the full food web is present. Nitrogen availability is negatively affected by bacterivores (rotifers and protozoa mostly) and positively affected by a cascading effect of mosquito larvae. 4When sedimentation rate is high, mosquitoes have a global positive effect on nitrogen production because they indirectly reduce the amount of nitrogen lost through sedimentation more than they export nitrogen through pupation. On the other hand, when sedimentation rate is low there is a hump-shaped relationship between the uptake rate of bacterivores by mosquito larvae and the nitrogen yield in the plant. 5We conclude that plant,bacteria and plant,mosquito interactions are predominantly mutualistic, whereas plant,bacterivore interactions are predominantly parasitic. Our work also illustrates how ecosystem properties (here nitrogen production by the phytotelma community) can be understood as a function of trophic complexity and can be seen as a product of selection at the scale of a community. [source]

    Comparison of sedimentation and occupation histories inside and outside rock shelters, Keep-River region, northwestern Australia

    I.A.K. Ward
    This paper compares archaeological evidence of Aboriginal occupation inside rock shelters and outside in adjacent sand sheets, focusing on two locations in the Keep-River region, northwestern Australia. Luminescence and radiocarbon dating reveal that occupation sequences inside rock shelters are generally younger ( < 10,000 yr B.P.) than outside ( < 18,000 yr B.P.). Differences in occupation chronology and artifact assemblages inside and outside rock shelters result from depositional and postdepositional processes and shifts in site function. An increase in regional sedimentation rate from 10 cm/ka , 1 in the Pleistocene to 20 cm/ka , 1 in the Holocene may account for late buildup of sediments within rock shelters, increased artifact accumulation, and reduced postdepositional disturbance in some settings. More intense use of rock shelters in the Late Holocene is indicated from a change in hunting technology and greater production of rock art. The results indicate that some cultural interpretations might be flawed unless archaeological evidence from rock-shelter and open-site excavations is integrated. © 2006 Wiley Periodicals, Inc. [source]

    A large carbon pool and small sink in boreal Holocene lake sediments

    GLOBAL CHANGE BIOLOGY, Issue 10 2004
    Pirkko Kortelainen
    Abstract Model-based estimates suggest that lake sediments may be a significant, long-term sink for organic carbon (C) at regional to global scales. These models have used various approaches to predict sediment storage at broad scales from very limited data sets. Here, we report a large-scale direct assessment of the standing stock and sedimentation rate of C for a representative set of lakes in Finland. The 122 lakes were selected from the statistically selected Nordic Lake Survey database, they cover the entire country and the water quality represents the average lake water quality in Finland. Unlike all prior estimates, these data use sediment cores that comprise the entire sediment record. The data show that within Finland, aquatic ecosystems contain the second largest areal C stocks (19 kg C m,2) after peatlands (72 kg C m,2), and exceed by significant amounts stocks in the forest soil (uppermost 75cm; 7.2 kg C m,2) and woody biomass (3.4 kg C m,2). Kauppi et al. (1997). The Finnish estimate extrapolated over the boreal region gives a total C pool in lakes 19,27 Pg C, significantly lower than the previous model-based estimates. [source]

    Predictors of anemia in patients on hemodialysis

    Willy AASEBŲ
    Abstract Even though the use of erythropoietin and intravenous iron has improved the treatment of anemia in hemodialysis patients, a considerable proportion of these patients still have anemia. The aim of this study was to identify predictors of anemia in a hemodialysis population. In a single-center hemodialysis unit, all patients were studied with blood tests and their medication recorded during a period of 22 months. Correlations with hemoglobin (Hb) were performed with a simple regression or a t test. Variables that reached 5% significance were entered in a multiple regression analysis. Selected variables were presented in quartiles with levels of Hb. Mean Hb was 11.3 g/dL, and 53 patients (40%) had Hb<11.0 g/dL. In the simple regression analysis Hb correlated positively with s-iron, CHr, s-albumin, and doses of sevelamer, and negatively with sedimentation rate (SR), ferritin, base excess, and doses of erythropoietin. In the multiple regression analysis erythrocytes SR was the only variable that remained significant. Elevated SR is the strongest predictor of anemia in hemodialysis patients receiving adequate treatment with erythropoietin and intravenous iron. Patients using high doses of sevelamer had higher Hb levels than patients using low doses. [source]

    Effects of food abundance and predictability on body condition and health parameters: experimental tests with the Hooded Crow

    IBIS, Issue 4 2002
    Camilla Acquarone
    It has been shown that small passerines can counteract variability of food resources by actively regulating their body reserves through an increase of mass. However, the effects of food predictability on body mass regulation and other body parameters, such as immune functions, in larger species have been little studied. To analyse the response of the Hooded Crow Corvus corone to food abundance and predictability, we performed three experiments with controlled food provisioning under laboratory conditions. Body mass, TOBEC (total body electrical conductivity) lean mass index, blood parameters and immune organ masses were measured at the beginning and end of a 15-day period. In the first experiment, the food release was predictable (same amount each day) but the quantity of food delivered to five groups of birds varied (37, 75, 100, 150 or 300 g/day). Low food levels induced a greater decrease in mass accompanied by an increase in erythrocyte sedimentation rate. In the second experiment, the same average quantity of food (100 g) was supplied according to either predictable or unpredictable (random) schedules. In this case, the crows lost more mass, and their erythrocyte sedimentation rate increased when food was unpredictable. In the third experiment, the same average quantity of food (150 g) was supplied according to either a predictable schedule or two schedules with different levels of variability. The group with a low level of variability did not differ from the control, while the group with a highly variable feeding schedule lost more mass. In this group, the higher mass loss was associated with greater variation of the erythrocyte sedimentation rate and a reduced Phytohaemagglutinin index of immunocompetence and haematocrit value. The results of experiments 2 and 3 contrast with findings in other passerines, which increase their mass when food availability is unpredictable. It appears that a body mass decrease in the Hooded Crow can be induced by a reduction of either food abundance (exp. 1) or food predictability (exp. 2, 3), and it is accompanied by a worsening of health state. [source]

    Probiotic preparation VSL#3 induces remission in children with mild to moderate acute ulcerative colitis: A pilot study

    Hien Q. Huynh MD
    Abstract Background: Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) that has periods of exacerbated symptoms and periods that are symptom-free. The treatment of active UC with probiotic bacteria could possibly induce remission. We evaluated the clinical efficacy and safety profile of probiotic preparation VSL#3 in the treatment of mild to moderate acute UC in the pediatric population. Methods: Eighteen eligible patients between the ages of 3,17 with mild to moderate acute UC received open-label VSL#3 daily in 2 divided doses for 8 weeks. The disease activity pre- and post-VSL#3 therapy was assessed by the simple clinical colitis activity index (SCCAI); Mayo ulcerative colitis endoscopic score; inflammatory markers: erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); serum cytokine profiling; and rectal tissue microbial profiling done at baseline and at week 8. Results: Thirteen patients completed 8 weeks of VSL#3 treatment and 5 patients were withdrawn due to lack of improvement. Remission (defined as SCCAI ,3) was achieved in 56% of children (n = 10); response (decrease in SCCAI ,2, but final score ,5) in 6% (n = 1); and no change or worsening in 39% (n = 7). Post-VSL#3 treatments demonstrated a bacterial taxonomy change in rectal biopsy. The VSL#3 was well tolerated in clinical trials and no biochemical and clinical adverse effects attributed to VSL#3 were identified. Conclusions: Treatment of pediatric patients diagnosed with mild to moderate UC with VSL#3 resulted in a remission rate of 56% and a combined remission/response rate of 61%. (Inflamm Bowel Dis 2008) [source]

    Efficacy of infliximab in pediatric Crohn's disease: A randomized multicenter open-label trial comparing scheduled to on demand maintenance therapy

    Frank M. Ruemmele MD
    Abstract Background: Infliximab (IFX) is efficacious in inducing remission in severe forms of pediatric Crohn's disease (CD). Adult studies indicate that IFX is also safe and well tolerated as maintenance therapy. The present study aimed to evaluate in a prospective manner the efficacy and safety of IFX as maintenance therapy of severe pediatric CD comparing scheduled and "on demand" treatment strategies. Methods: Forty children with CD (nonpenetrating, nonstricturing as well as penetrating forms, mean age: 13.9 ± 2.2 years) with a severe flare-up (Harvey,Bradshaw Index [HBI] ,5, erythrocyte sedimentation rate [ESR] >20 mm/h) despite well-conducted immunomodulator therapy (n = 36 azathioprine, n = 1 mercaptopurine, n = 3 methotrexate) combined with steroids were included in this randomized, multicenter, open-label study. Three IFX infusions (5 mg/kg) were administered at week (W)0/W2/W6. At W10, clinical remission (HBI <5) and steroid withdrawal were analyzed and IFX responders were randomized to maintenance therapy over 1 year: group A, scheduled every 2 months; group B, "on demand" on relapse. Results: In all, 34/40 children came into remission during IFX induction therapy (HBI: 6.7 ± 2.5 (WO) vs. 1.1 ± 1.5 (W10); P < 0.001). At the end of phase 2, 15/18 (83%) patients were in remission in group A compared to 8/13 (61%) children in group B (P < 0.01), with a mean HBI of 0.5 versus 3.2 points (group A versus B, P = 0.011). In group A, 3/13 (23.1%) children experienced a relapse compared to 11/12 (92%) children in group B. No severe adverse event occurred during this trial. Conclusions: IFX is well tolerated and safe as maintenance therapy for pediatric CD, with a clear advantage when used on a scheduled 2-month basis compared to an "on demand" basis. (Inflamm Bowel Dis 2009) [source]

    Enhanced formation of advanced oxidation protein products in IBD

    Malgorzata Krzystek-Korpacka PhD
    Abstract Background: Advanced oxidation protein products (AOPPs) are new protein markers of oxidative stress with pro-inflammatory properties, accumulated in many pathological conditions. The issue of their enhanced formation in IBD has not been addressed yet. Methods: The concentration of relative AOPPs (rAOPP; concentration of AOPPs divided by albumin level) were measured in 68 subjects with ulcerative colitis (UC), 50 subjects with Crohn's disease (CD) and 45 healthy volunteers, and related to disease phenotype, clinical and biochemical activity, and therapeutic strategy. Diagnostic utility of rAOPP was evaluated by ROC analysis. Results: In comparison with controls (1.367 ,mol/g), rAOPP were increased in inactive (1.778 ,mol/g, P = 0.053) and active (1.895 ,mol/g, P = 0.013) UC and in active (1.847 ,mol/g, P = 0.003) CD. In CD, but not UC, rAOPP correlated with disease activity (r = 0.42, P = 0.013). Significant correlations with the inflammatory/malnutrition indices-erythrocyte sedimentation rate (ESR) (r = 0.53), leukocytes (r = 0.33), platelets (r = 0.38), IL-6 (r = 0.36), and transferrin (r = ,0.35) were demonstrated in CD. In UC, rAOPP correlated only with ESR (r = 0.35) and IL-6 (r = 0.30). Instead, associations with antioxidant dismutase (r = 0.29) and catalase (r = 0.22) were observed. The diagnostic power of rAOPP in discriminating diseased from non-diseased subjects was less than that of C-reactive protein (CRP). Simultaneous determination of rAOPP and CRP did not significantly improve the power of single CRP determination. Conclusions: IBD was associated with enhanced formation of AOPP, which differed between C and UC with respect to the relationship between rAOPP and disease activity, inflammatory and antioxidant response. These differences may reflect divergent ways that oxidative stress develops in CD and UC. The diagnostic power of rAOPP was insufficient for its clinical application. (Inflamm Bowel Dis 2008) [source]

    Impaired intestinal iron absorption in Crohn's disease correlates with disease activity and markers of inflammation

    Gaith Semrin MD
    Abstract Background: Anemia in patients with Crohn's disease (CD) is a common problem of multifactorial origin, including blood loss, malabsorption of iron, and anemia of inflammation. Anemia of inflammation is caused by the effects of inflammatory cytokines [predominantly interleukin-6 (IL-6)] on iron transport in enterocytes and macrophages. We sought to elucidate alterations in iron absorption in pediatric patients with active and inactive CD. Methods: Nineteen subjects with CD (8 female, 11 male patients) were recruited between April 2003 and June 2004. After an overnight fast, serum iron and hemoglobin levels, serum markers of inflammation [IL-6, C-reactive protein (CRP), and erythrocyte sedimentation rate], and a urine sample for hepcidin assay were obtained at 8 am. Ferrous sulfate (1 mg/kg) was administered orally, followed by determination of serum iron concentrations hourly for 4 hours after the ingestion of iron. An area under the curve for iron absorption was calculated for each patient data set. Results: There was a strong inverse correlation between the area under the curve and IL-6 (P = 0.002) and area under the curve and CRP levels (P = 0.04). Similarly, the difference between baseline and 2-hour serum iron level (,[Fe]2hr) correlated with IL-6 (P = 0.008) and CRP (P = 0.045). When cutoff values for IL-6 (>5 pg/mL) and CRP (>1.0 mg/dL) were used, urine hepcidin levels also positively correlated with IL-6 and CRP levels (P = 0.003 and 0.007, respectively). Conclusions: Subjects with active CD have impaired oral iron absorption and elevated IL-6 levels compared with subjects with inactive disease. These findings suggest that oral iron may be of limited benefit to these patients. Future study is needed to define the molecular basis for impaired iron absorption. [source]

    Correlation of C-reactive protein with clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease

    Craig A Solem MD
    Abstract Introduction: We sought to examine the relationship between C-reactive protein (CRP) and clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease (IBD). Methods: All IBD patients at our institution between January 2002 and August 2003 who had a CRP, colonoscopy, and either small bowel follow-through (SBFT) or CT enterography (CTE) performed within 14 days were identified. Clinical activity was assessed retrospectively through review of the medical record. Logistic regression was used in Crohn's disease (CD) patients to estimate the odds ratio (OR) with 95% confidence intervals for an elevated CRP. Associations were assessed using Fisher exact test in ulcerative colitis (UC) patients due to small sample size. Results: One-hundred four CD patients (46% males) and 43 UC and indeterminate colitis patients (44% males) were identified. In CD patients, moderate-severe clinical activity (OR, 4.5; 95% CI, 1.1-18.3), active disease at colonoscopy (OR, 3.5; 95% CI, 1.4-8.9), and histologically severe inflammation (OR, 10.6; 95% CI; 1.1-104) were all significantly associated with CRP elevation. Abnormal small bowel radiographic imaging was not significantly associated with CRP elevation. In UC patients, CRP elevation was significantly associated with severe clinical activity, elevation in sedimentation rate, anemia, hypoalbuminemia, and active disease at ileocolonoscopy, but not with histologic inflammation. Conclusions: CRP elevation in IBD patients is associated with clinical disease activity, endoscopic inflammation, severely active histologic inflammation (in CD patients), and several other biomarkers of inflammation, but not with radiographic activity. [source]

    Efficacy and tolerance of infliximab in children and adolescents with Crohn's disease

    Dr. Thierry Lamireau
    Abstract Infliximab, a monoclonal antibody against tumor necrosis factor-alpha, has been shown to be effective for the treatment of refractory Crohn's disease in adult patients, but experience in pediatrics is limited. This retrospective study included 88 children and adolescents, 39 girls and 49 boys, with a median age of 14 years (range 3.3,17.9). Infliximab was indicated for active disease (66%) and/or fistulas (42%) that were refractory to corticosteroids (70%), and/or other immunosuppressive (82%) agents, and/or parenteral nutrition (20%). Patients received 1 to 17 infusions (median 4) of 5 mg/kg (range 3.8,7.3) of infliximab during a median time period of 4 months (1,17 months). Infusion reaction was noted in 13 patients (15%), with a total of 16 reactions in 450 infusions (4%). At Day 90 after the first infusion of infliximab, symptoms improved in 49% of patients, whereas 29% of patients were in remission and 13% of patients relapsed. From Day 0 to Day 90, Harvey,Bradshaw score decreased from 7.5 to 2.8 (P < 0.001), C-reactive protein from 36 to 16 mg/L (P < 0.01), and 1-hour erythrocyte sedimentation rate from 35 to 17 mm (P < 0.01). Dosage of corticosteroids decreased from to 0.59 to 0.17 mg/kg/d (P < 0.001); 53% of patients could be weaned of corticosteroids and 92% of parenteral nutrition. Treatment with infliximab is well tolerated and effective in most children and adolescents with Crohn's disease that is refractory to conventional immunosuppressive therapy. Nevertheless, long-term efficacy remains to be shown, and further studies are urgently needed to precisely determine the best modality of continuing treatment. [source]

    A case of progressive pseudorheumatoid arthropathy of ,childhood' with the diagnosis delayed to the fifth decade

    A. CEFLE
    Summary Progressive pseudorheumatoid arthropathy of childhood (PPAC) is a rare single gene disorder which is frequently misdiagnosed as juvenile rheumatoid arthritis. It is characterised with arthralgia, joint contractures, bony swelling of metacarpophalangeal and interphalangeal joints and platyspondyly. Clinical and laboratory signs of joint inflammation such as synovitis, a high erythrocyte sedimentation rate and an elevated C-reactive protein level are usually absent. Although the disease begins early in life (usually between 3 and 8 years of age), the diagnosis may be delayed. In the present case report, we describe a male patient diagnosed with PPAC at the age of 46 years, although he had been exhibiting the typical radiological and clinical features of the disease since the age of 7 years. [source]

    Giardia lamblia intestinalis: a new pathogen with possible link to Kikuchi,Fujimoto disease.

    An additional element in the disease jigsaw
    Summary A 16-year-old Caucasian girl of Albanian origin was admitted to the hospital complaining of intermittent fever (38 °C) for a week, nausea, vomiting, and abnormal laboratory findings (elevated serum aminotransferases levels AST/ALT 77/40 U/l and erythrocyte sedimentation rate 80 mm/first hour, as well as leukopenia 2.5 × 103/mm3), which were found in a blood examination. Physical examination revealed slight hepatomegaly and splenomegaly, as well as cervical and axillary lymphadenopathy. A diagnostic open lymph node biopsy was performed and Kikuchi,Fujimoto disease (KFD) was established based on the characteristic histological pattern. Other abnormal laboratory findings were C-reactive protein 6.8 mg/dl and serum lactate dehydrogenase 900 U/l. Her history included a diarrhoea syndrome 2 months before the present admission, during the summer holidays, for which she was treated with metronidazole. At that time, characteristic cysts of giardia lamblia intestinalis were observed in the stools. Herein, we present this case hypothesising that the protozoal infection caused by the giardia lamblia intestinalis was probably triggering an immune response leading to KFD. The patient's age in combination with this firstly reported protozoal pathogen, as a triggering agent leading to KFD, consist a very interesting originality. Additionally, some review data is also given. [source]

    Steroid responsiveness in a case of Riedel's thyroiditis and retroperitoneal fibrosis

    P.K. Moulik
    Summary Riedel's thyroiditis is a rare chronic inflammatory disease of the thyroid characterised by an invasive fibrotic process. We present a lady with newly diagnosed hypothyroidism, rapidly enlarging hard, fixed goitre, strongly positive thyroid antibodies and raised erythrocyte sedimentation rate (ESR). A tru-cut biopsy confirmed Riedel's struma. Regression of the goitre and reduction of antibody titres occurred after starting prednisolone, which was stopped after 10 months. Six months later, she presented with renal failure due to retroperitoneal fibrosis that was successfully treated by reinstitution of steroids and ureteric stenting. Very high titres of thyroid antibodies and hypothyroidism predating development of goitre suggest coexistence of Hashimoto's thyroiditis and Riedel's thyroiditis. Tru-cut biopsy obviated the need for open thyroidectomy. A predominantly inflammatory as opposed to fibrotic thyroid histology may predict good response to steroids. Relapse following steroid withdrawal may not only be in the thyroid but also at other sites. [source]

    Progressive macular hypomelanosis in Singapore: a clinico-pathological study

    Sujith Prasad W. Kumarasinghe MBBS
    Introduction, Progressive macular hypomelanosis (PMH), a condition of uncertain etiology, is characterized by asymptomatic hypopigmented macules predominantly located on the trunk. To date, there are no reports from South-East Asia concerning this condition. We sought to record the clinical features of PMH in Asian patients, identify etiologic factors, and study the structural and ultrastructural features of melanocytes in this disorder. Methods, Patients who presented to the National Skin Center with acquired, hypopigmented macules on the trunk, without a history of inflammation or infection, were recruited. Erythrocyte sedimentation rate (ESR), complete blood count, fasting blood glucose, liver function tests, skin scrapings for fungi, and skin biopsy specimens (from lesional and normal skin) were obtained. Biopsies were stained with hematoxylin and eosin (H&E), Fontana Masson, an immunohistochemical panel for identification of melanocyte differentiation antibodies (HMB 45, Melan A, and S100) and CD 68. Electron microscopy (EM) was also performed. The patients were evaluated every 3 months. Results, During a 9 month period, eight patients (all Chinese) presented with hypopigmented, ill-defined, confluent macules involving the lower aspect of the trunk. There were four men and four women, and the mean age was 25.9 years (range 19,45 years). Skin scrapings were negative for fungi and laboratory tests were normal. Microscopic evaluation of skin biopsy speciments showed reduced pigmentation of lesional as compared with normal appearing skin, but H&E-stained sections revealed only minimal histologic differences between lesional and normal skin. EM demonstrated a statistically significant (P = 0.047, Wilcoxon Signed Rank Test, Wilcoxon 95% CI 0.02,0.62) higher ratio of stage IV and late stage III (dark) melanosomes in normal vs. lesional skin. Conclusions, PMH may occur among young adults in Singapore. Its etiology is uncertain. The melanin content of lesional skin appears to be less than that in normal sites. EM shows a higher ratio of immature melanosomes in lesional vs. normal skin. [source]

    Tuberculosis verrucosa cutis: antitubercular therapy, a well-conceived diagnostic criterion

    Virendra N. Sehgal MD
    A 39-year-old housewife sustained inadvertent trauma to the right index finger about 6 years ago, whilst stitching clothes. A couple of weeks later, the site of trauma became hard and gritty. Ever since, it has progressed slowly, without any appreciable outward sign. It was not associated with any discomfort/pain. Consequent on an opinion from a surgeon, it was decided to operate on the right index finger. During the operation, under local anesthesia, a hard and gritty material was removed. The material was subjected to histopathologic study. Several stitches were applied to the wound. It failed to respond to antimicrobial therapy over a 4-week period, prompting the patient to seek another opinion. Examination of the skin surface revealed a plaque with an irregular configuration on and around the distal interphalangeal joint of the right index finger. It was erythematous and pigmented. The top of the plaque was irregular and had alternating elevations and depressions (Fig. 1). Diascopy was negative for apple jelly nodule. A bacillus Calmette,Guérin (BCG) vaccination scar was identified on the left deltoid. There was no regional lymphadenopathy or systemic abnormality. Mantoux test with intradermal injection of 0.1 mL SPAN's tuberculin (purified protein derivative/5 tuberculin units/0.1 mL) (Span Diagnostic Ltd., Murat, India) was negative after 72 h. Investigations, including total and differential leukocyte count, erythrocyte sedimentation rate, serum biochemistry, and renal and liver function tests, were within the normal range, as was a chest X-ray. Figure 1. Tuberculosis verrucosa cutis before (a) and after (b) antitubercular therapy (ATT) Hematoxylin and eosin-stained sections prepared from the biopsy taken from the lesion revealed noteworthy changes in the epidermis and the dermis. The former was marked by the presence of hyperkeratosis, acanthosis, and papillomatosis, whilst the latter contained tubercle granulomas. Each of the granulomas was well formed and consisted of large numbers of lymphocytes, histiocytes, and foreign body (Langerhans') giant cells (Fig. 2). Caseation necrosis and acid-fast bacilli could not be demonstrated. The preceding revelations were fairly conducive to the diagnosis. Accordingly, antitubercular therapy (ATT), comprising 450 mg of rifampicin, 300 mg of isonicotinic acid hydrazide, and 800 mg of ethambutol, was recommended for oral administration each day for 60 days. The outcome of the treatment was satisfactory, resulting in perceptible regression of the skin lesion (Fig. 1b). The patient was advised to continue the treatment for another 30 days, after which 450 mg of rifampicin and 300 mg of isonicotinic acid hydrazide were to be continued for another 6 months. Figure 2. Tuberculosis verrucosa cutis depicting well-formed tubercle(s) comprising lymphocytes, histiocytes, neutrophils, and a few giant cells (hematoxylin and eosin, × 100) [source]

    Cutaneous sarcoid-like granulomas with alveolar hemorrhage and c-ANCA PR-3

    Natividade Rocha MD
    A 28-year-old woman, employed as a leather factory worker, noted asymptomatic, well-delimited plaques on both knees, 6 years ago. The plaques were violaceous with a smooth surface. One appeared over a post-traumatic scar from childhood (Fig. 1). Two years later, she began to complain of symptoms suggestive of polyarthritis, first of the small joints of the hands (proximal interphalanges) and then of the larger joints (wrists, elbows, and knees). She was diagnosed with rheumatoid arthritis and began treatment with nonsteroidal anti-inflammatory drugs for 1 month without any change. Deflazacort, 12 mg/day, and hydroxychloroquine, 400 mg/day, were administered for 3 months, with improvement of her articular complaints, but not her skin lesions. Figure 1. Well-delimited, violaceous plaques with a smooth surface on the knees, one over an old post-traumatic scar One year later, she complained of dysphonia, which remitted spontaneously after some weeks. After one additional year, she noted papules, with similar characteristics to the plaques, on the elbows, and two well-delimited orange-to-brown plaques on the forehead (Fig. 2). Figure 2. Orange,brown plaques symmetrically placed on the forehead During the fifth year of the disease, she was referred for the first time to a dermatologist, who biopsied one of the knee lesions. The histologic result was compatible with "sarcoid granuloma." At that time, she presented with skin lesions as her only complaint. Sarcoidosis was suspected based on a chest X-ray, which revealed hilar lymphadenopathy and diffuse accentuation of the interstitium. In November 2000, she suddenly developed fever (40 °C), cough with hemoptysis, dysphonia, and subcutaneous nodules on the palmar surface of the fingers of both hands that were painless, well-delimited, 5 mm in diameter, and firm (Fig. 3). She reported a weight loss of 12 kg in the previous 3 months. Pulmonary condensation was found on auscultation, and she had palpable hepatomegaly. Peripheral lymphadenopathy was not present. Figure 3. Painless, well-delimited, firm subcutaneous nodules on the palmar surface of the fingers Laboratory investigations revealed normochromic, normocytic anemia (hemoglobin, 7.7 g/dL), iron deficit, a white blood cell count of 16,000/µL with neutrophilia, an erythrocyte sedimentation rate of 130 mm/h, elevation of liver enzymes, a slight increase in angiotensin-converting enzyme (ACE) level (72 U/L), hypergammaglobulinemia (IgG, 3350 mg/dL), antinuclear antibody (ANA) of 1 : 320, and a slight increase in CD4 and decrease in CD8 lymphocytes with normal cellular morphology in blood. Renal function, urine sediment, urine and serum calcium, complement (C4), dsDNA, antimitochondrial antibody, direct and indirect Coombs test, antineutrophil cytoplasmic antibody (ANCA), tuberculin skin tests, viral markers of hepatitis B, C, and human immunodeficiency virus (HIV), electrocardiogram (ECG), ophthalmic examinations, and culture for infectious agents in blood and sputum were all normal or negative. Computed tomography (CT) scan showed an infiltrate in the upper right pulmonary lobule with a central cavity and bilateral hilar lymphadenopathy (Fig. 4). Homogeneous hepatosplenomegaly was present. The bronchoalveolar lavage (BAL) showed a slight lymphocytic increase predominantly of CD8 cells and hemosiderosis. Stains for infectious agents, including acid-fast bacillus, fungi, Mycoplasma, and Legionella, were negative. Three biopsies from the forehead, elbows, and knees showed well-formed noncaseating epithelioid cell granulomas with giant cells of the Langhans type in the dermis, suggestive of sarcoidosis (Figs 5 and 6). A fourth biopsy from a finger nodule demonstrated inflammatory infiltration of the dermis and necrosis with cellular debris. Vasculitis was not seen (Fig. 7). Figure 4. Computed tomography scan showing an infiltrate in the upper right pulmonary lobule with a central cavity Figure 5. Beneath a flattened epidermis, several sarcoid granulomas composed of epithelioid histiocytes and several multinucleated giant cells of Langhans type can be seen (hematoxylin and eosin, ×10) Figure 6. Less well-formed sarcoid granulomas in a hyperkeratotic area, surrounded by a sparse rim of lymphocytes (hematoxylin and eosin, ×20) Figure 7. Foci of necrosis and fibrinoid degeneration with some neutrophil infiltration and nuclear dusting (hematoxylin and eosin, ×40) The patient was treated with a broad-spectrum empirical antimicrobial (levofloxacin, 500 mg daily intravenously) over 12 days, with prompt improvement in her symptoms and remission of the forehead and finger lesions. Nevertheless, on the first evaluation after hospitalization, the CT scan showed persistence of the pulmonary cavity (Fig. 8). A repeat ANCA determination was positive (cytoplasmic pattern, c-ANCA) at 1 : 640 by indirect immunofluorescence (IIF). Antiproteinase-3 antibody was demonstrated at 78 by enzyme-linked immunosorbent assay (ELISA). Figure 8. Computed tomography scan showing persistence of the pulmonary cavity She underwent an open lung biopsy which revealed intra-alveolar hemorrhage and scanty noncaseating epithelioid cell granulomas of the sarcoidosis type in the peripheral blood vessels without vasculitis. A diagnosis of Wegener's granulomatosis was made and she began prednisolone (1 mg/kg/day) and oral cyclophosphamide (2 mg/kg/day). One year later, she is asymptomatic, the skin lesions have completely remitted, c-ANCA is negative, and the CT scan shows partial regression of the pulmonary cavity. [source]

    A case of necrobiotic xanthogranuloma without paraproteinemia presenting as a solitary tumor on the thigh

    Sung Eun Chang MD
    A 82-year-old Korean woman had had a 6-month history of an asymptomatic, flat, hard, red to brown tumor on her right thigh. This lesion had been slowly enlarging with an advancing margin. She had noted gradually developing pain associated with necrosis and ulceration on the lesion. Examination revealed a solitary, 8 × 7.5 cm, yellow to dark red, telangiectatic tumor with multiple areas of punched out ulceration and a peripheral elevated yellowish margin on the right inner upper thigh (Fig. 1). No clinically similar lesions on the periorbital area or other sites were seen. Histologic examination revealed a massive palisading granulomatous infiltration with several layers of extensive bands of necrobiotic zone in the entire dermis and deep subcutaneous tissue (Fig. 2a). In the granulomatous infiltrate in the dermis and subcutis, many various-shaped, some bizarre, angulated, foreign-body type multinucleated giant cells, many Touton giant cells, and a few Langhans giant cells were found to be scattered (Fig. 2b). There were numerous xanthomatized histiocytes. Dense infiltration of lymphoplasma cells was seen in the periphery of the granuloma and perivascularly. Conspicuous granulomatous panniculitis composed of lymphoplasma cells, polymorphonuclear cells, foam cells, and Touton and foreign-body giant cells was also seen. However, cholesterol clefts and lymphoid follicles were not seen. Subcutaneous septae were widened by necrobiotic change and fibrosis with thrombosed large vessels. Gram, Gomeri-methenamine silver and acid-fast stains were negative. The necrobiotic areas were positive to alcian blue. Laboratory investigation revealed elevated white blood cell counts, anemia and elevated erythrocyte sedimentation rate. The following parameters were within the normal range: lipids, glucose, renal and liver function tests, serum complements, serum immunoglobulins, cryoglobulins and antinuclear antibodies. The findings of chest X-ray, skull X-ray and ectorcardiography were normal. Serum electrophoresis and serum immunoelectrophoresis revealed no abnormality. The patient was diagnosed as having necrobiotic xanthogranuloma without paraproteinemia. She was treated with oral steroid (0.5,0.6 mg/kg) and NSAIDS for 1 month with partial improvement of pain and the lesion ceased to enlarge. In the following 1 year of follow-up, with only intermittent NSAIDS, her lesion did not progress and there were no signs of systemic involvement or new skin lesions. Figure Figure 1 . (a) A solitary, red to brown plaque with multiple ulcerations and a peripheral elevated yellowish margin on the inner upper thigh Figure 2. (a) A dermal and subcutaneous massive xanthogranulomatous infiltrate with zonal necrobiosis of collagen (× 20). (b) Prominent infiltrate of xanthomatized histiocytes and giant cells with perivascular lymphoplasma cells (H&E, × 100) [source]

    An unusual association of pemphigus vulgaris with hyperprolactinemia

    MNAMS, Sujay Khandpur MD
    A 21-year-old unmarried woman presented with oral ulcerations and generalized, itchy, fluid-filled, skin lesions of 10 days' duration. The lesions ruptured spontaneously, resulting in extensive denuded areas covered by crusts. One month prior to this, she experienced pain and enlargement of both breasts with galactorrhea. Her menstrual cycles were normal initially, but later she developed menstrual irregularities. No past history suggestive of any other systemic or skin disease, including atopy or drug allergies, could be obtained. Her family history was not contributory. Dermatologic examination revealed multiple, flaccid bullae and extensive denuded areas of skin covered with crusts over the scalp, face, trunk, and upper and lower limbs (Fig. 1). Bulla spread sign and Nikolsky's sign were positive. The oral mucosa, including the lips, buccal surface, tongue, and palate, showed multiple erosions covered with necrotic slough. The rest of the mucocutaneous and systemic examination was within normal limits. Figure 1. Extensive erosions and flaccid bullae over the trunk with breast enlargement The patient's diagnostic work-up revealed: hemoglobin, 11.2 g%; total leukocyte count, 7400/mm3; differential leukocyte count, P62L34E2M2; erythrocyte sedimentation rate, 34 mm/h. A peripheral blood smear examination, urinalysis, blood sugar, and renal and liver function tests were normal. Venereal Disease Research Laboratory (VDRL) test and enzyme-linked immunoabsorbent assay (ELISA) for human immunodeficiency virus (HIV) were nonreactive. Antinuclear antibody, lupus erythematosus (LE) cell, rheumatoid factor, and anti-dsDNA levels were normal. Serum protein electrophoresis demonstrated increased levels of immunoglobulin G (IgG) antibody. The serum prolactin level was significantly raised to 139.49 ng/mL (normal, 3.6,18.9 ng/mL). The sex hormone levels, however, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and progesterone, were within normal limits. The thyroid hormone profile was also unaltered. Chest X-ray was normal. Ultrasound of the abdomen and pelvis revealed no visceral abnormality and computerized tomography (CT) scan of the pituitary sella showed no adenoma. Mammography was negative for breast malignancy. A Tzanck smear prepared from the base of the erosion showed multiple acantholytic cells and lymphocytes. Histologic examination from an intact vesicle was suggestive of pemphigus vulgaris (PV), showing a suprabasal cleft with acantholytic cells and the basal layer demonstrating a "row of tombstones" appearance (Fig. 2). Direct immunofluorescence (DIF) revealed the intercellular deposition of IgG and C3 throughout the epidermis in a "fishnet pattern." Indirect immunofluorescence (IIF) test performed on rat esophagus for circulating IgG antibody was positive in a titer of 1 : 120. Figure 2. Photomicrograph showing suprabasal cleft with "row of tombstones" appearance, suggestive of pemphigus vulgaris (hematoxylin and eosin, × 40) Based on the clinical and immunohistological features, a diagnosis of PV with idiopathic hyperprolactinemia was made. The patient was treated with bromocriptine mesylate (Tablet Proctinal, Glaxo Wellcome Ltd, India) at a dose of 2.5 mg twice a day. After 2 months of therapy, significant improvement in the skin lesions was observed. The existing lesions re-epithelialized with a drastic reduction in the number and distribution of new vesicles. However, no change in the mucosal erosions was noticed. IIF test demonstrated a lower antibody titer (1 : 40). The breast complaints also improved with a reduction in serum prolactin level to 6.5 ng/mL. The patient refused further treatment as she experienced nausea and dizziness with bromocriptine. After 2 weeks, the disease relapsed with the appearance of new vesicles over the forearms, abdomen, back, and thighs. She again complained of breast tenderness and galactorrhea, and the serum prolactin level was 95 ng/mL. The IgG titer increased to 1 : 120. Hence, treatment with oral prednisolone (2 mg/kg/day) and bromocriptine (2.5 mg twice a day) with an antiemetic was initiated. After 6 weeks, the skin lesions had cleared completely, the breast symptoms had improved, menses had become regular, and the prolactin level had decreased to 4 ng/mL. IIF test was negative for circulating antibody. Steroids were tapered off and maintenance therapy with bromocriptine at a dose of 2.5 mg/day was continued. [source]

    Lichenoid photodermatitis associated with nimesulide

    Umit Tursen MD
    An 81-year-old-female patient presented with a 2 week history of erythematous to violaceous lichenoid papules and plaques exhibiting a reticulated pattern on the ,,V'' area of the chest and dorsal hands. Fine, whitish reticulated networks were present over the surface of many well developed papules. The lesions were sharply demarcated and moderately pruritic (Fig. 1). Figure 1. ,Violaceous lichenoid papules with reticular pattern located on the ,,V'' area of the chest The result of routine complete blood cell count, urinalysis, erythrocyte sedimentation rate, liver and kidney function tests were within normal limits. Antinuclear and anti-DNA antibodies were negative, and total C3 and C4 complement levels were normal. Hepatitis B surface antigen, anti-Hepatitis B surface antigen, anti-Hepatitis B core IgM antibody were negative, while anti-Hepatitis C virus antibody was positive. A skin biopsy specimen obtained from the neck of our patient revealed an interface lichenoid dermatitis accompanied by individual necrotic epidermal keratinocytes, parakeratosis and eosinophils in the infiltrate (Fig. 2). Figure 2. ,Interface lichenoid dermatitis accompanied by individual necrotic epidermal keratinocytes and parakeratosis (Hematoxylin and eosin; original magnification, × 200) Nimesulide therapy was stopped and the patient was treated with topical corticosteroids and systemic antihistamines. The eruption resolved within 5 days. The rash returned following nimesulide rechallenge. [source]

    Acute generalized exanthematous pustulosis mimicking toxic epidermal necrolysis

    Arnon D. Cohen MD
    A 91-year-old patient presented with a nonfebrile, pruritic, widespread eruption that appeared 10 days after starting therapy with cefuroxime tablets, 1000 mg/day, due to stasis dermatitis with secondary infection. The patient was also treated with paracetamol tablets, 500,1000 mg/day, 10 days before the onset of the eruption. Previous diseases included congestive heart disease, hyperglycemia, and ectropion. There was no personal or family history of psoriasis. Additional medications, taken for more than 2 years at the time of the eruption, included indomethacin, captopril, hydrochlorothiazide, isosorbide-5-mononitrate tablets, and a combination drug Laxative®. Examination revealed widespread erythema involving 95% of the total body surface area, with numerous 1,2 mm nonfollicular pustules (Fig. 1). There was no predilection to the body folds. Within 24 h of hospitalization, during intravenous therapy with cefuroxime, the patient's condition worsened and bullae containing clear fluid appeared. Nikolsky's sign was positive on erythematous skin, and eventually skin detachment involved 41% of the total body surface area (Fig. 2). There were no target or target-like lesions and there was no involvement of the mucous membranes. Figure 1. Numerous, 1,2 mm, nonfollicular pustules, with confluence (viewed in the lower left part of the photograph), on erythematous skin Figure 2. Widespread skin detachment An early biopsy from a pustule revealed subcorneal and intraepidermal spongiform pustules, papillary edema, perivascular mononuclear infiltrate with a few eosinophils in the dermis, and leukocytoclastic vasculitis. A later biopsy showed similar findings with no evidence of full-thickness epidermal necrosis or necrotic keratinocytes. Direct immune fluorescence (DIF) taken from erythematous skin was negative. Laboratory studies showed the following results: sedimentation rate, 80 mm/h; white blood cell count, 26,200/mm3 with 87% polymorphonuclears and 1.8% eosinophils; hemoglobin, 13.0 g/dL; albumin, 2.8 g/dL (normal, 3.5,5.5 g/dL); other blood chemistry tests were normal. Immunologic studies for rheumatoid factor, antinuclear antibodies, antismooth muscle antibodies, antiparietal cell antibodies, antimitochondrial antibodies, C3, and C4 were normal or negative. Serology for venereal disease research laboratory (VDRL) test, Epstein,Barr virus, cytomegalovirus, hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and antistreptolysin titer was negative. Chest X-ray was normal. Blood cultures were negative. Swab cultures taken from the pustules revealed Staphylococcus aureus as well as coagulase-negative Staphylococcus. All systemic drugs, including intravenous cefuroxime, were withdrawn with close monitoring for signs of heart failure or infection. Topical therapy consisted of application of wet dressings. Within 10 days, the eruption resolved with re-epithelialization of the erosions and the appearance of widespread post-pustular desquamation (Fig. 3) Figure 3. Post-pustular desquamation on the trunk [source]

    Juvenile psoriatic arthritis with nail psoriasis in the absence of cutaneous lesions

    Carola Duran-McKinster MD
    A 4-year-old white boy without a significant family history had morning stiffness and painful swelling of his left knee and ankle, right elbow, and dorsolumbar region of 2 months' evolution. The following laboratory studies were within normal limits: complete blood cell count, C-reactive protein (CRP), latex, antistreptolysin, and antinuclear antibodies. Rheumatoid factor was negative and an increase in the erythrocyte sedimentation rate (ESR) was detected (56 mm/h). The pediatric department made an initial diagnosis of juvenile rheumatoid arthritis, and treatment with acetylsalicylic acid at 100 mg/kg/day and naproxen at 10 mg/kg/day was started. A thick, yellowish toenail was diagnosed as onychomycosis. No mycologic investigations were performed. Intermittent episodes of painful arthritis of different joints were present. The radiographic features of the peripheral joints included: narrow joint spaces, articular erosions, soft tissue swelling, and diffuse bony demineralization. Characteristic bilateral sacroiliitis and a swollen tendon sheath on the left ankle were detected. At 11 years of age the nail changes had extended to five other toenails and to four fingernails, were yellow,brown in color, and showed marked subungual hyperkeratosis ( Figs 1, 2). The rest of the nails showed significant nail pitting. Trials of griseofulvin alternated with itraconazole in an irregular form for five consecutive years resulted in no clinical improvement, which prompted a consultation to our dermatology department. On three different occasions, KOH nail specimens were negative for fungus, but the presence of parakeratotic cells aroused the suspicion of psoriasis. A complete physical examination was negative for psoriatic skin lesions. A nail bed biopsy specimen was characteristic of nail psoriasis ( Fig. 3). Figure 1. Thickened nails with severe subungual hyperkeratosis in five fingernails Figure 2. Secondary deformity of nail plate. No "sausage" fingers were observed Figure 3. Light microscopic appearance of a nail biopsy specimen showing parakeratotic hyperkeratosis, elongation of interpapillary processes, and Munroe abscess (arrow) (hematoxylin and eosin stain, ×40) The following human leukocyte antigens (HLAs) were positive: A9, A10, B12, B27, Cw1, Bw4, DR6, DR7, DQ1, DQ2, and DR53. A diagnosis of juvenile psoriatic arthritis associated with nail psoriasis was made. Toenail involvement became so painful that walking became very difficult. Occlusive 40% urea in vaseline applied to the affected toenails for 48 h resulted in significant improvement. Currently, the patient is 20 years old with nail involvement, but no psoriatic skin lesions have ever been observed. [source]