AMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2008
C. B. Drachenberg
Accurate diagnosis and grading of rejection and other pathological processes are of paramount importance to guide therapeutic interventions in patients with pancreas allograft dysfunction. A multi-disciplinary panel of pathologists, surgeons and nephrologists was convened for the purpose of developing a consensus document delineating the histopathological features for diagnosis and grading of rejection in pancreas transplant biopsies. Based on the available published data and the collective experience, criteria for the diagnosis of acute cell-mediated allograft rejection (ACMR) were established. Three severity grades (I/mild, II/moderate and III/severe) were defined based on lesions known to be more or less responsive to treatment and associated with better- or worse-graft outcomes, respectively. The features of chronic rejection/graft sclerosis were reassessed, and three histological stages were established. Tentative criteria for the diagnosis of antibody-mediated rejection were also characterized, in anticipation of future studies that ought to provide more information on this process. Criteria for needle core biopsy adequacy and guidelines for pathology reporting were also defined. The availability of a simple, reproducible, clinically relevant and internationally accepted schema for grading rejection should improve the level of diagnostic accuracy and facilitate communication between all parties involved in the care of pancreas transplant recipients. [source]

Transient versus prolonged hyperlocomotion following lateral fluid percussion injury in mongolian gerbils

JOURNAL OF NEUROSCIENCE RESEARCH, Issue 2 2006
Shihong Li
Abstract Posttraumatic hyperactivity is a neurobehavioral symptom commonly seen in patients after traumatic brain injury (TBI). No useful animal model has yet been established for evaluation of this important symptom. We induced either mild (MILD, 0.7,0.9 atm) or moderate (MOD, 1.3,1.6 atm) lateral fluid percussion injury (LFPI) in Mongolian gerbils. Open-field and T-maze tests were used during a 7-day period after the trauma. All animals were perfusion fixed for histopathological examinations. Transient locomotor hyperactivity was found with a peak at 6 hr after injury in the MILD animals, whereas MOD animals showed prolonged and severe hyperlocomotion throughout the 7-day posttrauma period (P < 0.0001). Interestingly, the temporal profile of the posttraumatic hyperactivity was similar to that of the working memory deficit in both injury groups. Histological examination revealed significant neural tissue damages, including cortical necrosis, white matter rarefaction, and neuronal loss in the hippocampus in the ipsilateral hemisphere of the MOD animals, vs. only negligible changes in the MILD animals. Correlation analysis revealed that the volume of white matter lesions was significantly correlated with both posttraumatic hyperactivity (r = 0.591, P < 0.01) and working memory deficit (r = ,0.859, P < 0.0001). Taken together, our findings confirm the successful reproduction of posttraumatic hyperactivity following experimental TBI. The posttraumatic hyperlocomotion probably shared pathomechanisms common to those of cognitive dysfunction caused by LFPI, supporting the speculation from previous studies that some neurobehavioral abnormities intimately correlate with TBI-induced cognitive dysfunction. Histopathologically, significant involvement of white matter damage in the posttraumatic functional deficits was indicated. © 2006 Wiley-Liss, Inc. [source]

INVESTIGATION OF A COMPLEX PLANT EXTRACT FOR MILD TO MODERATE ERECTILE DYSFUNCTION IN A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, PARALLEL-ARM STUDY

BJU INTERNATIONAL, Issue 11 2010
Elie Ghannam Nemr
No abstract is available for this article. [source]

Novel Approach to the Treatment of Hyperpigmented Photodamaged Skin: 4% Hydroquinone/0.3% Retinol versus Tretinoin 0.05% Emollient Cream

DERMATOLOGIC SURGERY, Issue 2005
Zoe Diana Draelos MD
Background. Mild to moderately photodamaged skin is characterized by dyspigmentation, fine wrinkles, and tactile roughness. An optimal approach to the topical treatment of photoaging would simultaneously address all appearance issues. Objective. This study was undertaken to evaluate the effect of 4% hydroquinone and 0.3% retinol in photoaging. Materials and Methods. A 16-week study was designed to evaluate the efficacy and tolerance of a single cream containing prescription topical 4% hydroquinone for dyspigmentation and the cosmeceutical 0.3% retinol for fine wrinkles in an emollient vehicle for tactile roughness. This novel formulation was compared with 0.05% tretinoin emollient cream, the standard against which all other topical photoaging treatments are compared. Investigator assessments, subject assessments, and photography represented the evaluation end points. Results. The cosmeceutical emollient 4% hydroquinone/0.3% retinol cream more effectively diminished the collective signs of photodamage than 0.05% tretinoin emollient cream in terms of dyspigmentation, fine wrinkles, and tactile roughness in 16 weeks. Conclusion. Combination therapy of hydroquinone and retinol may improve photoaging-associated hyperpigmentation. THIS STUDY WAS CONDUCTED AS PART OF A RESEARCH GRANT FROM MEDICIS THE DERMATOLOGY COMPANY, PHOENIX, ARIZONA. DR. DRAELOS HAS NO FINANCIAL INTEREST IN ANY OF THE MEDICATIONS DISCUSSED IN THIS RESEARCH. [source]

The Safety and Effectiveness of Single-Pass Erbium:YAG Laser in the Treatment of Mild to Moderate Photodamage

DERMATOLOGIC SURGERY, Issue 8 2004
David K. Avram MD
Background. There are several treatment modalities for mild to moderate photodamage. The demand for effective treatments with minimal side effects has increased. Objective. The objective of this study was to determine the effectiveness of short-pulsed erbium:YAG laser in treating mild to moderate photodamage. Methods. Twenty patients were treated with the short-pulse erbium:YAG laser on the face and neck. One pass was given over the entire face with two to three passes over the perioral and periorbital regions. Patients were evaluated for improvement of pigmentary irregularities, skin texture, and fine wrinkles. All side effects were recorded at follow-up visits. Two lasers were used, Sciton and Cynosure CO3, under local anesthesia. Results. There was a 58% reduction in pigment irregularities and a 54% improvement in skin texture. There was minimal improvement in fine wrinkles with one pass. Two and three passes resulted in a 50% reduction in wrinkles. The procedure was minimally painful. Side effects included 3 to 5 days of erythema and edema. Patients returned to work within 3 days on average. There were no infections. Patient satisfaction with the procedure was rated as very good. There was no difference in efficacy or adverse effects with either laser. Conclusions. One-pass short-pulse erbium:YAG laser in treating photodamage of the face and neck is safe and effective. There are minimal side effects and patients heal within 3 to 5 days. [source]

Utilization of the 1320-nm Nd:YAG Laser for the Reduction of Photoaging of the Hands

DERMATOLOGIC SURGERY, Issue 8 2004
FAACS, Neil Sadick MD
Background. Nonablative laser resurfacing has been shown to improve the appearance photoaged skin. Clinical improvement has been associated with dermal collagen remodeling. Objective. The objective was to determine the efficacy of a 1320-nm Nd:YAG laser for the treatment of photoaging hands. Methods. Seven patients with photoaged hands received six monthly treatments with a 1320-nm Nd:YAG laser. Improvement in skin smoothness was evaluated by objective and patient assessment using a 6-point improvement scale: 1=no improvement and 6=80% to 100% improvement. Results. Mild to moderate improvement was achieved as determined by both objective and patient assessment. Mean improvement by objective assessment was 2.4 points. Objective improvement was noted in four of seven patients, and these patients demonstrated a mean improvement score of 3.5 points. The mean improvement by patient assessment was 3.1 points. Conclusion. This case series demonstrates that the 1320-nm Nd:YAG laser with cryogen cooling can be effective for rejuvenation of photoaged hands. [source]

Resurfacing of Pitted Facial Acne Scars with a Long-Pulsed Er:YAG Laser

DERMATOLOGIC SURGERY, Issue 2 2001
Jeung-Tae Jeong MD
Background. Conventional short-pulsed Er:YAG lasers show less effective hemostasis and weak photothermal damage on papillary dermis. Recently, newer long-pulsed Er:YAG laser systems has been developed. Objective. To evaluate the clinical and histologic effects of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars. Methods. Thirty-five patients with pitted facial acne scars were treated with a long-pulsed Er:YAG laser. All patients had Fitzpatrick skin phototypes III,V. A pulsed Er:YAG laser with a 5 mm handpiece at a setting of 7.0,7.5 J/cm2 with a 10-msec pulse duration was used. The laser was fired at 5 Hz, with four to five passes. In 28 patients, the results of laser treatment were evaluated for the degree of clinical improvement, duration of erythema, pigmentary change, and any adverse events at 2 weeks, 1 month, and 3 months. In seven patients, skin biopsy specimens were obtained at the following intervals: immediately, 1 week, 2 weeks, 4 weeks, and 8 weeks postoperatively for histologic examination. Results. The results of long-pulsed Er:YAG laser resurfacing for pitted facial acne scars were excellent in 10 patients (36%), good in 16 patients (57%), and fair in 2 patients (7%). Erythema occurred in all patients after laser treatment and lasted longer than 3 months in 15 patients (54%). Postinflammatory hyperpigmentation occurred in 8 patients (29%). But the pigmentation faded or disappeared within 3 months. One patient (4%) experienced mild hypopigmentation. Pruritic symptoms that required medical intervention occurred in 16 patients (57%). Mild to moderate postoperative acne flare-up occurred in 8 patients (29%). No other adverse effects such as scarring, bacterial infection, or contact dermatitis were observed. Conclusion. In conclusion, resurfacing with a long-pulsed Er:YAG laser is a safe and very effective treatment modality for pitted facial acne scars. [source]

A New, Mild, General and Efficient Route to Aryl Ethyl Carbonates in Solvent-Free Conditions Promoted by Magnesium Perchlorate

EUROPEAN JOURNAL OF ORGANIC CHEMISTRY, Issue 19 2006
Giuseppe Bartoli
Abstract A new, general and mild method for the direct synthesis of aryl and alkyl ethyl carbonates promoted by a Lewis acid is reported. The reaction proceeds smoothly with diethyl dicarbonate in the presence of Mg(ClO4)2, a specific activator of 1,3-dicarbonyl compounds, and shows general applicability. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2006) [source]

New Functionalised Hydroxymethyl Ketones from the Mild and Chemoselective KMnO4 Oxidation of Chiral Terminal Olefins

EUROPEAN JOURNAL OF ORGANIC CHEMISTRY, Issue 1 2006
Carlo Bonini
Abstract Various terminal olefinic compounds are directly converted into the corresponding ,-hydroxy ketones in good yields by potassium permanganate oxidation. The reaction is also highly chemoselective in the presence of differently protected hydroxy groups and can be utilised for the preparation of polyfunctional compounds such as polyols. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2006) [source]

A Mild and Efficient Method for N -Arylnucleobase Synthesis via the Cross-Coupling Reactions of Nucleobases with Arylboronic Acids Catalyzed by Simple Copper Salts

HELVETICA CHIMICA ACTA, Issue 6 2008
Lan Tao
Abstract A simple and efficient copper-salt catalyzed N -arylation of nucleobases is reported. In a mixed solvent of MeOH and H2O, the coupling products were obtained in moderate to excellent yields at room temperature within a short time. A variety of substituted N -aryl nucleobases can be prepared through this procedure. [source]

Synthesis of Some Novel Thioxanthenone-Fused Azacrown Ethers, and Their Use as New Catalysts in the Efficient, Mild, and Regioselective Conversion of Epoxides to , -Hydroxy Thiocyanates with Ammonium Thiocyanate

HELVETICA CHIMICA ACTA, Issue 7 2007
Hashem Sharghi
Abstract The regioselective ring-opening reactions of some epoxides with ammonium thiocyanate in the presence of a series of new 9H -thioxanthen-9-one-fused azacrown ethers, i.e., 7,11 (Scheme,1), and also of dibenzo[18]crown-6 (12), Kryptofix®22 (13), and benzo[15]crown-5 (14) were studied (Tables 1 and 2). The epoxides were subjected to cleavage by NH4SCN in the presence of these catalysts under mild conditions in various aprotic solvents. Reagents and conditions were identified for the synthesis of individual , -hydroxy thiocyanates in high yield and with more than 90% regioselectivity. The results can be discussed in terms of a four-step mechanism (Scheme,2): 1) formation of a complex between catalyst and NH4SCN, 2) release of SCN, from the complex, 3) reaction of the released SCN, at the sterically less hindered site of the epoxide, and 4) regeneration of the catalyst. The major advantages of this method are the high regioselectivity, the simple regeneration of the catalyst, the reuse of it through several cycles without a decrease of activity, and the ease of workup of the reaction mixtures. [source]

Two Japanese cases of lichen planus pigmentosus-inversus

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 7 2007
Aki Kashima MD
Case 1 was a 51-year-old Japanese woman. She presented with an asymptomatic brown macule located on the right axilla of 2 months' duration. The smooth macule was 2 cm in diameter with a sharp demarcation (Fig. 1A). Figure 1. Photographs of skin lesions in two patients. (A) Case 1. Well-circumscribed brown macule without an active red border in the central portion of the right axilla. (B) Case 2. Symmetric distribution of brown macules without an active red border in the popliteal fossae Case 2 was a 62-year-old Japanese man. He presented with asymptomatic, symmetric, gray,brown macules located on the groin, axillae, and popliteal region of 6 months' duration. The smooth macules were several millimeters to centimeters in diameter and sharply demarcated (Fig. 1B). Oral or nail lesions, previous inflammatory processes in affected areas, and internal malignancies were absent. A causal relationship with drugs, recent sun exposure, or trauma could not be identified. Findings for work-up, including blood cell count, fasting blood sugar levels, liver function, serum electrolyte levels, serum electrophoresis, urinalysis, antinuclear antibodies, and serological examinations for human hepatitis viruses and syphilis, were within normal limits or negative. The lesions gradually disappeared without medication within 6 months. Biopsy specimens showed a lymphocytic infiltrate with basal vacuolar changes and prominent melanin incontinence in the upper dermis (Fig. 2A). The band-like lymphocytic infiltrate was moderate in Case 1 and mild in Case 2. Immunohistochemistry showed infiltrative CD8+ T lymphocytes with keratinocytic damage, indicating cytotoxic injury of the keratinocytes (Fig. 2B). Both the epidermis and the upper dermis contained CD1a+ cells (Fig. 2C). The keratinocytes focally and weakly expressed HLA-DR (Fig. 2D). These findings were identical in samples from both patients. Figure 2. Light and immunohistochemical microphotographs. (A) Mild, band-like, lymphocytic infiltrate with basal vacuolar change and prominent melanin incontinence in the upper dermis with apoptosis or necrosis of keratinocytes. (B) Epidermal infiltrate of CD8+ T lymphocytes with keratinocytic damage. (C) CD1a+ cells in the upper dermis. (D) Keratinocytes focally and weakly express HLA-DR (original magnifications: A, ×200; B,D, ×400) [source]

Depressive symptoms among cognitively normal versus cognitively impaired elderly subjects

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2001
Yan-sheng Li
Abstract Objectives The present cross-sectional study analyzed the prevalence and severity of depressive symptoms among patients with Alzheimer's disease (DAT), vascular dementia (VAD), and among the cognitively normal elderly. Putative risk factors contributing to depression were likewise evaluated. Methods Seventy-six DAT patients, 51 VAD patients, and 121 cognitively normal subjects were admitted to the study. Questionnaires concerning demography and their vascular and familial risk factors together with results of neuropsychological testing by combined Mini-Mental Status Examinations (MMSE), Cognitive Capacity Screening Examinations (CCSE), and Hamilton Depression Rating Scales (HDRS) were obtained so that resulting data would be statistically analyzed. Results Prevalence of depressive symptoms among VAD, DAT, and cognitively normal elderly were 31.4%, 19.9%, and 13.2%, respectively. 25.5% of VAD and 13.2% of DAT patients had depression of mild to moderate degrees. Regression analysis revealed that diagnosis of VAD and DAT, heart disease, and past history of depression was significantly associated with high HDRS scores. There was no correlation between degree of depression and severity of cognitive impairments. Conclusion Mild to moderate depression is a common comorbidity with organic dementia, especially VAD, but associated depression is independent of severity of cognitive impairments. Copyright © 2001 John Wiley & Sons, Ltd [source]

Pentafluorophenylammonium Trifluoromethanesulfonimide: Mild, Powerful, and Robust Catalyst for Mukaiyama Aldol and Mannich Reactions between Ketene Silyl Acetals and Ketones or Oxime Ethers

ADVANCED SYNTHESIS & CATALYSIS (PREVIOUSLY: JOURNAL FUER PRAKTISCHE CHEMIE), Issue 7 2010
Ryohei Nagase
Abstract Pentafluorophenylammonium trifluoromethanesulfonimide (C6F5N+H3,NTf2,) promotes Mukaiyama aldol and Mannich reactions using ketene silyl acetals with ketones and oxime ethers, respectively. The present robust method is mild, but powerful enough to utilize less accessible electrophiles such as enolizable ketones and oxime ethers to produce a variety of ,-hydroxy esters and ,-alkoxyamino esters, respectively. Mechanistic investigation revealed in situ generation of trimethylsilyl bistriflimide [Tf2N(TMS)], the truly active catalyst, which was supported by rational 1H,NMR measurements. [source]

Copper(II) Bromide/Boron Trifluoride Etherate-Cocatalyzed Cyclization of Ketene Dithioacetals and p -Quinones: a Mild and General Approach to Polyfunctionalized Benzofurans

ADVANCED SYNTHESIS & CATALYSIS (PREVIOUSLY: JOURNAL FUER PRAKTISCHE CHEMIE), Issue 5 2010
Yingjie Liu
Abstract A new application of copper(II) bromide-activated ketene dithioacetals as nucleophiles in organic chemistry has been developed. Under the cocatalysis of copper(II) bromide (2.0,mol%) and boron trifluoride etherate (10,mol%), the conjugate addition and sequential cyclization of ,-electron-withdrawing group-substituted ketene dithioacetals with p -quinones in acetonitrile at room temperature gave a variety of benzofurans. This formal [3+2],cycloaddition provides a general method for catalytic synthesis of polyfunctionalized benzofurans with the advantages of readily available starting materials, cheap catalysts, mild reaction conditions, good yields and wide range of synthetic potential for the benzofuran products. Further transformations of the resulting benzofurans to 2-aminobenzofurans and benzofuro[2,3- d]pyrimidine derivatives are also investigated. [source]

Rheumatic disease in the Australian Aborigine of Cape York Peninsula: a 1965 study

INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 3 2004
William Alexander DOUGLAS
Abstract Aim:, To study the prevalence of rheumatic disorders in two Aboriginal populations on the western coast of Cape York Peninsula. Methods:, Physical and radiological examination of 217 adult Aborigines at Aurukun Aboriginal Mission and 71 Aboriginal adults at Weipa Mission. The study was performed in October 1965. Results:, Mild to moderate degenerative arthritis was not uncommon in the populations examined. However, generalised or nodal osteoarthritis was not seen. One young woman had definite sero-positive rheumatoid arthritis. This woman's appearance suggested some Torres Strait Islander influence. No case of gouty arthritis or classical ankylosing spondylitis was encountered. An incidental finding of retrospective interest was that the calculated body mass index showed that the majority of adults were underweight by Caucasian standards. Conclusions:, These findings are of historic interest given the health impacts of social, cultural and environmental circumstances of Aborigines currently reported. [source]

A Mild, One-Pot Synthesis of Arylamines via Palladium- Catalyzed Addition of Aryl Aldehydes with Amines and Arylboronic Acids in Water

ADVANCED SYNTHESIS & CATALYSIS (PREVIOUSLY: JOURNAL FUER PRAKTISCHE CHEMIE), Issue 5 2009
Ajuan Yu
Abstract A mild, one-pot synthesis of diarylmethylamines via the palladium-catalyzed addition of aryl aldehydes with amines and arylboronic acids is reported. Best results were obtained in neat water with ammonium chloride as additive, affording diarylmethylamine derivatives as the main products. [source]

Hydrogen-Bonding Catalysis: Mild and Highly Chemoselective Oxidation of Sulfides

ADVANCED SYNTHESIS & CATALYSIS (PREVIOUSLY: JOURNAL FUER PRAKTISCHE CHEMIE), Issue 4 2009
Alessio Russo
Abstract N,N, -Bis[3,5-bis(trifluoromethyl)phenyl]thiourea, employed at only 1,mol% loading, was found to be a very effective catalyst for the oxidation of sulfides with tert -butyl hydroperoxide (TBHP), affording the sulfoxides in high yield, excellent chemoselectivity, fairly good diastereoselectivity. [source]

A Mild and Efficient Iron-Catalyzed Synthesis of Alkenyl Halides via Direct Addition of Benzyl Halides to Arylalkynes

ADVANCED SYNTHESIS & CATALYSIS (PREVIOUSLY: JOURNAL FUER PRAKTISCHE CHEMIE), Issue 3 2009
Zhongquan Liu
Abstract An efficient and mild iron-catalyzed synthesis of alkenyl halides has been developed via direct carbon-carbon bond formation by using benzyl halides and arylalkynes. [source]

Mild and Efficient Allylation of Aldehydes by using Copper Fluorapatite as Catalyst

ADVANCED SYNTHESIS & CATALYSIS (PREVIOUSLY: JOURNAL FUER PRAKTISCHE CHEMIE), Issue 10 2008
M. Lakshmi Kantam
Abstract A facile synthesis of homoallylic alcohols is achieved by the allylation of aldehydes with allylic metal reagents or allyl halides using copper fluorapatite (CuFAP) as catalyst under mild reaction conditions. A variety of aldehydes were converted to the corresponding homoallylic alchohols, demonstrating the versatility of the reaction. [source]

Prevalence of Alcohol-Related Problems in an Elderly Population and Their Association With Cognitive Impairment and Dementia

ALCOHOLISM, Issue 4 2010
Marcos A. Lopes
Background:, Studies investigating the association between alcohol use and cognitive disorders in the elderly population have produced divergent results. Moreover, the role of alcohol in cognitive dysfunction is not clear. The aims of this study were to estimate the prevalence of alcohol-related problems in an elderly population from Brazil and to investigate their association with cognitive and functional impairment (CFI) and dementia. Methods:, A community-based cross-sectional study was performed. A sample of 1,145 elderly people was examined in 2 phases. Several instruments were utilized in the first phase: the CAGE questionnaire was used to identify potential cases of alcohol-related problems, and a screening test for dementia was used to estimate CFI. The CAMDEX interview (Cambridge Examination) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) criteria were used for the clinical diagnosis of dementia in the second phase. Results:, "Heavy alcohol use" (CAGE , 2) was found in 92 subjects (prevalence: 8.2%). It was associated with gender (males, p < 0.001), low education (only in females, p = 0.002), and low socioeconomic level (p = 0.001, in females; p = 0.002, in males). The Mini Mental State Examination exhibited a nonlinear relationship with alcohol-related problems in females; "mild,moderate alcohol use" (CAGE < 2) presented the highest score. A significant association between alcohol-related problems and cognitive dysfunction was found only in females. "Heavy alcohol use" was associated with higher CFI and dementia rates compared to "mild,moderate alcohol use" (p = 0.003 and p < 0.001, respectively). "Mild,moderate alcohol use" had a tendency of association with lower CFI and dementia rates when compared to "no alcohol use" (p = 0.063 and 0.050, respectively). Conclusion:, Our findings suggest that alcohol use does not have a linear relationship with cognitive decline. [source]

Clinical trial: the safety and short-term efficacy of recombinant cholera toxin B subunit in the treatment of active Crohn's disease

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2010
P. STÅL
Aliment Pharmacol Ther,31, 387,395 Summary Background, The cholera toxin B subunit ameliorates experimentally induced colitis in mice. In humans, cholera toxin B subunit has never been tested in the treatment of Crohn's disease (CD). Aim, To evaluate the safety and efficacy of treatment with recombinant cholera toxin B subunit of patients with CD. Methods, An open-label, multicentre, nonrandomized trial including 15 patients with mild/moderate CD. Patients received an oral solution of 5 mg recombinant cholera toxin B subunit three times weekly for 2 weeks. Reduction in CD Activity Index (CDAI) with >100 between baseline and days 15, 29, 42 and 70 defined clinical response. Patients with CDAI score ,150 were defined as being in remission. Results, A significant decrease in CDAI score was observed. Response rates were 40% in the full analysis set and 42% in the per protocol analysis. Two patients receiving adjuvant treatment after day 29 were excluded, after which 40% were in remission at 4 weeks and 30% at 8 weeks post-treatment. Mild side effects (arthralgia, headache and pruritus) were seen in 33% of patients. Conclusions, Treatment with recombinant cholera toxin B subunit was safe. Approximately 40% of patients with active CD responded to treatment. Randomized studies are needed to establish the clinical efficacy of recombinant cholera toxin B subunit. [source]

Airway wall geometry in asthma and nonasthmatic eosinophilic bronchitis

ALLERGY, Issue 6 2009
S. Siddiqui
Background:, Variable airflow obstruction and airway hyperresponsiveness (AHR) are features of asthma, which are absent in nonasthmatic eosinophilic bronchitis (EB). Airway remodelling is characteristic of both conditions suggesting that remodelling and airway dysfunction are disassociated, but whether the airway geometry differs between asthma and nonasthmatic EB is uncertain. Methods:, We assessed airway geometry by computed tomography (CT) imaging in asthma vs EB. A total of 12 subjects with mild,moderate asthma, 14 subjects with refractory asthma, 10 subjects with EB and 11 healthy volunteers were recruited. Subjects had a narrow collimation (0.75 mm) CT scan from the aortic arch to the carina to capture the right upper lobe apical segmental bronchus (RB1). In subjects with asthma and EB, CT scans were performed before and after a 2-week course of oral prednisolone (0.5 mg/kg). Results:, Mild,moderate and refractory asthma were associated with RB1 wall thickening in contrast to subjects with nonasthmatic EB who had maintained RB1 patency without wall thickening [mean (SD) % wall area and luminal area mild-t0-moderate asthma 67.7 (7.3)% and 6.6 (2.8) mm2/m2, refractory asthma 67.3 (5.6)% and 6.7 (3.4) mm2/m2, healthy control group 59.7 (6.3)% and 8.7 (3.8) mm2/m2, EB 61.4 (7.8)% and 11.1 (4.6) mm2/m2 respectively; P < 0.05]. Airway wall thickening of non-RB1 airways generation three to six was a feature of asthma only. There was no change in airway geometry of RB1 after prednisolone. Proximal airway wall thickening was associated with AHR in asthma (r = ,0.56; P = 0.02). Conclusions:, Maintained airway patency in EB may protect against the development of AHR, whereas airway wall thickening may promote AHR in asthma. [source]

Efficacy of topical griseofulvin in treatment of tinea corporis

MYCOSES, Issue 3 2006
Mohamed A. A. Kassem
Summary Tinea infections are among the most common dermatological conditions throughout the world. Griseofulvin is a classical oral fungistatic antibiotic, active against Epidermophyton floccosum, Trichophyton and Microsporum species, the causative fungi of tinea corporis. To evaluate the efficacy of topical griseofulvin in the treatment of tinea circinata using three different vehicles for drug delivery. Sixteen patients with tinea circinata were instructed to apply either griseofulvin gel form in group A or a similar placebo gel for control group; a niosomal gel formulation of griseofulvin for group B or; a liposomal gel formulation of griseofulvin for group C. Patients were evaluated both clinically and mycologically after 3 weeks. Marked improvement was seen for groups A, B and C both clinically and mycologically while no improvement was observed in the placebo group. Mild and transient irritation was reported in four patients. Our results show that topical griseofulvin preparations may be effective and safe in treating tinea circinata and that further large-scale studies may establish the high efficacy of the niosomal gel formulation. [source]

Sleep-Disordered Breathing in Recipients of Implantable Defibrillators

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2009
WOLFRAM GRIMM M.D.
Study Objectives: To examine the prevalence and clinical significance of sleep-disordered breathing in patients with implantable cardioverter defibrillators (ICD). Methods and Results: Overnight sleep studies were performed in 129 ICD recipients who had no history of sleep apnea. The mean left ventricular ejection fraction (LVEF) was 29 ± 11%. Mild, moderate, and severe sleep apnea was diagnosed in the presence of an apnea/hypopnea index (AHI) of 5,15/h, 15.1,30/h, and >30/h, respectively. No sleep apnea was present in 49 patients (38%), 57 (44%) had central sleep apnea (CSA), and 23 patients (18%) had obstructive sleep apnea (OSA). Mild, moderate, and severe sleep apnea were present in 25%, 31%, and 44% of patients with CSA, compared with 52%, 22%, and 26% of patients with OSA (P < 0.05). LVEF was similar in patients with versus without OSA or CSA. Patients with CSA were significantly older and had a higher prevalence of ischemic cardiomyopathy than patients without sleep apnea. Conclusions: Previously undiagnosed CSA is common in ICD recipients. Severely disordered breathing during sleep was more prevalent among patients with CSA than patients with OSA. This prospective, observational study will examine the long-term clinical significance of sleep-disordered breathing in ICD recipients. [source]

Effects of Corticosteroid Therapy on the Long-Term Outcome of Radiofrequency Lesions in the Swine Caval Veins

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2008
GUILHERME FENELON M.D.
Background: We explored the angiographic and pathological effects of corticosteroids on the long-term outcome of radiofrequency (RF) ablation lesions in the swine caval veins. Methods: Under fluoroscopy guidance, a single linear RF lesion (4-mm tip, 60°C, 180 seconds) was created in each vena cava (from ±2 cm into the vein to the venoatrial junction) of 20 anesthetized minipigs (35± 2 kg). Three groups were studied: acute (n = 4), killed 1 hour after RF; control (n = 8), sacrificed 83± 1 days after RF; and pigs (n = 8) receiving hydrocortisone (400 mg i.v. after RF) and prednisone (25 mg po for 30 days), killed 83± 1 days post-RF. Angiography was performed before, immediately after ablation, and at follow-up. Then, animals were sacrificed for histological analysis. Results: Mild (<40%) or moderate (41,70%) acute luminal narrowing occurred in 19/20 (95%) inferior veins and in 13/20 (65%) superior veins. Severe (>70%) stenosis and occlusions were not noted. At follow-up, in both chronic groups, mean vessel diameters returned to baseline and progression of luminal narrowing did not occur in any vein. Of note, superior and inferior vena cava angiographic diameter for control and treated pigs did not differ. The same was observed for the cross-sectional luminal area. Acute lesions displayed transmural coagulative necrosis whereas chronic lesions revealed marked fibrosis. Histological findings were similar in controls and treated pigs. Conclusion: In this model, mild and moderate stenosis, occurring immediately after ablation, seems to resolve over time. Corticosteroids do not affect the long-term outcome of such RF lesions in the caval veins. [source]

ORIGINAL RESEARCH,EJACULATORY DISORDERS: Baseline Characteristics and Treatment Outcomes for Men with Acquired or Lifelong Premature Ejaculation with Mild or No Erectile Dysfunction: Integrated Analyses of Two Phase 3 Dapoxetine Trials

THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2010
Hartmut Porst MD
ABSTRACT Introduction., Premature ejaculation (PE) is classified as an acquired or lifelong condition but data on baseline characteristics and response to treatment of men with acquired or lifelong PE and mild erectile dysfunction (ED) or normal erectile function (EF) is limited. Aim., To present integrated analyses of baseline characteristics and treatment outcomes from phase 3 dapoxetine trials in men with acquired or lifelong PE and mild or no ED. Methods., Data were analyzed from two randomized, double-blind, placebo-controlled, phase 3 clinical trials (International and Asia-Pacific) that evaluated efficacy and safety of dapoxetine (30 mg or 60 mg as needed [PRN]) in patients with PE. Men were ,18 years, in a stable monogamous relationship for ,6 months, met DSM-IV-TR criteria for PE for ,6 months, had an International Index of Erectile Function EF domain score ,21, and had an intravaginal ejaculatory latency time (IELT) ,2 minutes in ,75% of intercourse episodes. Main Outcome Measures., Demographics, sexual history, and PE symptomatology at baseline, and mean IELT and patient-reported outcomes (PROs) at study end (week 12), were analyzed for men with acquired or lifelong PE and mild or no ED (EF score 21,25 vs. ,26). Results., Baseline characteristics except duration of PE were similar in men with acquired and lifelong PE, with no other differentiating features by ED status. Dapoxetine treatment improved significantly mean IELT (arithmetic and geometric) and PRO responses (perceived control over ejaculation, satisfaction with sexual intercourse, ejaculation-related personal distress, and interpersonal difficulty) for acquired and lifelong subtypes, but presence of mild ED diminished PRO responsiveness in both subtypes, particularly those with lifelong PE. Conclusions., Baseline characteristics and treatment outcomes were generally similar in men with acquired and lifelong PE. The presence of mild ED appears to be associated with a more modest treatment response, irrespective of lifelong or acquired PE subtype. Porst H, McMahon CG, Althof SE, Sharlip I, Bull S, Aquilina JW, Tesfaye F, and Rivas DA. Baseline characteristics and treatment outcomes for men with acquired or lifelong premature ejaculation with mild or no erectile dysfunction: Integrated analyses of two phase 3 dapoxetine trials. J Sex Med 2010;7:2231,2242. [source]

Radiofrequency Ablation for the Treatment of Mild to Moderate Obstructive Sleep Apnea

THE LARYNGOSCOPE, Issue 11 2002
Marc Bernard Blumen MD
Abstract Objectives/Hypothesis Obstructive sleep apnea syndrome is due to pharyngeal obstructions, which can take place at the level of the soft palate. Temperature-controlled radiofrequency ablation has been introduced as being capable of reducing soft tissue volume and excessive compliance. The aim of the study was to evaluate prospectively the possible efficacy of temperature-controlled radiofrequency ablation applied to the soft palate in subjects with mild to moderate obstructive sleep apnea syndrome. Study Design Twenty-nine patients with a respiratory disturbance index between 10 and 30 events per hour, body mass index equal to or less than 30 kg/m2, and obstruction at the level of the soft palate were included in a pilot, prospective nonrandomized study. Methods Snoring and daytime sleepiness were evaluated subjectively. Treatment (maximum of three sessions) was discontinued when the bed partner was satisfied with the snoring level. A full night recording was performed at least 4 months after the last treatment. Results Mean snoring level decreased significantly from 8.6 ± 1.3 to 3.3 ± 2.5 on a visual analogue scale (0,10). Daytime sleepiness decreased nonsignificantly. Mean respiratory disturbance index decreased significantly from 19.0 ± 6.1 events per hour to 9.8 ± 8.6 events per hour. Mean lowest oxygen saturation value increased nonsignificantly from 85.3% ± 4.1% to 86.4% ± 4.4%. Of the patients, 65.5% were cured of their disease. Conclusions Temperature-controlled radiofrequency ablation was effective in selected patients with mild to moderate obstructive sleep apnea syndrome. A full-night polysomnography is required after completion of treatment to rule out residual disease. [source]

Long-term management of vulval lichen sclerosus in adult women

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010
J. BRADFORD
Background:, Adult vulval lichen sclerosus (VLS) is usually a lifelong disease with an estimated remission rate after treatment of only 16% [Arch Dermatol 2004; 140 (6): 709]. Although superpotent topical corticosteroid (TCS) is the validated gold standard treatment to induce remission, little data are available on how remission should be maintained. Aims:, We present a retrospective chart review of 129 adult patients with VLS who have been under surveillance by the authors for a minimum duration of three years. Methods:, Remission was maintained in most patients with low-to-moderate potency TCS. All subjects' symptoms, signs, treatment regimes and response to treatment including compliance, symptom remission, disease progression with scarring, squamous cell carcinoma and side effects were recorded. Data were compared for the compliant and non-compliant groups. Fischer's exact test was used to identify significant differences. Results:, The mean age at presentation was 53.6 years and mean duration of follow-up was 6.2 years. Compliance was excellent: 84 (65%) of patients' self-reporting as being fully compliant. Symptom remission was achieved in 98% of compliant and 75% of non-compliant patients (P = 0.001) Progression of disease with scarring was not encountered in any of the compliant patients, but was seen in 35% of non-compliant patients (P = 0.0001). One patient had squamous cell carcinoma on first presentation. Carcinoma subsequently occurred in none of the compliant patients, and in five partly compliant patients (P = 0.004). Mild, reversible corticosteroid side effects were encountered in 7% of patients. Conclusions:, Long-term treatment of adult VLS with individualised regimes using moderate potency TCS is safe and effective. Patients require long-term follow-up. [source]

Clinicopathological features and treatment of intraductal papillary mucinous tumour of the pancreas

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2001
Dr M. Falconi
Background: The surgical strategy in patients with a pancreatic intraductal papillary mucinous tumour (IPMT) is still controversial. In this study the pathological findings in a series of patients were used to rationalize surgical choice. Methods: Fifty-one patients with IPMT were observed between 1988 and 1998 and treated by pancreatic resection. Factors evaluated included symptoms, tumour site, type of operation, histological findings and resection margins, tumour stage, follow-up and survival. Results: Pancreaticoduodenectomy was the most frequent surgical treatment (33 patients; 65 per cent), followed by left pancreatectomy (ten), total pancreatectomy (five) and middle pancreatectomy (three). Histological assessment revealed the tumour to be an adenoma in 13 patients (25 per cent), a borderline tumour in ten (20 per cent) and a carcinoma in 28 (55 per cent), 19 of which were invasive. Mild to moderate dysplasia was present at the resection margin in 20 specimens (41 per cent), and carcinoma in one. Local recurrence was observed in four patients (8 per cent), all of whom underwent a second resection. The 3-year actuarial survival rate for benign and malignant disease was 94 and 69 per cent respectively (P = 0·03). Conclusion: These results suggest that resection should be the treatment for IPMT. Management of the resection margin could be crucial in avoiding tumour recurrence. © 2001 British Journal of Surgery Society Ltd [source]