Acropustulosis, or chronic palmar plantar pustulosis (PPP), is a phenomenon of recurrent sterile pustules, erythema, and scaling affecting the palms and soles. Its pathogenesis is unclear, and it is ...difficult to treat. The purpose of this study was to elucidate further the factors involved in causing PPP, thereby enhancing the ability to manage this disease. All cases of PPP seen at Mayo Clinic Scottsdale from 1987 to 1993 were reviewed. 21 patients with PPP were identified, 15 of whom had been patch tested. 9 of the 15 patients (60%) showed positive patch test results. Fragrance was the most common sensitivity, but nickel, formaldehyde, para‐phenylenediamine, thiuram, neomycin, mercury, balsam of Peru, and cinnamic aldehyde sensitivities were demonstrated. Less important factors included atopy, fungal and bacterial infections, and irritation. Although the mechanism of this sterile pustulosis response does not depend solely on delayed hyper sensitivity mechanisms, we believe that we have demonstrated such a large number of positive patch tests in this chronic pustular dermatosis that patch testing should be considered in the routine work‐up of these patients.
The murine retina provides an ideal model for the study of vascular development. In this investigation we have examined the development of blood vessels in flat-mounted whole retinas from C57B6 mice ...ranging from birth to 4 months of age. Basement membrane components of blood vessels were visualized by indirect immunofluorescence with antibodies against type IV collagen and laminin. Endothelial cells (EC) were labeled with a plant lectin, Ricinus communis agglutinin I (RCA), and antibodies against angiotensin converting enzyme. Results show three stages of vascular differentiation. During the first stage (postnatal days P0-P10), vessels develop radially from optic disc to ora serrata within the presumptive nerve fiber layer. In the second stage beginning P4, vessels form within deeper retinal layers. In the third stage beginning P7, a capillary network develops as branches of radial vessels in the nerve fiber layer. The entire vascular system begins as a polygonal network of capillary-like vessels. Selective regression of various segments of these polygons leads to the ultimate arborous pattern of arteries, arterioles, veins, venules, and capillaries seen in the adult. Some individual EC appear to be left behind during this retraction process and pericytes may have a role in determining which vessel segments regress. This combination of flat-mounted whole retinas and probes specific for vascular elements provides an ideal system for the study of retinal vascularization and the characterization of vasculogenesis in general.
Patients with resuscitated ventricular tachyarrhythmias (ventricular tachycardia/ventricular fibrillation) benefit from implantable cardioverter-defibrillators (ICDs) compared with medical therapy. ...We hypothesized that the patients who benefit most from an ICD are those at greatest risk of death.
In the Canadian Implantable Defibrillator Study (CIDS), 659 patients with resuscitated ventricular tachyarrhythmias were randomly assigned to receive an ICD or amiodarone and were then followed for a mean of 3 years. There were 98 and 83 deaths in the amiodarone and ICD groups, respectively. We used multivariate Cox analysis to assess the impact of baseline parameters on the mortality in the amiodarone group. Reduced left ventricular ejection fraction, advanced age, and poor NYHA status identified high-risk patients (P=0.0001 to 0.0009). Quartiles of risk were constructed, and the mortality reduction associated with ICD treatment in each quartile was assessed. There was a significant interaction between risk quartile and the ICD treatment effect (P=0.011). In the highest risk quartile, there was a 50% relative risk reduction (95% CI 21% to 68%) of death in the ICD group, whereas in the 3 lower quartiles, there was no benefit. Patients who are most likely to benefit from an ICD can be identified with a simple risk score (>/=2 of the following factors: age >/=70 years, left ventricular ejection fraction </=35%, and NYHA class III or IV). Thirteen of 15 deaths that were prevented by the ICD occurred in patients with >/=2 risk factors.
In CIDS, patients at highest risk of death benefited most from ICD therapy. These can be identified easily on the basis of age, poor ventricular function, and poor functional status.
Severe Pain Confounds Neuropsychological Test Performance Mc Connolly, Eric J. Heyer Ruchey Sharma Christopher J. Winfree J. Mocco Donald J.Mahon Paul A.Cormick Donald O. Quest James G.Murtry Charles J. Riedel Ronald M. Lazar Yaakov Stern Sander E.
Journal of clinical and experimental neuropsychology,
10/2000, Letnik:
22, Številka:
5
Journal Article
Recenzirano
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There is little information on the effect of pain on neuropsychological test performance. We have undertaken this study to explore which tests are affected by pain, the magnitude of these changes, ...and other confounders of neuropsychological performance in a population of patients having spine surgery. Twenty-four elderly English speaking Caucasian patients (age > 60 years) were enrolled pre-operatively in this Institutional Review Board approved study. Pain scores using an 11-point Numeric Pain Intensity scale and performance on a neuropsychological battery (Controlled Oral Word Association, Rey Complex Figure, Trails A and B) were assessed at two times, before and one day after surgery. Scores were calculated using the standard algorithms and change scores were calculated by subtracting the baseline from follow-up scores. After surgery, performance on the Rey Complex Figure (r = -0.577, p = 0.004) and Trails Part A (r = 0.527, p = 0.01) declined with increasing post-operative pain scores. Women reported higher pain scores post-operatively than men (p = 0.046), and performed worse than men for change in performance on Trails Part A (p = 0.027). These data suggest that pain can influence performance on certain cognitive tests, and that some gender differences in these effects may occur. Interpretation of performance measures should take into account possible effects of pain, although our understanding of pain effects and ability to predict them in individual people, currently are quite limited.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Species richness gradients are ubiquitous in nature, but the mechanisms that generate and maintain these patterns at macroecological scales remain unresolved. We use a new approach that focuses on ...overlapping geographical ranges of species to reveal that Indo-Pacific corals are assembled within 11 distinct faunal provinces. Province limits are characterized by co-occurrence of multiple species range boundaries. Unexpectedly, these faunal breaks are poorly predicted by contemporary environmental conditions and the present-day distribution of habitat. Instead, faunal breaks show striking concordance with geological features (tectonic plates and mantle plume tracks). The depth range over which a species occurs, its larval development rate and genus age are important determinants of the likelihood that species will straddle faunal breaks. Our findings indicate that historical processes, habitat heterogeneity and species colonization ability account for more of the present-day biogeographical patterns of corals than explanations based on the contemporary distribution of reefs or environmental conditions.
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