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Mazanowska N, Jarmużek-Orska P, Pietrzak B, Pazik J, Jabiry-Zieniewicz Z, Kosiński P. First-Trimester Biochemical Serum Markers in Female Kidney Transplant Recipients-The Impact of Graft Function. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16352. [PMID: 36498421 PMCID: PMC9740865 DOI: 10.3390/ijerph192316352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/27/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Data on serum biochemistry markers as a component of the first-trimester screening test in pregnant kidney graft recipients are limited. In the absence of a separate validated algorithm, biochemical testing is commonly used in the first-trimester screening in kidney transplant recipients. Therefore, the study aimed to analyze first-trimester serum biochemical markers and the first trimester combined screening results in pregnant kidney graft recipients. A retrospective study was carried out in pregnant women who underwent the first-trimester combined screening test performed per the Fetal Medicine Foundation (FMF) protocol in 2009−2020. The study group included 27 pregnancies in kidney graft transplant recipients, and the control group was 110 patients with normal kidney function, matched according to age, body mass index (BMI), and gestational age. The biochemical serum markers (free beta-human chorionic gonadotropin [beta-hCG] and pregnancy-associated plasma protein A [PAPP-A]) were evaluated using the FMF-approved Roche Elecsys® assay and exhibited as multiples of the median (MoM) values. Data on first-trimester screening test results, perinatal outcomes, and graft function (assessed using serum creatinine concentrations) were analyzed. The analysis of first-trimester screening parameters revealed no difference in nuchal translucency (NT) measurements and uterine artery flow. However, free beta-hCG MoM and PAPP-A values were higher in posttransplant pregnancies than in controls: 3.47 ± 2.08 vs. 1.38 ± 0.85 (p = 0.035) and 1.46 ± 0.81 vs. 0.98 ± 0.57 (p = 0.007), respectively. The false positive rate of trisomy 21 (T21) screening in graft recipients was 25.9% vs. 3% in the controls. The free β-hCG MoM values positively correlated with serum creatinine levels before (r = 0.653; p < 0.001), during (r = 0.619; p = 0.001), and after pregnancy (r = 0.697; p < 0.001). There was a statistically significant negative correlation for PAPP-A MoM values for postpartum serum creatinine concentration (r = −0.424, p = 0.035). Our results show significantly higher serum concentrations of free beta-hCG and PAPP-A in posttransplant pregnancies than in healthy controls, confirmed when exhibited as MoM values and their association with graft function was assessed by serum creatinine concentration. Taking those changes into account would reduce the high number of false positive test results in this group. The validated first-trimester screening algorithm that considers altered kidney function in pregnant kidney graft recipients remains to be developed.
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Affiliation(s)
- Natalia Mazanowska
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. Starynkiewicza 1/3, 02-015 Warszawa, Poland
| | - Patrycja Jarmużek-Orska
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. Starynkiewicza 1/3, 02-015 Warszawa, Poland
| | - Bronisława Pietrzak
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. Starynkiewicza 1/3, 02-015 Warszawa, Poland
| | - Joanna Pazik
- Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, 02-015 Warszawa, Poland
| | - Zoulikha Jabiry-Zieniewicz
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. Starynkiewicza 1/3, 02-015 Warszawa, Poland
| | - Przemysław Kosiński
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, 02-091 Warszawa, Poland
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Valentin M, Muller F, Beaujard MP, Dreux S, Czerkiewicz I, Meyer V, Leruez M, Ville Y, Salomon LJ. First-trimester combined screening for trisomy 21 in women with renal disease. Prenat Diagn 2015; 35:244-8. [PMID: 25395363 DOI: 10.1002/pd.4528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/06/2014] [Accepted: 11/06/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the results of first-trimester combined screening for Down syndrome in women with chronic renal disease. METHOD Fifty-five pregnant women with renal disease were compared with 110 patients matched for maternal age, maternal weight, smoking status, and gestational age. Maternal renal function was assayed at the time of the combined screening, and renal insufficiency was defined by serum creatinine >90 µmol/L and renal clearance <80 mL/min. We defined three groups: kidney disease and normal renal function (group 1), kidney disease and renal insufficiency (group 2), and a control group (group 3). The values of nuchal translucency, pregnancy-associated plasma protein A, human β-chorionic gonadotrophin (hCGβ), and false-positive rates for Down syndrome screening were compared. RESULTS There were 39 (71%) and 16 (29%) cases in groups 1 and 2, respectively. Nuchal translucency and multiple of the median (MoM) pregnancy-associated plasma protein A were similar in the three groups. However, MoM hCGβ levels were higher in group 2 than in groups 1 and 3 (5.37 vs 1.1 vs 0.98 MoM, p = 0.0001). The resulting screen-positive rate was also higher in group 2 than in groups 1 and 3 (43.7% vs 10.2% vs 5.5%, p = 0.0001). CONCLUSION Trisomy 21 first-trimester screening using hCGβ is not suitable in the case of maternal renal failure. © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Morgane Valentin
- Department of Obstetrics and Maternal-Fetal Medicine, Necker Enfants Malades Hospital, AP-HP, Paris, France
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Grande M, Cararach V, Casals E, Borrell A. First-trimester Down syndrome screening in renal-transplanted pregnant women: a model for adjusting the false-positives rates. Prenat Diagn 2013; 33:467-70. [DOI: 10.1002/pd.4089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Maribel Grande
- Department of Maternal-Fetal Medicine; Institute Gynecology, Obstetrics and Neonatology, Hospital Clínic; Barcelona Catalonia Spain
| | - Vicenç Cararach
- Department of Maternal-Fetal Medicine; Institute Gynecology, Obstetrics and Neonatology, Hospital Clínic; Barcelona Catalonia Spain
| | - Elena Casals
- Centre de Diagnòstic Biomèdic; Barcelona Catalonia Spain
| | - Antoni Borrell
- Department of Maternal-Fetal Medicine; Institute Gynecology, Obstetrics and Neonatology, Hospital Clínic; Barcelona Catalonia Spain
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Benachi A, Dreux S, Kaddioui-Maalej S, Czerkiewicz I, Fakhouri F, Thervet E, Muller F. Down syndrome maternal serum screening in patients with renal disease. Am J Obstet Gynecol 2010; 203:60.e1-4. [PMID: 20417486 DOI: 10.1016/j.ajog.2010.01.080] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 10/20/2009] [Accepted: 01/27/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of the study was to determine the value of maternal serum Down syndrome screening in patients affected by renal disease. STUDY DESIGN A study group of 54 pregnant women with renal diseases defined before pregnancy, was compared with a control group of 108 patients matched for maternal age, maternal weight, smoking status, and gestational age. Maternal serum markers (free beta-human chorionic gonadotropin [hCG], total hCG, alpha-fetoprotein) expressed in multiple of median and maternal renal function markers (creatinine, beta2-microglobulin, alpha1-microglobulin) were assayed. RESULTS The percentage of patients in the Down syndrome at-risk group (>1:250) using free beta-hCG was significantly higher (P < .02) in the renal disease group (48%) than in the control group (12%). No significant difference was observed for total hCG (25% vs 15%). CONCLUSION Down syndrome screening using free beta-hCG is not applicable in patients with renal disease whatever the maternal serum creatinine and can be used with caution when total hCG is used.
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Affiliation(s)
- Alexandra Benachi
- Department of Obstetrics and Gynecology, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
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Spencer K, Enofe O, Cowans NJ, Stamatopoulou A. Is maternal renal disease a cause of elevated free β-hCG in first trimester aneuploidy screening? Prenat Diagn 2009; 29:1045-9. [DOI: 10.1002/pd.2347] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kroft EBM, van de Kerkhof PCM, Gerritsen MJP, de Jong EMGJ. Period of remission after treatment with UVA-1 in sclerodermic skin diseases. J Eur Acad Dermatol Venereol 2008; 22:839-44. [DOI: 10.1111/j.1468-3083.2007.02576.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ozdemir M, Engin B, Toy H, Mevlitoglu I. Treatment of plaque-type localized scleroderma with retinoic acid and ultraviolet A plus the photosensitizer psoralen: a case series. J Eur Acad Dermatol Venereol 2008; 22:519-21. [PMID: 18363929 DOI: 10.1111/j.1468-3083.2007.02390.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Durand F, Staumont D, Bonnevalle A, Hachulla E, Hatron PY, Thomas P. Ultraviolet A1 phototherapy for treatment of acrosclerosis in systemic sclerosis: controlled study with half-side comparison analysis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2007; 23:215-21. [DOI: 10.1111/j.1600-0781.2007.00308.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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El-Darouti MA, Marzouk SA, Abdel-Halim MRE. Muckle-Wells syndrome: report of six cases with hyperpigmented sclerodermoid skin lesions. Int J Dermatol 2006; 45:239-44. [PMID: 16533222 DOI: 10.1111/j.1365-4632.2004.02466.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Muckle-Wells syndrome (MWS) is a rare syndrome, characterized by chronic recurrent urticaria, often combined with fever, chills, rigors, malaise, and arthralgia. Progressive sensorineural deafness, and, in approximately one third of the patients, amyloidosis of the kidneys as well as of other organs may occur. It was first described in 1962 by Muckle and Wells. Herein we describe six cases of MWS showing, in addition to the classic features of MWS, unique skin lesions that to the best of our knowledge have not been described before in association with MWS.
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Weichenthal M, Schwarz T. Phototherapy: how does UV work? PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2006; 21:260-6. [PMID: 16149939 DOI: 10.1111/j.1600-0781.2005.00173.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Phototherapy has been largely empirical. Thus, despite the long term use its mechanisms of action are quite unclear. Because of the recent achievements in photoimmunology and molecular photobiology we are now beginning to understand some of the mechanisms. Many of the effects are certainly mediated via induction of apoptotic cell death. Another major mechanism is the induction of immunosuppression. This review primarily focuses on recent advances in photoimmunology which will contribute to the further understanding how phototherapy acts.
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Brenner M, Herzinger T, Berking C, Plewig G, Degitz K. Phototherapy and photochemotherapy of sclerosing skin diseases. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2005; 21:157-65. [PMID: 15888135 DOI: 10.1111/j.1600-0781.2005.00154.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The treatment of sclerosing skin diseases [systemic sclerosis, localized scleroderma, lichen sclerosus et atrophicus, sclerodermoid graft-vs.-host disease, scleredema adultorum (Buschke), scleromyxedema and necrobiosis lipoidica] is difficult and remains a great challenge. Numerous treatments, some with potentially hazardous side effects, are currently used with only limited success. The introduction of phototherapy and photochemotherapy for sclerosing skin diseases has considerably enriched the therapeutic panel and proven useful in a number of sclerosing skin diseases especially in localized scleroderma. Two phototherapeutic modalitites are used for the treatment of sclerosing skin diseases, long-wave ultraviolet A and psoralen plus ultraviolet A (PUVA). This article reviews current knowledge about the application of phototherapy and photochemotherapy to various sclerosing skin disorders.
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Affiliation(s)
- Michaela Brenner
- Department of Dermatology, Ludwig-Maximilians University, Frauenlobstrasse 9-11, 80337 Munich, Germany
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Rose RF, Goodfield MJD. Combining PUVA therapy with systemic immunosuppression to treat progressive diffuse morphoea. Clin Exp Dermatol 2005; 30:226-8. [PMID: 15807674 DOI: 10.1111/j.1365-2230.2004.01693.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cyclosporin and mycophenolate mofetil (MMF) are immunosuppressant agents now used frequently in the field of organ transplantation. More recently cyclosporin has been used for the treatment of a number of dermatological conditions, including severe psoriasis and eczema. Extensive diffuse morphoea is very difficult to treat. PUVA, UVA and a number of immunomodulating drugs have been used to attempt improvement but are most beneficial only in early disease. Combination treatments are often used in psoriasis, for example, but are not reported in morphoea. We present the case of a patient treated initially with cyclosporin and PUVA and subsequently with MMF and PUVA, with considerable improvement in his condition.
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Affiliation(s)
- R F Rose
- Leeds General Infirmary, Dermatology Department, Leeds, UK, LS1 3EX.
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Affiliation(s)
- Renz Mang
- Department of Dermatology, Heinrich-Heine-University Düsseldorf gGmbH, Auf'm Hennekamp 50, D-40225 Düsseldorf, Germany
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Morton A, Dalzell F, Isbel N, Prado T. Pregnancy outcome in a renal transplant recipient with residual mild tertiary hyperparathyroidism. BJOG 2005; 112:124-5. [PMID: 15663414 DOI: 10.1111/j.1471-0528.2004.00314.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Breuckmann F, Gambichler T, Altmeyer P, Kreuter A. UVA/UVA1 phototherapy and PUVA photochemotherapy in connective tissue diseases and related disorders: a research based review. BMC DERMATOLOGY 2004; 4:11. [PMID: 15380024 PMCID: PMC521488 DOI: 10.1186/1471-5945-4-11] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Accepted: 09/20/2004] [Indexed: 11/10/2022]
Abstract
BACKGROUND Broad-band UVA, long-wave UVA1 and PUVA treatment have been described as an alternative/adjunct therapeutic option in a number of inflammatory and malignant skin diseases. Nevertheless, controlled studies investigating the efficacy of UVA irradiation in connective tissue diseases and related disorders are rare. METHODS Searching the PubMed database the current article systematically reviews established and innovative therapeutic approaches of broad-band UVA irradiation, UVA1 phototherapy and PUVA photochemotherapy in a variety of different connective tissue disorders. RESULTS Potential pathways include immunomodulation of inflammation, induction of collagenases and initiation of apoptosis. Even though holding the risk of carcinogenesis, photoaging or UV-induced exacerbation, UVA phototherapy seems to exhibit a tolerable risk/benefit ratio at least in systemic sclerosis, localized scleroderma, extragenital lichen sclerosus et atrophicus, sclerodermoid graft-versus-host disease, lupus erythematosus and a number of sclerotic rarities. CONCLUSIONS Based on the data retrieved from the literature, therapeutic UVA exposure seems to be effective in connective tissue diseases and related disorders. However, more controlled investigations are needed in order to establish a clear-cut catalogue of indications.
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Affiliation(s)
- Frank Breuckmann
- Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Thilo Gambichler
- Dermatology Out-Patient Clinic, Oldchurch Hospital, Romford RM7 OBE, Greater London, UK
| | - Peter Altmeyer
- Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Alexander Kreuter
- Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany
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El-Mofty M, Mostafa W, Esmat S, Youssef R, Bousseila M, Nagi N, Shaker O, Abouzeid A. Suggested mechanisms of action of UVA phototherapy in morphea: a molecular study. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2004; 20:93-100. [PMID: 15030594 DOI: 10.1111/j.1600-0781.2004.00080.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ultraviolet A (UVA) phototherapy proved to be an efficient line of treatment of scleroderma. The mechanism through which it acts is still not clear. OBJECTIVES To detect the mechanism of action of UVA phototherapy in morphea through measuring its effect on the levels of different parameters related to collagen metabolism. METHODS Twenty-one cases of morphea were treated with low-dose broad-band UVA for 20 sessions. Twelve cases received 20 J/cm(2)/session with a cumulative dose of 400 J/cm(2) and nine cases received 10 J/cm(2)/session with a cumulative dose of 200 J/cm(2). The response was assessed clinically every week. Two skin biopsies were taken from the lesional skin of each patient before starting and after the end of therapy. Paraffin sections were examined for quantitative polymerase chain reaction measurement of collagen I, collagen III, collagenase, transforming growth factor-beta (TGF-beta) and interferon gamma (IFNgamma). RESULTS Eighteen patients reported remarkable softening of the skin lesions, with variable degrees ranging from moderate in 57.1% of them good in 19% to very good response in 9.5%. After treatment, all the studied parameters revealed statistically significant changes. There was a significant decrease in collagen I, collagen III and TGF-beta and a significant increase in collagenase (MMP-1) and IFNgamma. The relative change was found to be greatest in collagenase, followed by IFNgamma then TGF-beta and finally collagen I. The changes in collagen I, collagenase, IFNgamma and TGF-beta were found to increase gradually with the degree of clinical response. In all the parameters studied the relative change was significantly higher in cases treated with 20 J/cm(2)/session in contrast to those treated with 10 J/cm(2)/session although no statistically significant difference could be detected in the clinical response to those doses. CONCLUSIONS The efficacy of low-dose UVA phototherapy in the treatment of localized scleroderma is mainly obtained by the increased production of MMP-1 and IFNgamma, and to a lesser extent by decreasing TGF-beta and collagen production. Concerning the use of 10 or 20 J/cm(2)/session those effects are dose dependent, but the clinical response does not significantly differ.
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Affiliation(s)
- M El-Mofty
- Department of Dermatology, Phototherapy Unit, Faculty of Medicine, Cairo University, Egypt
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Affiliation(s)
- Kamran Ghoreschi
- Department of Dermatology, Ludwig-Maximilians University of Munich, Germany.
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Abstract
Long-wavelength ultraviolet A (340-400 nm; UVA1) therapy is currently available in only a few dermatology departments. Equipment capable of delivering this waveband has been available since 1981, but it is only over the past decade that increasing numbers of studies assessing the potential of this as a therapy have been published. High-dose UVA1, which requires expensive and space-occupying apparatus, is effective as a monotherapy for acute flares of atopic dermatitis, but it has not yet been formally assessed as an adjunct, rather than as an alternative to conventional therapies including potent and very potent topical corticosteroids. Low-dose (which can be administered using a standard phototherapy cubicle fitted with appropriate lamps) and medium-dose UVA1 may be less effective for this indication. Another condition for which UVA1 is effective, and is particularly promising because we have no reliably effective treatment already, is localized scleroderma. It also appears to be effective in systemic lupus erythematosus (although it is not yet clear when it is indicated, and its safety needs to be assessed in more patients) and in polymorphic light eruption (although there have been no studies suggesting that UVA1 will have any advantages over standard prophylactic phototherapies). Open studies and case series suggest that UVA1 may prove beneficial for various other diseases, including cutaneous T-cell lymphoma, lichen sclerosus, keloids, systemic sclerosis and hand dermatitis. In the centres where it is available, UVA1 has already proved a useful addition to the range of phototherapies previously available. However, much more research is needed to confirm its efficacy for many of its potential indications, and to determine when and how it should be used.
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Affiliation(s)
- R S Dawe
- Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Shenhav S, Gemer O, Sherman DJ, Peled R, Segal S. Midtrimester triple-test levels in women with chronic hypertension and altered renal function. Prenat Diagn 2003; 23:166-7. [PMID: 12575027 DOI: 10.1002/pd.564] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To study the association between midtrimester triple-test levels and renal function in pregnant women with chronic hypertension. METHODS Forty-three patients with chronic hypertension for whom renal function was evaluated by the creatinine clearance test between 14- and 20-weeks gestation were studied. Midtrimester triple-test values obtained as part of Down screening program were correlated with renal function. RESULTS hCG correlated inversely with creatinine clearance (r = -0.345; p = 0.002) and directly with alpha-fetoprotein (r = 0.499; p = 0.003). CONCLUSIONS In pregnant women with chronic hypertension, impaired renal function may alter midtrimester maternal serum hCG levels.
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Affiliation(s)
- Simon Shenhav
- Department of Obstetrics and Gynecology, Barzilai Medical Center, Ben-Gurion University of the Negev, Ashkelon 78306, Israel
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Karidas CN, Michailidis GD, Spencer K, Economides DL. Biochemical screening for Down syndrome in pregnancies following renal transplantation. Prenat Diagn 2002; 22:226-30. [PMID: 11920899 DOI: 10.1002/pd.294] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the performance of the double marker test [free beta-human chorionic gonadotrophin (beta-hCG) and alpha-fetoprotein (AFP)] as a screening test for Down syndrome in pregnant patients who had a prior renal transplant. DESIGN A retrospective study. SETTING The Fetal Medicine Unit, Royal Free Hospital, London, UK. METHODS Detailed records of 14 post-renal transplant pregnancies were obtained from the Renal Unit of our hospital where the patients were followed up. The serum concentrations of urea, creatinine, free beta-hCG and AFP at the time of the double marker test were recorded, with a cut-off point of 1:250 for the double marker test. A control group of 14 normal pregnancies matched for age, parity and gestational age was used. The Mann-Whitney U-test and t-tests of unequal variance were applied to compare parameters of the study and the control groups. RESULTS Two patients in each group were high risk for Down syndrome and amniocentesis revealed normal karyotype. No babies with Down syndrome were delivered in either group. Regression analysis showed significant correlation between free beta-hCG and urea concentrations (p<0.001) and free beta-hCG and creatinine concentrations (p<0.001), but not for AFP. CONCLUSIONS The present study demonstrates that residual renal function alterations persisting after renal transplantation can affect the levels of free beta-hCG and AFP, thus resulting in false-positive screening for Down syndrome. First trimester nuchal translucency (NT) measurement in combination with second trimester ultrasonographic markers can be used in these patients, or alternatively the free beta-hCG levels should be corrected according to the serum creatinine levels.
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Affiliation(s)
- C N Karidas
- Fetal Medicine Unit, The Royal Free Hospital, Pond Street, London NW3 2QG, UK
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Kreuter A, Gambichler T, Avermaete A, Jansen T, Hoffmann M, Hoffmann K, Altmeyer P, von Kobyletzki G, Bacharach-Buhles M. Combined treatment with calcipotriol ointment and low-dose ultraviolet A1 phototherapy in childhood morphea. Pediatr Dermatol 2001; 18:241-5. [PMID: 11438008 DOI: 10.1046/j.1525-1470.2001.018003241.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Various therapies for morphea have been used with limited success, including ones with potentially hazardous side effects. When morphea occurs in childhood it may lead to progressive and long-lasting induration of the skin and subcutaneous tissue, growth retardation, and muscle atrophy. We report an open prospective study in which the efficacy of a combined treatment with calcipotriol ointment and low-dose ultraviolet A1 (UVA1) phototherapy in childhood morphea was investigated. Nineteen children (mean age 8.5 years, range 3-13 years) with morphea were exposed to UVA1 (340-400 nm) phototherapy at a dose of 20 J/cm(2) four times a week for 10 weeks. Forty phototherapy sessions resulted in a cumulative dose of 800 J/cm(2) UVA1. In addition, calcipotriol ointment (0.005%) was applied twice a day. After 10 weeks, palpation and inspection showed a remarkable softening and repigmentation of formerly affected skin resulting in a highly significant (p < 0.001) decrease of the mean clinical score from 7.3 +/- 0.9 at the beginning to 2.4 +/- 0.9 (relative reduction 67.1%) at the end of combined therapy. Our results indicate that a combined therapy with calcipotriol ointment and low-dose UVA1 phototherapy is highly effective in childhood morphea. Further controlled studies are necessary to investigate whether this combined therapy is superior to UVA1 phototherapy alone.
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Affiliation(s)
- A Kreuter
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany.
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Kreuter A, Jansen T, Stücker M, Herde M, Hoffmann K, Altmeyer P, Von Kobyletzki G. Low-dose ultraviolet-A1 phototherapy for lichen sclerosus et atrophicus. Clin Exp Dermatol 2001; 26:30-2. [PMID: 11260173 DOI: 10.1046/j.1365-2230.2001.00754.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory skin disease characterized by white porcelain-like sclerotic skin lesions. It is most commonly seen in adult females and usually affects the genitoanal area. Extragenital LSA appears in 15-20% of cases. We report a 9-year-old Caucasian girl suffering from extragenital LSA that was resistant to conventional treatment. After 40 treatment sessions with low-dose UVA1 phototherapy, all skin lesions were resolved completely. Moreover, the improvement of skin status has been sustained during 6-months of follow-up. Long-wave UVA irradiation has been shown to induce intensively collagenase activity in human dermal fibroblasts. We suggest that UVA1 irradiation could be an effective treatment in patients suffering from extragenital LSA.
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Affiliation(s)
- A Kreuter
- Department of Dermatology, Ruhr-University Bochum, Germany
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