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Miller IM, Jemec GBE. Morphology: the mother of all biomarkers. Br J Dermatol 2024; 190:758-759. [PMID: 38214575 DOI: 10.1093/bjd/ljae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/27/2023] [Accepted: 12/27/2024] [Indexed: 01/13/2024]
Abstract
Recognition of morphology is important. This Perspectives article discusses the history of morphology in dermatology and the vital role of clinical morphology in the education of the next generation of dermatologists.
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Affiliation(s)
- Iben M Miller
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
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2
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Juhl CR, Bergholdt HKM, Miller IM, Jemec GBE, Kanters JK, Ellervik C. Dairy Intake and Acne Vulgaris: A Systematic Review and Meta-Analysis of 78,529 Children, Adolescents, and Young Adults. Nutrients 2018; 10:nu10081049. [PMID: 30096883 PMCID: PMC6115795 DOI: 10.3390/nu10081049] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 12/14/2022] Open
Abstract
A meta-analysis can help inform the debate about the epidemiological evidence on dairy intake and development of acne. A systematic literature search of PubMed from inception to 11 December 2017 was performed to estimate the association of dairy intake and acne in children, adolescents, and young adults in observational studies. We estimated the pooled random effects odds ratio (OR) (95% CI), heterogeneity (I²-statistics, Q-statistics), and publication bias. We included 14 studies (n = 78,529; 23,046 acne-cases/55,483 controls) aged 7⁻30 years. ORs for acne were 1.25 (95% CI: 1.15⁻1.36; p = 6.13 × 10-8) for any dairy, 1.22 (1.08⁻1.38; p = 1.62 × 10-3) for full-fat dairy, 1.28 (1.13⁻1.44; p = 8.23 × 10-5) for any milk, 1.22 (1.06⁻1.41; p = 6.66 × 10-3) for whole milk, 1.32 (1.16⁻1.52; p = 4.33 × 10-5) for low-fat/skim milk, 1.22 (1.00⁻1.50; p = 5.21 × 10-2) for cheese, and 1.36 (1.05⁻1.77; p = 2.21 × 10-2) for yogurt compared to no intake. ORs per frequency of any milk intake were 1.24 (0.95⁻1.62) by 2⁻6 glasses per week, 1.41 (1.05⁻1.90) by 1 glass per day, and 1.43 (1.09⁻1.88) by ≥2 glasses per day compared to intake less than weekly. Adjusted results were attenuated and compared unadjusted. There was publication bias (p = 4.71 × 10-3), and heterogeneity in the meta-analyses were explained by dairy and study characteristics. In conclusion, any dairy, such as milk, yogurt, and cheese, was associated with an increased OR for acne in individuals aged 7⁻30 years. However, results should be interpreted with caution due to heterogeneity and bias across studies.
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Affiliation(s)
- Christian R Juhl
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark.
| | - Helle K M Bergholdt
- Department of Production, Research, and Innovation, Region Zealand, 4180 Sorø, Denmark.
| | - Iben M Miller
- Department of Dermatology, Zealand University Hospital, 4000 Roskilde, Denmark.
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, 4000 Roskilde, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark.
| | - Jørgen K Kanters
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark.
| | - Christina Ellervik
- Department of Production, Research, and Innovation, Region Zealand, 4180 Sorø, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark.
- Department of Laboratory Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
- Department of Pathology, Harvard Medical School, Boston, MA 02115, USA.
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Miller IM, Wittreich J, Vogel R, Cook TJ. The Safety and Efficacy of Topical Norfloxacin Compared with Placebo in the Treatment of Acute, Bacterial Conjunctivitis. Eur J Ophthalmol 2018; 2:58-66. [PMID: 1498569 DOI: 10.1177/112067219200200202] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two hundred and eighty-four patients with acute conjunctivitis were enrolled in a double-masked study comparing norfloxacin ophthalmic solution with placebo. The proportion of patients who were clinically improved after 5 days treatment was 88.1 % in the norfloxacin group and 71.6% in the placebo group (p<0.01). The proportion of patients who had all organisms eradicated, including the coagulase-negative staphylococci, after two to three days treatment was 52.7% for norfloxacin and 23.9% for placebo (p<0.01) and 64.7% and 26.3% (p<0.01) respectively when the coagulase-negative staphylococci were not included. Adverse experiences occurred in 4.2% of the patients receiving norfloxacin compared to 7.1% of the placebo patients. None of the adverse experiences was serious.
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Affiliation(s)
- I M Miller
- Clinical Research Ophthalmology, Merck Sharp & Dohme Research Laboratory, West Point, PA
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Ring HC, Thorsen J, Saunte DM, Lilje B, Bay L, Riis PT, Larsen N, Andersen LO, Nielsen HV, Miller IM, Bjarnsholt T, Fuursted K, Jemec GB. The Follicular Skin Microbiome in Patients With Hidradenitis Suppurativa and Healthy Controls. JAMA Dermatol 2017; 153:897-905. [PMID: 28538949 DOI: 10.1001/jamadermatol.2017.0904] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Although the pathogenesis of hidradenitis suppurativa (HS) remains enigmatic, several factors point to potential involvement of the cutaneous microbiome. Insight into the cutaneous microbiome in HS using next-generation sequencing may provide novel data on the microbiological diversity of the skin. Objective To investigate the follicular skin microbiome in patients with HS and in healthy controls. Design, Setting, and Participants This case-control study obtained punch biopsy specimens from patients with HS (lesional and nonlesional) and healthy controls between October 1, 2014, and August 1, 2016. Data were analyzed from March to November 2016. Patients with HS were recruited from the Department of Dermatology, Zealand University Hospital, Roskilde, Denmark. Biopsy specimens were analyzed at the Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark. None of the participants received any antibiotics (systemic or topical therapy) within 1 month before the study. In patients with HS, biopsy specimens were obtained from lesional skin (axilla or groin) and nonlesional skin. Only nodules containing at least 1 visible hair follicle were biopsied. Biopsy specimens from healthy controls were obtained from the axilla only. Main Outcomes and Measures The different microbiomes were investigated using next-generation sequencing targeting 16S and 18S ribosomal RNA. Results The skin microbiome was characterized in 30 patients with HS (mean [SD] age, 46.9 [14.0] years; 19 [63% female]) and 24 healthy controls (mean [SD] age, 32.2 [12.0] years; 13 [54% female]). The next-generation sequencing data provided a previously unreported (to our knowledge) characterization of the skin microbiome in HS. The study demonstrated that the microbiome in HS differs significantly from that in healthy controls in lesional and nonlesional skin. Overall, the following 5 microbiome types were identified: Corynebacterium species (type I), Acinetobacter and Moraxella species (type II), Staphylococcus epidermidis (type III), Porphyromonas and Peptoniphilus species (type IV), and Propionibacterium acnes (type V). In lesional skin, microbiome types consisted predominantly of type I or type IV. Microbiome type IV was not detected in healthy controls. Several taxa, including Propionibacterium, showed a significantly higher relative abundance in healthy controls vs HS skin, indicating that Propionibacterium may be part of the pathogenesis in HS. Conclusions and Relevance The study findings suggest a link between a dysbiotic cutaneous microbiome and HS.
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Affiliation(s)
- Hans Christian Ring
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - Jonathan Thorsen
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ditte M Saunte
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - Berit Lilje
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Lene Bay
- Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
| | - Peter Theut Riis
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | | | - Lee O'Brien Andersen
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Henrik V Nielsen
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Iben M Miller
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - Thomas Bjarnsholt
- Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Fuursted
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Gregor Borut Jemec
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
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Ring HC, Thorsen J, Saunte DM, Lilje B, Bay L, Theut Riis P, Larsen N, O'Brien Andersen L, Vedel Nielsen H, Miller IM, Bjarnsholt T, Fuursted K, Jemec GB. Moderate to severe hidradenitis suppurativa patients do not have an altered bacterial composition in peripheral blood compared to healthy controls. J Eur Acad Dermatol Venereol 2017; 32:125-128. [PMID: 28833590 DOI: 10.1111/jdv.14538] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/21/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease defined by recurrent nodules, tunnels and scarring involving the intertriginous skin. Patients with HS often report an array of systemic symptoms such as fatigue and malaise. The aetiology of these symptoms remains unclear. Previously, various bacteria have been associated with mature HS lesions, and bacteraemia has been reported in patients with HS using traditional culturing methods. Thus, we hypothesized that a low-grade bacteraemia contributes to the symptomatology in patients with HS. OBJECTIVE To explore the potential presence of bacteraemia in patients with HS and healthy controls. METHOD A case-control study. Compositions of bacteria in the blood of 27 moderate to severe HS patients and 26 healthy controls were investigated using next-generation 16S ribosomal RNA gene sequencing (NGS) and routine anaerobic and aerobic blood culturing. None of the participants received any antibiotics (systemic or topical therapy) within 1 month prior to the study. HS patients with a recent flare were randomly selected by consecutive recruitment of eligible patients from the Department of Dermatology, Zealand University Hospital, Denmark. Healthy controls were recruited from the University of Copenhagen as well as from the healthcare staff. RESULTS The different bacterial compositions were investigated using NGS and traditional anaerobic and aerobic blood culturing. Our NGS analysis provided a previously unreported characterization of the bacterial composition in peripheral blood from patients with HS and healthy controls. Overall, our data demonstrated that patients with HS do not have a different bacterial composition in their peripheral blood than healthy controls. CONCLUSION The study suggests that the self-reported symptoms in HS such as malaise and fatigue may not be linked to bacteraemia.
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Affiliation(s)
- H C Ring
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - J Thorsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - D M Saunte
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - B Lilje
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - L Bay
- Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
| | - P Theut Riis
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - N Larsen
- Danish Genome Institute, Aarhus, Denmark
| | - L O'Brien Andersen
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - H Vedel Nielsen
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - I M Miller
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - T Bjarnsholt
- Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
| | - K Fuursted
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
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Ring HC, Bay L, Nilsson M, Kallenbach K, Miller IM, Saunte DM, Bjarnsholt T, Tolker-Nielsen T, Jemec GB. Bacterial biofilm in chronic lesions of hidradenitis suppurativa. Br J Dermatol 2017; 176:993-1000. [PMID: 27564400 DOI: 10.1111/bjd.15007] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chronic nonhealing or recurrent inflammatory lesions, reminiscent of infection but recalcitrant to antibiotic therapy, generally characterize biofilm-driven diseases. Chronic lesions of hidradenitis suppurativa (HS) exhibit several characteristics, which are compatible with well-known biofilm infections. OBJECTIVES To determine and quantify the potential presence of bacterial aggregates in chronic HS lesions. METHODS In 42 consecutive patients with HS suffering from chronic lesions, biopsies were obtained from lesional as well as from perilesional skin. Samples were investigated using peptide nucleic acid-fluorescence in situ hybridization in combination with confocal laser scanning microscopy. In addition, corresponding histopathological analysis on haematoxylin and eosin slides was performed. RESULTS Biofilms were seen in 67% of the samples of chronic lesions and in 75% of the perilesional samples. The mean diameter of aggregates in lesional skin was significantly greater than in perilesional skin (P = 0·01). Large biofilms (aggregates > 50 μm in diameter) were found in 42% of lesional samples and in only 5% of the perilesional samples (P = 0·009). The majority of the large biofilms were situated in sinus tracts (63%) or in the infundibulum (37%). The majority of the sinus tract samples (73%) contained active bacterial cells, which were associated with inflammation. CONCLUSIONS This study suggests that biofilm formation is associated with inflammation of chronic HS lesions. The aggregates most likely occur as a secondary event, possibly due to predisposing local anatomical changes such as sinus tracts (tunnels), keratinous detritus and dilated hair follicles.
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Affiliation(s)
- H C Ring
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - L Bay
- Department of Immunology and Microbiology, Costerton Biofilm Centre, University of Copenhagen, Denmark
| | - M Nilsson
- Department of Immunology and Microbiology, Costerton Biofilm Centre, University of Copenhagen, Denmark
| | - K Kallenbach
- Department of Pathology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - I M Miller
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - D M Saunte
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - T Bjarnsholt
- Department of Immunology and Microbiology, Costerton Biofilm Centre, University of Copenhagen, Denmark.,Department for Clinical Microbiology, Section 9301, Copenhagen University Hospital, Denmark
| | - T Tolker-Nielsen
- Department of Immunology and Microbiology, Costerton Biofilm Centre, University of Copenhagen, Denmark
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
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Ring HC, Bay L, Kallenbach K, Miller IM, Prens E, Saunte DM, Bjarnsholt T, Jemec GBE. Normal Skin Microbiota is Altered in Pre-clinical Hidradenitis Suppurativa. Acta Derm Venereol 2017; 97:208-213. [PMID: 27377144 DOI: 10.2340/00015555-2503] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease defined by recurrent nodules, tunnels (sinus tracts) and scarring involving the intertriginous regions. The clinical course of HS is compatible with a biofilm-driven disease, and biofilm has been described in lesional HS skin. We therefore hypothesized that clinically unaffected HS skin would also have an increased presence of biofilm compared with that of healthy controls. We conducted a case-control study, investigating the morphology of the axillary skin microbiota. Peptide nucleic acid - fluorescence in situ hybridization probes were used in combination with confocal laser scanning microscopy. Significant differences were found in both distribution and quantity of the cutaneous microbiota in clinically non-affected axillary skin of patients with HS compared with healthy controls. Surprisingly, we detected fewer bacteria and less biofilm in patients with HS. The reduced microbiota in patients with HS may play an important role in the early course of the disease.
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Affiliation(s)
- Hans Christian Ring
- Department of Dermatology, University Hospital Zealand, Faculty of Health and Medical Sciences, University of Copenhagen, DK-4000 Roskilde, Denmark.
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Zarchi K, Theut Riis P, Graversgaard C, Miller IM, Heidenheim M, Jemec GBE. Validation of a Screening Questionnaire for Chronic Leg Ulcers. INT J LOW EXTR WOUND 2016; 15:320-324. [DOI: 10.1177/1534734616671227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of a validated screening questionnaire to identify individuals with chronic leg ulcers allows large-scale population-based studies to be conducted that measure and monitor the prevalence of the disease. The aim of this study was to design and validate such a screening questionnaire to identify patients with chronic leg ulcers. A simple 3-item questionnaire was developed at the Department of Dermatology, University Hospital of Zealand, Denmark. In total, 90 patients attending the department’s outpatient clinic for dermatological diseases and chronic wounds were included in this study. All included participants completed the questionnaire and were subsequently examined by dermatologists. We found that the constructed 3-item questionnaire in this study had a sensitivity and specificity of 95% and 93% and a positive predictive value and negative predictive value of 78% and 95%, respectively. Moreover, we found that the use of the 3-item questionnaire, as compared with a single question, in which the participants were asked whether they currently have a leg ulcer, resulted in significantly higher positive predictive value (+11.6%, P = .035) and specificity (+5.6%, P = .046) of the diagnostic test. Future studies are merited to investigate the diagnostic accuracy of the questionnaire in other populations and settings.
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Affiliation(s)
- Kian Zarchi
- University Hospital of Zealand, Roskilde, Denmark
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9
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Affiliation(s)
| | | | - J B M Roberts
- Department of Urology, Southmead General Hospital and the United Bristol Hospitals, Bristol
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10
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Affiliation(s)
- Hans C Ring
- Department of Dermatology, Roskilde Hospital, Health Sciences Faculty, University of Copenhagen, Køgevej 7-13, DK-4000 Roskilde, Denmark.
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11
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Miller IM, Carlson N, Mogensen UB, Ellervik C, Jemec GBE. A Population- and Hospital-based Cross-sectional Study of Renal Function in Hidradenitis Suppurativa. Acta Derm Venereol 2016; 96:68-71. [PMID: 25710874 DOI: 10.2340/00015555-2072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The chronic inflammatory skin diseases hidradenitis suppurativa (HS) and psoriasis have been linked to cardiovascular risk factors and the latter has also been linked to possible renal dysfunction. Since basement membrane thinning in the skin of HS patients has been described, we speculated whether similar basement membrane defects might occur in renal tissue. Our objective was to investigate a possible association between HS and renal dysfunction. We performed a hospital and population-based cross-sectional study using estimated Glomerular-Filtration-Rate (eGFR) to assess renal function. Thirty-two hospital individuals with HS, 430 population individuals with HS, and 20,780 population individuals without HS were (controls) identified. The age-, sex-, smoking-, BMI-, hypertension- and diabetes-adjusted analysis revealed a statistically significant higher eGFR for the hospital group with HS and a mean difference in eGFR of 6.81 (1.27-12.35) ml/min/1.73 m2 between the hospital group with HS and the population group without HS. The observed higher eGFR in the hospital group with HS indicates a possible association of HS and renal dysfunction.
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Affiliation(s)
- Iben M Miller
- Department of Dermatology, Roskilde Hospital; Faculty of Health and Medical Sciences, University of Copenhagen, DK-4000 Roskilde, Denmark.
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12
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Miller IM, Rytgaard H, Mogensen UB, Miller E, Ring HC, Ellervik C, Jemec GB. Body composition and basal metabolic rate in Hidradenitis Suppurativa: a Danish population-based and hospital-based cross-sectional study. J Eur Acad Dermatol Venereol 2015; 30:980-8. [PMID: 26660945 DOI: 10.1111/jdv.13522] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several studies have suggested an association between Hidradenitis Suppurativa (HS) and obesity. Obesity is often expressed as Body Mass Index (BMI). However, BMI lacks information on body composition. General obesity is a predictor of health status and cardiovascular risk, but body composition (e.g. abdominal fat) may be more so. Basal metabolic rate (BMR) is an expression of resting metabolism and may serve as a complementary tool when assessing the possibly underlying metabolism behind a persons' body composition. OBJECTIVE To investigate the body composition and basal metabolic rate in individuals with HS compared with healthy controls. METHODS We performed a cross-sectional study on both a hospital-based and population-based HS group and compared with controls using Bioelectrical Impedance Analysis to assess body composition. RESULTS We identified a hospital-based HS group of 32 hospital HS patients, a population-based HS group of 430 population HS patients, and 20 780 controls. Age- and sex-adjusted analyses showed a 10.12% (P < 0.0001) significantly higher fat percentage in the hospital-based HS group and 3.11% (P < 0.0001) significantly higher fat percentage for the population-based HS group compared to controls. Correspondingly, the HS groups had a lower muscle percentage (P < 0.0001) and lower bone mass percentage (P < 0.0001). Furthermore, visceral fat rating (P < 0.0001), Body Mass Index (P < 0.0001), waist circumference (P < 0.0001), and Waist/Hip Ratio (P < 0.0001) was significantly higher in HS patients compared with controls. Additionally, age and sex-adjusted analyses showed a higher predicted estimate of BMR for the HS groups compared with controls (154.56 kcal/day (95% CI 54.96-254.16) (P = 0.0031) for the hospital-based HS group, and 82.63 kcal/day (95%CI 59.70-105.56) (P < 0.0001) for the population-based HS group). CONCLUSION Hidradenitis Suppurativa is associated with a high fat percentage, high visceral fat, and low muscle percentage adding to the morbidity of HS. The higher predicted estimate of basal metabolic rate (BMR) in HS patients may reflect a dysfunctional metabolism contributing to the high-fat-body composition.
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Affiliation(s)
- I M Miller
- Department of Dermatology, Roskilde Hospital, Roskilde, Denmark
| | - H Rytgaard
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - U B Mogensen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - E Miller
- Sports Science and Psychology, VUC&hf Nordjylland, Aalborg, Denmark
| | - H C Ring
- Department of Dermatology, Roskilde Hospital, Roskilde, Denmark
| | - C Ellervik
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Research, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - G B Jemec
- Department of Dermatology, Roskilde Hospital, Roskilde, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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13
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Miller IM, Ahlehoff O, Ibler K, Rytgaard H, Mogensen UB, Ellervik C, Jemec GB. Hidradenitis suppurativa may not be associated with venous thromboembolia: Results from a large Danish cross-sectional study. J Dermatol Sci 2015; 81:61-3. [PMID: 26522930 DOI: 10.1016/j.jdermsci.2015.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 11/17/2022]
Affiliation(s)
- I M Miller
- Department of Dermatology, Roskilde Hospital, Køgevej 7-13, 4000 Roskilde, Denmark.
| | - O Ahlehoff
- Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - K Ibler
- Department of Dermatology, Roskilde Hospital, Denmark
| | - H Rytgaard
- Department of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark
| | - U B Mogensen
- Department of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark
| | - C Ellervik
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Research, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - G B Jemec
- Department of Dermatology, Roskilde Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Køgevej 7-13, 4000 Roskilde, Denmark
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14
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Miller IM. Co-morbidities in inflammatory dermatological diseases. Psoriasis, hidradenitis suppurativa, and cardiovascular risk factors. Dan Med J 2015; 62:B5143. [PMID: 26324088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In conclusion, this thesis demonstrated an association between inflammatory dermatological diseases, i.e. psoriasis and hidradenitis suppurativa, and the metabolic syndrome putting these two patient groups at cardiovascular risk. Therefore, it is recommended as a minimum to screen hidradenitis and psoriasis patients attending in/outpatient clinics for the metabolic syndrome aimed at prevention of cardiovascular disease. The increased risk of metabolic syndrome adds to the range of well-known disease-related burdens e.g. the physical skin symptoms, the psychological impact thereof, and other co-morbidities, thus highlighting that both hidradenitis and psoriasis patients require general medical attention beyond the skin.
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Affiliation(s)
- Iben M Miller
- Department of Dermatology, Roskilde Hospital, Koegevej 7-13, 4000 Roskilde, Denmark.
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Miller IM, Skaaby T, Ellervik C, Jemec GBE. Quantifying cardiovascular disease risk factors in patients with psoriasis: a meta-analysis. Br J Dermatol 2014; 169:1180-7. [PMID: 23815240 DOI: 10.1111/bjd.12490] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND In a previous meta-analysis on categorical data we found an association between psoriasis and cardiovascular disease and associated risk factors. OBJECTIVES To quantify the level of cardiovascular disease risk factors in order to provide additional data for the clinical management of the increased risk. METHODS This was a meta-analysis of observational studies with continuous outcome using random-effects statistics. A systematic search of studies published before 25 October 2012 was conducted using the databases Medline, EMBASE, International Pharmaceutical Abstracts, PASCAL and BIOSIS. RESULTS We included 59 studies with up to 18 666 cases and 50 724 controls. Psoriasis cases had a higher total cholesterol [weighted mean difference 8·83 mg dL(-1) , 95% confidence interval (CI) 2·94-14·72, P = 0·003 (= 0·23 mmol L(-1) )], higher low-density lipoprotein cholesterol [9·90 mg dL(-1) , 95% CI 1·56-18·20, P = 0·020 (= 0·25 mmol L(-1) )], higher triglyceride [16·32 mg dL(-1) , 95% CI 12·02-20·63, P < 0·001 (= 0·18 mmol L(-1) )], a higher systolic blood pressure (4·77 mmHg, 95% CI 1·62-7·92, P = 0·003), a higher diastolic blood pressure (2·99 mmHg, 95% CI 0·60-5·38, P = 0·014), higher body mass idex (0·73 kg m(-2) , 95% CI 0·37-1·09, P < 0·001), higher waist circumference (3·61 cm, 95% CI 2·12-5·10, P < 0·001), higher fasting glucose [3·52 mg dL(-1) , 95% CI 0·64-6·41, P = 0·017 (= 0·20 mmol L(-1) )], higher nonfasting glucose [11·70 mg dL(-1) , 95% CI 11·24-12·15, P < 0·001 (= 0·65 mmol L(-1) )] and a higher HbA1c [1·09 mmol mol(-1) , 95% CI 0·87-1·31, P < 0·001 (= 2·2%)]. CONCLUSIONS From a preventive medicine perspective, the weighted mean differences between cases and controls are significant, and therefore relevant to the clinical management of patients with psoriasis.
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Affiliation(s)
- I M Miller
- Department of Dermatology, Roskilde Hospital, Køgevej 7-13, 4000 Roskilde, Denmark
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Vinding GR, Zarchi K, Ibler KS, Miller IM, Ellervik C, Jemec GBE. Is adult atopic eczema more common than we think? - A population-based study in Danish adults. Acta Derm Venereol 2014; 94:480-2. [PMID: 24217962 DOI: 10.2340/00015555-1761] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gabrielle R Vinding
- Department of Dermatology, Roskilde Hospital; and Faculty of Health and Medical Sciences, University of Copenhagen, DK-4000 Roskilde, Denmark.
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Ring HC, Miller IM, Benfeldt E, Jemec GB. Artefactual skin lesions in children and adolescents: review of the literature and two cases of factitious purpura. Int J Dermatol 2014; 54:e27-32. [DOI: 10.1111/ijd.12493] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hans Christian Ring
- Department of Dermatology; Roskilde Hospital; Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | - Iben M. Miller
- Department of Dermatology; Roskilde Hospital; Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | - Eva Benfeldt
- Department of Dermatology; Roskilde Hospital; Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | - Gregor B.E. Jemec
- Department of Dermatology; Roskilde Hospital; Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
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Ragnarson Tennvall G, Hjortsberg C, Bjarnason A, Gniadecki R, Heikkilä H, Jemec GBE, Kragballe K, Miller IM, Svensson Å. Treatment patterns, treatment satisfaction, severity of disease problems, and quality of life in patients with psoriasis in three Nordic countries. Acta Derm Venereol 2013; 93:442-5. [PMID: 23138500 DOI: 10.2340/00015555-1485] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Biological drugs are expensive, but can reduce symptoms and increase quality of life for patients with psoriasis. The aim of this study was to examine quality of life, disease severity and treatment satisfaction in Danish, Finnish and Swedish patients with psoriasis. Based on 12 months' data from patient surveys and chart reviews, 3 treatment groups were identified: topical, systemic and/or biological <12 months, and biological for 12 months. Regression analyses were performed to investigate influence on treatment satisfaction, disease problems and quality of life. Patients treated with biological drugs for 12 months showed the highest treatment satisfaction and the lowest Dermatology Life Quality Index score. A number of patients with topical treatment reported low quality of life, severe or very severe disease problems, and low treatment satisfaction. Some patients with psoriasis may be under-treated and might benefit from a more aggressive treatment strategy. It is important, however, that resource utilization is optimized and patients are not treated with more advanced agents than necessary.
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Yazdanyar S, Miller IM, Jemec GBE. Hidradenitis suppurativa and Crohn's disease: two cases that support an association. Acta Dermatovenerol Alp Pannonica Adriat 2010; 19:23-25. [PMID: 20976417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
An association between Crohn's disease and hidradenitis suppurativa has been suggested. The presence of Crohn's disease generally precedes the diagnosis of hidradenitis suppurativa. We present two new cases in which hidradenitis lesions developed before Crohn's disease, suggesting an overlap and supporting an association. Furthermore, in one of these cases, treatment with infliximab resulted in marked improvement in both the Crohn's disease and hidradenitis suppurativa.
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Affiliation(s)
- S Yazdanyar
- Department of Dermatology, Roskilde Hospital, Køgevej 7-13, Roskilde, Denmark.
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Jayakumar S, Jatavalabulla S, Miller IM. Peripheral primitive neuroectodermal tumour of the hand in an adult. J Hand Surg Eur Vol 2007; 32:460-1. [PMID: 17950200 DOI: 10.1016/j.jhse.2007.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2006] [Revised: 03/15/2007] [Accepted: 04/02/2007] [Indexed: 02/07/2023]
Abstract
We present a case of a 28 year-old woman who presented with a peripheral primitive neuroectodermal tumour of the right hand involving the fifth metacarpal and little finger. She underwent excision biopsy, then ray amputation of her right little finger. Initial radiological staging did not reveal metastasis but, after recurrence locally at two years and in spite of adjuvant chemotherapy and radiotherapy, the patient died of progressive metastatic disease 4 years later. The current concepts and difficulties in diagnosing these tumours are discussed.
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Abstract
OBJECTIVE Chronic depression starts at an early age for many individuals and could affect their accumulation of "human capital" (i.e., education, higher amounts of which can broaden occupational choice and increase earnings potential). The authors examined the impact, by gender, of early- (before age 22) versus late-onset major depressive disorder on educational attainment. They also determined whether the efficacy and sustainability of antidepressant treatments and psychosocial outcomes vary by age at onset and quantified the impact of early- versus late-onset, as well as never-occurring, major depressive disorder on expected lifetime earnings. METHOD The authors used logistic and multivariate regression methods to analyze data from a three-phase, multicenter, double-blind, randomized trial that compared sertraline and imipramine treatment of 531 patients with chronic depression aged 30 years and older. These data were integrated with U.S. Census Bureau data on 1995 earnings by age, educational attainment, and gender. RESULTS Early-onset major depressive disorder adversely affected the educational attainment of women but not of men. No significant difference in treatment responsiveness by age at onset was observed after 12 weeks of acute treatment or, for subjects rated as having responded, after 76 weeks of maintenance treatment. A randomly selected 21-year-old woman with early-onset major depressive disorder in 1995 could expect future annual earnings that were 12%-18% lower than those of a randomly selected 21-year-old woman whose onset of major depressive disorder occurred after age 21 or not at all. CONCLUSIONS Early-onset major depressive disorder causes substantial human capital loss, particularly for women. Detection and effective treatment of early-onset major depressive disorder may have substantial economic benefits.
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Affiliation(s)
- E R Berndt
- Massachusetts Institute of Technology, Cambridge, USA
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Miller IM. American hygienists set practice standards at home and abroad. RDH 1995; 15:41. [PMID: 10332426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Miller IM, Vogel R, Cook TJ, Wittreich J. Topically administered norfloxacin compared with topically administered gentamicin for the treatment of external ocular bacterial infections. The Worldwide Norfloxacin Ophthalmic Study Group. Am J Ophthalmol 1992; 113:638-44. [PMID: 1598954 DOI: 10.1016/s0002-9394(14)74787-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this double-masked study, we randomly assigned 488 patients with clinical signs of acute bacterial conjunctivitis or blepharitis, or both, to treatment with either norfloxacin ophthalmic solution 0.3% (245) or gentamicin ophthalmic solution 0.3% (243) for one week. Of the patients with positive cultures, 71% (85 of 120) of the norfloxacin-treated patients and 65% (86 of 133) of the gentamicin-treated patients were clinically cured. An additional 25% (30 of 120) of norfloxacin-treated patients and 32% (43 of 133) of gentamicin-treated patients were clinically improved. On the basis of posttreatment cultures, 89% of all cultured bacteria were eradicated (146 of 179 organisms) or suppressed (14 of 179 organisms) after treatment with norfloxacin. The condition of five norfloxacin-treated patients did not clinically improve, compared with the condition of eight gentamicin-treated patients. Both antibiotics had similar efficacy against gram-positive and against gram-negative organisms. One norfloxacin-treated patient and two gentamicin-treated patients withdrew from the study because of local intolerance. Norfloxacin appears to be an effective and relatively safe agent for the treatment of bacterial infections of the eyelids or conjunctiva, or both. In this study, norfloxacin was clinically and microbiologically similar in activity to gentamicin.
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Affiliation(s)
- I M Miller
- Merck, Sharp and Dohme Research Labs, West Point, PA 19436
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Miller IM, Wittreich JM, Cook T, Vogel R. The safety and efficacy of topical norfloxacin compared with chloramphenicol for the treatment of external ocular bacterial infections. The Norfloxacin-Chloramphenicol Ophthalmic Study Group. Eye (Lond) 1992; 6 ( Pt 1):111-4. [PMID: 1426394 DOI: 10.1038/eye.1992.23] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Two hundred and forty-six patients with signs of acute bacterial conjunctivitis and/or blepharitis were randomised to receive either norfloxacin or chloramphenicol for one week in this double-masked parallel group study. Ninety-two per cent of the norfloxacin-treated patients and 93% of the chloramphenicol-treated patients were rated as either clinically improved or cured at the end of the treatment period. Based upon pre-treatment bacteriological cultures, 31.3% of the patients had significant bacterial infection of the lids and/or conjunctiva. All of these culture-positive patients were rated as either clinically improved or cured. Based upon post-treatment cultures, 72 of 82 strains of Gram-positive and Gram-negative bacteria were eradicated or suppressed following treatment with either norfloxacin or chloramphenicol. However six of 41 strains persisted for norfloxacin and four of 41 for chloramphenicol. Two norfloxacin-treated patients and three chloramphenicol-treated patients had adverse experiences, predominantly ocular discomfort, which required cessation of drug therapy. Norfloxacin appears to be an effective and relatively safe agent for the treatment of bacterial infections of the lids and/or conjunctiva. In this study, norfloxacin was clinically and microbiologically similar in activity to chloramphenicol.
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Affiliation(s)
- I M Miller
- Department of Ophthalmic Clinical Research, Merck & Co., West Point, Pa
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Abstract
With increasing numbers of road traffic accidents, dislocation of the hip associated with fracture of the femoral head is becoming more common. Seven cases are presented. Treatment of this injury is difficult but it is suggested that conservative methods should be considered initially. Long-term follow-up is necessary as many of these patients develop late complications.
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Gengell JC, Miller IM, Roberts JB. Clinical trial of gestronol hexanoate (SH582) in benign prostatic hypertrophy. Proc R Soc Med 1972; 65:130. [PMID: 4117437 PMCID: PMC1644131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Miller IM. Pedodontic practice in general practice. Bull Ninth Dist Dent Soc 1967; 52:10 passim. [PMID: 4225539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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