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Skupski DW, Duzyj CM, Scholl J, Perez-Delboy A, Ruhstaller K, Plante LA, Hart LA, Palomares KTS, Ajemian B, Rosen T, Kinzler WL, Ananth C. Evaluation of classic and novel ultrasound signs of placenta accreta spectrum. Ultrasound Obstet Gynecol 2022; 59:465-473. [PMID: 34725869 DOI: 10.1002/uog.24804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Improvement in the antenatal diagnosis of placenta accreta spectrum (PAS) would allow preparation for delivery in a referral center, leading to decreased maternal morbidity and mortality. Our objectives were to assess the performance of classic ultrasound signs and to determine the value of novel ultrasound signs in the detection of PAS. METHODS This was a retrospective cohort study of women with second-trimester placenta previa who underwent third-trimester transvaginal ultrasound and all women with PAS in seven medical centers. A retrospective image review for signs of PAS was conducted by three maternal-fetal medicine physicians. Classic signs of PAS were defined as placental lacunae, bladder-wall interruption, myometrial thinning and subplacental hypervascularity. Novel signs were defined as small placental lacunae, irregular placenta-myometrium interface (PMI), vascular PMI, non-tapered placental edge and placental bulge towards the bladder. PAS was diagnosed based on difficulty in removing the placenta or pathological examination of the placenta. Multivariate regression analysis was performed and receiver-operating-characteristics (ROC) curves were generated to assess the performance of combined novel signs, combined classic signs and a model combining classic and novel signs. RESULTS A total of 385 cases with placenta previa were included, of which 55 had PAS (28 had placenta accreta, 11 had placenta increta and 16 had placenta percreta). The areas under the ROC curves for classic markers, novel markers and a model combining classic and novel markers for the detection of PAS were 0.81 (95% CI, 0.75-0.88), 0.84 (95% CI, 0.77-0.90) and 0.88 (95% CI, 0.82-0.94), respectively. A model combining classic and novel signs performed better than did the classic or novel markers individually (P = 0.03). An increasing number of signs was associated with a greater likelihood of PAS. With the presence of 0, 1, 2 and ≥ 3 classic ultrasound signs, PAS was present in 5%, 24%, 57% and 94% of cases, respectively. CONCLUSIONS We have confirmed the value of classic ultrasound signs of PAS. The use of novel ultrasound signs in combination with classic signs improved the detection of PAS. These findings have clinical implications for the detection of PAS and may help guide the obstetric management of patients diagnosed with these placental disorders. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D W Skupski
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, New York Presbyterian Queens, Flushing, NY, USA
- The Institute for Placental Medicine, New York Presbyterian Queens, Flushing, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - C M Duzyj
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - J Scholl
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, New York Presbyterian Queens, Flushing, NY, USA
- The Institute for Placental Medicine, New York Presbyterian Queens, Flushing, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - A Perez-Delboy
- Columbia University School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York, NY, USA
| | - K Ruhstaller
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Christiana Care Health System, Wilmington, DE, USA
| | - L A Plante
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Drexel University School of Medicine, Philadelphia, PA, USA
| | - L A Hart
- Department of Obstetrics and Gynecology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - K T S Palomares
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - B Ajemian
- Columbia University School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York, NY, USA
| | - T Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - W L Kinzler
- Departments of Obstetrics and Gynecology and Graduate Medical Education, NYU Langone Hospital - Long Island and NYU Long Island School of Medicine, Mineola, NY, USA
| | - C Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Cardiovascular Institute of New Jersey (CVI-NJ), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Environmental and Occupational Health Sciences Institute (EOHSI), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Jovanović A, Klimek P, Renn O, Schneider R, Øien K, Brown J, DiGennaro M, Liu Y, Pfau V, Jelić M, Rosen T, Caillard B, Chakravarty S, Chhantyal P. Assessing resilience of healthcare infrastructure exposed to COVID-19: emerging risks, resilience indicators, interdependencies and international standards. ACTA ACUST UNITED AC 2020; 40:252-286. [PMID: 32837821 PMCID: PMC7271643 DOI: 10.1007/s10669-020-09779-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the moment of preparation of this paper, the world is still globally in grip of the Corona (COVID-19) crisis, and the need to understand the broader overall framework of the crisis increases. As in similar cases in the past, also with this one, the main interest is on the “first response”. Fully appreciating the efforts of those risking their lives facing pandemics, this paper tries to identify the main elements of the larger, possibly global, framework, supported by international standards, needed to deal with new (emerging) risks resulting from threats like Corona and assess the resilience of systems affected. The paper proposes that future solutions should include a number of new elements, related to both risk and resilience. That should include broadening the scope of attention, currently focused onto preparation and response phases, to the phases of “understanding risks”, including emerging risks, and transformation and adaptation. The paper suggests to use resilience indicators in this process. The proposed approach has been applied in different cases involving critical infrastructures in Europe (energy supply, water supply, transportation, etc., exposed to various threats), including the health system in Austria. The detailed, indicator-based, resilience analysis included mapping resilience, resilience stress-testing, visualization, etc., showing, already before the COVID-19, the resilience (stress-testing) limits of the infrastructures. A simpler (57 indicator based) analysis has, then been done for 11 countries (including Austria). The paper links these results with the options available in the area of policies, standards, guidelines and tools (such as the RiskRadar), with focus on interdependencies and global standards—especially the new ISO 31,050, linking emerging risks and resilience.
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Affiliation(s)
- A Jovanović
- EU-VRi European Risk & Resilience Institute, 70178 Stuttgart, Germany.,R-Tech Steinbeis Advanced Risk Technologies, Fangelsbachstr. 14, 70178 Stuttgart, Germany
| | - P Klimek
- Medical University Vienna, Vienna, Austria
| | - O Renn
- Institute for Advanced Sustainability Studies (IASS), Potsdam, Germany
| | | | - K Øien
- SINTEF, Trondheim, Norway
| | - J Brown
- ISO, Thales, Melbourne, Australia
| | - M DiGennaro
- Johanniter Unfallhilfe e.V., Frankfurt, Germany
| | - Y Liu
- Beijing Municipal Institute of Labor Protection (BMILP), Beijing, China
| | - V Pfau
- EU-VRi European Risk & Resilience Institute, 70178 Stuttgart, Germany
| | - M Jelić
- R-Tech Steinbeis Advanced Risk Technologies, Fangelsbachstr. 14, 70178 Stuttgart, Germany
| | - T Rosen
- R-Tech Steinbeis Advanced Risk Technologies, Fangelsbachstr. 14, 70178 Stuttgart, Germany
| | - B Caillard
- EU-VRi European Risk & Resilience Institute, 70178 Stuttgart, Germany
| | - S Chakravarty
- R-Tech Steinbeis Advanced Risk Technologies, Fangelsbachstr. 14, 70178 Stuttgart, Germany
| | - P Chhantyal
- R-Tech Steinbeis Advanced Risk Technologies, Fangelsbachstr. 14, 70178 Stuttgart, Germany
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Rosen T, Dash KR, Breckman RS, Lachs MS, Lees KE, Sporn N, Stoeckle RJ. BUILT-IN ASSESSMENT TOOLS TO MOTIVATE IMPROVEMENTS IN CARE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Rosen
- Weill Cornell Medical College, New York, New York, United States
| | - K R Dash
- Education Development Center, Waltham, MA, USA
| | - R S Breckman
- Weill Cornell Medical College, New York, NY, USA
| | - M S Lachs
- Weill Cornell Medical College, New York, NY, USA
| | - K E Lees
- Education Development Center, Waltham, MA, USA
| | - N Sporn
- Education Development Center, Waltham, MA, USA
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Elman A, Mulcare MR, Stern ME, Sharma R, LoFaso VM, Breckman R, Lachs MS, Rosen T. THE VALUE OF A SOCIAL WORKER WITHIN A MULTI-DISCIPLINARY EMERGENCY DEPARTMENT TEAM TO COMBAT ELDER MISTREATMENT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Elman
- Weill Cornell Medicine, New York, New York, United States
| | - M R Mulcare
- Division of Emergency Medicine, Weill Cornell Medical College
| | - M E Stern
- Division of Emergency Medicine, Weill Cornell Medical College
| | - R Sharma
- Division of Emergency Medicine, Weill Cornell Medical College
| | - V M LoFaso
- Division of Geriatrics and Palliative Care, Weill Cornell Medical College
| | - R Breckman
- Division of Geriatrics and Palliative Care, Weill Cornell Medical College
| | - M S Lachs
- Division of Geriatrics and Palliative Care, Weill Cornell Medical College
| | - T Rosen
- Division of Emergency Medicine, Weill Cornell Medical College
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Rosen T, Elman A, Gogia K, Ulrey P, Connolly M, Lewis S, Lachs M, Clark S. PROSECUTING ELDER ABUSE, NEGLECT, AND EXPLOITATION: EXAMINATION OF A LARGE, URBAN U.S. COUNTY, 2008–2011. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Rosen
- Weill Cornell Medical College
| | | | - K Gogia
- Weill Cornell Medical College
| | - P Ulrey
- King County Prosecuting Attorney’s Office
| | - M Connolly
- Woodrow Wilson International Center for Scholars
| | - S Lewis
- New York University School of Medicine
| | - M Lachs
- Weill Cornell Medical College
| | - S Clark
- Weill Cornell Medical College
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Rosen T, Stern M, Mulcare M, McCarthy T, LoFaso V, Bloemen E, Breckman R, Lachs M. PROVIDER PERSPECTIVES ON A MULTI-DISCIPLINARY EMERGENCY DEPARTMENT INTERVENTION FOR ELDER ABUSE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T. Rosen
- Weill Cornell Medical College, New York, New York,
| | - M. Stern
- Weill Cornell Medical College, New York, New York,
| | - M.R. Mulcare
- Weill Cornell Medical College, New York, New York,
| | | | - V. LoFaso
- Weill Cornell Medical College, New York, New York,
| | - E.M. Bloemen
- University of Colorado School of Medicine, Aurora, Colorado
| | - R. Breckman
- Weill Cornell Medical College, New York, New York,
| | - M.S. Lachs
- Weill Cornell Medical College, New York, New York,
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Rosen T, Bloemen E, LoFaso V, Clark S, Reisig C, Floemenbaum N, Lachs M. EMF3 Mechanisms of Injury and Implements Used in Physical Elder Abuse: Preliminary Findings from a Pilot Study of Highly Adjudicated Cases. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Yu LJ, Wang B, Parobchak N, Roche N, Rosen T. STAT3 cooperates with the non-canonical NF-κB signaling to regulate pro-labor genes in the human placenta. Placenta 2015; 36:581-6. [PMID: 25771405 DOI: 10.1016/j.placenta.2015.02.013] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/03/2015] [Accepted: 02/23/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Our recent studies have shown that constitutively activated non-canonical RelB/NF-κB2 (p52) in the human placenta positively regulates the pro-labor genes CRH and COX-2. STAT3 regulates NF-κB2 (p100) processing to active p52, and in turn, nuclear activation of RelB/p52, by directly binding to p100/p52 in a variety of cancer cells. In the current study, we tested the hypothesis that STAT3 is involved in regulation of pro-labor genes by associating with RelB/p52 heterodimers in the human placenta. METHODS We used a variety of techniques including immunohistochemical staining, gene silencing, ectopic expression, chromatin immunoprecipitation, Western blot, RT-qPCR, and immunofluorescence assays in primary culture of cytotrophoblast and placental tissues. RESULTS We found that knockdown of STAT3 led to down-regulation of both CRH and COX-2 in a dose-dependent manner. By using chromatin immunoprecipitation, we further showed that interaction of RelB with the CRH or COX-2 gene promoters decreased when STAT3 was depleted. Immunofluorescence demonstrated co-localization of STAT3 with RelB or p100/p52 in both the cytoplasm and nucleus of term cytotrophoblasts. DISCUSSION Collectively, these results suggest that STAT3 constitutes part of the RelB/p52-containing activator complex that positively regulates pro-labor genes in the human placenta.
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Affiliation(s)
- L J Yu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - B Wang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
| | - N Parobchak
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - N Roche
- Department of Obstetrics, Gynecology, and Women's Health, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - T Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
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Mulcare M, Rosen T, Clark S, Viswanathan K, Calfee D, Stern M, Flomenbaum N. 215 A Novel Clinical Protocol for Placement and Management of Indwelling Urinary Catheters in Older Adults in the Emergency Department: Implementation and Impact Assessment. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rosen T, Mulcare M, Stern M, Clark S, Golden D, Lachs M, Flomenbaum N, Gallagher J. 225 Geriatric Burn Injuries Presenting to the Emergency Department of a Major Burn Center: Clinical Characteristics and Outcomes. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vinther KH, Egstrup K, Rosen T, Pararajasingam G, Tveskov C. Runs of premature atrial complexes predict increased mortality in patients with ischemic stroke and sinus rhythm. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ashkinadze E, Rosen T, Brooks SS, Katsanis N, Davis EE. Combining fetal sonography with genetic and allele pathogenicity studies to secure a neonatal diagnosis of Bardet-Biedl syndrome. Clin Genet 2012; 83:553-9. [PMID: 22998390 DOI: 10.1111/cge.12022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/16/2012] [Accepted: 09/17/2012] [Indexed: 02/06/2023]
Abstract
Bardet-Biedl syndrome (BBS) is a rare pediatric ciliopathy characterized by marked clinical variability and extensive genetic heterogeneity. Typical diagnosis of BBS is secured at a median of 9 years of age, and sometimes well into adolescence. Here, we report a patient in whom prenatal detection of increased nuchal fold, enlarged echogenic kidneys, and polydactyly prompted us to screen the most commonly mutated genes in BBS and the phenotypically and genetically overlapping ciliopathy, Meckel-Gruber syndrome (MKS). We identified the common Met390Arg mutation in BBS1 in compound heterozygosity with a novel intronic variant of unknown significance (VUS). Testing of mRNA harvested from primary foreskin fibroblasts obtained shortly after birth revealed the VUS to induce a cryptic splice site, which in turn led to a premature termination and mRNA degradation. To our knowledge, this is the earliest diagnosis of BBS in the absence of other affected individuals in the family, and exemplifies how combining clinical assessment with genetic and timely assays of variant pathogenicity can inform clinical diagnosis and assist with patient management in the prenatal and neonatal setting.
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Affiliation(s)
- E Ashkinadze
- Department of Obstetrics and Gynecology, UMDNJ Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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Powrie JK, Bassett EE, Rosen T, Jørgensen JO, Napoli R, Sacca L, Christiansen JS, Bengtsson BA, Sönksen PH. Detection of growth hormone abuse in sport. Growth Horm IGF Res 2007; 17:220-226. [PMID: 17339122 DOI: 10.1016/j.ghir.2007.01.011] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 01/09/2007] [Accepted: 01/23/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop a test for GH abuse in sport. DESIGN A double blind placebo controlled study of one month's GH administration to 102 healthy non-competing but trained subjects. Blood levels of nine markers of GH action were measured throughout the study and for 56 days after cessation of GH administration. Blood samples were also taken from 813 elite athletes both in and out of competition. RESULTS GH caused a significant change in the nine measured blood markers. Men were more sensitive to the effects of GH than women. IGF-I and N-terminal extension peptide of procollagen type III were selected to construct formulae which gave optimal discrimination between the GH and placebo groups. Adjustments were made to account for the fall in IGF-I and P-III-P with age and the altered distribution seen in elite athletes. Using a cut-off specificity of 1:10,000 these formulae would allow the detection of up to 86% of men and 60% of women abusing GH at the doses used in this study. CONCLUSIONS We report a methodology that will allow the detection of GH abuse. This will provide the basis of a robust and enforceable test identifying those who are already cheating and provide a deterrent to those who may be tempted to do so.
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Affiliation(s)
- J K Powrie
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, 3rd Floor, Thomas Guy house, Guy's Hospital, London SE1 9RT, UK.
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Abstract
Neostigmine is a treatment option for colonic pseudoobstruction. However, experience in using neostigmine for this indication in pregnant women is limited. We present a case of a woman with an estimated fetal gestational age of 34 weeks presented with what was believed to be a pseudoobstruction and when conservative management failed, neostigmine was administered with no adverse side effects. Ultimately, the patient was found to have a mechanical obstruction and we discuss the challenges in making this diagnosis in pregnancy. Neostigmine may be a viable alternative to colonoscopy in pregnant women for whom mechanical obstruction is properly excluded.
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Affiliation(s)
- M E Rausch
- 1Department of Obstetrics and Gynecology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY 10032, USA.
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Poretti F, Rosen T, Körner B, Vorwerk D. Randomisierte Untersuchung zur Anwendung eines Chitosan-Gerinnungspads zur Blutstillung bei transbrachialen Angiographien. ROFO-FORTSCHR RONTG 2005; 177:1260-6. [PMID: 16123873 DOI: 10.1055/s-2005-858328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 10/25/2022]
Abstract
PURPOSE Until now, no mechanical closure devices were available to achieve fast and secure hemostasis for vessel closure after catheterization of small arterial vessels. MATERIAL AND METHODS Eighty patients were randomized to evaluate the effect on hemostasis by use of a chitosan pad (Chito-Seal, Abbott Vascular Devices, Galway/Ireland) in comparison to manual compression after diagnostic transbrachial arterial catheterization. Hemostasis after three minutes and one hour as well as local development of a hematoma after one and twenty-four hours were assessed. RESULTS The use of chitosan pads significantly decreased the bleeding time in the first three minutes after manual compression time (p < 0.01). Significant decrease in bleeding risk at three minutes by use of the chitosan closure pads was also found in subgroups of patients with hypertension (p < 0.001) or diabetes (p < 0.01) and also in patients under anticoagulation therapy (p < 0.01). In addition, long-term protection from bleeding complications such as the risk of hematoma was decreased by the use of chitosan closure pads one hour (p < 0.01) or twenty-four hours (p < 0.001) after catheter removal. CONCLUSION The use of an intravascular anchor or suture system is not safely applicable in these vessels due to the small diameter of the brachial artery. Our results document a significant improvement in hemostasis by using chitosan pads in these cases.
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Affiliation(s)
- F Poretti
- Institut für diagnostische und interventionelle Radiologie, Klinikum Ingolstadt.
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Abstract
OBJECTIVES We present a case of an AIDS patient with Norwegian scabies manifest by a single, crusted plaque localised to the glans penis. METHODS A 45 year old man with AIDS presented to our clinic complaining of a red papular pruritic rash on his abdomen and anterior thighs and a single, thick, crusted, non-pruritic lesion on the penis. He had been treated with lindane topically prior to the development of the penile lesion without resolution of the pruritus or red papular lesions. A mineral oil preparation was obtained from the hyperkeratotic penile lesion and revealed numerous mite eggs and faeces. RESULTS The diagnosis of localised, genital Norwegian scabies was made. The patient was treated with ivermectin 200 micro g/kg per dose taken as two doses, 14 days apart, with complete resolution of both pruritus and skin lesions. CONCLUSIONS This patient is the first known report of Norwegian scabies localised as a single lesion on the penis. He was successfully treated with oral ivermectin monotherapy.
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Affiliation(s)
- A G Perna
- Department of Dermatology, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
PURPOSE To describe safety and efficacy of transbrachial selective carotid digital subtraction angiography (DSA) in outpatients. MATERIALS AND METHODS From July 1999 to November 2001, selective carotid angiography was performed in 141 outpatients preferably using a left brachial arterial approach. The average age of the patients was 68 years (range: 39 - 89 years). After flush aortography through a 4F-pigtail catheter, bilateral selective common carotid artery (CCA) catheterization was performed with 4F-Sidewinder-1 or Sidewinder-2 catheters. In 49 patients, Doppler-sonography was performed before or after arteriography. A total of 41 patients underwent carotid surgery. RESULTS Selective catheterization of the CCA was successful in 96 % of the cases. The diagnostic quality of the opacified aorta and CCA images was good to excellent. The overall complication rate did not exceed 2.1 %, and severe complications were not observed. One patient showed transient neurological symptoms and another mild nausea and agitation, probably as toxic reaction to the contrast medium. A single local hematoma developed after unsuccessful puncture of the brachial artery. CONCLUSION Transbrachial selective carotid DSA is safe, reliable and well-tolerated in outpatients and achieves a superimposition-free CCA visualization.
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Affiliation(s)
- T Rosen
- Institut für diagnostische und interventionelle Radiologie des Klinikums Ingolstadt.
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Abstract
PURPOSE To describe the rise of classical laboratory tests for inflammation following transarterial uterine fibroid embolization (UFE) in order to monitor the normal course following UFE. MATERIALS AND METHODS In 20 females, white blood cell (WBC) count and C-reactive protein (CRP) were determined before and up to 5 days after UFE. With the exception of one noninflammatory complication, the post-procedure course was uneventful in all patients. The measured values were correlated with both the total uterine volume and the amount of instilled embolizing agent. RESULTS Following UFE, an increase in the WBC count to an average maximum of 10.8 +/- 3.5/wL (range 5.9 - 18.6/wL) was found. In 13 of 20 patients, the WBC count was above normal on at least one day following UFE. The increase reached the maximum on the third post-interventional day and subsided within 5 days after the UFE. The CRP values increased significantly to an average maximum of 41.9 +/- 28.8 mg/l. The maximum was found on the 2nd post-interventional day in 8 patients, on the 3rd day in 11 patients and on the 4th day in one patient. No correlation to the total uterine volume or to the amount of the instilled embolizing agents was detected. CONCLUSION Following uncomplicated UFE, a steep increase in CRP occurs with no or only a mild increase in the WBC count, which does not indicate an infected fibroid. The maximum is reached on the 3rd or 4th post-interventional day, followed by a decline in CRP and normalization of the WBC count.
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Affiliation(s)
- D Vorwerk
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Ingolstadt.
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Rosen T, Schatz F, Kuczynski E, Lam H, Koo AB, Lockwood CJ. Thrombin-enhanced matrix metalloproteinase-1 expression: a mechanism linking placental abruption with premature rupture of the membranes. J Matern Fetal Neonatal Med 2002; 11:11-7. [PMID: 12380602 DOI: 10.1080/jmf.11.1.11.17] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Given the strong clinical association between the decidual hemorrhage of placental abruption and subsequent preterm premature rupture of the membranes, we assessed the effects of thrombin on the expression of the potent interstitial collagenase, matrix metalloproteinase-1 (MMP-1), in cultured endometrial stromal and decidual cells. STUDY DESIGN Stromal cells derived from predecidualized cycling endometrium and decidual cells from term decidua were cultured in a defined medium containing estradiol, to mimic the hormonal milieu of the non-pregnant proliferative phase, or estradiol plus medroxyprogesterone acetate (MPA), to mimic the hormonal milieu of pregnancy, in the presence and absence of thrombin. Culture media were examined for MMP-1 protein levels and cell lysates were examined for steady-state MMP-1 mRNA levels. RESULTS MPA strongly inhibited MMP-1 levels in endometrial stromal and term decidual cells. However, thrombin overcame this suppression, producing MMP-1 levels that were several-fold higher than control levels. CONCLUSION Extrapolation of thrombin-enhanced MMP-1 expression in cultured endometrial stromal and decidual cells to the in vivo pregnant state provides an explanation for the strong association between placental abruption and preterm membrane rupture.
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Affiliation(s)
- T Rosen
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York 10016, USA
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Abstract
BACKGROUND Factitious disease involving the breast is unusual. The rarely reported cases of this entity have been encountered in middle-aged women. In general, factitious disease can be distinguished on clinical and/or psychological grounds from self-induced disorders seen in malingerers and among those demonstrating Munchausen's syndrome. METHODS We report herein a male patient displaying factitious disease of the breast due to injection of a high viscosity liquid plastic material. RESULTS Establishment of the proper diagnosis was greatly delayed due to a lack of suspicion of this entity. Only direct confrontation of the patient with the biopsy results (lipogranulomatosis) led to a reluctant and then only partial admission of the self-induced nature of this patient's illness. CONCLUSION The clinician should remain vigilant for factitious disease when confronted with chronic or recurrent lesions of a bizarre or atypical morphology. Any body site can be involved, including the breast. Management is difficult and is best accomplished in conjunction with an appropriate mental health professional. Continued dramatic surgical interventions are contraindicated.
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Affiliation(s)
- T Rosen
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.
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21
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Rosen T, Sutin K, Carreno CA, Hibbett E, Funai EF. Central hemodynamic monitoring in a woman with acute respiratory insufficiency after evacuation of a complete molar pregnancy. A case report. J Reprod Med 2001; 46:916-22. [PMID: 11725738] [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: 02/22/2023]
Abstract
BACKGROUND The incidence of hydatiform moles in the United States is approximately 1 in 1,200 pregnancies. Acute respiratory insufficiency is a known complication of molar pregnancies, occurring in 8-11%. While there have been numerous case reports and retrospective studies describing respiratory complications following evacuation of hydatiform moles, only a limited number of reports provide data from central hemodynamic monitoring in patients with this complication. CASE A 16-year-old, Hispanic woman, gravida 1, para 0, presented to the emergency room at 13 weeks' gestational age by menstrual dating with complaints of vaginal bleeding for two days. The serum quantitative beta-hCG level was 1 x 10(6) mIU/mL, and a bedside sonogram was consistent with hydatiform mole. After informed consent was obtained, the patient underwent dilation and suction curettage. Approximately five minutes after evacuation of the uterus was begun, the patient developed pulmonary edema in the setting of oliguria. A pulmonary artery catheter was inserted to determine the etiology of the edema. The initial pulmonary capillary wedge pressure was > 18 mm Hg, consistent with hydrostatic pulmonary edema. Volume overload in association with a reduced colloid osmotic pressure to wedge pressure gradient was primarily responsible for the pulmonary edema in this patient. CONCLUSION The majority of case reports of pulmonary complications after evacuation of a hydatidiform mole were either presumed or documented to be due to trophoblastic pulmonary embolism. Thyrotoxicosis, fluid overload with dilutional anemia, preeclampsia, sepsis, hypoalbuminemia or a combination of these factors may be more common than trophoblastic embolization.
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Affiliation(s)
- T Rosen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, and Department of Anesthesia, New York University Medical Center, New York, New York, USA.
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22
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Rosen T, Kuczynski E, O'Neill LM, Funai EF, Lockwood CJ. Plasma levels of thrombin-antithrombin complexes predict preterm premature rupture of the fetal membranes. J Matern Fetal Med 2001; 10:297-300. [PMID: 11730490 DOI: 10.1080/714904361] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE Decidual hemorrhage (abruption) is strongly associated with preterm premature rupture of fetal membranes (PPROM). Moreover, thrombin enhances decidual matrix metalloproteinase (MMP) expression, and MMP has been strongly linked to PPROM. The current study sought to determine whether increased thrombin activation, as assessed by circulating maternal plasma thrombin-antithrombin (TAT) complexes, predicted subsequent PPROM. STUDY DESIGN We conducted a nested, case-control study of plasma TAT levels, measured by sensitive immunoassay, among 27 women with a singleton preterm birth preceded by PPROM and 54 matched, term controls. Receiver operating characteristic curve analysis was performed to identify the optimal TAT cut-off level predicting PPROM. RESULTS Mean gestational age at delivery in cases was 33.3 weeks, compared to 39.7 weeks in controls (p < 0.001). Compared with controls, women with PPROM had increased median plasma TAT levels in both the second trimester (5.1 microg/l (range 2.2-26.3 microg/l) vs. 3.2 microg/l (range 1.3-7.3 microg/l); p = 0.001) and third trimester (7.0 microg/l (range 2.6-85.8 microg/dl) vs. 4.8 microg/l (range 1.7-15.4 microg/dl); p = 0.01). In the PPROM group, 16.0% of the women exhibited bleeding during the pregnancy, while the corresponding value among controls was 3.6% (p = 0.07). In the second trimester, the odds ratio for PPROM with a TAT level of > 3.9 microg/l was 6.0 (95% CI 1.67-21.1). This value predicted PPROM with a sensitivity of 88%, specificity of 68% and positive and negative predictive values of 82% and 97%, respectively. CONCLUSION Second-trimester elevated plasma TAT concentrations are predictive of subsequent PPROM. These data provide further evidence that PPROM is associated with decidual thrombin activation.
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Affiliation(s)
- T Rosen
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York 10016, USA
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23
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Schell BJ, Rosen T, Rády P, Arany I, Tschen JA, Mack MF, Tyring SK. Verrucous carcinoma of the foot associated with human papillomavirus type 16. J Am Acad Dermatol 2001; 45:49-55. [PMID: 11423834 DOI: 10.1067/mjd.2001.113460] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [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: 11/22/2022]
Abstract
BACKGROUND We present 2 patients with verrucous carcinoma (VC) of the foot, a malignancy of unknown origin. OBJECTIVE Molecular studies from the VCs were undertaken to determine the presence, type, and physical state of human papillomavirus (HPV) as well as the expression levels of certain oncogenes and antioncogenes. METHODS Synthetic consensus and type-specific primers were used to determine the HPV type from both VCs via polymerase chain reaction (PCR). Verification of fragments was accomplished by means of specific isotope-labeled oligonucleotide probes. The physical state of HPV DNA was determined by two-dimensional gel electrophoresis. Quantitative oncogene and antioncogene expression studies were performed with the use of reverse transcriptase PCR. RESULTS HPV type 16 was identified in episomal and integrated forms in both tumors. Expression studies revealed increased messenger RNA levels of c-Ki-ras oncogene and the p53 antioncogene and decreased messenger RNA levels of the Rb antioncogene in both VCs. CONCLUSION Episomal and integrated forms of HPV-16 DNA were found in VCs of the foot, along with alterations of c-Ki-ras, p53, and Rb genes.
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Affiliation(s)
- B J Schell
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
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24
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Abstract
BACKGROUND Darkly pigmented individuals may manifest unusual or uncharacteristic presentations of various skin conditions, including heavy pigmentation of cutaneous tumors. OBJECTIVE To increase the awareness of an unusual presentation of Bowen's disease in a darkly pigmented individual. METHODS We report the case of a 52 year old black woman that presented with a lesion clinically consistent with malignant melanoma. However, histopathologic examination revealed pigmented Bowen's disease. RESULTS A biopsy is almost always indicated to confirm the diagnosis of lesions in darkly pigmented individuals. CONCLUSION This case is presented to reinforce the idea that pigmented Bowen's disease should be considered in the differential diagnosis of malignant melanoma.
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Affiliation(s)
- R Krishnan
- Baylor College of Medicine, Houston, Texas 77025, USA
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25
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Abstract
Dermatophyte infections of the penis and scrotum are relatively rare compared with those involving the groin. Four cases of penile tinea due to Trichophyton rubrum are described. All patients had associated foci of fungal infection, but only one had crural involvement. Treatment with oral antifungal agents led to complete resolution of penile dermatophytosis.
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Affiliation(s)
- J Pielop
- Baylor College of Medicine and the Veterans Affairs Medical Center, Houston, TX, USA
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26
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Abstract
BACKGROUND Condylomata lata of the toe webs are uncommon manifestations of secondary syphilis. Considering the recent decline in the incidence of syphilis in the United States, such lesions are likely to present infrequently. In some cases, this phenomenon may be the only physical sign of syphilis; therefore, it is important that a high index of suspicion is maintained when evaluating toe web lesions in patients at epidemiologic risk for syphilis. GOALS A case of secondary syphilis presenting solely with interdigital condyloma lata in the toe web spaces is reported, and similar cases reported in the literature are reviewed. STUDY DESIGN This article documents the diagnosis of secondary syphilis based on a positive serology in conjunction with the development of interdigital condyloma lata as the only physical finding suggestive of lues. RESULTS The latter lesions resolved after appropriate, adequate antibiotic therapy. CONCLUSIONS A case of condylomata lata of the toe webs without other pertinent physical findings is presented. Analogous to lesions typically seen in the anogenital region, moist exophytic toe web plaques may represent condyloma lata and thereby be a sign of secondary syphilis. The differential diagnosis includes tinea pedis, erythrasma, macerated corns, verrucae, and several tropical mycoses (chromomycosis, mycetoma).
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Affiliation(s)
- T Rosen
- Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030, USA.
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27
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Affiliation(s)
- R McCarthy
- University of Texas Medical Branch, Galveston, TX, USA.
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28
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Rosen T, Kuczynski E, O'Neill LM, Funai EF, Lockwood CJ. Plasma levels of thrombin-antithrombin complexes predict preterm premature rupture of the fetal membranes. J Matern Fetal Neonatal Med 2001. [DOI: 10.1080/jmf.10.5.297.300] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Rosen T. Hazardous hedgehogs. South Med J 2000; 93:936-8. [PMID: 11005362] [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: 02/17/2023]
Abstract
The African pygmy hedgehog has recently become a fashionable exotic pet in the United States, particularly in the South. As illustrated by the three cases reported, this mammalian insectivore can be a carrier of fungi that cause human dermatomycoses. The African pygmy hedgehog has also been associated with contact urticaria and human salmonellosis.
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Affiliation(s)
- T Rosen
- Department of Dermatology, Baylor College of Medicine, VA Medical Center, Houston, Tex, USA
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30
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Abstract
We report near clearing of keratoderma blennorrhagicum following topical application of tazarotene gel 0.1%. This is the first report detailing the use of tazarotene gel for this purpose.
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Affiliation(s)
- A Lewis
- Department of Dermatology, Baylor College of Medicine, Veteran's Affairs Medical Center, Houston, TX, USA
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31
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Radunovic N, Kuczynski E, Rosen T, Dukanac J, Petkovic S, Lockwood CJ. Plasma apolipoprotein A-I and B concentrations in growth-retarded fetuses: a link between low birth weight and adult atherosclerosis. J Clin Endocrinol Metab 2000; 85:85-8. [PMID: 10634369 DOI: 10.1210/jcem.85.1.6243] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Apolipoprotein B is elevated in growth-retarded compared with normally grown fetuses, demonstrating a link between low birth weight and risk of subsequent atherosclerosis. Increased apolipoprotein B levels and an elevated apolipoprotein B to A-I ratio are predictors of atherogenesis. Elevated apolipoprotein B levels in young adults have been linked to atherosclerosis in later life, whereas impaired fetal growth has been linked to higher than normal apolipoprotein B levels in adulthood. We conducted this research to test the hypothesis that circulating apolipoprotein A-I and B concentrations differ in growth-retarded compared with normal fetuses. Fetal umbilical plasma samples were obtained at diagnostic cordocenteses in 18 growth-retarded and 23 normally grown fetuses. Levels of apolipoprotein A-I and B were measured by turbidimetric assay. There were no differences in median (range) plasma apolipoprotein A-I concentrations between growth-retarded and normal fetuses [0.61 (0.30-1.42) vs. 0.60 (0.30-1.63) g/L, respectively; P = 0.94]. In contrast, we found significantly higher plasma apolipoprotein B levels in growth-retarded vs. normal fetuses [0.62 (0.37-1.84) vs. 0.40 (0.16-1.47) g/L, respectively; P<0.001]. Moreover, the ratio of apolipoprotein B to A-I was significantly higher in growth-retarded than in normal fetuses [1.00 (0.38-2.42) vs. 0.53 (0.31-1.80); P = 0.005]. Levels of apolipoprotein B are elevated in growth-retarded fetuses, suggesting a linkage between low birth weight and adult-onset atherosclerosis.
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Affiliation(s)
- N Radunovic
- Obstetrical and Gynecological Clinic of the University of Belgrade School of Medicine, Belgrade, Yugoslavia
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32
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Abstract
AIMS The purpose of this study was to assess the effect, if any, of color Doppler on the measurement of the amniotic fluid index in term pregnancies. It is hypothesized that color Doppler may enhance the detection of oligohydramnios. METHODS The amniotic fluid index was performed with and without color Doppler on pregnancies greater than or equal to 36 weeks gestational age. Differences in the mean amniotic fluid index measurements were assessed. The incidence of oligohydramnios was examined using both techniques. Differences in continuous variables were assessed with the paired t test, differences in categorical variables were assessed using the Fisher Exact Test. RESULTS There were 155 pregnancies examined, the amniotic fluid index was significantly decreased when color Doppler was added to the standard technique. (P < .0001) The incidence of oligohydramnios was higher with the application of color Doppler to the standard amniotic fluid index. (P < .05). CONCLUSIONS Color Doppler results in a significantly lower amniotic fluid volume measurement and may enhance the detection of oligohydramnios.
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Affiliation(s)
- A Bianco
- New York University Medical Center/Bellevue Hospital, Department of Obstetrics and Gynecology, New York, USA
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33
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Abstract
BACKGROUND AND OBJECTIVES Human bite injuries, while less frequent than cat or dog bites, usually stem from aggressive behavior, sports, or sexual activity. It has been thought that human bites have a higher rate of infection than animal bites, but this view is likely skewed because of the frequency of closed fist injuries presenting to emergency rooms. Human bites to the genitalia also occur, but are not often reported because of embarrassment. GOAL OF THE STUDY We report a genital ulceration after a human bite to the penis and review appropriate diagnostic and therapeutic maneuvers. STUDY DESIGN This article reports the development of a severe genital ulcer associated with a human bite to the penis secondarily infected, as verified by culture, with an oral flora organism Eikenella corrodens. RESULTS The genital ulceration healed after appropriate antibiotic therapy. CONCLUSIONS Treatment of human bites focuses on obtaining an accurate history and performing a salient physical examination, as well as early irrigation and debridement. Transmission of communicable disease should be considered as a possible consequence. Prophylactic antibiotic treatment and primary closure of wounds continue to be areas of controversy.
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Affiliation(s)
- T Rosen
- Baylor College of Medicine, Department of Dermatology, Houston, Texas 77030, USA
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34
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Abstract
BACKGROUND Dermatophyte infections are often accompanied by a striking inflammatory reaction, alleviation of which has often been achieved by the concomitant but controversial use of topical steroidal agents. Recent investigations have suggested the presence of inherent anti-inflammatory properties associated with certain antifungal agents, particularly those within the allylamine class. Butenafine, the first and only approved representative of the benzylamine antifungals, possesses a chemical structure and antifungal activity similar to the allylamines. Although several studies have demonstrated excellent antimycotic efficacy, none has addressed anti-inflammatory properties associated with butenafine. OBJECTIVE This study was designed to determine whether butenafine, a benzylamine antifungal, expresses anti-inflammatory activity in vivo. METHODS A randomized single-blinded control investigation comparing the attenuation of UVB irradiation-induced erythema by butenafine, its proprietary base cream, and no application (negative control) was performed in humans. RESULTS Butenafine demonstrated a significant and marked decrease in UVB-induced erythema as compared with both the base cream and the unaltered control. CONCLUSION The benzylamine antifungal agent butenafine demonstrates inherent anti-inflammatory properties, in vivo, as demonstrated by reduced cutaneous erythema response after UVB irradiation.
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Affiliation(s)
- W K Nahm
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
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35
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Rosen T, Unkefer RP. Treatment of pyoderma faciale with isotretinoin in a patient with ulcerative colitis. Cutis 1999; 64:107-9. [PMID: 10467503] [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: 02/13/2023]
Abstract
The explosive onset of fluctuant facial papulonodules, usually in young women, is characteristic of pyoderma faciale. This disorder is neither a true pyoderma nor a variant of acne, but rather a severe form of rosacea. The most effective therapeutic modality appears to be isotretinoin, especially if preceded by a brief course of oral corticosteroids or a short interval of application of potent topical corticosteroids. Despite our concern about the potential adverse effects of systemic retinoids on underlying inflammatory bowel disease, isotretinoin was given to a patient with refractory pyoderma faciale. Response was dramatic, and no ill effects were encountered.
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Affiliation(s)
- T Rosen
- Baylor College of Medicine, Houston, Texas, USA
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36
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Medina JC, Roche D, Shan B, Learned RM, Frankmoelle WP, Clark DL, Rosen T, Jaen JC. Novel halogenated sulfonamides inhibit the growth of multidrug resistant MCF-7/ADR cancer cells. Bioorg Med Chem Lett 1999; 9:1843-6. [PMID: 10406652 DOI: 10.1016/s0960-894x(99)00276-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.9] [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: 10/27/2022]
Abstract
In this report, we describe the synthesis of halogenated benzenesulfonamide compounds and their ability to inhibit the growth of HeLa, MCF-7 and MCF-7/ADR tumor cells in vitro. The multidrug resistance (MDR) phenotype of certain cells does not affect their sensitivity to these compounds. These agents belong to a family of compounds previously shown to bind irreversibly to cysteine-239 of beta-tubulin. Consistent with this mechanism of action, the cytotoxicities of these compounds appear to correlate with their ability to undergo nucleophilic aromatic substitution.
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Affiliation(s)
- J C Medina
- Tularik Inc., South San Francisco, CA 94080, USA
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37
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Lind SE, Goldshteyn S, Barry CP, Lindquist JR, Piergies AA, Rosen T, Schneider JR, Shevrin DH, Caprini JA. Assessment of coagulation system activation using spot urine measurements. Blood Coagul Fibrinolysis 1999; 10:285-9. [PMID: 10456620 DOI: 10.1097/00001721-199907000-00010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 11/26/2022]
Abstract
Coagulation system activation is most commonly assessed by measuring levels of one or more proteins in peripheral blood. Because faulty blood-drawing can cause activation of the coagulation system, artifactual elevations of such markers have been reported. We have therefore investigated the possibility of using randomly collected ('spot') urine samples as a non-invasive means of assessing the state of coagulation system activation. Using a commercially available enzyme-linked immunosorbent assay kit designed to measure plasma levels of fragment 1 + 2, we found immunoreactive fragment 2 in healthy control subjects, and significantly increased levels in diabetic and non-diabetic pregnant subjects, and patients with venous thromboembolism, prostate cancer, and diabetes. Measurements of excretion of immunoreactive fragment 2 are worth further study as an adjunct or alternative to plasma-based assays designed to detect or quantify coagulation system activation.
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Affiliation(s)
- S E Lind
- Department of Medicine, Evanston Northwestern Healthcare and Northwestern University Medical School, Illinois, USA.
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38
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De Doncker P, Gupta AK, Cel Rosso JQ, Daniel CR, Rosen T, Verspeelt J, Marynissen G, Meuleneers L, Moskovitz B, Jacko M, Shear N, Odom RB, Aly R, Scher RK, Elewski BE. Safety of itraconazole pulse therapy for onychomycosis. An update. Postgrad Med 1999; Spec No:17-25. [PMID: 10492662] [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: 02/14/2023]
Abstract
After experience with more than 34 million patients over 10 years, the safety of itraconazole and its potential drug-drug interactions are well known. In clinical trials, the average incidence of adverse events with a 1-week pulse regimen was 18% in pooled safety data (n = 2,867); only 2.2% of patients dropped out. In direct comparative trials, the incidence of mild and reversible adverse effects was comparable for itraconazole and terbinafine (31% and 28%, respectively) during treatment. The rate of permanent withdrawal because of adverse events was 3.6% for itraconazole and 7.5% for terbinafine (P < .05). Itraconazole was significantly better tolerated as evaluated by the investigator and patients. The analysis of the elderly subpopulation showed that patients 65 and older tolerated itraconazole pulse well, with only 20% experiencing mild and reversible side effects (total group). In direct comparative trials, itraconazole also produced fewer adverse effects than terbinafine (13% vs 32%, respectively). As newer oral antifungal agents gain widespread use, clinicians need to be aware of their potential drug-drug interactions and their possibly serious adverse events. However, pooled data from the 1-week itraconazole pulse regimen indicated a favorable safety profile, and a dose increase to 400 mg had no impact on safety.
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Affiliation(s)
- P De Doncker
- Department of Clinical Research, Janssen Research Foundation, Beerse, Belgium
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39
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Abstract
BACKGROUND Incidence rates of cutaneous malignant melanoma (CMM) have been increasing for decades among Caucasian populations worldwide. Multiple factors identify persons at increased risk of CMM, including those with a family history of melanoma and those with atypical moles. Approximately 6-12% of melanomas are familial and approximately 12% of patients with familial melanoma have multiple primary melanomas. OBJECTIVE To report a case of a patient with atypical moles and with 17 multiple primary melanomas. To review the literature on multiple primary melanomas as well as to review the genetics and treatment of melanoma. CONCLUSION Patients with numerous atypical moles and a family or personal history of melanoma are at greatest risk for developing CMM. Patients from this population tend to develop CMM approximately 10 years earlier than the general population and have an increased risk for developing multiple primary melanomas. Since genetic tests capable of detecting individuals with an inherited susceptibility to CMM are not available, it is important to identify those patients with an increased risk and monitor them closely with regular total-body examinations.
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Affiliation(s)
- N Conrad
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
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40
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Rosen T, Hoffman J, Jones A. Penile Kaposi's sarcoma. J Eur Acad Dermatol Venereol 1999; 13:71-3. [PMID: 10565640 DOI: 10.1111/j.1468-3083.1999.tb00853.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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41
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Shan B, Medina JC, Santha E, Frankmoelle WP, Chou TC, Learned RM, Narbut MR, Stott D, Wu P, Jaen JC, Rosen T, Timmermans PB, Beckmann H. Selective, covalent modification of beta-tubulin residue Cys-239 by T138067, an antitumor agent with in vivo efficacy against multidrug-resistant tumors. Proc Natl Acad Sci U S A 1999; 96:5686-91. [PMID: 10318945 PMCID: PMC21921 DOI: 10.1073/pnas.96.10.5686] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.1] [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: 12/23/2022] Open
Abstract
Microtubules are linear polymers of alpha- and beta-tubulin heterodimers and are the major constituents of mitotic spindles, which are essential for the separation of chromosomes during mitosis. Here we describe a synthetic compound, 2-fluoro-1-methoxy-4-pentafluorophenylsulfonamidobenzene (T138067), which covalently and selectively modifies the beta1, beta2, and beta4 isotypes of beta-tubulin at a conserved cysteine residue, thereby disrupting microtubule polymerization. Cells exposed to T138067 become altered in shape, indicating a collapse of the cytoskeleton, and show an increase in chromosomal ploidy. Subsequently, these cells undergo apoptosis. Furthermore, T138067 exhibits cytotoxicity against tumor cell lines that exhibit substantial resistance to vinblastine, paclitaxel, doxorubicin, and actinomycin D. T138067 is also equally efficacious in inhibiting the growth of sensitive and multidrug-resistant human tumor xenografts in athymic nude mice. These observations suggest that T138067 may be clinically useful for the treatment of multidrug-resistant tumors.
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Affiliation(s)
- B Shan
- Tularik Inc., Two Corporate Drive, South San Francisco, CA 94080, USA
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42
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Abstract
BACKGROUND Latex condoms are used as contraceptives and as preventives against sexually transmitted diseases. Latex rapidly and significantly deteriorates when exposed to pure mineral oil and vegetable oil. We wanted to determine if short exposures to readily available over-the-counter (OTC) intravaginal preparations could affect latex condom integrity. METHODS We compared the mean burst time of test latex condoms, which had 5-minute exposure to various OTC vaginal products, with the mean burst time of control (unexposed) condoms during pressurized air inflation. RESULTS Baby oil reduced the mean burst time from nearly a minute to just over 11 seconds. One intravaginal moisturizer and two intravaginal antifungal preparations also adversely affected latex condom integrity. Products that weakened latex condoms contained either mineral oil or vegetable oil. CONCLUSIONS Women who rely on latex condoms should exercise caution if using OTC vaginal products containing either mineral oil or vegetable oil. Such products apparently can decrease condom strength and potentially jeopardize efficacy.
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Affiliation(s)
- A D Rosen
- College of Biomedical Science, Texas A&M University, Houston, USA
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Karakayli G, Beckham G, Orengo I, Rosen T. Exfoliative dermatitis. Am Fam Physician 1999; 59:625-30. [PMID: 10029788] [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: 02/10/2023]
Abstract
Exfoliative dermatitis, also known as erythroderma, is an uncommon but serious skin disorder that family physicians must be able to recognize and treat appropriately. Although the etiology is often unknown, exfoliative dermatitis may be the result of a drug reaction or an underlying malignancy. The approach to treatment should include discontinuation of any potentially causative medications and a search for any underlying malignancy. One of the most common malignancies associated with exfoliative dermatitis is cutaneous T-cell lymphoma, which may not manifest for months or even years after the onset of the skin condition. Hospitalization is usually necessary for initial evaluation and treatment. In the hospital, special attention must be given to maintaining temperature control, replacing lost fluids and electrolytes, and preventing and treating infection. The long-term prognosis is good in patients with drug-induced disease, although the course tends to be remitting and relapsing in idiopathic cases. The prognosis of cases associated with malignancy typically depends on the outcome of the underlying malignancy.
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Affiliation(s)
- G Karakayli
- Baylor College of Medicine, Houston, Texas, USA
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Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a recurrent, suppurative disease manifested by abscesses, fistulas, and scarring. METHODS We reviewed the literature to identify reliable information regarding epidemiology, pathogenesis, clinical manifestations, evaluation and differential diagnosis, treatment, complications, and prognosis. RESULTS Hidradenitis suppurativa usually affects young women, with a prevalence of 0.3% to 4% in industrialized countries. Once considered to be "apocrine acne," HS is actually a defect of terminal follicular epithelium. Obesity, chemical irritants, or hyperandrogenism are not consistently associated; bacterial involvement is secondary. Hidradenitis suppurativa should be suspected in young adults with recurrent, deep furuncular lesions in flexural sites, especially when such lesions respond poorly to antibiotic therapy. Clindamycin and isotretinoin may be useful, though wide excision with healing by granulation is considered most efficacious. Anemia, arthropathy, and squamous cell carcinoma are potential complications. CONCLUSIONS Since spontaneous resolution is rare and progressive disability the rule, early definitive surgical treatment of HS is advisable.
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Affiliation(s)
- T J Brown
- Department of Dermatology, Baylor College of Medicine, and the Veterans Administration Medical Center, Houston, Tex 77030, USA
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Abstract
In 2 cases of cutaneous chromomycosis, potassium hydroxide preparations of lesional crust/scale easily revealed characteristic Medlar bodies. However, in both instances mycelia were also demonstrated. This contradicts the prevailing belief that concomitant spores and mycelia are found only in cerebral chromomycosis.
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Affiliation(s)
- M W Lee
- Department of Dermatology, Baylor College of Medicine, Houston, TX 77030, USA
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Medina JC, Shan B, Beckmann H, Farrell RP, Clark DL, Learned RM, Roche D, Li A, Baichwal V, Case C, Baeuerle PA, Rosen T, Jaen JC. Novel antineoplastic agents with efficacy against multidrug resistant tumor cells. Bioorg Med Chem Lett 1998; 8:2653-6. [PMID: 9873597 DOI: 10.1016/s0960-894x(98)00477-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A novel series of pentafluorobenzenesulfonamides has been shown to inhibit the growth of a variety of human tumor cell lines. Among the cell types against which these agents were evaluated were the multidrug resistant (MDR) cell lines MCF-7/ADR and P388/ADR. The cytotoxic activity of members of this series of compounds was not affected by the multidrug resistant pump in MCF-7/ADR or P388/ADR cells.
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Affiliation(s)
- J C Medina
- Tularik Inc., South San Francisco, CA 94080, USA
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Rosen T, Krikun G, Ma Y, Wang EY, Lockwood CJ, Guller S. Chronic antagonism of nuclear factor-kappaB activity in cytotrophoblasts by dexamethasone: a potential mechanism for antiinflammatory action of glucocorticoids in human placenta. J Clin Endocrinol Metab 1998; 83:3647-52. [PMID: 9768679 DOI: 10.1210/jcem.83.10.5151] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Circulating glucocorticoids are present in increasing quantities as human gestation progresses, peaking during labor whether it occurs before or at term. Although the precise role of glucocorticoids in pregnancy is not well defined, it is clear that glucocorticoids suppress inflammation in many cell types by antagonizing the acute stimulatory actions of members of the Rel/nuclear factor-kappaB (NF-kappaB) family on cytokine gene expression. In the present study we tested the hypothesis that during pregnancy, glucocorticoids chronically suppress inflammation in the human placenta. Cytotrophoblasts obtained from human term placentas were maintained for 48 h in culture medium supplemented with 10% charcoal-stripped calf serum with and without 100 nmol/L dexamethasone (DEX). Enzyme-linked immunosorbent assay studies revealed that cytotrophoblasts constitutively express interleukin-8 (IL-8), a known mediator of placental inflammation, between 24-96 h of culture. A 48-h treatment of cytotrophoblasts with 100 nmol/L DEX significantly reduced the production of IL-8 to 24+/-1% of control levels (P < 0.01). DEX and cortisol mediated a dose-dependent inhibition of IL-8 expression, with ED50 values of 5 and 50 nmol/L, respectively. DEX treatment also significantly reduced levels of IL-6 and tumor necrosis factor-alpha in culture medium, suggesting that glucocorticoids coordinately reduce cytokine levels in cytotrophoblasts. As cytokine expression is regulated by NF-kappaB and activator protein-1 (AP-1) transcription factors, electrophoretic mobility shift assays (n = 4) were used to determine whether DEX treatment altered the binding of nuclear proteins from cytotrophoblasts to labeled oligonucleotides corresponding to the kappaB and AP-1 response elements. We observed that a 48-h treatment of cytotrophoblasts with 100 nmol/L DEX markedly reduced binding of nuclear extracts from cytotrophoblasts to the kappaB response element. DEX treatment promoted a relatively smaller reduction of binding to the AP-1 response element. Northern blotting experiments revealed that DEX treatment did not alter the level of IkappaB, p50, or p65 messenger ribonucleic acid, suggesting that the antiinflammatory action of glucocorticoid in cytotrophoblasts did not directly involve alterations in the level of NF-kappaB proteins. Our results demonstrate a novel chronic suppressive action of glucocorticoid on cytokine production and nuclear binding of NF-kappaB and AP-1 proteins in cytotrophoblasts, providing a potential mechanism through which glucocorticoids may suppress inflammation at maternal-fetal interfaces across gestation.
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Affiliation(s)
- T Rosen
- Department of Obstetrics and Gynecology, New York University Medical Center, New York 10016, USA
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Abstract
Ulcerations may appear on the genitalia in a variety of both infectious and noninfectious conditions. The vast diversity of etiologies, coupled with the often overlapping morphological features, make the diagnosis of genital ulcerations a challenging endeavor. This article highlights the most important clinical manifestations and laboratory findings which aid in the proper diagnosis of genital ulcerations.
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Affiliation(s)
- T Rosen
- Department of Dermatology, Baylor College of Medicine, Houston, Texas.
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Abstract
Sexually transmitted diseases remain a prevalent problem in the United States and throughout the world, despite efforts in prevention and education. This review highlights the cutaneous manifestations of the following sexually transmitted diseases: syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, genital herpes, genital warts, scabies, and pediculosis pubis. Emphasis is placed on the clinical findings, diagnostic methodology, and recommended treatment for each disease.
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Affiliation(s)
- T Rosen
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
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