Prevention of entry of avian influenza and paramyxoviruses into an ornithological collection.
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Animals↗
Biomedical subjects
D Burrows
Publications and source records attributed to D Burrows.
Contact hypersensitivity in patients with orofacial granulomatosis.
BACKGROUND: Orofacial granulomatosis is a clinical entity presenting with chronic swelling of the oral or facial tissues in association with histological evidence of noncaseating granulomatous inflammation. Its cause remains unclear, but a possible role of contact sensitivity to dietary components has been proposed. OBJECTIVES: This study was performed to document the prevalence of contact sensitivity to food additives in patients with orofacial granulomatosis and assess the role of elimination diets in management. METHODS: Successive patients with a clinical diagnosis of orofacial granulomatosis were patch tested to the European Standard series and an Oral Battery containing common food additives. In addition, testing for immediate contact reactions to components of the Oral Battery was performed. In selected cases, appropriate elimination diets were implemented. RESULTS: Forty-eight patients were investigated. Ten showed positive reactions to components of the Oral Battery on standard patch testing and, of these, seven showed improvement on an elimination diet. CONCLUSIONS: Orofacial granulomatosis is a heterogenous clinical entity. Patch testing permits identification of a subgroup of patients likely to benefit from dietary manipulation and allows more appropriate targeting of such treatment.
Dermatitis, Allergic Contact↗
Evaluation of community radio as a medium for health messages.
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Evaluation Studies as Topic↗
Primary cutaneous adenoid cystic carcinoma.
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Aged↗
Long-lasting allergic patch test reactions to nickel sulfate: analysis by nickel quantification and immunocytochemistry.
We previously showed the median duration of positive patch test reactions to nickel sulfate (5% pet.) was 9 days, and defined as long-lasting (LLAPTR) the 14.3% of reactions that persisted for 17 days or longer. The pathomechanisms of LLAPTR are unclear, but may involve either localized antigen persistence or abnormal downregulation of the cellular immune response. In this study, we compared (a) the nickel concentration and (b) the immunocytochemical nature of the local immune reaction, between biopsies from LLAPTR (n = 8) and normally resolving allergic patch test reactions (NRAPTR) (n = 8) to nickel sulfate. The concentration of nickel in LLAPTR (median 0.56 microgram/g, range 0.25-3.87 micrograms/g, mean 0.83 microgram/g, 95% CI 0.35-1.31) and NRAPTR (median 0.58 microgram/g, range 0.2-1.85 micrograms/g, mean 0.88 microgram/g, 95% CI 0.02-1.74) was similar. Activated T lymphocytes, expressing surface IL-2 receptor, HLA DR, DR alpha 1, DP, DQ, and CD2 > CD8 > CD4 antigens, were seen throughout the dermis and occasionally infiltrating the suprabasal layer of the epidermis in all biopsies. CD1 and HLA DR, DR alpha 1, DP, and DQ-expressing Langerhans cells were present throughout the epidermis and occasionally seen in the papillary dermis. HLA DR, DR alpha 1, DP, and DQ antigen expression were also seen on the surface of non-dendritic cells in the epidermis (probably either keratinocytes or T lymphocytes) and vascular endothelial cells in the papillary dermis. There were no significant qualitative or quantitative differences in the immunocytochemical nature of the localized immune reaction between LLAPTR and NRAPTR. These findings suggest that the pathomechanism of LLAPTR to nickel sulfate is unlikely to be explained simply on the basis of nickel concentration or the nature of the localized immune reaction at the patch test site.
Adult↗
Day 4 is better than day 3 for a single patch test reading.
Readings were performed on day (D) 2, D3 and D4 after application of patch tests in 88 patients. 90 patch test reactions in 49 patients were interpreted as allergic and of past or present relevance. A single D2 reading detected 58 of the allergic reactions with 32 false-negatives and 23 false-positives. A single D3 reading detected 77 allergic reactions, with 13 false-negatives and 17 false-positives. A single D4 reading detected 85 allergic reactions, with 5 false-negatives and 9 false-positives. Therefore, if only a single reading is feasible, it is better performed on D4 than on D3.
Allergens↗
Corticosteroid contact allergy: an EECDRG multicentre study.
This article describes the results of an EECDRG multicentre study on contact allergy to corticosteroids. A total of 7238 patients were investigated: 6238 in 13 centres in the course of 1993, and 1000 patients in 1 centre in 1993 and 1994. The 5 corticosteroids tested were budesonide 0.1% pet., betamethasone-17-valerate 1% pet., clobetasol-17-propionate 1% pet., hydrocortisone-17-butyrate 1% eth., and tixocortol-21-pivalate 1% pet.; 189 (2.6%) gave a positive patchtest reaction (+, ++, + + +) to at least 1 of the corticosteroids. The data regarding the corticosteroid-sensitive patients, as well as the patchtest results, were recorded on a standardized form.
Administration, Topical↗
Dermatological presentation of disease associated with antineutrophil cytoplasmic antibodies: a report of two contrasting cases and a review of the literature.
Antineutrophil cytoplasmic antibody (ANCA)-associated disease (AAD) constitutes a pathological disease spectrum of a necrotizing vasculitis of small- and medium-sized vessels, extravascular granuloma formation, and necrotizing and crescentic glomerulonephritis, and also a clinical disease continuum which ranges from renal-limited disease to a widespread systemic vasculitis, including Wegener's granulomatosis and microscopic polyangiitis. In the latter, circulating ANCA are an aid to diagnosis and also may play a pathogenic part. Two contrasting patients with AAD are described, both of whom presented primary with dermatological features. These included a cutaneous purpuric vasculitis, orogenital ulceration, infarction of the fingertip, and pyoderma gangrenosum-like ulceration. These cases will familiarize dermatologists with both the concept and dermatological features of AAD.
Antibodies, Antineutrophil Cytoplasmic↗
Nickel-containing alloys and platings and their ability to cause dermatitis.
A broad range of nickel-containing alloys and coatings used in jewellery, watches and clothes, were patch tested in 100 nickel-sensitive subjects and in 20 nickel-negative controls. Three non-plated stainless-steel alloys tested caused no patch-test reaction. Nickel interliners under gold, silver or chromium plating, as well as nickel-silver and some white-gold alloys, caused positive patch-test reactions. Ear ornaments, wristwatches and buttons were the objects most frequently causing dermatitis. Half the nickel-sensitive participants suspected that they had been sensitized before the age of 20. The results of the study have been used as the basis for developing clinically relevant analytical methods for nickel release. The methods are proposed as European Standards and will be used in the Nickel Directive, an EC regulation aiming at the prevention of nickel allergy.
Adolescent↗
Fragrance contact dermatitis: a worldwide multicenter investigation (Part I).
OBJECTIVE: The aim of this study was to determine the prevalence of responses to selected fragrance materials in patients with suspect fragrance allergy and to evaluate risk factors and associations with such responses. The validity of using specific fragrance ingredients versus a mixture of fragrances was evaluated in terms of predicting allergy to different fragrance ingredients. METHODS: One hundred sixty-seven subjects were evaluated in seven centers worldwide with a fragrance mix, the eight ingredients in the fragrance mixture, six other well-known fragrance allergens, balsam of Peru, and 15 lesser studied fragrance materials. RESULTS: The age of the patients was 44.9 +/- 17.5 years (mean +/- SD). More than 85% were women. A relatively high proportion gave a past history of atopic disease. Facial eruptions (40%) and hand involvement (26.7%) were the most common topographic sites. All but 4 of the 35 fragrance materials produced a positive response in > 1%. A reaction to fragrance mix occurred in 47.3%. Seven of the 34 ingredients tested produced an allergic response in more than 10% of those tested. Men were more likely than women to exhibit a positive response to five fragrance ingredients. White persons were more likely to react to perfume mix (52.8% versus 25.3%) and certain ingredients in the mix than Asian persons. Allergy to benzyl salicylate was more common in Japan than in Europe or the United States. CONCLUSION: The age at which patients with perfume allergy present for evaluation is similar to that of other contactants. Atopic individuals may be overrepresented in this group of patients. Face involvement is likely. White persons are more likely to react to fragrance mix, whereas in Asian patients benzyl salicylate was a more frequent allergen. Fragrance mix corrected with 85.6% of positive responses to fragrance ingredients. The addition of ylang ylang oil, narcissus oil, and sandalwood oil to fragrance mix would be expected to pick up 94.2% with positive responses to fragrance materials; adding balsam of Peru increases this to 96%.
Adult↗
Multiple dermatofibromas in a patient with HIV infection.
We report the case of a 26-year-old man with haemophilia B and human immunodeficiency virus infection (HIV) who presented with a short history of multiple dermatofibromas. He also had troublesome psoriasis for which he was receiving acitretin with UVB therapy and had recently discontinued low-dose daily prednisolone for associated arthropathy. Multiple dermatofibromas are rare and have been reported previously in association with autoimmune disease, especially in individuals receiving immunosuppressive therapy. We believe this to be the first report of multiple dermatofibromas in an individual with advanced HIV infection and propose that it may be related to his viral-mediated immunodeficiency, possibly augmented by UVB and systemic corticosteroid therapy.
Acitretin↗
Testing with fragrance mix. Is the addition of sorbitan sesquioleate to the constituents useful?
In a multicentre study, the value of adding sorbitan sesquioleate (SSO) to the constituents of the 8% fragrance mix (FM) was investigated. In 7 centres, 709 consecutive patients were tested with 2 types of FM from different sources, its 8 constituents with 1% SSO, its 8 constituents without SSO, and 20% SSO. 5 patients (0.71%) reacted to the emulsifier SSO itself, read as definitely allergic on day 3/4. 53 patients reacted to either one of the mixes with an allergic type of reaction. When tested with the constituents without SSO, 41.5% showed an allergic reaction versus 54.7% with SSO. If both types of reactions were considered (allergic and irritant) 38.3% of 73 patients showed a positive "breakdown" result without SSO, versus 54.8% with SSO. The differences were statistically significant. Reactivity to FM constituents was changed in a specific pattern by addition of SSO--irritant reactions increased, particularly for cinnamic alcohol, eugenol, geraniol, oak moss and hydroxycitronellal, whereas others showed only a slight change. Allergic reactions were also increased by SSO, but the rank order of the top 3 sensitizers (isoeugenol, oak moss and eugenol) did not change. Cinnamic alcohol was the only constituent with decreased reactivity after addition of SSO. A positive history of fragrance sensitivity (HFS) was clearly associated with a positive allergic reaction to either the mix or 1 of its constituents (51% versus 28.6% with a negative HFS). Irritant reactions were linked to a negative HFS in a high proportion (64.3%).(ABSTRACT TRUNCATED AT 250 WORDS)
Allergens↗
Contact allergy to gold sodium thiosulfate.
278 consecutive patients with suspected contact dermatitis were patch tested with the European standard series and gold sodium thiosulfate (0.5% pet.): 13 patients (4.6%) had a positive allergic response to gold sodium thiosulfate (GST). All of these patients were female, with a mean age of 37 years. The most frequent site of eczema in these patients was the head and neck (62%). A seborrhoeic distribution of eczema was common. 46% had involvement of the limbs, 15% had a perianal or perivulval rash. The mean duration of eczema in this group of patients was 15.8 months. 54% of patients allergic to gold were also allergic to nickel. Biopsy of positive patch test reactions to GST were consistent with allergic contact dermatitis.
Adult↗
Patch testing with fragrances: results of a multicenter study of the European Environmental and Contact Dermatitis Research Group with 48 frequently used constituents of perfumes.
The objective of this study was to determine the frequency of reactivity to a series of commonly used fragrances in dermatological patients. A total of 48 fragrances (FF) were chosen, based on the publication of Fenn in 1989 in which the top 25 constituents of 3 types (1. perfumes, 2. household products, 3. soaps) of 400 commercial products on the US market had been determined. In a pilot study on a total of 1069 patients in 11 centres, the appropriate test concentration and vehicle were examined. For most fragrances, 1% and 5% were chosen, and petrolatum proved to be the best vehicle in comparison to isopropyl myristate and diethyl phthalate. In the main study, a set of 5 to 10 fragrances at 2 concentrations was patch tested in each centre on a minimum of 100 consecutive patients seen in the patch test clinic. These patients were also patch tested to a standard series with the 8% fragrance mix (FM) and its 8 constituents. In patients with a positive reaction to any of the 48 FF, a careful history with regard to past or present reactions to perfumed products was taken. A total of 1323 patients were tested in 11 centres. The 8% FM was positive in 89 patients (8.3% of 1072 patients). Allergic reactions to the constituents were most frequent to oak moss (24), isoeugenol (20), eugenol (13), cinnamic aldehyde (10) and geraniol (8). Reactions read as allergic on day 3/4 were observed only 10X to 7 materials of the new series (Iso E Super (2), Lyral (3), Cyclacet (1), DMBCA (1), Vertofix (1), citronellol (1) and amyl salicylate (1)). The remaining 41 fragrances were negative. 28 irritant or doubtful reactions on day 3/4 were observed to a total of 19 FF materials (more than 1 reaction: 5% citronellol (2), 1% amyl salicylate (2), 1% isononyl acetate (3), 0.1% musk xylol (2), 1% citral (2), and 1% ionone beta (2)). Clinical relevance of positive reactions to any of the FF series was not proved in a single case. This included the 4 reactions in patients who were negative to the 8% FM. In conclusion, the top 25 fragrances commonly found in various products caused few reactions in dermatological patients and these few appeared to be clinically irrelevant, with the possible exception of Lyral. However, this data should be interpreted in the light of the relatively small number of patients tested (only 100 in most centres).
Acrolein↗
Spread the word and reach a wider audience. Writing for publication.
1. The advancement of nursing depends on sharing ideas through submitting articles for publication. 2. Nurses are often reluctant to write up their ideas for publication. 3. A review of the literature is essential in understanding the principles of writing for publication. 4. A system of peer review should be developed in the workplace to encourage and support nurses in the publication process.
Diffusion of Innovation↗
The influence of the probability of survival on patients' preferences regarding cardiopulmonary resuscitation.
BACKGROUND: Studies suggest that a majority of elderly patients would want to undergo cardiopulmonary resuscitation (CPR) if they had a cardiac arrest. Yet few studies have examined their preferences after clinicians have informed them about the outcomes of CPR. METHODS: To study older patients' preferences regarding CPR, we interviewed as many ambulatory patients as possible in one geriatrics practice in Denver from August 1, 1991, through July 31, 1992. RESULTS: A total of 371 patients at least 60 years of age were eligible; 287 completed the interview (mean age, 77 years; range, 60 to 99). When asked about their wishes if they had cardiac arrest during an acute illness, 41 percent opted for CPR before learning the probability of survival to discharge. After learning the probability of survival (10 to 17 percent), 22 percent opted for CPR. Only 6 percent of patients 86 years of age or older opted for CPR under these conditions. When asked about a chronic illness in which the life expectancy was less than one year, 11 percent of the 287 patients opted for CPR before learning the probability of survival to discharge. After learning the probability of survival (0 to 5 percent), 5 percent said they would want CPR. CONCLUSIONS: Older patients readily understand prognostic information, which influences their preferences with respect to CPR. Most do not want to undergo CPR once a clinician explains the probability of survival after the procedure.
Advance Directives↗
Hypercalciuria and topical calcipotriol therapy.
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Calcitriol↗