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Puls B, Ding Y, Zhang F, Pan M, Lei Z, Pei Z, Jiang M, Bai Y, Forsyth C, Metzger M, Rana T, Zhang L, Ding X, Keefe M, Cai A, Redilla A, Lai M, He K, Li H, Chen G. Regeneration of Functional Neurons After Spinal Cord Injury via in situ NeuroD1-Mediated Astrocyte-to-Neuron Conversion. Front Cell Dev Biol 2020; 8:591883. [PMID: 33425896 PMCID: PMC7793709 DOI: 10.3389/fcell.2020.591883] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/25/2020] [Indexed: 01/06/2023] Open
Abstract
Spinal cord injury (SCI) often leads to impaired motor and sensory functions, partially because the injury-induced neuronal loss cannot be easily replenished through endogenous mechanisms. In vivo neuronal reprogramming has emerged as a novel technology to regenerate neurons from endogenous glial cells by forced expression of neurogenic transcription factors. We have previously demonstrated successful astrocyte-to-neuron conversion in mouse brains with injury or Alzheimer's disease by overexpressing a single neural transcription factor NeuroD1. Here we demonstrate regeneration of spinal cord neurons from reactive astrocytes after SCI through AAV NeuroD1-based gene therapy. We find that NeuroD1 converts reactive astrocytes into neurons in the dorsal horn of stab-injured spinal cord with high efficiency (~95%). Interestingly, NeuroD1-converted neurons in the dorsal horn mostly acquire glutamatergic neuronal subtype, expressing spinal cord-specific markers such as Tlx3 but not brain-specific markers such as Tbr1, suggesting that the astrocytic lineage and local microenvironment affect the cell fate after conversion. Electrophysiological recordings show that the NeuroD1-converted neurons can functionally mature and integrate into local spinal cord circuitry by displaying repetitive action potentials and spontaneous synaptic responses. We further show that NeuroD1-mediated neuronal conversion can occur in the contusive SCI model with a long delay after injury, allowing future studies to further evaluate this in vivo reprogramming technology for functional recovery after SCI. In conclusion, this study may suggest a paradigm shift from classical axonal regeneration to neuronal regeneration for spinal cord repair, using in vivo astrocyte-to-neuron conversion technology to regenerate functional new neurons in the gray matter.
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Affiliation(s)
- Brendan Puls
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Yan Ding
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Fengyu Zhang
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Mengjie Pan
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Zhuofan Lei
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Zifei Pei
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Mei Jiang
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Yuting Bai
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Cody Forsyth
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Morgan Metzger
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Tanvi Rana
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Lei Zhang
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Xiaoyun Ding
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Matthew Keefe
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Alice Cai
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Austin Redilla
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Michael Lai
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Kevin He
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Hedong Li
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Gong Chen
- Department of Biology, Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, United States
- Guangdong-Hong Kong-Macau Institute of CNS Regeneration, Jinan University, Guangzhou, China
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Xiao C, Polymeropoulos C, Brzezynski J, Prokosch L, Keefe M, Mohrman M, Birznieks G, Polymeropoulos M. Tasimelteon demonstrates efficacy to treat jet lag disorder in an 8 hour phase advance clinical study. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1175] [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: 10/25/2022]
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Kanungo R, Sanetullaev A, Tanaka J, Ishimoto S, Hagen G, Myo T, Suzuki T, Andreoiu C, Bender P, Chen AA, Davids B, Fallis J, Fortin JP, Galinski N, Gallant AT, Garrett PE, Hackman G, Hadinia B, Jansen G, Keefe M, Krücken R, Lighthall J, McNeice E, Miller D, Otsuka T, Purcell J, Randhawa JS, Roger T, Rojas A, Savajols H, Shotter A, Tanihata I, Thompson IJ, Unsworth C, Voss P, Wang Z. Evidence of soft dipole resonance in ^{11}li with isoscalar character. Phys Rev Lett 2015; 114:192502. [PMID: 26024166 DOI: 10.1103/physrevlett.114.192502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Indexed: 06/04/2023]
Abstract
The first conclusive evidence of a dipole resonance in ^{11}Li having isoscalar character observed from inelastic scattering with a novel solid deuteron target is reported. The experiment was performed at the newly commissioned IRIS facility at TRIUMF. The results show a resonance peak at an excitation energy of 1.03±0.03 MeV with a width of 0.51±0.11 MeV (FWHM). The angular distribution is consistent with a dipole excitation in the distorted-wave Born approximation framework. The observed resonance energy together with shell model calculations show the first signature that the monopole tensor interaction is important in ^{11}Li. The first ab initio calculations in the coupled cluster framework are also presented.
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Affiliation(s)
- R Kanungo
- Astronomy and Physics Department, Saint Mary's University, Halifax, Nova Scotia B3H 3C3, Canada
| | - A Sanetullaev
- Astronomy and Physics Department, Saint Mary's University, Halifax, Nova Scotia B3H 3C3, Canada
- TRIUMF, Vancouver, British Columbia V6T2A3, Canada
| | - J Tanaka
- RCNP, Osaka University, Mihogaoka, Ibaraki, Osaka 567 0047, Japan
| | - S Ishimoto
- High Energy Accelerator Research Organization (KEK), Ibaraki 305-0801, Japan
| | - G Hagen
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - T Myo
- General Education, Faculty of Engineering, Osaka Institute of Technology, Osaka, Osaka 535-8585, Japan
| | - T Suzuki
- Department of Physics, Nihon University, Setagaya-ku, Tokyo 156-8550, Japan
| | - C Andreoiu
- Department of Chemistry, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - P Bender
- TRIUMF, Vancouver, British Columbia V6T2A3, Canada
| | - A A Chen
- Department of Physics and Astronomy, McMaster University, Hamilton, Ontario L8S 4M1, Canada
| | - B Davids
- TRIUMF, Vancouver, British Columbia V6T2A3, Canada
| | - J Fallis
- TRIUMF, Vancouver, British Columbia V6T2A3, Canada
| | - J P Fortin
- Astronomy and Physics Department, Saint Mary's University, Halifax, Nova Scotia B3H 3C3, Canada
- Department of Physics, University of Laval, Quebec City, Quebec G1V 0A8, Canada
| | - N Galinski
- TRIUMF, Vancouver, British Columbia V6T2A3, Canada
| | - A T Gallant
- TRIUMF, Vancouver, British Columbia V6T2A3, Canada
| | - P E Garrett
- Department of Physics, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - G Hackman
- TRIUMF, Vancouver, British Columbia V6T2A3, Canada
| | - B Hadinia
- Department of Physics, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - G Jansen
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - M Keefe
- Astronomy and Physics Department, Saint Mary's University, Halifax, Nova Scotia B3H 3C3, Canada
| | - R Krücken
- TRIUMF, Vancouver, British Columbia V6T2A3, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - J Lighthall
- TRIUMF, Vancouver, British Columbia V6T2A3, Canada
| | - E McNeice
- Department of Physics and Astronomy, McMaster University, Hamilton, Ontario L8S 4M1, Canada
| | - D Miller
- TRIUMF, Vancouver, British Columbia V6T2A3, Canada
| | - T Otsuka
- Department of Physics and Center of Nuclear Studies, University of Tokyo, Bunky-ku, Tokyo 113-0033, Japan
| | - J Purcell
- Astronomy and Physics Department, Saint Mary's University, Halifax, Nova Scotia B3H 3C3, Canada
| | - J S Randhawa
- Astronomy and Physics Department, Saint Mary's University, Halifax, Nova Scotia B3H 3C3, Canada
| | - T Roger
- Grand Accélérateur National dIons Lourds, CEA/DSM-CNRS/IN2P3, B.P. 55027, F-14076 Caen Cedex 5, France
| | - A Rojas
- TRIUMF, Vancouver, British Columbia V6T2A3, Canada
| | - H Savajols
- Grand Accélérateur National dIons Lourds, CEA/DSM-CNRS/IN2P3, B.P. 55027, F-14076 Caen Cedex 5, France
| | - A Shotter
- School of Physics and Astronomy, University of Edinburgh, EH9 3JZ, Edinburgh, United Kingdom
| | - I Tanihata
- RCNP, Osaka University, Mihogaoka, Ibaraki, Osaka 567 0047, Japan
- School of Physics and Nuclear Energy Engineering and IRCNPC, Beihang University, Beijing 100191, China
| | - I J Thompson
- Lawrence Livermore National Laboratory, L-414, Livermore, California 94551, USA
| | - C Unsworth
- TRIUMF, Vancouver, British Columbia V6T2A3, Canada
| | - P Voss
- Department of Chemistry, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - Z Wang
- TRIUMF, Vancouver, British Columbia V6T2A3, Canada
- Department of Chemistry, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
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Wong J, Miller A, Cross N, Grundy K, Keefe M, Jardine D. Calciphylaxis: fatal arteriosclerosis of uncertain mechanism. Intern Med J 2014; 44:1040-1. [PMID: 25302725 DOI: 10.1111/imj.12562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/20/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J Wong
- Department of General Medicine, Christchurch Hospital, Christchurch, Canterbury, New Zealand
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Bewley A, Buckley C, Keefe M. Referral patterns and isotretinoin treatment of patients with acne vulgaris in a teaching hospital dermatology department over a 1-year period. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639809161378] [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: 11/13/2022]
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Saltis M, Criscitiello MF, Ohta Y, Keefe M, Trede NS, Goitsuka R, Flajnik MF. Evolutionarily conserved and divergent regions of the autoimmune regulator (Aire) gene: a comparative analysis. Immunogenetics 2008; 60:105-14. [PMID: 18214467 PMCID: PMC7039057 DOI: 10.1007/s00251-007-0268-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 12/05/2007] [Indexed: 01/06/2023]
Abstract
During T cell differentiation, medullary thymic epithelial cells (MTEC) expose developing T cells to tissue-specific antigens. MTEC expression of such self-antigens requires the transcription factor autoimmune regulator (Aire). In mammals, defects in aire result in multi-tissue, T cell-mediated autoimmunity. Because the T cell receptor repertoire is randomly generated and extremely diverse in all jawed vertebrates, it is likely that an aire-dependent T cell tolerance mechanism also exists in nonmammalian vertebrates. We have isolated aire genes from animals in all gnathostome classes except the cartilaginous fish by a combination of molecular techniques and scanning of expressed sequence tags and genomic databases. The deduced amino acid sequences of Aire were compared among mouse, human, opossum, chicken, Xenopus, zebrafish, and pufferfish. The first of two plant homeodomains (PHD) in human Aire and regions associated with nuclear and cytoplasmic localization are evolutionarily conserved, while other domains are either absent or divergent in one or more vertebrate classes. Furthermore, the second zinc-binding domain previously named Aire PHD2 appears to have greater sequence similarity with Ring finger domains than to PHD domains. Point mutations in defective human aire genes are generally found in the most evolutionarily conserved regions of the protein. These findings reveal a very rapid evolution of certain regions of aire during vertebrate evolution and support the existence of an aire-dependent mechanism of T cell tolerance dating back at least to the emergence of bony fish.
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Affiliation(s)
- Mark Saltis
- Department of Microbiology and Immunology, University of Maryland, Baltimore, MD 21201, USA
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Abstract
We present a case report of necrobiotic xanthogranuloma (NXG) in a 76-year-old Caucasian lady occurring as a nodule in a blepharoplasty scar. NXG is a rare histiocytic disease with progressive orbital and systemic features. Management options of excision biopsy or chemotherapy are discussed.
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Affiliation(s)
- S A Rayner
- Department of Ophthalmology, Southampton General Hospital, England
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Trede NS, Medenbach J, Damianov A, Hung LH, Weber GJ, Paw BH, Zhou Y, Hersey C, Zapata A, Keefe M, Barut BA, Stuart AB, Katz T, Amemiya CT, Zon LI, Bindereif A. Network of coregulated spliceosome components revealed by zebrafish mutant in recycling factor p110. Proc Natl Acad Sci U S A 2007; 104:6608-13. [PMID: 17416673 PMCID: PMC1871833 DOI: 10.1073/pnas.0701919104] [Citation(s) in RCA: 62] [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: 11/18/2022] Open
Abstract
The spliceosome cycle consists of assembly, catalysis, and recycling phases. Recycling of postspliceosomal U4 and U6 small nuclear ribonucleoproteins (snRNPs) requires p110/SART3, a general splicing factor. In this article, we report that the zebrafish earl grey (egy) mutation maps in the p110 gene and results in a phenotype characterized by thymus hypoplasia, other organ-specific defects, and death by 7 to 8 days postfertilization. U4/U6 snRNPs were disrupted in egy mutant embryos, demonstrating the importance of p110 for U4/U6 snRNP recycling in vivo. Surprisingly, expression profiling of the egy mutant revealed an extensive network of coordinately up-regulated components of the spliceosome cycle, providing a mechanism compensating for the recycling defect. Together, our data demonstrate that a mutation in a general splicing factor can lead to distinct defects in organ development and cause disease.
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Affiliation(s)
- Nikolaus S. Trede
- *Department of Pediatrics, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112
| | - Jan Medenbach
- Institute of Biochemistry, Justus-Liebig-University, D-35392 Giessen, Germany
| | - Andrey Damianov
- Institute of Biochemistry, Justus-Liebig-University, D-35392 Giessen, Germany
| | - Lee-Hsueh Hung
- Institute of Biochemistry, Justus-Liebig-University, D-35392 Giessen, Germany
| | - Gerhard J. Weber
- Howard Hughes Medical Institute, Division of Hematology/Oncology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115
| | - Barry H. Paw
- Division of Hematology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
| | - Yi Zhou
- Howard Hughes Medical Institute, Division of Hematology/Oncology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115
| | - Candace Hersey
- Howard Hughes Medical Institute, Division of Hematology/Oncology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115
| | - Agustin Zapata
- Department of Cell Biology, Faculty of Biology, Complutense University, 28040 Madrid, Spain; and
| | - Matthew Keefe
- Howard Hughes Medical Institute, Division of Hematology/Oncology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115
| | - Bruce A. Barut
- Howard Hughes Medical Institute, Division of Hematology/Oncology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115
| | - Andrew B. Stuart
- Benaroya Research Institute at Virginia Mason, Department of Biology, University of Washington, Seattle, WA 98101
| | - Tammisty Katz
- *Department of Pediatrics, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112
| | - Chris T. Amemiya
- Benaroya Research Institute at Virginia Mason, Department of Biology, University of Washington, Seattle, WA 98101
| | - Leonard I. Zon
- Howard Hughes Medical Institute, Division of Hematology/Oncology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115
- **To whom correspondence may be addressed at:
Howard Hughes Medical Institute, Department of Hematology/Oncology, Children's Hospital, Harvard Medical School, Karp Family Research Laboratories, 300 Longwood Avenue, Boston, MA 02115. E-mail:
| | - Albrecht Bindereif
- Institute of Biochemistry, Justus-Liebig-University, D-35392 Giessen, Germany
- To whom correspondence may be addressed at:
Institute of Biochemistry, Justus-Liebig-University, Heinrich-Buff-Ring 58, D-35392 Giessen, Germany. E-mail:
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Alam NA, Rowan AJ, Wortham NC, Pollard PJ, Mitchell M, Tyrer JP, Barclay E, Calonje E, Manek S, Adams SJ, Bowers PW, Burrows NP, Charles-Holmes R, Cook LJ, Daly BM, Ford GP, Fuller LC, Hadfield-Jones SE, Hardwick N, Highet AS, Keefe M, MacDonald-Hull SP, Potts EDA, Crone M, Wilkinson S, Camacho-Martinez F, Jablonska S, Ratnavel R, MacDonald A, Mann RJ, Grice K, Guillet G, Lewis-Jones MS, McGrath H, Seukeran DC, Morrison PJ, Fleming S, Rahman S, Kelsell D, Leigh I, Olpin S, Tomlinson IPM. Genetic and functional analyses of FH mutations in multiple cutaneous and uterine leiomyomatosis, hereditary leiomyomatosis and renal cancer, and fumarate hydratase deficiency. Hum Mol Genet 2003; 12:1241-52. [PMID: 12761039 DOI: 10.1093/hmg/ddg148] [Citation(s) in RCA: 246] [Impact Index Per Article: 11.7] [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: 11/14/2022] Open
Abstract
Germline mutations of the fumarate hydratase (FH, fumarase) gene are found in the recessive FH deficiency syndrome and in dominantly inherited susceptibility to multiple cutaneous and uterine leiomyomatosis (MCUL). We have previously reported a number of germline FH mutations from MCUL patients. In this study, we report additional FH mutations in MCUL and FH deficiency patients. Mutations can readily be found in about 75% of MCUL cases and most cases of FH deficiency. Some of the more common FH mutations are probably derived from founding individuals. Protein-truncating FH mutations are functionally null alleles. Disease-associated missense FH changes map to highly conserved residues, mostly in or around the enzyme's active site or activation site; we predict that these mutations severely compromise enzyme function. The mutation spectra in FH deficiency and MCUL are similar, although in the latter mutations tend to occur earlier in the gene and, perhaps, are more likely to result in a truncated or absent protein. We have found that not all mutation-carrier parents of FH deficiency children have a strong predisposition to leiomyomata. We have confirmed that renal carcinoma is sometimes part of MCUL, as part of the variant hereditary leiomyomatosis and renal cancer (HLRCC) syndrome, and have shown that these cancers may have either type II papillary or collecting duct morphology. We have found no association between the type or site of FH mutation and any aspect of the MCUL phenotype. Biochemical assay for reduced FH functional activity in the germline of MCUL patients can indicate carriers of FH mutations with high sensitivity and specificity, and can detect reduced FH activity in some patients without detectable FH mutations. We conclude that MCUL is probably a genetically homogeneous tumour predisposition syndrome, primarily resulting from absent or severely reduced fumarase activity, with currently unknown functional consequences for the smooth muscle or kidney cell.
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Affiliation(s)
- N A Alam
- Molecular and Population Genetics Laboratory, Cancer Research UK, Lincoln's Inn Fields, London WC2A 3PX, UK
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Affiliation(s)
- Roy A Palmer
- Department of Dermatology, Southampton University Hospitals Trust, Southampton SO14 0YG, UK.
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Bhushan M, Bleiker TO, Ballsdon AE, Allen MH, Sopwith M, Robinson MK, Clarke C, Weller RPJB, Graham-Brown RAC, Keefe M, Barker JNWN, Griffiths CEM. Anti-E-selectin is ineffective in the treatment of psoriasis: a randomized trial. Br J Dermatol 2002; 146:824-31. [PMID: 12000379 DOI: 10.1046/j.1365-2133.2002.04743.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Skin-homing, memory T lymphocytes play an important role in the pathogenesis of psoriasis by interacting with the vascular addressin, E-selectin and trafficking into lesional skin. Thus an attractive option for targeted therapy of the disease would be blockade of skin-homing T cells with an antibody directed at E-selectin. OBJECTIVE We performed a multicentre, randomized, placebo-controlled trial to investigate the clinical efficacy and side-effect profile of a humanized monoclonal antibody to E-selectin, CDP850, in the treatment of moderate to severe chronic plaque psoriasis. METHODS Patients with moderate/severe chronic plaque psoriasis were selected for study. Nine male subjects (mean age 37 years, range 25-47) were given 20 mg kg-1 CDP850 intravenously as a single dose and four subjects (three males, one female; mean age 40 years, range 23-50) received placebo infusion. Clinical response to treatment was assessed using the psoriasis area and severity index (PASI). Skin biopsies were taken for immunohistochemical analysis at the baseline, pretreatment, visit and also at day 2 and weeks 1 and 4 postinfusion. RESULTS The treatment was well-tolerated with a minimal side-effect profile. Plasma E-selectin levels were significantly decreased in those subjects who received CDP850 compared with those who had placebo for the entire study period. At the end of study (8 weeks postinfusion), there was no significant reduction in PASI from baseline for either the CDP850 or placebo-treated groups. Immunohistochemical analysis of biopsies taken from lesional psoriatic skin showed that 2 days after dosing with CDP850, staining for E-selectin was decreased, although not absent, on dermal vascular endothelial cells when compared with baseline (P < 0.01). This decrease in E-selectin expression was maintained 4 weeks after infusion (P < 0.05). It was not, however, accompanied by a significant reduction in numbers of neutrophils or lymphocytes in the dermis. There was a statistically significant increase in CD1a-positive epidermal Langerhans cells compared with pre-dose levels at week 1 (P < 0.05). CONCLUSIONS This clinicopathological study shows that anti-E-selectin (CDP850), although a well-tolerated, logical and safe therapy, does not appear to possess a therapeutic role in the treatment of chronic plaque psoriasis.
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Affiliation(s)
- M Bhushan
- The Dermatology Centre, Irving Building, University of Manchester, Hope Hospital, Salford, Manchester M6 8HD, UK
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Abstract
A 9-year-old girl developed hidradenitis suppurativa 3 months after the first signs of adrenarche. Such a close temporal relationship is consistent with the hypothesis that the disease is androgen dependent. Less than 2% of patients have onset of the disease before the age of 11 years. The exceptionally early age of onset in our patient may be partly explained by the fact that she had an early puberty.
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Affiliation(s)
- R A Palmer
- Department of Dermatology, Royal South Hants Hospital, Southampton, UK.
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Abstract
OBJECTIVE To examine the effect of application of activated autologous macrophages and basic fibroblast growth factor (FGF) on random skin flap survival in swine. DESIGN A randomized nonblinded controlled trial. According to a standard design, six dorsally based, random-pattern skin flaps were raised in each of 12 Yorkshire pigs. METHODS Twenty-five milliliters of blood is harvested from each animal 20 to 24 hours prior to flap creation. Monocytes are isolated, placed in culture medium, and then activated by the addition of platelet-derived growth factor (PDGF) and tissue growth factor beta (TGF-alpha). Following an 18-hour incubation period, the monocytes are decanted and quantified, and their viability confirmed. These cells are then infused into the wound bed of the treatment flaps immediately following flap creation, and FGF is added prior to flap closure. The position of treatment and control flaps is systematically varied with regard to anterior-to-posterior and side-to-side flap positions within each animal. The area of superficial flap necrosis is evaluated on postoperative day 7, digitally scanned, and analyzed using graphics software. Control flaps are elevated similarly, but receive no placebo treatment. RESULTS Two-way analysis of variance (ANOVA) demonstrated nonsignificant differences between pig side and anterior, middle, and posterior flap positions within treatment and control flap groups. Using side and position pooled data, a one-way ANOVA showed no statistically significant differences between treatment and control flaps. CONCLUSIONS The cellular and biochemical events following creation of a surgical wound are complex and incompletely understood. Our attempt to augment the natural role of the macrophage in wound healing by employing cytokines to activate these cells and to accelerate their arrival by implanting them into the wound bed failed to enhance flap survival. Further study is warranted to ascertain the details of wound healing, particularly with respect to cytokine concentrations and the timing of their roles, if we are to find a clinically applicable means of enhancing flap survival.
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Affiliation(s)
- K K Bach
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, San Diego, California 92134-5000, USA
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Abstract
A sister (aged 6 years) and brother (aged 8 years) presented four months apart with severe molluscum contagiosum. Both children demonstrated clinical and laboratory evidence of combined immunodeficiency. The extent of skin involvement by molluscum contagiosum precluded conventional treatment as well as intralesional interferon alpha (IFN alpha). Both subjects responded well to subcutaneous IFN alpha.
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Affiliation(s)
- J Hourihane
- University of Southampton, University Hospitals NHS Trust, UK
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Abstract
Erythropoietic protoporphyria is an uncommon disorder which causes a photosensitive cutaneous reaction, and occasionally hepatic dysfunction in affected individuals. We report a patient with erythropoietic protoporphyria who improved symptomatically during her two pregnancies. In the latter pregnancy, quantitative levels of plasma and erythrocyte protoporphyrins were reduced by more than half during the pregnancy compared with the levels before pregnancy and during lactation.
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Affiliation(s)
- A P Bewley
- Department of Dermatology, Royal South Hants Hospital, Southampton, U.K
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23
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Froese-Fretz A, Keefe M. The irritable infant. A model for helping families cope. Adv Nurse Pract 1997; 5:63-6. [PMID: 9459870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- A Froese-Fretz
- Fussy Baby Clinic, Day Surgery Center, Children's Hospital, Denver, USA
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24
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Bewley AP, Keefe M. Successful treatment of pemphigus vulgaris by pulsed intravenous immunoglobulin therapy. Br J Dermatol 1996; 135:128-9. [PMID: 8776376] [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: 02/02/2023]
Abstract
We report the successful treatment of a 36-year-old man with recalcitrant pemphigus vulgaris by pulsed intravenous immunoglobulin therapy, dexamethasone and cyclophosphamide. In addition to clinical resolution, indirect immunofluorescence antibodies have since largely been undetectable.
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Affiliation(s)
- A P Bewley
- Department of Dermatology, Southampton University Hospitals NHS Trust, Royal South Hants Hospital, U.K
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25
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Keefe M. Skin Disease in Childhood and Adolescence. West J Med 1996. [DOI: 10.1136/bmj.312.7043.1429] [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: 11/03/2022]
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26
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27
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Abstract
To investigate whether the high frequency of human papillomavirus infection in butchers may be linked to their higher than average incidence of lung cancer, we have examined lung cancers from 40 butchers and 26 controls for the presence of DNA from both HPV type 7, which is found almost uniquely in hand warts from butchers and fishermen, and for those HPV types associated with laryngeal and genital cancers. No HPV 7, and only a low frequency of HPV DNA was found, suggesting that HPV infection does not make an important contribution to the elevated levels of lung cancer in meat handlers. In addition, the frequency of p53 mutation was shown to be slightly lower than previously reported in lung cancers.
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Affiliation(s)
- A A al-Ghamdi
- Department of Pathology and Microbiology, University of Bristol, UK
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28
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29
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Abstract
OBJECTIVE To validate self screening by patients of high mole counts, assess the within family association of sun protection behaviour and mole counts, and estimate prevalence of risk factors for melanoma. SETTING AND SUBJECTS Systematic sample of families from a single affluent general practice population in Wessex. DESIGN Subjects completed a questionnaire about risk factors for melanoma and counted their moles. Subsequently a mole count was done by a general practitioner trained at dermatology clinics. MAIN OUTCOME MEASURES Validation of self counts by observer's count. Within family association of sun protection behaviour and mole counts; self reported risk factors. RESULTS 199/237 subjects (84%) returned the questionnaire; 212/237 (89%) were examined. High counts by patients on the front of the trunk (> 7 moles of > or = 2 mm) were reasonably sensitive (79%), predictive (75%), and specific (97%) of the observer's mole counts (kappa = 0.74), unlike arm or total body counts. Sun protection behaviour correlated between individuals and other family members (Spearman's coefficient r = 0.50, P < 0.01). In the past three months 15/114 adults (13.2%, 95% confidence interval 7.0% to 19.4%) reported any change in a mole and 6/114 (5.3%, 2.0% to 11.1%) "major" changes; 6/109 adults (5.5%, 2.1% to 11.6%) had both high mole counts and freckling. CONCLUSIONS Asking patients to count trunk moles could be a feasible way of identifying patients at high risk of melanoma. Concentrating on reported major changes in moles should avoid considerable workload in general practice. The generalisability of these findings and the adverse effects, net benefit in earlier diagnosis and prevention, and workload implications of such self screening need further research.
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Affiliation(s)
- P Little
- Faculty of Medicine, University of Southampton, Aldermoor Health Centre
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30
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Perkins W, Downie I, Keefe M, Chisholm M. Cutaneous necrosis in pregnancy secondary to activated protein C resistance in hereditary angioedema. J R Soc Med 1995; 88:229P-230P. [PMID: 7745572 PMCID: PMC1295172] [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: 01/26/2023] Open
Abstract
A 26-year-old woman with hereditary angineurotic oedema (HAE) presented at 22 weeks gestation with severe cutaneous necrosis similar to that seen in coumarin skin necrosis. Protein S deficiency secondary to HAE and pregnancy was postulated. Treatment with heparin, C1-inhibitor concentrates, systemic steroids and surgical debridement resulted in a successful outcome for both mother and child. Subsequent investigations revealed normal levels of protein C, antithrombin III, total protein S, free protein S but reduced function protein S activity with evidence of activated protein C resistance. Cutaneous necrosis has not been reported in associated with activated protein C resistance previously and the possible mechanisms are discussed.
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Affiliation(s)
- W Perkins
- Department of Dermatology, Royal South Hants Hospital, Southampton, UK
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31
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Abstract
The distribution of warts due to HPV7 in workers in six abattoirs and 103 retail and wholesale butcheries has been studied to determine whether the high prevalence of HPV7 in the meat trade is the result of enhanced person to person transmission, or whether it is a ubiquitous virus which is activated by an unknown factor in meat. Warts were detected in 164 of 486 men. Scrapings were taken from 156 men, and HPV DNA was found in 112 samples, 74 of which contained HPV7. HPV7 was found in 36 workplaces, and there was no evidence of clustering of cases, as would be expected if person to person transmission was occurring in the workplace. This suggests that HPV7 is widely distributed in the community, but only causes clinical disease under specific conditions. We suggest that some unknown factor in meat enhances viral replication.
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Affiliation(s)
- M Keefe
- Department of Dermatology, University of Southampton, Royal South Hants Hospital, Southampton, U.K
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32
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Abstract
Several studies have indicated a high prevalence of hand warts in meat handlers, although the reasons for this are not clear. The high prevalence may be partly due to HPV7, a virus found almost exclusively in meat handlers, but the source of HPV7 is not known. We have carried out a cross-sectional survey of hand warts in male meat workers and controls from other occupational groups, to investigate the reasons for the high prevalence of warts, and particularly of HPV7, in butchers. We studied 240 abattoir workers, 246 retail and wholesale butchers, 308 engineering fitters and 292 office workers. Each subject was interviewed using a standard questionnaire, and his hands were examined by a dermatologist. Scrapings from the warts were tested for HPV1, HPV2 and HPV7 by a polymerase chain reaction method. The prevalence of hand warts was 33.3% in the abattoir workers, 34.1% in the butchers, 19.5% in the engineers and 14.7% in the office workers. Scrapings were taken from 247 of 267 subjects with warts, and HPV DNA was detected in 151 samples. The most common viruses were HPV2 (94 men) and HPV7 (76 men). The excess of warts in meat workers was largely due to HPV7, which was found in only two of the office workers, and was not found in any of the engineers. Logistic regression analysis showed no association between the prevalence of hand warts (or HPV2 and HPV7 specifically) and hand trauma, cold and wet working conditions, smoking, atopy, or handling any particular kind of meat. We suggest that some constituent of animal flesh predisposes to replication of HPV7 in keratinized epithelium.
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Affiliation(s)
- M Keefe
- Department of Dermatology, University of Southampton, Royal South Hants Hospital, Southampton, U.K
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33
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Affiliation(s)
- M Keefe
- Department of Dermatology, Stobhill General Hospirtal, Glasgow, UK
| | - DC Dick
- Department of Dermatology, Stobhill General Hospirtal, Glasgow, UK
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Abstract
Steatocystoma multiplex is usually a minor cosmetic problem but rarely can be extremely disfiguring. Unfortunately, the very patients who would benefit most from treatment are usually regarded as having too may cysts for surgery. We report a case of extensive steatocystoma multiplex which was treated by a simple surgical technique under general anaesthetic.
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Affiliation(s)
- M Keefe
- Royal South Hants Hospital, Southampton, U.K
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35
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Abstract
Benign familial chronic pemphigus, or Hailey-Hailey disease, is a rare hereditary condition characterized by development of blisters at sites of friction such as the neck, axillae and groin. Contact sensitivity to topical medications is reported to be common and routine patch testing has been strongly advocated. We report a case of Hailey-Hailey disease in a 43-year-old veterinary surgeon who presented with an acute exacerbation of his disease caused by herpes simplex virus type 1 (HSV). Patch testing was carried out to exclude a coexistent contact dermatitis and was complicated by severe local blistering. We are reporting this case to remind clinicians that HSV is a recognized cause of exacerbations of this disease and to warn that patch testing is not without hazard.
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Affiliation(s)
- T Peppiatt
- Department of Dermatology, Royal South Hants Hospital
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36
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Abstract
Melanoma is a malignant skin tumour. If detected and surgically removed early whilst residing in the superficial part of the skin the prognosis is excellent. A seven-point check-list of signs and symptoms has been adopted by the Cancer Research Campaign to help non-dermatologists distinguish benign pigmented lesions from melanoma. The presence of irregularity in shape or outline of a mole is one of these important signs. However, it has recently been shown that not only patients, but also clinicians have difficulty in agreeing upon whether a mole exhibits irregularity or not. Computer image analysis methods have been developed to derive quantitative measures of those shape parameters which dermatologists appear to use in their assessment of shape irregularity. The overall shape of the lesion is expressed by the 'bulkiness' measure. Irregularity of the border is expressed by two fractal dimension measures, one for the 'structural' aspect of the shape and the other for the 'textural' aspect. These measures were used in combination to classify melanomas in the study containing silhouettes of 43 melanomas and 45 benign lesions producing correct classification with 91% sensitivity and 69% specificity. This paper describes computer image analysis aspects of the study.
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Affiliation(s)
- E Claridge
- School of Computer Science, University of Birmingham, Edgbaston, UK
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37
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Abstract
A 55-year-old female presented with a 1-year history of Bowen's disease on the leg at the site of a scar from an injury that occurred at 5 years-of-age. The clinical features in this case suggest a causal relationship, although trauma may have been acting as a co-carcinogenic factor to an unknown primary-cause. The relationship between trauma and malignancy is reviewed and proposals for further investigation are discussed.
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Affiliation(s)
- M Keefe
- Department of Dermatology, Royal South Hants Hospital, Southampton
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38
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Keefe M, Mackie RM. The relationship between risk of death from clinical stage 1 cutaneous melanoma and thickness of primary tumour: no evidence for steps in risk. Scottish Melanoma Group. Br J Cancer 1991; 64:598-602. [PMID: 1911205 PMCID: PMC1977630 DOI: 10.1038/bjc.1991.357] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Previous reports have suggested that the relationship between survival and thickness of primary cutaneous malignant melanoma is not linear, but that there are natural breakpoints at which survival worsens in a step fashion. Nine hundred and ninety-seven cases of primary cutaneous malignant melanoma less than 9.75 mm thick, excised in Scotland between 1979 and 1983 inclusive, were examined to see if this could be confirmed. An adjusted Cox's regression analysis showed that age, sex, site and thickness were all significant predictors of survival. Thickness was grouped either empirically or by the breakpoints reported by other authors. It was then entered into a model either as a regressor or as a factored variable. The ranges 0-9.75 mm and 0-2 mm were studied separately. In the 0-9.75 mm range the factored variable was a statistically significant better fit than the regressor for each set of breakpoints, including an empirical analysis with eight groups. This suggests that there is no single best fit and that a step-effect is unlikely. Across the 0-2 mm range there was no significant improvement in the fit if thickness was entered as a factored variable, again indicating that a step effect is unlikely. We argue that there is no biological or statistical evidence to support the existence of natural breakpoints.
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Affiliation(s)
- M Keefe
- Department of Dermatology, University of Glasgow, UK
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40
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41
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Abstract
We describe a case of papuloerythroderma. This is a distinctive clinical entity characterized by pruritus, red-brown flat-topped papules exhibiting the "deck-chair" sign, eosinophilia, and lymphopenia. We propose that the Langerhans cell may have a central role in the pathogenesis of papuloerthroderma and we describe an excellent response to photochemotherapy.
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Affiliation(s)
- R A Wakeel
- Department of Dermatology, Stobhill General Hospital, Glasgow, Scotland
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42
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Abstract
One-hundred and thirty (82%) of 159 patients who had been treated with cryotherapy for warts on the hands replied to a postal questionnaire. Most patients had wanted treatment for cosmetic reasons, although 35% also wanted treatment because of pain. Only 34% had used a wart paint for more than 6 weeks before referral. The long-term results of cryotherapy were poor, although 83% of patients thought they had been cured in the short-term; only 57% of patients were clear of warts after a median of 19 months' follow-up. Seventy-one per cent had defaulted from follow-up. In some cases this may have been encouraged by the dermatologists, but other reasons were pain, cost and perceived failure of treatment. Nearly 90% tolerated cryotherapy well and for 76% this was the preferred method of treatment. Fifty-nine per cent would have preferred to be treated in their local health centre and 85% would have been willing to be treated by a nurse. The results are discussed and we conclude that cryotherapy should be offered as a treatment for hand warts in most general practices.
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Affiliation(s)
- M Keefe
- Falkirk and District Royal Infirmary, Major's Loan, UK
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43
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44
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Abstract
A seven-point scoring system has been adopted by the Cancer Research Campaign to help non-dermatologists recognize melanoma (MM). Its value is reviewed in the light of increasing referrals of pigmented lesions. One-hundred and ninety-five patients (M:F, 43:152; mean age = 43 years, s.d. = 19) were asked whether their lesions possessed the seven points before diagnosis. The dermatologist assessed the signs. Six patients were unable to comply and some had multiple lesions; thus, 216 lesions were fully assessed by patient and dermatologist, and six by the dermatologist alone. Histology was obtained where appropriate. There were eight MMs, 95 naevi, 80 seborrhoeic warts, three dysplastic naevi, and 36 other lesions. Seven of the eight MMs were diagnosed clinically; the other was biopsied because of suspicious features and was a nodular MM. Four lesions suspected to be MMs proved benign. The predictive value (PV) of a clinical diagnosis of MM was 64% and of non-MM was 99%. Using accepted cutpoints for the seven-point system (refer if score greater than or equal to 3) patients' scores gave a PV for MM of 7% and for non-MM of 99%. Two MMs scored less than three. Dermatologists' scores gave a PV for MM of 8% and for non-MM of 99%. One MM scored less than 3. Univariate analyses showed that enlargement (P less than 0.05), dermatologists' assessments of an irregular margin (P less than 0.001), size (P less than 0.05) and pigmentary irregularity (P less than 0.05), and patients' assessments of size (P less than 0.05) were statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Keefe
- Department of Dermatology, Stobhill General Hospital, Glasgow, UK
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45
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46
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Abstract
We present a case of erysipelas which complicated chronic discoid lupus erythematosus (CDLE) of the face. The diagnosis and implications for management are discussed. The changing epidemiology and clinical spectrum of erysipelas are reviewed.
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47
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Keefe M, Munro F. Acute pancreatitis: a fatal complication of treatment of bullous pemphigoid with systemic corticosteroids. Dermatologica 1989; 179:73-5. [PMID: 2676630 DOI: 10.1159/000248315] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Acute pancreatitis may be a rare complication of systemic corticosteroids, although this is disputed. We describe a patient with bullous pemphigoid whose treatment was complicated by fatal acute pancreatitis. The question of a cause and effect relationship is discussed with reference to the literature. We emphasise the way that corticosteroids modified the presentation of acute pancreatitis in this case.
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Affiliation(s)
- M Keefe
- Department of Dermatology, Stobhill General Hospital, Glasgow, UK
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48
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Keefe M, Dick DC. An audit of wart treatment in a Scottish dermatology department. Health Bull (Edinb) 1989; 47:13-20. [PMID: 2703341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We measured a dermatology department's workload from wart treatment in terms of time and numbers, and we studied the use made of routine treatments according to the site of the warts and the age of the patient. Twenty-one per cent of new referrals were for warts and 19% of clinic time was used for wart treatment, 9% of clinic time was for plantar warts alone and 29.5% of new patients failed to attend. Overall cryotherapy was the commonest treatment, particularly for warts on the hands and face, 73.2% of patients treated for hand warts defaulted from follow-up and 11.3% were referred back for further treatment. The implications of the results are discussed and we argue that hospital budget holders should fund community-based wart treatment facilities.
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49
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Keefe M, Dick DC. Routine treatment of cutaneous warts: a questionnaire survey of general practitioners. J R Coll Gen Pract 1989; 39:21-3. [PMID: 2553943 PMCID: PMC1711564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A postal questionnaire was sent to 185 general practitioners to assess their approach to cutaneous warts and their views on the future development of the routine wart treatment service; 159 (85.9%) replied. A wide range of treatments were offered and most patients were given some treatment. The main reasons respondents gave for referring patients to hospital were failure of wart paints (73.6%) and lack of availability of liquid nitrogen (70.4%). Most general practitioners (74.2%) believed that dermatologists should spend less than 5% of their time treating warts. Many general practitioners (61.6%) wanted a practice-based wart clinic offering cryotherapy and 30.8% would like to refer directly to a hospital clinic run by a nurse. A practice clinic was more popular with general practitioners who have a treatment room nurse (P less than 0.01). Most seemed to appreciate the need for training to use liquid nitrogen. We conclude that general practitioners are keen to use cryotherapy and we argue that hospital management should provide the necessary resources for running a community-based service.
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50
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