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Headen AC, Berry CT, Jen M, Rubin AI. Misdiagnosis of neutrophilic erythema of infancy as leukocytoclastic vasculitis: A potential diagnostic pitfall in an infantile inflammatory dermatosis. J Cutan Pathol 2023; 50:289-293. [PMID: 36000215 DOI: 10.1111/cup.14302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/08/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Alvis C Headen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Corbett T Berry
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melinda Jen
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam I Rubin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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2
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Godse R, Dany M, Tamazian S, Wan J, Jen M, Rubin AI. Infantile Digital Fibromatosis/Inclusion Body Fibromatosis: A Comprehensive Literature Review. Skin Appendage Disord 2023; 9:1-7. [PMID: 36632366 PMCID: PMC9827721 DOI: 10.1159/000526253] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/19/2022] [Indexed: 01/14/2023] Open
Abstract
Infantile digital fibromatosis (IDF), or inclusion body fibromatosis, is a rare benign tumor that commonly presents as a solitary nodule composed of spindle cells within the dermis on the digits of infants and children. Evaluation often includes a biopsy and typical therapies include observation, intralesional corticosteroid injections, and complete surgical resection. Given the rarity of IDF, few clinicians have direct or extensive experience diagnosing or treating it. Here we present a comprehensive review of the presentation, diagnosis, and treatment for IDF.
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Affiliation(s)
- Rama Godse
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohammed Dany
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shant Tamazian
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joy Wan
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Melinda Jen
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam Ian Rubin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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3
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Cohen OG, Florez-Pollack S, Finn LS, Larijani M, Jen M, Treat J, Adams DM, Acord MR. Multifocal Kaposiform Hemangioendothelioma in a Newborn With Confirmatory Histopathology. Pediatrics 2022; 150:189664. [PMID: 36193691 DOI: 10.1542/peds.2022-056293] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/05/2022] Open
Abstract
Kaposiform hemangioendothelioma is classified as a locally aggressive vascular tumor of childhood resulting from abnormal angiogenesis and lymphangiogenesis. Most commonly, KHE presents as a single tissue mass, ranging from an erythematous papule to a violaceous indurated tumor. Definitive diagnosis requires tissue sampling with the demonstration of ill-defined nodules and fascicles of spindle-shaped D2-40 positive endothelial cells, forming slit-like vascular channels. This newborn presented with multifocal cutaneous Kaposiform hemangioendothelioma associated with Kasabach-Merritt phenomenon confirmed on histopathology with immunostaining.
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Affiliation(s)
| | | | - Laura S Finn
- Departments of Pathology and Laboratory Medicine
| | | | | | - James Treat
- Section of Dermatology.,Comprehensive Vascular Anomaly Program
| | - Denise M Adams
- Comprehensive Vascular Anomaly Program.,Division of Oncology
| | - Michael R Acord
- University of Pennsylvania Perelman School of Medicine.,Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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4
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Jahnke MN, O'Haver J, Gupta D, Hawryluk EB, Finelt N, Kruse L, Jen M, Horii KA, Frieden IJ, Price H, Coughlin CC. Care of Congenital Melanocytic Nevi in Newborns and Infants: Review and Management Recommendations. Pediatrics 2021; 148:183438. [PMID: 34845496 DOI: 10.1542/peds.2021-051536] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 01/06/2023] Open
Abstract
A pediatric dermatology expert working group performed a narrative review to describe care related to congenital melanocytic nevi (CMN) in neonates and infants. There are no published guidelines for most aspects of care, including routine skin care and visit intervals. Few guidelines exist for surgical management; newer recommendations favor conservative practice. Emerging evidence contributes to recommendations for screening MRI to evaluate for neural melanosis and related central nervous system complications, however, more research is needed. Risk for melanoma is generally low, but those with large, giant, or multiple CMN have a higher risk. Multidisciplinary care, with a focus on family and patient preferences, is of paramount importance. Without standardized screening and management guidelines, questions abound regarding appropriate physical examination intervals, potential treatment including full or partial excision, timing and frequency of imaging, melanoma risk, and assessment for neural melanosis. This review highlights the current state of knowledge concerning care of patients with CMN, reveals gaps in the literature surrounding skin care, and provides management recommendations. We additionally discuss cutaneous complications of CMN, such as pruritus, hypertrichosis, and wound healing. Resources and references for families and providers can help patients navigate this sometimes challenging diagnosis. Finally, we contribute expert care recommendations to the current body of literature as a foundation for the development of future, more comprehensive care guidelines.
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Affiliation(s)
- Marla N Jahnke
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Judith O'Haver
- Division of Dermatology, Phoenix Children's Hospital and College of Medicine, University of Arizona-Phoenix, Phoenix, Arizona
| | - Deepti Gupta
- Division of Dermatology, Seattle Children's Hospital, Seattle, Washington
| | - Elena B Hawryluk
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Nika Finelt
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Lacey Kruse
- Division of Dermatology, Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Melinda Jen
- Section of Pediatric Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kimberly A Horii
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri
| | - Ilona J Frieden
- Departments of Dermatology and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Harper Price
- Division of Dermatology, Phoenix Children's Hospital and College of Medicine, University of Arizona-Phoenix, Phoenix, Arizona
| | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, School of Medicine, Washington University in St Louis, St Louis, Missouri
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5
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Affiliation(s)
- Mary Larijani
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam I Rubin
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melinda Jen
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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6
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Tamazian S, Oboite M, Larijani M, Oliver B, Milbar H, Jen M, Treat JR. Toxic erythema of chemotherapy affecting the ears of an infant: A case report. Pediatr Dermatol 2021; 38:512-513. [PMID: 33481261 DOI: 10.1111/pde.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/30/2022]
Abstract
A 15-month-old boy presented with new onset symmetric erythema of the conchal bowls bilaterally in the setting of treatment with cytarabine. Findings were consistent with a diagnosis of toxic erythema of chemotherapy, an adverse effect of chemotherapy. In this report, we detail this uncommon manifestation in a young child along with a brief literature review of the background, pathophysiology, and treatment strategies of toxic erythema of chemotherapy to increase awareness of this presentation in pediatric populations.
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Affiliation(s)
- Shant Tamazian
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Oboite
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mary Larijani
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brittany Oliver
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Heather Milbar
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Melinda Jen
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - James R Treat
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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7
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Pei S, Fischer AS, Yan AC, Jen M, Kovarik CL, Chu EY, Rubin AI. Lymphedematous verrucous changes of the genital skin: an extraintestinal manifestation of Crohn disease. J Cutan Pathol 2021; 48:465-468. [PMID: 33470431 DOI: 10.1111/cup.13723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Susan Pei
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew S Fischer
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Albert C Yan
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melinda Jen
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carrie L Kovarik
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Y Chu
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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8
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Hawryluk EB, Moustafa D, Bartenstein D, Brahmbhatt M, Cordoro K, Gardner L, Gauthier A, Grossman D, Gupta D, Hunt RD, Jen M, Kao PC, Kruse LL, Lawley LP, London WB, Mansour D, O'Haver JA, Phung T, Pope E, Price HN, Rogers T, Shah SD, Wolner Z, Huang J, Marghoob AA. A retrospective multicenter study of fatal pediatric melanoma. J Am Acad Dermatol 2020; 83:1274-1281. [DOI: 10.1016/j.jaad.2020.06.1010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
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9
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Rosenthal J, Sibbald C, Jen M, Deardorff MA, Treat J. A PIK3CA mutation in an acquired capillary malformation. Pediatr Dermatol 2020; 37:246-247. [PMID: 31830321 DOI: 10.1111/pde.14068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/22/2019] [Revised: 10/25/2019] [Accepted: 11/01/2019] [Indexed: 11/27/2022]
Abstract
Acquired capillary malformations are rare vascular anomalies composed of dilated capillaries in the skin. We present a pediatric case of an acquired capillary malformation as a novel presentation of the PIK3CA-related overgrowth syndromes. Using next-generation sequencing, we identified a PIK3CA p.Val344Met mutation within the acquired capillary malformation with possible prognostic and therapeutic significance.
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Affiliation(s)
- Jaclyn Rosenthal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cathryn Sibbald
- Section of Dermatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Melinda Jen
- Section of Dermatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew A Deardorff
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - James Treat
- Section of Dermatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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10
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Valiga A, Neidig L, Cusack CA, Gaddis K, Jen M, Rubin A, Moon AT. Plexiform fibrohistiocytic tumor on the chest of a 5-year-old child and review of the literature. Pediatr Dermatol 2019; 36:490-496. [PMID: 30859648 DOI: 10.1111/pde.13805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 11/30/2022]
Abstract
Plexiform fibrohistiocytic tumor (PFT) is a rare neoplasm of mesenchymal origin that can be identified by its propensity for children and adolescents combined with a characteristic histologic arrangement of histiocytes and osteoclast-like giant cells whorled within tumor islands. A 5-year-old female presented with a raised, intermittently tender, and slowly enlarging tumor on her chest, which was histologically confirmed to be a PFT. We present this case along with a comprehensive review of PFT cases reported in the literature to describe the demographic, histologic, and rarely metastatic behavior of this entity. It is important to include PFT on the differential diagnosis of an enlarging tumor in the pediatric population.
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Affiliation(s)
- Alexander Valiga
- Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Lane Neidig
- Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Carrie Ann Cusack
- Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Kevin Gaddis
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melinda Jen
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam Rubin
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amanda T Moon
- Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania.,Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Abstract
Hidradenitis suppurativa is a painful chronic inflammatory skin condition characterized by inflammatory nodules that can lead to sinus tracts and scarring. Numerous treatments have been reported, though none have reliable efficacy. Antiinflammatory agents, such as tumor necrosis factor-alpha inhibitors and interleukin inhibitors, have been used as medical therapy for refractory cases. We describe here a case of severe hidradenitis suppurativa in a pediatric patient successfully treated with a combination of high-dose ustekinumab and hyperbaric oxygen therapy.
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Affiliation(s)
- Lauren E Provini
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Judith J Stellar
- Wound and Ostomy Program, Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Molly N Stetzer
- Wound and Ostomy Program, Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Phuong D Nguyen
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melinda Jen
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pediatrics, Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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12
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Winfree K, Ainsworth C, Njue A, Molife C, Lyall M, Jen M, Bittoni M, Heyes A, Carbone D. P3.01-110 Defining Aggressive Disease in Patients With Advanced NSCLC Receiving Second-Line Treatment: A Systematic Review. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1671] [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: 10/28/2022]
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13
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Nguyen M, Louis C, Sahota P, Chen Y, Wong A, Jen M, Hoonpongsimanont W. 90 Improvement of Emergency Department Workflow and Their Effects on Patient Satisfaction. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.095] [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: 10/28/2022]
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14
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Chang X, Li D, Tian L, Liu Y, March M, Wang T, Hou C, Pellegrino R, Levy R, Jen M, Soccio R, Sleiman P, Hakonarson H, Castelo-Soccio L. Heterozygous Deletion Impacting SMARCAD1 in the Original Kindred with Absent Dermatoglyphs and Associated Features (Baird, 1964). J Pediatr 2018; 194:248-252.e2. [PMID: 29269196 DOI: 10.1016/j.jpeds.2017.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 02/16/2017] [Revised: 10/06/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
Abstract
In 1964, Baird described a family with adermatoglyphia, facial milia, and skin fragility. Using whole exome sequencing, genotyping, and Sanger sequencing, we identified a 116-kb heterozygous deletion involving exons 1-9 of SMARCAD1 in descendants of this kindred. This contrasts with point mutations within exon 9 in all other reported families.
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Affiliation(s)
- Xiao Chang
- Center for Applied Genomics (CAG), The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Dong Li
- Center for Applied Genomics (CAG), The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lifeng Tian
- Center for Applied Genomics (CAG), The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Yichuan Liu
- Center for Applied Genomics (CAG), The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michael March
- Center for Applied Genomics (CAG), The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Tiancheng Wang
- Center for Applied Genomics (CAG), The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Cuiping Hou
- Center for Applied Genomics (CAG), The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Renata Pellegrino
- Center for Applied Genomics (CAG), The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Richard Levy
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania Perlman School of Medicine, Philadelphia, PA
| | - Melinda Jen
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania Perlman School of Medicine, Philadelphia, PA
| | - Raymond Soccio
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania Perlman School of Medicine, Philadelphia, PA
| | - Patrick Sleiman
- Center for Applied Genomics (CAG), The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Human Genetics Department of Pediatrics, Perelman School of Medicine, Philadelphia, PA
| | - Hakon Hakonarson
- Center for Applied Genomics (CAG), The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Human Genetics Department of Pediatrics, Perelman School of Medicine, Philadelphia, PA
| | - Leslie Castelo-Soccio
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania Perlman School of Medicine, Philadelphia, PA.
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15
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Ashchyan H, Jen M, Elenitsas R, Rubin AI. Surreptitious apple cider vinegar treatment of a melanocytic nevus: Newly described histologic features. J Cutan Pathol 2018; 45:307-309. [PMID: 29393529 DOI: 10.1111/cup.13102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/31/2017] [Accepted: 01/03/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Hovik Ashchyan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melinda Jen
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rosalie Elenitsas
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam I Rubin
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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16
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Van Batavia JP, Chu DI, Long CJ, Jen M, Canning DA, Weiss DA. Genitourinary involvement and management in children with Stevens-Johnson syndrome and toxic epidermal necrolysis. J Pediatr Urol 2017; 13:490.e1-490.e7. [PMID: 28314701 DOI: 10.1016/j.jpurol.2017.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 09/14/2016] [Accepted: 01/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are devastating hypersensitivity disorders that cause epidermal cell death and can affect all epidermal surfaces, including the urethra, vagina, labial and scrotal skin. Despite the well-described ocular and orofacial manifestations of SJS/TEN, there is a paucity of reports on the genitourinary (GU) symptoms and their management. Specifically, consulting services often ask the pediatric urology team if it is safe to place a urethral catheter, but there is no data in the literature to help guide management. The present study sought to review all pediatric cases of SJS/TEN in a tertiary care hospital to determine the incidence and optimal management of GU manifestations, including the use of urethral catheters. METHODS With IRB approval, cases of SJS and TEN that were managed as an inpatient between January 2008 and June 2015 were retrospectively reviewed in order to identify the extent of GU involvement/manifestations, the treatment provided, use of urethral catheterization and long-term follow-up or complications. RESULTS Thirty-one patients (15 female, 16 male; age range 2-18 years) presented with SJS or TEN over the study period. Etiologies for SJS/TEN included mycoplasma infection (48%) and medications (45%). Incidences of GU manifestations at presentation and their management are shown in Summary Table. Overall, 74% of patients had genital involvement of skin lesions. In 12 cases (39%), urology consultation was obtained. Twenty patients (61%) complained of dysuria and one child had gross hematuria in the setting of meatal lesion. Petroleum jelly was used in the majority of patients. A urethral catheter was placed in eight patients (25.8%, four female, four male) with a range of duration of 7-23 days. No patient developed hematuria or any other complications (i.e. strictures or urinary symptoms) after catheter removal. One boy required lysis of penile adhesions in the short-term. One of each gender developed penile and labial adhesions on long-term follow-up that self-resolved. CONCLUSIONS GU involvement in SJS/TEN occurred in almost three-quarters of patients and was managed conservatively like other skin/mucosal manifestations. Long-term sequelae were rare and urethral catheterization appeared to be safe, without any short-term or long-term complications.
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Affiliation(s)
- J P Van Batavia
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - D I Chu
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - C J Long
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Jen
- Section of Dermatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D A Canning
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - D A Weiss
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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17
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Jen M, Johnson J, Hou P, Liu H. SU-G-IeP1-07: Inaccuracy of Lesion Blood Flow Quantification Related to the Proton Density Reference Image in Arterial Spin Labeling MRI of Brain Tumors. Med Phys 2016. [DOI: 10.1118/1.4956967] [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: 11/07/2022] Open
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18
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Abstract
Genetic skin diseases, or genodermatoses, often have extracutaneous manifestations. Ocular manifestations in particular can have significant clinical implications, like blindness. Other manifestations, such as the corneal opacities that occur in X-linked ichthyosis, are asymptomatic but characteristic of a particular genodermatosis. Ophthalmologic examination can aid in diagnosis when characteristic findings are seen. The genodermatoses with ocular manifestations will be reviewed, but neurocutaneous, syndromes, genetic pigmentary disorders, and genetic metabolic diseases are not included because they are covered elsewhere in this issue.
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Affiliation(s)
- Melinda Jen
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia; Departments of Pediatrics and Dermatology, Perelman School of Medicine at the University of Pennsylvania, 3550 Market St, Second floor, Philadelphia, PA, 19104.
| | - Sudha Nallasamy
- The Vision Center, Children's Hospital Los Angeles; Department of Ophthalmology, Keck School of Medicine, University of Southern California, 4650 Sunset Blvd, MS #88, Los Angeles, CA, 90027
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Smith RJ, Boos MD, Burnham JM, McKay EM, Kim J, Jen M. Atypical Cutaneous Blastomycosis in a Child With Juvenile Idiopathic Arthritis on Infliximab. Pediatrics 2015; 136:e1386-9. [PMID: 26482671 DOI: 10.1542/peds.2015-1675] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 11/24/2022] Open
Abstract
Blastomyces dermatitidis is a dimorphic fungus endemic to much of North America, particularly the soils of the midwestern and southeastern United States. Human infection typically occurs through inhalation of airborne conidia, which can be followed occasionally by dissemination to the skin, bone, genitourinary system, and central nervous system. A hallmark of the pathogen is that it can cause disease in both immunocompetent and immunosuppressed populations. Blastomycosis is rare in pediatric patients, with cutaneous manifestations occurring even less frequently. Here, we report the case of a 9-year-old boy on iatrogenic immunosuppression with infliximab and methotrexate for juvenile idiopathic arthritis who presented with a nonhealing, indurated plaque of his right ear with significant superficial yellow crusting in the absence of constitutional symptoms. After failing a prolonged course of topical and oral antibiotic therapy, biopsy and tissue culture revealed Blastomyces dermatitidis infection. The area cleared after treatment with oral fluconazole and withdrawal of infliximab. To our knowledge, this is the first report of a pediatric patient developing an infection with B dermatitidis after initiation of therapy with a tumor necrosis factor-α inhibitor. This case also highlights an unusual morphology of cutaneous blastomycosis in an iatrogenically immunosuppressed child.
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Affiliation(s)
- Robert J Smith
- Perelman School of Medicine at the University of Pennsylvania, and
| | - Markus D Boos
- Perelman School of Medicine at the University of Pennsylvania, and Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Section of Dermatology
| | | | - Eileen M McKay
- Department of Pathology and Laboratory Medicine, and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jason Kim
- Infectious Disease, Department of Pediatrics, and
| | - Melinda Jen
- Perelman School of Medicine at the University of Pennsylvania, and Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Section of Dermatology,
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20
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Abstract
Bacillus Calmette-Guerin (BCG) vaccine complications in patients with severe combined immunodeficiency (SCID) have been well documented in the literature. We present a case in which the BCG vaccine was administered to an infant who was later diagnosed with SCID and presented with worsening localized BCG reaction upon arrival in the United States. Although the BCG vaccine is not routinely administered in the United States, it is important for physicians to be aware of potential complications of BCG vaccination since prompt treatment can be lifesaving.
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Affiliation(s)
- Amrit Khalsa
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Adam I Rubin
- Division of Dermatopathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Section of Pediatric Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melinda Jen
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Section of Pediatric Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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21
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Jen M, Yan F, Tseng Y, Lin C, Chen C, Liu H. SU-E-I-65: Estimation of Tagging Efficiency in Pseudo-Continuous Arterial Spin Labeling (pCASL) MRI. Med Phys 2015. [DOI: 10.1118/1.4924062] [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: 11/07/2022] Open
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22
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Abstract
We report six new cases of lipofibromatosis, an uncommon pediatric soft tissue neoplasm. This is the only series of patients to be described since the initial case series of 45 patients that characterized this entity in 2000. The purpose of this study was to characterize the presentation of lipofibromatosis to further define the clinical phenotype of this rare entity. Six patients were diagnosed with lipofibromatosis at our institution from 2000 to 2012. Patient age, sex, and ethnicity were recorded, along with tumor site and size, management, and recurrence data. Half of our patients were younger than 2 years old at presentation and the other half were school age. Boys and girls were affected with equal frequency. In five of six patients, lipofibromatosis presented in its "classic" form as a mass on the distal extremities. These tumors typically measured 1 to 2 cm in diameter, in contrast to case reports in the medical literature highlighting the occurrence of lipofibromatosis of greater size and at varied anatomic sites. The tumors in our series were managed using excision, with recurrence noted in 33%. Lipofibromatosis is an uncommon tumor typically found on the distal extremities of infants, although it can appear in various sizes and locations. It should be considered in the differential diagnosis of pediatric soft tissue neoplasms.
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Affiliation(s)
- Markus D Boos
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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23
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Abstract
1.Compare and contrast infantile hemangiomas with other vascular anomalies that may be confused clinically.2.Describe the vascular anomalies classification system according to the International Society for the Study of Vascular Anomalies (ISSVA), highlighting the differences between vascular tumors, such as infantile hemangiomas, and vascular malformations.3.Briefly review associated signs or syndromes found in the context of certain vascular anomalies.Infantile hemangiomas are the most common benign vascular tumor in infancy but may mimic many other types of vascular anomalies. In many cases, the appearance, time of onset, growth pattern, and consistency of infantile hemangiomas make the diagnosis straightforward (see "Pathogenesis of Infantile Hemangiomas" on p. 321). However, many other vascular lesions can appear quite similar to infantile hemangiomas, especially early in life, and at times this makes the correct diagnosis challenging.
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Affiliation(s)
- Marissa J Perman
- The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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25
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Abstract
Pediatric melanoma is rare but increasing in incidence. Because early diagnosis and treatment improves prognosis, clinicians need to include it as a possible diagnosis when evaluating a pigmented lesion in a pediatric patient. Some risk factors for melanoma include xeroderma pigmentosum, giant congenital melanocytic nevi, dysplastic nevus syndrome, atypical nevi, many acquired melanocytic nevi, family history of melanoma, and immunosuppression. Definitive treatment is with surgical excision. Adjuvant therapies such as chemotherapy, immunotherapy, and radiation therapy can be used in advanced cases.
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Affiliation(s)
- Melinda Jen
- Department of Dermatology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA
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26
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Abstract
Severe neck pain, stiffness, and torticollis in a child with Kawasaki disease commonly represent aseptic meningitis or lymphadenitis. Here we present an unusual case of severe cervical spine and bilateral temporomandibular joint arthritis in a 5-year-old boy with a relapse of Kawasaki disease and coronary artery ectasia. The patient had a favorable response to a second course of intravenous immunoglobulin G and indomethacin therapy, with complete resolution of his symptoms.
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Affiliation(s)
- Melinda Jen
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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27
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Siegel RM, Muppidi JR, Sarker M, Lobito A, Jen M, Martin D, Straus SE, Lenardo MJ. SPOTS: signaling protein oligomeric transduction structures are early mediators of death receptor-induced apoptosis at the plasma membrane. ACTA ACUST UNITED AC 2005; 167:735-44. [PMID: 15557123 PMCID: PMC2172594 DOI: 10.1083/jcb.200406101] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [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: 11/22/2022]
Abstract
Fas (CD95, APO-1, TNFRSF6) is a TNF receptor superfamily member that directly triggers apoptosis and contributes to the maintenance of lymphocyte homeostasis and prevention of autoimmunity. Although FADD and caspase-8 have been identified as key intracellular mediators of Fas signaling, it is not clear how recruitment of these proteins to the Fas death domain leads to activation of caspase-8 in the receptor signaling complex. We have used high-resolution confocal microscopy and live cell imaging to study the sequelae of early events in Fas signaling. These studies have revealed a new stage of Fas signaling in which receptor ligation leads to the formation of surface receptor oligomers that we term signaling protein oligomerization transduction structures (SPOTS). Formation of SPOTS depends on the presence of an intact Fas death domain and FADD but is independent of caspase activity. Analysis of cells expressing Fas mutations from patients with the autoimmune lymphoproliferative syndrome (ALPS) reveals that formation of SPOTS can be disrupted by distinct mechanisms in ALPS.
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Affiliation(s)
- Richard M Siegel
- Laboratory of Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
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Young DM, D'Argenio DA, Jen M, Parke D, Nicholas Ornston L. Gunsalus and Stanier set the stage for selection of cold-sensitive mutants apparently impaired in movement of FAD within 4-hydroxybenzoate hydroxylase. Biochem Biophys Res Commun 2004; 312:153-60. [PMID: 14630034 DOI: 10.1016/j.bbrc.2003.09.240] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- David M Young
- Department of Microbiology and Molecular Genetics, Harvard Medical School, 200 Longwood Ave., D1-219, Boston, MA 02115, USA
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29
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Thomson AB, Kirdeikis P, Lastiwka R, Zuk L, Jen M, Elias M, Johnston P. Food but not a chemically defined diet interferes with maintenance of intragastric pH at a predefined level using continuous pH-stat-adjusted intravenous infusion of ranitidine in healthy volunteers. Dig Dis Sci 1999; 44:1858-64. [PMID: 10505726 DOI: 10.1023/a:1018850908205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 12/09/2022]
Abstract
Eight healthy volunteers were used to determine the influence of a normal diet (food) versus an isocaloric chemically defined diet (CDD) on the dose of ranitidine infused continuously over 12 hr, required to maintain the intragastric pH > or = 5 or above. The dose of ranitidine used was adjusted by the pH-stat instrument, Gastrojet, and a target pH of 5.0 was selected. The average ranitidine dose was 43.5 mg for food, 28.3 mg for CDD, and 25.7 mg for fasting. Despite the higher dose of ranitidine used with food, the control of pH was lower than the desired and preset value of pH > or = 5: the average mean pH was 3.99 for food, 5.11 for CDD, and 5.75 for fasting. The percentage of time of pH > or = 5 was 32.0% for food, 73.7% for CDD, and 80.1% for fasting. Thus, when persons are fed a normal diet there is a need for higher doses of ranitidine to maintain the gastric pH > or = 5.0. Even with frequent monitoring of intragastric pH with the Gastrojet, there is much greater variability in pH control with food than with CDD or fasting, and the preset and desired pH level was not achieved. This difficulty in achieving desired end points of pH control when switching from a fasting to a fed state needs to be considered when intravenous ranitidine is used to obtain strict control of intragastric pH.
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Affiliation(s)
- A B Thomson
- Department of Medicine, Agriculture, Food, and Nutrition Sciences, University of Alberta, Edmonton, Canada
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