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Miller LE, Buzi A, Rogers RS, Elden LM. Response to Letter to the Editor Titled Remote Fiberoptic Nasopharyngolaryngoscopy in the Pediatric Population: Methodological Issues on Reliability and Accuracy. Ear Nose Throat J 2020; 100:271. [PMID: 32397808 DOI: 10.1177/0145561320926096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lauren E Miller
- Department of Otolaryngology, 1866Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Adva Buzi
- Department of Otolaryngology, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel S Rogers
- Biostatistics and Data Management Care, 6567Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, USA
| | - Lisa M Elden
- Department of Otolaryngology, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Miller LE, Buzi A, Williams A, Rogers RS, Ortiz AG, Jones-Ho KO, Elden LM. Reliability and Accuracy of Remote Fiberoptic Nasopharyngolaryngoscopy in the Pediatric Population. Ear Nose Throat J 2020; 100:604-609. [PMID: 32283977 DOI: 10.1177/0145561320919109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Telemedicine is an increasingly prevalent component of medical practice. In otolaryngology, there is the potential for telemedicine services to be performed in conjunction with device use, such as with a nasolaryngoscope. This study evaluates the reliability of remote examinations of the upper airway through an iPhone recording using a coupling device attached to a nasopharyngolaryngoscope (NPL). METHODS A prospective, blinded study was performed for pediatric patients requiring an NPL during an office visit. The NPL was performed using a coupling device attached to a smartphone to record the examination. A second, remote otolaryngologist then evaluated the recorded examination. Both otolaryngologists evaluated findings of anatomic sites including nasopharynx, oropharynx, base of tongue, larynx including subsites of epiglottis, arytenoids, aryepiglottic folds, false vocal cords, true vocal cords, patency of airway, and diagnostic impression, all of which were documented through a survey. Results of the survey were evaluated through inter-rater agreement using the κ statistic. RESULTS Forty-five patients underwent an NPL, all of which were included in the study. The average age was 4.9 years. The most common complaint requiring NPL was noisy breathing (n = 16). The inter-rater agreement for overall diagnosis was 0.74 with 80% percent agreement, rated as "good." Other anatomic subsites with "good" or better inter-rater agreement were nasopharynx (0.75), oropharynx (0.75), and true vocal cords (0.71), with strong percentage agreement of 89%, 91%, and 87%, respectively. Both users of the adaptor found the recording setup to run smoothly. CONCLUSION A telemedicine device for NPL use demonstrates strong diagnostic accuracy across providers and good overall evaluation. It holds potential for use in remote settings.
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Affiliation(s)
- Lauren E Miller
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Adva Buzi
- Department of Otolaryngology-Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ashley Williams
- Department of Otolaryngology-Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel S Rogers
- Biostatistics and Data Management Care-Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, USA
| | - Angel G Ortiz
- Biostatistics and Data Management Care-Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, USA
| | - Kellye O Jones-Ho
- Department of Otolaryngology-Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa M Elden
- Department of Otolaryngology-Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Doshi BS, Rogers RS, Whitworth HB, Stabnick EA, Britton J, Butler RB, Obstfeld AE, Witmer CM. Utility of repeat testing in the evaluation for von Willebrand disease in pediatric patients. J Thromb Haemost 2019; 17:1838-1847. [PMID: 31350816 DOI: 10.1111/jth.14591] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/23/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Von Willebrand disease (VWD) is the most common inherited bleeding disorder and is caused by quantitative and qualitative defects in von Willebrand factor (VWF). The laboratory diagnosis of VWD in pediatric patients is complicated by VWF interassay and intra-assay variability, stress-induced elevations in VWF levels, and a lack of significant bleeding history with which to correlate test results. OBJECTIVE Guidelines recommend repeat testing in patients with a high suspicion of VWD and unclear laboratory assay results; however, no studies have evaluated the utility of repeat VWF testing in pediatric patients. METHODS This retrospective single-center cohort study aimed to determine clinical variables associated with requiring more than one test to diagnose VWD and to establish a cutoff VWF value above which further testing is not informative. RESULTS Of 811 patients evaluated for a suspected bleeding disorder, 22.2% were diagnosed with VWD, with ~70% diagnosed on the first test. Patients with VWD were younger (5.8 vs. 8.5 years, P = .002) and more likely to have a family history of VWD (38% vs. 22%, P < .001) than those without VWD. Univariate analysis failed to identify any clinical variables that correlated with needing multiple tests for a VWD diagnosis. A cutoff of 100 IU/dL for VWF antigen or activity on the first test yielded negative predictive values >95%. CONCLUSIONS We demonstrate that the majority of pediatric patients had diagnostic VWF values on the first set of testing. Pediatric patients without a family history of VWD and VWF levels >100 IU/dL may not need further testing to rule out the diagnosis of VWD.
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Affiliation(s)
- Bhavya S Doshi
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel S Rogers
- Biostatistical and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hilary B Whitworth
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Emily A Stabnick
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jessica Britton
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Regina B Butler
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amrom E Obstfeld
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Char M Witmer
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
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Anderson K, Putterman E, Rogers RS, Patel D, Treat JR, Castelo-Soccio L. Treatment of severe pediatric atopic dermatitis with methotrexate: A retrospective review. Pediatr Dermatol 2019; 36:298-302. [PMID: 30811669 DOI: 10.1111/pde.13781] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVES Severe atopic dermatitis (AD) may require systemic immunomodulatory agents to control symptoms. A lack of evidence and guidelines for systemic AD therapy in children has led to variability in agents selected and uncertainty in their comparative efficacy and safety. Evaluation of the efficacy of methotrexate in children with severe AD was performed. METHODS We performed a retrospective chart review of 55 pediatric patients seen at Children's Hospital of Philadelphia that measured improvement using the Investigator's Global Assessment (IGA), a scale that rates AD symptoms from 0 to 5. RESULTS About 76% of patients showed improvement with methotrexate. Mean baseline IGA of all patients was 4.18. After 6-9 months of treatment, this improved to 2.94. There was additional improvement to a mean IGA score of 2.39 after 12-15 months of treatment. At the final visit before each patient stopped methotrexate, the mean IGA score was 2.71. Approximately 50% of patients experienced minor side effects with gastrointestinal side effects the most common. CONCLUSIONS In a diverse patient population, safety and efficacy of methotrexate was demonstrated. Significant improvement in IGA was noted for the majority after 6-9 months of therapy with further improvement when continuing treatment to 12-15 months. Methotrexate remains an important option for long-term symptom control with a favorable side effect profile and low cost.
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Affiliation(s)
- Kathryn Anderson
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elana Putterman
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Drexel University School of Medicine, Philadelphia, Pennsylvania
| | - Rachel S Rogers
- Westat Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Deepa Patel
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - James R Treat
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leslie Castelo-Soccio
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Putterman E, Patel DP, Andrade G, Harfmann KL, Hogeling M, Cheng CE, Goh C, Rogers RS, Castelo-Soccio L. Severity of disease and quality of life in parents of children with alopecia areata, totalis, and universalis: A prospective, cross-sectional study. J Am Acad Dermatol 2019; 80:1389-1394. [DOI: 10.1016/j.jaad.2018.12.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/29/2018] [Accepted: 12/27/2018] [Indexed: 01/01/2023]
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Lasa JJ, Rogers RS, Localio R, Shults J, Raymond T, Gaies M, Thiagarajan R, Laussen PC, Kilbaugh T, Berg RA, Nadkarni V, Topjian A. Extracorporeal Cardiopulmonary Resuscitation (E-CPR) During Pediatric In-Hospital Cardiopulmonary Arrest Is Associated With Improved Survival to Discharge: A Report from the American Heart Association's Get With The Guidelines-Resuscitation (GWTG-R) Registry. Circulation 2016; 133:165-76. [PMID: 26635402 PMCID: PMC4814337 DOI: 10.1161/circulationaha.115.016082] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although extracorporeal cardiopulmonary resuscitation (E-CPR) can result in survival after failed conventional CPR (C-CPR), no large, systematic comparison of pediatric E-CPR and continued C-CPR has been reported. METHODS AND RESULTS Consecutive patients <18 years old with CPR events ≥10 minutes in duration reported to the Get With the Guidelines-Resuscitation registry between January 2000 and December 2011 were identified. Hospitals were grouped by teaching status and location. Primary outcome was survival to discharge. Regression modeling was performed, conditioning on hospital groups. A secondary analysis was performed with the use of propensity score matching. Of 3756 evaluable patients, 591 (16%) received E-CPR and 3165 (84%) received C-CPR only. Survival to hospital discharge and survival with favorable neurological outcome (Pediatric Cerebral Performance Category score of 1-3 or unchanged from admission) were greater for E-CPR (40% [237 of 591] and 27% [133 of 496]) versus C-CPR patients (27% [862 of 3165] and 18% [512 of 2840]). Odds ratios (ORs) for survival to hospital discharge and survival with favorable neurological outcome were greater for E-CPR versus C-CPR. After adjustment for covariates, patients receiving E-CPR had higher odds of survival to discharge (OR, 2.80; 95% confidence interval, 2.13-3.69; P<0.001) and survival with favorable neurological outcome (OR, 2.64; 95% confidence interval, 1.91-3.64; P<0.001) than patients who received C-CPR. This association persisted when analyzed by propensity score-matched cohorts (OR, 1.70; 95% confidence interval, 1.33-2.18; P<0.001; and OR, 1.78; 95% confidence interval, 1.31-2.41; P<0.001, respectively]. CONCLUSION For children with in-hospital CPR of ≥10 minutes duration, E-CPR was associated with improved survival to hospital discharge and survival with favorable neurological outcome compared with C-CPR.
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Affiliation(s)
- Javier J Lasa
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.).
| | - Rachel S Rogers
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Russell Localio
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Justine Shults
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Tia Raymond
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Michael Gaies
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Ravi Thiagarajan
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Peter C Laussen
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Todd Kilbaugh
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Robert A Berg
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Vinay Nadkarni
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
| | - Alexis Topjian
- From Texas Children's Hospital, Houston (J.J.L.); Children's Hospital of Philadelphia, PA (R.S.R., R.L., J.S., T.K., R.A.B., V.N., A.T.); Medical City Children's Hospital, Dallas, TX (T.R.); University of Michigan C.S. Mott Children's Hospital, Ann Arbor (M.G.); Boston Children's Hospital, MA (R.T.); and Toronto Sick Kids Hospital, Canada (P.C.L.)
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Savla J, Lin KY, Pradhan M, Ruebner RL, Rogers RS, Haskins SS, Owens AT, Abt P, Gaynor JW, Shaddy RE, Rossano JW. Heart Retransplant Recipients Have Better Survival With Concurrent Kidney Transplant Than With Heart Retransplant Alone. J Am Heart Assoc 2015; 4:JAHA.115.002435. [PMID: 26656863 PMCID: PMC4845285 DOI: 10.1161/jaha.115.002435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart retransplant (HRT) recipients represent a growing number of transplant patients. The impact of concurrent kidney transplants (KTs) in this population has not been well studied. We tested the hypothesis that recipients of HRT with concurrent KT (HRT-KT) would have worse survival than recipients of HRT alone. METHODS AND RESULTS A retrospective analysis of the United Network of Organ Sharing database was performed for all patients undergoing HRT from 1987 to 2011. There were 1660 HRT patients, of which 116 (7%) received concurrent KT. Those who received HRT-KT had older age, longer wait-list time, worse kidney function, and more known diabetes. Survival among recipients of HRT-KT was significantly better than that of recipients of HRT alone (P=0.005). A subgroup of 323 HRT patients with severe kidney dysfunction (estimated glomerular filtration rate <30 mL/min per 1.73 m(2) or on dialysis) was studied in more detail, and 76 (24%) received concurrent KT. Those on dialysis at the time of HRT had better survival with versus without concurrent KT (P<0.0001). On multivariable analysis, concurrent KT was independently associated with better outcomes for all patients with HRT and for the subgroup of patients with severe kidney dysfunction. CONCLUSIONS Recipients of HRT-KT have better survival than recipients of HRT alone. Further research is needed to determine which HRT patients may benefit the most from concurrent KT.
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Affiliation(s)
- Jill Savla
- Department of Pediatrics, The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (J.S., K.Y.L., M.P., R.L.R., R.S.R., S.S.H., A.T.O., P.A., W.G., R.E.S., J.W.R.)
| | - Kimberly Y Lin
- Department of Pediatrics, The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (J.S., K.Y.L., M.P., R.L.R., R.S.R., S.S.H., A.T.O., P.A., W.G., R.E.S., J.W.R.)
| | - Madhura Pradhan
- Department of Pediatrics, The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (J.S., K.Y.L., M.P., R.L.R., R.S.R., S.S.H., A.T.O., P.A., W.G., R.E.S., J.W.R.)
| | - Rebecca L Ruebner
- Department of Pediatrics, The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (J.S., K.Y.L., M.P., R.L.R., R.S.R., S.S.H., A.T.O., P.A., W.G., R.E.S., J.W.R.)
| | - Rachel S Rogers
- Department of Pediatrics, The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (J.S., K.Y.L., M.P., R.L.R., R.S.R., S.S.H., A.T.O., P.A., W.G., R.E.S., J.W.R.)
| | - Somaly S Haskins
- Department of Pediatrics, The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (J.S., K.Y.L., M.P., R.L.R., R.S.R., S.S.H., A.T.O., P.A., W.G., R.E.S., J.W.R.)
| | - Anjali T Owens
- Department of Pediatrics, The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (J.S., K.Y.L., M.P., R.L.R., R.S.R., S.S.H., A.T.O., P.A., W.G., R.E.S., J.W.R.)
| | - Peter Abt
- Department of Pediatrics, The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (J.S., K.Y.L., M.P., R.L.R., R.S.R., S.S.H., A.T.O., P.A., W.G., R.E.S., J.W.R.)
| | - J William Gaynor
- Department of Pediatrics, The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (J.S., K.Y.L., M.P., R.L.R., R.S.R., S.S.H., A.T.O., P.A., W.G., R.E.S., J.W.R.)
| | - Robert E Shaddy
- Department of Pediatrics, The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (J.S., K.Y.L., M.P., R.L.R., R.S.R., S.S.H., A.T.O., P.A., W.G., R.E.S., J.W.R.)
| | - Joseph W Rossano
- Department of Pediatrics, The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (J.S., K.Y.L., M.P., R.L.R., R.S.R., S.S.H., A.T.O., P.A., W.G., R.E.S., J.W.R.)
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Reitz C, Tosto G, Vardarajan B, Rogaeva E, Ghani M, Rogers RS, Conrad C, Haines JL, Pericak-Vance MA, Fallin MD, Foroud T, Farrer LA, Schellenberg GD, George-Hyslop PS, Mayeux R. Independent and epistatic effects of variants in VPS10-d receptors on Alzheimer disease risk and processing of the amyloid precursor protein (APP). Transl Psychiatry 2013; 3:e256. [PMID: 23673467 PMCID: PMC3669917 DOI: 10.1038/tp.2013.13] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Genetic variants in the sortilin-related receptor (SORL1) and the sortilin-related vacuolar protein sorting 10 (VPS10) domain-containing receptor 1 (SORCS1) are associated with increased risk of Alzheimer's disease (AD), declining cognitive function and altered amyloid precursor protein (APP) processing. We explored whether other members of the (VPS10) domain-containing receptor protein family (the sortilin-related VPS10 domain-containing receptors 2 and 3 (SORCS2 and SORCS3) and sortilin (SORT1)) would have similar effects either independently or together. We conducted the analyses in a large Caucasian case control data set (n=11,840 cases, 10,931 controls) to determine the associations between single nucleotide polymorphisms (SNPs) in all the five homologous genes and AD risk. Evidence for interactions between SNPs in the five VPS10 domain receptor family genes was determined in epistatic statistical models. We also compared expression levels of SORCS2, SORCS3 and SORT1 in AD and control brains using microarray gene expression analyses and assessed the effects of these genes on γ-secretase processing of APP. Several SNPs in SORL1, SORCS1, SORCS2 and SORCS3 were associated with AD. In addition, four specific linkage disequilibrium blocks in SORCS1, SORCS2 and SORCS3 showed additive epistatic effects on the risk of AD (P≤0.0006). SORCS3, but not SORCS2 or SORT1, showed reduced expression in AD compared with control brains, but knockdown of all the three genes using short hairpin RNAs in HEK293 cells caused a significant threefold increase in APP processing (from P<0.001 to P<0.05). These findings indicate that in addition to SORL1 and SORCS1, variants in other members of the VPS10 domain receptor family (that is, SORCS1, SORCS2, SORCS3) are associated with AD risk and alter APP processing. More importantly, the results indicate that variants within these genes have epistatic effects on AD risk.
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Affiliation(s)
- C Reitz
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA,The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - G Tosto
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - B Vardarajan
- Department of Biostatistics, Boston University Schools of Medicine and Public Health, Boston, MA, USA
| | - E Rogaeva
- Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada
| | - M Ghani
- Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada
| | - R S Rogers
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - C Conrad
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - J L Haines
- Center for Human Genetics Research and Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M A Pericak-Vance
- Miami Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - M D Fallin
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - T Foroud
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, USA
| | - L A Farrer
- Department of Biostatistics, Boston University Schools of Medicine and Public Health, Boston, MA, USA,Department of Medicine (Biomedical Genetics), Boston University Schools of Medicine and Public Health, Boston, MA, USA,Department of Neurology, Boston University Schools of Medicine and Public Health, Boston, MA, USA,Department of Ophthalmology, Boston University Schools of Medicine and Public Health, Boston, MA, USA,Department of Genetics and Genomics, Boston University Schools of Medicine and Public Health, Boston, MA, USA,Department of Epidemiology, Boston University Schools of Medicine and Public Health, Boston, MA, USA
| | - G D Schellenberg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - P S George-Hyslop
- Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada,Department of Medicine, University Health Network, Toronto, Ontario, Canada,Department of Clinical Neurosciences, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - R Mayeux
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA,The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Epidemiology, School of Public Health, Columbia University, New York, NY, USA,Gertrude H. Sergievsky Center, Columbia University, 630 West 168th Street, New York, NY 10032, USA. E-mail:
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9
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Abstract
Recurrent aphthous stomatitis (RAS) is the most common idiopathic intraoral ulcerative disease in the USA. Aphthae typically occur in apparently healthy individuals, although an association with certain systemic diseases has been reported. Despite the unclear etiopathogenesis, new drug trials are continuously conducted in an attempt to reduce pain and dysfunction. We investigated four controversial topics: (1) Is complex aphthosis a mild form of Behçet's disease (BD)? (2) Is periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome a distinct medical entity? (3) Is RAS associated with other systemic diseases [e.g., celiac disease (CD) and B12 deficiency]? (4) Are there any new RAS treatments? Results from extensive literature searches, including a systematic review of RAS trials, suggested the following: (1) Complex aphthosis is not a mild form of BD in North America or Western Europe; (2) Diagnostic criteria for PFAPA have low specificity and the characteristics of the oral ulcers warrant further studies; (3) Oral ulcers may be associated with CD; however, these ulcers may not be RAS; RAS is rarely associated with B12 deficiency; nevertheless, B12 treatment may be beneficial, via mechanisms that warrant further study; (4) Thirty-three controlled trials published in the past 6 years reported some effectiveness, although potential for bias was high.
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Affiliation(s)
- L Baccaglini
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL 32610-3628, USA.
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10
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Abstract
Recurrent aphthous stomatitis (RAS) is the most common idiopathic intraoral ulcerative disease in the USA. Aphthae typically occur in apparently healthy individuals, although an association with certain systemic diseases has been reported. Despite the unclear etiopathogenesis, new drug trials are continuously conducted in an attempt to reduce pain and dysfunction. We investigated four controversial topics: (1) Is complex aphthosis a mild form of Behçet's disease (BD)? (2) Is periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome a distinct medical entity? (3) Is RAS associated with other systemic diseases [e.g., celiac disease (CD) and B12 deficiency]? (4) Are there any new RAS treatments? Results from extensive literature searches, including a systematic review of RAS trials, suggested the following: (1) Complex aphthosis is not a mild form of BD in North America or Western Europe; (2) Diagnostic criteria for PFAPA have low specificity and the characteristics of the oral ulcers warrant further studies; (3) Oral ulcers may be associated with CD; however, these ulcers may not be RAS; RAS is rarely associated with B12 deficiency; nevertheless, B12 treatment may be beneficial, via mechanisms that warrant further study; (4) Thirty-three controlled trials published in the past 6 years reported some effectiveness, although potential for bias was high.
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Affiliation(s)
- L Baccaglini
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL 32610-3628, USA.
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Brewer JD, Ekdawi NS, Torgerson RR, Camilleri MJ, Bruce AJ, Rogers RS, Maguire LJ, Baratz KH. Lichen planus and cicatricial conjunctivitis: disease course and response to therapy of 11 patients. J Eur Acad Dermatol Venereol 2010; 25:100-4. [DOI: 10.1111/j.1468-3083.2010.03693.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wu PY, Hanlon M, Eddins M, Tsui C, Rogers RS, Jensen JP, Matunis MJ, Weissman AM, Wolberger CP, Pickart CM. A conserved catalytic residue in the ubiquitin-conjugating enzyme family. EMBO J 2007. [DOI: 10.1038/sj.emboj.7601829] [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: 11/09/2022] Open
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14
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Tonkovic-Capin V, Galbraith SS, Rogers RS, Binion DG, Yancey KB. Cutaneous Crohn's disease mimicking Melkersson-Rosenthal syndrome: treatment with methotrexate. J Eur Acad Dermatol Venereol 2006; 20:449-52. [PMID: 16643147 DOI: 10.1111/j.1468-3083.2006.01458.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A woman with a 5-year history of unilateral orofacial granulomatosis required repeated evaluations (including sequential colonoscopies) to establish the diagnosis of cutaneous Crohn's disease, a condition that proved responsive to low doses of oral methotrexate administered weekly. To our knowledge this is the first report describing the use of methotrexate for treatment of orofacial granulomatosis caused by underlying Crohn's disease.
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Affiliation(s)
- V Tonkovic-Capin
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA.
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15
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Abstract
We describe a 25-year-old Caucasian man with a 13-year history of inflammatory Crohn's disease (CD) who was suffering recurrent severe oral and esophageal ulcerations for the past 3 years. His CD had been treated with infliximab infusions among other medications. The loss of efficacy was confirmed by antibodies to infliximab (ATI) and serum infliximab tests that showed high levels of ATIs and undetectable levels of infliximab respectively. These findings were consistent with significant immunogenic response to infliximab leading to loss of effect. Infliximab infusions and prednisone were discontinued and treatment of the CD was instituted with adalimumab, a human anti-tumor necrosis factor (TNF)-alpha biologic agent, to control the inflammatory small intestinal disease and dapsone for the oral and esophageal CD ulcerations. The patient's oral and esophageal lesions as well as the enteric CD are under control after 5 months of therapy.
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Affiliation(s)
- A R Sánchez
- Division of Periodontics, Department of Dental Specialties, Mayo Clinic, Mayo Building, Rochester, MN 55905, USA.
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Rogers RS, Graziottin TM, Lin CS, Kan YW, Lue TF. Intracavernosal vascular endothelial growth factor (VEGF) injection and adeno-associated virus-mediated VEGF gene therapy prevent and reverse venogenic erectile dysfunction in rats. Int J Impot Res 2003; 15:26-37. [PMID: 12605238 DOI: 10.1038/sj.ijir.3900943] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.5] [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: 11/09/2022]
Abstract
Penile veno-occlusive dysfunction (venogenic erectile dysfunction) is a common cause of erectile dysfunction (ED). We investigated whether vascular endothelial growth factor (VEGF) can be used to prevent and reverse venogenic ED in a rat model. Pharmacological cavernosometry was developed and validated using adult male rats with either arteriogenic or venogenic ED. Castrated animals were treated with intracavernous VEGF as either a recombinant protein (C+VEGF) or adeno-associated virus (AAV)-mediated VEGF gene therapy (C+VEGF gene) in an attempt to prevent the development of venogenic ED. Other animal groups received testosterone replacement (C+testosterone) or intracavernous AAV-LacZ gene (C+LacZ). Animals with documented venogenic ED were treated with intracavernous VEGF in an attempt to reverse their ED. Functional analysis (pharmacological infusion cavernosometry) was performed following treatment. Penile specimens were harvested for immunohistochemistry and electron microscopic evaluation. Castrated rats showed a decrease in papaverine-induced intracavernous pressure and an increase in maintenance and drop rates during pharmacological cavernosometry. These changes were prevented by systemic testosterone and intracavernous VEGF or AAV-VEGF therapy. Moreover, intracavernous VEGF was able to reverse the venogenic ED produced by castration. The quantity of penile smooth muscle detected by alpha actin staining decreased after castration but not in the C+T, C+VEGF, or C+VEGF gene groups. Transmission electron microscopy revealed atrophy of penile smooth muscle cells and nerves in the castrated rats. In VEGF-treated rats, regeneration of smooth muscle and nerves as well as endothelial cell hypertrophy and hyperplasia were the prominent features. In our animal model, systemic testosterone replacement or intracavernous VEGF (protein and VEGF gene) prevented the veno-occlusive dysfunction in castrated animals. In rats with established venous leakage, VEGF treatment reversed the cavernosometric findings of leakage. Intracavernous injection of either VEGF protein or VEGF gene may be a preferred therapy to preserve erectile function in patients in whom testosterone therapy is contraindicated.
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Affiliation(s)
- R S Rogers
- Knuppe Molecular Urology Laboratory, Department of Urology, University of California School of Medicine, 94143, USA
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18
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Abstract
Copper metallochaperones represent a new family of soluble, low-molecular-weight proteins that function to deliver copper to specific sites within a cell. How the metallochaperones acquire their copper, however, is not known. In this study, we have conducted a survey of known metal ion transporters in bakers' yeast, Saccharomyces cerevisiae, to identify those that contribute copper to pathways involving the metallochaperones Atxlp and Lys7p. The results indicatethat, in addition to the well known Ctr1p and Ctr3p high-affinity copper transporters, the metallochaperones can acquire their copper through pathways involving the relatively non-specific divalent metal ion transporter Fet4p and the putative low-affinitycopper transporter Ctr2p. We have examined the localization of Ctr2p using an epitope tagged version of the protein and find that Ctr2p does not localize to the cell surface but may operate at the level of the vacuole to mobilize intracellular copper. Inaddition to Ctrlp, Ctr2p, Ctr3p and Fet4p, other metal transport systems can act as upstream donors of copper for the metallochaperones when copper availability in the medium is increased. Although the nature of these auxiliary systems is unknown, they do not appear to involve the yeast members of the Nramp family of divalent transporters, or uptake mechanisms that involve endocytosis. Since vastly different metal transporters located at either the cell surface or intracellular sites can all contribute copper to metallochaperones, it is unlikely that the metallochaperones directly interact with the metal transporters to obtain the metal.
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Affiliation(s)
- M E Portnoy
- Department of Biochemistry, Johns Hopkins University School of Public Health, Baltimore, MD 21205, USA
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19
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Abstract
BACKGROUND Erythema multiforme (EM) is a complex disease that may have cutaneous and/or mucosal involvement. The severity may range from mild to severe and potentially life threatening. The literature cites many factors including viruses, infections, and medications as causes. This report documents a patient who developed EM secondary to a herpes simplex viral (HSV) infection. METHODS Two weeks following an eruption of herpes labialis, a 20-year-old white female patient developed acutely painful oral and labial ulcers accompanied by target skin lesions. A diagnosis of erythema multiforme (EM) was made. The patient was treated with antivirals, analgesics, and symptomatic therapy. RESULTS Nine days after the onset of symptoms, the oral and cutaneous lesions had started to heal and the patient no longer required pain medication. CONCLUSIONS Although the etiology of EM is still often unknown, infections with herpes simplex virus have been implicated as a possible precipitating factor. This case illustrates the association of the occurrence of EM with an HSV infection.
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Affiliation(s)
- L Ayangco
- Department of Dental Specialties, Mayo Clinic, Rochester, MN 55905, USA
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Sabet HY, Davis JL, Rogers RS. Mucous membrane pemphigoid, thymoma, and myasthenia gravis. Int J Dermatol 2000; 39:701-4. [PMID: 11044197] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- H Y Sabet
- Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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Talley JJ, Brown DL, Carter JS, Graneto MJ, Koboldt CM, Masferrer JL, Perkins WE, Rogers RS, Shaffer AF, Zhang YY, Zweifel BS, Seibert K. 4-[5-Methyl-3-phenylisoxazol-4-yl]- benzenesulfonamide, valdecoxib: a potent and selective inhibitor of COX-2. J Med Chem 2000; 43:775-7. [PMID: 10715145 DOI: 10.1021/jm990577v] [Citation(s) in RCA: 504] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J J Talley
- Searle Research and Development, 700 Chesterfield Parkway, St. Louis, Missouri 63198, USA.
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Affiliation(s)
- R S Rogers
- Department of Dermatology, Mayo Medical School, Rochester, MN 55905, USA
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Abstract
OBJECTIVE To describe the demographics, presentation, and outcome in patients with erythromelalgia--a rare and poorly understood clinical syndrome defined by the triad of red, hot, painful extremities. DESIGN Retrospective medical record review with follow-up by survey questionnaire. SETTING Large tertiary care medical center. SUBJECTS Patients with erythromelalgia examined at the Mayo Clinic, Rochester, Minn, between 1970 and 1994. INTERVENTION The medical records of 168 patients were analyzed. Follow-up data, which consisted of answers to 2 survey questionnaires or the most recent information in the medical record from patients still alive and death certificates or reports of death for those deceased patients, were obtained for all but 13 patients. MAIN OUTCOME MEASURES Survival, morbidity, and quality of life. RESULTS All patients were white; 122 (72.6%) were female, and 46 (27.4%) were male. At presentation, the patients' mean age was 55.8 years (age range, 5-91 years). Symptoms had been present since childhood in 7 patients (4.2%). Six patients (3.6%) had a first-degree relative with erythromelalgia. Symptoms were intermittent in 163 patients (97.0%) and constant in 5 (3.0%). Symptoms predominantly involved feet (148 patients [88.1%]) and hands (43 patients [25.6%]). Kaplan-Meier survival curves revealed a significant decrease in survival compared with that expected in persons of similar age and of the same sex (P<.001). After a mean follow-up of 8.7 years (range, 1.3-20 years), 30 patients (31.9%) reported worsening of, 25 (26.6%) no change in, 29 (30.9%) improvement in, and 10 (10.6%) complete resolution of the symptoms. On a standard health status questionnaire, scores for all but one of the health domains were significantly diminished in comparison with those in the US general population. CONCLUSION Erythromelalgia is a syndrome with significantly increased mortality and morbidity compared with the US general population.
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Affiliation(s)
- M D Davis
- Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA
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25
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Abstract
BACKGROUND The concept of contact allergy aggravating or inducing oral lichenoid mucositis diagnosed as oral lichen planus (OLP) is well recognized but somewhat controversial. OBJECTIVE We sought to identify clinically relevant contact allergens that may be important in the management of patients with OLP. METHODS We retrospectively reviewed patients with OLP who had patch tests performed at Mayo Clinic Rochester and Mayo Clinic Scottsdale from 1994 to 1997 and 1988 to 1997, respectively. RESULTS Patch tests were performed on 46 patients with a clinical and histopathologic diagnosis of OLP. Of these, 25 (54%) had positive patch test results. Eighteen (72%) of the patients with positive results had clinically relevant reactions. Of the patients with positive metal reactions, 5 had improvement after removal of the metal prosthesis or restoration. Six others noted that their most troublesome areas were adjacent to metal dental restorations. Six patients with reactions to flavorings and one patient with an acrylate dental retainer sensitivity had improvement after avoiding these allergens. CONCLUSION Our findings support the concept that contact allergy to metals, flavorings, and plastics can be important in the pathogenesis and management of patients with oral lichenoid mucositis diagnosed as OLP.
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Affiliation(s)
- J A Yiannias
- Department of Dermatology, Mayo Clinic Scottsdale, Arizona 85259, USA
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Sandroni P, Davis MD, Harper CM, Rogers RS, Harper CM, Rogers RS, Oʼfallon WM, Rooke TW, Low PA. Neurophysiologic and vascular studies in erythromelalgia: a retrospective analysis. J Clin Neuromuscul Dis 1999; 1:57-63. [PMID: 19078553 DOI: 10.1097/00131402-199912000-00001] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Erythromelaigia is a poorly understood clinical syndrome characterized by painful, hot, red extremities. We assessed the frequency and types of abnormalities observed during tests of vascular, peripheral neurophysiologic, and autonomic function in patients with erythromelalgia.Methods Of" 163 charts of patients fulfilling the clinical diagnosis of erythromelalgia. 93 patients underwent vascular studies Five of them had detailed vascular studies in 10 affected lower extremities performed before and during symptoms, fifty-four patients underwent neurophysiologic testing, 27 had autonomic reflex screening (ARS). and two had recordings of peripheral autonomic surface potentials (PASP).Results. Measurements in the toes during symptoms revealed a mean temperature increase of 11.6 C (P = 0,00011 along with a laser flow increase from a mean of 6.8 mL/min per 100 g tissue to 76.5 mL/min per 100 g tissue (P<.0.0001). Baseline TcPO; in the feet decreased by 6.7 mmHg (P = 0.032) during symptoms. Twenty-one of 54 electromyographic recordings were abnormal: all fulfilled the criteria for axonal neuropathy. Seventeen of 27 ARSs and one PASP showed severe postganglionic sudomotor impairment; five of 17 additionally had peripheral adrenergic dysfunction.Conclusions During symptoms, an increase in flow and temperature is accompanied paradoxically by a decrease in oxygenation of the affected area; a high proportion of patients have a distal small fiber neuropathy with selective involvement of cutaneous sympathetic fibers; in addition, large fiber neuropathy is often present.
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Affiliation(s)
- P Sandroni
- From the *Department of Neurology, daggerDepartment of Dermarology, the double dagger Section of Biostatistics, and the Gonada Vascular Center, Mayo Clinic and Mayo foundation Rochester, MN
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Abstract
OBJECTIVE To review a series of patients with a burning or sore mouth for elucidation of associated conditions and treatment outcome. MATERIAL AND METHODS We retrospectively studied 70 consecutive patients with a burning or sore mouth who were encountered at a tertiary-care center between 1979 and 1992. Clinical and laboratory findings were summarized, and follow-up data were analyzed. RESULTS The study cohort of 56 women and 14 men had a mean age of 59 years. They had had a burning or sore mouth for a mean duration of 2.5 years. Multiple etiologic factors for the burning or sore mouth were present in 37% of the study subjects. The most frequently associated conditions were psychiatric disease (30%), xerostomia (24%), geographic tongue (24%), nutritional deficiencies (21%), and allergic contact stomatitis (13%). With a treatment course tailored to the suspected causal factor, 72% of the patients who had follow-up reported improvement. CONCLUSION With a directed investigation, one or more causes could be identified in most patients who had a burning or sore mouth. Successful management of these symptoms was possible in a majority of the patients.
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Affiliation(s)
- L A Drage
- Department of Dermatology, Mayo Clinic Rochester, MN 55905, USA
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Affiliation(s)
- S J Meraw
- Department of Dentistry, Mayo Clinic, Rochester, Minnesota 55905-0001, USA
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Alonso-Llamazares J, Rogers RS, Oursler JR, Calobrisi SD. Bullous pemphigoid presenting as generalized pruritus: observations in six patients. Int J Dermatol 1998; 37:508-14. [PMID: 9679691] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Bullous pemphigoid is a chronic immunobullous disease of the elderly. Classically, tense, pruritic blisters develop on normal or erythematous skin. These may be preceded by a prodromal pruritic, urticarial, or eczematous eruption. Occasionally, patients may develop generalized pruritus without blisters as a prodrome of bullous pemphigoid. METHODS The records of the patients were reviewed. Biopsy specimens were studied by light and immunofluorescence microscopy. Serum specimens were studied by indirect immunofluorescence techniques including the salt-split skin technique. RESULTS We studied six elderly patients presenting with generalized pruritus as the dominant or single presenting feature of early bullous pemphigoid. Two of the six had rare vesicles at presentation. All had excoriations and one each presented with minimal urticarial or eczematous papules. Routine skin biopsies were largely nonspecific. All patients had confirmation of their diagnosis by either indirect or direct immunofluorescence testing or both. All six patients had their disease completely controlled by their treatment. CONCLUSIONS The clinical presentation of the six patients in our series and the eight previously reported patients should be regarded as an unusual prodromal manifestation of bullous pemphigoid characterized by generalized pruritus without primary skin lesions. This presentation could be described as "pruritic pemphigoid," because it joins the remarkable clinical finding of generalized pruritus with the underlying diagnosis of bullous pemphigoid. Elderly patients with severe or persistent unexplained generalized pruritus merit immunofluorescence testing to exclude bullous pemphigoid as the cause of the generalized pruritus. Establishing an early diagnosis permits the prompt institution of effective therapy with dapsone or systemic corticosteroids with an excellent prognosis for complete control of the disease.
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Davis MD, Daoud MS, Kirby B, Gibson LE, Rogers RS. Clinicopathologic correlation of hypocomplementemic and normocomplementemic urticarial vasculitis. J Am Acad Dermatol 1998; 38:899-905. [PMID: 9631995] [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: 02/07/2023]
Abstract
BACKGROUND Urticarial vasculitis is characterized by persistent urticarial lesions with histologic evidence of leukocytoclastic vasculitis. Hypocomplementemic urticarial vasculitis (HUV) is a distinct clinical entity in a subset of patients with urticarial vasculitis. OBJECTIVE We examined presentation of urticarial vasculitis and factors predictive of connective tissue disease. METHODS The clinical, histologic, and immunologic characteristics of 132 patients with urticarial vasculitis seen at the Mayo Clinic were examined, and features of the hypocomplementemic patients were compared with those of the normocomplementemic patients. RESULTS Twenty-four patients (18%) had hypocomplementemia; all were female. Interstitial dermal neutrophilia was seen in 19 biopsy specimens (83%). On direct immunofluorescence (DIF) testing of lesional skin, 23 patients (96%) had a continuous strong granular deposition of immunoreactants along the basement membrane zone compatible with lupus erythematosus in addition to vascular fluorescence. Systemic lupus erythematosus (SLE) was present or occurred in 13 (54%). One hundred eight patients (82%) had normocomplementemia; 65 (60%) were female. Interstitial dermal neutrophilia was seen in 11 of 26 (42%) randomly selected biopsy specimens. On DIF, one patient (1%) had the lupus band. SLE occurred in three patients (3%). CONCLUSION Patients with HUV were more likely to be female, to have diffuse neutrophilia on biopsy specimens stained with hematoxylin and eosin, to have continuous strong granular deposition of immunoreactants along the basement membrane zone on DIF, and to have SLE than normocomplementemic patients. We submit that HUV represents a subset of SLE with shared clinical, laboratory, and immunologic features.
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Affiliation(s)
- M D Davis
- Department of Dermatology, Mayo Clinic and Mayo Foundation Rochester, Minnesota 55905, USA
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Morey AF, McAninch JW, Duckett CP, Rogers RS. American Urological Association symptom index in the assessment of urethroplasty outcomes. J Urol 1998; 159:1192-4. [PMID: 9507830] [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: 02/06/2023]
Abstract
PURPOSE In men undergoing urethroplasty we used the American Urological Association (AUA) symptom index to assess the magnitude of symptoms and determine the validity of this index as an outcome assessment tool. MATERIALS AND METHODS The AUA symptom index was completed by individual interview of 50 men a mean of 41 years old who underwent urethral reconstruction. Symptom scores were then correlated with radiographic retrograde urethrograms and urinary flow rates to determine whether changes in the score were consistent with these other clinical indicators of success or failure. RESULTS Mean preoperative AUA symptom index score in all evaluable patients was 26.9 (maximum 35), indicating severely bothersome voiding symptoms. In patients with radiographic evidence of successful urethral reconstruction the average postoperative score was 5.1 (p <0.0001). In those with recurrent stricture after urethroplasty scores were essentially unchanged but after successful repeat urethroplasty the mean symptom index score decreased to 3.4 (p <0.0001). A statistically significant inverse correlation (r = -0.712, p <0.0001) was found between AUA symptom index scores and maximum urinary flow rates. CONCLUSIONS Patients with urethral strictures who are selected for formal urethroplasty have severe obstructive and irritative voiding symptoms. Results of the AUA symptom index correlate closely with conventional measures of urethroplasty outcome, such as radiographic retrograde urethrography and urinary flow studies. The AUA symptom index appears to have clinical validity as an adjunctive outcome assessment tool after urethroplasty.
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Affiliation(s)
- A F Morey
- Department of Urology, University of California School of Medicine and San Francisco General Hospital, 94110, USA
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Davis MDP, Sandroni P, Harper CM, Rogers RS, O'Fallon WM, Rooke TW, Low PA. Neurophysiologic and vascular studies in erythromelalgia: A retrospective analysis. J Dermatol Sci 1998. [DOI: 10.1016/s0923-1811(98)83707-9] [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: 12/01/2022]
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Abstract
Drug-induced linear IgA bullous disease most commonly occurs after exposure to vancomycin, but other medications may also trigger the eruption. We describe a 78-year-old man with linear IgA bullous disease related to treatment with phenytoin.
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Affiliation(s)
- J M Acostamadiedo
- Department of Internal Medicine, Mayo Clinic Jacksonville, Florida 32224, USA
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Abstract
The vermilion of the lips was conceptualized by Jean Darier as the semi-mucosa. The anatomy of the lips is transitional from skin to mucous membrane. This article emphasizes inflammatory diseases of the lips known as cheilitis. Angular cheilitis is a reactive process with several possible causes, including infections, mechanical, nutritional deficiency, and various dermatoses. Contact cheilitis may be caused by a primary irritant or a delayed hypersensitivity allergic reaction to contactants. Plasma cell cheilitis is a reactive periorificial mucositis. Exfoliative cheilitis is also a reactive process, probably secondary to factitious activity of the patient. Cheilitis glandularis is a chronic inflammatory disorder of the labial salivary glands and their ducts. There are three forms: simple, superficial suppurative, and deep suppurative. A premalignant potential is present in cheilitis glandularis. Cheilitis granulomatosa is one manifestation of orofacial granulomatosis. The granulomatous conditions of Melkersson-Rosenthal syndrome, sarcoidosis, and Crohn's disease may be associated with cheilitis granulomatosa or it may stand alone as Miescher's cheilitis. Actinic cheilitis is another premalignant form of cheilitis that is amenable to a variety of therapeutic modalities.
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Affiliation(s)
- R S Rogers
- Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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35
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Abstract
Recurrent aphthous stomatits (RAS) is also known as recurrent oral ulcers, recurrent aphthous ulcers, or simple or complex aphthosis. RAS is the most common inflammatory ulcerative condition of the oral mucosa in North American patients. RAS has been the subject of active investigation along multiple lines of research including epidemiology, immunology, clinical correlations and therapy. Clinical evaluation of the patient requires correct diagnosis of RAS and classification of the disease based on morphology (MIAU, MJAU, HU) and severity (simple versus complex). In order to properly diagnose and treat a patient with lesions of RAS, the clinician must exclude other causes of acute oral ulcers. Complex aphthosis and complex aphthosis variants associated with systemic disorders should be considered. The aphthous-like oral ulcerations of patients with HIV disease represent a challenging differential diagnosis. The association of lesions of RAS with hematinic deficiencies and gastrointestinal diseases provides an opportunity to identify a "correctable cause" which, with appropriate treatment, can result in a remission or substantial lessening of disease activity. Finally, when all of these factors are considered, the evaluation of the patient for Behçet's disease can be continued on firm grounds that one of the major criteria for the diagnosis of Behçet's disease has been met.
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Affiliation(s)
- R S Rogers
- Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905-0001, USA
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36
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Abstract
Recurrent aphthous stomatitis (RAS), commonly known as canker sores, has been reported as recurrent oral ulcers, recurrent aphthous ulcers, or simple or complex aphthosis. RAS is the most common inflammatory ulcerative condition of the oral mucosa in North American patients. One of its variants is the most painful condition of the oral mucosa. Recurrent aphthous stomatitis has been the subject of active investigation along multiple lines of research, including epidemiology, immunology, clinical correlations, and therapy. Clinical evaluation of the patient requires correct diagnosis of RAS and classification of the disease based on morphology (MiAU, MjAU, HU) and severity (simple versus complex). The natural history of individual lesions of RAS is important, because it is the bench mark against which treatment benefits are measured. The lesions of RAS are not caused by a single factor but occur in an environment that is permissive for development of lesions. These factors include trauma, smoking, stress, hormonal state, family history, food hypersensitivity and infectious or immunologic factors. The clinician should consider these elements of a multifactorial process leading to the development of lesions of RAS. To properly diagnose and treat a patient with lesions of RAS, the clinician must identify or exclude associated systemic disorders or "correctable causes." Behçet's disease and complex aphthosis variants, such as ulcus vulvae acutum, mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome, fever, aphthosis, pharyngitis, and adenitis (FAPA) syndrome, and cyclic neutropenia, should be considered. The aphthous-like oral ulcerations of patients with human immunodeficiency virus (HIV) disease represent a challenging differential diagnosis. The association of lesions of RAS with hematinic deficiencies and gastrointestinal diseases provides an opportunity to identify a "correctable cause," which, with appropriate treatment, can result in a remission or substantial lessening of disease activity.
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MESH Headings
- AIDS-Related Opportunistic Infections/diagnosis
- Behcet Syndrome/diagnosis
- Cartilage Diseases/diagnosis
- Communicable Diseases
- Deficiency Diseases/complications
- Dental Research
- Diagnosis, Differential
- Disease
- Fever/diagnosis
- Food Hypersensitivity/complications
- Gastrointestinal Diseases/complications
- Hormones/physiology
- Humans
- Lymphadenitis/diagnosis
- Mouth Mucosa/injuries
- Neutropenia/diagnosis
- North America
- Oral Ulcer/diagnosis
- Pain/physiopathology
- Pharyngitis/diagnosis
- Recurrence
- Smoking/adverse effects
- Stomatitis, Aphthous/classification
- Stomatitis, Aphthous/complications
- Stomatitis, Aphthous/diagnosis
- Stomatitis, Aphthous/epidemiology
- Stomatitis, Aphthous/genetics
- Stomatitis, Aphthous/immunology
- Stomatitis, Aphthous/physiopathology
- Stomatitis, Aphthous/therapy
- Stress, Physiological/complications
- Syndrome
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Affiliation(s)
- R S Rogers
- Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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37
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Penning TD, Talley JJ, Bertenshaw SR, Carter JS, Collins PW, Docter S, Graneto MJ, Lee LF, Malecha JW, Miyashiro JM, Rogers RS, Rogier DJ, Yu SS, Burton EG, Cogburn JN, Gregory SA, Koboldt CM, Perkins WE, Seibert K, Veenhuizen AW, Zhang YY, Isakson PC. Synthesis and biological evaluation of the 1,5-diarylpyrazole class of cyclooxygenase-2 inhibitors: identification of 4-[5-(4-methylphenyl)-3-(trifluoromethyl)-1H-pyrazol-1-yl]benze nesulfonamide (SC-58635, celecoxib). J Med Chem 1997; 40:1347-65. [PMID: 9135032 DOI: 10.1021/jm960803q] [Citation(s) in RCA: 1550] [Impact Index Per Article: 57.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A series of sulfonamide-containing 1,5-diarylpyrazole derivatives were prepared and evaluated for their ability to block cyclooxygenase-2 (COX-2) in vitro and in vivo. Extensive structure-activity relationship (SAR) work was carried out within this series, and a number of potent and selective inhibitors of COX-2 were identified. Since an early structural lead (1f, SC-236) exhibited an unacceptably long plasma half-life, a number of pyrazole analogs containing potential metabolic sites were evaluated further in vivo in an effort to identify compounds with acceptable pharmacokinetic profiles. This work led to the identification of 1i (4-[5-(4-methylphenyl)-3-(trifluoromethyl)- H-pyrazol-1-yl]benzenesulfonamide, SC-58635, celecoxib), which is currently in phase III clinical trials for the treatment of rheumatoid arthritis and osteoarthritis.
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Affiliation(s)
- T D Penning
- Department of Chemistry, Searle Research and Development, Skokie, Illinois 60077, USA
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38
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Abstract
To demonstrate the need for a through cutaneous and mucosal examination, we discuss and illustrate the spectrum of mucosal melanomas and unusual clinical variants of melanoma. Although cutaneous areas exposed to sunlight are most vulnerable, melanomas can occur in any site on the skin or mucous membranes. Pigmented nevi as well as mucosal and labial melanotic macules are lesions that simulate oral mucosal melanomas but are not associated with such a poor prognosis. In contrast, the 5-year survival rate for patients with malignant melanomas of the oral mucosa is only 5%. Similarly, the prognosis is poor for patients who have malignant melanomas of the vulva, vagina, male genitalia, or anorectal area; most patients with such lesions are 50 years of age or older. Subungual and plantar areas are common sites of malignant melanomas, and involvement of the eyelid margin portends a poor prognosis. Other rare variants-desmoplastic, amelanotic, and polypoid malignant melanomas-are associated with local recurrences and metastatic lesions. Early diagnosis is the key to proper treatment and improved survival rate for patients with these unusual variants of melanoma. Increased awareness of the wide variety of clinical features of melanoma should lead to earlier diagnosis.
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Affiliation(s)
- R S Rogers
- Department of Dermatology, Mayo Clinic Rochester, MN 55905, USA
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39
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Abstract
The Melkersson-Rosenthal syndrome is a rare disorder of unknown etiology characterized by a triad of recurrent orofacial swelling, relapsing facial paralysis, and fissured tongue. Exacerbations and recurrences are common. The orofacial swelling is characterized by fissured, reddish-brown, swollen, nonpruritic lips or firm edema of the face. The facial palsy is indistinguishable from Bell's palsy. The fissured tongue is seen in one third to one half of patients and, although the least common manifestation, its presence assists in diagnosis. The classic triad is not seen frequently in its complete form; therefore, diagnosis is difficult. This is particularly true because monosymptomatic and oligosymptomatic variants are seen more commonly. Cheilitis granulomatosa of Miescher is an example of a monosymptomatic variant of the Melkersson-Rosenthal syndrome. The histologic findings of noncaseating, sarcoidal granulomas support the diagnosis. These granulomas are not invariably present, and their absence does not exclude the diagnosis of the Melkersson-Rosenthal syndrome. Thus, the Melkersson-Rosenthal syndrome is a disease with elements of orofacial granulomatosis. Orofacial granulomatosis is a clinicopathologic entity describing oral lesions with noncaseating granulomas. The spectrum of this entity includes patients with oral Crohn's disease, patients with oral lesions who will develop typical bowel symptoms of Crohn's disease in the ensuing months to years, patients with tooth-associated infections, patients with sarcoidosis, and patients with food or contact allergies. The value of the clinicopathologic construct of orofacial granulomatosis is to provoke the careful search for provocative causes for the reactive symptom complex of the Melkersson-Rosenthal syndrome.
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Affiliation(s)
- R S Rogers
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
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40
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Benbrook DM, Rogers RS, Medlin MA, Dunn ST. Immunohistochemical analysis of proliferation and differentiation in organotypic cultures of cervical tumor cell lines. Tissue Cell 1995; 27:269-74. [PMID: 7645007 DOI: 10.1016/s0040-8166(95)80047-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Researchers have previously demonstrated that organotypic cultures of cervical tumor cell lines exhibit morphological characteristics similar to the in vivo biopsies from which they were derived (Rader et al., 1990). Both the in vivo biopsy and organotypic culture appeared undifferentiated. We have extended these studies with immunohistochemical analysis using the proliferation and differentiation markers, proliferating cell nuclear antigen (PCNA) and involucrin, respectively, to evaluate in more detail the ability of cervical tumor cell lines to differentiate in organotypic culture. An HPV-immortalized keratinocyte cell line, PE-4, expressed PCNA in the lower half and involucrin in the upper half of the organotypic culture which is consistent with the characteristics of a preneoplastic lesion in vivo. The CC-1 cell line, derived from an invasive squamous cell carcinoma, appeared undifferentiated, but expressed involucrin in the upper half of the organotypic culture. This is the first observation of expression of a differentiation marker in an organotypic culture of a cervical tumor cell line. The other cervical tumor cell lines, SiHa and HeLa, derived from a squamous cell carcinoma, and an adenocarcinoma of the cervix, respectively, did not express detectable levels of involucrin or mucin. All three cervical tumor cell lines, CC-1, SiHa and HeLa, expressed PCNA throughout their entire thickness. The majority of nuclei in SiHa and HeLa cultures were PCNA-positive, while the CC-1 cell line exhibited a lower growth fraction.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D M Benbrook
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA
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41
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Abstract
Melkersson-Rosenthal syndrome is a triad of recurrent orofacial swelling, relapsing facial paralysis, and fissured tongue. However, the classic triad is not frequently seen in its complete form. Monosymptomatic and oligosymptomatic forms are more common. The histological findings of sarcoid-like granuloma in skin or mucosal biopsy specimens support the diagnosis. The course is chronic but benign. Treatment is difficult, but intralesional or systemic corticosteroids may be helpful.
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Affiliation(s)
- M S Daoud
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA
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42
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Abstract
BACKGROUND Cicatricial pemphigoid (CP) (benign mucous membrane pemphigoid) is a rare, blistering disease of skin and mucous membrane. The disease rarely extends to involve the esophagus, and there are only a few cases reported in the radiological literature. The aims of this study were to document the frequency of esophageal involvement and to describe the findings on upper GI barium studies. METHODS A total of 197 patients with CP were seen at our institution from 1981 to 1991. The clinical and radiological findings of these patients were reviewed and compared with findings reported in the literature. RESULTS Esophageal involvement was documented in seven patients. Cervical esophageal webs were found in five of the seven patients. Two patients had single esophageal webs while three had multiple webs. Frank strictures of the esophagus were also seen in five patients. These were most common in the cervical esophagus, but strictures were also found in the mid and lower esophagus. Two of the strictures resulted in significant dysphagia and required multiple endoscopic dilatations. One of the dilatations was complicated by mucosal injury, and follow-up barium examination showed dissection of the esophageal mucosa from the cervical esophagus to the esophagogastric junction. One patient demonstrated intramural pseudodiverticulosis in the cervical esophagus. Functional disturbances demonstrated on barium studies included tracheal aspiration in two patients and nasopharyngeal reflux in three. CONCLUSIONS CP involves the esophagus in approximately 5% of cases. The hypopharynx and cervical esophagus are most commonly involved, but any portion of the esophagus may be involved, and multiple levels of involvement may be seen. Cervical esophageal webs, often multiple or complex, are the most common appearance on barium studies, but frank strictures are also found. Secondary manifestations of esophageal involvement include nasopharyngeal reflux, tracheal aspiration, and intramural pseudodiverticulosis.
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Affiliation(s)
- M F Naylor
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA
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43
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Su WP, Perniciaro C, Rogers RS, White JW. Chilblain lupus erythematosus (lupus pernio): clinical review of the Mayo Clinic experience and proposal of diagnostic criteria. Cutis 1994; 54:395-9. [PMID: 7867381] [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: 01/27/2023]
Abstract
Five cases of chilblain lupus erythematosus were retrospectively reviewed regarding their clinical, histopathologic, serologic, and immunofluorescence findings. Ages at onset of chilblain lupus erythematosus varied from 26 to 73 years, with a female-to-male ratio of 3:2. Since other entities can be confused with this disorder, we propose the following diagnostic criteria. The two major criteria are skin lesions in acral locations induced by exposure to cold or a drop in temperature, and evidence of lupus erythematosus in the skin lesions by results of histopathologic examination or direct immunofluorescence study. The three minor criteria are coexistence of systemic lupus erythematosus or other skin lesions of discoid lupus erythematosus, response to anti-lupus erythematosus therapy, and negative results of cryoglobulin and cold agglutinin studies. We conclude that chilblain lupus erythematosus can be diagnosed and treated. Discoid lupus erythematosus lesions respond more quickly to treatment than chilblain lupus erythematosus lesions. Treatment with antimalarial agents, prednisone, pentoxifylline, or dapsone was of benefit to our patients.
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Affiliation(s)
- W P Su
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905
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44
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Abstract
BACKGROUND Direct immunofluorescence testing is frequently used to diagnose inflammatory mucosal disorders, but its accuracy relative to histologic and clinical diagnosis has not been reported. OBJECTIVE Our purpose was to compare diagnoses made on the basis of direct immunofluorescence, histologic features, and clinical impression and define optimal immunofluorescence criteria. METHODS Direct immunofluorescence findings and diagnostic impressions for 500 unselected mucosal biopsy specimens were recorded, as were the histologic diagnosis, initial clinical impression, and final diagnosis made on the basis of all studies and follow-up. Sensitivity and specificity were calculated for each parameter by diagnosis and site. RESULTS Direct immunofluorescence testing was superior for diagnosing pemphigus and pemphigoid and was slightly inferior to histologic evaluation for diagnosing lichen planus. Optimal criteria were IgG and C3 intercellular substance staining for pemphigus, linear C3 basement membrane zone deposits for pemphigoid, and shaggy fibrinogen basement membrane zone staining plus IgM cytoids for lichen planus. Direct immunofluorescence testing was diagnostic for several extraoral mucosal biopsy specimens. CONCLUSION Direct immunofluorescence is a valuable diagnostic tool for diseases of the oral mucosa and other mucosal sites.
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Affiliation(s)
- S D Helander
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905
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45
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Guitart J, McGillis ST, Bailin PL, Bergfeld WF, Rogers RS. Human papillomavirus-induced verrucous carcinoma of the mouth. Case report of an aggressive tumor. J Dermatol Surg Oncol 1993; 19:875-7. [PMID: 8396162 DOI: 10.1111/j.1524-4725.1993.tb01022.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- J Guitart
- Department of Dermatology, Cleveland Clinic Foundation, OH 44195
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46
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Bertenshaw SR, Rogers RS, Stern MK, Norman BH, Moore WM, Jerome GM, Branson LM, McDonald JF, McMahon EG, Palomo MA. Phosphorus-containing inhibitors of endothelin converting enzyme: effects of the electronic nature of phosphorus on inhibitor potency. J Med Chem 1993; 36:173-6. [PMID: 8421284 DOI: 10.1021/jm00053a023] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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47
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Zimmer WM, Rogers RS, Reeve CM, Sheridan PJ. Orofacial manifestations of Melkersson-Rosenthal syndrome. A study of 42 patients and review of 220 cases from the literature. Oral Surg Oral Med Oral Pathol 1992; 74:610-9. [PMID: 1437063 DOI: 10.1016/0030-4220(92)90354-s] [Citation(s) in RCA: 138] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We investigated orofacial manifestations in 42 patients with Melkersson-Rosenthal syndrome who were examined at our institution between 1965 and 1990. Patient histories and histologic and clinical findings were reviewed in detail. These data were compared with the oral findings in 220 cases that were reported in the literature between 1965 and 1990. There were 28 females in our study. The age at onset of signs and symptoms varied widely with a mean of 33.8 years. Most frequent initial signs were labial edema, facial swelling, and Bell's palsy. During the course of the disease, 75% of all patients had labial swelling, 50% had facial edema, and 33% had Bell's palsy. Swelling, erythema, or painful erosions that affected the gingiva, buccal mucosa, palate, or tongue were common intraoral symptoms. A comparison with patients reported in the literature revealed a similar frequency of extraoral symptoms but more prevalent intraoral symptoms in our patients.
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48
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Jorizzo JL, Salisbury PL, Rogers RS, Goldsmith SM, Shar GG, Callen JP, Wise CM, Semble EL, White WL. Oral lesions in systemic lupus erythematosus. Do ulcerative lesions represent a necrotizing vasculitis? J Am Acad Dermatol 1992; 27:389-94. [PMID: 1401272 DOI: 10.1016/0190-9622(92)70204-s] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND It has been suggested that oral lesions in patients with systemic lupus erythematosus (SLE) may be grouped clinically as erythema, discoid lesions, or oral ulcerations. Oral ulcerations have been said to foretell a severe systemic disease flare and the proposal that oral ulcers represent a mucosal vasculitis has been suggested to explain this hypothesis. OBJECTIVE Our objective was to test the hypothesis that oral ulcers in patients with SLE result from vasculitis. METHODS We studied 10 patients with American College of Rheumatology (ACR) criteria for a diagnosis of SLE who had oral lesions of lupus (six prospectively and four retrospectively) clinically and by routine and immunofluorescence microscopy. Biopsy specimens were reviewed in a single-blinded fashion. RESULTS In our patients, no oral lesion, regardless of morphology, demonstrated vasculitis histologically. All lesions demonstrated an interface mucositis. CONCLUSION Our data strongly contradict the hypothesis that leukocytoclastic vasculitis explains a possible unproven correlation between oral ulceration and disease flares in patients with SLE.
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Affiliation(s)
- J L Jorizzo
- Department of Dermatology, Bowman Gray School of Medicine, Winston-Salem, NC 27157-1071
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49
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Affiliation(s)
- D R Mehregan
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905
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50
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Abstract
Canker sores and cold sores are common, relatively banal diseases of the oral mucosa and lips, occurring most often in young persons. Some otherwise healthy patients may have a more severe variant, such as major aphthous ulcers, recurring lesions of aphthous stomatitis, or acute herpetic gingivostomatitis. Other patients may present with severe recurrent herpes simplex labialis or chronic oral candidiasis, and in these patients an immunodeficiency state must be considered.
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Affiliation(s)
- R S Rogers
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905
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