Drinking water from alternative water sources: differences in beliefs, social norms and factors of perceived behavioural control across eight Australian locations.

Australia is facing serious challenges in the management of water in various urban and regional locations. Two popular responses to these challenges are increasing supply through alternative water sources such as recycled and desalinated water. However, significant gaps exist in our knowledge of community attitudes to these alternative sources of water, particularly for potable use. This paper reports results from an Australian study of community attitudes to alternative water sources. Sixty six qualitative interviews were held at eight locations with distinctly different water situations. This paper explores all three antecedents to the behaviour of drinking recycled water and desalinated water as postulated by the Theory of Planned Behaviour: attitudes, social norms and factors of perceived behavioural control. Key results indicate that while people hold both positive and negative beliefs (mostly cost, health and environmental concerns) about water from alternative sources, nearly all of them are willing to drink it if the water crisis were to deteriorate further. People also feel they lack knowledge and state that information from scientists would influence their decision to drink recycled and desalinated water most. Friends and relatives are most influential in preventing people from drinking recycled water. The findings reported in this paper have major implications for water policy, and will be of particular interest to water engineers. The paper raises a provocative question: Is it better to avoid public consultation in introducing water from alternative sources?

Urban versus regional--how public attitudes to recycled water differ in these contexts.

This paper reports findings from a comparative study which investigated public attitudes to recycled water in two Australian locations both in the state of Victoria: the capital city, Melbourne, and Bendigo, an urban regional centre. Two commercial buildings were used as case studies, one at each location. These buildings will soon be using recycled water for non-potable uses. The study was facilitated by an on-line survey of future occupants of both buildings to gauge their attitudes to recycled water use. Specifically the paper reports on happiness/willingness to use recycled water for various uses and attitudinal factors which were found to influence this. The circumstances for potable water availability and recycled water use differ in Melbourne and Bendigo, making this study a significant contribution to understanding public acceptance of recycled water use in these different contexts. No significant difference in happiness to use recycled water was found between locations. However, prior experience (use) of recycled water was found to be a significant and positive factor in facilitating happiness/willingness to use recycled water, particularly for closer to personal contact uses such as showering and drinking. Various attitudinal and demographic variables were found to influence happiness to use recycled water. Results indicate it is not just the locational context of water availability that influences happiness to use recycled water, but a person's experience and particular perceptions that will facilitate greater willingness to use recycled water.

Asthma, rhinitis and dermatitis triggered by fungal infection: therapeutic effects of terbinafine.

We report 2 atopic patients suffering from tinea unguium caused by Trichophyton rubrum. In addition, both patients had symptoms of allergies: one had perennial rhinoconjunctivitis and bronchial asthma, the other had chronic dermatitis of the face and neck. In both cases, their allergy symptoms improved dramatically during oral therapy with the antifungal agent terbinafine (250 mg/day) and relapsed after its discontinuation.

[Drug reaction to terbinafine simulating an acute generalized exanthematous pustulosis]. / Arzneimittelreaktion auf Terbinafin unter dem Bild einer akuten generalisierten exanthematischen Pustulose (AGEP).

Oral terbinafine (Lamisil) is a widely used and effective therapy of dermatophyte infections. A 20-year-old patient was treated with oral terbinafine for an inguinal-scrotal fungal infection and developed an acute generalized exanthematic pustulosis (AGEP) and fever. Histological examination of skin biopsy revealed subcorneal and spongiform pustules. The diagnosis of an AGEP induced by terbinafine was established based on the history, clinical manifestations, and laboratory findings. Clinical features, differential diagnosis, causative drugs, and the therapy of AGEP are discussed and the literature on cases of terbinafine-induced AGEP is reviewed.

Safety and efficacy of specific immunotherapy with standardized allergenic extracts adsorbed on aluminium hydroxide.

Specific immunotherapy (SIT) with standardized allergenic extracts is the only specific treatment of allergic patients. In order to evaluate the safety, side effects, and efficacy of SIT with standardized extracts adsorbed to aluminium hydroxide manufactured by Stallergènes S.A., a prospective multicenter open study was performed in Switzerland. Fifteen patients suffering from seasonal or perennial rhinoconjunctivitis with or without asthma were included in the trial and received a total of 442 injections with standardized mix of grass pollens (n = 8) or house dust mites (n = 7) over one year. Low incidence of local reactions was noted (7%). Subcutaneous nodules (granuloma) following injections were not recorded. Only a few systemic reactions (one mild rhinitis, one mild asthma attack, one worsening of eczema) were recorded. No anaphylactic reactions requiring adrenaline were recorded. No admission to the hospital was required. Global appreciation of the physicians and the patients after the first year of treatment showed a good efficacy of SIT: Only two patients (13%) did not improve. A worsening of the symptoms was not observed. In order to assess the efficacy, skin reactivity and conjunctival reactivity to allergen challenge were compared before and after one year of treatment as well as immunologic parameters (such as specific IgE, specific IgG4) in blood samples. A significant decrease in skin reactivity (p = .001) and in conjunctival reactivity (p = .01) was observed. Specific IgE level decreased for both types of allergens but to a significantly greater extent for grass pollen allergen (p = .03). Specific IgG4 level increased significantly for grass (p = 0.01) and for mites (p = 0.04). Specific immunotherapy appears to be a valuable tool in the efficient management of the allergic respiratory diseases.

Photodynamic therapy of superficial basal cell carcinomas using topical 5-aminolevulinic acid in a nanocolloid lotion.

BACKGROUND: Photodynamic therapy (PDT) of superficial basal cell carcinomas using endogenous protoporphyrin IX generated by topically applied 5-aminolevulinic acid (5-ALA) is an innovative and clinically encouraging approach. OBJECTIVE: This paper reports on the first results of an ongoing clinical study on photodynamic therapy of 55 basal cell carcinomas in 19 patients. METHODS: Because of the chemical instability of 5-ALA, a novel nanocolloid lotion was developed. This formulation was applied to the lesions under occlusive dressing 6 h before irradiation with visible light from an unfiltered halogen lamp. Light-induced fluorescence was used to ascertain the superficial extension of the tumors. The response to the therapy was assessed by visual inspection and in 13 patients also by biopsies. RESULTS: After a single treatment, 47 (85%) basal cell carcinomas showed a complete response at a follow-up time of at least 6 months. For the remaining 8 (15%) lesions, a partial response was observed, indicated by a marked reduction of the tumor size. The treatment modality without local anesthetics was well tolerated by all patients, with only slight discomfort during light irradiation. CONCLUSION: Our results indicate that 5-ALA-PDT with our novel formulation, a nanocolloid lotion, is a highly effective and convenient therapy for the treatment of superficial basal cell carcinomas. Its use in the treatment of nodular tumors needs further investigations.

Eruptive vellus hair cyst and steatocystoma multiplex: hybrid cysts.

Steatocystoma multiplex (SM) and eruptive vellus hair cyst (EVHC) are known as clinically similar but histologically distinct entities, first described by Jamieson in 1873 and Esterly et al. in 1977, respectively. Herein we describe a 24-year-old female patient with both lesions on the anterior chest wall. The biopsy showed portions of two cysts close together with features of SM in one part and features of EVHC in the other part. Our case gives further evidence that these two conditions are closely related. To the best of our knowledge this is the first case where such an anatomically close relationship between these two types of cysts has been described.

Uremic small-artery disease with medial calcification and intimal hyperplasia (so-called calciphylaxis): a complication of chronic renal failure and benefit from parathyroidectomy.

BACKGROUND: Uremic small-artery disease with medial calcification and intimal hyperplasia can lead to life-threatening skin necrosis or acral gangrene. It is a distinct complication of chronic renal failure that must be differentiated from soft-tissue calcification. An increased calcium-phosphate product and secondary hyperparathyroidism are the main underlying conditions. The benefit of parathyroidectomy is controversial. OBJECTIVE: This article is based on a literature search to determine prognostic factors and, in particular, the benefit of parathyroidectomy. METHODS: The literature on uremic small-artery disease (so-called calciphylaxis) was reviewed (full data set: 104 cases, including five of our own). The therapeutic benefit of parathyroidectomy and the relation between prognostic predictors (localization, dialysis, and transplant) and outcome were analyzed. The relation between diabetes and acral gangrene was also examined. Further epidemiologic data on the reviewed group of patients were established. RESULTS: Thirty-eight of 58 patients who underwent parathyroidectomy survived compared with 13 of 37 patients who did not undergo parathyroidectomy (p = 0.007, n = 95). Forty of 53 patients with distal localization of necrosis survived compared with 11 of 42 patients with proximal pattern (p < 0.00001; n = 95). Dialysis and kidney transplantation followed by immunosuppression showed no relation to disease outcome. No association was found between diabetes and acral gangrene (p = 0.50). CONCLUSION: Uremic small-artery disease is a distinct complication of chronic renal failure. Its recognition and early diagnosis should allow more effective treatment. In our retrospective study parathyroidectomy was significantly related to survival. Only a randomized, controlled, prospective trial (parathyroidectomy vs conservative treatment of secondary hyperparathyroidism) can establish the value of parathyroidectomy in uremic small-artery disease.

[Periarteritis nodosa cutanea. 20 years follow-up with leg pain, Raynaud syndrome and nail changes]. / Periarteriitis nodosa cutanea. 20jähriger Verlauf mit Beinschmerzen, Raynaud-Syndrom und Nagelveränderungen.

Polyarteritis nodosa is a multi-systemic vasculitic disease process involving small and medium-sized arteries throughout the body. Cutaneous polyarteritis nodosa has been described as a limited form involving the skin, skeletal muscles, and peripheral nerves. A protracted course of 20 years or longer, with few cases eventually developing visceral involvement, has been emphasized by many authors. A case of polyarteritis with a 20-year history of exacerbations and spontaneous remissions that never seriously compromised the patient's health is presented. The initial and predominant symptoms were leg pains, Raynaud's phenomenon, and nail defects (onychoschizia).

[Idiopathic elastolysis of the mid-dermis]. / Idiopathische Elastolyse der mittleren Dermis.

Idiopathic middermal elastolysis (IMDE) is a rare disorder with two different clinical presentations: type I lesions, with tiny wrinkles along skin cleavage lines in large confluent areas, and type II lesions, with small perifollicular papular protrusions. The histopathological picture is characteristic. IMDE is mainly seen in healthy young or middle-aged women. We describe a 60-year-old male patient with this disorder. The special interest of this case report is that there was no photosensitivity and no exacerbation with PUV therapy. IMDE is probably a special sort of elastolytic disorder, for which immunologic mechanisms seem possible.

Dysplastic nevus syndrome: intrafamilial identification of carriers by cytogenetics.

Seven members of a family with dysplastic nevus syndrome (DNS) were examined clinically; skin biopsies of unaffected skin from 6 were taken. Biopsy-derived cultivated fibroblasts were examined by cytogenetic methods, i.e. by measuring the spontaneous and the UVB- and UVC-driven increase in sister chromatid exchange (SCE). A male patient with malignant melanoma, his son and his nephew, both with multiple dysplastic nevi, showed a distinctive elevation of UV-induced SCE, whereas the other, unaffected members of the family showed normal values. These results give evidence that in siblings with DNS the affected members can be identified not only on clinicopathological grounds but also by UV-induced elevated SCE at the cytogenetic level.

[Werner syndrome with torpid trophic ulcera cruris]. / Werner-Syndrom mit torpiden trophischen Ulcera cruris.

Werner's syndrome is a rare, autosomal recessive inherited disorder with a distinctive clinical picture. The characteristic physiognomy, shortness of stature with thin extremities, and large trophic ulcers are the key signs for the diagnosis. Premature greying of the hair and baldness, juvenile cataracts, a tendency to diabetes mellitus, hypogonadism, calcifications of the blood vessels, osteoporosis, metastatic calcifications of the soft tissue and an elevated incidence of neoplasms are further important features. We describe two patients with this disorder.