Numerical analysis of Venous External Scaffolding Technology for Saphenous Vein Grafts.

This paper presents a method for analyzing and comparing numerically Saphenous Vein Grafts (SVGs) following Coronary Artery Bypass Graft surgery (CABG). The method analyses the flow dynamics inside vein grafts with and without supporting using Venous External Scaffolding Technology (VEST). The numerical method uses patients׳ specific computational fluid dynamics (CFD) methods to characterize the relevant hemodynamic parameters of patients׳ SVGs. The method was used to compare the hemodynamics of six patient׳s specific model and flow conditions of stented and non-stented SVGs, 12 months post-transplantation. The flow parameters used to characterize the grafts׳ hemodynamics include Time Averaged Wall Shear Stress (TAWSS), Oscillatory Shear Index (OSI) and Relative Residence Time (RRT). The effect of stenting was clearly demonstrated by the chosen parameters. SVGs under constriction of VEST were associated with similar spatial average of TAWSS (10.73 vs 10.29 dyn/cm(2)), yet had fewer lesions with low TAWSS, lower OSI (0.041 vs 0.08) and RRT (0.12 vs 0.24), and more uniform flow with less flow discrepancies. In conclusion, the suggested method and parameters well demonstrated the advantage of VEST support. Stenting vein grafts with VEST improved hemodynamic factors which are correlated to graft failure following CABG procedure.

Pemphigus vulgaris induced by radiotherapy.

Pemphigus can be triggered or induced by many insults, such as drugs, infections, viruses and neoplasms. X-ray-induced pemphigus has been recorded only rarely in the literature. We describe the case of a woman with pemphigus vulgaris in remission, who relapsed 1 week after completion of an irradiation course for breast cancer, in the exact location of the radiation. We review the previous 15 cases from the literature and outline the common features of those cases.

Smoking can be good for you.

Smoking is without doubt one of the greatest causes of avoidable illness and death in the modern world. Most well known is the relationship between smoking and numerous cancers, cerebrovascular and cardiovascular disease. Smoking and most especially nicotine, are, however, sometimes beneficial in certain diseases, including Parkinson's, Alzheimer's, allergic alveolitis, nausea and vomiting of pregnancy, pre-eclampsia, fibroids, carcinoma of body of uterus, ulcerative colitis, pyoderma gangrenosum, aphthous stomatitis and ulceration, pemphigus, herpes simplex and acne. In the immensely justifiable enthusiasm to discredit this dangerous activity, the mechanisms behind these beneficial effects tend to have been un-discussed or ignored. It is the aim of this paper to spur interest in the reasons for these effects. If the mechanisms are elucidated, therapeutic advances may be possible.

Co-existing sensitivity to metronidazole and isothiazolinone.

A 68-year-old woman developed allergic contact dermatitis to topical metronidazole gel as proven by positive patch tests to the gel and to metronidazole. She was also allergic to methylchloroisothiazolinone and methylisothiazolinone (MC/MI). The similarity between the two molecules and the fact that the patient reacted to the gel after the very short incubation period of 1 day (i.e. not long enough for acquiring an active sensitization) makes the possibility of a cross-reaction between these substances very plausible. As the isothiazolinones are widely used and comprise an important and relatively frequent cause of allergic contact dermatitis, a cross-reactivity with metronidazole means that perhaps there should have been more cases of metronidazole allergy is more common than the current literature suggests.

The EAE-associated behavioral syndrome: I. Temporal correlation with inflammatory mediators.

To elucidate the mechanisms underlying the EAE-associated behavioral syndrome (EBS), we examined the temporal correlation between the behavioral alterations and inflammatory processes. Onset of the behavioral syndrome was associated with the onset of brain infiltration, as well as mRNA expression of interleukin 1 beta (IL-1 beta) and tumor necrosis factor alpha (TNF-alpha) and elevated production of interleukin 1 beta protein and prostaglandin E(2) (PGE(2)). Sickness behavior symptoms coincided with peak cytokine expression. Behavioral recovery was associated with a reduction of cytokine expression, but not infiltration, PGE(2) production or motor disturbances. These results suggest that inflammatory processes in general, and the production of pro-inflammatory cytokines in particular, are involved in mediating EAE-associated sickness behavior.

The EAE-associated behavioral syndrome: II. Modulation by anti-inflammatory treatments.

EAE is associated with sickness behavior symptoms that are temporally correlated with inflammatory processes. To further elucidate the role of inflammatory mediators in the behavioral syndrome, EAE mice were injected daily with anti-inflammatory drugs, beginning at disease onset. Dexamethasone or interleukin-1 (IL-1) receptor antagonist or the prostaglandins synthesis inhibitor indomethacin attenuated the behavioral symptoms. Administration of the tumor necrosis-factor alpha (TNF-alpha) synthesis inhibitor pentoxifylline or targeted deletion of the type I TNF receptor had no behavioral effects whereas administration of pentoxifylline in IL-1ra-treated mice further reversed the behavioral depression. These findings demonstrate the critical involvement of pro-inflammatory cytokines and prostaglandins in the EAE-associated behavioral syndrome, and may have implications for understanding and treating the neuropsychiatric disturbances in multiple sclerosis (MS) patients.

Experimental autoimmune encephalomyelitis-associated behavioral syndrome as a model of 'depression due to multiple sclerosis'.

Many medical conditions, including inflammatory diseases such as multiple sclerosis (MS), are often accompanied by a high prevalence of depressive episodes. Inflammatory mediators, such as cytokines, were implicated in illness-associated depressive conditions, both in humans and in animals. For example, MS-associated depression (MSD) was attributed to pathophysiological processes such as immune dysregulation and cerebral inflammation. We have recently documented a depressive-like behavioral syndrome in mice with experimental autoimmune encephalomyelitis (EAE), an established model of MS. In the present paper, we discuss the similarities between the EAE-associated behavioral syndrome (EBS) and MSD, in terms of phenomenology, putative mechanisms and responsiveness to anti-depressive therapy. In particular, we show that: (1) EAE and depression are associated not only with similar behavioral symptomatology, but also with common physiological alterations, including impaired serotonergic neurotransmission, and activation of neuroendocrine (e.g., adrenocortical) and inflammatory cytokine systems; (2) the EBS precedes any neurological deficit during the initial EAE attack, as well as further exacerbations, and remits during recovery and between relapses. Similarly, in many MS patients depression precedes and accompanies the attacks and wanes during remissions; (3) females show increased susceptibility to EBS. Similarly, depression is much more prevalent in women than in men; (4) chronic treatment with the tricyclic anti-depressant imipramine reduced EAE-induced mortality, body-weight loss and behavioral suppression. Similarly, anti-depressant drugs have been used effectively in treating MSD. These findings suggest that the EBS may serve as an animal model for MSD.

Stress-induced SAPHO syndrome.

We describe the case of a woman with the classic combination of features of synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome, including pustulosis palmo-plantaris and anterior chest wall involvement. The varying symptomology, etiology and pathogenesis of this syndrome and the contribution of stress are discussed. The authors ascribe the dearth of reported cases to lack of awareness and recognition of SAPHO, and not to the real incidence of the syndrome.

Comparison of simultaneous patch testing with parthenolide and sesquiterpene lactone mix.

Several studies have pointed out that the sesquiterpene lactone (SL) mix is a safe, though inadequate, screen for Compositae allergy. To test the usefulness of the sesquiterpene lactone parthenolide as a supplementary Compositae screening test to the mix, both were included in the standard series in 2 Danish dermatology departments. Among 2244 patients tested, 46 (2%) were positive to SL mix and 73-75% of these were positive to parthenolide. The results demonstrate that parthenolide is not suitable as a supplementary screening agent to SL mix, but may be a fairly good screen on its own if the mix is not available.

Peeling skin syndrome with hair changes.

A 13-year-old boy with typical peeling skin syndrome (PSS) is described. The clinical picture corresponded to the inflammatory variant of PSS (type B). In addition, the patient had gross and microscopic hair anomalies such as trichorrhexis invaginata-like changes, irregular hair shaft torsions and moniliform hair shaft diameter reductions. The observed dysmorphic hair changes are discussed and interpreted as being an integral component of the dermatosis in this case. To the best of our knowledge, such hair anomalies have not yet been described in PSS.