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  • 1
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Extracorporeal photochemotherapy has been proven effective in selected T-cell mediated diseases.〈section xml:id="abs1-2"〉〈title type="main"〉Aim:To evaluate the safety and efficacy of extracorporeal photochemotherapy in patients with steroid-dependent Crohn’s disease by an open, monocentric trial in three phases of 24 weeks each.〈section xml:id="abs1-3"〉〈title type="main"〉Methods:In phase 1 standardized steroid tapering was initiated in patients with a history of steroid-dependent Crohn’s disease. Those with a prospectively evaluated maintenance dose of at least 10 mg/day prednisolone continued steroid-withdrawal under the application of extracorporeal photochemotherapy in phase 2. The duration of remission or response was followed during phase 3. Colonic tissue bioptically obtained before and after extracorporeal photochemotherapy was studied by immunofluorescence microscopy for the presence of photoadduct positive cells.〈section xml:id="abs1-4"〉〈title type="main"〉Results:Out of 24 patients included in phase 1, 10 entered phase 2 for extracorporeal photochemotherapy. Four subjects achieved remission and four others response. Significant reductions in serum C-reactive protein levels and intestinal permeability were measured, as well as increases in quality of life and plasma adrenocorticotropic hormone levels. No major side-effects were observed. Remission remained stable in three out of four patients during phase 3. In three patients, positive nuclear stainings of photoadducts were detected in colonic mononuclear cells after extracorporeal photochemotherapy.〈section xml:id="abs1-5"〉〈title type="main"〉Conclusions:Extracorporeal photochemotherapy represents a safe steroid-sparing approach in patients with Crohn’s disease and is associated with intestinal homing of photopheresed cells.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We report what we believe to be a novel skin manifestation of dioxin intoxication. A 30-year-old woman with 2,3,7,8-tetrachlorodibenzo-p-dioxin levels of 144,000 pg g−1 blood fat presented with severe chloracne that affected the entire integument. She also exhibited acral granuloma annulare-like lesions and distal onycholysis and, at a later time point, showed signs of hypertrichosis, as well as brownish-grey hyperpigmentation of the face. In addition, she developed punctate keratoderma-like lesions on the palms and soles. These lesions were negative for human papillomavirus and histologically characterized by cone-shaped hyperkeratoses invaginating, but not penetrating, into the dermis. Squamous syringometaplasia of the eccrine glands was observed in the immediate vicinity of these lesions. Both clinically and histologically these alterations are essentially indistinguishable from what is described as keratosis punctata palmaris et plantaris (KPPP). Although a fortuitous coincidence of chloracne and KPPP cannot be formally excluded, the possibility exists that in our patient toxic levels of dioxin were causally involved in this disorder of keratinization.
    Type of Medium: Electronic Resource
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