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  • 1
    Electronic Resource
    Electronic Resource
    Cefotiam-induced IgE-mediated occupational contact anaphylaxis of nurses; case reports, RAST analysis, and a review of the literature (1994)
    Oxford, UK : Blackwell Publishing Ltd
    Clinical & experimental allergy 24 (1994), S. 0 
    Details
    ISSN: 1365-2222
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Cefotiam (CTM) is one of the most popular cephem antibiotics in Japan. Recently we experienced two cases of nurses with CTM-induced contact anaphylaxis. When they were preparing drip infusions of antibiotics or working around other nurses doing so, they suddenly fell into shock with other symptoms such as flushing, urtiearia, abdominal distress, vomiting, dyspnoea and or loss of consciousness. The symptoms never occurred after they avoided exposure to CTM. Passive cutaneous or open patch tests were positive for CTM. Histamine release was induced by CTM from washed leucocytes. RAST analysis using CTM-human serum albumin-coupled dises showed high % RAST count, suggesting that these reactions were mediated by IgE antibodies. A RAST inhibition test suggested that the methyl-thiotetrazol side-chain was the main antigenic determinant. Both patients had hand dermatitis that had appeared preceding the episodes of anaphylaxis. Although the dermatitis had been resistant to treatments, it also disappeared after they avoided exposure to CTM, It seemed likely that it was also induced or exacerbated by CTM and facilitated the penetration of CTM to cause anaphylaxis. The literature is also reviewed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2222.1994.tb00208.x
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  • 2
    Electronic Resource
    Electronic Resource
    Randomized double-blind study of cyclosporin in chronic ‘idiopathic’ urticaria (2000)
    Oxford, UK : Blackwell Science Ltd
    British journal of dermatology 143 (2000), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background Histamine-releasing activity (HRA) is detectable in up to 50% of patients with chronic ordinary urticaria.  Objectives To determine the effect of cyclosporin on clinical features and HRA in patients with chronic urticaria.  Methods Thirty patients with severe unremitting disease, responding poorly to antihistamines and showing a positive autologous serum skin test (ASST) as a marker of HRA, were randomized to 4 mg kg−1 daily of cyclosporin (Sandimmun®, n = 20) or placebo (n = 10) for 4 weeks. Non-responders were offered open-label cyclosporin for 4 weeks. All were followed for up to 20 weeks or until clinical relapse; all took cetirizine 20 mg daily throughout the study. The primary measure of efficacy was a daily urticaria activity score (UAS) of weal numbers and itch (maximum score 42 per week). A positive response was defined as a reduction to 〈 25% of baseline weekly UAS and relapse as a return to 〉 75%. The effect of cyclosporin on serum HRA was assessed by in vitro basophil histamine release assays and ASSTs before and after treatment.  Results Twenty-nine patients (19 active, 10 controls) completed the randomized trial medication. Eight of 19 on active treatment but none on placebo had responded at 4 weeks (P 〈 0·05). Three others on active drug met the criterion for response at 2 weeks but not at 4 weeks. Mean reduction in UAS between weeks 0 and 4 was 12·7 (95% confidence interval, CI 6·6–18·8) for active and 2·3 (95% CI − 3·3–7·9) for placebo (P = 0·005). Seventeen non-responders (seven randomized to active and 10 to placebo) chose open-label cyclosporin and 11 responded after 4 weeks. Six of the eight randomized active drug responders relapsed within 6 weeks. Of the 19 responders to randomized and open-label cyclosporin, five (26%) had not relapsed by the study end-point. Mean in vitro serum HRA fell from 36% (95% CI 22–49%) to 5% (95% CI 1–8%) after cyclosporin treatment (n = 11, P 〈 0·0001). The ASST response to post-treatment serum was also reduced (P 〈 0·05).  Conclusions This study shows that cyclosporin is effective for chronic urticaria and provides further evidence for a role of histamine-releasing autoantibodies in the pathogenesis of this chronic ‘idiopathic’ disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2133.2000.03664.x
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  • 3
    Electronic Resource
    Electronic Resource
    Human leucocyte antigen class II associations in chronic idiopathic urticaria (1999)
    Oxford BSL : Blackwell Science Ltd
    British journal of dermatology 140 (1999), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The major histocompatibility complex (MHC) acts as a marker for self during T-cell ontogeny and is associated with the pathogenesis of many autoimmune diseases. Recent investigations have shown about 30% of patients with chronic idiopathic urticaria (CIU) have IgG autoantibodies against the high-affinity IgE receptor, FcεRI, or IgE. A link between MHC class II alleles and CIU has not been reported previously. DNA was extracted from blood of 100 Caucasian patients with CIU, and the MHC class II type determined using the polymerase chain reaction with sequence-specific primers, testing for DRB and DQB1 alleles. The frequency of alleles in CIU patients was compared with that found in 603 controls. Further human leucocyte antigen (HLA) typing on patient subsets, classified by the patients' responses to intradermal injection of autologous serum and their serum-induced histamine release from basophil leucocytes of healthy donors, was undertaken. HLA DRB1*04 (DR4) and its associated allele, DQB1*0302 (DQ8), are raised in CIU patients compared with a control population (P = 2 × 10−5 and P = 2 × 10−4, respectively). HLA DRB1*15 (DR15) and its associated allele, DQB1*06 (DQ6), are significantly less frequently associated with CIU. The HLA DRB1*04 association is particularly strong (corrected P = 3.6 × 10−6) for patients whose serum has in vivo and in vitro histamine-releasing activity. HLA class II typing is consistent with the concept that CIU is a heterogeneous disease, and supports an autoimmune pathogenesis in a subset of patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2133.1999.02815.x
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  • 4
    Electronic Resource
    Electronic Resource
    Analysis of patients with congenital diaphragmatic hernia requiring pre-operative extracorporeal membrane oxygenation (ECMO) (1998)
    Springer
    Pediatric surgery international 14 (1998), S. 25-29 
    Details
    ISSN: 1437-9813
    Keywords: Key words Congenital diaphragmatic hernia  ; Extracorporeal membrane oxygenation  ;  Pulmonary ; hypoplasia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The purpose of this report was to analyze the patients requiring preoperative extracorporeal membrane oxygenation (ECMO) as the most critical group of patients with congenital diaphragmatic hernia (CDH) and to identify any special features. Over the past 11 years, out of 72 neonates with CDH admitted before 24 h of age, 40 (56%) could be managed with conventional therapies while the other 32 (44%) required ECMO. Seventeen infants requiring preoperative ECMO were classified as group 1, and the 15 with postoperative ECMO as group 2 (controls). The records of patients in both groups were analyzed. Patients in group 1 were not only severely hypoxic, but also significantly hypercapneic on admission, and in 14 (82%) the diaphragmatic defect was so large or totally agenetic that a prosthetic patch was necessary. The average age at onset of ECMO in group 1 was 13.1 h, and the average duration was 159 h. Major hemorrhagic complications including intracranial hemorrhage occurred with a significantly higher frequency in group 1. The survival rate in group 1 was 41%, compared with 73% in group 2 and 85% in non-ECMO patients. Four infants in group 1 with extremely hypoplastic lungs could not be weaned from ECMO, and died without undergoing an operation. Moreover, 4 of the 7 survivors in group 1 required prolonged (105–658 days) ventilator care with a tracheostomy after weaning from ECMO, and were frequently hospitalized thereafter. The pulmonary function of these patients remained severely underdeveloped for a long time; indeed, the average pulmonary perfusion ratio of the affected side remained at only 40% of the contralateral side in group 1, although the volume ratio reached 85%. These findings may suggest that the main pathology of the patients requiring preoperative ECMO was a high degree of pulmonary hypoplasia, and that there will be limitations to management using ECMO.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050428
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  • 5
    Electronic Resource
    Electronic Resource
    Comparison of venoarterial versus venovenous access in the cerebral circulation of newborns undergoing extracorporeal membrane oxygenation (1999)
    Springer
    Pediatric surgery international 15 (1999), S. 78-84 
    Details
    ISSN: 1437-9813
    Keywords: Key words Extracorporeal membrane oxygenation ; Cerebral blood flow velocity ; Cerebral hemorrhage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study was designed to compare venoarterial (VA) with venovenous (VV) access in the cerebral circulation of newborn infants during extracorporeal membrane oxygenation (ECMO). Among 14 infants with VA ECMO, 7 had no intracranial complications (group 1), while the others (group 2) developed intracranial hemorrhage (ICH). In contrast, among 19 infants with VV ECMO, only 1 developed ICH. Serial echocardiograms were performed before and after 1, 6, 12, and 24 h and 2 and 3 days of ECMO. The mean cerebral blood flow (CBF) velocities were measured in the anterior cerebral artery (ACA), right and left internal carotid arteries (Rt, Lt-ICA), basilar artery (BA), and right and left middle cerebral arteries (Rt, Lt-MCA). Ejection fraction (EF), cardiac output (CO), and stroke volume (SV) were also measured using standard echography. The velocity levels in the ACA, Rt-MCA, and Lt-MCA in VA ECMO were lower than those in VV ECMO, while those in the Lt-ICA and BA in VA ECMO were higher than those in VV ECMO. The EF, CO, and SV were lower in cases of VA ECMO than in VV ECMO. In cases of VA ECMO, there were no differences between groups 1 and 2 in velocities in the ACA, Rt-ICA, or Lt-ICA. However the velocities in group 2 in the BA, Rt-MCA, and Lt-MCA were lower than those in group 1 before and during ECMO. Similarly, the EF, CO, and SV were lower in group 2 (12.0%–31.0%, 0.10–0.32 l/min, and 0.66–1.55 ml, respectively) than in group 1 (29.5%–49.3%, 0.25–0.63 l/min, and 2.15–3.85 ml) during ECMO. However, in the infants on VV ECMO the CBF was either maintained or gradually increased before and during ECMO. Their cardiac parameters were: EF 46.1%–53.0%, CO 0.43–0.52 l/min, and SV 2.72–3.84 ml during ECMO. It is concluded that in VA ECMO CBF velocities, particularly in infants who developed ICH, decreased after the onset of ECMO in association with poor cardiac function, while in VV ECMO they were stable, probably due to normal systemic hemodynamics and cardiac function.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050521
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  • 6
    Electronic Resource
    Electronic Resource
    Absence of R42X and R635X mutations in the LAMB3 gene in 12 Japanese patients with junctional epidermolysis bullosa (1997)
    Springer
    Archives of dermatological research 289 (1997), S. 174-176 
    Details
    ISSN: 1432-069X
    Keywords: Key words Laminin 5 ; GB3 ; Herlitz ; JEB
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004030050175
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