Congenital Langerhans cell histiocytosis mimicking a "blueberry muffin baby".

Congenital Langerhans cell histiocytosis (LCH) is a rare condition with great diversity. A case of congenital skin-only LCH presenting as a "blueberry muffin baby" with a spontaneous regression by the age of 8 months is reported here. New insights into clinical manifestations and prognosis, which is not uniformly positive, are discussed.

Plasmapheresis and cyclophosphamide as successful treatments for pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is an ulcerative skin disorder of unknown aetiology. We describe a 40-year-old woman with long-standing PG and who did not respond to the usual treatments; however, she was treated successfully with plasmapheresis followed by pulse intravenous cyclophospamide therapy.

Continuous and intermittent itraconazole dosing schedules for the treatment of onychomycosis: a pharmacokinetic comparison.

This multicentre, double-blind, randomized study compared the pharmacokinetics of itraconazole given at 200 mg once daily for 3 months and intermittently at 200 mg twice daily for 1 week per month followed by a 3-week drug-free period for 3 months in the treatment of onychomycosis. Patients were followed for 9 months after treatment. Itraconazole and hydroxy-itraconazole plasma concentrations and itraconazole nail tip concentrations were determined at regular intervals.

A double-blind, randomized study comparing itraconazole pulse therapy with continuous dosing for the treatment of toe-nail onychomycosis.

In this multicentre, double-blind, parallel group study, we evaluated the efficacy and safety of continuous treatment with itraconazole, 200 mg daily for 3 months, in comparison with itraconazole pulse therapy, 400 mg daily 1 week per month for 3 months, in the treatment of toe-nail onychomycosis. The study included 129 patients with distal subungual onychomycosis of the toe-nails, confirmed by microscopy and positive for dermatophyte culture; 65 received continuous treatment and 64 received pulse therapy. Patients were followed up for 9 months after treatment.

Transfer of clonidine and dexmedetomidine across the isolated perfused human placenta.

Background: The placental transfer of the alpha 2 receptor agonist clonidine, earlier used as an adjuvant in obstetric epidural analgesia, was compared with the transfer of the newer and more alpha 2-selective agonist dexmedetomidine.

Methods: Term placentas were obtained immediately after delivery with maternal consent and a 2-hour recycling perfusion of a single placental cotyledon was performed. Disappearance from the maternal circulation, accumulation in placental tissue and appearance in the fetal circulation of clonidine or dexmedetomidine with the reference compound antipyrine were followed in 4 experiments for both drugs.

A clinical and pharmacokinetic comparison of ropivacaine and bupivacaine in axillary plexus block.

The clinical and pharmacokinetic properties of ropivacaine and bupivacaine, both 5 mg/mL, used in axillary plexus block were compared in 60 patients in this randomized, double-blind, parallel-group study. The axillary plexus was identified with a nerve stimulator and 30, 35, or 40 mL of drug, depending on body weight, was injected into the perivascular sheath. In 20 patients, venous blood samples for the pharmacokinetic measurement were obtained over 24 h.

Transfer of lidocaine and bupivacaine across the isolated perfused human placenta.

Drug permeability and pharmacokinetics through the placenta are important factors determining foetal drug exposure. The purpose of the present study was to establish a perfused human placental cotyledon system to assess the placental transfer of lidocaine and bupivacaine, widely used local anaesthetics in obstetric anaesthesia. Term placentas were obtained immediately after delivery with maternal consent and a two-hour recycling perfusion of a single placental cotyledon was performed.

The effects of epidural ropivacaine and bupivacaine for cesarean section on uteroplacental and fetal circulation.

Background: Ropivacaine is a new long-acting amide local anesthetic that has been shown in animal studies to have less dysrhythmogenic and cardiotoxic potential than bupivacaine. The intravenous administration of ropivacaine has not been associated with any detrimental effects on uterine blood flow in pregnant ewes. The purpose of this randomized, double-blind study was to examine the effects of epidural ropivacaine for cesarean section on blood flow velocity waveforms in uteroplacental and fetal arteries with color Doppler ultrasound and to assess whether the block modified fetal myocardial function.

Hand eczema in Finnish farmers. A questionnaire-based clinical study.

In a population of 2005 Finnish farmers, 172 (8.6%) reported hand or forearm dermatoses in a self-administered questionnaire. 138 (80%) of them attended a clinical examination.

Dermatoses determined in a population of farmers in a questionnaire-based clinical study including methodology validation.

Objectives: The study analyzed skin diseases in a population sample of Finnish farmers descriptively and in the process validated the question "Do you have a skin disease now?"

Methods: All farmers from one Finnish municipality were surveyed for dermatoses, first with a questionnaire and then with a clinical examination of those who reported dermatoses. Another population of farmers answered a set of questions immediately before a clinical examination, and the self-report of current dermatosis was validated.

Results: Eczema was diagnosed for 66% of the women and 53% of the men who had reported dermatosis in the questionnaire study 6 to 12 months earlier.

Maternal expectations and experiences of labour pain--options of 1091 Finnish parturients.

A prospective survey of 1091 Finnish parturients was conducted in order to ascertain mothers' expectations for labour pain relief, to measure the actual pain during all three stages of labour and to question their satisfaction and the adequacy of pain relief on the third day following delivery. Antenatal expectations for pain relief were surveyed. Mothers were questioned on pain levels in the delivery room and 3 days after giving birth.

Parturients' assessment of water blocks, pethidine, nitrous oxide, paracervical and epidural blocks in labour.

This prospective study evaluated the extent to which the analgesic procedures available resulted in efficient pain relief in 833 Finnish parturients. Their pain ratings were recorded according to their own assessment of pain intensity during labour before and after pain management and according to their total pain experience recalled on the third day after delivery. Only regional blocks significantly diminished pain scores during labour and a striking decrease in pain level (P < 0.

Uteroplacental haemodynamics during spinal anaesthesia for caesarean section with two types of uterine displacement.

The effects of two types of uterine displacement, on uterine and umbilical artery blood flow waveforms were investigated in 22 healthy parturients undergoing elective caesarean section. Displacement was accomplished with either a wedge under the right hip or a mechanical displacer plus 5 degrees left lateral tilt of the operating table. The first 14 patients were assigned randomly into one of the two displacement methods and the left (underlying) uterine and umbilical artery blood flow waveforms were recorded.

Uteroplacental and fetal circulation during extradural bupivacaine-adrenaline and bupivacaine for caesarean section in hypertensive pregnancies with chronic fetal asphyxia.

We have studied the effects of an extradural block during Caesarean section using either bupivacaine plain or with adrenaline 85-100 micrograms on blood velocity waveforms of maternal uterine and placental arcuate arteries and fetal umbilical, renal and middle cerebral arteries, in 20 hypertensive parturients with chronic fetal asphyxia. Fetal myocardial function was investigated at the same time by M-mode echocardiography. Extradural anaesthesia resulted in a significant decrease in maternal mean systolic and diastolic arterial pressures in both groups, but this was more marked after plain bupivacaine.

Mucha-Habermann disease: a diagnostic possibility for prolonged fever associated with systemic and skin symptoms.

The severe form of Mucha-Habermann disease with systemic symptoms is a rarely diagnosed disease which should be considered for children with prolonged fever, impaired general condition, skin manifestations and elevated C-reactive protein concentration and/or erythrocyte sedimentation rate. Eleven cases have been described previously in children. We describe two acute episodes of this syndrome in a three-year-old child; the diagnosis was based on clinical, dermatological and histological findings.

Epidural sufentanil and bupivacaine for labor analgesia and Doppler velocimetry of the umbilical and uterine arteries.

Background: The pain of parturition is associated with major physiologic alterations mediated by neurohumoral factors and increased activation of the sympathetic nervous system. Epidural local anesthetics abolish or alleviate many of the pain-mediated responses by reducing maternal catecholamine levels, inducing sympathectomy and consequent vasodilatation. The hormone response to surgical stress is not attenuated after epidural opioids as efficiently as after local anesthetics.

Ephedrine and phenylephrine for avoiding maternal hypotension due to spinal anaesthesia for caesarean section. Effects on uteroplacental and fetal haemodynamics.

The effects of i.v. vasopressors on Doppler velocimetry of the maternal uterine and placental arcuate arteries and the fetal umbilical, renal and middle cerebral arteries were studied during spinal anaesthesia in 19 healthy parturients undergoing elective caesarean section.

Efficacy and safety of itraconazole in the long-term treatment of onychomycosis.

Sixty-one patients with a clinical diagnosis of onychomycosis in finger or toe nails were treated with itraconazole 100 mg/day or griseofulvin 500 mg/day for six to nine months. The infective causes were Trichophyton rubrum, Trichophyton mentagrophytes, or Trichophyton violaceum, and in two cases Candida albicans. A total of 27 finger and 390 toe nails were infected.

Effects of extradural bupivacaine with adrenaline for caesarean section on uteroplacental and fetal circulation.

We have studied the effects of an extradural block using bupivacaine with adrenaline 90-100 micrograms on blood flow in the maternal uterine and placental arcuate arteries and the fetal umbilical, renal and middle cerebral arteries, using a colour Doppler technique in eight healthy parturients undergoing elective Caesarean section. Fetal myocardial function was investigated simultaneously by M-mode echocardiography. Maternal heart rate increased and diastolic arterial pressure decreased after extradural administration of bupivacaine with adrenaline.

Uteroplacental and fetal haemodynamics during extradural anaesthesia for caesarean section.

We have studied the effects of extradural anaesthesia with bupivacaine (plain) in eight healthy parturients undergoing elective Caesarean section, on blood flow in maternal uterine and placental arcuate arteries and in fetal umbilical, renal and middle cerebral arteries, using a colour Doppler technique. Simultaneously, fetal myocardial function was investigated by M-mode echocardiography. Maternal and fetal blood velocity waveform indices did not change significantly.

Plasma catecholamines, corticosterone, glucose and fatty acids concentrations and mean arterial pressure and body temperature in haemorrhagic hypovolaemia, hypothermia and a combination of these in the rabbit.

Venous plasma noradrenaline, adrenaline, dopamine, corticosterone, glucose and free fatty acid concentrations were measured in anaesthetized rabbits during hypovolaemia, hypothermia and a combination of these. The anaesthetic used was Hypnorm, which contains fentanyl and fluanisone. In the hypovolaemia group blood was shed via the venous cannula until the mean arterial pressure was 50 mmHg.

Visceral pain during caesarean section under spinal and epidural anaesthesia with bupivacaine.

In a randomized study, the incidence of visceral pain was evaluated in 46 patients undergoing elective caesarean section under spinal or epidural anaesthesia with 0.5% bupivacaine. If the patient experienced pain during the operation, a standard visual analogue scale ranging from 0 to 10 was used to assess the degree of pain.

Does ephedrine influence newborn neurobehavioural responses and spectral EEG when used to prevent maternal hypotension during caesarean section?

The recovery of 16 infants born by elective caesarean section with spinal anaesthesia, in which either ephedrine or fluid load was used to prevent maternal hypotension, were studied using Scanlon's neurobehavioural tests and a computerized EEG. Neurobehavioural testing showed no differences between the ephedrine and the non-ephedrine groups of infants at ages of 3 h, 1 day, 2 days and 4-5 days, whereas the spectral EEG showed significant differences between the two groups during the first 2 h after delivery, which had disappeared 24 h later. It is suggested that small doses of ephedrine given to the mother i.

The effect of lumbar epidural analgesia on the neurobehavioural responses of newborn infants.

The effects of maternal lumbar epidural analgesia (Th10-L5) on the neonatal neurobehavioural response were studied at the ages of 3 h, 1 day, 2 days and 4-5 days. The subjects were healthy, full-term neonates, born vaginally to 15 mothers with lumbar epidural block and 19 mothers without analgesia. Those delivered with epidural analgesia scored significantly better on alertness at the age of 3 h, 2 days and 4-5 days than the control group.