Changes in filaggrin degradation products and corneocyte surface texture by season.

BACKGROUND: During the winter in northern countries, the risk of dermatitis is increased due to low temperature and humidity. Dermatitis is particularly common on weather-exposed skin such as the cheeks and hands. Recently, increased numbers of unidentified nanosized protrusions on the corneocyte surface were associated with dermatitis and deficiency of natural moisturizing factor (NMF). OBJECTIVES: To investigate the effect of season on NMF levels and corneocyte surface texture in cheek and hand skin of healthy adults. METHODS: Eighty healthy volunteers (40 male and 40 female) were recruited: 40 aged 18-40 years and 40 aged ≥ 70 years. Cheek and dorsal hand skin was tape stripped in the winter and summer. Analysis for NMF and corneocyte surface texture was done (Dermal Texture Index, DTI). Potential confounders were registered and adjusted for. RESULTS: In cheek skin, NMF levels were reduced and DTI elevated during the winter compared with the summer. Older participants had higher NMF levels than younger participants. In the summer, DTI level was dependent on self-reported ultraviolet exposure. In hand skin, NMF levels were higher during the winter than in the summer, and female participants had higher NMF levels than male participants. CONCLUSIONS: Seasonal effects on NMF and DTI on the cheeks and hands were found, suggesting an influence of climatic factors at the biochemical and ultrastructural levels. Significant variations were also observed regarding age and sex, making it difficult to draw firm conclusions. Our study adds new pieces to the puzzle of seasonal differences in xerosis and dermatitis.

Effect of atopic skin stressors on natural moisturizing factors and cytokines in healthy adult epidermis.

BACKGROUND: Epidermal deficiency of filaggrin, and the derived natural moisturizing factors (NMFs), is associated with increased risk of atopic dermatitis (AD). While filaggrin gene mutations cause filaggrin deficiency, there is limited insight into the causative environmental factors. OBJECTIVES: To explore the effect of selected exogenous skin stressors on NMF and skin cytokine levels in healthy adult epidermis. METHODS: Forty healthy volunteers (aged 18-49 years) were exposed to hard, soft and chlorinated water, 0·5% sodium lauryl sulfate, house dust mite, cat allergen, staphylococcal enterotoxin B (SEB), cooling and histamine. Participants were tape-stripped and biophysiological measurements performed. NMF was determined after 24 and 48 h, whereas skin cytokines were measured after 24 h for selected exposures. RESULTS: At 24 h, a significant decrease in NMFs was observed for soft (0·51 ± 0·19 g m-2 h-1 ) and hard water (0·61 ± 0·32 g m-2 h-1 ) compared with occlusion alone (0·71 ± 0·18 g m-2 h-1 ). Hard water led to increased levels of interleukin (IL)-4, interferon (IFN)-γ and IL-10. Exposure to house dust mite and SEB led to a significant decrease in NMFs after 24 h (0·77 ± 0·28 and 0·80 ± 0·28 g m-2 h-1 , respectively) compared with occlusion alone (1·00 ± 0·42 g m-2 h-1 ). House dust mite led to an increase in IFN-γ, IL-2 and IL-4 vs. the nonoccluded control site. CONCLUSIONS: Based on experimental exposure to selected atopic skin stressors, we conclude that NMFs levels are decreased along with increased secretion of various skin cytokines in healthy individuals. Our data highlight environmental factors that might play a role in AD pathophysiology.

[Infusion of mivacurium and atracurium guided by manual tactile evaluation]. / Infusion af mivacurium og atracurium styret ved hjaelp af manuel vurdering.

INTRODUCTION: The aim of this investigation was to compare the use of a continuous infusion of mivacurium or atracurium guided by tactile evaluation of the neuromuscular block. MATERIALS AND METHODS: Forty-five patients were randomly allocated to three groups of patients. Group M and MN received a bolus dose of mivacurium 0.15 mg/kg followed by a continuous infusion and group AN a bolus dose of atracurium 0.4 mg/kg followed by an infusion. RESULTS: The neuromuscular blockade recovered spontaneously in group M and was antagonised in group MN and AN. The level of block was quantified by tactile evaluation. The time to full recovery was significantly shorter in patients receiving mivacurium compared to patients given atracurium, 14.5, 12.0 and 18.0 min, respectively. Further, reversal with neostigmine significantly enhanced recovery following mivacurium. CONCLUSION: A continuous infusion of mivacurium and atracurium can easily be performed, guided by tactile evaluation of the neuromuscular block and the effect can be reversed by neostigmine.

Evaluation of 119 anaesthetics received after investigation for susceptibility to malignant hyperthermia.

A questionnaire was sent to the first 371 patients investigated for MH susceptibility at the Danish MH Register, in order to assess sequelae from the muscle biopsy and possible subsequent anaesthetic complications. The purpose was to evaluate both the safety of anaesthetizing MH-susceptible (MHS) patients without the use of trigger agents, and the safety of giving trigger agents to non-susceptible (MHN) patients. Eighty-eight per cent of patients alive replied to the questionnaire. Of these, 22% complained about discomfort at the site of the biopsy, 2% had experienced problems when needing a subsequent anaesthetic, and 0.9% had had trouble when applying for life or accident insurance. The median observation period for all patients following the muscle biopsy was 5.5 years (range 27 months-11 years). During this period, 36 MHS patients had been anaesthetized 52 times (28 general and 23 regional anaesthetics, data missing in one case) without any MH-related complications. None of the patients had received prophylactic dantrolene. Three MHE patients had received non-trigger anaesthetic agents on three occasions without development of MH. Thirty-five MHN patients had been anaesthetized 64 times, and 13 of these MHN patients had received trigger agents 26 times without any signs of MH. An estimate of the probability of clinical MH developing in MHN patients subsequently anaesthetized with trigger agents was found to be 0-24.7% (95% confidence limits), whereas the probability of clinical MH developing in MHS patients anaesthetized with non-trigger agents was 0-9.7% (95% confidence limits).

Extracorporeal shock wave lithotripsy of kidney stones does not induce transient bacteremia. A prospective study. The Copenhagen Extracorporeal Shock Wave Lithotripsy Study Group.

During 58 extracorporeal shock wave lithotripsies 161 blood cultures were drawn to evaluate the incidence of bacteremia during the procedure. Only 3 blood cultures drawn during the procedure yielded bacteria, in all cases probably skin flora contaminants. Post-lithotripsy fever was noted in 29% of the patients, and could not be associated with transient bacteremia and was not influenced by antimicrobial prophylaxis. Patients with a positive urine culture after extracoporeal shock wave lithotripsy may have an increased risk of septicemia.