The purpose of this study was to assess the long-term benefit of isotretinoin in otherwise therapy-resistant acne. We also assessed risk factors which might influence the long-term outcome. We studied 88 patients (mean age 20.8 years), most of whom had suffered from acne for many years (mean 7.4 years). They received isotretinoin in an initial dose of 0.5 or 1.0 mg/kg/day. The dose was subsequently adjusted according to response and side-effects. Most patients only required 4 months' therapy to produce at least 85% clinical improvement. The patients were seen up to 10 years post-therapy (mean 9 years). Sixty-one patients were still virtually clear of disease. Of the others, 16% required further treatment with conventional antibiotics and 23% required a second course of isotretinoin. Of those who relapsed, 96% did so within 3 years of stopping therapy. The patients' age, sex, and duration of acne did not influence outcome. However, in patients with predominantly truncal acne, especially when severe, there was an increased incidence of relapse. Sebum excretion is known to correlate with acne severity, but the long-term degree of sebum suppression was found not to be related to relapse. The dose schedule, in particular cumulative dose, was an important factor in determining relapse rate. Those patients who received 0.5 mg/kg daily, or a cumulative dose of < 120 mg/kg, had a significantly higher relapse rate than patients receiving a larger dose. We did not elicit any long-term systemic or biochemical side-effects. We conclude that isotretinoin is a safe and effective therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Innovative sorption strategies for the detoxification of aflatoxins have been developed. NovaSil clay (NS) has been shown to prevent aflatoxicosis in a variety of animals when included in their diet. Results have shown that NS clay binds aflatoxins with high affinity and high capacity in the gastrointestinal tract, resulting in a notable reduction in the bioavailability of these toxins without interfering with the utilization of vitamins and other micronutrients. This strategy is being evaluated as a potential remedy for acute aflatoxicosis, and as a sustainable human intervention for aflatoxins via the diet. Phase I and II clinical trials confirmed the apparent safety of NS for further study in humans. A recent study in Ghanaians at high risk for aflatoxicosis has indicated that NS (at a dose level of 0.25%) is effective in decreasing biomarkers of aflatoxin exposure and does not interfere with the levels of serum vitamins A and E, and iron and zinc. In summary, enterosorption strategies/ therapies based on NS clay are promising for the management of aflatoxins and as a sustainable public health intervention. The NS clay remedy is novel, inexpensive and easily disseminated. Based on the present research, aflatoxin sequestering clays should be rigorously evaluated in vitro and in vivo, and should meet the following criteria: (1) favourable thermodynamic characteristics of mycotoxin sorption, (2) tolerable levels of priority metals, dioxins/furans and other hazardous contaminants, (3) safety and efficacy in multiple animal species, (4) safety and efficacy in long-term studies, and (5) negligible interactions with vitamins, iron and zinc and other micronutrients.

Geophagy, the intentional ingestion of soil, is a widespread phenomenon whose function is still debated. Recent studies suggest that consumed soils adsorb dietary toxins and provide sodium. However, quantification of soil choice has been absent from most studies, prohibiting the direct comparison of soil use and characteristics.To determine correlates among bird use and soil characteristics, we analyze physical structure, mineral composition, and alkaloid adsorption (14 soil characteristics in total) for 22 soil samples from a riverbank 'clay lick' used by macaws and parrots (family Psittacidae) in Amazon lowland forests in the Tambopata region of southeastern Peru. We quantified bird preferences through photographic mapping. Mineral concentrations were determined using analyses designed to approximate the mineral availability in the vertebrate stomach. The sodium levels in the soil were much higher than in food plants consumed by parrots in this region. Both adsorption of quinine, the model alkaloid used, and sodium concentration correlated significantly with bird use. Sodium explained a much higher percentage of the variation in bird use than quinine adsorption. However, the analyses were complicated by the high degree of correlation among soil variables: clay percentage and sodium concentration were highly correlated with each other and with bird use, making it impossible to determine which of these may have the greater contribution to bird preference. The results suggest that the soils consumed provide an important source of dietary sodium and adsorb alkaloid toxins.Abstract in Spanish is available at http://www.blackwell-synergy.com/loi/btp.

Thirty‐seven Ugandan Africans with Kaposi's sarcoma were studied prospectively and a clinical classification was devised based on the clinical presentation of the disease and the appearance of the cutaneous tumours. The disease could be sub‐classified into four major groups. The first consisted of patients with nodular disease which was associated with a relatively benign clinical course. Patients in the next two groups (florid and infiltrative) had more aggressive disease with extensive cutaneous lesions on one or more extremities, generally associated with involvement of adjacent bone. Cutaneous lesions in the florid group were exophytic tumours while in the infiltrative group deep lesions associated with dense fibrosis predominated, Finally, the lymph‐adenopathic variety occurred mainly in children where lymph‐node involvement was usually the sole manifestation, and in young adults where skin involvement was seen concomitantly. Differing histological patterns were found to correlate with the four clinical types of involvement.

Up to 9% of renal transplant recipients have severe multifactorial erythropoietin-resistant anemia. Human parvovirus B19 (PVB19) infection can cause severe anemia and is likely underreported. Sparse information on epidemiology and management in this population exists. To address these issues, after our first index case, we modified our clinical practice to prospectively screen patients with persistent hemoglobin (Hb) <10 mg/dL for PVB19 infection after excluding common causes of anemia including erythropoietin resistance. Potentially infected patients were further evaluated by serology, qualitative polymerase chain reaction (quPCR) and bone marrow biopsy (BMB) for cytomegalovirus, Epstein-Barr virus, PVB19 and other etiologies. Over 3 months, 212 kidney recipients visited outpatient clinics. Of 52 recipients with anemia, 8 had an Hb <10 mg/dL with erythropoietin resistance and were screened for PVB19 infection. Three cases had PVB19 infection by quPCR and often-inconclusive serology/BMB results. Cases had immunosuppression reduced and received IVIG (0.5 gm/kg × 4 doses) with recovery from anemia, viral clearance in two cases and one recurrence. PVB19-mediated anemia occurred in up to three out of eight (38%) screened kidney recipients with Hb <10 mg/dL resistant to erythrypoietin. We recommend prospective risk stratification for this population, high indices of suspicion using at least qualitative techniques for diagnosis and treatment goal for viral eradication.

This study describes a large series of BBAVFs and makes an extensive comparison between the one-stage and two-stage operations. Significantly improved overall functional patency is demonstrated for the two-stage operation.

Brachiobasilic transposition fistulae have good long-term patency rates. The complication rate, although high, is lower than that reported for PTFE grafts. Brachiobasilic fistulae should be used in preference to PTFE grafts for secondary access.

We investigated 299 patients treated 5-10 years ago with isotretinoin, and followed them for 5 years post-treatment. Of the 299 patients 22.7% required repeat courses of treatment; 17% had two courses, 5% had three courses and 1% had 4-5 courses. Response to further treatment was predictably successful, was not associated with any additional adverse reactions, and produced no persistent side-effects. Factors contributing to the need for further courses of treatment included lower dose regimens (0.1 and 0.5 mg/kg), the presence of severe acne, being a female over the age of 25 at the onset of therapy, and having a prolonged history of acne.