Idiopathic Flushing with Dysesthesia: Treatment with the 585nm Pulsed Dye Laser

Objective: The purpose of this study was to analyze the efficacy and safety of the 585nm pulsed dye laser for the treatment of idiopathic flushing with dysesthesia. Design: This was a retrospective study of patients treated with a 585nm pulsed dye laser with fluences ranging from 3.5 to 7.5J/cm² (purpura threshold fluences), a pulse duration of 450μsec, and a spot size of 5 or 10mm. Setting: The Ronald 0. Perelman Department of Dermatology at New York University Medical Center. Participants: Ten adult subjects who presented with flushing with dysesthesia. Measurements: Participants subjectively evaluated the decrease in dysesthesia and the number of flushing episodes. The objective response to treatment was evaluated by a single physician using pre- and postoperative photographs. The severity of postoperative erythema was compared with baseline using an ordinal scale ranging from zero (resolution of erythema) to four (76-100% of baseline erythema). Results: The mean number of treatments received by the subjects was seven. The mean fluence was 6.66J/cm². Subjectively, 100 percent of subjects reported a decrease in dysethesia and the number of flushing episodes. Objectively, subjects demonstrated at least a 62.5-percent reduction in erythema. Conclusion: Laser surgery provided subjective relief of dysesthesia and decreased the number of flushing episodes with a greater than 62-percent objective reduction in the severity of erythema. The 585nm pulsed dye laser is a safe, efficacious treatment for the signs and symptoms of idiopathic flushing with dysesthesia.Flushing is a transient, episodic redness of the face, neck, upper chest, and/or epigastric area that is associated with certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion.1 Blushing is flushing exclusively provoked by an emotional stimulus.2,3 Dysesthesia is defined as an unpleasant, abnormal sensation that is produced by normal stimuli.4Idiopathic flushing is a diagnosis of exclusion.3,5-8 In a subset of patients with idiopathic flushing, dysesthesia may be noted, and patients describe this symptom as a warm, unpleasant, burning sensation. Patients with this constellation of signs and symptoms, which is henceforth referred to as idiopathic flushing with dysesthesia, consistently deny concomitant pruritus. Furthermore, associated signs and symptoms, such as bronchospasm, abdominal cramps, diarrhea, headache, hypotension, or tachycardia, are rare in these patients.The objectives of this study were to define the characteristics of a poorly defined disorder, idiopathic flushing with dysesthesia, and to evaluate the treatment of subjects with this disorder using the 585nm pulsed dye laser.     

A UK Consensus Group on management of glucocorticoid-induced osteoporosis: an update

Abstract. Eastell R, Reid DM, Compston J, Cooper C, Fogelman I, Francis RM, Hosking DJ, Purdie DW, Ralston SH, Reeve J, Russell RGG, Stevenson JC, Torgerson DJ (University of Sheffield Medical School, Sheffield; University of Aberdeen, Aberdeen; University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge; Southampton General Hospital, Southampton; Guy's Hospital, London; Freeman Hospital, Newcastle upon Tyne; Nottingham City Hospital, Nottingham; Hull Royal Infirmary, Hull; Wynn Institute for Metabolic Research, London; and the University of York, York, UK). A UK Consensus Group on management of glucocorticoid-induced osteoporosis: an update (Review). J Intern Med 1998; 244: 271–292.
In the UK, over 250 000 patients take continuous oral glucocorticoids (GCs), yet no more than 14% receive any therapy to prevent bone loss, a major complication of GC treatment. Bone loss is rapid, particularly in the first year, and fracture risk may double. This review, based wherever possible on clinical evidence, aims to provide easy-to-use guidance with wide applicability. A treatment algorithm is presented for adults receiving GC doses of 7.5 mg day⁻¹ or more for 6 months or more. General measures, e.g. alternative GCs and routes of administration, and therapeutic interventions, e.g. cyclical etidronate and hormone replacement, are recommended.     

The export of immunoglobulin D by human neoplastic B lymphocytes

An investigation has been made into the ability of human neoplastic B lymphocytes expressing surface IgM and IgD to export IgD in culture. Cells that expressed surface Ig of the lambda light chain type frequently exported IgD (10/12 patients), whereas cells expressing surface Ig of the kappa light chain type exported no IgD, although most (8/11 patients) were able to export IgM. It appears, therefore, that in most of the 23 cases studied, cells synthesizing IgD with lambda light chains can both express and export IgD, whereas those synthesizing IgD kappa can only insert it into the surface membrane. This finding and the known preponderance of lambda in plasma IgD imply that the possession of a lambda chain facilitates the IgD secretory pathway, a conclusion that implicates a control mechanism subsequent to the surface/secretory dichotomy arising from different splicings of heavy chain messenger RNA.     

Responding mindfully to distressing psychosis: A grounded theory analysis

Abstract

This study investigates the psychological process involved when people with current distressing psychosis learned to respond mindfully to unpleasant psychotic sensations (voices, thoughts, and images). Sixteen participants were interviewed on completion of a mindfulness group program. Grounded theory methodology was used to generate a theory of the core psychological process using a systematically applied set of methods linking analysis with data collection. The theory inducted describes the experience of relating differently to psychosis through a three-stage process: centering in awareness of psychosis; allowing voices, thoughts, and images to come and go without reacting or struggle; and reclaiming power through acceptance of psychosis and the self. The conceptual and clinical applications of the theory and its limits are discussed.     

Launching the Tidal Model in an adult mental health programme

AIM: To implement a new model of psychiatric nursing that uses person-centred care to empower people with acute mental health problems. METHOD: A pilot study involved the introduction of the model into two wards in the acute mental health services in Newcastle City Health Trust. This was followed by introduction of the model into all nine adult acute wards in the service. One ward was evaluated for six months before and six months after introducing the model and nurses' perceptions of the model have been assessed using questionnaires. RESULTS: Preliminary findings of the ward evaluation show that since the model has been implemented, more people have been admitted on an informal basis and fewer have been subject to sections of the Mental Health Act (MHA); the number of admissions has doubled while the length of stay has decreased; violent incidents and episodes of self-harm have decreased; the use of restraint has decreased; and the interval between admission and assessment has decreased. Preliminary analysis of the nursing questionnaires shows positive perceptions of the model. CONCLUSION: The introduction of this model appears to have had a positive impact on the care being given to patients and the nurses using the model appear to be satisfied with the use of patient-centred care.