home *** CD-ROM | disk | FTP | other *** search
/ Year Books 1991 / Year Books 1991.iso / dp / 08 / 087.pkg < prev    next >
Unknown  |  1992-06-06  |  129.6 KB

open in: MacOS 8.1     |     Win98     |     DOS

view JSON data     |     view as text

This file was not able to be converted.
This format is not currently supported by dexvert.

ConfidenceProgramDetectionMatch TypeSupport
66% dexvert OS/2 Installation Package (archive/os2InstallPackage) ext Supported
1% dexvert BeOS Installation Package (archive/beOSInstallPackage) ext Unsupported
1% dexvert Newton Package (archive/newtonPackage) ext Unsupported
1% dexvert Independence War 2 mod Package (other/independenceWar2ModPackage) ext Unsupported
100% file data default



hex view
+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 21 00 |.DP1.1..|......!.|
|00000010| 00 00 16 00 00 00 33 35 | 00 00 00 01 f2 01 00 00 |......35|........|
|00000020| 94 0d 00 00 33 36 00 00 | 00 01 86 0f 00 00 0c 10 |....36..|........|
|00000030| 00 00 33 37 00 00 00 01 | 92 1f 00 00 b2 0d 00 00 |..37....|........|
|00000040| 33 38 00 00 00 01 44 2d | 00 00 ea 0c 00 00 33 39 |38....D-|......39|
|00000050| 00 00 00 01 2e 3a 00 00 | 5a 0b 00 00 35 30 00 00 |.....:..|Z...50..|
|00000060| 00 01 88 45 00 00 72 0d | 00 00 35 31 00 00 00 01 |...E..r.|..51....|
|00000070| fa 52 00 00 82 10 00 00 | 35 32 00 00 00 01 7c 63 |.R......|52....|c|
|00000080| 00 00 23 16 00 00 35 33 | 00 00 00 01 9f 79 00 00 |..#...53|.....y..|
|00000090| d8 07 00 00 35 34 00 00 | 00 01 77 81 00 00 ad 0f |....54..|..w.....|
|000000a0| 00 00 35 35 00 00 00 01 | 24 91 00 00 9b 14 00 00 |..55....|$.......|
|000000b0| 35 36 00 00 00 01 bf a5 | 00 00 bd 0e 00 00 35 37 |56......|......57|
|000000c0| 00 00 00 01 7c b4 00 00 | f9 0c 00 00 35 38 00 00 |....|...|....58..|
|000000d0| 00 01 75 c1 00 00 f1 10 | 00 00 35 39 00 00 00 01 |..u.....|..59....|
|000000e0| 66 d2 00 00 b5 10 00 00 | 36 30 00 00 00 01 1b e3 |f.......|60......|
|000000f0| 00 00 2c 16 00 00 36 31 | 00 00 00 01 47 f9 00 00 |..,...61|....G...|
|00000100| e9 11 00 00 36 32 00 00 | 00 01 30 0b 01 00 ce 0c |....62..|..0.....|
|00000110| 00 00 36 33 00 00 00 01 | fe 17 01 00 d4 13 00 00 |..63....|........|
|00000120| 36 34 00 00 00 01 d2 2b | 01 00 94 14 00 00 36 35 |64.....+|......65|
|00000130| 00 00 00 01 66 40 01 00 | 24 0c 00 00 36 36 00 00 |....f@..|$...66..|
|00000140| 00 01 8a 4c 01 00 98 0e | 00 00 36 37 00 00 00 01 |...L....|..67....|
|00000150| 22 5b 01 00 44 11 00 00 | 36 38 00 00 00 01 66 6c |"[..D...|68....fl|
|00000160| 01 00 90 11 00 00 36 39 | 00 00 00 01 f6 7d 01 00 |......69|.....}..|
|00000170| 9d 0e 00 00 37 30 00 00 | 00 01 93 8c 01 00 d9 0c |....70..|........|
|00000180| 00 00 37 31 00 00 00 01 | 6c 99 01 00 23 0f 00 00 |..71....|l...#...|
|00000190| 37 32 00 00 00 01 8f a8 | 01 00 fd 0c 00 00 37 33 |72......|......73|
|000001a0| 00 00 00 01 8c b5 01 00 | 70 12 00 00 37 34 00 00 |........|p...74..|
|000001b0| 00 01 fc c7 01 00 c0 14 | 00 00 37 35 00 00 00 01 |........|..75....|
|000001c0| bc dc 01 00 f1 0e 00 00 | 37 36 00 00 00 01 ad eb |........|76......|
|000001d0| 01 00 ed 0b 00 00 37 37 | 00 00 00 01 9a f7 01 00 |......77|........|
|000001e0| b0 0e 00 00 00 00 00 00 | 00 00 4a 06 02 00 00 00 |........|..J.....|
|000001f0| 00 00 24 55 6e 69 71 75 | 65 5f 49 44 7b 59 52 42 |..$Uniqu|e_ID{YRB|
|00000200| 30 38 37 33 35 7d 0d 0a | 24 54 69 74 6c 65 7b 54 |08735}..|$Title{T|
|00000210| 72 65 61 74 6d 65 6e 74 | 20 6f 66 20 41 64 76 61 |reatment| of Adva|
|00000220| 6e 63 65 64 20 53 71 75 | 61 6d 6f 75 73 20 43 65 |nced Squ|amous Ce|
|00000230| 6c 6c 20 43 61 72 63 69 | 6e 6f 6d 61 20 6f 66 20 |ll Carci|noma of |
|00000240| 74 68 65 20 53 6b 69 6e | 20 57 69 74 68 20 49 73 |the Skin| With Is|
|00000250| 6f 74 72 65 74 69 6e 6f | 69 6e 7d 0d 0a 24 41 75 |otretino|in}..$Au|
|00000260| 74 68 6f 72 7b 0d 0a 4c | 69 70 70 6d 61 6e 2c 20 |thor{..L|ippman, |
|00000270| 53 4d 0d 0a 4d 65 79 73 | 6b 65 6e 73 2c 20 46 4c |SM..Meys|kens, FL|
|00000280| 20 4a 72 7d 0d 0a 24 41 | 66 66 69 6c 69 61 74 69 | Jr}..$A|ffiliati|
|00000290| 6f 6e 7b 55 6e 69 76 20 | 6f 66 20 41 72 69 7a 6f |on{Univ |of Arizo|
|000002a0| 6e 61 7d 0d 0a 24 53 75 | 62 6a 65 63 74 7b 43 61 |na}..$Su|bject{Ca|
|000002b0| 72 63 69 6e 6f 6d 61 2c | 20 73 6b 69 6e 2c 20 69 |rcinoma,| skin, i|
|000002c0| 73 6f 74 72 65 74 69 6e | 6f 69 6e 20 69 6e 3b 0d |sotretin|oin in;.|
|000002d0| 0a 53 6b 69 6e 20 63 61 | 72 63 69 6e 6f 6d 61 2c |.Skin ca|rcinoma,|
|000002e0| 20 69 73 6f 74 72 65 74 | 69 6e 6f 69 6e 20 69 6e | isotret|inoin in|
|000002f0| 7d 0d 0a 24 4a 6f 75 72 | 6e 61 6c 7b 41 6e 6e 20 |}..$Jour|nal{Ann |
|00000300| 49 6e 74 65 72 6e 20 4d | 65 64 7d 0d 0a 24 56 6f |Intern M|ed}..$Vo|
|00000310| 6c 75 6d 65 7b 31 30 37 | 7d 0d 0a 24 50 61 67 65 |lume{107|}..$Page|
|00000320| 7b 34 39 39 2d 35 30 31 | 7d 0d 0a 24 44 61 74 65 |{499-501|}..$Date|
|00000330| 7b 4f 63 74 6f 62 65 72 | 20 31 39 38 37 7d 0d 0a |{October| 1987}..|
|00000340| 24 59 42 56 6f 6c 7b 31 | 39 38 39 20 59 65 61 72 |$YBVol{1|989 Year|
|00000350| 20 42 6f 6f 6b 20 6f 66 | 20 50 6c 61 73 74 69 63 | Book of| Plastic|
|00000360| 2c 20 52 65 63 6f 6e 73 | 74 72 75 63 74 69 76 65 |, Recons|tructive|
|00000370| 2c 20 61 6e 64 20 41 65 | 73 74 68 65 74 69 63 20 |, and Ae|sthetic |
|00000380| 53 75 72 67 65 72 79 7d | 0d 0a 24 43 68 61 70 74 |Surgery}|..$Chapt|
|00000390| 65 72 7b 32 2d 39 7d 0d | 0a 24 59 42 45 64 69 74 |er{2-9}.|.$YBEdit|
|000003a0| 6f 72 7b 44 72 73 2e 20 | 4d 69 6c 6c 65 72 2c 20 |or{Drs. |Miller, |
|000003b0| 42 65 6e 6e 65 74 74 2c | 20 48 61 79 6e 65 73 2c |Bennett,| Haynes,|
|000003c0| 20 48 6f 65 68 6e 2c 20 | 4d 63 4b 69 6e 6e 65 79 | Hoehn, |McKinney|
|000003d0| 2c 20 61 6e 64 20 57 68 | 69 74 61 6b 65 72 7d 0d |, and Wh|itaker}.|
|000003e0| 0a 24 54 61 62 6c 65 7b | 54 61 62 6c 65 20 4f 6d |.$Table{|Table Om|
|000003f0| 69 74 74 65 64 7d 0d 0a | 24 43 6f 6d 6d 65 6e 74 |itted}..|$Comment|
|00000400| 61 74 6f 72 7b 53 2e 48 | 2e 20 4d 69 6c 6c 65 72 |ator{S.H|. Miller|
|00000410| 2c 20 4d 2e 44 7d 0d 0a | 0d 0a 43 6f 70 79 72 69 |, M.D}..|..Copyri|
|00000420| 67 68 74 20 28 63 29 20 | 59 65 61 72 20 42 6f 6f |ght (c) |Year Boo|
|00000430| 6b 20 4d 65 64 69 63 61 | 6c 20 50 75 62 6c 69 73 |k Medica|l Publis|
|00000440| 68 65 72 73 2c 20 49 6e | 63 2e 2c 20 31 39 38 39 |hers, In|c., 1989|
|00000450| 0d 0a 0d 0a 31 39 38 39 | 20 59 65 61 72 20 42 6f |....1989| Year Bo|
|00000460| 6f 6b 20 6f 66 20 50 6c | 61 73 74 69 63 2c 20 52 |ok of Pl|astic, R|
|00000470| 65 63 6f 6e 73 74 72 75 | 63 74 69 76 65 2c 20 61 |econstru|ctive, a|
|00000480| 6e 64 20 41 65 73 74 68 | 65 74 69 63 20 53 75 72 |nd Aesth|etic Sur|
|00000490| 67 65 72 79 20 28 52 29 | 0d 0a 0d 0a 43 68 61 70 |gery (R)|....Chap|
|000004a0| 74 65 72 20 32 2d 2d 4e | 65 6f 70 6c 61 73 74 69 |ter 2--N|eoplasti|
|000004b0| 63 2c 20 49 6e 66 6c 61 | 6d 6d 61 74 6f 72 79 2c |c, Infla|mmatory,|
|000004c0| 20 61 6e 64 20 44 65 67 | 65 6e 65 72 61 74 69 76 | and Deg|enerativ|
|000004d0| 65 20 44 69 73 65 61 73 | 65 73 0d 0a 0d 0a 4d 61 |e Diseas|es....Ma|
|000004e0| 6c 69 67 6e 61 6e 74 0d | 0a 0d 0a 2d 2d 2d 2d 2d |lignant.|...-----|
|000004f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000500| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000510| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000520| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000530| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 54 72 65 |--------|---..Tre|
|00000540| 61 74 6d 65 6e 74 20 6f | 66 20 41 64 76 61 6e 63 |atment o|f Advanc|
|00000550| 65 64 20 53 71 75 61 6d | 6f 75 73 20 43 65 6c 6c |ed Squam|ous Cell|
|00000560| 20 43 61 72 63 69 6e 6f | 6d 61 20 6f 66 20 74 68 | Carcino|ma of th|
|00000570| 65 20 53 6b 69 6e 20 57 | 69 74 68 20 49 73 6f 74 |e Skin W|ith Isot|
|00000580| 72 65 74 69 6e 6f 69 6e | 0d 0a 0d 0a 4c 69 70 70 |retinoin|....Lipp|
|00000590| 6d 61 6e 20 53 4d 2c 20 | 4d 65 79 73 6b 65 6e 73 |man SM, |Meyskens|
|000005a0| 20 46 4c 20 4a 72 0d 0a | 28 55 6e 69 76 20 6f 66 | FL Jr..|(Univ of|
|000005b0| 20 41 72 69 7a 6f 6e 61 | 29 0d 0a 41 6e 6e 20 49 | Arizona|)..Ann I|
|000005c0| 6e 74 65 72 6e 20 4d 65 | 64 20 31 30 37 3a 34 39 |ntern Me|d 107:49|
|000005d0| 39 2d 35 30 31 2c 20 4f | 63 74 6f 62 65 72 20 31 |9-501, O|ctober 1|
|000005e0| 39 38 37 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |987..---|--------|
|000005f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000600| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000610| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000620| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000630| 2d 2d 2d 2d 2d 0d 0a 0d | 0a 41 62 73 74 72 61 63 |-----...|.Abstrac|
|00000640| 74 0d 0a 0d 0a 20 20 20 | 20 20 53 71 75 61 6d 6f |t.... | Squamo|
|00000650| 75 73 20 63 65 6c 6c 20 | 63 61 72 63 69 6e 6f 6d |us cell |carcinom|
|00000660| 61 20 6f 66 20 74 68 65 | 20 73 6b 69 6e 20 69 73 |a of the| skin is|
|00000670| 20 63 6f 6d 6d 6f 6e 6c | 79 20 74 72 65 61 74 65 | commonl|y treate|
|00000680| 64 20 77 69 74 68 20 73 | 75 72 67 65 72 79 20 6f |d with s|urgery o|
|00000690| 72 0d 0a 72 61 64 69 61 | 74 69 6f 6e 20 74 68 65 |r..radia|tion the|
|000006a0| 72 61 70 79 2c 20 77 68 | 69 63 68 20 69 73 20 65 |rapy, wh|ich is e|
|000006b0| 66 66 65 63 74 69 76 65 | 20 69 6e 20 39 30 25 20 |ffective| in 90% |
|000006c0| 6f 66 20 74 68 65 20 63 | 61 73 65 73 20 74 72 65 |of the c|ases tre|
|000006d0| 61 74 65 64 2e 20 20 48 | 6f 77 65 76 65 72 2c 0d |ated. H|owever,.|
|000006e0| 0a 63 68 65 6d 6f 74 68 | 65 72 61 70 79 20 68 61 |.chemoth|erapy ha|
|000006f0| 73 20 79 69 65 6c 64 65 | 64 20 70 6f 6f 72 20 72 |s yielde|d poor r|
|00000700| 65 73 75 6c 74 73 20 66 | 6f 72 20 74 68 6f 73 65 |esults f|or those|
|00000710| 20 70 61 74 69 65 6e 74 | 73 20 77 68 6f 20 68 61 | patient|s who ha|
|00000720| 76 65 20 72 65 66 72 61 | 63 74 6f 72 79 0d 0a 73 |ve refra|ctory..s|
|00000730| 71 75 61 6d 6f 75 73 20 | 63 61 72 63 69 6e 6f 6d |quamous |carcinom|
|00000740| 61 20 6f 66 20 74 68 65 | 20 73 6b 69 6e 2e 20 20 |a of the| skin. |
|00000750| 52 65 63 65 6e 74 20 65 | 78 70 65 72 69 6d 65 6e |Recent e|xperimen|
|00000760| 74 61 6c 20 73 74 75 64 | 69 65 73 20 68 61 76 65 |tal stud|ies have|
|00000770| 20 73 68 6f 77 6e 20 74 | 68 61 74 0d 0a 72 65 74 | shown t|hat..ret|
|00000780| 69 6e 6f 69 64 73 20 61 | 63 74 20 61 67 61 69 6e |inoids a|ct again|
|00000790| 73 74 20 73 71 75 61 6d | 6f 75 73 20 63 65 6c 6c |st squam|ous cell|
|000007a0| 20 63 61 72 63 69 6e 6f | 6d 61 20 69 6e 20 76 69 | carcino|ma in vi|
|000007b0| 74 72 6f 20 61 6e 64 20 | 69 6e 20 76 69 76 6f 2e |tro and |in vivo.|
|000007c0| 20 20 46 6f 75 72 0d 0a | 70 61 74 69 65 6e 74 73 | Four..|patients|
|000007d0| 20 77 68 6f 20 68 61 64 | 20 72 65 66 72 61 63 74 | who had| refract|
|000007e0| 6f 72 79 20 61 64 76 61 | 6e 63 65 64 20 73 71 75 |ory adva|nced squ|
|000007f0| 61 6d 6f 75 73 20 63 65 | 6c 6c 20 63 61 72 63 69 |amous ce|ll carci|
|00000800| 6e 6f 6d 61 20 6f 66 20 | 74 68 65 20 73 6b 69 6e |noma of |the skin|
|00000810| 20 68 61 64 0d 0a 73 75 | 63 63 65 73 73 66 75 6c | had..su|ccessful|
|00000820| 20 72 65 73 70 6f 6e 73 | 65 73 20 74 6f 20 74 72 | respons|es to tr|
|00000830| 65 61 74 6d 65 6e 74 20 | 77 69 74 68 20 6f 72 61 |eatment |with ora|
|00000840| 6c 20 69 73 6f 74 72 65 | 74 69 6e 6f 69 6e 2e 20 |l isotre|tinoin. |
|00000850| 20 4f 6e 65 20 63 61 73 | 65 20 72 65 70 6f 72 74 | One cas|e report|
|00000860| 20 69 73 0d 0a 70 72 65 | 73 65 6e 74 65 64 20 68 | is..pre|sented h|
|00000870| 65 72 65 2e 0d 0a 0d 0a | 20 20 20 20 20 4d 61 6e |ere.....| Man|
|00000880| 2c 20 37 37 2c 20 68 61 | 64 20 70 72 65 76 69 6f |, 77, ha|d previo|
|00000890| 75 73 6c 79 20 72 65 63 | 65 69 76 65 64 20 74 72 |usly rec|eived tr|
|000008a0| 65 61 74 6d 65 6e 74 20 | 77 69 74 68 20 72 61 64 |eatment |with rad|
|000008b0| 69 61 74 69 6f 6e 20 74 | 68 65 72 61 70 79 20 66 |iation t|herapy f|
|000008c0| 6f 72 20 61 0d 0a 73 6d | 61 6c 6c 20 6e 65 63 6b |or a..sm|all neck|
|000008d0| 20 6c 65 73 69 6f 6e 20 | 61 6e 64 20 61 20 6c 75 | lesion |and a lu|
|000008e0| 6d 70 20 6f 6e 20 68 69 | 73 20 6e 6f 73 65 2e 20 |mp on hi|s nose. |
|000008f0| 20 41 73 20 68 65 20 68 | 61 64 20 72 65 66 75 73 | As he h|ad refus|
|00000900| 65 64 20 66 75 72 74 68 | 65 72 20 74 72 65 61 74 |ed furth|er treat|
|00000910| 6d 65 6e 74 2c 0d 0a 62 | 6f 74 68 20 6c 65 73 69 |ment,..b|oth lesi|
|00000920| 6f 6e 73 20 70 72 6f 67 | 72 65 73 73 65 64 2c 20 |ons prog|ressed, |
|00000930| 61 6e 64 20 61 74 20 70 | 72 65 73 65 6e 74 61 74 |and at p|resentat|
|00000940| 69 6f 6e 20 68 65 20 68 | 61 64 20 61 20 6d 61 73 |ion he h|ad a mas|
|00000950| 73 69 76 65 2c 20 69 6e | 64 75 72 61 74 65 64 2c |sive, in|durated,|
|00000960| 20 61 6e 64 0d 0a 65 72 | 79 74 68 65 6d 61 74 6f | and..er|ythemato|
|00000970| 75 73 20 65 78 6f 70 68 | 79 74 69 63 20 66 75 6e |us exoph|ytic fun|
|00000980| 67 61 74 69 6e 67 20 6c | 65 73 69 6f 6e 20 6f 6e |gating l|esion on|
|00000990| 20 74 68 65 20 72 69 67 | 68 74 20 73 69 64 65 20 | the rig|ht side |
|000009a0| 6f 66 20 68 69 73 20 6e | 65 63 6b 20 28 46 69 67 |of his n|eck (Fig|
|000009b0| 20 32 2d 34 2c 0d 0a 41 | 29 20 61 6e 64 20 63 6f | 2-4,..A|) and co|
|000009c0| 6d 70 6c 65 74 65 20 64 | 65 73 74 72 75 63 74 69 |mplete d|estructi|
|000009d0| 6f 6e 20 61 6e 64 20 65 | 72 6f 73 69 6f 6e 20 6f |on and e|rosion o|
|000009e0| 66 20 74 68 65 20 6e 6f | 73 65 2e 20 20 48 65 20 |f the no|se. He |
|000009f0| 77 61 73 20 74 72 65 61 | 74 65 64 20 77 69 74 68 |was trea|ted with|
|00000a00| 20 6f 72 61 6c 0d 0a 69 | 73 6f 74 72 65 74 69 6e | oral..i|sotretin|
|00000a10| 6f 69 6e 20 69 6e 20 64 | 61 69 6c 79 20 64 69 76 |oin in d|aily div|
|00000a20| 69 64 65 64 20 64 6f 73 | 65 73 20 6f 66 20 31 20 |ided dos|es of 1 |
|00000a30| 6d 67 2f 6b 67 20 62 6f | 64 79 20 77 65 69 67 68 |mg/kg bo|dy weigh|
|00000a40| 74 2e 20 20 57 69 74 68 | 69 6e 20 74 68 65 20 66 |t. With|in the f|
|00000a50| 69 72 73 74 20 33 0d 0a | 77 65 65 6b 73 20 6f 66 |irst 3..|weeks of|
|00000a60| 20 69 73 6f 74 72 65 74 | 69 6e 6f 69 6e 20 74 72 | isotret|inoin tr|
|00000a70| 65 61 74 6d 65 6e 74 2c | 20 74 68 65 20 62 75 6c |eatment,| the bul|
|00000a80| 6b 20 6f 66 20 74 68 65 | 20 6e 65 63 6b 20 74 75 |k of the| neck tu|
|00000a90| 6d 6f 72 20 72 65 67 72 | 65 73 73 65 64 0d 0a 73 |mor regr|essed..s|
|00000aa0| 69 67 6e 69 66 69 63 61 | 6e 74 6c 79 2e 20 20 41 |ignifica|ntly. A|
|00000ab0| 66 74 65 72 20 36 20 6d | 6f 6e 74 68 73 20 6f 66 |fter 6 m|onths of|
|00000ac0| 20 69 73 6f 74 72 65 74 | 69 6e 6f 69 6e 20 74 72 | isotret|inoin tr|
|00000ad0| 65 61 74 6d 65 6e 74 2c | 20 6f 6e 6c 79 20 61 20 |eatment,| only a |
|00000ae0| 6e 6f 6e 64 69 73 63 72 | 65 74 65 2c 0d 0a 66 6c |nondiscr|ete,..fl|
|00000af0| 61 74 2c 20 72 65 73 69 | 64 75 61 6c 20 6c 65 73 |at, resi|dual les|
|00000b00| 69 6f 6e 20 72 65 6d 61 | 69 6e 65 64 20 6f 6e 20 |ion rema|ined on |
|00000b10| 68 69 73 20 6e 65 63 6b | 20 28 46 69 67 20 32 2d |his neck| (Fig 2-|
|00000b20| 34 2c 42 29 3b 20 74 68 | 65 20 6e 61 73 61 6c 20 |4,B); th|e nasal |
|00000b30| 6c 65 73 69 6f 6e 20 68 | 61 64 0d 0a 72 65 67 72 |lesion h|ad..regr|
|00000b40| 65 73 73 65 64 20 62 79 | 20 37 30 25 2e 20 20 48 |essed by| 70%. H|
|00000b50| 6f 77 65 76 65 72 2c 20 | 61 74 20 74 68 65 20 31 |owever, |at the 1|
|00000b60| 31 2d 6d 6f 6e 74 68 20 | 66 6f 6c 6c 6f 77 2d 75 |1-month |follow-u|
|00000b70| 70 20 65 78 61 6d 69 6e | 61 74 69 6f 6e 2c 20 68 |p examin|ation, h|
|00000b80| 69 73 20 6e 65 63 6b 20 | 6d 61 73 73 0d 0a 68 61 |is neck |mass..ha|
|00000b90| 64 20 72 65 63 75 72 72 | 65 64 2e 20 20 48 65 20 |d recurr|ed. He |
|00000ba0| 77 61 73 20 67 69 76 65 | 6e 20 63 68 65 6d 6f 74 |was give|n chemot|
|00000bb0| 68 65 72 61 70 79 20 77 | 69 74 68 20 66 6c 75 6f |herapy w|ith fluo|
|00000bc0| 72 6f 75 72 61 63 69 6c | 20 61 6e 64 20 63 69 73 |rouracil| and cis|
|00000bd0| 70 6c 61 74 69 6e 2c 20 | 77 68 69 63 68 0d 0a 69 |platin, |which..i|
|00000be0| 6e 64 75 63 65 64 20 61 | 20 70 61 72 74 69 61 6c |nduced a| partial|
|00000bf0| 20 72 65 73 70 6f 6e 73 | 65 20 61 66 74 65 72 20 | respons|e after |
|00000c00| 32 20 63 79 63 6c 65 73 | 2e 0d 0a 0d 0a 20 20 20 |2 cycles|..... |
|00000c10| 20 20 54 68 65 20 6f 74 | 68 65 72 20 33 20 70 61 | The ot|her 3 pa|
|00000c20| 74 69 65 6e 74 73 20 77 | 68 6f 20 61 6c 73 6f 20 |tients w|ho also |
|00000c30| 68 61 64 20 72 65 66 72 | 61 63 74 6f 72 79 20 73 |had refr|actory s|
|00000c40| 71 75 61 6d 6f 75 73 20 | 63 65 6c 6c 20 63 61 72 |quamous |cell car|
|00000c50| 63 69 6e 6f 6d 61 20 6f | 66 20 74 68 65 0d 0a 73 |cinoma o|f the..s|
|00000c60| 6b 69 6e 20 73 68 6f 77 | 65 64 20 6d 61 6a 6f 72 |kin show|ed major|
|00000c70| 20 64 69 73 65 61 73 65 | 20 72 65 67 72 65 73 73 | disease| regress|
|00000c80| 69 6f 6e 20 77 69 74 68 | 69 6e 20 34 20 77 65 65 |ion with|in 4 wee|
|00000c90| 6b 73 20 6f 66 20 73 74 | 61 72 74 69 6e 67 20 6f |ks of st|arting o|
|00000ca0| 72 61 6c 0d 0a 69 73 6f | 74 72 65 74 69 6e 6f 69 |ral..iso|tretinoi|
|00000cb0| 6e 20 74 68 65 72 61 70 | 79 2e 20 20 52 65 6d 69 |n therap|y. Remi|
|00000cc0| 73 73 69 6f 6e 73 20 77 | 65 72 65 20 73 75 73 74 |ssions w|ere sust|
|00000cd0| 61 69 6e 65 64 20 64 75 | 72 69 6e 67 20 66 6f 6c |ained du|ring fol|
|00000ce0| 6c 6f 77 2d 75 70 2e 20 | 20 53 69 64 65 20 65 66 |low-up. | Side ef|
|00000cf0| 66 65 63 74 73 0d 0a 6f | 66 20 69 73 6f 74 72 65 |fects..o|f isotre|
|00000d00| 74 69 6e 6f 69 6e 20 77 | 65 72 65 20 67 65 6e 65 |tinoin w|ere gene|
|00000d10| 72 61 6c 6c 79 20 6d 69 | 6c 64 20 61 6e 64 20 69 |rally mi|ld and i|
|00000d20| 6e 63 6c 75 64 65 64 20 | 72 65 76 65 72 73 69 62 |ncluded |reversib|
|00000d30| 6c 65 20 6d 75 63 6f 63 | 75 74 61 6e 65 6f 75 73 |le mucoc|utaneous|
|00000d40| 0d 0a 72 65 61 63 74 69 | 6f 6e 73 20 61 6e 64 20 |..reacti|ons and |
|00000d50| 61 73 79 6d 70 74 6f 6d | 61 74 69 63 20 6c 61 62 |asymptom|atic lab|
|00000d60| 6f 72 61 74 6f 72 79 20 | 61 62 6e 6f 72 6d 61 6c |oratory |abnormal|
|00000d70| 69 74 69 65 73 2e 20 20 | 54 68 65 20 74 72 65 61 |ities. |The trea|
|00000d80| 74 6d 65 6e 74 20 6f 66 | 20 61 64 76 61 6e 63 65 |tment of| advance|
|00000d90| 64 0d 0a 73 71 75 61 6d | 6f 75 73 20 63 65 6c 6c |d..squam|ous cell|
|00000da0| 20 63 61 72 63 69 6e 6f | 6d 61 20 6f 66 20 74 68 | carcino|ma of th|
|00000db0| 65 20 73 6b 69 6e 20 77 | 69 74 68 20 69 73 6f 74 |e skin w|ith isot|
|00000dc0| 72 65 74 69 6e 6f 69 6e | 20 73 68 6f 75 6c 64 20 |retinoin| should |
|00000dd0| 62 65 20 69 6e 76 65 73 | 74 69 67 61 74 65 64 0d |be inves|tigated.|
|00000de0| 0a 66 75 72 74 68 65 72 | 2c 20 61 73 20 69 74 20 |.further|, as it |
|00000df0| 61 70 70 65 61 72 73 20 | 74 6f 20 62 65 20 71 75 |appears |to be qu|
|00000e00| 69 74 65 20 65 66 66 65 | 63 74 69 76 65 20 61 6e |ite effe|ctive an|
|00000e10| 64 20 69 73 20 77 65 6c | 6c 20 74 6f 6c 65 72 61 |d is wel|l tolera|
|00000e20| 74 65 64 2e 0d 0a 0d 0a | 50 6f 73 74 2d 43 6f 6d |ted.....|Post-Com|
|00000e30| 6d 65 6e 74 0d 0a 0d 0a | 20 20 20 20 20 45 6e 63 |ment....| Enc|
|00000e40| 6f 75 72 61 67 69 6e 67 | 20 72 65 73 75 6c 74 73 |ouraging| results|
|00000e50| 20 69 6e 20 74 72 65 61 | 74 69 6e 67 20 61 64 76 | in trea|ting adv|
|00000e60| 61 6e 63 65 64 20 73 71 | 75 61 6d 6f 75 73 20 63 |anced sq|uamous c|
|00000e70| 65 6c 6c 20 63 61 6e 63 | 65 72 73 20 69 6e 20 61 |ell canc|ers in a|
|00000e80| 20 73 6d 61 6c 6c 0d 0a | 6e 75 6d 62 65 72 20 6f | small..|number o|
|00000e90| 66 20 70 61 74 69 65 6e | 74 73 2e 20 20 4f 74 68 |f patien|ts. Oth|
|00000ea0| 65 72 20 72 65 70 6f 72 | 74 73 20 75 73 69 6e 67 |er repor|ts using|
|00000eb0| 20 76 69 74 61 6d 69 6e | 20 41 20 64 65 72 69 76 | vitamin| A deriv|
|00000ec0| 61 74 69 76 65 73 20 66 | 6f 72 20 74 68 69 73 20 |atives f|or this |
|00000ed0| 70 75 72 70 6f 73 65 0d | 0a 61 72 65 20 65 71 75 |purpose.|.are equ|
|00000ee0| 61 6c 6c 79 20 65 6e 63 | 6f 75 72 61 67 69 6e 67 |ally enc|ouraging|
|00000ef0| 20 62 75 74 20 61 6c 73 | 6f 20 69 6e 76 6f 6c 76 | but als|o involv|
|00000f00| 65 20 73 6d 61 6c 6c 20 | 6e 75 6d 62 65 72 73 20 |e small |numbers |
|00000f10| 6f 66 20 70 61 74 69 65 | 6e 74 73 2e 20 20 4f 62 |of patie|nts. Ob|
|00000f20| 76 69 6f 75 73 6c 79 0d | 0a 6e 65 65 64 65 64 20 |viously.|.needed |
|00000f30| 69 73 20 61 20 6c 61 72 | 67 65 2d 73 63 61 6c 65 |is a lar|ge-scale|
|00000f40| 20 73 74 75 64 79 20 74 | 6f 20 64 6f 63 75 6d 65 | study t|o docume|
|00000f50| 6e 74 20 74 68 65 20 65 | 66 66 69 63 61 63 79 20 |nt the e|fficacy |
|00000f60| 6f 66 20 69 73 6f 74 72 | 65 74 69 6e 6f 69 6e 2e |of isotr|etinoin.|
|00000f70| 2d 2d 53 2e 48 2e 0d 0a | 4d 69 6c 6c 65 72 2c 20 |--S.H...|Miller, |
|00000f80| 4d 2e 44 2e 0d 0a 24 55 | 6e 69 71 75 65 5f 49 44 |M.D...$U|nique_ID|
|00000f90| 7b 59 52 42 30 38 37 33 | 36 7d 0d 0a 24 54 69 74 |{YRB0873|6}..$Tit|
|00000fa0| 6c 65 7b 54 68 69 6e 20 | 53 74 61 67 65 20 49 20 |le{Thin |Stage I |
|00000fb0| 50 72 69 6d 61 72 79 20 | 43 75 74 61 6e 65 6f 75 |Primary |Cutaneou|
|00000fc0| 73 20 4d 61 6c 69 67 6e | 61 6e 74 20 4d 65 6c 61 |s Malign|ant Mela|
|00000fd0| 6e 6f 6d 61 3a 20 20 43 | 6f 6d 70 61 72 69 73 6f |noma: C|ompariso|
|00000fe0| 6e 20 6f 66 20 45 78 63 | 69 73 69 6f 6e 20 57 69 |n of Exc|ision Wi|
|00000ff0| 74 68 20 4d 61 72 67 69 | 6e 73 20 6f 66 20 31 20 |th Margi|ns of 1 |
|00001000| 6f 72 20 33 20 43 4d 7d | 0d 0a 24 41 75 74 68 6f |or 3 CM}|..$Autho|
|00001010| 72 7b 0d 0a 56 65 72 6f | 6e 65 73 69 2c 20 55 0d |r{..Vero|nesi, U.|
|00001020| 0a 43 61 73 63 69 6e 65 | 6c 6c 69 2c 20 4e 0d 0a |.Cascine|lli, N..|
|00001030| 41 64 61 6d 75 73 2c 20 | 4a 0d 0a 42 61 6c 63 68 |Adamus, |J..Balch|
|00001040| 2c 20 43 0d 0a 42 61 6e | 64 69 65 72 69 2c 20 44 |, C..Ban|dieri, D|
|00001050| 0d 0a 42 61 72 63 68 75 | 6b 2c 20 41 0d 0a 42 75 |..Barchu|k, A..Bu|
|00001060| 66 61 6c 69 6e 6f 2c 20 | 52 0d 0a 43 72 61 69 67 |falino, |R..Craig|
|00001070| 2c 20 50 0d 0a 44 65 20 | 4d 61 72 73 69 6c 6c 61 |, P..De |Marsilla|
|00001080| 63 2c 20 4a 0d 0a 44 75 | 72 61 6e 64 2c 20 4a 43 |c, J..Du|rand, JC|
|00001090| 0d 0a 76 61 6e 20 47 65 | 65 6c 2c 20 41 4e 0d 0a |..van Ge|el, AN..|
|000010a0| 48 6f 6c 6d 73 74 72 6f | 6d 2c 20 48 0d 0a 48 75 |Holmstro|m, H..Hu|
|000010b0| 6e 74 65 72 2c 20 4a 41 | 0d 0a 4a 6f 72 67 65 6e |nter, JA|..Jorgen|
|000010c0| 73 65 6e 2c 20 4f 47 0d | 0a 4b 69 73 73 2c 20 42 |sen, OG.|.Kiss, B|
|000010d0| 0d 0a 4b 72 6f 6f 6e 2c | 20 42 0d 0a 4c 61 63 6f |..Kroon,| B..Laco|
|000010e0| 75 72 2c 20 4a 0d 0a 4c | 65 6a 65 75 6e 65 2c 20 |ur, J..L|ejeune, |
|000010f0| 46 0d 0a 4d 61 63 6b 69 | 65 2c 20 52 0d 0a 4d 65 |F..Macki|e, R..Me|
|00001100| 63 68 6c 2c 20 5a 0d 0a | 4d 69 74 72 6f 76 2c 20 |chl, Z..|Mitrov, |
|00001110| 47 0d 0a 4d 6f 72 61 62 | 69 74 6f 2c 20 41 0d 0a |G..Morab|ito, A..|
|00001120| 4e 6f 73 65 6b 2c 20 48 | 0d 0a 50 61 6e 69 7a 7a |Nosek, H|..Panizz|
|00001130| 6f 6e 2c 20 52 0d 0a 50 | 72 61 64 65 2c 20 4d 0d |on, R..P|rade, M.|
|00001140| 0a 53 61 6e 74 69 2c 20 | 50 0d 0a 56 61 6e 20 53 |.Santi, |P..Van S|
|00001150| 6c 6f 6f 74 65 6e 2c 20 | 45 0d 0a 54 6f 6d 69 6e |looten, |E..Tomin|
|00001160| 2c 20 52 0d 0a 54 72 61 | 70 65 7a 6e 69 6b 6f 76 |, R..Tra|peznikov|
|00001170| 2c 20 4e 0d 0a 54 73 61 | 6e 6f 76 2c 20 54 0d 0a |, N..Tsa|nov, T..|
|00001180| 55 72 69 73 74 2c 20 4d | 0d 0a 57 6f 7a 6e 69 61 |Urist, M|..Woznia|
|00001190| 6b 2c 20 4b 44 7d 0d 0a | 24 41 66 66 69 6c 69 61 |k, KD}..|$Affilia|
|000011a0| 74 69 6f 6e 7b 4e 61 74 | 6c 20 43 61 6e 63 65 72 |tion{Nat|l Cancer|
|000011b0| 20 49 6e 73 74 2c 20 4d | 69 6c 61 6e 2c 20 49 74 | Inst, M|ilan, It|
|000011c0| 61 6c 79 3b 20 4f 6e 63 | 6f 6c 6f 67 69 63 61 6c |aly; Onc|ological|
|000011d0| 20 49 6e 73 74 2c 20 47 | 6c 69 77 69 63 65 2c 20 | Inst, G|liwice, |
|000011e0| 50 6f 6c 61 6e 64 3b 20 | 55 6e 69 76 20 6f 66 20 |Poland; |Univ of |
|000011f0| 41 6c 61 62 61 6d 61 3b | 20 48 6f 73 70 20 41 43 |Alabama;| Hosp AC|
|00001200| 20 43 61 6d 61 72 67 6f | 2c 20 53 61 6f 20 50 61 | Camargo|, Sao Pa|
|00001210| 75 6c 6f 2c 20 42 72 61 | 7a 69 6c 3b 20 50 65 74 |ulo, Bra|zil; Pet|
|00001220| 72 6f 76 20 52 65 73 65 | 61 72 63 68 20 49 6e 73 |rov Rese|arch Ins|
|00001230| 74 20 6f 66 20 4f 6e 63 | 6f 6c 6f 67 79 2c 20 4c |t of Onc|ology, L|
|00001240| 65 6e 69 6e 67 72 61 64 | 3b 20 65 74 20 61 6c 7d |eningrad|; et al}|
|00001250| 0d 0a 24 53 75 62 6a 65 | 63 74 7b 4d 65 6c 61 6e |..$Subje|ct{Melan|
|00001260| 6f 6d 61 2c 20 6d 61 6c | 69 67 6e 61 6e 74 20 73 |oma, mal|ignant s|
|00001270| 6b 69 6e 2c 20 73 74 61 | 67 65 20 49 20 70 72 69 |kin, sta|ge I pri|
|00001280| 6d 61 72 79 2c 20 65 78 | 63 69 73 69 6f 6e 7d 0d |mary, ex|cision}.|
|00001290| 0a 24 4a 6f 75 72 6e 61 | 6c 7b 4e 20 45 6e 67 6c |.$Journa|l{N Engl|
|000012a0| 20 4a 20 4d 65 64 7d 0d | 0a 24 56 6f 6c 75 6d 65 | J Med}.|.$Volume|
|000012b0| 7b 33 31 38 7d 0d 0a 24 | 50 61 67 65 7b 31 31 35 |{318}..$|Page{115|
|000012c0| 39 2d 31 31 36 32 7d 0d | 0a 24 44 61 74 65 7b 4d |9-1162}.|.$Date{M|
|000012d0| 61 79 20 35 2c 20 31 39 | 38 38 7d 0d 0a 24 59 42 |ay 5, 19|88}..$YB|
|000012e0| 56 6f 6c 7b 31 39 38 39 | 20 59 65 61 72 20 42 6f |Vol{1989| Year Bo|
|000012f0| 6f 6b 20 6f 66 20 50 6c | 61 73 74 69 63 2c 20 52 |ok of Pl|astic, R|
|00001300| 65 63 6f 6e 73 74 72 75 | 63 74 69 76 65 2c 20 61 |econstru|ctive, a|
|00001310| 6e 64 20 41 65 73 74 68 | 65 74 69 63 20 53 75 72 |nd Aesth|etic Sur|
|00001320| 67 65 72 79 7d 0d 0a 24 | 43 68 61 70 74 65 72 7b |gery}..$|Chapter{|
|00001330| 32 2d 31 32 7d 0d 0a 24 | 59 42 45 64 69 74 6f 72 |2-12}..$|YBEditor|
|00001340| 7b 44 72 73 2e 20 4d 69 | 6c 6c 65 72 2c 20 42 65 |{Drs. Mi|ller, Be|
|00001350| 6e 6e 65 74 74 2c 20 48 | 61 79 6e 65 73 2c 20 48 |nnett, H|aynes, H|
|00001360| 6f 65 68 6e 2c 20 4d 63 | 4b 69 6e 6e 65 79 2c 20 |oehn, Mc|Kinney, |
|00001370| 61 6e 64 20 57 68 69 74 | 61 6b 65 72 7d 0d 0a 24 |and Whit|aker}..$|
|00001380| 54 61 62 6c 65 7b 7d 0d | 0a 24 43 6f 6d 6d 65 6e |Table{}.|.$Commen|
|00001390| 74 61 74 6f 72 7b 53 2e | 48 2e 20 4d 69 6c 6c 65 |tator{S.|H. Mille|
|000013a0| 72 2c 20 4d 2e 44 2e 7d | 0d 0a 0d 0a 43 6f 70 79 |r, M.D.}|....Copy|
|000013b0| 72 69 67 68 74 20 28 63 | 29 20 59 65 61 72 20 42 |right (c|) Year B|
|000013c0| 6f 6f 6b 20 4d 65 64 69 | 63 61 6c 20 50 75 62 6c |ook Medi|cal Publ|
|000013d0| 69 73 68 65 72 73 2c 20 | 49 6e 63 2e 2c 20 31 39 |ishers, |Inc., 19|
|000013e0| 38 39 0d 0a 0d 0a 31 39 | 38 39 20 59 65 61 72 20 |89....19|89 Year |
|000013f0| 42 6f 6f 6b 20 6f 66 20 | 50 6c 61 73 74 69 63 2c |Book of |Plastic,|
|00001400| 20 52 65 63 6f 6e 73 74 | 72 75 63 74 69 76 65 2c | Reconst|ructive,|
|00001410| 20 61 6e 64 20 41 65 73 | 74 68 65 74 69 63 20 53 | and Aes|thetic S|
|00001420| 75 72 67 65 72 79 20 28 | 52 29 0d 0a 0d 0a 43 68 |urgery (|R)....Ch|
|00001430| 61 70 74 65 72 20 32 2d | 2d 4e 65 6f 70 6c 61 73 |apter 2-|-Neoplas|
|00001440| 74 69 63 2c 20 49 6e 66 | 6c 61 6d 6d 61 74 6f 72 |tic, Inf|lammator|
|00001450| 79 2c 20 61 6e 64 20 44 | 65 67 65 6e 65 72 61 74 |y, and D|egenerat|
|00001460| 69 76 65 20 44 69 73 65 | 61 73 65 73 0d 0a 0d 0a |ive Dise|ases....|
|00001470| 4d 61 6c 69 67 6e 61 6e | 74 0d 0a 0d 0a 2d 2d 2d |Malignan|t....---|
|00001480| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001490| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000014a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000014b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000014c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 54 |--------|-----..T|
|000014d0| 68 69 6e 20 53 74 61 67 | 65 20 49 20 50 72 69 6d |hin Stag|e I Prim|
|000014e0| 61 72 79 20 43 75 74 61 | 6e 65 6f 75 73 20 4d 61 |ary Cuta|neous Ma|
|000014f0| 6c 69 67 6e 61 6e 74 20 | 4d 65 6c 61 6e 6f 6d 61 |lignant |Melanoma|
|00001500| 3a 20 20 43 6f 6d 70 61 | 72 69 73 6f 6e 20 6f 66 |: Compa|rison of|
|00001510| 20 45 78 63 69 73 69 6f | 6e 20 57 69 74 68 0d 0a | Excisio|n With..|
|00001520| 4d 61 72 67 69 6e 73 20 | 6f 66 20 31 20 6f 72 20 |Margins |of 1 or |
|00001530| 33 20 43 4d 0d 0a 0d 0a | 56 65 72 6f 6e 65 73 69 |3 CM....|Veronesi|
|00001540| 20 55 2c 20 43 61 73 63 | 69 6e 65 6c 6c 69 20 4e | U, Casc|inelli N|
|00001550| 2c 20 41 64 61 6d 75 73 | 20 4a 2c 20 42 61 6c 63 |, Adamus| J, Balc|
|00001560| 68 20 43 2c 20 42 61 6e | 64 69 65 72 69 20 44 2c |h C, Ban|dieri D,|
|00001570| 20 42 61 72 63 68 75 6b | 20 41 2c 20 42 75 66 61 | Barchuk| A, Bufa|
|00001580| 6c 69 6e 6f 20 52 2c 0d | 0a 43 72 61 69 67 20 50 |lino R,.|.Craig P|
|00001590| 2c 20 44 65 20 4d 61 72 | 73 69 6c 6c 61 63 20 4a |, De Mar|sillac J|
|000015a0| 2c 20 44 75 72 61 6e 64 | 20 4a 43 2c 20 76 61 6e |, Durand| JC, van|
|000015b0| 20 47 65 65 6c 20 41 4e | 2c 20 48 6f 6c 6d 73 74 | Geel AN|, Holmst|
|000015c0| 72 6f 6d 20 48 2c 20 48 | 75 6e 74 65 72 20 4a 41 |rom H, H|unter JA|
|000015d0| 2c 0d 0a 4a 6f 72 67 65 | 6e 73 65 6e 20 4f 47 2c |,..Jorge|nsen OG,|
|000015e0| 20 4b 69 73 73 20 42 2c | 20 4b 72 6f 6f 6e 20 42 | Kiss B,| Kroon B|
|000015f0| 2c 20 4c 61 63 6f 75 72 | 20 4a 2c 20 4c 65 6a 65 |, Lacour| J, Leje|
|00001600| 75 6e 65 20 46 2c 20 4d | 61 63 6b 69 65 20 52 2c |une F, M|ackie R,|
|00001610| 20 4d 65 63 68 6c 20 5a | 2c 20 4d 69 74 72 6f 76 | Mechl Z|, Mitrov|
|00001620| 20 47 2c 0d 0a 4d 6f 72 | 61 62 69 74 6f 20 41 2c | G,..Mor|abito A,|
|00001630| 20 4e 6f 73 65 6b 20 48 | 2c 20 50 61 6e 69 7a 7a | Nosek H|, Panizz|
|00001640| 6f 6e 20 52 2c 20 50 72 | 61 64 65 20 4d 2c 20 53 |on R, Pr|ade M, S|
|00001650| 61 6e 74 69 20 50 2c 20 | 56 61 6e 20 53 6c 6f 6f |anti P, |Van Sloo|
|00001660| 74 65 6e 20 45 2c 20 54 | 6f 6d 69 6e 20 52 2c 0d |ten E, T|omin R,.|
|00001670| 0a 54 72 61 70 65 7a 6e | 69 6b 6f 76 20 4e 2c 20 |.Trapezn|ikov N, |
|00001680| 54 73 61 6e 6f 76 20 54 | 2c 20 55 72 69 73 74 20 |Tsanov T|, Urist |
|00001690| 4d 2c 20 57 6f 7a 6e 69 | 61 6b 20 4b 44 0d 0a 28 |M, Wozni|ak KD..(|
|000016a0| 4e 61 74 6c 20 43 61 6e | 63 65 72 20 49 6e 73 74 |Natl Can|cer Inst|
|000016b0| 2c 20 4d 69 6c 61 6e 2c | 20 49 74 61 6c 79 3b 20 |, Milan,| Italy; |
|000016c0| 4f 6e 63 6f 6c 6f 67 69 | 63 61 6c 20 49 6e 73 74 |Oncologi|cal Inst|
|000016d0| 2c 20 47 6c 69 77 69 63 | 65 2c 20 50 6f 6c 61 6e |, Gliwic|e, Polan|
|000016e0| 64 3b 20 55 6e 69 76 20 | 6f 66 0d 0a 41 6c 61 62 |d; Univ |of..Alab|
|000016f0| 61 6d 61 3b 20 48 6f 73 | 70 20 41 43 20 43 61 6d |ama; Hos|p AC Cam|
|00001700| 61 72 67 6f 2c 20 53 61 | 6f 20 50 61 75 6c 6f 2c |argo, Sa|o Paulo,|
|00001710| 20 42 72 61 7a 69 6c 3b | 20 50 65 74 72 6f 76 20 | Brazil;| Petrov |
|00001720| 52 65 73 65 61 72 63 68 | 20 49 6e 73 74 20 6f 66 |Research| Inst of|
|00001730| 20 4f 6e 63 6f 6c 6f 67 | 79 2c 0d 0a 4c 65 6e 69 | Oncolog|y,..Leni|
|00001740| 6e 67 72 61 64 3b 20 65 | 74 20 61 6c 29 0d 0a 4e |ngrad; e|t al)..N|
|00001750| 20 45 6e 67 6c 20 4a 20 | 4d 65 64 20 33 31 38 3a | Engl J |Med 318:|
|00001760| 31 31 35 39 2d 31 31 36 | 32 2c 20 4d 61 79 20 35 |1159-116|2, May 5|
|00001770| 2c 20 31 39 38 38 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |, 1988..|--------|
|00001780| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001790| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000017a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000017b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000017c0| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 0d 0a 41 62 73 74 |--------|....Abst|
|000017d0| 72 61 63 74 0d 0a 0d 0a | 20 20 20 20 20 4d 61 6c |ract....| Mal|
|000017e0| 69 67 6e 61 6e 74 20 6d | 65 6c 61 6e 6f 6d 61 73 |ignant m|elanomas|
|000017f0| 20 68 61 76 65 20 6c 6f | 6e 67 20 62 65 65 6e 20 | have lo|ng been |
|00001800| 74 72 65 61 74 65 64 20 | 62 79 20 77 69 64 65 20 |treated |by wide |
|00001810| 65 78 63 69 73 69 6f 6e | 20 6f 66 20 74 68 65 0d |excision| of the.|
|00001820| 0a 73 75 72 72 6f 75 6e | 64 69 6e 67 20 73 6b 69 |.surroun|ding ski|
|00001830| 6e 2e 20 20 53 6f 20 66 | 65 77 20 63 61 73 65 73 |n. So f|ew cases|
|00001840| 20 77 65 72 65 20 66 6f | 75 6e 64 20 69 6e 20 77 | were fo|und in w|
|00001850| 68 69 63 68 20 61 20 6e | 61 72 72 6f 77 20 65 78 |hich a n|arrow ex|
|00001860| 63 69 73 69 6f 6e 20 77 | 61 73 0d 0a 70 65 72 66 |cision w|as..perf|
|00001870| 6f 72 6d 65 64 20 74 68 | 61 74 20 69 74 20 77 61 |ormed th|at it wa|
|00001880| 73 20 69 6d 70 6f 73 73 | 69 62 6c 65 20 74 6f 20 |s imposs|ible to |
|00001890| 63 6f 6d 70 61 72 65 20 | 6f 75 74 63 6f 6d 65 73 |compare |outcomes|
|000018a0| 20 6f 66 20 74 68 65 20 | 32 20 64 69 66 66 65 72 | of the |2 differ|
|000018b0| 65 6e 74 0d 0a 65 78 63 | 69 73 69 6f 6e 73 2e 20 |ent..exc|isions. |
|000018c0| 20 54 68 65 20 57 6f 72 | 6c 64 20 48 65 61 6c 74 | The Wor|ld Healt|
|000018d0| 68 20 4f 72 67 61 6e 69 | 7a 61 74 69 6f 6e 20 4d |h Organi|zation M|
|000018e0| 65 6c 61 6e 6f 6d 61 20 | 47 72 6f 75 70 20 64 65 |elanoma |Group de|
|000018f0| 76 69 73 65 64 20 61 20 | 73 74 75 64 79 20 6f 66 |vised a |study of|
|00001900| 20 36 31 32 0d 0a 63 61 | 73 65 73 20 69 6e 20 77 | 612..ca|ses in w|
|00001910| 68 69 63 68 20 63 6c 69 | 6e 69 63 61 6c 20 53 74 |hich cli|nical St|
|00001920| 61 67 65 20 49 20 6d 65 | 6c 61 6e 6f 6d 61 73 20 |age I me|lanomas |
|00001930| 6e 6f 20 6d 6f 72 65 20 | 74 68 61 6e 20 32 20 6d |no more |than 2 m|
|00001940| 6d 20 74 68 69 63 6b 20 | 77 65 72 65 20 74 72 65 |m thick |were tre|
|00001950| 61 74 65 64 0d 0a 77 69 | 74 68 20 65 69 74 68 65 |ated..wi|th eithe|
|00001960| 72 20 77 69 64 65 20 6f | 72 20 6e 61 72 72 6f 77 |r wide o|r narrow|
|00001970| 20 65 78 63 69 73 69 6f | 6e 20 61 6e 64 20 65 76 | excisio|n and ev|
|00001980| 61 6c 75 61 74 65 64 20 | 64 75 72 69 6e 67 20 61 |aluated |during a|
|00001990| 20 6d 65 61 6e 20 66 6f | 6c 6c 6f 77 2d 75 70 20 | mean fo|llow-up |
|000019a0| 70 65 72 69 6f 64 0d 0a | 6f 66 20 35 35 20 6d 6f |period..|of 55 mo|
|000019b0| 6e 74 68 73 2e 0d 0a 20 | 20 20 20 20 53 75 72 67 |nths... | Surg|
|000019c0| 69 63 61 6c 20 74 72 65 | 61 74 6d 65 6e 74 20 77 |ical tre|atment w|
|000019d0| 61 73 20 73 69 6d 69 6c | 61 72 20 65 78 63 65 70 |as simil|ar excep|
|000019e0| 74 20 66 6f 72 20 74 68 | 65 20 65 78 74 65 6e 74 |t for th|e extent|
|000019f0| 20 6f 66 20 74 68 65 20 | 65 78 63 69 73 69 6f 6e | of the |excision|
|00001a00| 2e 20 20 41 0d 0a 6e 61 | 72 72 6f 77 20 6d 61 72 |. A..na|rrow mar|
|00001a10| 67 69 6e 20 65 78 74 65 | 6e 64 65 64 20 31 20 63 |gin exte|nded 1 c|
|00001a20| 6d 20 66 72 6f 6d 20 74 | 68 65 20 65 64 67 65 20 |m from t|he edge |
|00001a30| 6f 66 20 74 68 65 20 6c | 65 73 69 6f 6e 2c 20 61 |of the l|esion, a|
|00001a40| 6e 64 20 61 20 77 69 64 | 65 20 6d 61 72 67 69 6e |nd a wid|e margin|
|00001a50| 20 77 61 73 0d 0a 6f 6e | 65 20 74 68 61 74 20 65 | was..on|e that e|
|00001a60| 78 74 65 6e 64 65 64 20 | 61 74 20 6c 65 61 73 74 |xtended |at least|
|00001a70| 20 33 20 63 6d 20 62 65 | 79 6f 6e 64 20 74 68 65 | 3 cm be|yond the|
|00001a80| 20 6c 65 73 69 6f 6e 2e | 20 20 4e 61 72 72 6f 77 | lesion.| Narrow|
|00001a90| 20 65 78 63 69 73 69 6f | 6e 20 77 61 73 20 75 73 | excisio|n was us|
|00001aa0| 65 64 20 66 6f 72 0d 0a | 34 39 2e 37 25 20 6f 66 |ed for..|49.7% of|
|00001ab0| 20 70 61 74 69 65 6e 74 | 73 2e 20 20 54 68 65 72 | patient|s. Ther|
|00001ac0| 65 20 77 61 73 20 6e 6f | 20 73 69 67 6e 69 66 69 |e was no| signifi|
|00001ad0| 63 61 6e 74 20 64 69 66 | 66 65 72 65 6e 63 65 20 |cant dif|ference |
|00001ae0| 62 65 74 77 65 65 6e 20 | 74 68 65 20 74 68 69 63 |between |the thic|
|00001af0| 6b 6e 65 73 73 20 6f 66 | 0d 0a 74 75 6d 6f 72 73 |kness of|..tumors|
|00001b00| 20 69 6e 20 74 68 65 20 | 32 20 67 72 6f 75 70 73 | in the |2 groups|
|00001b10| 2e 0d 0a 20 20 20 20 20 | 50 61 74 69 65 6e 74 73 |... |Patients|
|00001b20| 20 77 65 72 65 20 65 78 | 61 6d 69 6e 65 64 20 62 | were ex|amined b|
|00001b30| 69 6d 6f 6e 74 68 6c 79 | 20 66 6f 72 20 74 68 65 |imonthly| for the|
|00001b40| 20 66 69 72 73 74 20 32 | 20 79 65 61 72 73 20 61 | first 2| years a|
|00001b50| 6e 64 20 71 75 61 72 74 | 65 72 6c 79 20 64 75 72 |nd quart|erly dur|
|00001b60| 69 6e 67 0d 0a 74 68 65 | 20 74 68 69 72 64 20 74 |ing..the| third t|
|00001b70| 6f 20 66 69 66 74 68 20 | 79 65 61 72 2e 20 20 45 |o fifth |year. E|
|00001b80| 78 61 6d 69 6e 61 74 69 | 6f 6e 73 20 77 65 72 65 |xaminati|ons were|
|00001b90| 20 70 65 72 66 6f 72 6d | 65 64 20 65 76 65 72 79 | perform|ed every|
|00001ba0| 20 36 20 6d 6f 6e 74 68 | 73 20 74 68 65 72 65 61 | 6 month|s therea|
|00001bb0| 66 74 65 72 2e 0d 0a 41 | 6e 79 20 74 72 65 61 74 |fter...A|ny treat|
|00001bc0| 6d 65 6e 74 20 72 65 71 | 75 69 72 65 64 20 64 75 |ment req|uired du|
|00001bd0| 72 69 6e 67 20 74 68 65 | 20 66 69 72 73 74 20 35 |ring the| first 5|
|00001be0| 20 79 65 61 72 73 20 66 | 6f 6c 6c 6f 77 65 64 20 | years f|ollowed |
|00001bf0| 73 74 61 6e 64 61 72 64 | 20 67 75 69 64 65 6c 69 |standard| guideli|
|00001c00| 6e 65 73 2e 0d 0a 49 66 | 20 6d 65 6c 61 6e 6f 6d |nes...If| melanom|
|00001c10| 61 20 72 65 63 75 72 72 | 65 64 20 6c 6f 63 61 6c |a recurr|ed local|
|00001c20| 6c 79 2c 20 74 68 65 20 | 70 61 74 69 65 6e 74 20 |ly, the |patient |
|00001c30| 75 6e 64 65 72 77 65 6e | 74 20 77 69 64 65 20 73 |underwen|t wide s|
|00001c40| 75 72 67 69 63 61 6c 20 | 65 78 63 69 73 69 6f 6e |urgical |excision|
|00001c50| 2e 0d 0a 20 20 20 20 20 | 54 68 65 20 34 2d 79 65 |... |The 4-ye|
|00001c60| 61 72 20 61 63 74 75 61 | 72 69 61 6c 20 73 75 72 |ar actua|rial sur|
|00001c70| 76 69 76 61 6c 20 72 61 | 74 65 73 20 77 65 72 65 |vival ra|tes were|
|00001c80| 20 73 69 6d 69 6c 61 72 | 20 66 6f 72 20 62 6f 74 | similar| for bot|
|00001c90| 68 20 67 72 6f 75 70 73 | 3a 20 20 39 36 2e 38 25 |h groups|: 96.8%|
|00001ca0| 0d 0a 66 6f 72 20 6e 61 | 72 72 6f 77 20 65 78 63 |..for na|rrow exc|
|00001cb0| 69 73 69 6f 6e 20 61 6e | 64 20 39 36 2e 30 25 20 |ision an|d 96.0% |
|00001cc0| 66 6f 72 20 77 69 64 65 | 20 65 78 63 69 73 69 6f |for wide| excisio|
|00001cd0| 6e 2e 20 20 4f 66 20 74 | 68 65 20 33 32 20 70 61 |n. Of t|he 32 pa|
|00001ce0| 74 69 65 6e 74 73 20 66 | 6f 75 6e 64 20 74 6f 0d |tients f|ound to.|
|00001cf0| 0a 68 61 76 65 20 64 69 | 73 74 61 6e 74 20 6d 65 |.have di|stant me|
|00001d00| 74 61 73 74 61 73 65 73 | 2c 20 74 68 65 72 65 20 |tastases|, there |
|00001d10| 77 61 73 20 6e 6f 20 73 | 74 61 74 69 73 74 69 63 |was no s|tatistic|
|00001d20| 61 6c 20 64 69 66 66 65 | 72 65 6e 63 65 20 62 65 |al diffe|rence be|
|00001d30| 74 77 65 65 6e 20 6d 6f | 64 65 73 20 6f 66 0d 0a |tween mo|des of..|
|00001d40| 74 72 65 61 74 6d 65 6e | 74 2e 20 20 53 69 6d 69 |treatmen|t. Simi|
|00001d50| 6c 61 72 6c 79 2c 20 6f | 66 20 33 36 20 70 61 74 |larly, o|f 36 pat|
|00001d60| 69 65 6e 74 73 20 77 69 | 74 68 20 72 65 67 69 6f |ients wi|th regio|
|00001d70| 6e 61 6c 20 6e 6f 64 61 | 6c 20 6d 65 74 61 73 74 |nal noda|l metast|
|00001d80| 61 73 65 73 2c 20 34 2e | 36 25 20 77 65 72 65 0d |ases, 4.|6% were.|
|00001d90| 0a 66 72 6f 6d 20 74 68 | 65 20 6e 61 72 72 6f 77 |.from th|e narrow|
|00001da0| 2d 65 78 63 69 73 69 6f | 6e 20 67 72 6f 75 70 20 |-excisio|n group |
|00001db0| 61 6e 64 20 36 2e 35 25 | 20 75 6e 64 65 72 77 65 |and 6.5%| underwe|
|00001dc0| 6e 74 20 77 69 64 65 20 | 65 78 63 69 73 69 6f 6e |nt wide |excision|
|00001dd0| 2e 0d 0a 20 20 20 20 20 | 54 68 65 20 65 76 69 64 |... |The evid|
|00001de0| 65 6e 63 65 20 66 72 6f | 6d 20 74 68 69 73 20 74 |ence fro|m this t|
|00001df0| 72 69 61 6c 20 73 68 6f | 77 73 20 6e 61 72 72 6f |rial sho|ws narro|
|00001e00| 77 20 65 78 63 69 73 69 | 6f 6e 20 74 6f 20 62 65 |w excisi|on to be|
|00001e10| 20 61 73 20 65 66 66 65 | 63 74 69 76 65 20 61 0d | as effe|ctive a.|
|00001e20| 0a 74 72 65 61 74 6d 65 | 6e 74 20 61 73 20 74 68 |.treatme|nt as th|
|00001e30| 65 20 70 72 65 76 69 6f | 75 73 6c 79 20 61 63 63 |e previo|usly acc|
|00001e40| 65 70 74 65 64 20 6d 65 | 74 68 6f 64 20 6f 66 20 |epted me|thod of |
|00001e50| 63 68 6f 69 63 65 20 69 | 6e 20 74 68 69 6e 20 70 |choice i|n thin p|
|00001e60| 72 69 6d 61 72 79 20 6d | 65 6c 61 6e 6f 6d 61 73 |rimary m|elanomas|
|00001e70| 2e 0d 0a 57 69 74 68 20 | 65 61 72 6c 79 20 64 65 |...With |early de|
|00001e80| 74 65 63 74 69 6f 6e 2c | 20 74 68 65 20 73 75 72 |tection,| the sur|
|00001e90| 76 69 76 61 6c 20 72 61 | 74 65 20 66 6f 72 20 74 |vival ra|te for t|
|00001ea0| 68 69 73 20 66 6f 72 6d | 20 6f 66 20 6d 65 6c 61 |his form| of mela|
|00001eb0| 6e 6f 6d 61 20 69 73 20 | 71 75 69 74 65 20 68 69 |noma is |quite hi|
|00001ec0| 67 68 2e 0d 0a 0d 0a 0d | 0a 50 6f 73 74 2d 43 6f |gh......|.Post-Co|
|00001ed0| 6d 6d 65 6e 74 0d 0a 0d | 0a 20 20 20 20 20 54 68 |mment...|. Th|
|00001ee0| 65 20 65 76 69 64 65 6e | 63 65 20 74 6f 20 73 75 |e eviden|ce to su|
|00001ef0| 70 70 6f 72 74 20 6f 6e | 65 27 73 20 6f 77 6e 20 |pport on|e's own |
|00001f00| 70 72 65 6a 75 64 69 63 | 65 20 69 73 20 61 6c 77 |prejudic|e is alw|
|00001f10| 61 79 73 20 63 6f 6d 66 | 6f 72 74 69 6e 67 2e 20 |ays comf|orting. |
|00001f20| 20 4f 74 68 65 72 0d 0a | 73 74 75 64 69 65 73 20 | Other..|studies |
|00001f30| 68 61 76 65 20 73 68 6f | 77 6e 20 73 69 6d 69 6c |have sho|wn simil|
|00001f40| 61 72 20 72 65 73 75 6c | 74 73 2e 20 20 57 69 6c |ar resul|ts. Wil|
|00001f50| 6c 20 74 68 65 20 64 61 | 74 61 20 68 6f 6c 64 20 |l the da|ta hold |
|00001f60| 75 70 20 61 74 20 74 68 | 65 20 31 30 2d 79 65 61 |up at th|e 10-yea|
|00001f70| 72 0d 0a 66 6f 6c 6c 6f | 77 2d 75 70 3f 2d 2d 53 |r..follo|w-up?--S|
|00001f80| 2e 48 2e 20 4d 69 6c 6c | 65 72 2c 20 4d 2e 44 2e |.H. Mill|er, M.D.|
|00001f90| 0d 0a 24 55 6e 69 71 75 | 65 5f 49 44 7b 59 52 42 |..$Uniqu|e_ID{YRB|
|00001fa0| 30 38 37 33 37 7d 0d 0a | 24 54 69 74 6c 65 7b 45 |08737}..|$Title{E|
|00001fb0| 66 66 65 63 74 20 6f 66 | 20 53 65 76 65 72 65 20 |ffect of| Severe |
|00001fc0| 42 75 72 6e 20 49 6e 6a | 75 72 79 20 6f 6e 20 53 |Burn Inj|ury on S|
|00001fd0| 75 62 73 74 72 61 74 65 | 20 43 79 63 6c 69 6e 67 |ubstrate| Cycling|
|00001fe0| 20 62 79 20 47 6c 75 63 | 6f 73 65 20 61 6e 64 20 | by Gluc|ose and |
|00001ff0| 46 61 74 74 79 20 41 63 | 69 64 73 7d 0d 0a 24 41 |Fatty Ac|ids}..$A|
|00002000| 75 74 68 6f 72 7b 0d 0a | 57 6f 6c 66 65 2c 20 52 |uthor{..|Wolfe, R|
|00002010| 52 0d 0a 48 65 72 6e 64 | 6f 6e 2c 20 44 4e 0d 0a |R..Hernd|on, DN..|
|00002020| 4a 61 68 6f 6f 72 2c 20 | 46 0d 0a 4d 69 79 6f 73 |Jahoor, |F..Miyos|
|00002030| 68 69 2c 20 48 0d 0a 57 | 6f 6c 66 65 2c 20 4d 7d |hi, H..W|olfe, M}|
|00002040| 0d 0a 24 41 66 66 69 6c | 69 61 74 69 6f 6e 7b 55 |..$Affil|iation{U|
|00002050| 6e 69 76 20 6f 66 20 54 | 65 78 61 73 2c 20 53 68 |niv of T|exas, Sh|
|00002060| 72 69 6e 65 72 73 20 42 | 75 72 6e 73 20 49 6e 73 |riners B|urns Ins|
|00002070| 74 2c 20 47 61 6c 76 65 | 73 74 6f 6e 2c 20 54 65 |t, Galve|ston, Te|
|00002080| 78 7d 0d 0a 24 53 75 62 | 6a 65 63 74 7b 42 75 72 |x}..$Sub|ject{Bur|
|00002090| 6e 2c 20 62 75 72 6e 73 | 20 66 61 74 74 79 20 61 |n, burns| fatty a|
|000020a0| 63 69 64 73 20 61 66 74 | 65 72 3b 0d 0a 42 75 72 |cids aft|er;..Bur|
|000020b0| 6e 2c 20 62 75 72 6e 73 | 20 67 6c 75 63 6f 73 65 |n, burns| glucose|
|000020c0| 20 61 66 74 65 72 3b 0d | 0a 46 61 74 74 79 20 61 | after;.|.Fatty a|
|000020d0| 63 69 64 73 20 61 66 74 | 65 72 20 62 75 72 6e 73 |cids aft|er burns|
|000020e0| 3b 0d 0a 47 6c 75 63 6f | 73 65 20 61 66 74 65 72 |;..Gluco|se after|
|000020f0| 20 62 75 72 6e 73 7d 0d | 0a 24 4a 6f 75 72 6e 61 | burns}.|.$Journa|
|00002100| 6c 7b 4e 20 45 6e 67 6c | 20 4a 20 4d 65 64 7d 0d |l{N Engl| J Med}.|
|00002110| 0a 24 56 6f 6c 75 6d 65 | 7b 33 31 37 7d 0d 0a 24 |.$Volume|{317}..$|
|00002120| 50 61 67 65 7b 34 30 33 | 2d 34 30 38 7d 0d 0a 24 |Page{403|-408}..$|
|00002130| 44 61 74 65 7b 41 75 67 | 20 31 33 2c 20 31 39 38 |Date{Aug| 13, 198|
|00002140| 37 7d 0d 0a 24 59 42 56 | 6f 6c 7b 31 39 38 39 20 |7}..$YBV|ol{1989 |
|00002150| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 50 6c 61 |Year Boo|k of Pla|
|00002160| 73 74 69 63 2c 20 52 65 | 63 6f 6e 73 74 72 75 63 |stic, Re|construc|
|00002170| 74 69 76 65 2c 20 61 6e | 64 20 41 65 73 74 68 65 |tive, an|d Aesthe|
|00002180| 74 69 63 20 53 75 72 67 | 65 72 79 7d 0d 0a 24 43 |tic Surg|ery}..$C|
|00002190| 68 61 70 74 65 72 7b 33 | 2d 32 38 7d 0d 0a 24 59 |hapter{3|-28}..$Y|
|000021a0| 42 45 64 69 74 6f 72 7b | 44 72 73 2e 20 4d 69 6c |BEditor{|Drs. Mil|
|000021b0| 6c 65 72 2c 20 42 65 6e | 6e 65 74 74 2c 20 48 61 |ler, Ben|nett, Ha|
|000021c0| 79 6e 65 73 2c 20 48 6f | 65 68 6e 2c 20 4d 63 4b |ynes, Ho|ehn, McK|
|000021d0| 69 6e 6e 65 79 2c 20 61 | 6e 64 20 57 68 69 74 61 |inney, a|nd Whita|
|000021e0| 6b 65 72 7d 0d 0a 24 54 | 61 62 6c 65 7b 7d 0d 0a |ker}..$T|able{}..|
|000021f0| 24 43 6f 6d 6d 65 6e 74 | 61 74 6f 72 7b 42 2e 57 |$Comment|ator{B.W|
|00002200| 2e 20 48 61 79 6e 65 73 | 2c 20 4a 72 2e 2c 20 4d |. Haynes|, Jr., M|
|00002210| 2e 44 2e 7d 0d 0a 0d 0a | 43 6f 70 79 72 69 67 68 |.D.}....|Copyrigh|
|00002220| 74 20 28 63 29 20 59 65 | 61 72 20 42 6f 6f 6b 20 |t (c) Ye|ar Book |
|00002230| 4d 65 64 69 63 61 6c 20 | 50 75 62 6c 69 73 68 65 |Medical |Publishe|
|00002240| 72 73 2c 20 49 6e 63 2e | 2c 20 31 39 38 39 0d 0a |rs, Inc.|, 1989..|
|00002250| 0d 0a 31 39 38 39 20 59 | 65 61 72 20 42 6f 6f 6b |..1989 Y|ear Book|
|00002260| 20 6f 66 20 50 6c 61 73 | 74 69 63 2c 20 52 65 63 | of Plas|tic, Rec|
|00002270| 6f 6e 73 74 72 75 63 74 | 69 76 65 2c 20 61 6e 64 |onstruct|ive, and|
|00002280| 20 41 65 73 74 68 65 74 | 69 63 20 53 75 72 67 65 | Aesthet|ic Surge|
|00002290| 72 79 20 28 52 29 0d 0a | 0d 0a 43 68 61 70 74 65 |ry (R)..|..Chapte|
|000022a0| 72 20 33 2d 2d 54 72 61 | 75 6d 61 0d 0a 0d 0a 42 |r 3--Tra|uma....B|
|000022b0| 75 72 6e 73 0d 0a 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |urns....|--------|
|000022c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000022d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000022e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000022f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002300| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 45 66 66 65 63 74 |--------|..Effect|
|00002310| 20 6f 66 20 53 65 76 65 | 72 65 20 42 75 72 6e 20 | of Seve|re Burn |
|00002320| 49 6e 6a 75 72 79 20 6f | 6e 20 53 75 62 73 74 72 |Injury o|n Substr|
|00002330| 61 74 65 20 43 79 63 6c | 69 6e 67 20 62 79 20 47 |ate Cycl|ing by G|
|00002340| 6c 75 63 6f 73 65 20 61 | 6e 64 20 46 61 74 74 79 |lucose a|nd Fatty|
|00002350| 20 41 63 69 64 73 0d 0a | 0d 0a 57 6f 6c 66 65 20 | Acids..|..Wolfe |
|00002360| 52 52 2c 20 48 65 72 6e | 64 6f 6e 20 44 4e 2c 20 |RR, Hern|don DN, |
|00002370| 4a 61 68 6f 6f 72 20 46 | 2c 20 4d 69 79 6f 73 68 |Jahoor F|, Miyosh|
|00002380| 69 20 48 2c 20 57 6f 6c | 66 65 20 4d 0d 0a 28 55 |i H, Wol|fe M..(U|
|00002390| 6e 69 76 20 6f 66 20 54 | 65 78 61 73 2c 20 53 68 |niv of T|exas, Sh|
|000023a0| 72 69 6e 65 72 73 20 42 | 75 72 6e 73 20 49 6e 73 |riners B|urns Ins|
|000023b0| 74 2c 20 47 61 6c 76 65 | 73 74 6f 6e 2c 20 54 65 |t, Galve|ston, Te|
|000023c0| 78 29 0d 0a 4e 20 45 6e | 67 6c 20 4a 20 4d 65 64 |x)..N En|gl J Med|
|000023d0| 20 33 31 37 3a 34 30 33 | 2d 34 30 38 2c 20 41 75 | 317:403|-408, Au|
|000023e0| 67 20 31 33 2c 20 31 39 | 38 37 0d 0a 2d 2d 2d 2d |g 13, 19|87..----|
|000023f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002400| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002410| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002420| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002430| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|00002440| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|.... |
|00002450| 20 49 6e 63 72 65 61 73 | 65 73 20 69 6e 20 6d 65 | Increas|es in me|
|00002460| 74 61 62 6f 6c 69 63 20 | 72 61 74 65 20 61 6e 64 |tabolic |rate and|
|00002470| 20 63 6f 72 65 20 74 65 | 6d 70 65 72 61 74 75 72 | core te|mperatur|
|00002480| 65 20 61 72 65 20 63 6f | 6d 6d 6f 6e 20 72 65 73 |e are co|mmon res|
|00002490| 70 6f 6e 73 65 73 20 74 | 6f 0d 0a 73 65 76 65 72 |ponses t|o..sever|
|000024a0| 65 20 69 6e 6a 75 72 79 | 2e 20 20 54 68 65 20 68 |e injury|. The h|
|000024b0| 79 70 6f 74 68 65 73 69 | 73 20 74 68 61 74 20 74 |ypothesi|s that t|
|000024c0| 68 65 73 65 20 72 65 73 | 70 6f 6e 73 65 73 20 61 |hese res|ponses a|
|000024d0| 72 65 20 74 68 65 20 72 | 65 73 75 6c 74 20 6f 66 |re the r|esult of|
|000024e0| 20 69 6e 63 72 65 61 73 | 65 73 0d 0a 69 6e 20 73 | increas|es..in s|
|000024f0| 75 62 73 74 72 61 74 65 | 20 63 79 63 6c 69 6e 67 |ubstrate| cycling|
|00002500| 20 77 61 73 20 69 6e 76 | 65 73 74 69 67 61 74 65 | was inv|estigate|
|00002510| 64 2e 20 20 54 68 65 20 | 65 78 69 73 74 65 6e 63 |d. The |existenc|
|00002520| 65 20 6f 66 20 73 75 62 | 73 74 72 61 74 65 20 63 |e of sub|strate c|
|00002530| 79 63 6c 65 73 20 77 61 | 73 0d 0a 70 72 6f 70 6f |ycles wa|s..propo|
|00002540| 73 65 64 20 61 62 6f 75 | 74 20 32 30 20 79 65 61 |sed abou|t 20 yea|
|00002550| 72 73 20 61 67 6f 2c 20 | 70 72 69 6d 61 72 69 6c |rs ago, |primaril|
|00002560| 79 20 6f 6e 20 74 68 65 | 20 62 61 73 69 73 20 6f |y on the| basis o|
|00002570| 66 20 74 68 65 6f 72 65 | 74 69 63 61 6c 0d 0a 63 |f theore|tical..c|
|00002580| 6f 6e 73 69 64 65 72 61 | 74 69 6f 6e 73 20 61 6e |onsidera|tions an|
|00002590| 64 20 64 61 74 61 20 66 | 72 6f 6d 20 69 6e 20 76 |d data f|rom in v|
|000025a0| 69 74 72 6f 20 65 78 70 | 65 72 69 6d 65 6e 74 73 |itro exp|eriments|
|000025b0| 2e 20 20 41 20 73 75 62 | 73 74 72 61 74 65 20 63 |. A sub|strate c|
|000025c0| 79 63 6c 65 20 6d 61 79 | 20 6f 63 63 75 72 0d 0a |ycle may| occur..|
|000025d0| 77 68 65 6e 20 6f 70 70 | 6f 73 69 6e 67 20 6e 6f |when opp|osing no|
|000025e0| 6e 65 71 75 69 6c 69 62 | 72 69 75 6d 20 72 65 61 |nequilib|rium rea|
|000025f0| 63 74 69 6f 6e 73 20 63 | 61 74 61 6c 79 7a 65 64 |ctions c|atalyzed|
|00002600| 20 62 79 20 64 69 66 66 | 65 72 65 6e 74 20 65 6e | by diff|erent en|
|00002610| 7a 79 6d 65 73 20 61 72 | 65 0d 0a 6f 70 65 72 61 |zymes ar|e..opera|
|00002620| 74 69 6e 67 20 73 69 6d | 75 6c 74 61 6e 65 6f 75 |ting sim|ultaneou|
|00002630| 73 6c 79 2e 0d 0a 20 20 | 20 20 20 54 68 65 72 65 |sly... | There|
|00002640| 20 77 65 72 65 20 31 38 | 20 6e 6f 72 6d 61 6c 20 | were 18| normal |
|00002650| 76 6f 6c 75 6e 74 65 65 | 72 73 2c 20 69 6e 63 6c |voluntee|rs, incl|
|00002660| 75 64 69 6e 67 20 31 30 | 20 61 64 75 6c 74 73 20 |uding 10| adults |
|00002670| 61 67 65 64 20 32 31 2d | 33 35 20 79 65 61 72 73 |aged 21-|35 years|
|00002680| 20 61 6e 64 20 38 0d 0a | 63 68 69 6c 64 72 65 6e | and 8..|children|
|00002690| 20 61 67 65 64 20 35 2d | 31 35 20 79 65 61 72 73 | aged 5-|15 years|
|000026a0| 2c 20 61 6e 64 20 31 38 | 20 70 61 74 69 65 6e 74 |, and 18| patient|
|000026b0| 73 20 77 69 74 68 20 73 | 65 76 65 72 65 20 62 75 |s with s|evere bu|
|000026c0| 72 6e 73 2c 20 69 6e 63 | 6c 75 64 69 6e 67 20 38 |rns, inc|luding 8|
|000026d0| 20 61 64 75 6c 74 73 0d | 0a 77 69 74 68 20 61 20 | adults.|.with a |
|000026e0| 6d 65 61 6e 20 61 67 65 | 20 6f 66 20 32 37 20 79 |mean age| of 27 y|
|000026f0| 65 61 72 73 20 61 6e 64 | 20 31 30 20 63 68 69 6c |ears and| 10 chil|
|00002700| 64 72 65 6e 20 77 69 74 | 68 20 61 20 6d 65 61 6e |dren wit|h a mean|
|00002710| 20 61 67 65 20 6f 66 20 | 38 20 79 65 61 72 73 2c | age of |8 years,|
|00002720| 20 77 68 6f 20 77 65 72 | 65 0d 0a 69 6e 20 61 20 | who wer|e..in a |
|00002730| 68 79 70 65 72 6d 65 74 | 61 62 6f 6c 69 63 20 73 |hypermet|abolic s|
|00002740| 74 61 74 65 2e 20 20 53 | 74 61 62 6c 65 2d 69 73 |tate. S|table-is|
|00002750| 6f 74 6f 70 65 20 74 72 | 61 63 65 72 73 20 77 65 |otope tr|acers we|
|00002760| 72 65 20 75 73 65 64 20 | 74 6f 20 71 75 61 6e 74 |re used |to quant|
|00002770| 69 66 79 0d 0a 73 75 62 | 73 74 72 61 74 65 20 63 |ify..sub|strate c|
|00002780| 79 63 6c 69 6e 67 20 69 | 6e 20 74 68 65 20 70 61 |ycling i|n the pa|
|00002790| 74 68 77 61 79 73 20 6f | 66 20 67 6c 79 63 6f 6c |thways o|f glycol|
|000027a0| 79 73 69 73 20 61 6e 64 | 20 67 6c 75 63 6f 6e 65 |ysis and| glucone|
|000027b0| 6f 67 65 6e 65 73 69 73 | 20 61 6e 64 20 6f 66 20 |ogenesis| and of |
|000027c0| 61 0d 0a 63 79 63 6c 65 | 20 69 6e 76 6f 6c 76 69 |a..cycle| involvi|
|000027d0| 6e 67 20 74 68 65 20 73 | 69 6d 75 6c 74 61 6e 65 |ng the s|imultane|
|000027e0| 6f 75 73 20 62 72 65 61 | 6b 64 6f 77 6e 20 61 6e |ous brea|kdown an|
|000027f0| 64 20 73 79 6e 74 68 65 | 73 69 73 20 6f 66 20 73 |d synthe|sis of s|
|00002800| 74 6f 72 65 64 20 74 72 | 69 67 6c 79 63 65 72 69 |tored tr|iglyceri|
|00002810| 64 65 2e 0d 0a 20 20 20 | 20 20 49 6e 20 74 68 65 |de... | In the|
|00002820| 20 62 75 72 6e 20 70 61 | 74 69 65 6e 74 73 2c 20 | burn pa|tients, |
|00002830| 74 6f 74 61 6c 20 72 61 | 74 65 73 20 6f 66 20 74 |total ra|tes of t|
|00002840| 72 69 67 6c 79 63 65 72 | 69 64 65 2d 66 61 74 74 |riglycer|ide-fatt|
|00002850| 79 20 61 63 69 64 20 63 | 79 63 6c 69 6e 67 20 61 |y acid c|ycling a|
|00002860| 6e 64 0d 0a 67 6c 79 63 | 6f 6c 79 74 69 63 2d 67 |nd..glyc|olytic-g|
|00002870| 6c 75 63 6f 6e 65 6f 67 | 65 6e 69 63 20 63 79 63 |luconeog|enic cyc|
|00002880| 6c 69 6e 67 20 77 65 72 | 65 20 65 6c 65 76 61 74 |ling wer|e elevat|
|00002890| 65 64 20 62 79 20 34 35 | 30 25 20 61 6e 64 20 32 |ed by 45|0% and 2|
|000028a0| 35 30 25 2c 20 72 65 73 | 70 65 63 74 69 76 65 6c |50%, res|pectivel|
|000028b0| 79 2e 0d 0a 41 6e 20 69 | 6e 66 75 73 69 6f 6e 20 |y...An i|nfusion |
|000028c0| 6f 66 20 70 72 6f 70 72 | 61 6e 6f 6c 6f 6c 20 69 |of propr|anolol i|
|000028d0| 6e 20 74 68 65 20 62 75 | 72 6e 20 70 61 74 69 65 |n the bu|rn patie|
|000028e0| 6e 74 73 20 67 72 65 61 | 74 6c 79 20 72 65 64 75 |nts grea|tly redu|
|000028f0| 63 65 64 0d 0a 74 72 69 | 67 6c 79 63 65 72 69 64 |ced..tri|glycerid|
|00002900| 65 2d 66 61 74 74 79 20 | 61 63 69 64 20 63 79 63 |e-fatty |acid cyc|
|00002910| 6c 69 6e 67 2c 20 62 75 | 74 20 64 69 64 20 6e 6f |ling, bu|t did no|
|00002920| 74 20 61 66 66 65 63 74 | 20 67 6c 75 63 6f 6e 65 |t affect| glucone|
|00002930| 6f 67 65 6e 69 63 2d 67 | 6c 79 63 6f 6c 79 74 69 |ogenic-g|lycolyti|
|00002940| 63 0d 0a 63 79 63 6c 69 | 6e 67 2e 0d 0a 20 20 20 |c..cycli|ng... |
|00002950| 20 20 49 6e 63 72 65 61 | 73 65 64 20 73 75 62 73 | Increa|sed subs|
|00002960| 74 72 61 74 65 20 63 79 | 63 6c 69 6e 67 20 63 6f |trate cy|cling co|
|00002970| 6e 74 72 69 62 75 74 65 | 73 20 74 6f 20 74 68 65 |ntribute|s to the|
|00002980| 20 69 6e 63 72 65 61 73 | 65 64 20 74 68 65 72 6d | increas|ed therm|
|00002990| 6f 67 65 6e 65 73 69 73 | 20 61 6e 64 0d 0a 65 6e |ogenesis| and..en|
|000029a0| 65 72 67 79 20 65 78 70 | 65 6e 64 69 74 75 72 65 |ergy exp|enditure|
|000029b0| 20 6f 62 73 65 72 76 65 | 64 20 61 66 74 65 72 20 | observe|d after |
|000029c0| 73 65 76 65 72 65 20 62 | 75 72 6e 73 2e 20 20 54 |severe b|urns. T|
|000029d0| 68 65 20 69 6e 63 72 65 | 61 73 65 64 0d 0a 74 72 |he incre|ased..tr|
|000029e0| 69 67 6c 79 63 65 72 69 | 64 65 2d 66 61 74 74 79 |iglyceri|de-fatty|
|000029f0| 20 61 63 69 64 20 63 79 | 63 6c 69 6e 67 20 61 70 | acid cy|cling ap|
|00002a00| 70 65 61 72 73 20 74 6f | 20 62 65 20 74 68 65 20 |pears to| be the |
|00002a10| 72 65 73 75 6c 74 20 6f | 66 20 62 65 74 61 2d 61 |result o|f beta-a|
|00002a20| 64 72 65 6e 65 72 67 69 | 63 0d 0a 73 74 69 6d 75 |drenergi|c..stimu|
|00002a30| 6c 61 74 69 6f 6e 2e 20 | 20 46 75 72 74 68 65 72 |lation. | Further|
|00002a40| 20 73 74 75 64 69 65 73 | 20 61 72 65 20 72 65 71 | studies| are req|
|00002a50| 75 69 72 65 64 20 74 6f | 20 64 65 74 65 72 6d 69 |uired to| determi|
|00002a60| 6e 65 20 77 68 65 74 68 | 65 72 20 74 68 65 20 63 |ne wheth|er the c|
|00002a70| 79 63 6c 65 73 20 61 72 | 65 0d 0a 69 6d 70 6f 72 |ycles ar|e..impor|
|00002a80| 74 61 6e 74 20 61 64 61 | 70 74 69 76 65 20 72 65 |tant ada|ptive re|
|00002a90| 73 70 6f 6e 73 65 73 20 | 77 68 69 63 68 20 70 6c |sponses |which pl|
|00002aa0| 61 79 20 61 20 72 6f 6c | 65 20 69 6e 20 6d 65 74 |ay a rol|e in met|
|00002ab0| 61 62 6f 6c 69 63 20 63 | 6f 6e 74 72 6f 6c 2c 20 |abolic c|ontrol, |
|00002ac0| 6f 72 20 77 68 65 74 68 | 65 72 0d 0a 74 68 65 79 |or wheth|er..they|
|00002ad0| 20 61 72 65 20 66 75 74 | 69 6c 65 20 63 79 63 6c | are fut|ile cycl|
|00002ae0| 65 73 20 77 68 69 63 68 | 20 6f 6e 6c 79 20 69 6e |es which| only in|
|00002af0| 63 72 65 61 73 65 20 63 | 61 6c 6f 72 69 63 20 72 |crease c|aloric r|
|00002b00| 65 71 75 69 72 65 6d 65 | 6e 74 73 20 61 6e 64 20 |equireme|nts and |
|00002b10| 62 6f 64 79 0d 0a 74 65 | 6d 70 65 72 61 74 75 72 |body..te|mperatur|
|00002b20| 65 73 20 6f 66 20 70 61 | 74 69 65 6e 74 73 20 69 |es of pa|tients i|
|00002b30| 6e 20 73 65 76 65 72 65 | 20 70 68 79 73 69 63 61 |n severe| physica|
|00002b40| 6c 20 73 74 72 65 73 73 | 2e 0d 0a 0d 0a 50 6f 73 |l stress|.....Pos|
|00002b50| 74 2d 43 6f 6d 6d 65 6e | 74 0d 0a 0d 0a 20 20 20 |t-Commen|t.... |
|00002b60| 20 20 41 73 20 61 20 6d | 65 74 61 62 6f 6c 69 63 | As a m|etabolic|
|00002b70| 20 63 6f 6e 63 65 70 74 | 2c 20 73 75 62 73 74 72 | concept|, substr|
|00002b80| 61 74 65 20 63 79 63 6c | 69 6e 67 20 68 61 73 20 |ate cycl|ing has |
|00002b90| 62 65 65 6e 20 73 75 73 | 70 65 63 74 20 61 73 20 |been sus|pect as |
|00002ba0| 61 20 63 61 75 73 65 20 | 6f 66 0d 0a 69 6e 63 72 |a cause |of..incr|
|00002bb0| 65 61 73 65 64 20 6d 65 | 74 61 62 6f 6c 69 63 20 |eased me|tabolic |
|00002bc0| 72 61 74 65 20 61 6e 64 | 20 68 65 61 74 20 70 72 |rate and| heat pr|
|00002bd0| 6f 64 75 63 74 69 6f 6e | 2c 20 77 68 69 63 68 20 |oduction|, which |
|00002be0| 69 6e 20 65 78 63 65 73 | 73 20 63 6f 75 6c 64 20 |in exces|s could |
|00002bf0| 62 65 0d 0a 63 6f 75 6e | 74 65 72 70 72 6f 64 75 |be..coun|terprodu|
|00002c00| 63 74 69 76 65 20 61 73 | 20 61 6e 20 65 6e 65 72 |ctive as| an ener|
|00002c10| 67 79 20 77 61 73 74 65 | 2e 20 20 54 68 69 73 20 |gy waste|. This |
|00002c20| 73 74 75 64 79 20 6f 66 | 66 65 72 73 20 65 76 69 |study of|fers evi|
|00002c30| 64 65 6e 63 65 20 74 68 | 61 74 20 65 78 63 65 73 |dence th|at exces|
|00002c40| 73 0d 0a 63 79 63 6c 69 | 6e 67 20 6d 61 79 20 6f |s..cycli|ng may o|
|00002c50| 63 63 75 72 20 61 6e 64 | 2c 20 66 75 72 74 68 65 |ccur and|, furthe|
|00002c60| 72 2c 20 74 68 61 74 20 | 62 65 74 61 2d 62 6c 6f |r, that |beta-blo|
|00002c70| 63 6b 61 64 65 20 6d 61 | 79 20 64 69 6d 69 6e 69 |ckade ma|y dimini|
|00002c80| 73 68 20 74 68 69 73 20 | 65 6e 65 72 67 79 0d 0a |sh this |energy..|
|00002c90| 63 6f 73 74 2e 20 20 49 | 66 20 74 68 65 20 63 6f |cost. I|f the co|
|00002ca0| 6e 63 65 70 74 20 69 73 | 20 63 6f 72 72 65 63 74 |ncept is| correct|
|00002cb0| 2c 20 63 6f 6e 74 72 6f | 6c 20 6f 66 20 63 79 63 |, contro|l of cyc|
|00002cc0| 6c 69 6e 67 20 69 6e 20 | 6b 65 79 20 73 79 73 74 |ling in |key syst|
|00002cd0| 65 6d 73 20 6d 61 79 20 | 6f 66 66 65 72 20 61 6e |ems may |offer an|
|00002ce0| 0d 0a 65 6e 65 72 67 79 | 2d 73 70 61 72 69 6e 67 |..energy|-sparing|
|00002cf0| 20 61 70 70 72 6f 61 63 | 68 20 6f 66 20 73 69 67 | approac|h of sig|
|00002d00| 6e 69 66 69 63 61 6e 63 | 65 20 69 6e 20 74 68 65 |nificanc|e in the|
|00002d10| 20 73 65 76 65 72 65 6c | 79 20 62 75 72 6e 65 64 | severel|y burned|
|00002d20| 20 70 61 74 69 65 6e 74 | 2e 2d 2d 42 2e 57 2e 0d | patient|.--B.W..|
|00002d30| 0a 48 61 79 6e 65 73 2c | 20 4a 72 2e 2c 20 4d 2e |.Haynes,| Jr., M.|
|00002d40| 44 2e 0d 0a 24 55 6e 69 | 71 75 65 5f 49 44 7b 59 |D...$Uni|que_ID{Y|
|00002d50| 52 42 30 38 37 33 38 7d | 0d 0a 24 54 69 74 6c 65 |RB08738}|..$Title|
|00002d60| 7b 42 75 72 6e 20 57 6f | 75 6e 64 73 20 52 65 73 |{Burn Wo|unds Res|
|00002d70| 75 72 66 61 63 65 64 20 | 62 79 20 43 75 6c 74 75 |urfaced |by Cultu|
|00002d80| 72 65 64 20 45 70 69 64 | 65 72 6d 61 6c 20 41 75 |red Epid|ermal Au|
|00002d90| 74 6f 67 72 61 66 74 73 | 20 53 68 6f 77 20 41 62 |tografts| Show Ab|
|00002da0| 6e 6f 72 6d 61 6c 20 52 | 65 63 6f 6e 73 74 69 74 |normal R|econstit|
|00002db0| 75 74 69 6f 6e 20 6f 66 | 20 41 6e 63 68 6f 72 69 |ution of| Anchori|
|00002dc0| 6e 67 20 46 69 62 72 69 | 6c 73 7d 0d 0a 24 41 75 |ng Fibri|ls}..$Au|
|00002dd0| 74 68 6f 72 7b 0d 0a 57 | 6f 6f 64 6c 65 79 2c 20 |thor{..W|oodley, |
|00002de0| 44 54 0d 0a 50 65 74 65 | 72 73 6f 6e 2c 20 48 44 |DT..Pete|rson, HD|
|00002df0| 0d 0a 48 65 72 7a 6f 67 | 2c 20 53 52 0d 0a 53 74 |..Herzog|, SR..St|
|00002e00| 72 69 63 6b 6c 69 6e 2c | 20 47 50 0d 0a 42 75 72 |ricklin,| GP..Bur|
|00002e10| 67 65 73 6f 6e 2c 20 52 | 45 0d 0a 42 72 69 67 67 |geson, R|E..Brigg|
|00002e20| 61 6d 61 6e 2c 20 52 41 | 0d 0a 43 72 6f 6e 63 65 |aman, RA|..Cronce|
|00002e30| 2c 20 44 4a 0d 0a 4f 27 | 4b 65 65 66 65 2c 20 45 |, DJ..O'|Keefe, E|
|00002e40| 4a 7d 0d 0a 24 41 66 66 | 69 6c 69 61 74 69 6f 6e |J}..$Aff|iliation|
|00002e50| 7b 55 6e 69 76 20 6f 66 | 20 4e 6f 72 74 68 20 43 |{Univ of| North C|
|00002e60| 61 72 6f 6c 69 6e 61 20 | 61 74 20 43 68 61 70 65 |arolina |at Chape|
|00002e70| 6c 20 48 69 6c 6c 3b 20 | 55 6e 69 76 20 6f 66 20 |l Hill; |Univ of |
|00002e80| 54 65 6e 6e 65 73 73 65 | 65 2c 20 4d 65 6d 70 68 |Tennesse|e, Memph|
|00002e90| 69 73 3b 20 53 68 72 69 | 6e 65 72 27 73 20 48 6f |is; Shri|ner's Ho|
|00002ea0| 73 70 20 66 6f 72 20 43 | 72 69 70 70 6c 65 64 20 |sp for C|rippled |
|00002eb0| 43 68 69 6c 64 72 65 6e | 2c 20 50 6f 72 74 6c 61 |Children|, Portla|
|00002ec0| 6e 64 2c 20 4f 72 65 7d | 0d 0a 24 53 75 62 6a 65 |nd, Ore}|..$Subje|
|00002ed0| 63 74 7b 42 75 72 6e 2c | 20 62 75 72 6e 73 20 72 |ct{Burn,| burns r|
|00002ee0| 65 73 75 72 66 61 63 65 | 64 20 77 69 74 68 20 65 |esurface|d with e|
|00002ef0| 70 69 64 65 72 6d 61 6c | 20 61 75 74 6f 67 72 61 |pidermal| autogra|
|00002f00| 66 74 73 2c 20 61 6e 64 | 20 66 69 62 72 69 6c 73 |fts, and| fibrils|
|00002f10| 3b 0d 0a 45 70 69 64 65 | 72 6d 61 6c 20 72 65 73 |;..Epide|rmal res|
|00002f20| 75 72 66 61 63 69 6e 67 | 2c 20 61 6e 64 20 66 69 |urfacing|, and fi|
|00002f30| 62 72 69 6c 73 3b 0d 0a | 47 72 61 66 74 20 65 70 |brils;..|Graft ep|
|00002f40| 69 64 65 72 6d 61 6c 20 | 61 75 74 6f 67 72 61 66 |idermal |autograf|
|00002f50| 74 2c 20 63 75 6c 74 75 | 72 65 64 2c 20 66 6f 72 |t, cultu|red, for|
|00002f60| 20 62 75 72 6e 20 72 65 | 73 75 72 66 61 63 69 6e | burn re|surfacin|
|00002f70| 67 2c 20 61 6e 64 20 66 | 69 62 72 69 6c 73 7d 0d |g, and f|ibrils}.|
|00002f80| 0a 24 4a 6f 75 72 6e 61 | 6c 7b 4a 41 4d 41 7d 0d |.$Journa|l{JAMA}.|
|00002f90| 0a 24 56 6f 6c 75 6d 65 | 7b 32 35 39 7d 0d 0a 24 |.$Volume|{259}..$|
|00002fa0| 50 61 67 65 7b 32 35 36 | 36 2d 32 35 37 31 7d 0d |Page{256|6-2571}.|
|00002fb0| 0a 24 44 61 74 65 7b 4d | 61 79 20 36 2c 20 31 39 |.$Date{M|ay 6, 19|
|00002fc0| 38 38 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 38 39 |88}..$YB|Vol{1989|
|00002fd0| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 50 6c | Year Bo|ok of Pl|
|00002fe0| 61 73 74 69 63 2c 20 52 | 65 63 6f 6e 73 74 72 75 |astic, R|econstru|
|00002ff0| 63 74 69 76 65 2c 20 61 | 6e 64 20 41 65 73 74 68 |ctive, a|nd Aesth|
|00003000| 65 74 69 63 20 53 75 72 | 67 65 72 79 7d 0d 0a 24 |etic Sur|gery}..$|
|00003010| 43 68 61 70 74 65 72 7b | 33 2d 33 32 7d 0d 0a 24 |Chapter{|3-32}..$|
|00003020| 59 42 45 64 69 74 6f 72 | 7b 44 72 73 2e 20 4d 69 |YBEditor|{Drs. Mi|
|00003030| 6c 6c 65 72 2c 20 42 65 | 6e 6e 65 74 74 2c 20 48 |ller, Be|nnett, H|
|00003040| 61 79 6e 65 73 2c 20 48 | 6f 65 68 6e 2c 20 4d 63 |aynes, H|oehn, Mc|
|00003050| 4b 69 6e 6e 65 79 2c 20 | 61 6e 64 20 57 68 69 74 |Kinney, |and Whit|
|00003060| 61 6b 65 72 7d 0d 0a 24 | 54 61 62 6c 65 7b 7d 0d |aker}..$|Table{}.|
|00003070| 0a 24 43 6f 6d 6d 65 6e | 74 61 74 6f 72 7b 42 2e |.$Commen|tator{B.|
|00003080| 57 2e 20 48 61 79 6e 65 | 73 2c 20 4a 72 2e 2c 20 |W. Hayne|s, Jr., |
|00003090| 4d 2e 44 2e 7d 0d 0a 0d | 0a 43 6f 70 79 72 69 67 |M.D.}...|.Copyrig|
|000030a0| 68 74 20 28 63 29 20 59 | 65 61 72 20 42 6f 6f 6b |ht (c) Y|ear Book|
|000030b0| 20 4d 65 64 69 63 61 6c | 20 50 75 62 6c 69 73 68 | Medical| Publish|
|000030c0| 65 72 73 2c 20 49 6e 63 | 2e 2c 20 31 39 38 39 0d |ers, Inc|., 1989.|
|000030d0| 0a 0d 0a 31 39 38 39 20 | 59 65 61 72 20 42 6f 6f |...1989 |Year Boo|
|000030e0| 6b 20 6f 66 20 50 6c 61 | 73 74 69 63 2c 20 52 65 |k of Pla|stic, Re|
|000030f0| 63 6f 6e 73 74 72 75 63 | 74 69 76 65 2c 20 61 6e |construc|tive, an|
|00003100| 64 20 41 65 73 74 68 65 | 74 69 63 20 53 75 72 67 |d Aesthe|tic Surg|
|00003110| 65 72 79 20 28 52 29 0d | 0a 0d 0a 43 68 61 70 74 |ery (R).|...Chapt|
|00003120| 65 72 20 33 2d 2d 54 72 | 61 75 6d 61 0d 0a 0d 0a |er 3--Tr|auma....|
|00003130| 42 75 72 6e 73 0d 0a 0d | 0a 2d 2d 2d 2d 2d 2d 2d |Burns...|.-------|
|00003140| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003150| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003160| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003170| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003180| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 42 75 72 6e 20 |--------|-..Burn |
|00003190| 57 6f 75 6e 64 73 20 52 | 65 73 75 72 66 61 63 65 |Wounds R|esurface|
|000031a0| 64 20 62 79 20 43 75 6c | 74 75 72 65 64 20 45 70 |d by Cul|tured Ep|
|000031b0| 69 64 65 72 6d 61 6c 20 | 41 75 74 6f 67 72 61 66 |idermal |Autograf|
|000031c0| 74 73 20 53 68 6f 77 20 | 41 62 6e 6f 72 6d 61 6c |ts Show |Abnormal|
|000031d0| 0d 0a 52 65 63 6f 6e 73 | 74 69 74 75 74 69 6f 6e |..Recons|titution|
|000031e0| 20 6f 66 20 41 6e 63 68 | 6f 72 69 6e 67 20 46 69 | of Anch|oring Fi|
|000031f0| 62 72 69 6c 73 0d 0a 0d | 0a 57 6f 6f 64 6c 65 79 |brils...|.Woodley|
|00003200| 20 44 54 2c 20 50 65 74 | 65 72 73 6f 6e 20 48 44 | DT, Pet|erson HD|
|00003210| 2c 20 48 65 72 7a 6f 67 | 20 53 52 2c 20 53 74 72 |, Herzog| SR, Str|
|00003220| 69 63 6b 6c 69 6e 20 47 | 50 2c 20 42 75 72 67 65 |icklin G|P, Burge|
|00003230| 73 6f 6e 20 52 45 2c 20 | 42 72 69 67 67 61 6d 61 |son RE, |Briggama|
|00003240| 6e 20 52 41 2c 0d 0a 43 | 72 6f 6e 63 65 20 44 4a |n RA,..C|ronce DJ|
|00003250| 2c 20 4f 27 4b 65 65 66 | 65 20 45 4a 0d 0a 28 55 |, O'Keef|e EJ..(U|
|00003260| 6e 69 76 20 6f 66 20 4e | 6f 72 74 68 20 43 61 72 |niv of N|orth Car|
|00003270| 6f 6c 69 6e 61 20 61 74 | 20 43 68 61 70 65 6c 20 |olina at| Chapel |
|00003280| 48 69 6c 6c 3b 20 55 6e | 69 76 20 6f 66 20 54 65 |Hill; Un|iv of Te|
|00003290| 6e 6e 65 73 73 65 65 2c | 20 4d 65 6d 70 68 69 73 |nnessee,| Memphis|
|000032a0| 3b 20 53 68 72 69 6e 65 | 72 27 73 0d 0a 48 6f 73 |; Shrine|r's..Hos|
|000032b0| 70 20 66 6f 72 20 43 72 | 69 70 70 6c 65 64 20 43 |p for Cr|ippled C|
|000032c0| 68 69 6c 64 72 65 6e 2c | 20 50 6f 72 74 6c 61 6e |hildren,| Portlan|
|000032d0| 64 2c 20 4f 72 65 29 0d | 0a 4a 41 4d 41 20 32 35 |d, Ore).|.JAMA 25|
|000032e0| 39 3a 32 35 36 36 2d 32 | 35 37 31 2c 20 4d 61 79 |9:2566-2|571, May|
|000032f0| 20 36 2c 20 31 39 38 38 | 0d 0a 2d 2d 2d 2d 2d 2d | 6, 1988|..------|
|00003300| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003310| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003320| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003330| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003340| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 0d 0a 41 62 |--------|--....Ab|
|00003350| 73 74 72 61 63 74 0d 0a | 0d 0a 20 20 20 20 20 46 |stract..|.. F|
|00003360| 6f 75 72 20 62 75 72 6e | 20 70 61 74 69 65 6e 74 |our burn| patient|
|00003370| 73 20 68 61 64 20 74 68 | 65 69 72 20 77 6f 75 6e |s had th|eir woun|
|00003380| 64 73 20 63 6f 76 65 72 | 65 64 20 62 79 20 63 75 |ds cover|ed by cu|
|00003390| 6c 74 75 72 65 64 20 6b | 65 72 61 74 69 6e 6f 63 |ltured k|eratinoc|
|000033a0| 79 74 65 0d 0a 61 75 74 | 6f 67 72 61 66 74 73 20 |yte..aut|ografts |
|000033b0| 62 75 74 20 65 78 68 69 | 62 69 74 65 64 20 73 6b |but exhi|bited sk|
|000033c0| 69 6e 20 66 72 61 67 69 | 6c 69 74 79 20 66 6f 72 |in fragi|lity for|
|000033d0| 20 75 70 20 74 6f 20 37 | 20 6d 6f 6e 74 68 73 20 | up to 7| months |
|000033e0| 61 66 74 65 72 20 67 72 | 61 66 74 69 6e 67 20 6f |after gr|afting o|
|000033f0| 72 0d 0a 73 70 6f 6e 74 | 61 6e 65 6f 75 73 20 62 |r..spont|aneous b|
|00003400| 6c 69 73 74 65 72 69 6e | 67 2c 20 6f 72 20 62 6f |listerin|g, or bo|
|00003410| 74 68 2e 20 20 53 70 65 | 63 69 66 69 63 20 69 6d |th. Spe|cific im|
|00003420| 6d 75 6e 6f 6c 6f 67 69 | 63 20 70 72 6f 62 65 73 |munologi|c probes|
|00003430| 20 77 65 72 65 20 75 73 | 65 64 20 69 6e 20 61 6e | were us|ed in an|
|00003440| 0d 0a 61 74 74 65 6d 70 | 74 20 74 6f 20 64 65 74 |..attemp|t to det|
|00003450| 65 72 6d 69 6e 65 20 77 | 68 65 74 68 65 72 20 6d |ermine w|hether m|
|00003460| 61 6a 6f 72 20 63 6f 6d | 70 6f 6e 65 6e 74 73 20 |ajor com|ponents |
|00003470| 6f 66 20 74 68 65 20 64 | 65 72 6d 6f 65 70 69 64 |of the d|ermoepid|
|00003480| 65 72 6d 61 6c 20 6a 75 | 6e 63 74 69 6f 6e 20 61 |ermal ju|nction a|
|00003490| 72 65 0d 0a 70 72 65 73 | 65 6e 74 20 62 65 6e 65 |re..pres|ent bene|
|000034a0| 61 74 68 20 74 68 65 73 | 65 20 61 75 74 6f 67 72 |ath thes|e autogr|
|000034b0| 61 66 74 73 20 64 75 72 | 69 6e 67 20 68 65 61 6c |afts dur|ing heal|
|000034c0| 69 6e 67 2e 20 20 54 77 | 6f 20 61 64 75 6c 74 73 |ing. Tw|o adults|
|000034d0| 20 61 6e 64 20 32 20 63 | 68 69 6c 64 72 65 6e 20 | and 2 c|hildren |
|000034e0| 77 65 72 65 0d 0a 73 74 | 75 64 69 65 64 2e 20 20 |were..st|udied. |
|000034f0| 54 68 72 65 65 20 77 6f | 75 6e 64 73 20 77 65 72 |Three wo|unds wer|
|00003500| 65 20 67 72 61 66 74 65 | 64 20 32 2d 33 20 77 65 |e grafte|d 2-3 we|
|00003510| 65 6b 73 20 61 66 74 65 | 72 20 62 75 72 6e 20 69 |eks afte|r burn i|
|00003520| 6e 6a 75 72 79 2c 20 61 | 6e 64 20 31 20 77 61 73 |njury, a|nd 1 was|
|00003530| 0d 0a 67 72 61 66 74 65 | 64 20 61 66 74 65 72 20 |..grafte|d after |
|00003540| 35 20 77 65 65 6b 73 2e | 0d 0a 20 20 20 20 20 49 |5 weeks.|.. I|
|00003550| 6e 20 61 6c 6c 20 70 61 | 74 69 65 6e 74 73 2c 20 |n all pa|tients, |
|00003560| 74 68 65 20 72 65 63 6f | 6e 73 74 69 74 75 74 65 |the reco|nstitute|
|00003570| 64 20 62 61 73 65 6d 65 | 6e 74 20 6d 65 6d 62 72 |d baseme|nt membr|
|00003580| 61 6e 65 20 7a 6f 6e 65 | 20 62 65 6e 65 61 74 68 |ane zone| beneath|
|00003590| 20 74 68 65 0d 0a 61 75 | 74 6f 67 72 61 66 74 73 | the..au|tografts|
|000035a0| 20 77 61 73 20 69 6e 63 | 6f 6d 70 6c 65 74 65 2c | was inc|omplete,|
|000035b0| 20 6c 61 63 6b 69 6e 67 | 20 74 79 70 65 20 49 56 | lacking| type IV|
|000035c0| 20 28 62 61 73 65 6d 65 | 6e 74 20 6d 65 6d 62 72 | (baseme|nt membr|
|000035d0| 61 6e 65 29 20 63 6f 6c | 6c 61 67 65 6e 20 37 2d |ane) col|lagen 7-|
|000035e0| 53 0d 0a 73 69 74 65 73 | 20 61 6e 64 20 61 6e 63 |S..sites| and anc|
|000035f0| 68 6f 72 69 6e 67 20 66 | 69 62 72 69 6c 73 2e 20 |horing f|ibrils. |
|00003600| 20 49 6e 20 31 20 70 61 | 74 69 65 6e 74 2c 20 73 | In 1 pa|tient, s|
|00003610| 75 63 74 69 6f 6e 20 62 | 6c 69 73 74 65 72 73 20 |uction b|listers |
|00003620| 68 61 64 20 66 6f 72 6d | 65 64 20 69 6e 20 74 68 |had form|ed in th|
|00003630| 65 0d 0a 61 75 74 6f 67 | 72 61 66 74 20 61 74 20 |e..autog|raft at |
|00003640| 31 37 20 6d 69 6e 75 74 | 65 73 2c 20 77 69 74 68 |17 minut|es, with|
|00003650| 20 61 20 63 6c 65 61 76 | 61 67 65 20 70 6c 61 6e | a cleav|age plan|
|00003660| 65 20 62 65 6c 6f 77 20 | 74 68 65 20 6c 61 6d 69 |e below |the lami|
|00003670| 6e 61 20 64 65 6e 73 61 | 20 6f 66 20 74 68 65 0d |na densa| of the.|
|00003680| 0a 62 61 73 65 6d 65 6e | 74 20 6d 65 6d 62 72 61 |.basemen|t membra|
|00003690| 6e 65 2e 20 20 4e 6f 72 | 6d 61 6c 20 73 6b 69 6e |ne. Nor|mal skin|
|000036a0| 20 6f 66 20 61 6e 20 75 | 6e 62 75 72 6e 65 64 20 | of an u|nburned |
|000036b0| 73 69 74 65 20 62 6c 69 | 73 74 65 72 65 64 20 61 |site bli|stered a|
|000036c0| 74 20 36 35 20 6d 69 6e | 75 74 65 73 2c 0d 0a 77 |t 65 min|utes,..w|
|000036d0| 69 74 68 20 61 20 73 75 | 70 65 72 66 69 63 69 61 |ith a su|perficia|
|000036e0| 6c 20 63 6c 65 61 76 61 | 67 65 20 70 6c 61 6e 65 |l cleava|ge plane|
|000036f0| 20 61 62 6f 76 65 20 74 | 68 65 20 62 61 73 61 6c | above t|he basal|
|00003700| 20 6c 61 6d 69 6e 61 2e | 0d 0a 20 20 20 20 20 46 | lamina.|.. F|
|00003710| 72 61 67 69 6c 65 20 73 | 6b 69 6e 20 70 72 65 73 |ragile s|kin pres|
|00003720| 65 6e 74 20 6c 61 74 65 | 20 61 66 74 65 72 20 65 |ent late| after e|
|00003730| 70 69 64 65 72 6d 61 6c | 20 61 75 74 6f 67 72 61 |pidermal| autogra|
|00003740| 66 74 69 6e 67 20 69 6e | 20 62 75 72 6e 2d 69 6e |fting in| burn-in|
|00003750| 6a 75 72 65 64 0d 0a 70 | 61 74 69 65 6e 74 73 20 |jured..p|atients |
|00003760| 6d 61 79 20 72 65 66 6c | 65 63 74 20 64 65 66 65 |may refl|ect defe|
|00003770| 63 74 69 76 65 20 61 6e | 63 68 6f 72 69 6e 67 20 |ctive an|choring |
|00003780| 66 69 62 72 69 6c 73 2e | 20 20 49 6e 20 61 64 64 |fibrils.| In add|
|00003790| 69 74 69 6f 6e 2c 20 61 | 20 6c 61 63 6b 20 6f 66 |ition, a| lack of|
|000037a0| 0d 0a 66 6f 72 6d 61 74 | 69 6f 6e 20 6f 66 20 65 |..format|ion of e|
|000037b0| 70 69 64 65 72 6d 61 6c | 20 72 65 74 65 20 70 65 |pidermal| rete pe|
|000037c0| 67 73 20 61 6e 64 20 64 | 65 72 6d 61 6c 20 70 61 |gs and d|ermal pa|
|000037d0| 70 69 6c 6c 61 65 20 6d | 61 79 20 63 6f 6e 74 72 |pillae m|ay contr|
|000037e0| 69 62 75 74 65 20 74 6f | 20 70 6f 6f 72 0d 0a 64 |ibute to| poor..d|
|000037f0| 65 72 6d 6f 65 70 69 64 | 65 72 6d 61 6c 20 61 64 |ermoepid|ermal ad|
|00003800| 68 65 72 65 6e 63 65 20 | 69 6e 20 61 75 74 6f 67 |herence |in autog|
|00003810| 72 61 66 74 20 73 69 74 | 65 73 2e 0d 0a 0d 0a 50 |raft sit|es.....P|
|00003820| 6f 73 74 2d 43 6f 6d 6d | 65 6e 74 0d 0a 0d 0a 20 |ost-Comm|ent.... |
|00003830| 20 20 20 20 54 68 69 73 | 20 73 74 75 64 79 20 70 | This| study p|
|00003840| 69 6e 70 6f 69 6e 74 73 | 20 61 20 62 61 73 69 63 |inpoints| a basic|
|00003850| 20 70 72 6f 62 6c 65 6d | 20 77 69 74 68 20 63 75 | problem| with cu|
|00003860| 6c 74 75 72 65 64 20 65 | 70 69 64 65 72 6d 61 6c |ltured e|pidermal|
|00003870| 20 61 75 74 6f 67 72 61 | 66 74 73 2c 0d 0a 74 68 | autogra|fts,..th|
|00003880| 61 74 20 69 73 2c 20 74 | 68 65 20 66 61 69 6c 75 |at is, t|he failu|
|00003890| 72 65 20 74 6f 20 61 74 | 74 61 63 68 20 73 65 63 |re to at|tach sec|
|000038a0| 75 72 65 6c 79 20 74 6f | 20 66 61 73 63 69 61 20 |urely to| fascia |
|000038b0| 61 6e 64 20 66 6f 72 6d | 20 61 20 66 75 6e 63 74 |and form| a funct|
|000038c0| 69 6f 6e 61 6c 20 73 75 | 72 66 61 63 65 2e 0d 0a |ional su|rface...|
|000038d0| 49 6e 63 72 69 6d 69 6e | 61 74 65 64 20 69 6e 20 |Incrimin|ated in |
|000038e0| 74 68 69 73 20 66 61 69 | 6c 75 72 65 20 69 73 20 |this fai|lure is |
|000038f0| 74 68 65 20 61 6e 63 68 | 6f 72 69 6e 67 20 66 69 |the anch|oring fi|
|00003900| 62 72 69 6c 20 6f 72 20 | 62 61 73 65 6d 65 6e 74 |bril or |basement|
|00003910| 20 6d 65 6d 62 72 61 6e | 65 20 28 74 79 70 65 0d | membran|e (type.|
|00003920| 0a 49 56 29 20 63 6f 6c | 6c 61 67 65 6e 20 64 65 |.IV) col|lagen de|
|00003930| 70 6f 73 69 74 69 6f 6e | 2c 20 6f 72 20 62 6f 74 |position|, or bot|
|00003940| 68 2e 20 20 43 72 69 74 | 69 63 61 6c 20 74 6f 20 |h. Crit|ical to |
|00003950| 73 6b 69 6e 20 73 75 72 | 76 69 76 61 6c 20 61 6e |skin sur|vival an|
|00003960| 64 20 66 75 6e 63 74 69 | 6f 6e 20 69 73 20 74 68 |d functi|on is th|
|00003970| 65 0d 0a 64 65 72 6d 6f | 65 70 69 64 65 72 6d 61 |e..dermo|epiderma|
|00003980| 6c 20 6a 75 6e 63 74 69 | 6f 6e 20 61 6e 64 20 62 |l juncti|on and b|
|00003990| 61 73 65 6d 65 6e 74 20 | 6d 65 6d 62 72 61 6e 65 |asement |membrane|
|000039a0| 20 61 74 74 61 63 68 6d | 65 6e 74 20 74 6f 20 65 | attachm|ent to e|
|000039b0| 70 69 64 65 72 6d 69 73 | 2e 20 20 46 61 73 63 69 |pidermis|. Fasci|
|000039c0| 61 0d 0a 69 73 20 6e 6f | 74 20 64 65 72 6d 69 73 |a..is no|t dermis|
|000039d0| 2c 20 61 6e 64 20 74 68 | 65 20 63 72 69 74 69 63 |, and th|e critic|
|000039e0| 61 6c 20 64 69 66 66 65 | 72 65 6e 63 65 20 62 65 |al diffe|rence be|
|000039f0| 74 77 65 65 6e 20 74 68 | 65 20 32 20 63 6f 6c 6c |tween th|e 2 coll|
|00003a00| 61 67 65 6e 73 20 69 73 | 0d 0a 69 6d 70 6f 72 74 |agens is|..import|
|00003a10| 61 6e 74 2e 2d 2d 42 2e | 57 2e 20 48 61 79 6e 65 |ant.--B.|W. Hayne|
|00003a20| 73 2c 20 4a 72 2e 2c 20 | 4d 2e 44 2e 0d 0a 24 55 |s, Jr., |M.D...$U|
|00003a30| 6e 69 71 75 65 5f 49 44 | 7b 59 52 42 30 38 37 33 |nique_ID|{YRB0873|
|00003a40| 39 7d 0d 0a 24 54 69 74 | 6c 65 7b 54 6f 70 69 63 |9}..$Tit|le{Topic|
|00003a50| 61 6c 20 54 72 65 74 69 | 6e 6f 69 6e 20 49 6d 70 |al Treti|noin Imp|
|00003a60| 72 6f 76 65 73 20 50 68 | 6f 74 6f 61 67 65 64 20 |roves Ph|otoaged |
|00003a70| 53 6b 69 6e 3a 20 20 41 | 20 44 6f 75 62 6c 65 2d |Skin: A| Double-|
|00003a80| 42 6c 69 6e 64 20 56 65 | 68 69 63 6c 65 2d 43 6f |Blind Ve|hicle-Co|
|00003a90| 6e 74 72 6f 6c 6c 65 64 | 20 53 74 75 64 79 7d 0d |ntrolled| Study}.|
|00003aa0| 0a 24 41 75 74 68 6f 72 | 7b 0d 0a 57 65 69 73 73 |.$Author|{..Weiss|
|00003ab0| 2c 20 4a 53 0d 0a 45 6c | 6c 69 73 2c 20 43 4e 0d |, JS..El|lis, CN.|
|00003ac0| 0a 48 65 61 64 69 6e 67 | 74 6f 6e 2c 20 4a 54 0d |.Heading|ton, JT.|
|00003ad0| 0a 54 69 6e 63 6f 66 66 | 2c 20 54 0d 0a 48 61 6d |.Tincoff|, T..Ham|
|00003ae0| 69 6c 74 6f 6e 2c 20 54 | 41 0d 0a 56 6f 6f 72 68 |ilton, T|A..Voorh|
|00003af0| 65 65 73 2c 20 4a 4a 7d | 0d 0a 24 41 66 66 69 6c |ees, JJ}|..$Affil|
|00003b00| 69 61 74 69 6f 6e 7b 55 | 6e 69 76 20 6f 66 20 4d |iation{U|niv of M|
|00003b10| 69 63 68 69 67 61 6e 7d | 0d 0a 24 53 75 62 6a 65 |ichigan}|..$Subje|
|00003b20| 63 74 7b 50 68 6f 74 6f | 61 67 65 64 20 73 6b 69 |ct{Photo|aged ski|
|00003b30| 6e 2c 20 74 72 65 74 69 | 6e 6f 69 6e 20 66 6f 72 |n, treti|noin for|
|00003b40| 3b 0d 0a 53 6b 69 6e 20 | 70 68 6f 74 6f 61 67 65 |;..Skin |photoage|
|00003b50| 64 2c 20 74 72 65 74 69 | 6e 6f 69 6e 20 66 6f 72 |d, treti|noin for|
|00003b60| 3b 0d 0a 54 72 65 74 69 | 6e 6f 69 6e 20 66 6f 72 |;..Treti|noin for|
|00003b70| 20 70 68 6f 74 6f 61 67 | 65 64 20 73 6b 69 6e 7d | photoag|ed skin}|
|00003b80| 0d 0a 24 4a 6f 75 72 6e | 61 6c 7b 4a 41 4d 41 7d |..$Journ|al{JAMA}|
|00003b90| 0d 0a 24 56 6f 6c 75 6d | 65 7b 32 35 39 7d 0d 0a |..$Volum|e{259}..|
|00003ba0| 24 50 61 67 65 7b 35 32 | 37 2d 35 33 32 7d 0d 0a |$Page{52|7-532}..|
|00003bb0| 24 44 61 74 65 7b 4a 61 | 6e 20 32 32 2d 32 39 2c |$Date{Ja|n 22-29,|
|00003bc0| 20 31 39 38 38 7d 0d 0a | 24 59 42 56 6f 6c 7b 31 | 1988}..|$YBVol{1|
|00003bd0| 39 38 39 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |989 Year| Book of|
|00003be0| 20 50 6c 61 73 74 69 63 | 2c 20 52 65 63 6f 6e 73 | Plastic|, Recons|
|00003bf0| 74 72 75 63 74 69 76 65 | 2c 20 61 6e 64 20 41 65 |tructive|, and Ae|
|00003c00| 73 74 68 65 74 69 63 20 | 53 75 72 67 65 72 79 7d |sthetic |Surgery}|
|00003c10| 0d 0a 24 43 68 61 70 74 | 65 72 7b 34 2d 31 38 7d |..$Chapt|er{4-18}|
|00003c20| 0d 0a 24 59 42 45 64 69 | 74 6f 72 7b 44 72 73 2e |..$YBEdi|tor{Drs.|
|00003c30| 20 4d 69 6c 6c 65 72 2c | 20 42 65 6e 6e 65 74 74 | Miller,| Bennett|
|00003c40| 2c 20 48 61 79 6e 65 73 | 2c 20 48 6f 65 68 6e 2c |, Haynes|, Hoehn,|
|00003c50| 20 4d 63 4b 69 6e 6e 65 | 79 2c 20 61 6e 64 20 57 | McKinne|y, and W|
|00003c60| 68 69 74 61 6b 65 72 7d | 0d 0a 24 54 61 62 6c 65 |hitaker}|..$Table|
|00003c70| 7b 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |{}..$Com|mentator|
|00003c80| 7b 50 2e 20 4d 63 4b 69 | 6e 6e 65 79 2c 20 4d 2e |{P. McKi|nney, M.|
|00003c90| 44 2e 7d 0d 0a 0d 0a 43 | 6f 70 79 72 69 67 68 74 |D.}....C|opyright|
|00003ca0| 20 28 63 29 20 59 65 61 | 72 20 42 6f 6f 6b 20 4d | (c) Yea|r Book M|
|00003cb0| 65 64 69 63 61 6c 20 50 | 75 62 6c 69 73 68 65 72 |edical P|ublisher|
|00003cc0| 73 2c 20 49 6e 63 2e 2c | 20 31 39 38 39 0d 0a 0d |s, Inc.,| 1989...|
|00003cd0| 0a 31 39 38 39 20 59 65 | 61 72 20 42 6f 6f 6b 20 |.1989 Ye|ar Book |
|00003ce0| 6f 66 20 50 6c 61 73 74 | 69 63 2c 20 52 65 63 6f |of Plast|ic, Reco|
|00003cf0| 6e 73 74 72 75 63 74 69 | 76 65 2c 20 61 6e 64 20 |nstructi|ve, and |
|00003d00| 41 65 73 74 68 65 74 69 | 63 20 53 75 72 67 65 72 |Aestheti|c Surger|
|00003d10| 79 20 28 52 29 0d 0a 0d | 0a 43 68 61 70 74 65 72 |y (R)...|.Chapter|
|00003d20| 20 34 2d 2d 41 65 73 74 | 68 65 74 69 63 20 53 75 | 4--Aest|hetic Su|
|00003d30| 72 67 65 72 79 0d 0a 0d | 0a 46 61 63 65 0d 0a 0d |rgery...|.Face...|
|00003d40| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|00003d50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003d60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003d70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003d80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003d90| 2d 0d 0a 54 6f 70 69 63 | 61 6c 20 54 72 65 74 69 |-..Topic|al Treti|
|00003da0| 6e 6f 69 6e 20 49 6d 70 | 72 6f 76 65 73 20 50 68 |noin Imp|roves Ph|
|00003db0| 6f 74 6f 61 67 65 64 20 | 53 6b 69 6e 3a 20 20 41 |otoaged |Skin: A|
|00003dc0| 20 44 6f 75 62 6c 65 2d | 42 6c 69 6e 64 20 56 65 | Double-|Blind Ve|
|00003dd0| 68 69 63 6c 65 2d 43 6f | 6e 74 72 6f 6c 6c 65 64 |hicle-Co|ntrolled|
|00003de0| 0d 0a 53 74 75 64 79 0d | 0a 0d 0a 57 65 69 73 73 |..Study.|...Weiss|
|00003df0| 20 4a 53 2c 20 45 6c 6c | 69 73 20 43 4e 2c 20 48 | JS, Ell|is CN, H|
|00003e00| 65 61 64 69 6e 67 74 6f | 6e 20 4a 54 2c 20 54 69 |eadingto|n JT, Ti|
|00003e10| 6e 63 6f 66 66 20 54 2c | 20 48 61 6d 69 6c 74 6f |ncoff T,| Hamilto|
|00003e20| 6e 20 54 41 2c 20 56 6f | 6f 72 68 65 65 73 20 4a |n TA, Vo|orhees J|
|00003e30| 4a 0d 0a 28 55 6e 69 76 | 20 6f 66 20 4d 69 63 68 |J..(Univ| of Mich|
|00003e40| 69 67 61 6e 29 0d 0a 4a | 41 4d 41 20 32 35 39 3a |igan)..J|AMA 259:|
|00003e50| 35 32 37 2d 35 33 32 2c | 20 4a 61 6e 20 32 32 2d |527-532,| Jan 22-|
|00003e60| 32 39 2c 20 31 39 38 38 | 0d 0a 2d 2d 2d 2d 2d 2d |29, 1988|..------|
|00003e70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003e80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003e90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003ea0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003eb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 0d 0a 41 62 |--------|--....Ab|
|00003ec0| 73 74 72 61 63 74 0d 0a | 0d 0a 20 20 20 20 20 54 |stract..|.. T|
|00003ed0| 68 65 20 61 67 69 6e 67 | 20 70 72 6f 63 65 73 73 |he aging| process|
|00003ee0| 20 6f 66 20 74 68 65 20 | 73 6b 69 6e 20 63 61 6e | of the |skin can|
|00003ef0| 20 62 65 20 64 69 76 69 | 64 65 64 20 69 6e 74 6f | be divi|ded into|
|00003f00| 20 32 20 63 6f 6d 70 6f | 6e 65 6e 74 73 3a 20 20 | 2 compo|nents: |
|00003f10| 69 6e 74 72 69 6e 73 69 | 63 0d 0a 61 67 69 6e 67 |intrinsi|c..aging|
|00003f20| 20 61 6e 64 20 70 68 6f | 74 6f 61 67 69 6e 67 2e | and pho|toaging.|
|00003f30| 20 20 53 6f 6d 65 20 63 | 68 61 6e 67 65 73 20 61 | Some c|hanges a|
|00003f40| 73 73 6f 63 69 61 74 65 | 64 20 77 69 74 68 20 70 |ssociate|d with p|
|00003f50| 68 6f 74 6f 61 67 69 6e | 67 20 6d 61 79 20 62 65 |hotoagin|g may be|
|00003f60| 0d 0a 72 65 76 65 72 73 | 69 62 6c 65 2e 20 20 41 |..revers|ible. A|
|00003f70| 20 72 61 6e 64 6f 6d 69 | 7a 65 64 2c 20 64 6f 75 | randomi|zed, dou|
|00003f80| 62 6c 65 2d 62 6c 69 6e | 64 2c 20 76 65 68 69 63 |ble-blin|d, vehic|
|00003f90| 6c 65 2d 63 6f 6e 74 72 | 6f 6c 6c 65 64 20 73 74 |le-contr|olled st|
|00003fa0| 75 64 79 20 77 61 73 20 | 64 6f 6e 65 20 74 6f 0d |udy was |done to.|
|00003fb0| 0a 61 73 73 65 73 73 20 | 74 68 65 20 65 66 66 69 |.assess |the effi|
|00003fc0| 63 61 63 79 20 6f 66 20 | 30 2e 31 25 20 74 72 65 |cacy of |0.1% tre|
|00003fd0| 74 69 6e 6f 69 6e 20 63 | 72 65 61 6d 20 69 6e 20 |tinoin c|ream in |
|00003fe0| 74 68 65 20 74 72 65 61 | 74 6d 65 6e 74 20 6f 66 |the trea|tment of|
|00003ff0| 20 70 68 6f 74 6f 61 67 | 69 6e 67 2e 0d 0a 20 20 | photoag|ing... |
|00004000| 20 20 20 46 6f 72 74 79 | 20 77 68 69 74 65 20 70 | Forty| white p|
|00004010| 61 74 69 65 6e 74 73 20 | 61 67 65 64 20 33 35 20 |atients |aged 35 |
|00004020| 74 6f 20 37 30 20 79 65 | 61 72 73 20 70 61 72 74 |to 70 ye|ars part|
|00004030| 69 63 69 70 61 74 65 64 | 20 69 6e 20 74 68 65 20 |icipated| in the |
|00004040| 73 74 75 64 79 2e 20 20 | 41 6c 6c 0d 0a 77 65 72 |study. |All..wer|
|00004050| 65 20 69 6e 20 67 6f 6f | 64 20 68 65 61 6c 74 68 |e in goo|d health|
|00004060| 20 65 78 63 65 70 74 20 | 66 6f 72 20 63 6c 69 6e | except |for clin|
|00004070| 69 63 61 6c 6c 79 20 64 | 69 61 67 6e 6f 73 65 64 |ically d|iagnosed|
|00004080| 20 64 65 72 6d 61 74 6f | 68 65 6c 69 6f 73 69 73 | dermato|heliosis|
|00004090| 20 6f 66 20 74 68 65 20 | 66 61 63 65 0d 0a 61 6e | of the |face..an|
|000040a0| 64 20 66 6f 72 65 61 72 | 6d 73 2e 20 20 54 68 65 |d forear|ms. The|
|000040b0| 20 70 61 74 69 65 6e 74 | 73 20 61 70 70 6c 69 65 | patient|s applie|
|000040c0| 64 20 74 6f 70 69 63 61 | 6c 20 74 72 65 74 69 6e |d topica|l tretin|
|000040d0| 6f 69 6e 20 74 6f 20 31 | 20 66 6f 72 65 61 72 6d |oin to 1| forearm|
|000040e0| 20 61 6e 64 20 76 65 68 | 69 63 6c 65 0d 0a 63 72 | and veh|icle..cr|
|000040f0| 65 61 6d 20 74 6f 20 74 | 68 65 20 6f 74 68 65 72 |eam to t|he other|
|00004100| 2e 20 20 48 61 6c 66 20 | 61 6c 73 6f 20 61 70 70 |. Half |also app|
|00004110| 6c 69 65 64 20 74 72 65 | 74 69 6e 6f 69 6e 20 74 |lied tre|tinoin t|
|00004120| 6f 20 74 68 65 20 66 61 | 63 65 2c 20 61 6e 64 20 |o the fa|ce, and |
|00004130| 68 61 6c 66 20 61 70 70 | 6c 69 65 64 0d 0a 74 68 |half app|lied..th|
|00004140| 65 20 76 65 68 69 63 6c | 65 20 63 72 65 61 6d 2e |e vehicl|e cream.|
|00004150| 0d 0a 20 20 20 20 20 41 | 6c 6c 20 33 30 20 70 61 |.. A|ll 30 pa|
|00004160| 74 69 65 6e 74 73 20 77 | 68 6f 20 63 6f 6d 70 6c |tients w|ho compl|
|00004170| 65 74 65 64 20 74 68 65 | 20 73 74 75 64 79 20 68 |eted the| study h|
|00004180| 61 64 20 73 69 67 6e 69 | 66 69 63 61 6e 74 20 69 |ad signi|ficant i|
|00004190| 6d 70 72 6f 76 65 6d 65 | 6e 74 20 69 6e 0d 0a 70 |mproveme|nt in..p|
|000041a0| 68 6f 74 6f 61 67 69 6e | 67 20 6f 6e 20 74 68 65 |hotoagin|g on the|
|000041b0| 20 74 72 65 74 69 6e 6f | 69 6e 2d 74 72 65 61 74 | tretino|in-treat|
|000041c0| 65 64 20 66 6f 72 65 61 | 72 6d 73 20 62 75 74 20 |ed forea|rms but |
|000041d0| 6e 6f 74 20 6f 6e 20 74 | 68 65 20 76 65 68 69 63 |not on t|he vehic|
|000041e0| 6c 65 2d 74 72 65 61 74 | 65 64 0d 0a 66 6f 72 65 |le-treat|ed..fore|
|000041f0| 61 72 6d 73 2e 20 20 46 | 6f 75 72 74 65 65 6e 20 |arms. F|ourteen |
|00004200| 6f 66 20 74 68 65 20 31 | 35 20 70 61 74 69 65 6e |of the 1|5 patien|
|00004210| 74 73 20 77 68 6f 20 72 | 65 63 65 69 76 65 64 20 |ts who r|eceived |
|00004220| 74 72 65 74 69 6e 6f 69 | 6e 20 74 72 65 61 74 6d |tretinoi|n treatm|
|00004230| 65 6e 74 20 6f 66 20 74 | 68 65 0d 0a 66 61 63 65 |ent of t|he..face|
|00004240| 20 73 68 6f 77 65 64 20 | 69 6d 70 72 6f 76 65 6d | showed |improvem|
|00004250| 65 6e 74 2c 20 77 68 65 | 72 65 61 73 20 6e 6f 6e |ent, whe|reas non|
|00004260| 65 20 6f 66 20 74 68 65 | 20 76 65 68 69 63 6c 65 |e of the| vehicle|
|00004270| 2d 74 72 65 61 74 65 64 | 20 66 61 63 65 73 20 77 |-treated| faces w|
|00004280| 65 72 65 0d 0a 69 6d 70 | 72 6f 76 65 64 2e 20 20 |ere..imp|roved. |
|00004290| 53 74 61 74 69 73 74 69 | 63 61 6c 6c 79 20 73 69 |Statisti|cally si|
|000042a0| 67 6e 69 66 69 63 61 6e | 74 20 68 69 73 74 6f 6c |gnifican|t histol|
|000042b0| 6f 67 69 63 20 63 68 61 | 6e 67 65 73 20 77 65 72 |ogic cha|nges wer|
|000042c0| 65 20 6f 62 73 65 72 76 | 65 64 20 69 6e 20 66 6f |e observ|ed in fo|
|000042d0| 72 65 61 72 6d 0d 0a 73 | 6b 69 6e 20 74 72 65 61 |rearm..s|kin trea|
|000042e0| 74 65 64 20 77 69 74 68 | 20 74 72 65 74 69 6e 6f |ted with| tretino|
|000042f0| 69 6e 2c 20 62 75 74 20 | 6e 6f 74 20 77 69 74 68 |in, but |not with|
|00004300| 20 74 68 65 20 76 65 68 | 69 63 6c 65 20 63 72 65 | the veh|icle cre|
|00004310| 61 6d 2e 20 20 49 72 72 | 69 74 61 74 69 6f 6e 20 |am. Irr|itation |
|00004320| 6f 66 20 74 68 65 0d 0a | 74 72 65 74 69 6e 6f 69 |of the..|tretinoi|
|00004330| 6e 2d 74 72 65 61 74 65 | 64 20 73 6b 69 6e 20 77 |n-treate|d skin w|
|00004340| 61 73 20 74 68 65 20 6f | 6e 6c 79 20 73 69 64 65 |as the o|nly side|
|00004350| 20 65 66 66 65 63 74 2e | 0d 0a 20 20 20 20 20 54 | effect.|.. T|
|00004360| 68 69 73 20 73 74 75 64 | 79 20 63 6f 6e 66 69 72 |his stud|y confir|
|00004370| 6d 73 20 61 6e 64 20 65 | 78 74 65 6e 64 73 20 70 |ms and e|xtends p|
|00004380| 72 65 76 69 6f 75 73 20 | 6f 70 65 6e 20 61 73 73 |revious |open ass|
|00004390| 65 73 73 6d 65 6e 74 73 | 20 6f 66 20 74 6f 70 69 |essments| of topi|
|000043a0| 63 61 6c 0d 0a 74 72 65 | 74 69 6e 6f 69 6e 20 74 |cal..tre|tinoin t|
|000043b0| 68 61 74 20 73 75 67 67 | 65 73 74 65 64 20 69 74 |hat sugg|ested it|
|000043c0| 73 20 65 66 66 69 63 61 | 63 79 20 69 6e 20 74 68 |s effica|cy in th|
|000043d0| 65 20 74 72 65 61 74 6d | 65 6e 74 20 6f 66 20 70 |e treatm|ent of p|
|000043e0| 68 6f 74 6f 61 67 69 6e | 67 2e 20 20 54 68 65 73 |hotoagin|g. Thes|
|000043f0| 65 0d 0a 72 65 73 75 6c | 74 73 20 73 68 6f 77 20 |e..resul|ts show |
|00004400| 74 68 61 74 20 74 72 65 | 74 69 6e 6f 69 6e 20 70 |that tre|tinoin p|
|00004410| 72 6f 76 69 64 65 73 20 | 73 6f 6d 65 20 72 65 76 |rovides |some rev|
|00004420| 65 72 73 61 6c 20 6f 66 | 20 70 68 6f 74 6f 64 61 |ersal of| photoda|
|00004430| 6d 61 67 65 64 20 73 6b | 69 6e 2e 0d 0a 0d 0a 50 |maged sk|in.....P|
|00004440| 6f 73 74 2d 43 6f 6d 6d | 65 6e 74 0d 0a 0d 0a 20 |ost-Comm|ent.... |
|00004450| 20 20 20 20 57 65 6c 6c | 2c 20 69 74 20 73 65 65 | Well|, it see|
|00004460| 6d 73 20 74 6f 20 77 6f | 72 6b 20 66 6f 72 20 73 |ms to wo|rk for s|
|00004470| 6f 6d 65 20 69 6e 64 69 | 76 69 64 75 61 6c 73 20 |ome indi|viduals |
|00004480| 61 6e 64 20 69 73 20 77 | 6f 72 74 68 20 61 20 74 |and is w|orth a t|
|00004490| 72 79 20 69 6e 20 73 6d | 61 6c 6c 0d 0a 61 72 65 |ry in sm|all..are|
|000044a0| 61 73 2e 20 20 41 73 20 | 77 69 74 68 20 61 6e 79 |as. As |with any|
|000044b0| 20 6d 65 64 69 63 61 74 | 69 6f 6e 2c 20 69 74 73 | medicat|ion, its|
|000044c0| 20 6c 6f 6e 67 2d 74 65 | 72 6d 20 65 66 66 65 63 | long-te|rm effec|
|000044d0| 74 73 20 61 72 65 20 6e | 6f 74 20 6b 6e 6f 77 6e |ts are n|ot known|
|000044e0| 2e 20 20 54 68 65 0d 0a | 70 61 74 69 65 6e 74 20 |. The..|patient |
|000044f0| 6d 61 79 20 62 65 63 6f | 6d 65 20 76 65 72 79 20 |may beco|me very |
|00004500| 65 6e 74 68 75 73 69 61 | 73 74 69 63 20 61 62 6f |enthusia|stic abo|
|00004510| 75 74 20 74 68 65 20 6d | 65 64 69 63 61 74 69 6f |ut the m|edicatio|
|00004520| 6e 2c 20 61 6e 64 20 69 | 6e 20 31 20 69 6e 73 74 |n, and i|n 1 inst|
|00004530| 61 6e 63 65 20 6f 66 0d | 0a 77 68 69 63 68 20 49 |ance of.|.which I|
|00004540| 20 61 6d 20 61 77 61 72 | 65 2c 20 61 20 70 61 74 | am awar|e, a pat|
|00004550| 69 65 6e 74 20 61 70 70 | 6c 69 65 64 20 69 74 20 |ient app|lied it |
|00004560| 74 6f 20 68 65 72 20 65 | 6e 74 69 72 65 20 62 6f |to her e|ntire bo|
|00004570| 64 79 2e 2d 2d 50 2e 20 | 4d 63 4b 69 6e 6e 65 79 |dy.--P. |McKinney|
|00004580| 2c 20 4d 2e 44 2e 0d 0a | 24 55 6e 69 71 75 65 5f |, M.D...|$Unique_|
|00004590| 49 44 7b 59 52 42 30 38 | 37 35 30 7d 0d 0a 24 54 |ID{YRB08|750}..$T|
|000045a0| 69 74 6c 65 7b 44 6f 6d | 69 6e 61 6e 74 20 49 6e |itle{Dom|inant In|
|000045b0| 68 65 72 69 74 61 6e 63 | 65 20 6f 66 20 41 74 6f |heritanc|e of Ato|
|000045c0| 70 69 63 20 49 6d 6d 75 | 6e 6f 67 6c 6f 62 75 6c |pic Immu|noglobul|
|000045d0| 69 6e 2d 45 20 52 65 73 | 70 6f 6e 73 69 76 65 6e |in-E Res|ponsiven|
|000045e0| 65 73 73 7d 0d 0a 24 41 | 75 74 68 6f 72 7b 0d 0a |ess}..$A|uthor{..|
|000045f0| 43 6f 6f 6b 73 6f 6e 2c | 20 57 4f 43 4d 0d 0a 48 |Cookson,| WOCM..H|
|00004600| 6f 70 6b 69 6e 2c 20 4a | 4d 7d 0d 0a 24 41 66 66 |opkin, J|M}..$Aff|
|00004610| 69 6c 69 61 74 69 6f 6e | 7b 43 68 75 72 63 68 69 |iliation|{Churchi|
|00004620| 6c 6c 20 48 6f 73 70 2c | 20 4f 78 66 6f 72 64 2c |ll Hosp,| Oxford,|
|00004630| 20 45 6e 67 6c 61 6e 64 | 7d 0d 0a 24 53 75 62 6a | England|}..$Subj|
|00004640| 65 63 74 7b 49 6e 68 65 | 72 69 74 61 6e 63 65 2c |ect{Inhe|ritance,|
|00004650| 20 64 6f 6d 69 6e 61 6e | 74 2c 20 6f 66 20 61 74 | dominan|t, of at|
|00004660| 6f 70 69 63 20 69 6d 6d | 75 6e 6f 67 6c 6f 62 75 |opic imm|unoglobu|
|00004670| 6c 69 6e 2d 45 20 72 65 | 73 70 6f 6e 73 69 76 65 |lin-E re|sponsive|
|00004680| 6e 65 73 73 3b 0d 0a 49 | 6d 6d 75 6e 6f 67 6c 6f |ness;..I|mmunoglo|
|00004690| 62 75 6c 69 6e 20 45 20 | 72 65 73 70 6f 6e 73 69 |bulin E |responsi|
|000046a0| 76 65 6e 65 73 73 2c 20 | 61 74 6f 70 69 63 2c 20 |veness, |atopic, |
|000046b0| 64 6f 6d 69 6e 61 6e 74 | 20 69 6e 68 65 72 69 74 |dominant| inherit|
|000046c0| 61 6e 63 65 20 6f 66 3b | 0d 0a 48 65 72 65 64 69 |ance of;|..Heredi|
|000046d0| 74 79 2c 20 64 6f 6d 69 | 6e 61 6e 74 20 69 6e 68 |ty, domi|nant inh|
|000046e0| 65 72 69 74 61 6e 63 65 | 20 6f 66 20 61 74 6f 70 |eritance| of atop|
|000046f0| 69 63 20 69 6d 6d 75 6e | 6f 67 6c 6f 62 75 6c 69 |ic immun|oglobuli|
|00004700| 6e 2d 45 20 72 65 73 70 | 6f 6e 73 69 76 65 6e 65 |n-E resp|onsivene|
|00004710| 73 73 3b 0d 0a 41 74 6f | 70 69 63 20 69 6d 6d 75 |ss;..Ato|pic immu|
|00004720| 6e 6f 67 6c 6f 62 75 6c | 69 6e 2d 45 20 72 65 73 |noglobul|in-E res|
|00004730| 70 6f 6e 73 69 76 65 6e | 65 73 73 2c 20 64 6f 6d |ponsiven|ess, dom|
|00004740| 69 6e 61 6e 74 20 69 6e | 68 65 72 69 74 61 6e 63 |inant in|heritanc|
|00004750| 65 20 6f 66 7d 0d 0a 24 | 4a 6f 75 72 6e 61 6c 7b |e of}..$|Journal{|
|00004760| 4c 61 6e 63 65 74 7d 0d | 0a 24 56 6f 6c 75 6d 65 |Lancet}.|.$Volume|
|00004770| 7b 31 7d 0d 0a 24 50 61 | 67 65 7b 38 36 2d 38 38 |{1}..$Pa|ge{86-88|
|00004780| 7d 0d 0a 24 44 61 74 65 | 7b 4a 61 6e 20 31 36 2c |}..$Date|{Jan 16,|
|00004790| 20 31 39 38 38 7d 0d 0a | 24 59 42 56 6f 6c 7b 31 | 1988}..|$YBVol{1|
|000047a0| 39 38 39 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |989 Year| Book of|
|000047b0| 20 50 75 6c 6d 6f 6e 61 | 72 79 20 44 69 73 65 61 | Pulmona|ry Disea|
|000047c0| 73 65 7d 0d 0a 24 43 68 | 61 70 74 65 72 7b 32 2d |se}..$Ch|apter{2-|
|000047d0| 32 32 7d 0d 0a 24 59 42 | 45 64 69 74 6f 72 7b 44 |22}..$YB|Editor{D|
|000047e0| 72 73 2e 20 47 72 65 65 | 6e 2c 20 42 61 6c 6c 2c |rs. Gree|n, Ball,|
|000047f0| 20 4d 69 63 68 61 65 6c | 2c 20 50 65 74 65 72 73 | Michael|, Peters|
|00004800| 2c 20 54 65 72 72 79 2c | 20 54 6f 63 6b 6d 61 6e |, Terry,| Tockman|
|00004810| 2c 20 61 6e 64 20 57 69 | 73 65 7d 0d 0a 24 54 61 |, and Wi|se}..$Ta|
|00004820| 62 6c 65 7b 7d 0d 0a 24 | 43 6f 6d 6d 65 6e 74 61 |ble{}..$|Commenta|
|00004830| 74 6f 72 7b 53 2e 50 2e | 20 50 65 74 65 72 73 2c |tor{S.P.| Peters,|
|00004840| 20 4d 2e 44 2e 2c 20 50 | 68 2e 44 2e 7d 0d 0a 0d | M.D., P|h.D.}...|
|00004850| 0a 43 6f 70 79 72 69 67 | 68 74 20 28 63 29 20 59 |.Copyrig|ht (c) Y|
|00004860| 65 61 72 20 42 6f 6f 6b | 20 4d 65 64 69 63 61 6c |ear Book| Medical|
|00004870| 20 50 75 62 6c 69 73 68 | 65 72 73 2c 20 49 6e 63 | Publish|ers, Inc|
|00004880| 2e 2c 20 31 39 38 39 0d | 0a 0d 0a 31 39 38 39 20 |., 1989.|...1989 |
|00004890| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 50 75 6c |Year Boo|k of Pul|
|000048a0| 6d 6f 6e 61 72 79 20 44 | 69 73 65 61 73 65 20 28 |monary D|isease (|
|000048b0| 52 29 0d 0a 0d 0a 43 68 | 61 70 74 65 72 20 32 2d |R)....Ch|apter 2-|
|000048c0| 2d 41 73 74 68 6d 61 20 | 61 6e 64 20 53 65 6c 65 |-Asthma |and Sele|
|000048d0| 63 74 65 64 20 49 6d 6d | 75 6e 6f 6c 6f 67 69 63 |cted Imm|unologic|
|000048e0| 61 6c 6c 79 20 4d 65 64 | 69 61 74 65 64 20 4c 75 |ally Med|iated Lu|
|000048f0| 6e 67 20 44 69 73 65 61 | 73 65 73 0d 0a 0d 0a 50 |ng Disea|ses....P|
|00004900| 61 74 68 6f 67 65 6e 69 | 73 69 73 0d 0a 0d 0a 2d |athogeni|sis....-|
|00004910| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004920| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004930| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004940| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004950| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
|00004960| 0a 44 6f 6d 69 6e 61 6e | 74 20 49 6e 68 65 72 69 |.Dominan|t Inheri|
|00004970| 74 61 6e 63 65 20 6f 66 | 20 41 74 6f 70 69 63 20 |tance of| Atopic |
|00004980| 49 6d 6d 75 6e 6f 67 6c | 6f 62 75 6c 69 6e 2d 45 |Immunogl|obulin-E|
|00004990| 20 52 65 73 70 6f 6e 73 | 69 76 65 6e 65 73 73 0d | Respons|iveness.|
|000049a0| 0a 0d 0a 43 6f 6f 6b 73 | 6f 6e 20 57 4f 43 4d 2c |...Cooks|on WOCM,|
|000049b0| 20 48 6f 70 6b 69 6e 20 | 4a 4d 0d 0a 28 43 68 75 | Hopkin |JM..(Chu|
|000049c0| 72 63 68 69 6c 6c 20 48 | 6f 73 70 2c 20 4f 78 66 |rchill H|osp, Oxf|
|000049d0| 6f 72 64 2c 20 45 6e 67 | 6c 61 6e 64 29 0d 0a 4c |ord, Eng|land)..L|
|000049e0| 61 6e 63 65 74 20 31 3a | 38 36 2d 38 38 2c 20 4a |ancet 1:|86-88, J|
|000049f0| 61 6e 20 31 36 2c 20 31 | 39 38 38 0d 0a 2d 2d 2d |an 16, 1|988..---|
|00004a00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004a10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004a20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004a30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004a40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 0d |--------|-----...|
|00004a50| 0a 41 62 73 74 72 61 63 | 74 0d 0a 0d 0a 20 20 20 |.Abstrac|t.... |
|00004a60| 20 20 54 68 65 20 62 61 | 73 69 73 20 6f 66 20 61 | The ba|sis of a|
|00004a70| 74 6f 70 69 63 20 49 67 | 45 20 72 65 73 70 6f 6e |topic Ig|E respon|
|00004a80| 73 69 76 65 6e 65 73 73 | 20 69 73 20 69 6e 63 6f |siveness| is inco|
|00004a90| 6d 70 6c 65 74 65 6c 79 | 20 75 6e 64 65 72 73 74 |mpletely| underst|
|00004aa0| 6f 6f 64 2e 20 20 54 68 | 65 0d 0a 66 61 6d 69 6c |ood. Th|e..famil|
|00004ab0| 69 61 6c 20 6f 63 63 75 | 72 72 65 6e 63 65 20 6f |ial occu|rrence o|
|00004ac0| 66 20 61 74 6f 70 79 20 | 77 61 73 20 64 65 74 65 |f atopy |was dete|
|00004ad0| 72 6d 69 6e 65 64 20 69 | 6e 20 32 33 39 20 6d 65 |rmined i|n 239 me|
|00004ae0| 6d 62 65 72 73 20 6f 66 | 20 34 30 20 6e 75 63 6c |mbers of| 40 nucl|
|00004af0| 65 61 72 20 61 6e 64 20 | 33 0d 0a 65 78 74 65 6e |ear and |3..exten|
|00004b00| 64 65 64 20 66 61 6d 69 | 6c 69 65 73 2e 20 20 41 |ded fami|lies. A|
|00004b10| 74 6f 70 79 20 77 61 73 | 20 64 65 66 69 6e 65 64 |topy was| defined|
|00004b20| 20 61 73 20 74 68 65 20 | 70 72 65 73 65 6e 63 65 | as the |presence|
|00004b30| 20 6f 66 20 70 6f 73 69 | 74 69 76 65 20 73 6b 69 | of posi|tive ski|
|00004b40| 6e 20 70 72 69 63 6b 0d | 0a 74 65 73 74 20 72 65 |n prick.|.test re|
|00004b50| 73 70 6f 6e 73 65 2c 20 | 61 20 73 65 72 75 6d 20 |sponse, |a serum |
|00004b60| 49 67 45 20 74 69 74 65 | 72 20 6d 6f 72 65 20 74 |IgE tite|r more t|
|00004b70| 68 61 6e 20 32 20 53 44 | 20 61 62 6f 76 65 20 74 |han 2 SD| above t|
|00004b80| 68 65 20 6d 65 61 6e 2c | 20 6f 72 20 62 79 20 61 |he mean,| or by a|
|00004b90| 20 70 6f 73 69 74 69 76 | 65 0d 0a 72 61 64 69 6f | positiv|e..radio|
|00004ba0| 61 6c 6c 65 72 67 6f 73 | 6f 72 62 65 6e 74 20 74 |allergos|orbent t|
|00004bb0| 65 73 74 20 72 65 73 75 | 6c 74 2e 0d 0a 20 20 20 |est resu|lt... |
|00004bc0| 20 20 45 69 67 68 74 79 | 2d 74 68 72 65 65 20 70 | Eighty|-three p|
|00004bd0| 65 72 63 65 6e 74 20 6f | 66 20 64 65 73 69 67 6e |ercent o|f design|
|00004be0| 61 74 65 64 20 61 74 6f | 70 69 63 20 70 61 74 69 |ated ato|pic pati|
|00004bf0| 65 6e 74 73 20 72 65 70 | 6f 72 74 65 64 20 73 79 |ents rep|orted sy|
|00004c00| 6d 70 74 6f 6d 73 20 6f | 66 0d 0a 61 74 6f 70 69 |mptoms o|f..atopi|
|00004c10| 63 20 64 69 73 65 61 73 | 65 2c 20 61 6c 74 68 6f |c diseas|e, altho|
|00004c20| 75 67 68 20 66 65 77 65 | 72 20 74 68 61 6e 20 61 |ugh fewe|r than a|
|00004c30| 20 74 68 69 72 64 20 63 | 6f 6e 73 69 64 65 72 65 | third c|onsidere|
|00004c40| 64 20 74 68 65 6d 73 65 | 6c 76 65 73 20 74 6f 20 |d themse|lves to |
|00004c50| 62 65 20 61 74 6f 70 69 | 63 2e 0d 0a 4e 69 6e 65 |be atopi|c...Nine|
|00004c60| 74 79 20 70 65 72 63 65 | 6e 74 20 6f 66 20 61 74 |ty perce|nt of at|
|00004c70| 6f 70 69 63 20 63 68 69 | 6c 64 72 65 6e 20 69 6e |opic chi|ldren in|
|00004c80| 20 74 68 65 20 6e 75 63 | 6c 65 61 72 20 66 61 6d | the nuc|lear fam|
|00004c90| 69 6c 69 65 73 20 68 61 | 64 20 61 74 20 6c 65 61 |ilies ha|d at lea|
|00004ca0| 73 74 20 31 20 61 74 6f | 70 69 63 0d 0a 70 61 72 |st 1 ato|pic..par|
|00004cb0| 65 6e 74 2e 20 20 41 74 | 6f 70 79 20 77 61 73 20 |ent. At|opy was |
|00004cc0| 74 72 61 6e 73 6d 69 74 | 74 65 64 20 76 65 72 74 |transmit|ted vert|
|00004cd0| 69 63 61 6c 6c 79 20 69 | 6e 20 65 61 63 68 20 6f |ically i|n each o|
|00004ce0| 66 20 74 68 65 20 65 78 | 74 65 6e 64 65 64 20 66 |f the ex|tended f|
|00004cf0| 61 6d 69 6c 69 65 73 2e | 0d 0a 54 68 69 72 74 79 |amilies.|..Thirty|
|00004d00| 2d 6f 6e 65 20 6f 66 20 | 34 37 20 6f 66 66 73 70 |-one of |47 offsp|
|00004d10| 72 69 6e 67 20 6f 66 20 | 6d 61 72 72 69 61 67 65 |ring of |marriage|
|00004d20| 73 20 62 65 74 77 65 65 | 6e 20 61 74 6f 70 69 63 |s betwee|n atopic|
|00004d30| 20 61 6e 64 20 75 6e 61 | 66 66 65 63 74 65 64 20 | and una|ffected |
|00004d40| 70 61 72 65 6e 74 73 0d | 0a 77 65 72 65 20 61 74 |parents.|.were at|
|00004d50| 6f 70 69 63 2e 0d 0a 20 | 20 20 20 20 54 68 65 20 |opic... | The |
|00004d60| 64 69 73 70 6f 73 69 74 | 69 6f 6e 20 74 6f 20 70 |disposit|ion to p|
|00004d70| 72 6f 64 75 63 65 20 49 | 67 45 20 69 6e 20 72 65 |roduce I|gE in re|
|00004d80| 73 70 6f 6e 73 65 20 74 | 6f 20 63 6f 6d 6d 6f 6e |sponse t|o common|
|00004d90| 20 61 6c 6c 65 72 67 65 | 6e 73 2c 20 6f 72 20 61 | allerge|ns, or a|
|00004da0| 74 6f 70 79 2c 0d 0a 61 | 70 70 65 61 72 73 20 74 |topy,..a|ppears t|
|00004db0| 6f 20 62 65 20 69 6e 68 | 65 72 69 74 65 64 20 61 |o be inh|erited a|
|00004dc0| 73 20 61 6e 20 61 75 74 | 6f 73 6f 6d 61 6c 20 64 |s an aut|osomal d|
|00004dd0| 6f 6d 69 6e 61 6e 74 20 | 63 68 61 72 61 63 74 65 |ominant |characte|
|00004de0| 72 69 73 74 69 63 2e 20 | 20 4f 74 68 65 72 20 66 |ristic. | Other f|
|00004df0| 61 63 74 6f 72 73 2c 0d | 0a 64 65 66 69 6e 69 74 |actors,.|.definit|
|00004e00| 65 6c 79 20 65 6e 76 69 | 72 6f 6e 6d 65 6e 74 61 |ely envi|ronmenta|
|00004e10| 6c 20 61 6e 64 20 70 6f | 73 73 69 62 6c 79 20 64 |l and po|ssibly d|
|00004e20| 65 76 65 6c 6f 70 6d 65 | 6e 74 61 6c 2c 20 69 6e |evelopme|ntal, in|
|00004e30| 66 6c 75 65 6e 63 65 20 | 63 6c 69 6e 69 63 61 6c |fluence |clinical|
|00004e40| 0d 0a 65 78 70 72 65 73 | 73 69 6f 6e 20 6f 66 20 |..expres|sion of |
|00004e50| 74 68 65 20 69 6e 68 65 | 72 69 74 65 64 20 61 74 |the inhe|rited at|
|00004e60| 6f 70 69 63 20 74 72 61 | 69 74 20 69 6e 20 64 69 |opic tra|it in di|
|00004e70| 66 66 65 72 65 6e 74 20 | 74 69 73 73 75 65 73 20 |fferent |tissues |
|00004e80| 61 6e 64 20 64 69 66 66 | 65 72 65 6e 74 0d 0a 69 |and diff|erent..i|
|00004e90| 6e 64 69 76 69 64 75 61 | 6c 73 2e 0d 0a 0d 0a 50 |ndividua|ls.....P|
|00004ea0| 6f 73 74 2d 43 6f 6d 6d | 65 6e 74 0d 0a 0d 0a 20 |ost-Comm|ent.... |
|00004eb0| 20 20 20 20 54 68 65 20 | 63 6f 6e 63 6c 75 73 69 | The |conclusi|
|00004ec0| 6f 6e 20 6f 66 20 74 68 | 69 73 20 61 72 74 69 63 |on of th|is artic|
|00004ed0| 6c 65 2c 20 69 66 20 69 | 6e 20 66 61 63 74 20 69 |le, if i|n fact i|
|00004ee0| 74 20 77 65 72 65 20 74 | 72 75 65 2c 20 61 70 70 |t were t|rue, app|
|00004ef0| 65 61 72 73 20 74 6f 6f | 0d 0a 73 74 72 61 69 67 |ears too|..straig|
|00004f00| 68 74 66 6f 72 77 61 72 | 64 20 61 6e 64 20 73 69 |htforwar|d and si|
|00004f10| 6d 70 6c 65 20 66 6f 72 | 20 75 73 20 6e 6f 74 20 |mple for| us not |
|00004f20| 74 6f 20 68 61 76 65 20 | 6b 6e 6f 77 6e 20 69 74 |to have |known it|
|00004f30| 20 75 6e 74 69 6c 20 6e | 6f 77 2e 20 20 57 68 79 | until n|ow. Why|
|00004f40| 20 68 61 76 65 0d 0a 74 | 68 65 73 65 20 61 75 74 | have..t|hese aut|
|00004f50| 68 6f 72 73 20 72 65 61 | 63 68 65 64 20 61 20 64 |hors rea|ched a d|
|00004f60| 69 66 66 65 72 65 6e 74 | 20 63 6f 6e 63 6c 75 73 |ifferent| conclus|
|00004f70| 69 6f 6e 20 66 72 6f 6d | 20 74 68 65 20 67 65 6e |ion from| the gen|
|00004f80| 65 72 61 6c 6c 79 20 61 | 63 63 65 70 74 65 64 20 |erally a|ccepted |
|00004f90| 6f 6e 65 0d 0a 74 68 61 | 74 20 49 67 45 20 72 65 |one..tha|t IgE re|
|00004fa0| 73 70 6f 6e 73 69 76 65 | 6e 65 73 73 20 69 73 20 |sponsive|ness is |
|00004fb0| 61 6e 20 61 75 74 6f 73 | 6f 6d 61 6c 20 72 65 63 |an autos|omal rec|
|00004fc0| 65 73 73 69 76 65 20 74 | 72 61 69 74 3f 20 20 4f |essive t|rait? O|
|00004fd0| 6e 65 20 66 61 63 74 6f | 72 20 6d 61 79 20 62 65 |ne facto|r may be|
|00004fe0| 20 74 68 65 0d 0a 61 75 | 74 68 6f 72 73 27 20 76 | the..au|thors' v|
|00004ff0| 65 72 79 20 6c 69 62 65 | 72 61 6c 20 64 65 66 69 |ery libe|ral defi|
|00005000| 6e 69 74 69 6f 6e 20 6f | 66 20 61 74 6f 70 69 63 |nition o|f atopic|
|00005010| 2e 20 20 41 73 20 74 68 | 65 79 20 70 6f 69 6e 74 |. As th|ey point|
|00005020| 20 6f 75 74 2c 20 74 68 | 65 69 72 20 63 72 69 74 | out, th|eir crit|
|00005030| 65 72 69 61 0d 0a 66 6f | 72 20 6c 61 62 65 6c 69 |eria..fo|r labeli|
|00005040| 6e 67 20 61 6e 20 69 6e | 64 69 76 69 64 75 61 6c |ng an in|dividual|
|00005050| 20 61 73 20 22 61 74 6f | 70 69 63 20 49 67 45 2d | as "ato|pic IgE-|
|00005060| 72 65 73 70 6f 6e 73 69 | 76 65 22 20 69 6e 76 6f |responsi|ve" invo|
|00005070| 6c 76 65 73 20 65 69 74 | 68 65 72 20 61 20 70 6f |lves eit|her a po|
|00005080| 73 69 74 69 76 65 0d 0a | 73 6b 69 6e 20 74 65 73 |sitive..|skin tes|
|00005090| 74 20 28 75 73 69 6e 67 | 20 6c 69 62 65 72 61 6c |t (using| liberal|
|000050a0| 20 63 72 69 74 65 72 69 | 61 29 20 6f 72 20 74 68 | criteri|a) or th|
|000050b0| 65 20 70 72 65 73 65 6e | 63 65 20 6f 66 20 61 20 |e presen|ce of a |
|000050c0| 68 69 67 68 20 49 67 45 | 20 6c 65 76 65 6c 20 6f |high IgE| level o|
|000050d0| 72 20 61 0d 0a 70 6f 73 | 69 74 69 76 65 20 72 61 |r a..pos|itive ra|
|000050e0| 64 69 6f 61 6c 6c 65 72 | 67 6f 73 6f 72 62 65 6e |dioaller|gosorben|
|000050f0| 74 20 74 65 73 74 20 28 | 52 41 53 54 29 2e 20 20 |t test (|RAST). |
|00005100| 41 20 68 69 67 68 20 49 | 67 45 20 6c 65 76 65 6c |A high I|gE level|
|00005110| 20 63 61 6e 20 62 65 20 | 63 61 75 73 65 64 20 62 | can be |caused b|
|00005120| 79 0d 0a 66 61 63 74 6f | 72 73 20 6f 74 68 65 72 |y..facto|rs other|
|00005130| 20 74 68 61 6e 20 61 74 | 6f 70 69 63 20 61 6c 6c | than at|opic all|
|00005140| 65 72 67 79 20 28 61 6c | 74 68 6f 75 67 68 20 74 |ergy (al|though t|
|00005150| 68 69 73 20 70 6f 69 6e | 74 20 69 73 20 73 6f 6d |his poin|t is som|
|00005160| 65 77 68 61 74 20 73 65 | 6d 61 6e 74 69 63 29 2e |ewhat se|mantic).|
|00005170| 0d 0a 41 6e 64 2c 20 63 | 65 72 74 61 69 6e 6c 79 |..And, c|ertainly|
|00005180| 2c 20 74 68 65 20 73 70 | 65 63 69 66 69 63 69 74 |, the sp|ecificit|
|00005190| 79 20 6f 66 20 61 74 20 | 6c 65 61 73 74 20 73 6f |y of at |least so|
|000051a0| 6d 65 20 52 41 53 54 73 | 20 68 61 73 20 62 65 65 |me RASTs| has bee|
|000051b0| 6e 20 71 75 65 73 74 69 | 6f 6e 65 64 2e 20 20 49 |n questi|oned. I|
|000051c0| 2c 0d 0a 6c 69 6b 65 20 | 6d 61 6e 79 20 6f 66 20 |,..like |many of |
|000051d0| 6d 79 20 66 6f 72 6d 65 | 72 20 63 6f 6c 6c 65 61 |my forme|r collea|
|000051e0| 67 75 65 73 20 69 6e 20 | 42 61 6c 74 69 6d 6f 72 |gues in |Baltimor|
|000051f0| 65 2c 20 72 65 6d 61 69 | 6e 20 73 6b 65 70 74 69 |e, remai|n skepti|
|00005200| 63 61 6c 20 6f 66 20 74 | 68 65 20 61 75 74 68 6f |cal of t|he autho|
|00005210| 72 73 27 0d 0a 70 72 6f | 76 6f 63 61 74 69 76 65 |rs'..pro|vocative|
|00005220| 20 63 6f 6e 63 6c 75 73 | 69 6f 6e 2e 20 20 48 6f | conclus|ion. Ho|
|00005230| 77 65 76 65 72 2c 20 74 | 68 65 69 72 20 73 75 67 |wever, t|heir sug|
|00005240| 67 65 73 74 69 6f 6e 20 | 74 6f 20 61 6e 73 77 65 |gestion |to answe|
|00005250| 72 20 74 68 69 73 20 71 | 75 65 73 74 69 6f 6e 0d |r this q|uestion.|
|00005260| 0a 64 65 66 69 6e 69 74 | 69 76 65 6c 79 20 62 79 |.definit|ively by|
|00005270| 20 6d 6f 6c 65 63 75 6c | 61 72 20 67 65 6e 65 74 | molecul|ar genet|
|00005280| 69 63 20 6c 69 6e 6b 61 | 67 65 20 61 6e 61 6c 79 |ic linka|ge analy|
|00005290| 73 69 73 20 69 73 20 63 | 65 72 74 61 69 6e 6c 79 |sis is c|ertainly|
|000052a0| 20 61 20 67 6f 6f 64 20 | 6f 6e 65 3b 20 77 65 0d | a good |one; we.|
|000052b0| 0a 6c 6f 6f 6b 20 66 6f | 72 77 61 72 64 20 74 6f |.look fo|rward to|
|000052c0| 20 74 68 65 20 72 65 73 | 75 6c 74 73 20 6f 66 20 | the res|ults of |
|000052d0| 74 68 65 73 65 20 73 74 | 75 64 69 65 73 2e 2d 2d |these st|udies.--|
|000052e0| 53 2e 50 2e 20 50 65 74 | 65 72 73 2c 20 4d 2e 44 |S.P. Pet|ers, M.D|
|000052f0| 2e 2c 20 50 68 2e 44 2e | 0d 0a 24 55 6e 69 71 75 |., Ph.D.|..$Uniqu|
|00005300| 65 5f 49 44 7b 59 52 42 | 30 38 37 35 31 7d 0d 0a |e_ID{YRB|08751}..|
|00005310| 24 54 69 74 6c 65 7b 44 | 69 66 66 65 72 65 6e 63 |$Title{D|ifferenc|
|00005320| 65 73 20 69 6e 20 48 6f | 73 70 69 74 61 6c 20 41 |es in Ho|spital A|
|00005330| 73 74 68 6d 61 20 4d 61 | 6e 61 67 65 6d 65 6e 74 |sthma Ma|nagement|
|00005340| 7d 0d 0a 24 41 75 74 68 | 6f 72 7b 0d 0a 42 75 63 |}..$Auth|or{..Buc|
|00005350| 6b 6e 61 6c 6c 2c 20 43 | 45 0d 0a 52 6f 62 65 72 |knall, C|E..Rober|
|00005360| 74 73 6f 6e 2c 20 43 0d | 0a 4d 6f 72 61 6e 2c 20 |tson, C.|.Moran, |
|00005370| 46 0d 0a 53 74 65 76 65 | 6e 73 6f 6e 2c 20 52 44 |F..Steve|nson, RD|
|00005380| 7d 0d 0a 24 41 66 66 69 | 6c 69 61 74 69 6f 6e 7b |}..$Affi|liation{|
|00005390| 47 6c 61 73 67 6f 77 20 | 52 6f 79 61 6c 20 49 6e |Glasgow |Royal In|
|000053a0| 66 69 72 6d 61 72 79 3b | 20 53 74 72 61 74 68 63 |firmary;| Strathc|
|000053b0| 6c 79 64 65 20 55 6e 69 | 76 2c 20 47 6c 61 73 67 |lyde Uni|v, Glasg|
|000053c0| 6f 77 7d 0d 0a 24 53 75 | 62 6a 65 63 74 7b 41 73 |ow}..$Su|bject{As|
|000053d0| 74 68 6d 61 2c 20 68 6f | 73 70 69 74 61 6c 20 6d |thma, ho|spital m|
|000053e0| 61 6e 61 67 65 6d 65 6e | 74 2c 20 64 69 66 66 65 |anagemen|t, diffe|
|000053f0| 72 65 6e 63 65 73 20 69 | 6e 7d 0d 0a 24 4a 6f 75 |rences i|n}..$Jou|
|00005400| 72 6e 61 6c 7b 4c 61 6e | 63 65 74 7d 0d 0a 24 56 |rnal{Lan|cet}..$V|
|00005410| 6f 6c 75 6d 65 7b 31 7d | 0d 0a 24 50 61 67 65 7b |olume{1}|..$Page{|
|00005420| 37 34 38 2d 37 35 30 7d | 0d 0a 24 44 61 74 65 7b |748-750}|..$Date{|
|00005430| 41 70 72 20 32 2c 20 31 | 39 38 38 7d 0d 0a 24 59 |Apr 2, 1|988}..$Y|
|00005440| 42 56 6f 6c 7b 31 39 38 | 39 20 59 65 61 72 20 42 |BVol{198|9 Year B|
|00005450| 6f 6f 6b 20 6f 66 20 50 | 75 6c 6d 6f 6e 61 72 79 |ook of P|ulmonary|
|00005460| 20 44 69 73 65 61 73 65 | 7d 0d 0a 24 43 68 61 70 | Disease|}..$Chap|
|00005470| 74 65 72 7b 32 2d 32 36 | 7d 0d 0a 24 59 42 45 64 |ter{2-26|}..$YBEd|
|00005480| 69 74 6f 72 7b 44 72 73 | 2e 20 47 72 65 65 6e 2c |itor{Drs|. Green,|
|00005490| 20 42 61 6c 6c 2c 20 4d | 69 63 68 61 65 6c 2c 20 | Ball, M|ichael, |
|000054a0| 50 65 74 65 72 73 2c 20 | 54 65 72 72 79 2c 20 54 |Peters, |Terry, T|
|000054b0| 6f 63 6b 6d 61 6e 2c 20 | 61 6e 64 20 57 69 73 65 |ockman, |and Wise|
|000054c0| 7d 0d 0a 24 54 61 62 6c | 65 7b 54 61 62 6c 65 20 |}..$Tabl|e{Table |
|000054d0| 4f 6d 69 74 74 65 64 7d | 0d 0a 24 43 6f 6d 6d 65 |Omitted}|..$Comme|
|000054e0| 6e 74 61 74 6f 72 7b 53 | 2e 50 2e 20 50 65 74 65 |ntator{S|.P. Pete|
|000054f0| 72 73 2c 20 4d 2e 44 2e | 2c 20 50 68 2e 44 2e 7d |rs, M.D.|, Ph.D.}|
|00005500| 0d 0a 0d 0a 43 6f 70 79 | 72 69 67 68 74 20 28 63 |....Copy|right (c|
|00005510| 29 20 59 65 61 72 20 42 | 6f 6f 6b 20 4d 65 64 69 |) Year B|ook Medi|
|00005520| 63 61 6c 20 50 75 62 6c | 69 73 68 65 72 73 2c 20 |cal Publ|ishers, |
|00005530| 49 6e 63 2e 2c 20 31 39 | 38 39 0d 0a 0d 0a 31 39 |Inc., 19|89....19|
|00005540| 38 39 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |89 Year |Book of |
|00005550| 50 75 6c 6d 6f 6e 61 72 | 79 20 44 69 73 65 61 73 |Pulmonar|y Diseas|
|00005560| 65 20 28 52 29 0d 0a 0d | 0a 43 68 61 70 74 65 72 |e (R)...|.Chapter|
|00005570| 20 32 2d 2d 41 73 74 68 | 6d 61 20 61 6e 64 20 53 | 2--Asth|ma and S|
|00005580| 65 6c 65 63 74 65 64 20 | 49 6d 6d 75 6e 6f 6c 6f |elected |Immunolo|
|00005590| 67 69 63 61 6c 6c 79 20 | 4d 65 64 69 61 74 65 64 |gically |Mediated|
|000055a0| 20 4c 75 6e 67 20 44 69 | 73 65 61 73 65 73 0d 0a | Lung Di|seases..|
|000055b0| 0d 0a 54 68 65 72 61 70 | 79 0d 0a 0d 0a 2d 2d 2d |..Therap|y....---|
|000055c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000055d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000055e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000055f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005600| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 44 |--------|-----..D|
|00005610| 69 66 66 65 72 65 6e 63 | 65 73 20 69 6e 20 48 6f |ifferenc|es in Ho|
|00005620| 73 70 69 74 61 6c 20 41 | 73 74 68 6d 61 20 4d 61 |spital A|sthma Ma|
|00005630| 6e 61 67 65 6d 65 6e 74 | 0d 0a 0d 0a 42 75 63 6b |nagement|....Buck|
|00005640| 6e 61 6c 6c 20 43 45 2c | 20 52 6f 62 65 72 74 73 |nall CE,| Roberts|
|00005650| 6f 6e 20 43 2c 20 4d 6f | 72 61 6e 20 46 2c 20 53 |on C, Mo|ran F, S|
|00005660| 74 65 76 65 6e 73 6f 6e | 20 52 44 0d 0a 28 47 6c |tevenson| RD..(Gl|
|00005670| 61 73 67 6f 77 20 52 6f | 79 61 6c 20 49 6e 66 69 |asgow Ro|yal Infi|
|00005680| 72 6d 61 72 79 3b 20 53 | 74 72 61 74 68 63 6c 79 |rmary; S|trathcly|
|00005690| 64 65 20 55 6e 69 76 2c | 20 47 6c 61 73 67 6f 77 |de Univ,| Glasgow|
|000056a0| 29 0d 0a 4c 61 6e 63 65 | 74 20 31 3a 37 34 38 2d |)..Lance|t 1:748-|
|000056b0| 37 35 30 2c 20 41 70 72 | 20 32 2c 20 31 39 38 38 |750, Apr| 2, 1988|
|000056c0| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|000056d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000056e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000056f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005700| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005710| 2d 2d 0d 0a 0d 0a 41 62 | 73 74 72 61 63 74 0d 0a |--....Ab|stract..|
|00005720| 0d 0a 20 20 20 20 20 41 | 20 73 75 72 76 65 79 20 |.. A| survey |
|00005730| 6f 66 20 61 73 74 68 6d | 61 20 70 61 74 69 65 6e |of asthm|a patien|
|00005740| 74 73 20 74 72 65 61 74 | 65 64 20 64 75 72 69 6e |ts treat|ed durin|
|00005750| 67 20 31 20 79 65 61 72 | 20 61 74 20 74 68 65 20 |g 1 year| at the |
|00005760| 47 6c 61 73 67 6f 77 20 | 52 6f 79 61 6c 0d 0a 49 |Glasgow |Royal..I|
|00005770| 6e 66 69 72 6d 61 72 79 | 20 66 6f 75 6e 64 20 74 |nfirmary| found t|
|00005780| 68 61 74 20 64 69 61 67 | 6e 6f 73 69 73 2c 20 6d |hat diag|nosis, m|
|00005790| 61 6e 61 67 65 6d 65 6e | 74 2c 20 61 6e 64 20 66 |anagemen|t, and f|
|000057a0| 6f 6c 6c 6f 77 2d 75 70 | 20 76 61 72 79 20 63 6f |ollow-up| vary co|
|000057b0| 6e 73 69 64 65 72 61 62 | 6c 79 0d 0a 61 6d 6f 6e |nsiderab|ly..amon|
|000057c0| 67 20 68 6f 73 70 69 74 | 61 6c 20 64 65 70 61 72 |g hospit|al depar|
|000057d0| 74 6d 65 6e 74 73 2e 20 | 20 50 61 74 69 65 6e 74 |tments. | Patient|
|000057e0| 73 20 73 65 65 6e 20 69 | 6e 20 77 61 72 64 73 20 |s seen i|n wards |
|000057f0| 68 61 76 69 6e 67 20 61 | 20 73 70 65 63 69 61 6c |having a| special|
|00005800| 20 69 6e 74 65 72 65 73 | 74 20 69 6e 0d 0a 72 65 | interes|t in..re|
|00005810| 73 70 69 72 61 74 6f 72 | 79 20 6d 65 64 69 63 69 |spirator|y medici|
|00005820| 6e 65 20 28 67 72 6f 75 | 70 20 52 29 20 72 65 63 |ne (grou|p R) rec|
|00005830| 65 69 76 65 64 20 6d 6f | 72 65 20 74 68 6f 72 6f |eived mo|re thoro|
|00005840| 75 67 68 20 74 72 65 61 | 74 6d 65 6e 74 20 61 6e |ugh trea|tment an|
|00005850| 64 20 68 61 64 20 61 20 | 66 61 72 0d 0a 62 65 74 |d had a |far..bet|
|00005860| 74 65 72 20 6f 75 74 63 | 6f 6d 65 20 74 68 61 6e |ter outc|ome than|
|00005870| 20 74 68 6f 73 65 20 61 | 64 6d 69 74 74 65 64 20 | those a|dmitted |
|00005880| 74 6f 20 67 65 6e 65 72 | 61 6c 20 77 61 72 64 73 |to gener|al wards|
|00005890| 20 77 69 74 68 6f 75 74 | 20 72 65 73 70 69 72 61 | without| respira|
|000058a0| 74 6f 72 79 0d 0a 73 70 | 65 63 69 61 6c 69 7a 61 |tory..sp|ecializa|
|000058b0| 74 69 6f 6e 20 28 67 72 | 6f 75 70 20 47 29 2e 0d |tion (gr|oup G)..|
|000058c0| 0a 20 20 20 20 20 50 61 | 74 69 65 6e 74 73 20 69 |. Pa|tients i|
|000058d0| 6e 20 74 68 65 20 32 20 | 67 72 6f 75 70 73 20 77 |n the 2 |groups w|
|000058e0| 65 72 65 20 73 69 6d 69 | 6c 61 72 20 77 69 74 68 |ere simi|lar with|
|000058f0| 20 72 65 67 61 72 64 20 | 74 6f 20 6d 65 64 69 63 | regard |to medic|
|00005900| 61 6c 20 63 6f 6e 64 69 | 74 69 6f 6e 2c 20 73 65 |al condi|tion, se|
|00005910| 78 0d 0a 64 69 73 74 72 | 69 62 75 74 69 6f 6e 2c |x..distr|ibution,|
|00005920| 20 61 6e 64 20 6f 74 68 | 65 72 20 76 61 72 69 61 | and oth|er varia|
|00005930| 62 6c 65 73 2e 20 20 54 | 68 6f 73 65 20 69 6e 20 |bles. T|hose in |
|00005940| 67 72 6f 75 70 20 52 20 | 68 61 64 20 73 69 67 6e |group R |had sign|
|00005950| 69 66 69 63 61 6e 74 6c | 79 20 68 69 67 68 65 72 |ificantl|y higher|
|00005960| 0d 0a 72 61 74 65 73 20 | 6f 66 20 74 72 65 61 74 |..rates |of treat|
|00005970| 6d 65 6e 74 20 77 69 74 | 68 20 6f 72 61 6c 20 63 |ment wit|h oral c|
|00005980| 6f 72 74 69 63 6f 73 74 | 65 72 6f 69 64 73 2c 20 |orticost|eroids, |
|00005990| 6d 6f 6e 69 74 6f 72 69 | 6e 67 20 6f 66 20 70 65 |monitori|ng of pe|
|000059a0| 61 6b 20 66 6c 6f 77 20 | 72 61 74 65 73 20 6f 72 |ak flow |rates or|
|000059b0| 0d 0a 73 70 69 72 6f 6d | 65 74 72 79 2c 20 61 6e |..spirom|etry, an|
|000059c0| 64 20 61 70 70 6f 69 6e | 74 6d 65 6e 74 73 20 66 |d appoin|tments f|
|000059d0| 6f 72 20 66 6f 6c 6c 6f | 77 2d 75 70 20 72 65 76 |or follo|w-up rev|
|000059e0| 69 65 77 2e 20 20 53 68 | 6f 72 74 2d 74 65 72 6d |iew. Sh|ort-term|
|000059f0| 20 61 6e 64 20 6c 6f 6e | 67 2d 74 65 72 6d 0d 0a | and lon|g-term..|
|00005a00| 6f 75 74 63 6f 6d 65 73 | 20 77 65 72 65 20 6d 61 |outcomes| were ma|
|00005a10| 72 6b 65 64 6c 79 20 62 | 65 74 74 65 72 20 69 6e |rkedly b|etter in|
|00005a20| 20 67 72 6f 75 70 20 52 | 20 70 61 74 69 65 6e 74 | group R| patient|
|00005a30| 73 20 28 54 61 62 6c 65 | 20 31 29 2e 20 20 42 65 |s (Table| 1). Be|
|00005a40| 63 61 75 73 65 20 74 68 | 65 0d 0a 61 76 65 72 61 |cause th|e..avera|
|00005a50| 67 65 20 61 67 65 20 6f | 66 20 67 72 6f 75 70 20 |ge age o|f group |
|00005a60| 47 20 70 61 74 69 65 6e | 74 73 20 77 61 73 20 73 |G patien|ts was s|
|00005a70| 6f 6d 65 77 68 61 74 20 | 68 69 67 68 65 72 20 74 |omewhat |higher t|
|00005a80| 68 61 6e 20 74 68 61 74 | 20 6f 66 20 67 72 6f 75 |han that| of grou|
|00005a90| 70 20 52 2c 20 61 0d 0a | 63 6f 6d 70 61 72 69 73 |p R, a..|comparis|
|00005aa0| 6f 6e 20 77 61 73 20 6d | 61 64 65 20 6f 66 20 6d |on was m|ade of m|
|00005ab0| 61 74 63 68 65 64 20 70 | 61 69 72 73 20 66 72 6f |atched p|airs fro|
|00005ac0| 6d 20 74 68 65 20 32 20 | 67 72 6f 75 70 73 2e 20 |m the 2 |groups. |
|00005ad0| 20 49 6d 70 6f 72 74 61 | 6e 74 20 64 69 66 66 65 | Importa|nt diffe|
|00005ae0| 72 65 6e 63 65 73 0d 0a | 72 65 6d 61 69 6e 65 64 |rences..|remained|
|00005af0| 20 73 69 67 6e 69 66 69 | 63 61 6e 74 20 69 6e 20 | signifi|cant in |
|00005b00| 74 68 69 73 20 63 61 73 | 65 2d 63 6f 6e 74 72 6f |this cas|e-contro|
|00005b10| 6c 20 61 6e 61 6c 79 73 | 69 73 20 28 54 61 62 6c |l analys|is (Tabl|
|00005b20| 65 20 32 29 2e 0d 0a 20 | 20 20 20 20 50 68 79 73 |e 2)... | Phys|
|00005b30| 69 63 69 61 6e 73 20 77 | 69 74 68 6f 75 74 20 73 |icians w|ithout s|
|00005b40| 70 65 63 69 61 6c 69 73 | 74 20 72 65 73 70 69 72 |pecialis|t respir|
|00005b50| 61 74 6f 72 79 20 69 6e | 74 65 72 65 73 74 20 77 |atory in|terest w|
|00005b60| 65 72 65 20 6d 6f 72 65 | 20 6c 69 6b 65 6c 79 0d |ere more| likely.|
|00005b70| 0a 28 73 6f 6d 65 74 69 | 6d 65 73 20 65 72 72 6f |.(someti|mes erro|
|00005b80| 6e 65 6f 75 73 6c 79 29 | 20 74 6f 20 64 69 61 67 |neously)| to diag|
|00005b90| 6e 6f 73 65 20 63 68 72 | 6f 6e 69 63 20 6f 62 73 |nose chr|onic obs|
|00005ba0| 74 72 75 63 74 69 76 65 | 20 61 69 72 77 61 79 73 |tructive| airways|
|00005bb0| 20 64 69 73 65 61 73 65 | 20 74 68 61 6e 0d 0a 61 | disease| than..a|
|00005bc0| 73 74 68 6d 61 2e 20 20 | 54 68 69 73 20 64 69 73 |sthma. |This dis|
|00005bd0| 74 69 6e 63 74 69 6f 6e | 20 68 61 73 20 73 65 72 |tinction| has ser|
|00005be0| 69 6f 75 73 20 69 6d 70 | 6c 69 63 61 74 69 6f 6e |ious imp|lication|
|00005bf0| 73 20 66 6f 72 20 61 20 | 70 61 74 69 65 6e 74 27 |s for a |patient'|
|00005c00| 73 20 74 72 65 61 74 6d | 65 6e 74 20 61 6e 64 0d |s treatm|ent and.|
|00005c10| 0a 70 72 6f 67 6e 6f 73 | 69 73 2e 20 20 44 65 73 |.prognos|is. Des|
|00005c20| 70 69 74 65 20 61 64 76 | 61 6e 63 65 73 20 69 6e |pite adv|ances in|
|00005c30| 20 61 73 74 68 6d 61 20 | 74 68 65 72 61 70 79 2c | asthma |therapy,|
|00005c40| 20 6d 6f 72 74 61 6c 69 | 74 79 20 72 61 74 65 73 | mortali|ty rates|
|00005c50| 20 68 61 76 65 20 6e 6f | 74 20 66 61 6c 6c 65 6e | have no|t fallen|
|00005c60| 0d 0a 64 75 72 69 6e 67 | 20 74 68 65 20 70 61 73 |..during| the pas|
|00005c70| 74 20 32 30 20 79 65 61 | 72 73 2e 20 20 49 6e 61 |t 20 yea|rs. Ina|
|00005c80| 64 65 71 75 61 74 65 20 | 6d 61 6e 61 67 65 6d 65 |dequate |manageme|
|00005c90| 6e 74 20 6f 66 20 61 73 | 74 68 6d 61 20 6c 65 61 |nt of as|thma lea|
|00005ca0| 64 73 20 74 6f 20 75 6e | 6e 65 63 65 73 73 61 72 |ds to un|necessar|
|00005cb0| 79 0d 0a 72 65 6c 61 70 | 73 65 20 61 6e 64 2c 20 |y..relap|se and, |
|00005cc0| 6f 6e 20 6f 63 63 61 73 | 69 6f 6e 2c 20 74 6f 20 |on occas|ion, to |
|00005cd0| 64 65 61 74 68 2e 0d 0a | 0d 0a 50 6f 73 74 2d 43 |death...|..Post-C|
|00005ce0| 6f 6d 6d 65 6e 74 0d 0a | 0d 0a 20 20 20 20 20 54 |omment..|.. T|
|00005cf0| 68 69 73 20 61 72 74 69 | 63 6c 65 20 70 72 65 73 |his arti|cle pres|
|00005d00| 65 6e 74 73 20 72 61 74 | 68 65 72 20 63 6f 6e 76 |ents rat|her conv|
|00005d10| 69 6e 63 69 6e 67 20 65 | 76 69 64 65 6e 63 65 20 |incing e|vidence |
|00005d20| 74 68 61 74 20 70 68 79 | 73 69 63 69 61 6e 73 20 |that phy|sicians |
|00005d30| 77 69 74 68 20 61 0d 0a | 73 70 65 63 69 61 6c 20 |with a..|special |
|00005d40| 69 6e 74 65 72 65 73 74 | 20 69 6e 20 72 65 73 70 |interest| in resp|
|00005d50| 69 72 61 74 6f 72 79 20 | 6d 65 64 69 63 69 6e 65 |iratory |medicine|
|00005d60| 20 74 72 65 61 74 20 70 | 61 74 69 65 6e 74 73 20 | treat p|atients |
|00005d70| 77 69 74 68 20 61 73 74 | 68 6d 61 20 64 69 66 66 |with ast|hma diff|
|00005d80| 65 72 65 6e 74 6c 79 2c | 0d 0a 61 6e 64 20 6d 6f |erently,|..and mo|
|00005d90| 72 65 20 65 66 66 65 63 | 74 69 76 65 6c 79 2c 20 |re effec|tively, |
|00005da0| 74 68 61 6e 20 70 68 79 | 73 69 63 69 61 6e 73 20 |than phy|sicians |
|00005db0| 77 69 74 68 6f 75 74 20 | 74 68 69 73 20 73 70 65 |without |this spe|
|00005dc0| 63 69 61 6c 20 69 6e 74 | 65 72 65 73 74 2e 20 20 |cial int|erest. |
|00005dd0| 54 77 6f 0d 0a 69 6d 70 | 6f 72 74 61 6e 74 20 69 |Two..imp|ortant i|
|00005de0| 73 73 75 65 73 20 63 6f | 75 6c 64 20 62 65 20 72 |ssues co|uld be r|
|00005df0| 61 69 73 65 64 20 63 6f | 6e 63 65 72 6e 69 6e 67 |aised co|ncerning|
|00005e00| 20 74 68 69 73 20 6f 62 | 73 65 72 76 61 74 69 6f | this ob|servatio|
|00005e10| 6e 2c 20 73 68 6f 75 6c | 64 20 69 74 20 62 65 0d |n, shoul|d it be.|
|00005e20| 0a 63 6f 6e 66 69 72 6d | 65 64 2e 20 20 46 69 72 |.confirm|ed. Fir|
|00005e30| 73 74 2c 20 69 66 20 22 | 73 70 65 63 69 61 6c 20 |st, if "|special |
|00005e40| 69 6e 74 65 72 65 73 74 | 22 20 63 61 6e 20 62 65 |interest|" can be|
|00005e50| 20 65 71 75 61 74 65 64 | 20 77 69 74 68 20 22 73 | equated| with "s|
|00005e60| 70 65 63 69 61 6c 20 74 | 72 61 69 6e 69 6e 67 22 |pecial t|raining"|
|00005e70| 0d 0a 28 61 73 20 69 6e | 20 61 20 72 65 73 70 69 |..(as in| a respi|
|00005e80| 72 61 74 6f 72 79 20 73 | 75 62 73 70 65 63 69 61 |ratory s|ubspecia|
|00005e90| 6c 69 73 74 29 2c 20 74 | 68 69 73 20 6f 62 73 65 |list), t|his obse|
|00005ea0| 72 76 61 74 69 6f 6e 20 | 77 6f 75 6c 64 20 73 75 |rvation |would su|
|00005eb0| 67 67 65 73 74 20 74 68 | 61 74 0d 0a 73 70 65 63 |ggest th|at..spec|
|00005ec0| 69 61 6c 69 73 74 73 20 | 74 72 65 61 74 20 61 73 |ialists |treat as|
|00005ed0| 74 68 6d 61 20 6d 6f 72 | 65 20 73 75 63 63 65 73 |thma mor|e succes|
|00005ee0| 73 66 75 6c 6c 79 20 28 | 61 6e 64 20 70 65 72 68 |sfully (|and perh|
|00005ef0| 61 70 73 20 61 74 20 6c | 6f 77 65 72 20 6f 76 65 |aps at l|ower ove|
|00005f00| 72 61 6c 6c 20 63 6f 73 | 74 20 62 79 0d 0a 61 76 |rall cos|t by..av|
|00005f10| 6f 69 64 69 6e 67 20 72 | 65 70 65 61 74 65 64 20 |oiding r|epeated |
|00005f20| 68 6f 73 70 69 74 61 6c | 69 7a 61 74 69 6f 6e 29 |hospital|ization)|
|00005f30| 20 74 68 61 6e 20 67 65 | 6e 65 72 61 6c 69 73 74 | than ge|neralist|
|00005f40| 73 20 64 6f 2e 20 20 46 | 6f 72 20 74 68 6f 73 65 |s do. F|or those|
|00005f50| 20 69 6e 64 69 76 69 64 | 75 61 6c 73 0d 0a 77 6f | individ|uals..wo|
|00005f60| 6e 64 65 72 69 6e 67 20 | 77 68 79 20 73 70 65 63 |ndering |why spec|
|00005f70| 69 61 6c 69 73 74 73 20 | 72 65 63 65 69 76 65 20 |ialists |receive |
|00005f80| 68 69 67 68 65 72 20 66 | 65 65 73 20 66 6f 72 20 |higher f|ees for |
|00005f90| 70 65 72 66 6f 72 6d 69 | 6e 67 20 74 68 65 20 22 |performi|ng the "|
|00005fa0| 73 61 6d 65 0d 0a 66 75 | 6e 63 74 69 6f 6e 73 22 |same..fu|nctions"|
|00005fb0| 20 61 73 20 67 65 6e 65 | 72 61 6c 69 73 74 73 2c | as gene|ralists,|
|00005fc0| 20 74 68 69 73 20 63 6f | 75 6c 64 20 70 72 6f 76 | this co|uld prov|
|00005fd0| 69 64 65 20 61 6e 20 61 | 6e 73 77 65 72 2e 20 20 |ide an a|nswer. |
|00005fe0| 53 65 63 6f 6e 64 2c 20 | 74 68 69 73 0d 0a 6f 62 |Second, |this..ob|
|00005ff0| 73 65 72 76 61 74 69 6f | 6e 20 73 75 67 67 65 73 |servatio|n sugges|
|00006000| 74 73 20 61 20 6d 65 63 | 68 61 6e 69 73 6d 20 62 |ts a mec|hanism b|
|00006010| 79 20 77 68 69 63 68 20 | 74 68 65 20 69 6d 70 6f |y which |the impo|
|00006020| 72 74 61 6e 63 65 20 6f | 66 20 74 72 65 61 74 6d |rtance o|f treatm|
|00006030| 65 6e 74 20 74 6f 20 61 | 73 74 68 6d 61 0d 0a 6d |ent to a|sthma..m|
|00006040| 6f 72 74 61 6c 69 74 79 | 20 63 61 6e 20 62 65 20 |ortality| can be |
|00006050| 65 78 61 6d 69 6e 65 64 | 2e 20 20 5b 57 65 20 68 |examined|. [We h|
|00006060| 61 76 65 20 64 69 73 63 | 75 73 73 65 64 20 74 68 |ave disc|ussed th|
|00006070| 65 20 69 73 73 75 65 20 | 6f 66 20 61 20 72 65 63 |e issue |of a rec|
|00006080| 65 6e 74 20 69 6e 63 72 | 65 61 73 65 20 69 6e 0d |ent incr|ease in.|
|00006090| 0a 6d 6f 72 74 61 6c 69 | 74 79 20 69 6e 20 61 73 |.mortali|ty in as|
|000060a0| 74 68 6d 61 74 69 63 73 | 20 69 6e 20 70 61 73 74 |thmatics| in past|
|000060b0| 20 69 73 73 75 65 73 20 | 6f 66 20 74 68 65 20 59 | issues |of the Y|
|000060c0| 45 41 52 20 42 4f 4f 4b | 20 28 31 39 38 36 2c 20 |EAR BOOK| (1986, |
|000060d0| 70 70 20 37 36 2d 37 37 | 3b 20 31 39 38 37 2c 0d |pp 76-77|; 1987,.|
|000060e0| 0a 70 70 20 36 33 2d 36 | 34 3b 20 31 39 38 38 2c |.pp 63-6|4; 1988,|
|000060f0| 20 70 70 20 39 38 2d 39 | 39 29 5d 2e 20 57 68 65 | pp 98-9|9)]. Whe|
|00006100| 72 65 61 73 20 61 20 6e | 75 6d 62 65 72 20 6f 66 |reas a n|umber of|
|00006110| 20 66 61 63 74 6f 72 73 | 20 68 61 76 65 20 62 65 | factors| have be|
|00006120| 65 6e 20 64 69 73 63 75 | 73 73 65 64 20 61 73 0d |en discu|ssed as.|
|00006130| 0a 70 6f 73 73 69 62 6c | 65 20 63 61 75 73 65 73 |.possibl|e causes|
|00006140| 20 6f 66 20 74 68 69 73 | 20 69 6e 63 72 65 61 73 | of this| increas|
|00006150| 65 20 69 6e 20 6d 6f 72 | 74 61 6c 69 74 79 2c 20 |e in mor|tality, |
|00006160| 69 6e 63 6c 75 64 69 6e | 67 20 70 73 79 63 68 6f |includin|g psycho|
|00006170| 73 6f 63 69 61 6c 20 66 | 61 63 74 6f 72 73 20 69 |social f|actors i|
|00006180| 6e 0d 0a 74 68 65 20 70 | 61 74 69 65 6e 74 2c 20 |n..the p|atient, |
|00006190| 74 68 65 20 69 6e 74 72 | 6f 64 75 63 74 69 6f 6e |the intr|oduction|
|000061a0| 20 6f 66 20 6e 65 77 20 | 64 72 75 67 73 20 28 69 | of new |drugs (i|
|000061b0| 6e 68 61 6c 65 64 20 62 | 65 74 61 2d 61 67 6f 6e |nhaled b|eta-agon|
|000061c0| 69 73 74 73 29 20 66 6f | 72 20 74 68 65 0d 0a 74 |ists) fo|r the..t|
|000061d0| 72 65 61 74 6d 65 6e 74 | 20 6f 66 20 61 73 74 68 |reatment| of asth|
|000061e0| 6d 61 2c 20 61 6e 64 20 | 74 68 65 20 70 6f 73 73 |ma, and |the poss|
|000061f0| 69 62 6c 65 20 22 75 6e | 64 65 72 20 74 72 65 61 |ible "un|der trea|
|00006200| 74 6d 65 6e 74 22 20 6f | 66 20 61 73 74 68 6d 61 |tment" o|f asthma|
|00006210| 20 62 79 20 70 68 79 73 | 69 63 69 61 6e 73 2c 0d | by phys|icians,.|
|00006220| 0a 69 74 20 69 73 20 73 | 74 69 6c 6c 20 6e 6f 74 |.it is s|till not|
|00006230| 20 63 6c 65 61 72 20 77 | 68 69 63 68 20 6f 66 20 | clear w|hich of |
|00006240| 74 68 65 73 65 20 6f 72 | 20 6f 74 68 65 72 20 66 |these or| other f|
|00006250| 61 63 74 6f 72 73 20 69 | 73 20 69 6d 70 6f 72 74 |actors i|s import|
|00006260| 61 6e 74 20 69 6e 20 74 | 68 69 73 0d 0a 70 72 6f |ant in t|his..pro|
|00006270| 62 6c 65 6d 2e 20 20 49 | 66 20 6d 6f 72 74 61 6c |blem. I|f mortal|
|00006280| 69 74 79 20 77 65 72 65 | 20 64 65 74 65 72 6d 69 |ity were| determi|
|00006290| 6e 65 64 20 74 6f 20 62 | 65 20 68 69 67 68 65 72 |ned to b|e higher|
|000062a0| 20 69 6e 20 6f 6e 65 20 | 67 72 6f 75 70 20 6f 66 | in one |group of|
|000062b0| 20 70 61 74 69 65 6e 74 | 73 20 6f 72 0d 0a 74 68 | patient|s or..th|
|000062c0| 65 20 6f 74 68 65 72 2c | 20 74 68 65 20 69 6d 70 |e other,| the imp|
|000062d0| 61 63 74 20 6f 66 20 74 | 72 65 61 74 6d 65 6e 74 |act of t|reatment|
|000062e0| 20 6f 6e 20 6d 6f 72 74 | 61 6c 69 74 79 20 77 6f | on mort|ality wo|
|000062f0| 75 6c 64 20 62 65 20 69 | 6d 70 6c 69 65 64 2e 20 |uld be i|mplied. |
|00006300| 20 54 68 69 73 20 61 72 | 74 69 63 6c 65 0d 0a 69 | This ar|ticle..i|
|00006310| 73 20 6c 69 6b 65 6c 79 | 20 74 6f 20 62 65 20 64 |s likely| to be d|
|00006320| 65 62 61 74 65 64 2e 20 | 20 57 65 20 61 77 61 69 |ebated. | We awai|
|00006330| 74 20 66 75 72 74 68 65 | 72 20 73 61 6c 76 6f 73 |t furthe|r salvos|
|00006340| 20 69 6e 20 74 68 69 73 | 20 70 6f 74 65 6e 74 69 | in this| potenti|
|00006350| 61 6c 0d 0a 63 6f 6e 74 | 72 6f 76 65 72 73 79 2e |al..cont|roversy.|
|00006360| 2d 2d 53 2e 50 2e 20 50 | 65 74 65 72 73 2c 20 4d |--S.P. P|eters, M|
|00006370| 2e 44 2e 2c 20 50 68 2e | 44 2e 0d 0a 24 55 6e 69 |.D., Ph.|D...$Uni|
|00006380| 71 75 65 5f 49 44 7b 59 | 52 42 30 38 37 35 32 7d |que_ID{Y|RB08752}|
|00006390| 0d 0a 24 54 69 74 6c 65 | 7b 4d 65 74 68 6f 74 72 |..$Title|{Methotr|
|000063a0| 65 78 61 74 65 20 69 6e | 20 74 68 65 20 54 72 65 |exate in| the Tre|
|000063b0| 61 74 6d 65 6e 74 20 6f | 66 20 43 6f 72 74 69 63 |atment o|f Cortic|
|000063c0| 6f 73 74 65 72 6f 69 64 | 2d 44 65 70 65 6e 64 65 |osteroid|-Depende|
|000063d0| 6e 74 20 41 73 74 68 6d | 61 3a 20 20 41 20 44 6f |nt Asthm|a: A Do|
|000063e0| 75 62 6c 65 2d 42 6c 69 | 6e 64 20 43 72 6f 73 73 |uble-Bli|nd Cross|
|000063f0| 6f 76 65 72 20 53 74 75 | 64 79 7d 0d 0a 24 41 75 |over Stu|dy}..$Au|
+--------+-------------------------+-------------------------+--------+--------+
Only 25.0 KB of data is shown above.