Hydroxyethyl starch-induced itch: Relevance of light microscopic analysis of semi-thin sections and electron microscopy
ABSTRACT Hydroxyethyl starch (HES) is widely used as a plasma substitute for improving microcirculation. A major side effect of HES is severe pruritus caused by HES deposits in the skin. Since specific changes are difficult to see in paraffin sections, electron microscopy is the golden standard technique in the diagnosis of HES-induced skin disease. Our aim was to compare electron microscopic search for HES deposits with other techniques.
During the last ten years, we biopsied 21 patients suspected of having HES-induced pruritus. We compared conventional microscopy with hematoxylin & eosin and toluidine blue-stained paraffin sections, toluidine blue-stained glycide ether-embedded, semithin sections and transmission electron microscopy.
In 9 patients specific HES deposits could be found by evaluating toluidine blue stained semithin sections by light microscopy alone. In 6 of these cases electron microscopy was also done and confirmed the findings. In contrast, no specific findings due to HES deposits could be detected by conventional histology.
If specific HES deposits are found in toluidine blue-stained, glycide ether-embedded semithin sections, electron microscopy is not required.
Conference Paper: Analysis of Microvia Interconnects[Show abstract] [Hide abstract]
ABSTRACT: The development of high density circuitry has promoted the introduction of the microvia technology which relies on organic dielectrics and vertical interconnects of reduced dimensions. In this paper, microvia interconnects are evaluated both through simulation using an FDTD model and experimental measurements, and have shown good electrical performance.ARFTG Conference Digest-Spring, 51st; 07/1998
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ABSTRACT: Hydroxyethyl starch is a key component of many colloid volume expanders used in hypovolemic shock and otologic disease. Pruritus is a common side effect. Histopathology reveals multiple cytoplasmic vacuoles in dermal macrophages, endothelial cells, and perineural cells with electron-dense foreign material within the said vacuoles. Although classically refractory to treatment with corticosteroids and antihistamines, some benefit has been achieved with capsaicin, ultraviolet light therapy, and oral naltrexone. We present a case responsive to menthol and camphor and discuss the possible therapeutic mechanism.Journal of the American Academy of Dermatology 08/2008; 59(1):151-3. DOI:10.1016/j.jaad.2008.03.034 · 5.00 Impact Factor
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ABSTRACT: Geriatric patients are frequently afflicted by pruritic dermatoses. Most pruritic elderly patients present with a skin eruption. The high prevalence of pruritic inflammatory skin disorders in elderly patients is a consequence of three physiological changes that occur with aging: (1) the epidermal barrier repair is diminished; (2) the immune systems of elderly patients are activated and have defective Th1 function along with enhanced Th2 function (immunosenescense); and (3) neurodegenerative disorders may lead to pruritus by their central or peripheral effects. These consequences of aging may all afflict the same patient, explaining why elderly people often have multiple overlapping skin conditions. The following article outlines the pathogenesis of the most common forms of pruritic skin disease in elderly patients and the hallmarks that allow the dermatologist to establish an accurate diagnosis and also suggests a management strategy for each common type of pruritic skin disease in the elderly patient.Seminars in cutaneous medicine and surgery 06/2011; 30(2):113-7. DOI:10.1016/j.sder.2011.04.002 · 2.40 Impact Factor