[Mortality during the first six years after cholecystectomy. A review of all cholecystectomies in women in Denmark during 1977-1981]. / Dødeligheden i de første seks år efter kolecystektomi. Opgørelse af samtlige kolecystektomier blandt kvinder i Danmark i perioden 1977-1981.

It has been a prevailing assumption that cholecystectomy patients by and large follow a pattern of survival similar to that of the normal population. This paper presents a population-based study of the long-term survival after cholecystectomy in order to reassess this assumption. Based on data available in the Danish National Hospital Register, the records of all Danish women who were operated between 1977 and 1981 were examined and studied up to six years subsequent to surgery. Cholecystectomy patients who were free of diagnosed cancer and who had no major co-surgery (n = 11,123) were compared to both hysterectomy patients and a sample of the female population. Adjusting for age and other covariates, patients with psychiatric hospital admissions prior to surgery experienced a threefold risk of dying within six years after surgery. Patients with prior somatic admissions and patient with acute admissions had a relative risk (RR) of about 1.5. Cholecystectomy patients had a significantly increased mortality when compared to hysterectomy patients, RR = 1.3 (1.1-1.6), and to the population sample. Heart diseases and cancer occurred significantly more often as causes of death among cholecystectomy patients when compared to hysterectomy patients, but our data suggest that the occurrence of many other causes of death may be increased among cholecystectomy patients as well. The authors concluded that cholecystectomy patients are subject to relatively higher levels of mortality than previously assumed in parts of the literature. Furthermore, the increase seems to be attributable to a multitude of causes of death. The most likely explanation of the excess mortality among cholecystectomy patients is that gallbladder patients are relatively fragile. Indeed, with this vulnerable group of patients the potential trauma of the surgical intervention itself needs careful consideration.

Isolated extragenital HPV-thirties-group-positive bowenoid papulosis in an AIDS patient.

We report a case of extragenital bowenoid papulosis in a man with AIDS. The lesions occurred on the anterolateral aspects of the neck, and were not associated with clinical genital or periungual involvement. In situ hybridization demonstrated abundant HPV DNA within the thirties group (31/33/35), in the absence of HPV-16 or -18.

Complete remissions in psoralen and UV-A (PUVA)-refractory mycosis fungoides-type cutaneous T-cell lymphoma with combined interferon alfa and PUVA.

UNLABELLED: BACKGROUND AND DESIGN--The optimal therapy for the mycosis fungoides type of cutaneous T-cell lymphoma has yet to be determined. Based on recent reports on the efficacy of high-dose interferon alfa in cutaneous T-cell lymphoma, we chose to test the hypothesis that systemic adjunctive therapy with low-dose interferon alfa along with psoralen and long-wave UV-A radiation (PUVA) could decrease the amount of PUVA necessary to achieve the best response, as well as improve the therapeutic effect of PUVA. Five patients with cutaneous T-cell lymphoma (mycosis fungoides type) were initially treated unsuccessfully with PUVA alone (three times a week for at least 3 months); PUVA was stopped, patients' diseases were re-staged, then interferon alfa (3 x 10(6) U/d for 1 week, then 6 x 10(6) U/d for 1 week) was initiated 2 weeks prior to restarting PUVA. Responses to treatment were graded as complete remission (skin clear, or negative biopsy specimens of remaining dermatitic lesions), partial remission (> 50% improvement), progression (> 25% worsening), or no change (failure to qualify for other categories) at 4, 8, 12, and 16 weeks. OBSERVATIONS--After 3 to 5 months of treatment with PUVA thrice weekly, none of the patients treated with PUVA alone had achieved complete remission. By contrast, systemic adjunctive therapy with low-dose interferon alfa along with PUVA resulted in complete remissions in all five (100%) patients in an average of 3.2 months (in three patients, lesions were cleared by 3 months). Average of 107 additional joules (68% more) and 1.6 additional months of PUVA administered thrice weekly was required to achieve the best response attainable with PUVA alone compared with complete remissions achieved with combined interferon alfa and PUVA therapy. CONCLUSION: --These data indicate that patients with disease refractory to PUVA alone can achieve a complete remission if they restart treatment with PUVA in combination with well-tolerated low doses of interferon alfa. In addition, the duration of PUVA exposure can be reduced with the addition of low-dose interferon alfa to the conventional PUVA treatment of cutaneous T-cell lymphoma of the mycosis fungoides type in such patients.

Double-blind, placebo-controlled study to evaluate the efficacy of fish oil and low-dose UVB in the treatment of psoriasis.

Since eicosanoids have been implicated in the pathogenesis of psoriasis, less potent eicosanoid mediators derived from fish oil might improve psoriasis. Using a double-blind, randomized, parallel design, 18 patients with stable, plaque psoriasis received capsules of either fish oil or identical-appearing placebo olive oil for 15 weeks, with concomitant sub-erythemal UVB in weeks 3 to 11. At the conclusion of phototherapy, and 4 weeks later, patients in the fish oil group had a greater decrease in the total body surface area of psoriasis and more improvement compared to patients in the olive oil group. The improvement in the fish oil group was statistically significantly greater for all parameters compared to the change in the olive oil group. The apparent safety and general health-promoting features of fish oil could provide an ideal adjunctive therapy for psoriasis.

Meclofenomate inhibition of UV-induced erythema--a randomized, placebo-controlled, double-blind study.

Systemic intradermal and topical inhibitors of eicosanoid synthesis have been shown to decrease the intensity delay the onset of erythema produced with a single exposure to ultraviolet (UV) light. We studied the effect of single and multiple doses of meclofenomate on erythema induced by single and multiple doses of UV light. Thirty Caucasian subjects took either meclofenomate 100 mg t.i.d. or matching placebo for 5 days, crossing over to the alternative for 5 more days after a 2-day washout period. A statistical analysis was made of erythema response immediately prior to the study and then on 8 successive days during the study. Analysis of single and multiple exposure data revealed a statistically significant inhibition of erythema from meclofenomate therapy as compared with placebo.

Cutaneous melanomas in patients treated with psoralens plus ultraviolet A. A case report and the experience of the PUVA Follow-up Study.

Psoralens plus ultraviolet A (PUVA) therapy is widely used in the treatment of psoriasis and other cutaneous conditions. We present the case of a patient who developed a superficial spreading melanoma 3 years after first being treated with PUVA. The development of melanomas in patients receiving PUVA is reviewed. During 13,224 person-years of prospective follow-up of 1380 patients enrolled in the PUVA follow-up study, three melanomas were diagnosed, which does not differ significantly from the expected rate (relative risk = 1.5 with 90% confidence interval 0.3 to 7.3). However, considering the effects of PUVA on melanocytes and that the development of melanomas may have a long latent period, continued follow-up studies are indicated.

Psoralen photochemotherapy.

Psoralens and sunlight have been used by the Egyptians and Indians for hundreds of years for the treatment of vitiligo. The combination of oral psoralens and artificial ultraviolet A (PUVA) therapy was approved for the management of severe psoriasis by the Food and Drug Administration in 1982. Since then PUVA therapy has been found to be an effective modality in the treatment of many cutaneous conditions. When properly administered, the major short-term side effects are minimal. The long-term side effects may include an increased risk of squamous cell carcinoma, atypical cutaneous pigmentation, accelerated skin aging, and ophthalmologic abnormalities. By careful patient selection and limiting the cumulative UVA dosage and frequency by using combinations or alternative therapies, these side effects may be reduced. Continued reporting of carefully carried out long-term prospective studies will provide us with more knowledge of the long-term side effects of PUVA. In the meantime, for each patient on PUVA therapy the risk/benefit ratio should be carefully considered.

Effect of continued ultraviolet B phototherapy on the duration of remission of psoriasis: a randomized study.

Phototherapy using sunburn spectrum ultraviolet radiation (UVB) is now a frequently utilized treatment for psoriasis that is extensive or has not responded to topical preparations. Four university centers performed a prospective randomized clinical trial to compare remission times of patients with psoriasis who continued UVB phototherapy after initial clearing with this therapy and patients whose UVB phototherapy was discontinued within 3 weeks of clearing. As assessed by life table methods, the time to flare after initial clearing for patients on UVB maintenance therapy was significantly longer than for patients who discontinued UVB within 3 weeks after initial clearing. Our data suggest that continuing UVB phototherapy after initial clearing contributes to the duration of disease control and is justified for many patients.

Artificial light sources.

A wide variety of artificial light sources exists for use in the diagnosis and treatment of photosensitivity disorders. A discussion of the advantages and disadvantages of these light sources (including gas discharge arcs, fluorescent lamps, and other apparatus) illustrates the importance of matching the emission spectrum of the light source, the spectral response of the radiometer, and the photobiologic action spectrum. Environmental and occupational exposure to artificial light sources may contribute to photosensitivity disorders.

Lenticular psoralen photoproducts and cataracts of a PUVA-treated psoriatic patient.

Psoralen photoproducts were identified in association with cataracts in a psoriatic patient several years after oral methoxsalen plus ultraviolet A light (PUVA) therapy. Patients should be required to wear adequate optical protection not only during PUVA therapy but 24 hours following ingestion of methoxsalen.

Plantar fibromatosis responds to intralesional steroids.

A case of plantar fibromatosis that responded to five monthly intralesional steroid injections is reported. Improvement was noted after 3 to 4 months of therapy. Intralesional steroid injections may represent an alternative to surgery in patients with plantar fibromatosis or Dupuytren's contractures.

UV-B phototherapy. An overview.

The medical uses of nonionizing electromagnetic radiation have changed over time with light source technology and research in photobiology. Multiple UV light phototherapy protocols have been developed. A discussion of the relative importance of light sources with respect to the action spectrum for psoriasis phototherapy, as well as the need for tar and other adjuvants, is important to the understanding of a comparison between various regimens. A number of skin conditions other than psoriasis are also responsive to UV light phototherapy.

Recurrent granulomatous dermatitis with eosinophilia. Wells' syndrome.

A 27-year-old woman developed a chronic, recurrent eruption of the face and upper extremities with the clinical and histopathologic features of recurrent granulomatous dermatitis with eosinophilia (Wells' syndrome). As described in 15 previously reported cases, this disorder is characterized by two clinical phases (eosinophilic cellulitis and granulomatous plaque phase) and three histopathologic stages. The latter are particularly remarkable for a diffuse dermal and subcutaneous eosinophilia in acute lesions and scattered flame figures in chronic lesions. Distinctive findings in this case were the predominance of facial involvement and the symptomatic response to topical corticosteroids. Although etiology and pathogenesis are unknown, we feel that Wells' syndrome is a unique yet rarely recognized clinicopathologic entity.

Subcutaneous alternariosis.

Alternaria species are common plant pathogens, but a rare cause of human infection. Previously reported cases of cutaneous alternariosis (Alternaria alternata) in both healthy and immunosuppressed hosts have been characterized by a chronic localized ulcerative eruption in exposed sites. Dermal granulomatous infiltration and variable epidermal changes, with hyphae in both the dermis and epidermis, are characteristic. We present a case with certain unique features. This is the first reported human infection with Alternaria dianthicola. In addition, our patient showed the unusual presentation of clinically noninflammatory subcutaneous nodules of the chest wall. The subcutaneous location of the granulomatous process may have been attributable to deep traumatic inoculation. The circumscribed nodular quality of the infection allowed a surgical therapeutic approach.

Pigmented purpuric lichenoid dermatitis of Gougerot-Blum mimicking Kaposi's sarcoma.

A case of pigmented purpuric lichenoid dermatitis of Gougerot-Blum is presented and the pertinent literature is reviewed. This case is unusual in that the lesions were unilateral and very limited in extent. The patient presented with a localized pigmented purpuric eruption of plaques on the dorsum of one foot which mimicked Kaposi's sarcoma. However, a biopsy confirmed the diagnosis of pigmented purpuric lichenoid dermatitis of Gougerot-Blum.

Decreased urinary polyamines in patients with psoriasis treated with etretinate.

Oral administration of the aromatic retinoid etretinate is effective therapy for psoriasis and other epidermal hyperproliferative disorders. Since polyamine metabolism is known to be important in cell growth and differentiation, we measured urinary levels of the polyamines putrescine, spermidine, and spermine as a reflection of cutaneous polyamine metabolism in 19 psoriatic patients treated with etretinate for 16 weeks. Using thin-layer chromatography, polyamine determinations were performed on urine collected pretherapy, during therapy, and 8 weeks after therapy was concluded. Good to excellent clearing of psoriasis occurred in 18 of 19 patients. All urinary polyamines showed a downward trend in the first week of therapy, prior to significant clinical improvement. At week 16 of therapy, the greatest reduction in mean urinary polyamine content occurred. Mean putrescine levels decreased from pretherapy to week 16 by 27% (p less than 0.001), mean spermidine values fell by 34% (p less than 0.001), and mean spermine levels declined by 37% (p = 0.005). These data are consistent with the hypothesis that etretinate inhibits polyamine biosynthesis.

Etretinate therapy causes increases in lipid levels in patients with psoriasis.

We investigated changes in serum triglyceride, cholesterol, and high-density lipoprotein cholesterol (HDLC) levels during etretinate administration in 21 patients with psoriasis. Mean serum triglyceride and cholesterol values showed a statistically significant increase during etretinate therapy compared with placebo treatment; mean HDLC levels did not change. During etretinate therapy, elevations out of the normal range occurred in 77% of the patients for serum triglycerides and 25% for serum cholesterol. Eight weeks after discontinuation of the drug regimen, patients' mean serum triglyceride and cholesterol levels were not statistically different from those found prior to therapy. Nevertheless, eight weeks after therapy had been stopped, six (32%) of 19 patients had cholesterol values that were still 20% or more above their baseline levels; the prolonged etretinate excretion time could have been responsible. The mechanisms for the etretinate-induced lipid elevations are unknown.