ABSTRACT
Acquired haemophilia is rare and potentially fatal, with a mortality of 20% if left untreated. There is a strong association with other autoimmune diseases. This report describes a patient with rheumatoid arthritis, vitiligo, and bullous pemphigoid where the diagnosis of acquired haemophilia was made after an extensive bleed into a bullous lesion in the buccal mucosa. This case highlights some of the potential complications of acquired haemophilia and its treatment.
Subject(s)
Arthritis, Rheumatoid/complications , Hemophilia A/etiology , Oral Hemorrhage/etiology , Pemphigoid, Bullous/complications , Vitiligo/complications , Aged , Hemophilia A/drug therapy , Humans , Male , Mouth MucosaABSTRACT
Molecular epidemiology has linked ultraviolet-induced DNA damage with mutagenesis and skin carcinogenesis. Ultraviolet radiation may damage DNA in one of two ways: either directly, leading to lesions such as cyclobutane thymine dimers (T<>T), or indirectly, via photosensitizers that generate free radical species that may ultimately produce such oxidative lesions as 8-oxo-2'-deoxyguanosine. We report the results of a pilot, case control study in which seven, healthy, human volunteers (skin type II; aged 23-56 y; three male, four female) received a suberythemal dose of whole body irradiation from ultraviolet-A-emitting fluorescent tubes used in psoralen plus ultraviolet A therapy. First void, mid-stream urine samples were collected pre-exposure and daily postexposure, for up to 13 d. Analysis of urinary 8-oxo-2'-deoxyguanosine and cyclobutane thymine dimers was by competitive enzyme-linked immunosorbent assay (interassay coefficient of variation < or = 10%) and compared with a matched, control group of unirradiated individuals. A maximal increase in levels of urinary 8-oxo-2'-deoxyguanosine was seen 4 d post-ultraviolet exposure. A subsequent reduction was noted, before finally returning to baseline. Similarly, cyclobutane thymine dimer levels peaked 3 d postexposure, before returning to baseline. In contrast to the 8-oxo-2'-deoxyguanosine analysis, however, a second peak was noted at days 9-11, before again returning to baseline. This is the first report examining urinary 8-oxo-2'-deoxyguanosine and cyclobutane thymine dimers following ultraviolet exposure of healthy human subjects. This work illustrates the induction and time course for excretion of ultraviolet-induced lesions, perhaps alluding to repair and ultimately offering the potential to define psoralen plus ultraviolet A dosage regimes in terms of minimizing DNA damage and hence cancer risk.
Subject(s)
Deoxyguanosine/analogs & derivatives , Deoxyguanosine/metabolism , Pyrimidine Dimers/metabolism , 8-Hydroxy-2'-Deoxyguanosine , Adult , Case-Control Studies , DNA Damage/radiation effects , Deoxyguanosine/urine , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Middle Aged , PUVA Therapy , Pilot Projects , Psoriasis/etiology , Reproducibility of Results , Skin Neoplasms/etiology , Ultraviolet RaysABSTRACT
Psoralen in conjunction with UVA (PUVA) is perhaps the most effective treatment for psoriasis. It is, however, a risk factor for skin cancer in these patients and there is a need to develop non-invasive assays reflective of treatment-induced DNA damage. We report here the assessment of two important lesions, thymine dimer (T<>T) and 8-oxo-2'-deoxyguanosine (8-OHdG), in the urine of psoriasis patients. It was found that, once corrected for urine concentration, the psoriatic group had significantly higher (P<0. 0001) urinary levels of thymine dimers compared to the control group. No significant differences in urinary 8-OHdG levels were noted between the psoriatic, atopic dermatitis and control groups. Therefore biomonitoring of therapy from the very start with this simple and non-invasive assay could perhaps be an effective measure of the risk involved with the treatment allowing optimization for minimal-risk therapy.
Subject(s)
Deoxyguanosine/analogs & derivatives , Psoriasis/urine , Pyrimidine Dimers/urine , 8-Hydroxy-2'-Deoxyguanosine , Adolescent , Adult , Aged , Aged, 80 and over , DNA Damage/genetics , Deoxyguanosine/urine , Female , Humans , Male , Middle Aged , PUVA Therapy/adverse effects , Poly T/therapeutic use , Psoriasis/drug therapy , Risk AssessmentABSTRACT
This is a case report of small cell lung cancer (SCLC) that underwent spontaneous regression. This was associated with severe neuropathy, which was unresponsive to therapy, including corticosteroids and plasmapheresis. We present here the case report and a brief review of the literature.
Subject(s)
Carcinoma, Small Cell/physiopathology , Lung Neoplasms/physiopathology , Neoplasm Regression, Spontaneous/physiopathology , Peripheral Nervous System Diseases/physiopathology , Solitary Pulmonary Nodule/physiopathology , Aged , Carcinoma, Small Cell/diagnostic imaging , Female , Humans , Lung Neoplasms/diagnostic imaging , Solitary Pulmonary Nodule/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Tissue expansion is a recent advance in skin cover technique. Its empirical use has enabled many previously difficult reconstructions to be completed without recourse to distant flaps. Its high complication rate and lack of basic scientific understanding at present restrict its use to selected cases, but the quality of repairs possible by this method encourage further serious scientific study.
