Height, whole Body Surface Area, gender, working outdoors, and sunbathing in previous summer are important determinants of serum 25-hydroxyvitamin D levels.

OBJECTIVE: To investigate if serum 25-hydroxyvitamin D (25(OH)D) is related to the whole Body Surface Area (BSA), and to several other anthropometric and environmental factors. MATERIALS/METHODS: Serum 25(OH)D was determined in 489 apparently healthy subjects (346 women and 143 men, mean age 43.9 years) in April and May. From all subjects the following data were available: height, body weight, waist to hip ratio, BSA, BMI, environment of work (indoors vs. outdoors), habit of regularly sunbathing during previous summer(s), fear of sun, dwelling in city or village, and skin color. RESULTS: Approximately 43% of the participants had serum 25(OH)D levels between 10 and 20 ng/ml, 44% had values between 20.1 and 30 ng/ml, whereas about 5% had values below 10 ng/ml and only 9% had values above 30 ng/ml. There was a significant positive relationship between 25(OH)D, height and BSA, which was more pronounced for BSA in obese subjects even after adjustment for work outdoors and sunbathing during previous summer(s). Outdoor workers and sunbathers had higher 25(OH)D compared to indoor workers and non-sunbathers respectively. Men when compared to women had higher 25(OH)D regardless of BMI and this difference was apparently due to the fact that men were taller, had greater BSA, and worked more often outdoors. CONCLUSIONS: Height, whole BSA, gender, working outdoors and sunbathing in previous summer(s) proved to be significant determinants of serum 25(OH)D. Vitamin D status is higher in taller individuals with greater BSA, and in men when compared to women.

Angiosarcoma of the heart: case report and review of the literature.

BACKGROUND: Primary angiosarcoma of the heart is an extremely rare malignant disease. PATIENTS AND METHODS: A 32-year-old female with primary angiosarcoma of the heart at an advanced stage with lung and bone metastases is presented. The tumor showed extensive expression of c-erb-B2 and a moderate expression of c-kit. Chemotherapy (cisplatin, epirubicin and ifosfamide) was administered. Herceptin as well as glivec were added to the above combination. RESULTS: There was a good partial response and the lung deposits almost disappeared. The duration of response was 6 months. CONCLUSION: This case of angiosarcoma of the heart is presented because of the extreme rarity of this disease, and its responsiveness to chemotherapy in combination with imatinib and herceptin.

Munchausen's syndrome presenting as severe panniculitis.

Factitious disorders may trouble any physician during his/her career. A considerable number of cases of Munchausen's syndrome (self-induced disorder) are misdiagnosed in clinical practice. A 36-year-old woman was admitted to our hospital because of fever and abdominal pain. Physical examination showed signs of inflammation of the abdominal wall, and histological examination revealed severe panniculitis. We investigated various aetiologic factors that could probably be related to fat necrosis, but we found no explanation of the phenomenon until we verified the diagnosis of Munchausen's syndrome. 2 years later, the patient underwent surgery for removal of needles, which she herself had deliberately located under her skin. High index of suspicion and physician's persistence are necessary to make the correct diagnosis in the various protean manifestations of Munchausen's syndrome.

Autologous blood transfusion in oral and maxillofacial surgery patients with the use of erythropoietin.

BACKGROUND: Autologous blood transfusion presents few infectious or immunologic side effects. The aim of the present study was to determine the impact of autologous blood transfusion with or without recombinant human erythropoietin (rHuEPO) in patients who underwent elective maxillofacial operations. MATERIAL: Seventy eight consecutive patients (29 men and 49 women) underwent elective maxillofacial operations during the years 1990-95. STUDY DESIGN AND METHODS: The patients were randomly assigned to three groups: In group 1, 30 patients preoperatively underwent autologous blood predonation with intravenous injection of erythropoietin 600 lU/kg after each blood predonation and autologous blood transfusion intraoperatively; in group 2, 28 patients underwent the same procedure without erythropoietin and in group 3, 20 patients underwent homologous transfusion serving as control group. All patients received ferrous sulphate daily by mouth, preoperatively until one week postoperatively. RESULTS: Group 1 patients showed higher levels of haematocrit, haemoglobin and red blood cell count pre- and postoperatively than the group 2 patients. It was also shown that the use of rHuEPO contributed to an improvement of the blood parameters of the patients in the group 1 compared with those of the patients in groups 2 and 3.