Socioeconomic characteristics and melanoma incidence.

PURPOSE: This investigation examines the relationship between socioeconomic status (SES) and melanoma incidence in counties included in the Surveillance, Epidemiology, and End Results Registry (SEER) in the United States from 1973 to 1993. METHODS: Cases included whites, aged at least 15 years, with a morphologic diagnosis of malignant melanoma, residing in one of 199 counties at the time of diagnosis. County level measures of SES including median household income, percentage of high school graduates, and percentage of families below poverty were abstracted from the 1950, 1960, 1970, 1980, and 1990 U.S. Census data. The relationship between SES factors and melanoma rates was examined by hierarchical Poisson regression. RESULTS: The percentage of high school graduates was significantly and positively associated with the incidence of melanoma (relative risk (RR), 1.28; 95% confidence interval (CI), 1.21-1.35), after controlling for age at diagnosis, gender, time period, latitude, and percentage of Hispanics in the county. Percentage of families below poverty was significantly inversely associated with the incidence of melanoma (RR, 0.66; 95% CI, 0.55-0.78). When education and poverty were included in the same model, both the positive effects of education (RR, 1.23; 95% CI, 1.16-1.31) and the negative effects of poverty (RR, 0.85; 95% CI, 0.74-0.98) persisted. In contrast, median household income was not associated with melanoma incidence in a similar multivariable model (RR, 1.00; 95% CI, 0.99-1.00). CONCLUSION: Whether the effect of education on incidence of melanoma reflects lifestyle behaviors that modify exposure to sunlight or some other factor remains unclear. Nonetheless, the findings of this study suggest that the determinant is primarily related to education, not income.

Splenic autotransplant and residual partial spleen: prevention of septicemia.

Postsplenectomy septicemia carries an ominous prognosis. Accompanying disseminated intravascular coagulation and adrenal hemorrhage result in a high mortality, despite aggressive treatment by antibiotics. The efficacy of prevention by in situ partial spleen and splenic auto-transplant were evaluated in Sprague-Dawley rats. All totally splenectomized rats died following intravenous challenge of live pneumococcus. Both partial spleens and autotransplants gave substantial protection. The rats which succumbed to pneumococcal sepsis demonstrated massive fibrin thrombi in renal glomeruli and frank adrenal hemorrhage, strikingly similar to clinical observations.

Sarcoidosis presenting as an intramedullary spinal cord mass.

A patient with sarcoidosis of the spinal cord showing cord enlargement upon myelography is presented. The literature regarding spinal cord involvement with sarcoidosis, the indications for operation, and treatment is reviewed.

Gastric hyalinization associated with peptic ulceration.

Gastric hyalinization, the severe hyaline thickening of the stomach wall that predominantly involves the submucosa, seems to have been described only in autopsy cases. Although initially thought to be a consequence of radiation or chemotherapy, subsequent studies suggested that it results from an artifactual postmortem chemical denaturation of the protein of the gastric submucosa, possibly related to an agonal tear in the gastric submucosa. We studied the clinicopathologic and ultrastructural findings in a case that had morphologic features of gastric hyalinization but that, in contrast with previous reports, was present in a surgically removed stomach and was associated with a small, chronic, peptic ulcer, with clinical manifestations of gastromegaly and borderline gastric retention. Ultrastructurally, the severe submucosal hyaline thickening that focally involved the muscularis and serosa largely consisted of proteinaceous material, ground substance, and collagen fibers, with occasional interspersed fibroblasts and myofibroblasts. This case indicated that gastric hyalinization can be a nonartifactual and clinically significant entity that may be associated with peptic ulcer disease and that should be distinguished from neoplastic (linitis plastica) and other processes.