ABSTRACT
BACKGROUND: Skin field cancerization (SFC) is a process that occurs in areas of the skin that have undergone genomic alterations induced by ultraviolet radiation. Actinic keratosis (AK) is a sign of its activity. OBJECTIVES: To evaluate the effectiveness and safety of 0·5% colchicine (COL) cream vs. methyl aminolaevulinate photodynamic therapy (MAL-PDT) in the treatment of AK and SFC. METHODS: We conducted a randomized, open, intrasubject controlled trial. A total of 36 participants with 3-10 AKs on each forearm were treated with either COL cream (twice daily for 10 days) or a single session of MAL-PDT and were reassessed after 60 days. The clinical evaluation was performed using AK count, forearm photoageing scale (PAS) and AK degree (AKD). Patients underwent central forearm biopsies and histopathological evaluation by keratinocyte intraepithelial neoplasia (KIN) assessment, epithelial atrophy and immunohistochemistry (p53/Ki67). RESULTS: Overall, 50% of patients were male. The mean age was 70·9 years (SD 8·6) and phototypes I and II were predominant (89%). Total clearance was observed in six (17%) forearms treated with COL and seven (19%) forearms treated with MAL-PDT (P = 0·76); partial clearance was observed in 44% of forearms in the COL group and 67% of forearms in the MAL-PDT group (P = 0·07). In both COL and MAL-PDT groups, reductions in PAS (-6% vs. -6%) and AKD (-45% vs. -40%) were observed. KIN normalized in 28% of patients treated with MAL-PDT and 20% of those treated with COL. Epithelial atrophy reduced after treatment (P < 0·01). Expression levels of Ki67 and p53 were also assessed. Mild or moderate adverse effects were similar for both groups. CONCLUSIONS: COL 0·5% cream and MAL-PDT are safe and effective for treating SFC.
Subject(s)
Aminolevulinic Acid/analogs & derivatives , Colchicine/administration & dosage , Keratosis, Actinic/drug therapy , Photochemotherapy/methods , Photosensitizing Agents/administration & dosage , Skin/pathology , Aged , Aminolevulinic Acid/administration & dosage , Aminolevulinic Acid/adverse effects , Atrophy/drug therapy , Atrophy/pathology , Biopsy , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/prevention & control , Colchicine/adverse effects , Disease Progression , Female , Forearm , Humans , Keratosis, Actinic/pathology , Male , Middle Aged , Patient Preference/statistics & numerical data , Photochemotherapy/adverse effects , Photosensitizing Agents/adverse effects , Skin/drug effects , Skin/radiation effects , Skin Cream/administration & dosage , Skin Cream/adverse effects , Skin Neoplasms/pathology , Skin Neoplasms/prevention & control , Treatment Outcome , Ultraviolet Rays/adverse effectsABSTRACT
Recent studies have suggested the beneficial effects of GH treatment in patients with dilated cardiomyopathy. We have treated with recombinant human growth hormone (rhGH) a 6-year-old female with a complex congenital heart defect (severe tricuspid hypoplasia and malposition of the great arteries), who developed a progressive dilated cardiomyopathy of unknown etiology. rhGH treatment (0,1 U/kg/day, for 3 months) did not improve cardiac function, nor clinical symptoms, although we have no clear explanations for this. However, a trial with rhGH may be offered to children with dilated cardiomyopathy and waiting for heart transplantation.
Subject(s)
Cardiomyopathy, Dilated/therapy , Heart Defects, Congenital/therapy , Human Growth Hormone/therapeutic use , Age Determination by Skeleton , Cardiomyopathy, Dilated/physiopathology , Child , Female , Heart Defects, Congenital/physiopathology , Heart Transplantation , Heart Ventricles/physiopathology , Humans , Thyroid Function Tests , Transposition of Great Vessels/physiopathology , Transposition of Great Vessels/therapy , Tricuspid Valve/abnormalities , Ultrasonography, Doppler, ColorABSTRACT
We evaluated growth hormone binding protein (GHBP) activity in a group of obese children (12 boys and 12 girls, age 3.1-14.7 years, BMI 21.1-33.3, 11 prepubertal and 13 early pubertal) and in 26 age-matched normal weight children (14 boys and 12 girls, age 2.1-16.0 years, BMI 14.2-21.4, 18 prepubertal and 8 early pubertal). All children were of normal stature. GHBP activity was significantly higher in the obese (39.1 +/- 1.1%) than in the control children (28.3 +/- 1.0%, p < 0.0001). Mean serum GHBP was not different between boys and girls or between prepubertal and pubertal subjects. A positive correlation was found between BMI and GHBP levels only in the normal weight children (r = 0.425, p < 0.05). Baseline insulin concentrations in the obese children were 97.6 +/- 7.9 pmol/l (normal values, 45.0 +/- 18.6 pmol/l), and the mean insulin AUC following OGTT in the obese was 811.3 +/- 160.7 pmol/l (normal values, 373.1 +/- 150.1 pmol/l). Serum GHBP activity in the obese was not correlated with baseline serum insulin concentrations or with the insulin AUC following OGTT. In conclusion, we found that obese children have elevated GHBP activity, and speculate that this phenomenon may serve to compensate for their reduced GH secretion and accelerated GH clearance.
