Becker's melanosis in a woman.

Becker's melanosis is a relatively common, benign hamartoma, which is usually characterized by a hyperpigmented, hypertrichotic patch on the upper trunk or proximal upper extremities of males, with its onset during the peripubertal years. Commonly, there is an associated smooth muscle hamartoma on histology. We present a woman with a Becker's melanosis on the leg without hypertrichosis. We believe that the spectrum of Becker's nevus is greater than commonly thought and that cases similar to ours are not rare, but have been diagnosed as other conditions.

Erythema elevatum diutinum mimicking extensive keloids; quiz 386.

GOAL: To describe a case of erythema elevatum diutinum (EED) that clinically mimicked extensive keloids. OBJECTIVES: Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Describe the clinical presentation and lesion appearance in EED. 2. Discuss the electron microscopic and laboratory findings of EED. 3. Outline treatment options for EED. CME: This article has been peer reviewed and approved by Michael Fisher, MD, Professor of Medicine, Albert Einstein College of Medicine. REVIEW DATE: April 2001. This activity has been planned and implemented in accordance with the Essentials and Standards of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Albert Einstein College of Medicine and Quadrant HealthCom, Inc. The Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians. Albert Einstein College of Medicine designates this educational activity for a maximum of 1.0 hour in category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. This activity has been planned and produced in accordance with ACCME Essentials.

The concentration levels of Cd, Pb, Hg, Cu, Zn and Se in blood of the population in the Czech Republic.

Knowledge of normal levels of concentrations of trace elements (Cd, Pb, Hg, Cu, Zn, and Se) in the population serves, among others, in design of regulations concerning health protection, determination of exposure limits and prevention of diseases caused by deficiency of trace elements. Concentrations of the named elements in whole blood of the Czech population were determined by means of atomic absorption spectrometry. The blood was collected during 1996-1998 from 1,216 blood donors (896 males and 320 females, average age 33 years) and 758 children (397 boys and 361 girls, average age 9.9 years). Mineralisation in a microwave digestion system was used in sample preparation. The accuracy of results was checked by means of the Control material Seronorm Whole Blood 404107 and Seronorm Serum 704121, Nycomed. Values of concentrations of the trace elements in blood found for adult (medians) were 0.7 microgram Cd.l-1, 800 micrograms Cu.l-1, 0.78 microgram Hg.l-1, 41 micrograms Pb.l-1, 76 micrograms Se.l-1, and 5,800 micrograms Zn.l-1, respectively. Statistically significant differences between men and women have been found in the concentrations of Cu, Hg, Pb, and Zn. In the juvenile population following medians of concentrations have been found: 0.15 microgram Cd.l-1, 1,047 micrograms Cu.l-1, 0.46 microgram Hg.l-1, 34 micrograms Pb.l-1, 69 micrograms Se.l-1, and 8,180 micrograms Zn.l-1. Statistically significant differences between boys and girls were found only in Pb and Zn concentrations. Concentrations of the studied elements correspond to the published values concerning population not exposed professionally.

Relation between concentration of lead, zinc and lysozyme in placentas of women with intrauterine foetal growth retardation.

Intrauterine foetal growth retardation (IUGR) implies increased risk of morbidity and mortality of the newborn. Aetiology of intrauterine retardation is probably multifactorial and may include maternal infection, malnutrition, placental dysfunction, hypertension, toxaemia, smoking, professional and environmental exposure. The work concentrates on the lead, zinc and lysozyme levels in blood and placental tissues of 50 females in the IUGR group and 43 females from a control group. Statistically significant differences in zinc and lead levels between the compared group were found. The IUGR group had lower zinc and higher lead levels. A significant negative correlation of zinc and lead levels was observed. We found a statistically significant relationship between lead levels in placental tissues and the age of the pregnant women. Higher age is associated with higher lead levels in placental tissue, whereas zinc levels decrease. In placental tissues of pregnant females of the IUGR group higher lysozyme levels were found. On the basis of the discussed results the authors recommend zinc supplementation during the pregnancy.

Health risk assessment in evaluation of metals in TSP.

The authors submit information on the prediction of the health risk assessment, they used for defining the air pollution by air particulates. Trace metal and toxic metal analysis is used in the cancer risk assessment. This approach gives a better view of adverse effects on health. The evaluation of air pollution, expressed only in nanograms of metals per cubic meter, says nothing about the health of the inhabitants.

[Relation of metal and lysozyme levels in the placentas of women with intrauterine fetal growth retardation]. / Vztah koncentrace kovu a lyzozymu v placentách zen s intrauterinní rustovou retardací plodu.

In a group of women who gave birth to a foetus with marked growth retardation and 27 women who were delivered of eutrophic neonates the lead, cadmium, zinc and lysozyme levels in placental tissue were assessed. The investigation revealed the following results: the lead level was in the investigated group significantly higher than in the control group (15.24 ng/g vs. 11.31 ng/g). Conversely the zinc levels were significantly higher in the control group (20.52 micrograms/g vs. 14.3 micrograms/g of placental tissue). The lead, cadmium and lysozyme values rise with the womens' age in the examined placentae, while the zinc levels decline. With the elevated zinc level the lead and cadmium content in the placentae of the exposed group declines. The lysozyme values increase along with the rise of all investigated elements with the exception of zinc, where the dynamics are reversed. The findings justify the recommendation of zinc supplementation during pregnancy.

Visual contrast sensitivity deficits in Bohemian children.

Visual contrast sensitivity (VCS) tests have been used successfully in medical diagnosis and subclinical neurotoxicity detection. This paper reports VCS measurements in three studies of children in the Czech Republic. Study 1 compared children in standard schools and schools for the learning disabled. Studies 2 and 3 compared children in Teplice, an area in which soft-brown coal combustion produced high levels of pollutants (e.g. Hg, As, SO2, NOx, and aromatic hydrocarbons), with children in areas of low air pollution, Znojmo and/or Prachatice. It was hypothesized that in utero exposure to the combustion products disrupted neurological development (Sram, 1991). The VCS test (Stereo Optical Co.) consisted of circular fields containing sinusoidal gratings at 5 spatial frequencies (1.5-18 cycles/degree) and various levels of contrast. Subjects indicated orientation of the gratings by pointing left, up, or right. Visual acuity and VCS were measured in each eye of 74 children in Study 1,327 second-grade children in Study 2, and 426 fourth-grade children in Study 3. Hair samples were collected in Studies 2 and 3 analyzed for Hg and As content. Children attending schools for the learning disabled scored significantly lower than controls on VCS, whereas visual acuity was normal. The deficit was greatest at mid- to high spatial frequency. In Study 2, significant VCS deficits were seen in exposed second-grade children at low to mid-spatial frequency, even though visual acuity was slightly above control level. Regression analyses showed that VCS had no relationship to As, but a significant negative correlation with hair Hg was observed in the exposed district. However, current Hg levels were higher in Prachatice. VCS deficits were not observed in the fourth-grade students of Teplice in Study 3. The results of Study 1 indicated that behavioral VCS testing in field studies is practical in young, non-English speaking children, and suggested that vision may be compromised in learning-disabled children. Studies 2 and 3 indicated that at these levels, current Hg body-burdens are poor predictors of VCS. If the VCS deficits seen in Study 2 were related to prenatal exposures, the results of Study 3 suggest that they represent a developmental delay. A longitudinal-study design is needed to address this issue.

[Foreign substances in maternal milk]. / Cizorodé látky v materském mléce.

In 1984-1985 72 specimens of human milk were examined for hexachlorobenzene, DDE and polychlorinated biphenyls and 69 specimens for lead and cadmium. The residual levels (expressed in mg.kg-1 milk fat) were as follows: hexachlorobenzene 1.97 (0.24-5.58), DDE 1.56 (0.17-5.80) and polychlorinated biphenyls 3.18 (1.28-9.08). All specimens were positive. The lead levels were 1.68 (less than 0.10-6.75), cadmium levels 0.31 (less than 0.05-1.08) ng.ml-1 milk. Lead was present in 94.2%, cadmium in 98.6% specimens. The results were compared with other areas of the CSSR, data from the literature and hygienic standards. The authors discuss limited or discontinued breastfeeding in high occupational exposure. Finally they emphasize advantages associated with breastfeeding and the justification of a prolactation programme.

Basophils in incontinentia pigmenti.

Incontinentia pigmenti is a rare genodermatosis of unknown etiology. A female infant with features typical of this disease was found to have basophils in early vesicular lesions. Mediators from these cells may be responsible for the accumulation of eosinophils in these lesions.

Bowel-bypass syndrome without bowel bypass. Bowel-associated dermatosis-arthritis syndrome.

A recurrent, episodic illness that occurs in as many as 20% of patients who undergo ileojejunal bypass surgery for morbid obesity has been well characterized and includes inflammatory cutaneous lesions with a histologic appearance like that of neutrophilic vasculitis, a nondeforming polyarthritis, and other systemic manifestations. Current concepts of pathogenesis center on overgrowth of bacterial flora in the bypassed bowel segment with subsequent development of a circulating immune complex disease. We report, for the first time to our knowledge, an identical clinicopathologic syndrome in four patients who have not had jejunoileal bypass surgery. Each patient, however, had other gastrointestinal disease that we believe predisposed to this syndrome, possibly via circulating immune complexes with bowel-associated antigens. We propose the expanded term, bowel-associated dermatosis-arthritis syndrome, to incorporate these new cases. We believe that this is not a rare syndrome and that it is easily distinguishable from other types of cutaneous necrotizing vasculitis.

Spreading pigmented actinic keratosis.

We present four cases of spreading pigmented actinic keratoses, an only recently described pigmented lesion of sun-exposed areas, in which the histologic appearance is that of actinic keratosis with the additional feature of excessive melanin deposition in the lower epidermis and in the upper dermis. Clinically, it is a brown patch or plaque with a smooth surface, usually larger than 1 cm, that tends to spread centrifugally. Clinical differential diagnoses include seborrheic keratosis, melanocytic nevus, senile lentigo, lentigo maligna, and lentigo maligna melanoma. This pigmented lesion is probably much more common than the existing literature would indicate.

Circadian changes of the SIgA, lysozyme, albumin and copper content of saliva.

The authors investigated SigA, Lysozyme (muramidase), albumin and copper levels in the saliva of sixteen children in the course of the day. A total of nine blood samples was taken in three-hour intervals from each child. Statistically highly significant changes were found in SIgA with a minimal average at 11 a.m. and maximum at 5 a.m. In albumin the maximum was recorded already at 11 p.m., while the minumum was at 11 a.m. The changes of copper values were different, with the maximum at 11 a.m. and minimum at 2 a.m., with smallest individual differences of mean daily levels. Lysozyme displayed an individual variability of levels and the lowest correlation with the investigated rhythms. A statistically significant difference was found only between samples collected during day- and night time. The findings are discussed from the aspects of other relations which might influence the assessed values.