Mucinous eccrine carcinoma of lower eyelid: a case report.

A rare case of primary mucinous eccrine carcinoma of the lower eyelid in a 45 year old female is described. The lesion was diagnosed clinically as melanoma. We report this case because of unusual nature of this tumor and rare presentation in a female patient.

Risk assessment: the emperor's new clothes?

This article reviews the risk assessment procedures and instruments that are being used by child protection agencies. Although supportive of the concept of risk assessment, the authors argue that all current instruments have major methodological deficiencies that limit the utility of such instruments as a means of predicting future abusive or neglectful behavior. The authors suggest how risk assessment decisions should be made at each stage of a child protection investigation.

Physician attitudes toward confidential care for adolescents.

We examined factors that determine whether pediatricians will grant confidential care to adolescents. Through four vignettes, in which adolescents of different ages and maturity requested confidential care, we assessed the willingness of physicians to give such care for four problems: request for contraceptive, diagnosis of gonorrhea, intrauterine device found incidentally on x-ray study, and illicit drug use. A random sample of 932 physicians responded to the vignettes. Overall, physicians agreed to give confidential care to adolescents in 75% of the vignettes. They were more likely to give confidentiality in cases involving sexual activity. They supported confidential care for 87% of patients requesting contraceptives, but for only 54% reporting illicit drug use. The proportion of physicians supporting confidentiality increased with age and maturity of the minors. Seventeen-year-old mature adolescents seeking contraceptives were given confidentiality by 97% of physicians. Thus physician responses to vignettes indicated that they strongly support confidential care for adolescents as represented in the clinical vignettes.

Hypoxic injury to human alveolar macrophages accelerates release of previously bound neutrophil elastase. Implications for lung connective tissue injury including pulmonary emphysema.

Human neutrophil elastase and other neutrophil granule constituents are internalized by human alveolar macrophages in vitro via receptor-mediated endocytosis, and immunoreactive neutrophil elastase is detectable within alveolar macrophages freshly harvested from human smokers. To gain insight into the potential role of neutrophil elastase bound by alveolar macrophages in the pathogenesis of connective tissue proteolysis, we have chosen hypoxia as a model of macrophage injury and have studied its effect upon the fate of bound neutrophil elastase. We found (1) that in a 3-h incubation after brief exposure to neutrophil elastase, control alveolar macrophages partially degraded bound enzyme, but they also released intact, enzymatically active, elastase in small amounts; (2) that release of TCA-insoluble radiolabeled elastase and elastase activity was enhanced fivefold and twofold over control, respectively, by alveolar macrophage injury during a 3-h incubation in humidified nitrogen; (3) that enzymatic activity of bound neutrophil elastase was largely masked by human neutrophil elastase-inhibitory activity of macrophage cell extracts. The data suggest (1) that the fate of neutrophil elastase bound to alveolar macrophages may be modulated by the local tissue environment; (2) that noxious agents may cause proteolytic tissue injury in the vicinity of alveolar macrophages by enhancing release of bound neutrophil elastase; (3) that alveolar macrophages may participate in the pathogenesis of centrilobular pulmonary emphysema by serving as a vector for neutrophil elastase, even if elastase activity is not detectable in alveolar macrophage lysates.

Fate of human neutrophil elastase following receptor-mediated endocytosis by human alveolar macrophages. Implications for connective tissue injury.

AM may be important in the pathogenesis of centrilobular emphysema of cigarette smokers because smokers' AM release elastolytic activity into culture medium and an expanded population of AM is found in lung regions of smokers where destructive lesions occur. AM are capable of receptor-mediated endocytosis of neutrophil elastase in vitro, but little has been known about the fate of the enzyme after endocytosis. We have observed that after brief exposure to HLE in vitro, (1) CEs of cultured human AM contain detectable quantities of neutrophil elastase and elastase activity for days; (2) endocytosed neutrophil elastase is slowly degraded by the macrophages; (3) neutrophil elastase and elastase activity are slowly released into the culture medium conditioned by the macrophages; (4) elastase activity released into CM by the macrophages has catalytic properties of neutrophil elastase; and (5) elastase released into CM during 5 days in culture is fourfold greater than the initial elastase activity of the CEs, suggesting that enzymatic activity of endocytosed elastase is masked by an intracellular inhibitor. Thus macrophages both degrade and release endocytosed neutrophil elastase and may play a very complex role in modulation of neutrophil elastase injury to connective tissue in the lung and other tissues.