Treatment with a barrier-strengthening moisturizing cream delays relapse of atopic dermatitis: a prospective and randomized controlled clinical trial.

BACKGROUND: Standard treatment of atopic dermatitis (AD) is based on topical glucocorticosteroids or calcineurin inhibitors to treat flares combined with moisturizer treatment to alleviate dry skin symptoms. Patients with AD have an abnormal skin barrier function, and strategies for reducing the risks for eczema would be to repair the barrier or prevent barrier dysfunction. OBJECTIVES: The objective of this study was to explore the time to relapse of eczema during a 26-week maintenance treatment with a urea containing moisturizer compared to no treatment (neither medical nor non-medicated preparations) after successful clearing of atopic lesions. The moisturizer has previously been shown to improve skin barrier function. METHODS: Patients applied betamethasone valerate (0.1%) on eczematous lesions during a 3-week period. Those with cleared eczema entered a 26-week maintenance phase, applying the moisturizer or left the previously affected area untreated. Upon eczema relapse, patients were instructed to contact the clinic and to have the relapse confirmed by the investigator. RESULTS: Fifty-five patients entered the study and 44 patients were included in the maintenance phase (22 using moisturizer twice daily and 22 using no treatment). Median time to relapse for patients treated with moisturizer was > 180 days (duration of the study) compared with 30 days for the no-treatment group. Sixty-eight per cent of the patients treated with the moisturizer and 32% of the untreated patients remained free from eczema during the observation period. CONCLUSIONS: Maintenance treatment with a barrier-improving urea moisturizer on previous eczematous areas reduced the risk of relapse to approximately one third of that of no treatment.

Post-depositional redistribution and gradual accumulation of 137Cs in a riparian wetland ecosystem in Sweden.

After the Chernobyl accident, high activity concentrations of (137)Cs (>1 MBq m(-2)) were detected in a riparian swamp in the central-eastern part of Sweden. The objective of this study was to clarify the redistribution processes behind the accumulation of (137)Cs in the wetland. A mass balance budget of (137)Cs was calculated based on soil and sediment samples and reports in the literature. Results showed that accumulation occurred over several years. Of all the (137)Cs activity discharged between 1986 and 2002 from the upstream lake, 29% was estimated to be retained in the wetland. In 2003, measurements showed that 17 kBq m(-2) sedimented on the stream banks of the wetland. Continuing overbank sedimentation by spring flooding prolongs the time that the wetland will contain high activity concentrations of (137)Cs. Consequently, organisms living in wetlands serving as sinks for (137)Cs may become exposed over long time periods to high activity concentrations.

Estimation of radiation doses from (137)Cs to frogs in a wetland ecosystem.

Currently, there is no established methodology to estimate radiation doses to non-human biota. Therefore, in this study, various dose models were used to estimate radiation doses to moor frogs (Rana arvalis) in a wetland ecosystem contaminated with (137)Cs. External dose estimations were based on activity concentrations of (137)Cs in soil and water, considering changes in habitat over a life-cycle. Internal doses were calculated from the activity concentrations of (137)Cs measured in moor frogs. Depending on the dose model used, the results varied substantially. External dose rates ranged from 21 to 160 mGy/y, and internal dose rates varied between 1 and 14 mGy/y. Maximum total dose rates to frogs were below the expected safe level for terrestrial populations, but close to the suggested critical dose rate for amphibians. The results show that realistic assumptions in dose models are particularly important at high levels of contamination.

Trophic transfer and passive uptake of a polychlorinated biphenyl in experimental marine microbial communities.

To study the uptake mechanisms of 2,2',4,4',6,6'-hexachlorobiphenyl (HxCB 153) in microplankton with different feeding strategies, two laboratory communities were used. Trophic transfer of HxCB 153 was tested in a heterotrophic microbial food web consisting of bacteria, flagellates, and ciliates. Passive uptake was tested in a community consisting of algae and bacteria. The experiments were conducted over 6 d, and samples were retrieved daily. In the heterotrophic food web, a significant increase of the HxCB 153 concentration was observed in the top predator level (ciliates, p < 0.05), where the concentration doubled during the 3 d of the experiment. A concomitant decrease was observed in the ciliate prey (flagellates), indicating that HxCB 153 was redistributed due to trophic transfer. On average, 33% of the HxCB 153 was sorbed to ciliates over the course of the experiment. In the experiment with algae and bacteria, the HxCB 153 concentrations were relatively stable over time. The largest fraction partitioned into bacteria (57%), whereas only 4% of the HxCB 153 sorbed to the algae. The uptake was 8-fold higher in ciliates than in algae, although the algal biomass was 10-fold higher. The results imply that trophic transfer may be a significant transport route of more hydrophobic organic contaminants (HOCs) in plankton communities. In transfer models, this pathway may be taken into consideration so that the transport rate of HOCs to higher trophic levels is not underestimated.

Elemental changes in skin from patients with basal cell carcinoma.

Intracellular ionic shifts have been described in connection with normal and abnormal cell proliferation. This study was conducted to determine the elemental composition of a cell tumor classified as basal cell carcinoma in skin. The biopsies were taken from 10 patients. Control biopsies were taken from the non-affected skin from the same patients. Cryosections were cut and attached to carbon specimen holders. After freeze drying the sections were analyzed by X-ray microanalysis in a scanning microscope. The X-ray microanalytical results showed that the content of magnesium, phosphorus and potassium was significantly higher in the cancer cells than in the control cells (p < 0.05). The content of sodium, chlorine, calcium and sulfur was similar in both affected and unaffected cells. We conclude from these data that basal cell carcinoma has a characteristic elemental composition. It is possible that increased potassium and magnesium levels have a stimulatory effect on this tumor type, in contrast to other types of cancer cells where elevated sodium and chlorine and lowered potassium levels have frequently been found.

Multiple basal cell carcinoma. A clinical evaluation of risk factors.

Basal cell carcinoma (BCC) is the most common malignant skin tumour. There is evidence that the number of patients who develop more than one basal cell carcinoma (mBCC) is increasing. The aim of this study was to elucidate possible risk factors for developing mBCC. Among twelve risk factors considered, skin tumour among relatives was the strongest, with an odds ratio of 10.9 (p < 0.001). The second strongest risk factor was sunburn after the age of 60, odds ratio 4.4 (p < 0.001). The results suggest that the presence of skin tumour in the family and sunburn after age 60 are independent factors associated with mBCC. To our knowledge this has not previously been reported.

Multiple basal cell carcinomas: no association with HLA-DRB, HLA-DQA1 or HLA-DQB1 in Swedish patients.

Many diseases with autoimmune features are associated with alleles of the human leucocyte antigen (HLA). However, few if any malignant disorders have reproducibly been shown to be HLA-associated. In three independent studies, using serological tissue typing techniques, an increase of the HLA class II specificity DR1 has been found in patients with multiple basal cell carcinomas. These observations prompted us to determine the frequencies of DRB1, DQA1, and DQB1 alleles by high-resolution genomic tissue-typing methods, including subdivision of the serological DR1 specificity in the four sequence-defined alleles, DRB1*0101 to DRB1*0104, in 50 unrelated Swedish patients with a history of four or more basal cell carcinomas and 250 healthy controls. The frequency of DR1 was the same in patients and controls (18%). All DR1-positive patients and controls carried the DQA1*0101 and DQB1*0501 alleles. Six of the nine DR1-positive patients and controls carried the DQA1*0101 and DQB1*0501 allels. Six of the nine DR1-positive patients were DRB1*0101-positive, one DRB1*0102 and two carried the DRB1*0103 allele. This distribution of DRB1*01 alleles did not differ from the one found in the controls. We conclude that genetic factors associated with the HLA class II region do not contribute significantly to the aetiology of multiple basal cell carcinomas.

Occurrence of other malignancies in 1973 patients with basal cell carcinoma.

To evaluate the possible association of other malignancies with basal cell carcinoma, we reviewed 1973 consecutive patients with basal cell carcinoma. We searched the Swedish Cancer Registry for records reporting malignancies in the study population (1958-1984) and the expected number of malignancies was calculated on the basis of age- and sex-standardized incidence data. In 452 patients with basal cell carcinoma another malignancy was diagnosed. The expected number was 323 (relative risk = 1.4; 95% confidence interval = 1.3 to 1.5). A significant association with basal cell carcinoma was found in four cancer types for men and in three for women. For skin malignancies other than malignant melanoma there was more than a sixfold increased risk for men (relative risk = 6.8; 95% confidence interval = 4.8 to 9.4) and more than a threefold increased risk for women (relative risk = 3.1; 95% confidence interval = 1.4 to 5.9) during the period after the diagnosis of basal cell carcinoma. During the period before the diagnosis of basal cell carcinoma, there were also increased risks (men: relative risk = 5.0; 95% confidence interval = 3.1 to 7.5; women: relative risk = 4.0; 95% confidence interval = 1.9 to 7.4). This was in contrast to the risks of malignant melanoma. Before the diagnosis of basal cell carcinoma there was no significant increased risk of malignant melanoma but after the diagnosis there was more than a sixfold increased risk for men (relative risk = 6.8; 95% confidence interval = 4.8 to 9.4) and more than a fourfold increased risk for women (relative risk = 4.2; 95% confidence interval = 1.5 to 9.2).(ABSTRACT TRUNCATED AT 250 WORDS)

The incidence of basal cell carcinoma in an area of Stockholm County during the period 1971-1980.

A study was made of the incidence of basal cell cancer among a population of residents within a limited catchment area in Stockholm during the period 1971-1980. The age-standardized incidence of basal cell cancer increased by an average of 11.9% per year (p less than 0.005) and the incidence rate more than doubled during the ten-year period. There was no statistically significant difference in the rate of increase for men and women. Nor was any such difference noted between face, head and neck and other skin areas.

Malignant tumours of the colon and rectum in patients aged 30 and younger.

Hospital records of the 27 patients, aged 30 years or younger, with carcinoma of the colon or rectum diagnosed 1969--1970, were reviewed. Predisposing diseases were found in 12 cases, 10 of these did not survive 5 years. Of 15 patients without predisposing disease 9 survived 5 years. The material is small but the prognosis does not seem to be worse in young patients with colonic cancer compared to elderly, provided the tumour has not developed from a predisposing disease. In such cases an early prophylactic operation must always be considered.

Carcinoids of the colon and rectum in patients aged 30 and younger.

Carcinoid tumours of the colon and rectum were diagnosed in 26 patients, 30 years or younger, in Sweden during 1969--1970. Patho-anatomical description was adequate in 24 cases and of these 23 were localized to the appendix and one to the caecum. The treatment was appendicectomy and in the last case ceacal resection. None of the patients had carcinoid syndrom. One patient was lost at follow-up, the 5-year survival rate of the remaining 25 patients was 100 per cent.

Outcome following treatment of anal fistulae in Crohn's disease.

The results of treating 24 patients with anal fistulae and active intestinal Crohn's disease is reported. Four patients had multiple extended, seven high and ten low fistulae and three patients had sinus tracts. Seven patients with only minor discomfort were treated conservatively and five of them healed. Thirteen were treated by local surgery and ten subsequently healed. Four patients with rectal Crohn's disease and multiple fitulous systems were submitted to abdominoperineal excision. These results indicate that in patients without rectal involvement, conservative treatment and local surgery is indicated.

Anal tuberculosis. A report of two cases.

Two cases of anal tuberculosis are reported. One presented as an ulceration in the anal canal and the other as an anal abscess and fistula. Both were diagnostic problems, tuberculosis was not suspected at first. Both were cured, one by medical treatment, the other by combined surgical and medical treatment.