Small cell malignant melanoma: a variant of naevoid melanoma. Clinicopathological features and histological differential diagnosis.

AIMS: To describe the clinical and histopathological features of a rare variant of naevoid melanoma, small cell melanoma, and discuss the histological differential diagnoses. METHODS: The clinical and histological features of cases of malignant melanoma with the histological features of small (non-Merkel like) melanoma were reviewed and documented. In addition, five cases had available material for immunohistochemistry and this was performed using antibodies to the S100 protein and melan-A, and the HMB-45 antibody. RESULTS: There were 15 cases of small cell melanoma from 14 (10 female, four male) patients, aged between 30 and 77 (mean, 48.6) years. The trunk was the most common location. In more than half the cases, the provisional diagnosis was melanoma/borderline lesion. All shared similar histological appearances of an intraepidermal component of in situ melanoma and a dermal component of nests of cells with hyperchromatic nuclei and scanty cytoplasm, usually in tightly packed nests. All components (junctional and intradermal) of the lesions investigated by immunohistochemistry were positive both for S100 protein and melan-A. All junctional components were positive with HMB-45, but with variable staining of the dermal components with this antibody. CONCLUSIONS: Small cell malignant melanoma is postulated to be a distinct histopathological entity and a rare variant of naevoid melanoma. Such lesions can be difficult to interpret and easily missed at scanning magnification because the cells of the dermal component mimic benign naevus cells.

A novel means of self-protection, unrelated to toxin activation, confers immunity to the bactericidal effects of the Enterococcus faecalis cytolysin.

Enterococcus faecalis has become a pervasive clinical problem due to the emergence of resistance to most antibiotics. The cytolysin of E. faecalis is a novel bacterial toxin that contributes to the severity of disease. It consists of two structural subunits, which together possess both hemolytic and bactericidal activity. Both toxin subunits are encoded in a complex operon frequently harbored on pheromone-responsive plasmids. E. faecalis strains lacking such plasmids are susceptible to the bactericidal effects of the cytolysin. A novel cytolysin immunity determinant at the 3' end of the pAD1 cytolysin operon is described in the present study. Deletion analysis and specific mutagenesis isolated the immunity function to a single open reading frame. Specific mutagenesis experiments demonstrate that cytolysin immunity is unrelated to cytolysin activator (CylA) expression as previously proposed. Cytolysin immunity is, however, encoded on the same transcript as and 3' to CylA, and previous associations between immunity and CylA can be ascribed to the polar behavior of Tn917 insertion.

Effects of an adult cancer camp on hope, perceived social support, coping, and mood states.

PURPOSE/OBJECTIVES: To determine whether attendance of an adult cancer camp had an effect on campers' hope, perception of social support, use of coping strategies, and mood states. DESIGN: Pre- and post-test; no control group. SETTING: Cancer camps in two medium-sized mid-western cities. SAMPLE: 32 of 45 eligible first-time campers; predominantly middle-aged, married women who were within one year of diagnosis. METHODS: Participants completed five mailed questionnaires within two weeks prior to attending camp and one week after returning home from camp. MAIN RESEARCH VARIABLES: Levels of hope, perceptions of social support, coping strategies, and mood states. FINDINGS: No significant differences in hope, perceived social support, or coping strategies precamp to postcamp. Campers were significantly less angry and less energetic postcamp. Although nonsignificant, changes over time were in the expected direction. CONCLUSIONS: Small sample size and lack of instrument sensitivity to detect change or lack of changeability of measured attributes may have contributed to the lack of significant change scores. Replication with larger groups and a control group is recommended. IMPLICATIONS FOR NURSING PRACTICE: Cancer camp may improve quality of life for adults with cancer, but more study is needed. Campers' oral evaluations were very positive, and some campers acknowledged a new appreciation for the value of support from others with cancer.

Pretibial myxoedema: a manifestation of lymphoedema?

Pretibial myxoedema (PTM) in its most extreme form clinically resembles lymphoedema. Studies with quantitative lymphoscintigraphy and fluorescence microlymphography in two patients with extensive PTM confirmed the presence of both functional and structural changes in the lymphatic system. We suggest that mucin deposition in the dermis causes compression of the dermal lymphatics, which results in dermal oedema and the clinical features of lymphoedema.

Attractiveness of the male Acheta domesticus calling song to females. III. The relation of age-correlated changes in syllable period recognition and phonotactic threshold to juvenile hormone III biosynthesis.

1. Most crickets first demonstrated positive phonotaxis to 65 dB CSs having a 53-62 ms SP by day 3 following the imaginal molt (Fig. 3B). The onset of copulatory readiness occurred on average at 3.2 days. 2. The attractive range of SPs for most females became progressively broader as they aged (Fig. 4). Three to 4-day-old females were attracted to a smaller number of CS SPs than were 20-21 day old females (Fig. 4). 3. Older, less selective females did not typically respond to the same range of CS SPs (Fig. 6). However, they were more likely to respond to some SPs (especially 50 ms) than to others (Fig. 7). 4. The phonotactic threshold decreased from 95 dB or greater on day 0 to a mean of 55 dB by day 3, during a period of increasing JHIII biosynthesis, and thereafter remained at that level (Fig. 8). 5. During a period of maximal JHIII production, 3-5 day-old females usually responded to 4 of the 7 SPs presented (Fig. 8). Females older than 12 days were unselective for CS SP, and JHIII synthesis remained at a level below the peak production on day 4 (Fig. 8). 6. Older females, that were unselective for CS SP, became as selective as 3 to 5-day-old females within 4 days of topical application of JHIII (Figs. 9-11).

Determinants of grief resolution in cancer death.

The death of a loved one can be very difficult, and yet there is little information about how nurses can help someone through it. The purpose of this exploratory ex post facto study was to determine whether the circumstances of a cancer death influence the grief resolution of the survivor at one month after the death. The circumstances that were studied include: (1) the place of death, (2) the length of the cancer illness, (3) the perceived social support from family/friends, (4) the perceived social support from nurses, (5) satisfaction with the care received by the loved one, and (6) the quality of death of the loved one. Data were gathered from 43 survivors (spouses, children, and parents) through questionnaires and an open-ended interview. The study findings provide a better understanding and knowledge of nursing interventions for the family/friend of the imminently terminal cancer patient.

Type VII collagen antibody LH 7.2 identifies basement membrane characteristics of thin malignant melanomas.

A monoclonal antibody (LH 7.2) to the carboxy terminal of type VII collagen has been used in an indirect immunoperoxidase method on frozen sections of biopsies of benign compound and intradermal cellular naevi, dysplastic naevi, and malignant melanomas, to label the epidermal basement membrane. Benign intradermal naevi had an intact membrane with the dermal naevus cell component lying beneath it. Compound naevi showed proliferating junctional nests of naevus cells pushing through the membrane towards the dermis beneath. In contrast, dysplastic naevi and melanomas showed a progressive displacement of the membrane downwards. Thin lesions were confined above the membrane. With increasing tumour thickness, discontinuities in the membrane were seen and foci of invasive growth through the line of the membrane were identified. These studies suggest that the good prognosis of thin melanomas is associated with confinement of the tumour within an expanded epidermis above the basement membrane.

PUVA-induced blisters, complement deposition, and damage to the dermoepidermal junction.

We followed the course of 56 patients receiving psoralen plus long-wave ultraviolet light (PUVA) therapy. Nonhemorrhagic blisters developed on clinically normal skin on the limbs of seven patients. Seeming to be related to friction and trauma, the blisters form as a result of damage to the basal and suprabasal layers. Perilesional skin specimens from all blistered patients contained granular deposits of C3 at the dermoepidermal junction, around the upper dermal blood vessels, or at both sites. The average time for initiation and complete formation of suction blisters was measured in 51 patients at different stages during the course of PUVA treatment. Blister separation was in the lamina lucida, with the pemphigoid antigen in the roof while the blister floor contained the lamina densa, laminin, and type IV collagen. This impaired dermoepidermal adhesion was a general phenomenon that occurred in all PUVA-treated patients. The mechanism remains to be determined.

Relaxation therapy for hypertension. Comparison of effects with concomitant placebo, diuretic, and beta-blocker.

We compared the effects of relaxation therapy in hypertensive patients taking placebo, a beta-blocker (atenolol, 100 mg/d), or a diuretic (chlorthalidone, 50 mg/d), and we also compared the effects of relaxation therapy with the effects of the latter two drugs alone. Blood pressures were measured not only in the relaxation therapists' office and at a hypertension clinic, but also in the patient's environment by means of 24-hour ambulatory blood pressure recordings. The effect of relaxation therapy, while statistically significant, was modest. There was no generalization of effect to ambulatory blood pressure. Atenolol was significantly more effective than relaxation in reducing both systolic and diastolic pressure. Chlorthalidone was significantly more effective than relaxation in reducing systolic but not diastolic pressure in the hypertension clinic only. The long-term effects of relaxation were independent of concomitant drug use, but within the actual relaxation sessions blood pressure dropped further during chlorthalidone than during placebo or atenolol treatment.

The psychosocial adjustment of the Amerasian refugees. Findings from the Personality Inventory for Children.

The purpose of this study was to investigate the psychosocial adjustment of 24 Amerasian youths who had immigrated to the United States in 1983 and 1984. The Personality Inventory for Children (PIC) was translated into Vietnamese and administered to 18 mothers of Amerasian youths in a social service agency in a large southern city. Respondents reported significant mood disturbance and psychological distress in their children. Specifically, the depression, somatization, withdrawal, and psychosis subscales of the PIC were clinically elevated for the entire group. An evaluation of individual profiles revealed marked tendencies toward somatization and withdrawal. These findings are consistent with other studies on the psychosocial adjustment of Southeast Asian refugees.

The nature of mycosis fungoides.

Thirty-four patients with a clinical diagnosis of plaque stage mycosis fungoides, poikiloderma atrophicans vasculare (poikiloderma) and parapsoriasis en plaques (parapsoriasis) were investigated for evidence of extracutaneous disease using a biochemical screen, blood films, bone marrow examination, chest radiograph, abdominal ultrasound, isotope liver scan, liver biopsy and lymphangiography. Skin biopsies were also taken from these patients and, in order to rule out non-specific histological change, from 29 controls with inflammatory skin disease; the slides were examined blind by two independent observers for evidence of mycosis fungoides or poikiloderma and graded accordingly. Both observers were able to differentiate significantly histological grades of mycosis fungoides corresponding to the clinical diagnosis although exact histological grades only corresponded on 35 per cent of slides. Features graded as classical or probable mycosis fungoides were found in between 22 and 67 per cent of patients with parapsoriasis and between 67 and 100 per cent of those with poikiloderma. We found no evidence of extracutaneous disease in any of our patients. Lymphangiograms were abnormal in 30 of 31 examinations but the changes were non-specific and did not correspond to disease type, duration or extent. Four patients had apparently unrelated co-existing disease including chronic lymphatic leukaemia in two, a monoclonal gammopathy and autoimmune haemolytic anaemia. This study shows that in its early stages mycosis fungoides is predominantly if not primarily a cutaneous disease. The findings also suggest that parapsoriasis and poikiloderma are part of the same disorder as mycosis fungoides or evolve into it. Aggressive treatment to prevent progression to mycosis fungoides plaque and tumour stage should therefore be tried. The findings support the idea that mycosis fungoides is a reactive rather than a neoplastic disorder.

Drug acetylation and expression of lupus erythematosus.

Acetylator phenotype was measure in 58 patients presenting to a skin clinic with discoid lupus erythematosus (DLE) and in 51 normal healthy subjects. Twenty seven of the patients with DLE were found to have evidence of systemic lupus erythematosus (D+SLE). Frequency of slow acetylator phenotype was 58% in all DLE patients, 52% in those with D+SLE and was no different from the 57% in controls. The distribution of acetylator phenotypes within the groups with DLE and those with D+SLE was similar to controls. Severity of DLE was assessed as number of skin lesions and median lesion count was 11.5 in slow acetylators and 10 in fast acetylators but in D+SLE median lesion count was 22 in slow acetylators and 12 in fast acetylators, and there was a significant inverse relationship between lesion count and rate of acetylation; scores for systemic involvement showed no relationship. We conclude that there is no difference in the frequency or distribution of slow acetylator phenotype between normal subjects and patients with DLE with or without SLE but that actual rate of acetylation may determine severity of expression of the disease in slow acetylators.

Extragenital granuloma inguinale (Donovanosis) diagnosed in the United Kingdom: a clinical, histological, and electron microscopical study.

An extremely rare case of primary extragenital granuloma inguinale affecting the axillae is reported. Clinical, histological, and electron microscopical features of the disease are described, and the rarity, absence of genital lesions, and consequent difficulty in diagnosis are emphasised.

Increased feeding by rats after subdiabetogenic streptozotocin treatment: a role for insulin in satiety.

Rats given streptozotocin showed varying degrees of glucose intolerance, ranging from mild to overt symptoms of diabetes mellitus. After being deprived of food overnight, both mild and overt diabetics consumed more food than controls did during 5-hr or 7-hr feeding tests. All animals ate large amounts of food during the first hour of the tests, but both groups of diabetics began to eat again sooner than controls did. Rats demonstrating the greatest degree of glucose intolerance before the test ate the most during the test. These and other findings suggest that feeding by diabetic rats after an overnight fast is an inverse function of their residual capacity for glucose utilization, which occurs despite elevations in blood glucose levels, and is not simply a compensatory response to glucose loss in urine. A modified glucostatic hypothesis is proposed in which insulin may normally promote satiety by influencing peripheral metabolism and making ingested calories utilizable.

A randomized double-blind comparison of PUVA-etretinate and PUVA-placebo in the treatment of chronic plaque psoriasis.

Twenty-eight patients with chronic plaque psoriasis affecting 20-40% of their body surface were treated with either PUVA and placebo (thirteen patients) or PUVA and etretinate (0.75 mg/kg) (fifteen patients). PUVA was given three times a week for a maximum of 10 weeks after a 2-week period on placebo or etretinate alone. Four patients failed to clear with PUVA and placebo compared with one patient with PUVA and etretinate, and the mean total UV-A dose to clear was lower with etretinate (mean = 62.1 J/cm2) than with placebo (mean = 77.3 J/cm2) but none of these differences were significant. Because the additional response to etretinate was only marginal, whilst unwanted effects were common, we found no advantage in adding etretinate to PUVA.