Radiation therapy for Bowen's disease: lessons for lesions of the lower extremity.

OBJECTIVE: A retrospective outcomes review of radiotherapy for Bowen's disease was performed to analyze all patients treated with radiation therapy between 1993 and 1997 at the Naval Medical Center, San Diego. METHODS: Eleven patients with 16 lesions were treated with a median time-dose-fractionation value of 105 (range, 93-108). RESULTS: All 11 patients were without evidence of disease within 1 to 2 months of completing treatment. Four of the 16 lesions (25%) were unhealed at time of last follow-up; the remainder healed with good cosmetic result. All unhealed lesions were on the lower extremity. Median follow-up was 27.5 months (range, 9-57 months). CONCLUSION: Radiation remains a good therapeutic option in selected patients with Bowen's disease, but caution should be exercised before selection of patients with lesions in potentially poor healing areas, such as the lower extremity.

Opportunity on the edge of orthodoxy: medically qualified hydropathists in the era of reform, 1840-60.

Following the lead of the Lancet's attacks in the 1840s, historians have considered hydropathy and hydropathists in Britain as part of fringe or heterodox medicine. Yet the distance between varieties of orthodox theory and practice and hydropathy was small, and many of the most prominent hydropathists held orthodox views and qualifications. Examining the educational backgrounds and careers of 40 early British hydropathists, the authors suggest that hydropathy and hydropathic establishments, like specialists hospitals, asylums, and spa practice, provided an alternative niche to general practice in the crowded British medical market and a way to 'fame and fortune' for medical men outside the metropolitan élite.

Hemangiomas in infants and children. An algorithm for intervention.

Considerable confusion exists with the diagnosis and management of vascular birthmarks. For this article we reviewed charts for the diagnosis and recommended management of 208 new patients with vascular birthmarks presenting to the Albany Medical Center Vascular Malformation Clinic, Albany, NY, over a 26-month period from October 1995 through December 1997. Based on our patient population, data available, and the current literature, we concluded that an early evaluation and an accurate diagnosis in infants with a vascular birthmark are important. Furthermore, intervention by way of systemic steroids, laser therapy, or surgical debulking is appropriate and safe in a select group of patients presenting with a proliferating hemangioma and in patients with an involuting but disfiguring hemangioma. Also in this article we present an algorithm to assist the clinician with the management of the pediatric patient with a diagnosis of a hemangioma.

Delay in diagnosis: indeterminate leprosy presenting with rheumatic manifestations.

BACKGROUND: Rheumatic complications are common in leprosy (Hansen's disease) and can be the primary complaint delaying accurate diagnosis. OBJECTIVE: Such a case is reported here: a 61-year-old woman with indeterminate leprosy presented with symmetric arthritis and purpura. Despite biopsy and evaluation by several physicians, leprosy was not suspected. After 2 years of progressive symptoms, a second biopsy revealed lepromatous leprosy. CONCLUSION: In this case, lack of clinical suspicion and unfamiliarity with the histology of indeterminate leprosy delayed diagnosis and treatment. Leprosy should be considered in the differential diagnosis of patients presenting with unusual rheumatic and persistent cutaneous manifestations.

Genomic organization and mapping of the human and mouse neuronal beta2-nicotinic acetylcholine receptor genes.

As a first step in determining whether there are polymorphisms in the nicotinic acetylcholine receptor (nAChR) genes that are associated with nicotine addiction, we isolated genomic clones of the beta2-nAChR genes from human and mouse BAC libraries. Although cDNA sequences were available for the human gene, only the promoter sequence had been reported for the mouse gene. We determined the genomic structures by sequencing 12 kb of the human gene and over 7 kb of the mouse gene. While the sizes of exons in the mouse and human genes are the same, the introns differ in size. Both promoters have a high GC content (60-80%) proximal to the AUG and share a neural-restrictive silencer element (NRSE), but overall sequence identity is only 72%. Using a 6-Mb YAC contig of Chr 1, we mapped the human beta2-nAChR gene, CHRNB2, to 1q21.3 with the order of markers cen, FLG, IVL, LOR, CHRNB2, tel. The mouse gene, Acrb2, had previously been mapped to Chr 3 in a region orthologous to human Chr 1. We refined mapping of the mouse gene and other markers on a radiation hybrid panel of Chr 3 and found the order cen, Acrb2, Lor, Iv1, Flg, tel. Our results indicate that this cluster of markers on human Chr 1 is inverted with respect to its orientation on the chromosome compared with markers in the orthologous region of mouse Chr 3.

Neutrophilic lobular (pustular) panniculitis associated with rheumatoid arthritis: a case report and review of the literature.

Rheumatoid nodules, which affect the subcutis around joints, are the most frequent specific cutaneous lesions of rheumatoid arthritis (RA). Panniculitis is a rarely reported and nonspecific complication of RA. We report a 42-year-old woman with seropositive RA who presented with a 2-month history of lower leg panniculitis. Biopsy of a leg nodule showed a lobular neutrophilic infiltrate with lipophages and central basophilic necrosis. In addition, focal changes of lipomembranous fat necrosis indicative of ischemic damage were identified at the margins of the lobular infiltrate. Neutrophilic lobular panniculitis is commonly detected in panniculitis secondary to bacterial infections, pancreatitis, and factitial causes. However, this pattern of panniculitis has also been reported in some cases of erythema nodosum-like lesions found in Behçet disease or bowel bypass syndrome and in rare cases of seropositive RA. These reported histologic findings fall into the spectrum of neutrophilic vascular reactions described by Jorizzo and Daniels for RA-associated dermatoses. In view of these findings. RA and related neutrophilic dermatoses (e.g., Behçet disease) should be included in the differential diagnosis of neutrophilic lobular panniculitis.

Acquired vulvar lymphangioma mimicking genital warts. A case report and review of the literature.

A 44-year-old female developed confluent, dusky red, pruritic labial papules clinically suspected to be genital warts. She had a long-standing history of Crohn's disease with vulvar fistulae. The papular eruption developed after several bouts of cellulitis in a region of vulvar lymphedema. Shave biopsy of a papule exhibited papillated epidermal hyperplasia overlying a dermis with a 'Swiss-cheese' appearance secondary to lymphedema and superficial ectatic thin-walled vascular spaces characteristic of lymphangiectasias. Review of published cases reveals that acquired lymphangiomas often affect the vulva compared to other cutaneous sites and can be associated with surgery, radiation therapy, infection (e.g., erysipelas, tuberculosis), Crohn's disease, congenital dysplastic angiopathy and congenital lymphedema. Rather than translucent vesicles ('frog spawn') typical of extragenital cutaneous lymphangiomas, vulvar lymphangiomas often present as verrucous papules that can be mistaken for genital warts. In this case, we believe that the combination of vulvar Crohn's disease and recurrent cellulitis resulted in local lymphatic destruction, lymphedema and ultimately symptomatic lymphangiectasias that mimicked genital warts.

Marjolin's ulcer arising in a burn scar.

Marjolin's ulcer-a term used to describe a malignancy arising in chronic ulcers of the skin, sinuses, scar tissue, and especially burns scars-occurs in two forms: an acute variant in which the malignant changes occur within a year of injury, and a chronic form in which the injury may precede the malignancy by decades. Illustrating the more common chronic form, we present the case of a 32-year old Haitian woman with an extensive squamous cell carcinoma arising from a burn scar on the dorsum of her right hand, with a review of the literature pertaining to burn scar carcinoma.

Other than healing: medical practitioners and the business of life assurance during the nineteenth and early twentieth centuries.

The purpose of this paper is to explore briefly the nature, development and implications of the relationship between medical practitioners and life assurance companies. The aim is to elucidate the development both of the medical profession and the life insurance business--two important aspects of economic and social change in the nineteenth and early twentieth centuries which are usually treated separately. The focus is primarily, though not exclusively, on Scottish companies as they carried out a disproportionately large amount of the UK life assurance business by the mid-nineteenth century. The insurance industry's increasing, and increasingly systematic, tapping of medical expertise enabled it to raise profits by reducing losses on standard policies and by venturing out into types of business previously thought too risky. While nineteenth-century medical therapeutics may have left much to be desired, medical involvement in insurance suggests that medical practitioners were by no means ineffective. At the same time, a substantial proportion of the medical profession gained valuable part-time appointments which helped to alter the diagnostic techniques of the profession more generally. Thus insurance turns out to be an especially important element in the 'non-healing' aspects of medicine, with spin-offs for the healing side as well.

Gibberellic Acid effects on greening in pea seedlings.

The effect of gibberellic acid (GA) on light-induced greening of etiolated pea plants (Pisum sativum [L.] cultivars Alaska and Progress) was characterized. Progress, a GA-deficient dwarf of Alaska, was found to accumulate chlorophyll and light harvesting chlorophyll protein associated with photosystem II (LHC-II) more rapidly than Alaska, Alaska treated with GA, or Progress treated with GA. A slightly lower chlorophyll content was noted after 24 hours of light induced greening for Alaska treated with GA relative to untreated Alaska. GA-treated Progress, Alaska, and GA-treated Alaska all gave essentially identical patterns for LHC-II accumulation. Similar patterns of LHC-II mRNA induction were found in all four treatments indicating that differences in mRNA induction did not cause differences in LHC-II accumulation. Chlorophyll and LHC-II accumulation in each treatment followed the same patterns of accumulation and a significant correlation (at the 0.01 level of significance) was found between chlorophyll and LHC-II content. Since Progress treated with GA accumulated LHC-II and chlorophyll in a manner similar to that of Alaska, it is clear that GA alters the process of greening either directly or indirectly.

Bromothymol blue and carbohydrate-sensitive plating media.

A new plating medium using bromothymol blue (BTB) indicator is described and compared with eosin-methylene blue (EMB), MacConkey, and Endo media. These media were tested with L-arabinose by plating fermenting and nonfermenting mutant strains of Escherichia coli. The minimum concentrations of L-arabinose that permitted differentiation of these strains were determined. Different concentrations were required for differentiating confluent patches of cells, isolated colonies, and closely spaced or adjacent colonies. L-Arabinose, L-rhamnose, D-lactose, and D-galactose were tested with modified enteric media and with BTB medium, again to determine minimum usable concentrations. BTB media and reformulated conventional media allowed detection of acidification, aerobically, at one-fifth to one-hundredth the (1%, wt/vol) concentration of carbohydrate used in standard indicator plates.