Mucinous carcinoma: a translucent blue papule on an 89-year-old man.

An 89-year-old man with no significant medical history presented with a slow-growing, asymptomatic translucent blue mass noticed 1 year prior to evaluation. Review of symptoms was negative for constitutional symptoms, gastrointestinal (GI) disturbance, and visual complaints. Physical evaluation revealed a 4-mm firm light blue translucent papule on the left medial canthus (Figure 1). No cervical or axillary adenopathy was present. No further lesions were identified during full body skin examination, including chest wall masses. A diagnostic study was performed and stained with hematoxylin-eosin (Figure 2) and periodic acid-Schiff (Figure 3).

Practice trends in the treatment of actinic keratosis in the United States: 0.5% fluorouracil and combination cryotherapy plus fluorouracil are underused despite evidence of benefit.

BACKGROUND: Topical fluorouracil and cryotherapy are among the most commonly used treatments for actinic keratosis. Evidence shows that 0.5% fluorouracil has similar efficacy and is better tolerated than 5% fluorouracil. Evidence also shows that combination therapy with cryosurgery and fluorouracil is beneficial. OBJECTIVE: To examine fluorouracil and cryotherapy use in the treatment of actinic keratosis. METHODS: The National Ambulatory Medical Care Survey database was queried for visits for actinic keratosis. Visits were analyzed for patient demographics, provider specialty, and treatment regimens. Fluorouracil and cryotherapy use was analyzed over time. RESULTS: Cryotherapy was the most commonly used treatment for actinic keratosis. Fluorouracil products were prescribed to 1.1 million patients (6.6%) between 2001 and 2008; of these, dermatologists prescribed 0.5% fluorouracil in 51.8% of cases and 5% fluorouracil in 38.9% of cases. Combination fluorouracil and cryotherapy was used for only 1.1% of actinic keratosis visits between 1993 and 2008 and was never used by nondermatologists. CONCLUSIONS: Despite evidence suggesting comparable efficacy, greater tolerability, and lower cost of 0.5% fluorouracil relative to 5% fluorouracil, 5% fluorouracil is used by dermatologists almost as often as 0.5% fluorouracil. Among nondermatologists, 5% fluorouracil is used exclusively. Combination therapy of fluorouracil and cryotherapy is underused despite evidence of its benefit.

Mercury activates vascular endothelial cell phospholipase D through thiols and oxidative stress.

Currently, mercury has been identified as a risk factor of cardiovascular diseases among humans. Here, the authors tested the hypothesis that mercury modulates the activity of the endothelial lipid signaling enzyme, phospholipase D (PLD), which is an important player in the endothelial cell (EC) barrier functions. Monolayers of bovine pulmonary artery ECs (BPAECs) in culture, following labeling of membrane phospholipids with [32P]orthophosphate, were exposed to mercuric chloride (inorganic form), methylmercury chloride (environmental form), and thimerosal (pharmaceutical form), and the formation of phosphatidylbutanol as an index of PLD activity was determined by thin-layer chromatography and liquid scintillation counting. All three forms of mercury significantly activated PLD in BPAECs in a dose-dependent (0 to 50 microM) and time-dependent (0 to 60 min) fashion. Metal chelators significantly attenuated mercury-induced PLD activation, suggesting that cellular mercury-ligand interaction(s) is required for the enzyme activation and that chelators are suitable blockers for mercury-induced PLD activation. Sulfhydryl (thiol-protective) agents and antioxidants also significantly attenuated the mercury-induced PLD activation in BPAECs. Enhanced reactive oxygen species generation, as an index of oxidative stress, was observed in BPAECs treated with methylmercury that was attenuated by antioxidants. All the three different forms of mercury significantly induced the decrease of levels of total cellular thiols. For the first time, this study revealed that mercury induced the activation of PLD in the vascular ECs wherein cellular thiols and oxidative stress acted as signal mediators for the enzyme activation. The results underscore the importance of PLD signaling in mercury-induced endothelial dysfunctions ultimately leading to cardiovascular diseases.