Therapeutic ionizing radiation and the incidence of basal cell carcinoma and squamous cell carcinoma. The New Hampshire Skin Cancer Study Group.

OBJECTIVE: To estimate the relative risk of developing basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) after receiving therapeutic ionizing radiation. DESIGN: Population-based case-control study. SETTING: New Hampshire. PATIENTS: A total of 592 cases of BCC and 289 cases of SCC identified through a statewide surveillance system and 536 age- and sex-matched controls selected from population lists. MAIN OUTCOME MEASURES: Histologically confirmed BCC and invasive SCC diagnosed between July 1, 1993, through June 30, 1995, among New Hampshire residents. RESULTS: Information regarding radiotherapy and other factors was obtained through personal interviews. An attempt was made to review the radiation treatment records of subjects who reported a history of radiotherapy. Overall, an increased risk of both BCC and SCC was found in relation to therapeutic ionizing radiation. Elevated risks were confined to the site of radiation exposure (BCC odds ratio, 3. 30; 95% confidence interval, 1.60-6.81; SCC odds ratio, 2.94; 95% confidence interval, 1.30-6.67) and were most pronounced for those irradiated for acne exposure. For SCC, an association with radiotherapy was observed only among those whose skin was likely to sunburn with sun exposure. CONCLUSIONS: These results largely agree with those of previous studies on the risk of BCC in relation to ionizing radiation exposure. In addition, they suggest that the risk of SCC may be increased by radiotherapy, especially in individuals prone to sunburn with sun exposure. Arch Dermatol. 2000;136:1007-1011

Helicobacter heilmannii-like spiral bacteria in gastric mucosal biopsies. Prevalence and clinical significance.

BACKGROUND: Gastric Helicobacter pylori (Hp) is highly associated with histological gastritis and peptic ulcer disease, yet Helicobacter heilmannii (Hh, also known as Gastrospirillum hominis) may be a less frequent gastric pathogen about which less is known. PATIENTS AND METHODS: We evaluated 1223 gastric biopsies from 1042 upper endoscopies with biopsies performed over 1 year. Spiral bacteria were specifically sought in biopsies from 912 endoscopies. Clinical and pathologic data from patients with unusual spiral bacteria were tabulated and sera were evaluated for anti-Hp antibodies. RESULTS: The histologic prevalences of Hp and Hh-like bacteria were 59% and 0.5%, respectively, in 912 endoscopies. All four patients with Hh-like spiral bacteria had gastrointestinal symptoms and histologic gastritis. Two had immigrated from the Philippines and one from Belgium. Endoscopic findings and clinical course varied. One improved spontaneously; one improved following antibiotic therapy. One patient's symptoms and bacteria persisted without therapy. One patient coinfected with Hp was treated with apparent clearance of Hh but persistence of Hp. CONCLUSIONS: Helicobacter heilmannii-like bacteria can be distinguished from Hp with routine histologic stains; both bacteria are irregularly distributed. Helicobacter heilmannii appears to be a significant though uncommon cause of gastric inflammation. Some patients with Hh-like bacteria may benefit from anti-Hp therapy.

Superficial granulomatous pyoderma.

Superficial granulomatous pyoderma, recently described as a variant of pyoderma gangrenosum, would be better termed pathergic granulomatous cutaneous ulceration as the seven previously described cases, as well as our own two cases, have significant dermal involvement histologically and heal with scarring. In contrast to pyoderma gangrenosum, lesions of superficial granulomatous pyoderma respond to less toxic anti-inflammatory agents.

Probable azathioprine hepatotoxicity: a case report.

A patient with polymyositis was treated initially with corticosteroids. Subsequently, azathioprine was added but was associated with transient hepatotoxicity on two separate occasions, 6 months apart. Both episodes occurred 3 weeks after starting the latter drug. This is the first case of azathioprine toxicity documented by both histopathology and drug challenge.

Oakwood Hospital needs assessment for community health promotion.

A survey was conducted to determine community health concerns, interests, and perceived health needs. The survey data were used in the selection of health promotion interventions. An index of Concern/Information Need/Participation Willingness (CIP) was developed as a model for planning, implementing, marketing, and evaluating programs.

Hyperkalemia provoked by acute hepatic necrosis.

Six patients with varying degrees of renal insufficiency developed severe hyperkalemia following hepatic necrosis. The hyperkalemia was seen prior to or concomitant with marked elevations in hepatic enzymes. The basis of the liver disease appeared to involve congestive heart failure and/or hypotension. Necrotic liver cells released intracellular potassium into the blood of patients who were unable to handle the additional potassium load because of renal insufficiency and metabolic acidosis. Furthermore, a shift of potassium into the intracellular space is impaired in uremics by defective Na-K ATPase activity, possibly induced by uremic toxins. The 3 diabetic patients in our series may additionally have had aldosterone deficiency leading to impaired cellular potassium uptake.

Effect of indomethacin on the ocular hypotensive action of timolol maleate.

A randomized, double-masked, cross-over study of nine healthy normal subjects was conducted to determine whether indomethacin affected the ocular hypotensive action of timolol maleate. A significant decrease in intraocular pressure occurred with timolol maleate 0.5% eyedrops (used twice a day) alone. Indomethacin (25 mg three times a day, given orally) administered concurrently had no effect on timolol's hypotensive action. No subjective or objective side effects occurred and there were no significant changes in blood pressure, pulse rate, or respiratory rate with either treatment.

Cicatricial ectropion due to essential skin shrinkage: treatment with rotational upper-lid pedicle flaps.

Ectropion is sometimes due to a shortage of skin of the lower lid (cicatricial) and may result from previous surgery, trauma, burns, skin diseases etc. Excessive exposure to the sun has also been incriminated. Vertical traction lines in the skin of the lower lid, accentuated by gazing up or by opening the mouth, suggest this condition. This paper describes the use of pedicle skin flaps rotated from the upper lid to treat cicatricial ectropion occurring in the absence of any predisposing factor and not responding to conservative treatment--that is, due to essential skin shrinkage. All 10 patients had an improved appearance, and epiphora persisted in only 1 patient, who subsequently underwent a punctum-enlarging procedure. In an 11th patient there was insufficient redundant upper-lid skin, so a free skin graft was used instead.

Silver staining of cerebrospinal fluid IgG in isoelectric focusing gels.

A silver staining technique to be used on isoelectric focusing (IEF) gels for cerebrospinal fluid (CSF) oligoclonal IgG bands is described. The technique provides a sensitivity for detection of greater than 0.17 micrograms of IgG. The additional use of immunofixation with anti-human IgG antiserum rather than chemical fixation improves the sensitivity two-fold and permits identification of the oligoclonal bands as IgG. The technique enables one to focus small volumes of unconcentrated CSF (less than 40 microliters) and provides a powerful research tool.

Ligandin and Z protein in binding of thyroid hormones by the liver.

Sephadex G-100 chromatography of rat liver supernatant after addition of [125I]T3 revealed four peaks of protein-bound radioactivity in the void volume, albumin, ligandin, and Z-containing regions, respectively. The peaks were identified by cochromatography of BSP and [125I]T3 and immonodiffusion with antiratligandin IgG and antirat Z IgG. Binding of [125I]T4 to rat liver supernatant occurred in void volume, albumin, and Z regions only. Studies in vivo reveal a pattern of [125I]T3 binding to rat liver supernatant fractions quantitatively different from that observed in vitro. [125I]T4 binding to liver supernatant fractions in vivo occurred in all four peaks. BSP or bilirubin added to liver supernatant decreased T3 and T4 binding by each fraction. Flavaspidic acid inhibited binding of T3 and T4 to albumin, ligandin, and Z protein. Phenobarbital pretreatment of rats increased binding of T3 by ligandin and of T4 by albumin-containing fractions. Circular dichroism studies with purified rat liver ligandin suggest that T3 and T4 bind competitively to the same site as does bilirubin; the association constants of T3 and T4 for ligandin are 10(6) and 10(5) M-1, respectively. T4 was bound only by purified ligandin and not by ligandin in liver supernatant. To determine whether unconjugated bilirubin interferes with hepatic uptake of T3, [125I]T3 was administered to icteric homozygous and phenotypically normal heterozygous Gunn rats. Hepatic uptake and supernatant binding [125I]T3 were significantly reduced in homozygous Gunn rats. Hepatic uptake of [125I]T3 was also reduced in vivo by infusion of BSP with or without flavaspidic acid. BSP infusion abolished [125I]T3 binding to ligandin; BSP and flavaspidic acid abolished binding to ligandin and Z. These observations suggest that ligandin and Z protein are thyroid hormone binding proteins in rat liver cytosol and may influence the net flux of iodothyronies from plasma into the liver.