High incidence of skin cancer in the Channel Islands.

BACKGROUND: Previous studies looking at rates of malignant melanoma (MM) and nonmelanoma skin cancer (NMSC) in the UK have documented one of the highest rates in the southwest of England; however, the incidence of these tumours in Guernsey and Jersey, two of the Channel Islands, has not previously been reported. AIMS: To determine the incidence of cutaneous MM and NMSC in the Channel Islands. METHODS: Data for the period 2005-2009 were obtained from clinical and histopathological records for all MMs excised in the Channel Islands, and from the South-west Cancer Registry for MMs excised in the southwest of England and for NMSCs in both areas. The age-standardized incidence rate (ASRs) per 100,000 of the population in the Channel Islands were compared with those with the southwest of England, the UK and the rest of Europe where available. The MM characteristics of the Channel Islands were then compared with the southwest of England using standardized incidence ratios (SIRs). RESULTS: The ASR/100,000 for cutaneous MM for 2005-2009 was 30 for the Channel Islands (31.3 for Jersey, 28.2 for Guernsey), 20.3 for the southwest of England, and 15.6 for the UK. Comparison with the rest of Europe indicated that the incidence of MM in the Channel Islands is one of the highest in Europe. The highest incidence of MM was in the over 65 years age group on both Guernsey and Jersey, and when divided into 5-year age bands, the 70-74 years age group had the highest rate. This suggests that this particular age group may have previously received greater exposure to some environmental factor that promotes MM development. The ASR/100,000 for NMSC was also higher for the Channel Islands (263.3) than for the southwest of England (174.6) for 2005-2009, and for the UK in 2009 (104.9). CONCLUSIONS: This study indicates that the Channel Islands have a high incidence of skin cancer (both MM and NMSC). In addition, the data show that the ASRs in older people in this population group differ from those in mainland UK, showing higher rates in the over 65 years age group.

[Quantification of the probability of milk contamination by Listeria monocytogenes during manufacture of hard cheese]. / Probabilités de contamination du lait par Listeria monocytogenes pendant la fabrication du fromage à pâte dure.

BACKGROUND: The present work is concerned with the probability of contamination by Listeria monocytogenes in the artisanal manufacture of Swiss Emmental hard cheese made from raw milk. The simulation model follows the evolution of the contaminant flora from raw milk at the farm to milk mixing, storage at the cheese factory and to the cheese manufacturing process. METHODS: The simulations are based on models of predictive microbiology, namely the exponential growth model of bacteria including the lag-time, a cardinal growth model and a Log-linear model of thermal deactivation of bacteria. RESULTS: The results of the actual simulation indicate that the contamination of milk at the farm is a rare event (P=0.0036), but the mixing of milk at the cheese factory leads to a higher probability of contamination of cheese milk (P=0.07). Elevated bacterial concentrations are mainly due to cases of mastitis involving Listeria monocytogenes. The decline in bacterial counts during cheese manufacture depends on the curing temperature (52-54 degrees C) and varies between 1.5 and 3.2 Log cfu/ml. Freshly manufactured Emmental-cheese made from contaminated raw milk is expected to have only 4.6 cfu of heat injured Listeria monocytogenes /kg cheese mass in the press. CONCLUSION: Depending on listeria evolution, from the press to the product consumption, consumer exposure has been evaluated and might result in 1 to 10 Listeria monocytogenes per portion of cheese. The bacterial presence could be due to recontamination during packaging, distribution and cheese preparation by the consumer. Based on the presented data and estimations, it is concluded that the consumption of traditionally/artisanal manufactured Swiss Emmental hard cheese presents an extremely low, but existent risk, especially for people with a deficient or diminished immune system.

[Pearl index of the new Sof-T spiral in relation to ultrasound follow-up]. / Pearl-Index der neuen Sof-T-Spirale abhängig von der Ultraschallkontrolle.

463 patients (109 nulliparae, 354 uni- and multiparae) were fitted with a new intrauterine device (IUD), Sof-T, and observed during 6,624 cycles. Two independent centres participated in the study. The T of Sof-T is made of flexible polyethylene, the two occlusion bodies, of medically approved silastic. If the Sof-T is correctly placed, they lie in the uterine horns. A copper wire of a total surface of 360 mm2 is winded around the vertical branch. The echogenicity of the occlusion bodies facilitates their visualization by ultrasound, thus improving the safety of the new Sof-T. The softness and the adaptability of these occlusion bodies to the cavity of the uterus decreased trauma, and thus hemorrhage and pain, compared to 16 other studies on IUDs. The small number of salpingitis recorded in our study of the Sof-T may be attributed to the fact that the pathogens transported and transmitted by sperm could probably not penetrate into the uterine tubes because they were stopped by the occlusion bodies.

Molluscum contagiosum virus types in genital and non-genital lesions.

The endonuclease digest patterns of viral DNA from 48 genital and 45 non-genital molluscum contagiosum virus (MCV) lesions were examined. The overall ratio of MCVI to MCVII was 3.23:1. There was no predominance of either MCV type in genital lesions. No obvious morphological differences were seen between MCVI and MCVII lesions. MCVII was not found in any patient under 15 years old.

Fatal Stevens-Johnson syndrome following urography with iopamidol in systemic lupus erythematosus.

A 46 year old white woman with active systemic lupus erythematosus developed a skin rash 8 hours after intravenous urography with the non-ionic contrast medium iopamidol. Severe Stevens-Johnson syndrome with erythema multiforme, intrahepatic cholestasis, pulmonary infiltrates and acute renal failure ensued, leading to her death. Although non-ionic contrast media are generally less toxic than traditional ionic agents, their use in patients with immunological disease may be hazardous.

Intrauterine occlusion body (IUB). Preliminary report.

The IUB or SOF-T is a further development of the IUD with additional functions and properties. In 368 IUB insertions over a period of 48 months, there was no intrauterine pregnancy. There was a low removal rate due to bleeding, pain, infection or partial expulsion in 277 insertions performed at two university centers over an average period of 8-1/2 cycles. In 80 cases tubal occlusion was directly or indirectly proven by different methods. The improved ultrasound localisation of the IUB is possibly responsible for its effectiveness and the soft ends are probably the main reason for its improved tolerance compared to other IUDs.

Molluscum contagiosum: characterization of viral DNA and clinical features.

Restriction endonuclease analysis of molluscum contagiosum virus DNA revealed two subtypes. In a study of 46 isolates from 41 patients, some with no other disorder and some with atopic dermatitis, the ratio of MCV I isolates to MCV II was 34:12. Multiple clustered lesions removed at the same time from an individual patient yielded only one type of MCV. Lesions induced by MCV I or MCV II were indistinguishable on the basis of size and form. Neither subtype was associated exclusively with lesions at certain sites or with other clinical features. Heterogeneity of DNA restriction endonuclease cleavage patterns amongst isolates of the same subtype was observed, this being greatest for MCV II.

Galactose tolerance in patients with atopic cataracts.

Galactosaemia has been suggested as a contributory factor in the pathogenesis of some presenile and senile cataracts. To assess whether galactosaemia plays any part in the development of atopic cataracts a galactose tolerance test was carried out in eight atopic dermatitis patients whose cataracts had appeared between the ages of 12 and 39 years. In seven patients a normal result was obtained and in one the result was just above normal. Impaired galactose tolerance appears to have no role in the pathogenesis of atopic cataract.

Hereditary angioedema and thyroid autoimmunity.

Sera from 91 patients with hereditary angioedema were screened for thyroid antibodies. The results for the 77 patients more than 17 years old were compared with previously published data for the prevalence of thyroid disease in a large community (Whickham). Of the female patients with hereditary angioedema, the prevalence of thyroglobulin antibodies (TGA) was 14.0%, higher than the expected 3% (p less than 0.001). The prevalence of thyroid microsomal antibodies (TMA) was 20%, also higher than the expected 7.6% (p less than 0.01). The age distributions of the females in both groups differed: in the group with hereditary angioedema there was a greater proportion of younger patients which should have resulted in a lower prevalence of thyroid antibodies. Adjusting for related patients with hereditary angioedema, there was still an increased prevalence of TGA (p less than 0.01) and TMA (p less than 0.01).

Essential fatty acids in the plasma phospholipids of patients with atopic cataracts.

Abnormal levels of the essential fatty acids (EFA) in plasma phospholipids have been reported in atopic dermatitis. We have compared EFA levels in 10 patients with atopic cataracts and 29 atopic dermatitis patients without cataracts and found no significant differences, with the exception that higher levels of adrenic acid occurred in those with cataracts.

Emerging pattern of Lyme disease in the United Kingdom and Irish Republic.

In the past year there have been 68 cases of Lyme disease in the United Kingdom and Republic of Ireland. 41 patients had erythema chronicum migrans, and 8 of them had associated neurological disease. 13 further patients presented with neurological disease without a preceding skin lesion. Myocarditis was present in 1 patient. Ixodes ricinus was confirmed as the vector for Lyme disease. In two areas deer were found to be infected by Borrelia burgdorferi, the causative organism of Lyme disease. 86% of 45 deer sera tested had significant antibody titres against B burgdorferi.

Oral spironolactone: an effective treatment for acne vulgaris in women.

The effect of oral spironolactone (200 mg daily) on acne vulgaris has been studied in 21 women in a randomized, placebo-controlled, double-blind crossover study using 3 month treatment periods. Compared with placebo, spironolactone produced significant improvement as assessed by subjective benefit (P less than 0. 001), number of inflamed lesions (P less than 0 . 001) and by an independently evaluated photographic method (P less than 0 .02). There was a fall in sex hormone binding globulin but no significant changes in plasma testosterone and derived free testosterone. Initial plasma androgen levels were no higher in responders than in non-responders, nor did oral contraceptive use appear to affect clinical response. Spironolactone is a useful alternative therapy for women with acne vulgaris.