Oral terbinafine in toenail dermatophytosis. A double-blind, placebo-controlled multicenter study with 12 months' follow-up.

The treatment of onychomycosis has previously often been protracted and unsuccessful. Terbinafine has been shown to be effective in short-term regimens. In this double-blind, placebo-controlled study, 148 patients with toenail dermatophytosis were randomized to treatment with either 250 mg terbinafine daily or placebo for 3 months. An additional treatment was given for 3 months to patients whose infection had not responded. The patients were followed clinically and mycologically through 12 months. After 3 months 82% of the terbinafine-treated group, versus 5% of the placebo group, showed significant improvement, i.e. negative culture and growth of unaffected nail more than 2 mm (p = < 0.0001). After 12 months clinical and mycological cure was seen in 40% of the patients treated with terbinafine for 3 or 6 months, while 67-81% were clinically cured, but with positive microscopy. Side-effects occurred in 13.5% of the terbinafine group, versus 5.4% of the placebo group, and were mild. 250 mg terbinafine daily for 3 months was significantly more effective than placebo. The efficacy did not appear to improve with additional treatment for 3 months.

[Occupational eczema due to contact with Alstromeria (Inca lily)]. / Erhvervsbetinget eksem efter Alstromeria (Inkalilje).

A 35-year old woman developed allergic contact dermatitis after she had been sensitized to Alstromeria while working as a florist.

Oesophageal cancer in Greenland: selected epidemiological and clinical aspects.

During 1955--1974, forty cases of oesophageal cancer were diagnosed among indigenous Greenlanders. The annual incidence rates per 100,000, age adjusted to the "world" population, were 16.3 for males and 11.8 for females in 1955--1964. The corresponding rates in 1965--1974 were 15.9 for males and 6.7 for females with a male:feamle ratio of 2.4:1. These rates rank among the moderately high rates found in India, Puerto Rico and France and in the black population in the US. Age distribution, anatomical location and prognosis followed the normal pattern for oesophageal cancer disease. No particular occupational trend was apparent and there was no difference between towns and settlements. However, a statistically significant geographical gradient of frequency was found with higher rates in the southernmost 3 districts. The traditional Greenland diet may contain concentrations of precursors sufficient to create carcinogenic levels of nitrosamines. Further studies are needed in particular of environmental factors such as foodstuffs, homebrewed beer, drinking water and cigarette smoking. Attention should be focused on the special ecological conditions in southern Greenland.

Occurrence of cirrhosis and primary liver cancer in an Eskimo population hyperendemically infected with hepatitis B virus.

Hepatitis type B is hyperendemic in Greenland with serologic evidence of infection in 54% of adults and a hepatitis B surface antigen (HBsAg) carrier rate of 7--25%. The impact of this infection rate on the occurrence of cirrhosis and primary liver cancer (PLC) was studied. Mortality rates for cirrhosis were obtained from official mortality statistics, 1951--1975. PLC was identified by a study of all biopsy and necropsy material taken in the study area during the same period. Neither cirrhosis nor PLC was found to be a more prevalent cause of death in this population than in Northern Europe where hepatitis B is at least 10-fold less prevalent. It is concluded that hepatitis B infection per se does not contribute significantly to the development of cirrhosis or to PLC, at least in the Eskimo population of Greenland.

Incidence of salivary gland neoplasms in Greenland with special reference to an anaplastic carcinoma.

Forty-two salivary gland neoplasms were diagnosed in Greenland 1955--1974. Twenty-five cases were malignant of which 92 per cent were an undifferentiated carcinoma, histologically identical to malignant lymphoepithelial lesion. Age adjusted incidence rates for salivary gland carcinomas 1965--1974 were among the highest on record, significantly higher than in Denmark. Prognosis was poor with a 5-year determinate survival rate of 14 per cent. The majority of previously reported malignant lymphoepithelial lesions of salivary glands have occurred in Arctic dwellers in Alaska and Northern Canda. Virus infection and/or dietary deficiencies may be etiological factors. In the present study secondary nasopharyngeal carcinoma could not always be excluded.

Carcinoma of the uterine cervix and dysplasia in Greenland.

A preliminary study, based on officially recorded cases of cervical carcinoma, dysplasia and carcinoma in situ in Greenlandic women over the period 1955-1975 revealed a total of 117 cases of carcinoma and 119 cases of dysplasia and carcinoma in situ. The incidence of invasive carcinoma, age-adjusted to "European standard population" (Doll 1976), exhibited a rise from 20.9 per 100,000 in 1955-1959 to 84.8 in 1970-1975. The latter incidence rate is one of the highest in the world, and about 2.5 times as high as the most recently recorded incidence in Denmark. Age-specific incidence rates for cervical carcinoma in Greenland for 1970-1975 showed significantly higher values in the age groups 15-49 and 60-64 years as compared with the most recent Danish rates. The crude incidence of dysplasia and carcinoma in situ per 100,000 women over 15 years of age rose from 10.5 for 1955-1959 to 137.5 for 1970-1975. The corresponding incidence for severe dysplasia and carcinoma in situ was 93.7 for 1970-1975. There has most likely been a more complete registration of these initial stages during recent years, although organized detection work has not been initiated.

Nasopharyngeal cancer in Greenland. The incidence in an Arctic Eskimo population.

Nasopharyngeal cancer is very common among the Chinese in various parts of the world, particularly Southern China, and frequent in certain other Mongoloid groups in Southeast Asia. Also, the incidence among the Eskimos of the western Canadian Arctic and Alaska is considerably higher than would be expected. Ths paper reports for the first time the incidence of nasopharyngeal cancer among native Greenlanders, an Eskimo population with some admixture of Caucasian blood. During 1955-1976, thirty-five cases of nasopharyngeal cancer were diagnosed. Ninety-four per cent (33 cases) were squamous cell carcinomas, including lymphoepitheliomas. Incidence rates 1965-1976, age adjusted to the "world" population distribution, were 12.3 and 8.5 per 100,000 per annum for males and females respectively. These rates are among the highest recorded in the world and significantly higher than among the Caucasian population in Denmark. Compared with other high risk populations nasopharyngeal cancer among Greenlanders had an older age distribution and a lower male-to-female sex ratio. An additional 11 cases with malignant involvement, seeminly confined only to cervical lymph nodes, may have included some undiagnosed nasopharyngeal cancers. Thus the calculated incidence rates of this study could represent only minimum rates. Further research is needed especially with regard to the HL-A profile and to possible traces of Epstein-Barr virus infection.

Hepatitis Ain Greenland: importance of specific antibody testing in epidemiologic surveillance.

An epidemic of viral hepatitis type A in an arctic area is described. From 1970-1974, 4961 clinical cases of hepatitis were reported in Greenland, corresponding to 11 per cent of the total population. Epidemiologic surveillance indicated person-to-person transmission of the disease, apparently by the oralfecal route. The course of the disease was mild, and complications were rare with a case fatality rate of 0.3%. Ninety-three per cent of the cases occurred in individuals 1-25 years of age, suggesting widespread immunity in the adult population presumably due to infection with hepatitis A during a similar epidemic in 1947-1948. The occurrence of antibody to hepatitis A antigen (anti-HA) in healthy Greenlanders, as detected by radioimmunoassay, closely paralleled this observation. Anti-HA was present in 38 (93%) of 41 individuals born before 1948 and in one (3%) of 29 younger persons. Anti-HA also was detected during the epidemic in the sera of 25 randomly selected hepatitis cases. Immunoglobin analysis in three acute-phase sera showed anti-HA reactivity predominantly in the IgM fraction. The epidemic showed no relation to the hepatitis episodes occurring annually in the area, and seroepidemiologic data indicated that the endemic hepatitis may be caused by hepatitis B virus only.

Kaposi's sarcoma in polar eskimos.

Two cases of Kaposi's sarcoma (KS) are described in patients of pure Eskimo trait from the northernmost part of the world. The clinical and histological findings corresponded to KS in other parts of the world. This report on KS in Eskimos from the sparsely populated Arctic areas may support the opinion that KS is more common outside Africa than the literature indicates.