Leukaemia cutis in chronic lymphocytic leukaemia following varicella zoster virus reactivation

We report a case of a 75-year-old male with indolent chronic lymphocytic leukaemia (CLL) for 8 years, who presented with a 6-month history of a painful, zosteriform eruption in a T3-4 distribution that evolved into an unusual crop of papular nodules. Upon biopsy and immunostaining of these lesions CLL was proven consistent with leukaemia cutis related to varicella-zoster virus reactivation. In the absence of other treatment indices, he was commenced on chlorambucil with successful resolution of both his pain and the lesions.

Apparent improvement in survival for carcinoma of the cervix following the introduction of chemoradiation--a Will Rogers phenomenon

The improved survival for bulky cervical cancers (> 4cm) reported with combination platinum based chemoradiation (1999) prompted a move away from surgery as these cases frequently received adjuvant radiotherapy and were exposed to the morbidity of multimodality treatment. The period pre-1999 (Group 1) was compared with post-1999 (Group 2) when chemoradiation was the preferred treatment for bulky operable cervical cancer. Significantly more cases were treated surgically among Group 1 compared with Group 2 (79% vs. 62%; P < 0.001). Switching from surgery to radiotherapy improved survival in both treatment categories (73% vs. 78% and 37% vs. 44%, respectively) but with no improvement in overall survival (70%/ov.s 70%). Survival (86%) was similar in both groups among surgically treated women with tumors < 4 cm, but significantly more in Group 2 with negative nodes received postoperative adjuvant chemoradiotherapy (Groups 1 vs. 2; 16% vs.37.5%: P < 0.001) and overall the surgically treated patients received more not less multimodality treatment (46.5% vs. 59%; P = 0.7).

A qualitative investigation into the opinions of adolescent females regarding their body image concerns and dieting practices in the Republic of Ireland (ROI)

The aim of this study was to investigate the opinions of female adolescents living in the ROI on issues relating to body image and dietary practice. A qualitative study was selected to enable the issues to be explored in depth. Sixteen focus groups were executed with adolescent females (n=124) aged 15-16 years. Data collection took place during class time in both rural and urban schools in the ROI. Data were analysed using a qualitative thematic methodology, namely framework analysis. High levels of body dissatisfaction existed and dieting was found to be prevalent. The influence of media celebrities was significant. The girls not only aspired to be like them in terms of physique but also followed their alleged dieting regimes in detail. Peers also influenced body dissatisfaction and dieting practices. Consequently, eating habits were altered to accommodate this quest for thinness with a tendency to skip main meals as part of the dieting practice while maintaining an unhealthy snacking pattern. The results are of concern as the adolescent females were utilising unhealthy methods of weight control such as skipping meals and fasting in their quest to obtain a thin physique. A slim body image was deemed important for peer acceptance; hence 'crash' dieting was in existence. This mindset and the resultant dietary practices may have negative health consequences during both adolescence and later life. School interventions targeting adolescent females and focusing on healthy eating and body image are therefore urgently required.

Notochord anomalies in the adriamycin rat model: A morphologic and molecular basis for the VACTERL association

BACKGROUND/PURPOSE

The Adriamycin rat model (ARM) is a reliable model of the VACTERL association. The notochord is structurally abnormal in the region of the foregut, midgut, and hindgut in the ARM. The authors hypothesised that notochord anomalies allow ectopic expression of molecular signals in the developing embryo and thus lead to VACTERL malformations. This study was designed to investigate this hypothesis.

METHODS

Adriamycin (1.75 mg/kg) was administered intraperitoneally to pregnant rats on days 7, 8, and 9 of gestation. Control animals were given saline. Embryos were recovered on gestational days 10.5 to 14 at (1/2)-day intervals and at full term. The first group of embryos were embedded in resin, and sagittal sections stained with Toluidine blue were studied for morphologic abnormalities. The second group of embryos were examined using in situ hybridization for the expression of Sonic Hedgehog (Shh), a patterning gene implicated in the etiology of the VACTERL association.

RESULTS

Twenty-seven of the 28 (96.4%) full-term embryos showed VACTERL anomalies. Forty-five of the 50 (90%) experimental embryos (gestational days 10.5 to 14) showed notochord abnormalities. Abnormal ventral branches from the notochord toward the gut were a commonly observed abnormality. These were seen to impinge on the developing foregut, midgut, dorsal aorta, and kidney. In situ hybridization for Shh showed that these branches from the notochord expressed Shh in 66.6% of experimental embryos. This abnormal Shh expression was not seen in the control embryos.

CONCLUSIONS

Adriamycin diffusely induces altered notochord morphology in the rat embryo. The abnormal notochord morphology may allow ectopic expression of Sonic Hedgehog, and, thus, contribute to the malformations found in the VACTERL association.

Xarvcf, Xenopus member of the p120 catenin subfamily associating with cadherin juxtamembrane region

The catenin ARVCF is a member of the p120(ctn) subfamily of Armadillo proteins. A number of catenins directly bind cadherin cytoplasmic tails, contributing to the modulation of cell-cell adhesion and motility processes. Some catenins, such as beta-catenin (and likely p120(ctn)), have additional roles within signaling pathways regulating gene transcription. We have isolated the Xenopus homolog of human ARVCF. Utilizing the cadherin membrane proximal region known to bind p120(ctn) and delta-catenin, coimmunoprecipitation experiments demonstrate that Xarvcf, likewise, binds cadherin in this region and that corresponding point mutations within conserved residues abrogate the Xarvcf-cadherin association. Western blot analysis of Xarvcf protein across a series of developmental stages reveals changes in protein mobility, likely due to changes in phosphorylation. Xarvcf is a maternally provided transcript and expressed in the embryo throughout all stages of development. Interestingly, Xarvcf mRNA is differentially spliced to produce several isoforms, one of which is developmentally regulated. In common with the putative post-translational modifications of the Xarvcf protein, the presence of alternative splice isoforms suggests that Xarvcf possesses the capacity to effect developmental functions in a regulatable manner.

Mucin-like carcinoma associated antigen (MCA) at presentation with breast cancer

The usefulness of serum measurements of mucin-like carcinoma associated antigen (MCA) in 100 women at presentation with breast cancer was evaluated. Peripheral venous blood was drawn and MCA values determined by radioimmunoassay. Twenty women presenting with benign breast disease and 20 normal women served as controls. There was no difference in the MCA values between the benign breast disease group and the normal group: 4.1 +/- 0.9 units/ml versus 5.0 +/- 0.75 units/ml (mean +/- sem). The following were the MCA values for patients by stage; stage 1: 11.2 +/- 1.02, stage 2: 11.0 +/- 1.29, stage 3: 20.2 +/- 6.7, stage 4: 31 +/- 5.0. Statistical analysis of stage versus controls showed significant elevations only in stage 3 and 4 disease (p < 0.05). We conclude that MCA may be a useful serum tumour marker only in advanced breast cancer but is unreliable in detection of early breast cancer.

Family study of atypical nevi with investigation of heparin sulfate proteoglycan

BACKGROUND

The epidemiology of atypical nevi (AN) is currently obscure; however the diagnosis must be made early in order to follow these individuals and treat any melanomas that may arise at an early stage, thus preventing premature death.

MATERIALS AND METHODS

Following the guidelines of the NIH on clinical and histologic features of ANS, 38 adult members in 8 families were investigated. Twenty-seven were physically examined and 25 biopsied. Biopsies from ANS and junctional nevi from unrelated persons were also stained with antibodies against heparan sulfate proteoglycan (HSPG).

RESULTS

At least 21 of 38 members had ANS. Staining with HSPG antibodies did not differentiate between ANS and benign junctional nevi, all showing slightly irregular staining. In seven of eight families, two or more family members were affected by ANS.

CONCLUSIONS

Although it is not known whether or not HSPG plays a role in melanomas becoming invasive, or the potential of melanoma developing in ANS there were no differentiating features of staining in ANS, and junctional nevi to help in the differential-diagnosis of the two.

The association between coeliac disease, dermatitis herpetiformis and certain HLA-antigens in Icelanders

Twenty-eight cases of coeliac disease (CD) and seven of dermatitis herpetiformis (DH) have been verified in Iceland. Standard serological techniques were used for HLA typing. Twenty-five individuals with CD were typed, 21 (84%) of whom carried DR3,DQ2. Twelve of these 25 (48%) had DR3,DR7, DQ2, which makes them possibly homozygous for DQ2, and suggests that homozygosity of DQ2 increases the risk for CD. The four DH patients that were typed all had HLA-B8,DR3,DQ2. It is concluded that CD and DH are associated with DR3, DQZ in Icelanders.

A unique congenital glossocervical fistula

Lateral cervical fistulae which communicate with the oropharynx are considered to result from incomplete obliteration of the second branchial cleft and pouch. Classically these fistulae have a well-defined pathway through the neck. We present a case, and discuss the aetiology, of a fistula extending from the lateral neck via a previously undescribed course through the neck structures and opening into the posterior aspect of the tongue at the level of the vallate papillae.

Studies on complement deposits in epidermolysis bullosa acquisita and bullous pemphigoid

Epidermolysis bullosa acquisita (EBA) is an inflammatory subepidermal blistering disease characterized by circulating and tissue-bound autoantibodies specific for type VII collagen of the basement membrane zone. The antibodies consist of both complement- and noncomplement-binding populations and belong to all four subclasses of IgG. We investigated the presence of the membrane attack complex C3b, C5, and S protein in EBA and compared C3b and C5 in EBA and bullous pemphigoid. In 10 patients with EBA, these components were detected at the basement membrane zone as follows: membrane attack complex, 90%; S protein, 90%; direct C5, 90%; C3b, 100%; and C5 binding, 90%. In the patients with bullous pemphigoid, the results were as follows: direct C5, 58%; C3b, 33%; and C5 binding, 19%. These results provide additional evidence for complement activation at the basement membrane zone in EBA, show that complement activation in EBA proceeds to activation of terminal complement components, and suggest that EBA antibodies are more potent activators of C5 than are bullous pemphigoid antibodies.

Characterization of the changes in matrix molecules at the dermoepidermal junction in lupus erythematosus

Electron microscopy has revealed that the deposition of immunoglobulin in the skin of lupus erythematosus (LE) patients occurs on and below the basal lamina of the basement membrane (BM). The composition of the BM is now to some extent known, and antibodies have been developed against several of its individual components. In this study, we attempt to elucidate the status of some matrix molecules in the dermoepidermal junction in LE. Lesional and nonlesional skin from LE patients was examined using immunofluorescence microscopy with monoclonal and polyclonal antibodies against 6 matrix molecules. Immuno-electron microscopy using monoclonal antibodies was used to discern changes in type IV and type VII collagen. By immuno-fluorescence microscopy, type IV collagen, type VII collagen, and fibronectin were altered in lesional skin. There was a statistically significant correlation between the presence of immunoglobulin and alteration of type IV collagen and type VII collagen in lesional skin. The alterations in type IV and type VII collagens were confirmed on immuno-electron microscopy which showed fragmentation of staining of both antigenic components, particularly type IV collagen.

The role of aspiration cytologic examination in the diagnosis of carcinoma of the breast

A study of 2,000 patients who had undergone fine needle aspiration of a solid lump of the breast was conducted to determine the accuracy of this technique. During the period 1982 to 1989, all patients with a solid mammary mass, presenting to a specialized breast unit were initially investigated by fine needle aspiration cytologic examination (FNAC). To date, we present data on 2,000 consecutive aspirations with matching histologic diagnosis on the excised pathologic specimens. In particular, the relationship between tumor histologic factors and the accuracy of cytologic diagnosis was examined. The sensitivity of FNAC in the diagnosis of a malignant growth was 84 per cent; this represents first aspiration results only. The specificity was more than 99 per cent. The rate of acellular or unsatisfactory aspirations was 12 per cent. We had a positive predictive rate for diagnosis in carcinoma of the breast of almost 95 per cent. The diagnosis of lobular and in situ patterns of disease was questioned, with three of three in situ lesions and ten of 23 lobular lesions missed by FNAC. We do not recommend that FNAC replace excision biopsy and frozen section in the diagnosis of carcinoma of the breast.

Distal oesophageal ph monitoring for gastro-oesophageal reflux

We investigated eight hour distal intra-oesophageal ph testing to see if this could replace the traditional 24 hour test period without significant loss of sensitivity in the diagnosis of gastro-oesophageal reflux (GOR) disease in symptomatic refluxers. Thirty-four patients were tested, all of whom had classical De Meester symptoms of GOR. All patients were admitted to hospital and commenced on 24 hour ambulant ph monitoring of the distal oesophagus. This was followed by a period of eight hour testing. The following variables were determined: (i) total reflux time, (ii) number of reflux episodes (total, upright and supine), (iii) longest episode of reflux, (iv) percent of time that ph was below four (total, upright and supine). All patients underwent endoscopic examination of the oesophagus subsequently. Twenty four hour monitoring resulted in a positive diagnosis of GOR in 26 of 34 patients, giving an overall sensitivity of 75%. Eight hour testing was positive in 23 patients (sensitivity of 68%, not significantly different). The best correlations were obtained when comparing total reflux episodes (r = 0.75, p less than 0.001), and the percent time ph less than 4 (total) (r = 0.69, p less than 0.001). Nineteen patients had evidence of oesophagitis on endoscopy, and in all such patients both eight and 24 hour testing were positive. We conclude therefore, that eight hour ph monitoring can be reliably used in the diagnosis of pathological GOR in patients symptomatic for acid reflux.

Heavy and light chain isotypes of immunoglobulin in epidermolysis bullosa acquisita

Epidermolysis bullosa acquisita (EBA) is a chronic acquired blistering disease with characteristic clinical, pathologic, and immunopathologic features. The disease is characterized immunopathologically by circulating and tissue-bound IgG class autoantibodies (EBA antibodies) to the basement membrane zone of stratified squamous epithelium. Previous studies have shown that circulating and tissue-bound EBA antibodies are heterogenous in their ability to activate complement and have raised the possibility that functional heterogeneity might be related to IgG subclass restriction. In this study, we have characterized the IgG subclasses of the circulating and tissue-bound EBA antibodies by immunofluorescence and have examined the relationship between IgG subclass and complement binding. The results show that EBA antibodies belonging to all IgG subclasses are present in the skin of EBA patients. The results also show that EBA antibodies belonging to all IgG subclasses are present in the sera of most patients, including sera with and without complement binding EBA antibodies.

Subacute cutaneous lupus erythematosus in Iceland

Identification of patients with subacute cutaneous lupus erythematosus (SCLE) in Iceland was performed by means of a survey based on the histopathologic or immunofluorescent diagnosis of lupus erythematosus. Respondents underwent serologic studies, gave histories, and, dependent upon the latter, were examined. The resultant proportional rate of patients with SCLE approached 10% of all lupus erythematosus cases.

Detection of splenosis: 99Tcm tin colloid scanning and computed transmission tomography compared

Ten patients who had been splenectomized for trauma between 1 and 11 years previously were studied by computed tomography (CT) and radionuclide scanning with 99Tcm tin colloid on the same day. Computed tomography detected splenic tissue in three patients. Radionuclide scanning detected splenic tissue in eight patients, including two cases of typical splenosis not identified by CT. Radionuclide scanning was found to be more sensitive in the detection of residual splenic tissue than CT.

Periungual hyperpigmentation mimicking Hutchinson's sign associated with minocycline administration

An assessment of the occurrence rate of periungual hyperpigmentation with subungual melanoma (Hutchinson's sign) and periungual hyperpigmentation with other subungual lesions has not been published, although periungual hyperpigmentation with a pigmented streak or other pigmented lesion of the nail has been considered pathognomonic for subungual melanoma for a century. We report a case of minocycline hyperpigmentation presenting as a longitudinal pigmented streak of the nail associated with periungual hyperpigmentation. These pigmentary changes could be mistaken for Hutchinson's sign.

Hereditary complement (C6) deficiency associated with systemic lupus erythematosus, Sjögren's syndrome and hyperthyroidism

Results of clinical, serologic and histologic studies documenting an association between hereditary C6 deficiency and a connective tissue disease are provided. The propositus had systemic lupus erythematosus with prominent discoid features, Sjögren's syndrome and hyperthyroidism. Serum C6 was undetectable by radial immunodiffusion and hemolytic assays. Serologic and typing studies performed on 9 family members suggested an autosomal codominant transmission. No correlation with a specific HLA phenotype was established.

Dermatophytes in Iceland

Prior to 1982, no reliable information was available on prevailing dermatophyte species or infections in Iceland. In 1983-1984 fungal cultures performed on 96 patients revealed that Trichophyton tonsurans was the most common isolate, followed by Trichophyton mentagrophytes and Trichophyton rubrum. There were no cases of tinea capitis and tinea corporis was rare, but the most common sites of infection were the feet and toenails.