Reduced serum concentrations of riboflavine and ascorbic acid, and blood thiamine pyrophosphate and pyridoxal-5-phosphate in geriatric patients with and without pressure sores.

BACKGROUND: Patients with pressure sores have as part of their treatment been reefed with energy and proteins with varying result. It has been uncertain, however, to what an extent these patients also were depleted of micronutrients which might be critical for ulcer healing. OBJECTIVE: To study the nutritional intake and nutritional status of a number of micronutrients in geriatric pressure sore patients and in matched controls. DESIGN: The nutritional intake and nutritional status as anthropometric measures, serum conc. of albumin, zinc, and of vitamins (ascorbic acid, riboflavin, calcidiol), were measured. Thiamin pyrophosphate and pyridoxal-5-phosphate were determined in whole blood from 11 geriatric in-patients with pressure sores and 11 matched controls. RESULTS: The serum conc. of ascorbic acid was significantly (p< 0.05) more reduced in pressure sore patients (mean+/-S.D.) 4.2+/-3.4 (ug/ml) than in control patients 7.4+/-5.4 (ug/ml) which still was lower than in a reference group (10.9+/-1.9) (ug/ml). In all the geriatric patients compared to the reference group, the conc. of serum-riboflavin was reduced to about 15 %, thiamine-pyrophosphate and pyridoxine-5-phosphate in whole blood and serum calcidiol to about 50 %, without any differences between the pressure sore patients and the matched controls. CONCLUSION: Refeeding of pressure sore patients who often are catabolic and have increased needs for protein and energy, should include micronutrients not only to cover recommended dietary allowances, but sufficient to reach normal nutritional status for the individual micronutrient.

Measurement of the mechanical properties of skin with ballistometer and suction cup.

BACKGROUND: There is no consensus on the methodology for describing the mechanical properties of human skin in vivo. Current descriptions are generally method dependent. METHOD: The mechanical properties of palmar skin of the hypothenar as well as dorsal and ventral forearm skin were studied in 17 healthy volunteers. Two methods were used: ballistometry [Dia-stron Torsional Ballistometer (Diastron Ltd., Andover, UK)] and suction cup [The Dermaflex machine (Cortex Technology, Hadsund, Denmark)]. RESULTS: A moderate degree of correlation was found between the methods (rs=0.315-0.540), while internal correlation between different measures obtained with one method was higher (rs=0.375-0.967). The suction cup method parameters (distensibility and elasticity) correlated significantly with the ballistometry parameters (indentation, alpha, area and coefficient of restitution), while the hysteresis did not correlate to ballistometry parameters. The coefficient of variation of both methods (CV=0.02-0.35) was within the range obtained with other non-invasive methods, e.g., TEWL. Regional differences were identified with both methods, while only the suction cup method identified age-related changes. CONCLUSIONS: The results suggest that while both methods may be useful, they describe related but not identical aspects of skin mechanics. The differences in measuring principle suggest that the suction cup method predominantly measures elasticity, while the ballistometer predominantly appears to measure stiffness. Hysteresis may be a unique measure of skin viscosity. Additional studies, however, are needed to specify the clinical significance of the various measures of skin mechanics.

Optimized UVB treatment of psoriasis: a controlled, left-right comparison trial.

In a randomized, controlled, left-right comparison study, 20 patients with chronic plaque psoriasis were treated with UVB. One side of the body received UVB in a conventional regimen with fixed dose increments, the other side was given UVB doses according to measurements of skin pigmentation. Skin pigmentation was quantified by the skin reflectance technique. The relationship between skin pigmentation and sensitivity to UV radiation was used to optimize and individualize the initial UVB exposure dose. Clinical outcome, initial, final and cumulative UVB doses, time to 50% reduction in PASI score, and side-effects were compared. The consequence of the optimization of the UVB doses with a skin reflectance meter was that the initial UVB dose was significantly higher than in the conventional UVB regimen. PASI scoring demonstrated a more rapid improvement during the first 2 weeks of treatment on the half body receiving the optimized treatment compared to the other side (P < 0.05). This new technique offers the same therapeutical advantages and security as a dose regimen guided by minimal erythema dose testing. However, measurement of skin pigmentation by skin reflectance is a quick method which can be operated easily by nurses.

Structural hair shaft abnormalities in hypomelanosis of ito and other ectodermal dysplasias.

Hair samples from patients with different ectodermal dysplasias; hypohidrotic ectodermal dysplasia, pachyonychia congenita, tricho-dento-osseous syndrome, tricho-rhino-phalangeal syndrome, and hypomelanosis of Ito were investigated using a scanning electron microscope. The hairs of the patients showed different structural abnormalities; twisted hairs, longitudinal grooves, trichorrhexis nodosa as well as variations in the hair caliber. Hair shaft abnormalities, as in our patients with tricho-dento-osseous syndrome, and hypomelanosis of Ito have so far not been described.

Skin disease in military personnel.

Skin disease, disease of the musculoskeletal system, and respiratory infections are the most frequent reasons for military personnel to seek medical care. The Oslo Military Clinic serves all of the military personnel in Oslo and the surrounding region, including officers and civilian employees. From September 1996 to May 1997, 1,360 patients were diagnosed and treated by the author, and the data are included in the following study. Upper respiratory disease was the primary reason for seeking medical attention in 26% of the patients, 21% visited the clinic because of disease or pain in the musculoskeletal system, and 16% suffered from a skin disease. Apart from the low number of female patients, the patient population and the disease spectrum observed in the military clinic are very similar to those in a general medical practice. Among the 222 patients suffering from a cutaneous disease, eczema (42 patients), allergy (excluding dermatitis) (34 patients), acne vulgaris (23 patients), and sexually transmitted diseases (28 patients) were the most prevalent processes. Other less prevalent skin diseases were fungal infections, herpes simplex infection, nevi, common warts, and superficial bacterial skin infections. Skin diseases seen in one patient only included erysipelas, herpes zoster, dermatitis herpetiformis, and Ehlers-Danlos syndrome. Good clinical skills in dermatology are of paramount importance in military medicine, and if possible, the military should appoint a dermatologist to its medical team to rapidly diagnose and treat the large number of patients with skin disorders.

Pili torti and sensorineural hearing loss. A follow-up of Bjørnstad's original patients and a review of the literature.

In 1965, Bjørnstad described 8 patients with pili torti, of whom five also suffered from hearing loss. The combination of these two findings was later coined Bjørnstad's syndrome. Typically, these patients develop hair loss in the first two years of life, while the hearing deficit may become evident in the first three to four years of life. However, considerable differences regarding age of onset and clinical severity have been reported, a pronounced hair shaft abnormality is often associated with severe hearing deficits. In a recent study of a Mexican family with pili torti and deafness, the inheritance was determined to be autosomal recessive, and mapped to the gene locus 2q34-q36. Hypogonadism and mental retardation are associated findings that have been described in patients with Bjørnstad syndrome. In this re-investigation of Bjørnstad's original patients, two additional patients with pili torti and hearing loss are described, and a review of the published cases of Bjørnstad's syndrome is given, as well as a short overview of syndromes and conditions with twisted hairs.

Cutaneous malignant melanoma in Norway: experiences from the Norwegian Melanoma Project.

The Norwegian Melanoma Project was conducted during 1989-1993 as a co-operative study by the dermatological, surgical, oncological and pathological departments of the five university hospitals in Norway. We present the results from the patients diagnosed and treated in our dermatological department at Ullevaal Hospital. During the study period 4582 patients received a clinical evaluation of pigmented lesions and 1347 patients were included in follow-up analyses, which consisted of a complete anamnestical evaluation and a clinical and pathological investigation of excised pigmented lesions. In all, 66 cutaneous malignant melanomas, 50 superficial spreading melanomas, seven lentigo maligna melanomas, eight nodular melanomas and one acral lentiginous melanoma were diagnosed. Correlation of the clinical and anamnestical information demonstrated an increased risk of developing malignant melanoma in persons with red hair and skin type I/II. When the histological thickness of superficial spreading melanomas diagnosed before the start of the project was compared with that of those treated during the project, there was a significant decrease in thickness in the project period.

Vitiligo caused by chloroquine phototoxicity.

A six year old girl of Ethiopian origin suffering from atopic eczema since the age of two is presented. Prior to a visit to her grandparents in Ethiopia, she received 250 mg chloroquine weekly as a prophylaxis against malaria. Three weeks thereafter, she developed sharply demarcated depigmented areas on the face, especially in the periorbital area. On returning home to Norway the medication was discontinued, and after a few weeks the first signs of repigmentation were noticed. Eight months after cessation of therapy, almost complete repigmentation had been achieved. Complete repigmentation was observed one year after the cessation of chloroquine-therapy.

Benign symmetric lipomatosis Launois-Bensaude successfully treated with extensive plastic surgery.

Benign symmetric lipomatosis is a rare condition predominantly seen in male patients. The etiology is unknown, and therapy is difficult, although liposuction has had effect. We describe a 38-year-old male patient who had suffered from severe adipositas since the age of 7. Due to an ulceration in the groin, he later needed intensive care, and in order to normalize his condition, extensive surgical treatment became necessary.

[A classification system of anogenital findings. A diagnostic tool in the assessment of sexually abused children]. / Klassifikasjonsliste av anogenitale funn. Et hjelpemiddel i diagnostikken av seksuelle overgrep mot barn.

The assessment of suspected sexual child abuse demands teamwork where the paediatrician plays a central role. From a juridical point of view, the task of the paediatrician is to evaluate the anatomic, microbiologic and forensic medical findings. In 1995, in order to improve the quality of this work, Norwegian paediatricians established a peer review group which meets on a regular basis. Based on available literature and the experience of the individual members, a classification system for anogenital findings has been developed. The findings are divided into five classes. Class one comprises findings frequently seen in children who have not been abused. Class two comprises findings not considered to be normal, but for which there could be many different causes. Classes three, four and five represent findings which are increasingly predictive with respect to injury penetration or attempted penetration. Since our knowledge of anogenital anatomy in children who have not been abused is limited, our classification system should be updated regularly.

Evaluation of phototoxic properties of oral antidiabetics and diuretics. Photohemolysis model as a screening method for recognizing potential photosensitizing drugs.

The oral hypoglycemic drugs carbutamide, chlorpropamide, glibenclamide, glubornuride, gliclazide, glipizide, gliquidone, glisoxepide, glymidine, tolazamide and tolbutamide, and the diuretics acetazolamide, bemetizide, bendroflumethiazide, benzthiazide, benzylhydrochlorothiazide, bumetanide, butizide, chlorazanile, chlorothiazide, chlortalidone, clopamide, cyclopenthiazide, cyclothiazide, diazoxide, etozoline, furosemide, hydrochlorothiazide, hydroflumethiazide, indapamide, mefruside, metolazone, piretanide, polythiazide, trichlormethiazide, and xipamide were investigated for photohemolytic properties in vitro. Irradiation with a SOL 3 apparatus (solar simulating irradiation) revealed hemolysis in the presence of five oral hypoglycemic agents and in the presence of 19 out of the 25 tested diuretics. Photohemolysis was induced in the presence of three substances, respectively, after exposure to UVA or visible light. UVB alone did not induce phototoxic hemolysis in the presence of the tested drugs. Compared to clinical reports on photosensitivity reactions, the photohemolysis model seems a good predictive model in recognizing potential photosensitizing sulfonamides.

Cell cultures in the investigation of thiazide phototoxicity.

The NHIK 3025 cell line (Norsk Hydro Institutt for Kreftforskning), a human in situ carcinoma of the cervix cell line, was used to investigate the thiazides bemetizide, bendroflumethiazide, benzylhydrochlorothiazide, bumetanide, butizide, chlortalidone, furosemide, hydrochlorothiazide, hydroflumethiazide, indapamide, piretanide, polythiazide, trichlormethiazide and xipamide for their potential phototoxic properties. Cell death following UVA irradiation and dependent on test substance concentration was observed in the presence of all the tested substances except chlortalidone, furosemide, indapamide and xipamide. Bendroflumethiazide was phototoxic at concentrations of 0.05 mM and higher; bemetizide, benzylhydrochlorothiazide, bumetanide and hydroflumethiazide were phototoxic at 0.25 mM and higher and butizide, hydrochlorothiazide, piretanide, polythiazide and trichlormethiazide were phototoxic at 0.5 mM and higher.

Chloroquine-induced vitiligo-like depigmentation.

A 6-year-old girl of Ethiopian origin with atopic eczema from the age of 2 years is reported. Prior to a visit to her grandparents in Ethiopia, she received 250 mg chloroquine weekly as prophylaxis against malaria. Three weeks later she developed sharply demarcated depigmentation on the face, especially in the peritoneal area. On returning home to Norway, the medication was discontinued and after a few weeks the first repigmentation was noticed. Complete repigmentation was observed 1 year after cessation of chloroquine therapy.