Basal cell carcinomas in a tertiary referral centre: a systematic analysis.

BACKGROUND: Basal cell carcinoma (BCC) is the most frequent skin cancer with increasing incidence and generally high cure rates. BCC can be quite aggressive and is difficult to treat. OBJECTIVES: To investigate BCCs with a focus on histological subtypes, treatment procedures and correlation to clinical progress to collect further information on complex BCC cases. METHODS: In this retrospective single-centre analysis the dermatopathology database, a network of cooperating dermatological surgeons, was queried for BCC cases between January 2007 and December 2011. Of 14,423 samples from a total of 9652 patients initially identified, 2938 patients were treated at the University Hospital Zurich and had corresponding local electronic patient records. RESULTS: Patients (n = 2938) (with 4769 diagnoses, 2006 re-excisions with 1180 microscopically controlled surgeries) were classified based on severity estimations into 2240 simple, 640 moderate, and 58 severe cases, including one BCC-treatment-associated death and 11 patients with subsequent participation in a clinical trial. In moderate and severe cases (n = 698), there were significantly higher rates of unique histological diagnoses (n = 2·5; P < 0·0001), higher association with basosquamous carcinoma [odds ratio (OR) 3·6; P < 0·0001] and sclerosing BCC (OR 2·48; P < 0·0001). Of the patients with basosquamous carcinoma 82·6% had a previous history of BCC. CONCLUSIONS: This is the first study that analyses the frequency of complicated BCCs in a tertiary referral centre. There were 6·6% moderate (640 of 9652) and 0·6% (58 of 9652) severe cases. We found significantly more varying histological diagnoses and significant association with aggressive subtypes in moderate and severe cases. These patients might especially benefit from new therapeutic options.

Diabetic Ketoacidosis Associated with Sodium-Glucose Cotransporter 2 Inhibitors: Clinical and Biochemical Characteristics of 29 Cases.

Objective: To describe the clinical and biochemical characteristics of all reported cases of DKA associated with SGLT2 inhibitor use in patients with type 2 diabetes mellitus and to identify potential risk factors. Design: A retrospective case series was conducted between March 2013 and August 2019 using an electronic medical record search algorithm. Results: 25 patients met the criteria for DKA associated with SGLT2i use (total of 29 cases), 15 were female, average age was 54.24 years, and mean diabetes duration was 8.76 years. The majority of the patients (23 patients) had no history of prior DKA. Average blood glucose concentrations at presentation were 298.9 ± 152.7 mg/dl. Interestingly, nearly half of the episodes (14) met the criteria of euglycemic DKA (glucose <250 mg/dl). Average anion gap values were 26.59 ± 6.15 mg/dl, bicarbonate values were 11.14 ± 5.57 mg/dl, and pH values were 7.16 ± 0.12. All had positive serum and urine ketones. The most common presenting symptoms were nausea, vomiting (18 cases), and abdominal pain (10 cases). Common precipitants were poor oral intake (18 cases) and infection (10 cases). A variety of drugs were prescribed along with an SGLT2i, and 11 of the patients were using insulin. None of the cases were fatal. Comparison between euglycemic DKA and hyperglycemic DKA did not identify any significant difference. A major limitation factor of the study was the lack of control group or comparison to other antiglycemic agents to assess the relative risk. Conclusions: The majority of SGLT2i-associated DKA cases occurred in patients with T2DM without prior episodes of DKA. The most common presenting symptoms were nausea, vomiting, and abdominal pain, while poor food intake and infection were the main precipitants. Clinicians should consider the possibility of DKA in SGLT2i-treated patients presenting with these symptoms, even in absence of marked hyperglycemia.

Nitrosamine levels in human blood, urine and gastric aspirate following ingestion of foods containing potential nitrosamine precursors or preformed nitrosamines.

In studies of the effect of diet on nitrosamine levels in selected human physiological fluids, volunteers were fed meals containing fish or beef (sources of precursor amines) or bacon (a source of preformed nitrosamines), in combination with spinach and vegetable juice to supply nitrite via possible reduction of nitrate. Blood, urine and gastric contents were sampled periodically for up to 4 hr after feeding. The results of the study indicated that traces of nitrosamines, usually N-nitrosodimethylamine, were present in many samples of blood, urine and gastric contents, even after an 8-hr fast. Eating the test meals led to a slight increase in nitrosamine levels in the blood and stomach contents in a few subjects. The data obtained from this study suggest that gastric formation of nitrosamine does not appear to be an important health factor in normal people, since the levels of nitrosamines found in physiological fluids are not markedly increased after eating.

Amino acid distribution in brain after use of amphetamines and beta-phenylethylamine.

Amino acids in rat brain were assayed after IP injection d-amphetamine or beta-phenylethylamine (PEA). Results revealed elevated values when one utilized 2.0-12 mg/kg of d-amphetamine. At 15 mg/kg, however, all amino acids fell into the control range except tryptophan which was elevated nearly threefold, and methionine which showed a tenfold decrease. When utilizing PEA to induce the behavioral changes only methionine is decreased at all concentrations of PEA. Chlorpromazine did not disturb the amino acid distribution induced by amphetamine or PEA. When haloperidol was utilized as the neuroleptic to prevent behavioral change there was a significant increase above control of all the amino acids including homocysteine. The implications of this are discussed in the text.