Infiltrated papules on the trunk and headaches: A case of actinic granuloma and a review of the literature.

Actinic granuloma is a rare granulomatous reaction that is more commonly seen in females and thought to occur as an autoimmune response to actinic damage of elastic tissue. We discuss a case of a patient with actinic granuloma presenting with concomitant temporal arteritis. Our case and review of the literature emphasize the association between actinic granuloma and temporal arteritis, a serious inflammatory condition that could lead to blindness if misdiagnosed.

Modulation of cyclin-dependent kinase 4 by binding of magnesium (II) and manganese (II).

All kinases require an essential divalent metal for their activity. In this study, we investigated the metal dependence of cyclin-dependent kinase 4 (CDK4). With Mg(2+) as the essential metal and MgATP being the variable substrate, the maximum velocity, V, was not affected by changes in metal concentration, whereas V/K was perturbed, indicating that the metal effects were mainly derived from a change in the K(m) for MgATP. Analysis of the metal dependence of initial rates according to a simple metal binding model indicated the presence on enzyme of one activating metal-binding site with a dissociation constant, K(d(a)), of 5 +/-1 mM, and three inhibitory metal-binding sites with an averaged dissociation constant, K(d(i)), of 12+/-1 mM and that the binding of metal to the activating and inhibitory sites appeared to be ordered with binding of metal to the activating site first. Substitution of Mn(2+) for Mg(2+) yielded similar metal dependence kinetics with a value of 1.0+/-0.1 and 4.7+/-0.1 for K(d(a)) and K(d(i)), respectively. The inhibition constants for the inhibition of CDK4 by MgADP and a small molecule inhibitor were also perturbed by Mg(2+). K(d(a)) values estimated from the metal variation of the inhibition of CDK4 by MgADP (6+/-3 mM) and a small molecule inhibitor (3+/-1 mM), were in good agreement with the K(d(a)) value (5+/-1 mM) obtained from the metal variation of the initial rate of CDK4. By using the van't Hoff plot, the temperature dependence of K(d(a)) and K(d(i)) yielded an enthalpy of -6.0 +/- 1.1 kcal/mol for binding of Mg(2+) to the activating site and -3.2 +/- 0.6 kcal/mol for Mg(2+) binding to the inhibitory sites. The values of associated entropy were also negative, indicating that these metal binding reactions were entirely enthalpy-driven. These data were consistent with metal binding to multiple sites on CDK4 that perturbs the enzyme structure, modulates the enzyme activity, and alters the affinities of inhibitor for the metal-bound enzyme species. However, the affinities of small molecule inhibitors for CDK4 were not affected by the change of metal from Mg(2+) to Mn(2+), suggesting that the structures of enzyme-Mg(2+) and enzyme-Mn(2+) were similar.

Ethical dilemmas in dermatologic surgery.

Dermatologic surgery presents a unique set of ethical dilemmas not frequently discussed within the medical literature. This contribution presents a few cases commonly encountered by dermatologic surgeons. The case-based discussion follows a principles-based framework for analysis and seeks to identify the central moral conflict and exemplify the development of sound reasoning for subsequent decision making through the consideration of multiple viewpoints and the weighing of potential consequences. Additional cases are provided in concise format to encourage further analysis and discourse on the distinct ethical dilemmas encountered within dermatologic surgery.