Erythrocyte uroporphyrinogen decarboxylase activity in porphyria cutanea tarda: a study of 40 consecutive patients.

We measured uroporphyrinogen decarboxylase (UROD) activity in erythrocyte lysates obtained from 40 consecutive patients with porphyria cutanea tarda (PCT) without selection for family history. Enzyme determinations indicated that 28% of the patients had abnormally decreased UROD activity in erythrocytes; this finding did not always correlate with family history. Two siblings with PCT and normal erythrocytic, but abnormally decreased hepatic UROD activities, were encountered. This finding suggests that familial PCT may occur not only with decreased erythrocyte UROD activity, but also with a normal UROD activity in erythrocytes.

Consort contact dermatitis due to oak moss.

An allergic contact dermatitis in a woman was found to be due to oak moss in her husband's after-shave lotion. When routine patch testing reveals a positive reaction, the dermatologist should consider exposure to the antigen not only in the patient but also through contact with the patient's consort.

Evaluation of the relative contribution of exposure routes in a health risk assessment of dioxin emissions from a municipal waste incinerator.

Polychlorinated dioxins (PCDDs) and furans (PCDFs) are perceived by the public as the most hazardous materials emitted from municipal waste incinerators. These compounds disperse in the atmosphere and deposit on environmental media, where they may bioconcentrate in the food chain, resulting in a number of potential sources for human exposure. We performed a cancer risk assessment of PCDD/PCDF emissions from a municipal waste incinerator to evaluate the relative contribution of various exposure routes. Three scenarios were examined, all of which predicted ingestion of fish to be a significant source of exposure. In the common case, representative of the general population consuming mainly foods from commercial sources, inhalation was predicted to be the source of greatest exposure, followed by ingestion of fish, beef, milk, vegetation, and soil. In addition to fish, milk and beef ingestion contributed significantly to total exposure under the highly-exposed and worst case scenarios. Life-time cancer risk from the emitted PCDD/PCDFs was assessed for each scenario and was estimated as 1.8 x 10(-7) (common case), 2.5 x 10(-6) (highly-exposed case), and 6.7 x 10(-6) (worst case). In view of the conservative assumptions used in the assessment, the relatively low magnitude of these risks suggests that the PCDD/PCDF emissions from this incinerator should not be considered a significant public health concern.

Nursing care of patients with esophageal cancer.

Esophageal cancer is an uncommon but aggressive disease with the potential for early metastasis. The majority of patients will present with metastatic disease, and treatment is usually palliative. This affects the physical and psychosocial needs of the patient and family. The nurse plays a crucial role in the care of these individuals and, therefore, needs a current and in-depth understanding of the disease, its treatment, and its nursing management.

Nursing care of the patient with spinal cord compression.

Spinal cord compression (SCC) is a common oncologic emergency that can profoundly affect the remainder of the patient's life. SCC develops when pressure is exerted on the spinal cord by a tumor or by a collapsed vertebral body that has been replaced by cancer. When the condition is diagnosed and treated early, the patient may maintain ambulatory status; however, when the diagnosis is made late and neurologic compromise has occurred already, there is minimal expectation that impaired functions will return. SCC is treated with dexamethasone and radiation therapy, and surgery occasionally is performed. Nursing care, an integral component in the management of this challenging condition, may be as simple as educating the at-risk patient about the signs and symptoms of SCC or as complex as meeting the many needs of the paraplegic patient. This article reviews the etiology and clinical presentation of SCC as well as assessment, treatment, and nursing care related to the condition.

Cancer of the prostate: treatment and nursing implications.

PURPOSE/OBJECTIVES: To review the clinical manifestations, current treatment, and nursing management of prostate cancer. DATA SOURCES: Published articles, book chapters, American Cancer Society booklets. DATA SYNTHESIS: Prostate cancer is a slow-growing malignancy and usually is asymptomatic in its early stages. It causes acute urinary obstruction at more advanced stages, and patients may present with metastatic disease. Diagnosis is made by biopsy, and treatment options include periodic observation, surgery, radiotherapy hormonal manipulation, and chemotherapy with standard or investigational drugs or combination therapy. The major complications associated with surgery and radiation therapy are transient or permanent incontinence and impotence. CONCLUSIONS: Because no definitive method for identifying clinically important lesions exists, much controversy surrounds prostate cancer treatment. Issues significant to the diagnosis and treatment of all stages of prostate cancer are identified, and nursing care concerns focusing on treatment and disease-related problems are presented. IMPLICATIONS FOR NURSING PRACTICE: Nursing care focuses on providing patients with accurate information to make informed decisions regarding treatment for early stage disease, on promoting comfort, and on preventing and managing treatment and disease-related complications. Nursing diagnoses include knowledge deficit; altered sexual patterns, body image disturbance, altered urinary elimination, diarrhea, impaired skin integrity, and pain, fatigue, bleeding, and infection, all of which are related to surgery, pathologic fractures, spinal cord compression, and edema of the scrotum/lower extremities.

Hair casts or pseudonits acquired following psychological trauma.

We present an unusual case of hair casts occurring after psychological trauma. These pseudonits must be correctly differentiated from pediculosis capitis.

Vitiligo and pernicious anemia presenting as congestive heart failure.

The skin often provides diagnostic clues to systemic disorders. Vitiligo is an acquired disease characterized by depigmentation of the skin due to destruction of melanocytes. Vitiligo may be an autoimmune disease and is associated with other disorders that may also arise due to autoimmune mechanisms. We present the unusual case of vitiligo associated with pernicious anemia in a patient who presented to the hospital because of hyperdynamic congestive heart failure.

A review of blepharochalasis and other causes of the lax, wrinkled eyelid.

Cosmetically unappealing lax, wrinkled eyelid skin may result from various processes including connective tissue diseases, natural aging, and blepharochalasis. Since the end-stage eyelid changes due to several different processes are similar, the presence or absence of prior chronic or recurrent eyelid edema is an important differentiating point. We review blepharochalasis and provide a logical approach to its differential diagnosis.

Eruptive vellus hair cysts.

Eruptive vellus hair cysts are an apparent developmental anomaly of vellus hair follicles that result in an asymptomatic papular eruption characteristically located on the anterior chest in young patients. A case of eruptive vellus hair cysts in reported, and the clinical and histologic findings are reviewed.

Cutaneous sinus of dental origin: a diagnosis requiring clinical and radiologic correlation.

Cutaneous sinuses may arise from chronic dental infections. These sinus tracts usually appear as suppurative lesions of the chin or neck. Diagnosis is made by palpating the lesion and by radiologic examination demonstrating periapical dental abscess. Treatment with dental extraction or root canal results in resorption of the inflammatory fistula. Since many patients with sinus tracts of dental origin do not have any complaints of tooth or mouth pain, the correct diagnosis may be overlooked by the unsuspecting clinician.

Coma blisters: report and review.

Coma blisters are self-limited lesions that occur in the setting of coma of various causes, but are most commonly associated with barbiturate overdose. Examination of a skin biopsy specimen demonstrates the characteristic presence of eccrine sweat duct necrosis. Although the exact cause of coma blisters remains unknown, they are not related to underlying infections or rheumatologic disorders, and do not contraindicate the continued therapeutic use of barbiturates.

Basal cell carcinoma of the scalp in a black patient.

Basal cell carcinoma rarely occurs in black persons. When it does occur, it most often involves the sun-exposed areas of the face. Basal cell carcinoma of the scalp often occurs after other predisposing events such as radiation damage, nevus sebaceus, or systemic conditions such as arsenic exposure or immunosuppression. We report the unusual case of a basal cell tumor arising de novo on the scalp of a black patient with none of these predisposing conditions.

Noduloulcerative or "malignant" syphilis occurring in an otherwise healthy woman: report and review of a dramatic dermatosis.

We present the case of an otherwise healthy woman with noduloulcerative ("malignant") syphilis, the first female patient reported with this dermatosis in fifty years. This rare form of secondary syphilis is characterized by noduloulcerative lesions with rupioid crusts that dramatically involve the face while usually sparing the palms and soles. The aggression and destruction of the skin lesions may mimic that of other granulomatous and infiltrative dermatoses. Since the incidence of syphilis is increasing, physicians should be aware of this variant that is so disfiguring it has historically been referred to as lues maligna.

Phytophotodermatitis.

Phytophotodermatitis is a skin eruption resulting from the interaction of the sun's radiant energy and photosensitizing compounds found in various plants. Common offenders are celery, limes and certain oranges, as well as natural grasses. The acute phase of the skin eruption is characterized by edema and erythema. In the chronic phase, hyperpigmentation may develop at the contact site.

Surgical amelioration of Dercum's disease: a report and review.

Dercum's disease, or adiposis dolorosa, is a rare condition characterized by painful lipomas, usually on the extremities of obese postmenopausal women. At present, there are no treatments known to alter the progressive course of this often incapacitating disease. Surgical intervention, while not preventive, is useful in ameliorating local symptoms of pain. We report a characteristic 15-year course of Dercum's disease.

Linear porokeratosis: successful treatment with diamond fraise dermabrasion.

A patient with linear porokeratosis was successfully treated with diamond fraise dermabrasion. Follow-up evaluation revealed an excellent cosmetic result with adequate repigmentation, no scarring, and no recurrence of lesions. Long-term follow-up will be necessary to determine whether dermabrasion treatment of linear porokeratosis provides adequate prophylaxis against the subsequent development of malignancy.

Use of touch preparation for rapid diagnosis of disseminated candidiasis.

Disseminated candidiasis is the most common fungal infection occurring in patients with hematologic malignancies. Unless rapidly diagnosed and treated, it is usually fatal. The signs and symptoms of disseminated candidiasis are nonspecific but sometimes include a skin eruption of papulonodules with pale centers. Biopsy or culture of skin lesions does not usually allow prompt diagnosis. We describe two patients with leukemia with disseminated candidiasis in whom the diagnosis was rapidly made by a potassium hydroxide preparation and a Gram's stain of a touch preparation of the punch biopsy specimen.