Metal chelator combined with permeability enhancer ameliorates oxidative stress-associated neurodegeneration in rat eyes with elevated intraocular pressure.

Because as many as half of glaucoma patients on intraocular pressure (IOP)-lowering therapy continue to experience optic nerve toxicity, it is imperative to find other effective therapies. Iron and calcium ions play key roles in oxidative stress, a hallmark of glaucoma. Therefore, we tested metal chelation by means of ethylenediaminetetraacetic acid (EDTA) combined with the permeability enhancer methylsulfonylmethane (MSM) applied topically on the eye to determine if this noninvasive treatment is neuroprotective in rat optic nerve and retinal ganglion cells exposed to oxidative stress induced by elevated IOP. Hyaluronic acid (HA) was injected into the anterior chamber of the rat eye to elevate the IOP. EDTA-MSM was applied topically to the eye for 3 months. Eyeballs and optic nerves were processed for histological assessment of cytoarchitecture. Protein-lipid aldehyde adducts and cyclooxygenase-2 (COX-2) were detected immunohistochemically. HA administration increased IOP and associated oxidative stress and inflammation. Elevated IOP was not affected by EDTA-MSM treatment. However, oxidative damage and inflammation were ameliorated as reflected by a decrease in formation of protein-lipid aldehyde adducts and COX-2 expression, respectively. Furthermore, EDTA-MSM treatment increased retinal ganglion cell survival and decreased demyelination of optic nerve compared with untreated eyes. Chelation treatment with EDTA-MSM ameliorates sequelae of IOP-induced toxicity without affecting IOP. Because most current therapies aim at reducing IOP and damage occurs even in the absence of elevated IOP, EDTA-MSM has the potential to work in conjunction with pressure-reducing therapies to alleviate damage to the optic nerve and retinal ganglion cells.

Regional variation in the use of medications by older Canadians--a persistent and incompletely understood phenomena.

BACKGROUND: We have previously reported on regional variability in medication consumption by older Canadians. In this study, we used longitudinal data to determine whether regional differences in commonly consumed medications persisted and to explore potential explanatory factors for observed differences. METHODS: We utilized data from the second phase of the Canadian Study of Health and Aging to assess the number, types, and variability of medications used between regions. Linear and logistic regressions (LRs) were used to predict the number of medications and the use of specific agents where significant regional variability was found to exist. RESULTS: There were significant regional differences in the number of medications consumed and in the prevalence of use of acetaminophen (p < 0.002), benzodiazepines (p < 0.020), nitrates (p = 0.040), and complementary and alternative medicines (CAMs; p < 0.020). The proportion of subjects using acetaminophen was highest in British Columbia (44.6%) and lowest in Quebec (27.3%). Benzodiazepine and nitrate consumption was highest in Quebec (35.9 and 19%, respectively) and lowest in the Praires (18.2%) and Atlantic Canada (6.6%). CAM use was highest in British Columbia (47.1%) and lowest in the Atlantic region (26.8%). Similar inter-regional differences had been found 5 years previously. There were no significant regional differences in the prevalence of hypertension, myocardial infarction, diabetes, arthritis/rheumatism, or depression. Region remained a significant explanatory variable for the number of medications and nitrate, benzodiazepine, and CAM use in our multivariate models. CONCLUSIONS: Regional differences in medication use persisted over the course of this longitudinal study. Much of the variability remains unexplained. The reasons for regional differences in consumption of drugs and their clinical significance should be addressed.

Mycosis fungoides bullosa: report of a case and review of the literature.

Mycosis fungoides, the most common type of cutaneous T-cell lymphoma, can manifest in a variety of clinical and histologic forms. Presentation with vesiculobullous lesions is extremely rare. We report the ninth documented case of mycosis fungoides bullosa in which other concomitant autoimmune blistering diseases were ruled out by negative immunofluorescence. All previously reported cases in the world literature since the first in 1887 are reviewed. We recommend the following defining criteria for the disease: (1) clinically apparent vesiculobullous lesions, with or without typical mycosis fungoides lesions (patches, plaques, tumors); (2) typical histologic features of mycosis fungoides (atypical lyphoid cells, epidermotropism, Pautrier's microabscesses) with intraepidermal or subepidermal blisters; (3) negative immunofluorescence (both direct and indirect, if possible) to rule out concomitant autoimmune bullous diseases; (4) negative evaluation for other possible causes of vesiculobullous lesions (eg, medications, bacterial or viral infection, porphyria, phototherapy).

Reductive dehalogenation of trichloroacetic acid by Trichlorobacter thiogenes gen. nov., sp. nov.

A bacterium able to grow via reductive dechlorination of trichloroacetate was isolated from anaerobic soil enrichments. The isolate, designated strain K1, is a member of the delta proteobacteria and is related to other known sulfur and ferric iron reducers. In anaerobic mineral media supplemented with acetate and trichloroacetate, its doubling time was 6 h. Alternative electron donor and acceptors were acetoin and sulfur or fumarate, respectively. Trichloroacetate dehalogenation activity was constitutively present, and the dechlorination product was dichloroacetate and chloride. Trichloroacetate conversion seemed to be coupled to a novel sulfur-sulfide redox cycle, which shuttled electrons from acetate oxidation to trichloroacetate reduction. In view of its unique physiological characteristics, the name Trichlorobacter thiogenes is suggested for strain K1.

Increased use of cardiovascular medications in seniors prescribed non-ASA non-steroidal anti-inflammatory drugs.

The objective of this study was to determine the relationship between the prescribing of non-ASA non-steroidal anti-inflammatory drugs (NANSAID) and the prescribing of select cardiovascular (CV) medications. We performed a retrospective, cross-sectional analysis of the prescribed use of these medications between December 1, 1990 and June 30, 1991 by Albertans 65 years of age and older utilizing data from the publically-funded drug benefit plan. Variables examined were: the number of individuals prescribed NANSAID and CV medications; mean daily dose for these medications; calculated relative dose; the proportion of NANSAID users prescribed CV medications compared to non-users; and the relative proportions of users of specific NANSAID prescribed CV medication. We found that 33.4% and 19.6% of Albertan seniors were prescribed CV medications and NANSAID, respectively. NANSAID users were twice as likely to be prescribed CV medications as compared to non-users. Intermediate/high dose NANSAID users were more likely to be prescribed a CV medication as compared to low-dose users. The risk of being prescribed a CV medication was highest for indomethacin and users of multiple NANSAID, while ibuprofen users had the lowest risk. We conclude that NANSAID users are more likely to be also prescribed CV medications. Subjects who consume a lower dose of NANSAID are less likely to be prescribed CV medications. For different NANSAID, there is a spectrum of risk.

Complementary medicine use in a dementia clinic population.

Complementary medicine is frequently utilized for a variety of chronic health problems. We evaluated its use among patients attending a Canadian dementia clinic. Using a telephone survey, we inquired about the use of alternative therapy, including nutritional supplements, herbal remedies, and chelation therapy, for problems with cognition. Only 9.6% of our patient population used complementary medicine as a treatment for cognitive problems. A further 29% used complementary medicines for general health promotion. While higher use might have been anticipated because of the limited conventional therapies available, we did not find a high prevalence of consumption of alternative medicine for cognitive problems. Knowledge of the use of these therapies is still important and should not be neglected. A nonjudgmental inquiry into all therapies being used (for whatever reason) should be part of the assessment of any patient with suspected dementia.

Oral premedication for local anesthesia in plastic surgery: prospective, randomized, blind comparison of lorazepam and temazepam.

Patients undergoing plastic surgical procedures under local anesthesia as inpatients were entered into a phase III randomized, blind trial designed to compare two commonly used oral premedications, lorazepam and temazepam. The effects of the drugs on each patient's memory, pain, sedation, and anxiety were assessed by questions asked of the patient, the nurse, and the surgeon. Analysis was based on 100 randomized patients. Lorazepam had a significantly greater amnesic effect (p < 0.0001), resulted in less pain with the local anesthetic injection (p = 0.006), and had a greater sedative effect than temazepam (p < 0.0001, patient's assessment; p = 0.005, observers' assessments). There was no significant difference in anxiolysis between the two premedications (p = 0.20). If premedication is indicated, we advocate the use of lorazepam rather than temazepam as premedication for plastic surgical procedures to be performed under local anesthesia, provided there is adequate postoperative supervision.

Seabather's eruption. Clinical, histologic, and immunologic features.

BACKGROUND: Seabather's eruption (SE) is a highly pruritic eruption under swimwear that occurs after bathing in the ocean. Its cause has been unknown. Few data have been collected since the classic description by Sams in 1949. OBJECTIVE: Our purpose was to describe the clinical and histopathologic findings in SE and to confirm the cause. METHODS: Patients with a pruritic eruption that developed after swimming were seen within 1 week of onset. Skin biopsy specimens and sera were obtained in selected cases. Water samples taken from areas of active SE outbreaks were examined for a causative organism. Sera were tested by enzyme-linked immunosorbent assay for reactivity to this organism. RESULTS: In southeast Florida, during a 4-month period, 70 patients with SE were seen. Inflammatory papules and pruritus were noted within hours of exposure. Eruptions were maximal in areas covered by a bathing suit. Children were more likely than adults to have systemic symptoms. The average duration of the eruption and pruritus was 12.5 days, with recurrences in 4.3% of patients. Histopathologic examination revealed a superficial and deep perivascular and interstitial infiltrate consisting of lymphocytes, neutrophils, and eosinophils. Water samples contained many cnidarian larvae, later grown to maturity and identified as Linuche unguiculata (thimble jellyfish). Enzyme-linked immunosorbent assay demonstrated in patients' sera high IgG levels specific for L. unguiculata. CONCLUSION: SE is a severely pruritic marine dermatosis that resolves spontaneously within 2 weeks. Therapy is symptomatic but often ineffective. Sera from affected persons showed specific reactivity to L. unguiculata.

A study of acne treatments as risk factors for skin cancer of the head and neck.

A retrospective questionnaire was conducted as to the risk factors for facial skin cancer with emphasis on acne and past treatments for acne, in particular use of benzoyl peroxide preparations. The response rate was 90.9% for 964 cases and 79.9% for 3856 controls. There was no association between acne and the use of any acne medication for the risk of facial skin cancer. Cases of skin cancer were significantly more likely to have used phototherapy or sunbeds than the controls (P = 0.024), and more likely to have had radiotherapy prior to diagnosis (P = 0.001). The major risk factors as determined by generalized linear interactive modelling were family history of skin cancer (odds ratio 2.68; 95% confidence interval 2.15, 3.34), light skin (1.54; 1.25, 1.89), sunburning easily (1.43; 1.16, 1.76) and Irish, Scottish, Scandinavian or German mothers (1.33; 1.11, 1.59).

Patch testing in actinic prurigo.

42 out of 93 Saskatchewan Indians (32 female (F) and 10 male (M] with actinic prurigo were patch tested to standard series allergens between 1983 and 1987. Positive reactions were most frequently seen with nickel (3F:2M) and colophony. All 3 positive patch tests to colophony were in males. The same patients were also patch tested to extracts of 21 Saskatchewan plants and 3 Hollister-Stier plant extracts. Only 1 male and 2 females had positive patch tests. None of these 3 had rashes on the eyelids, behind the ears or under the chin. We conclude that plant contact dermatitis is unlikely to be mistaken for actinic prurigo in Saskatchewan.