Daylight-mediated photodynamic therapy of basal cell carcinomas - an explorative study.

BACKGROUND: Studies have shown that daylight-photodynamic therapy (PDT) is an effective treatment of actinic keratoses, nearly pain free and more convenient for both the clinics and patients. Treatment of basal cell carcinomas (BCCs) is another main indication for PDT. OBJECTIVES: The aim of this open, uncontrolled, prospective explorative study was to evaluate the efficacy of daylight-PDT for BCCs. METHODS: Twenty-one patients with a total of 32 BCCs located in the face, scalp, chest, back and lower leg received one cycle of daylight-methyl aminolevulinate (MAL)-PDT, consisting of two treatments 1 week apart. After sunscreen application and lesion preparation, MAL was applied and patients exposed themselves to daylight for 2½ h. Daylight exposure was monitored with a wrist-borne dosimeter. RESULTS: At 3-month follow-up, complete response was seen in 30 lesions (94%) and in 19 patients (90%). At 12-month follow-up, six lesions had recurred resulting in a total recurrence rate of 21% (6/29) as one lesion was lost to follow-up. Twelve months after daylight-PDT, 74% (23/31) of the treated lesions showed complete response. During each treatment, the mean effective light dose was 10.8 J/cm(2) during an average of 152 min of daylight exposure. Treatment was pain free with good or excellent cosmesis. CONCLUSIONS: In conclusion, daylight-PDT proved to be as effective as conventional PDT in the treatment of BCCs in this explorative clinical study. Daylight-PDT was pain free and more convenient for both clinicians and patients. The cosmetic outcome was good or excellent. Larger studies need to confirm the findings of this study.

Evaluation of pneumonia diagnosis in intensive care patients.

The aims of this study were to investigate the frequency of bronchopneumonia diagnosed by histological criteria among autopsied intensive care unit (ICU) patients and to compare these with rates of pneumonia diagnosed by conventional clinical methods. The study material comprised 141 autopsied ICU patients from 7 ICUs in university hospitals in Copenhagen from a 1-y period. A total of 20 lung tissue specimens were sampled from each patient and the histopathological diagnoses were classified as no, mild, moderate or severe bronchopneumonia. Inter-observer variation was calculated using kappa statistics. Demographic data and diagnoses of pneumonia were registered from the patient files. Twenty-six percent of the patients had pneumonia diagnosed whilst in the ICU. Histological evidence of pneumonia, found for every second patient, was regarded as the gold standard. Diagnosis of pneumonia in the ICU had a sensitivity of 29% and if diagnoses of pneumonia during the month before ICU-admission were included, a sensitivity of 60% was found. Specificity for pneumonia diagnosed in the ICU was 77%. The percentage of all ICU-patients with pneumonia was calculated to be between 36% and 56%, depending on the extent of excess mortality attributable to pneumonia. Pulmonary segments with histologically diagnosed pneumonic lesions were distributed diffusely, although the upper segments tended to be affected less. Nearly all patients had other histopathological findings than bronchopneumonia. The reliability coefficient among the 6 pathologists was found to be moderately good (kappa = 0.45).

Clinical and dermatoscopic diagnosis of malignant melanoma. Assessed by expert and non-expert groups.

We investigated the nosographic and diagnostic probabilities and likelihood ratios of dermatoscopy in order to evaluate the method's role in decision-making regarding melanoma. Clinical slides and dermatoscopic photos were obtained from 232 patients referred for dermatoscopy. Four dermatoscopy "experts" and 5 "non-experts" assessed the slides. Diagnoses were compared with histopathology. Sensitivity of the clinical assessments was 0.78 vs. 0.69 ("experts" vs. "non-experts"), sensitivity of dermatoscopy assessment was 0.83 vs. 0.69 (p = 0.04). The expert group demonstrated increased specificity (from 0.89 to 0.94) when applying dermatoscopy compared with clinical assessment alone (p=0.03). Positive likelihood ratios were doubled in the "expert group" and the negative likelihood ratios improved 25% with dermatoscopy compared with clinical assessment.

The delayed-type hypersensitivity reaction is dependent on IL-8. Inhibition of a tuberculin skin reaction by an anti-IL-8 monoclonal antibody.

Cell-mediated immune reactions are essential to our immune response toward foreign organisms such as microorganisms, or in the response toward foreign tissue Ags, as seen in the rejection of allogeneic transplanted organs. Similar reactions form the basis for the development and the progression of delayed-type hypersensitivity (DTH) reactions. We found that the alpha-chemokine IL-8 plays an important pathophysiologic role for the development of a DTH reaction because infusion of a neutralizing anti-IL-8 mAb (WS-4) was able to suppress the development of a tuberculin skin reaction in rabbits, as judged by histologic, biochemical, and clinical examinations. Thus, the number of neutrophil granulocytes and lymphocytes at the site of tuberculin injection was decreased considerably, and the clinical signs of inflammation were suppressed almost completely at 24 h after intracutaneous injection of tuberculin, as judged by the size of the infiltrates. In contrast, we did not see any effect on the visible erythema of the skin. We found that the tissue content of myeloperoxidase (MPO), reflecting the number of infiltrating neutrophils, was lowered significantly. Furthermore, immunohistochemical analysis confirmed that IL-8 immunoreactivity is actually enhanced in the skin of positive tuberculin reactions. The results indicate that IL-8 plays an important role for the early accumulation of leukocytes in the skin and for the clinical signs of a DTH reaction.

Primary paraganglioma of the lung. Report of two cases and review of the literature.

Two cases of primary paragangliomas of the lung are presented. The first occurred in a 69-year-old woman and was a grossly and histologically benign tumour. The other case occurred in a 33-year-old woman who had metastases to the peribronchial lymph nodes. This seems to be the second malignant case reported. No evidence of recurrence nor metastatic disease was found at follow-up, 8 months for the first case and 7 years for the second, respectively. The morphological and immunohistochemical findings are discussed and the literature comprising 20 cases is reviewed.

[Preclinical hereditary hemochromatosis--is there an indication for preventive screening?]. / Praeklinisk hereditaer haemokromatose--er der behov for profylaktisk screening?

A 54 year-old previously healthy woman was admitted with staphylococcus aureus septicaemia. The patient had been treated with oral iron supplementation for two years due to fatigue. In the evaluation of postinfectious anaemia, serum transferrin saturation and serum ferritin were found persistently elevated with values of 74% and 950 micrograms/1, respectively. Hereditary haemochromatosis was suspected even though there was no history of liver disease or diabetes mellitus in the family. A bone marrow biopsy showed a normal content of haemosiderin iron. The liver biopsy revealed haemosiderosis, mainly located to the periportal hepatocytes, and fibrosis in the portal tracts. The HLA-type was A3, B7, B37. Over a period of ten months, a total of 3.9 g of iron was removed by venesection while S-ferritin declined to 31 micrograms/l. A sister to the proband had an identical HLA type, but normal iron status markers, either indicating heterozygosity or homozygosity with lack of penetrance. In preclinical hereditary haemochromatosis, early diagnosis and treatment is essential in order to prevent organ damage and to improve prognosis. Prophylactic screening is recommended. The identification of one homozygous subject in a Danish year-cohort of 60.000 persons costs approximately 40.000 Danish kroner (7.000 US+).

Impact of soft tissue on in vivo accuracy of bone mineral measurements in the spine, hip, and forearm: a human cadaver study.

The impact of soft tissue in vivo on accuracy of bone mineral density (BMD) measurements of the spine and hip by dual energy X-ray absorptiometry and of the forearm by single photon absorptiometry was assessed by use of 14 human cadavers. The in vivo accuracy errors (SEE%) were: forearm 3-5%, anteroposterior spine 5.3%, lateral spine 10-12%, and femoral greater trochanter, neck, total, intertrochanteric, and Ward's triangle 3%, 6.5%, 6.7%, 8%, and 11-13%, respectively. Except from the lateral spine and the greater trochanter, the slopes of the linear regressions of in vivo BMD against in vitro BMD were not significantly different from 1 (p > 0.05). The calculated random accuracy error of BMD measurements due to fat inhomogeneity was estimated to 3-4% for the anteroposterior spine and 9-14% for the lateral spine (from abdominal computed tomography in 26 healthy women). In conclusion, acceptable accuracy errors below 6-7% (of soft tissue in vivo) of BMD measurements were obtained in the anteroposterior spine, the forearm, and the neck, greater trochanter, and total proximal femur.