The effect of humic acid on the uptake of mercury(II), cadmium(II), and zinc(II) by Chinook salmon (Oncorhynchus tshawytscha) eggs.

The Chinook salmon (Oncorhynchus tshawytscha) is endangered or threatened in several of its ranges. The uptake of metals by Chinook salmon eggs and how humic acid (HA) affects the uptake is a subject of interest. Humic acid (0, 0.001, 0.01, and 0.05g/l) reduces the uptake of the metal ions Hg(II), Cd(II), and Zn(II), (1.0 microM) by eggs. HA is more effective in reducing the uptake of Hg than that of Cd or Zn. At [HA] = 0.001 g/L Hg uptake is reduced by 44% compared to no HA, while Cd and Zn uptakes are slightly or not reduced. Once the metals are taken up by the eggs, Hg migrates more slowly from the chorion to the yolk than either Zn or Cd. In experiments in which the metal contents of the chorion and yolk were measured at up to 24 h and five days after uptake, the order of migration was Cd > Zn > Hg. This observation is important when discussing the effects of metals on biological processes in the yolk because when Hg is taken up by eggs, a smaller percentage reaches the yolk than does Cd and Zn.

"Cloned" hairlines: the use of bisected hair follicles to create finer hairlines.

BACKGROUND: One living hair follicle, if horizontally bisected in the proper location, can be induced to subsequently produce two growing follicles. Their unpredictable growth rate, often less than 50%, has limited their use on a large scale. Their resultant finer caliber, however, can be used to benefit patients undergoing hair replacement surgery. OBJECTIVE: To determine whether horizontally bisected hairs can be employed to create finer, feathered anterior and temporal hairlines. METHODS: Twenty autologous terminal donor hairs were bisected as closely as possible to the "bulge" area immediately inferior to the zone of attachment of the arrector pili muscle. The 20 hair "shafts" were implanted along the left hairline. Twenty "bulbs" were implanted along the right hairline. Growth was evaluated and tabulated 2.5-8 months after transplant surgery. The procedure has been performed on 14 patients to date. Follow-up has been obtained on six patients ranging in age from 29 to 57 years. RESULTS: Overall, patients exhibited 46% growth from hair "shafts" (upper portion) and 47% growth from "bulbs" (lower portion). These bisected hairs were finer in caliber (diameter) than the original donor hairs. CONCLUSION: Horizontally bisected donor hairs can be implanted to create finer hairlines than otherwise would be expected from the theory of donor dominance. Further study is necessary in order to evaluate long-term success and additional applications of this technique.

Dermal grafting.

At the 1999 American Academy of Dermatology symposium on soft-tissue augmentation, Dr. Arnold Klein mentioned 31 different [figure: see text] filler substances now available world-wide. Of these 31, 29 were either synthetic or modified, and only two (dermis and fat) were autologous material reimplanted without significant alteration. Dermal grafts have stood the test of time. Before skin surfacing is performed, one must fill up depressions not improved by the resurfacing technique. The dermatologist or plastic surgeon should seriously consider adding dermal grafting to his or her armamentarium. Patients will likely be grateful!

Azone enhances clinical effectiveness of an optimized formulation of triamcinolone acetonide in atopic dermatitis.

BACKGROUND: Atopic dermatitis is a chronic, relapsing condition affecting up to 14% of the population in Western countries. Topical corticosteroids are the mainstay of treatment. Triamcinolone acetonide, a corticoid of intermediate potency, has proven useful in the treatment of atopic dermatitis. AIM: To evaluate the effectiveness of a triamcinolone acetonide-laurocapram combination in the treatment of atopic dermatitis. METHODS: One hundred and fifty patients were enrolled in a three-arm, parallel group, controlled clinical trial evaluating the effectiveness of a triamcinolone acetonide (0.05%) and laurocapram combination, applied twice daily for 2 weeks, in the treatment of atopic dermatitis. Fifty patients received triamcinolone acetonide-laurocapram (TNX), 50 triamcinolone acetonide (TN), and 50 a vehicle control formulation (AN). Response to treatment was evaluated by change in disease severity at 6 h, at 3, 8, and 15 days after the start of treatment, and by the global change in disease status. RESULTS: TNX effected a significantly higher degree of improvement in the signs and symptoms of atopic dermatitis (erythema, induration, and pruritus) and a greater overall improvement in disease status compared with treatment with TN or AN. Treatment-associated side-effects were local reactions, occurring in three, two, and six patients in the TNX, TN, and AN groups, respectively. CONCLUSIONS: The results suggest that the incorporation of laurocapram in the formulation enhances the effectiveness of triamcinolone acetonide, without compromising its safety profile.

Treatment of axillary hyperhidrosis: combination of the starch-iodine test with the tumescent liposuction technique.

OBJECTIVE: To evaluate and permanently improve axillary hyperhidrosis. BACKGROUND: Excessive sweating of the axillae is a common problem for which patients frequently seek dermatologic advice and therapy. Many treatments, including aluminum chloride, topical and systemic anticholinergic agents, tranquilizers, iontophoresis, direct surgical excision, botulinum toxin injection, and thoracic sympathectomy, have been employed to control this problem. All have drawbacks of one sort or another. METHODS: The starch-iodine technique for delineation of preoperative and postoperative axillary sweating is described in detail. A method of sweat gland removal utilizing tumescent liposuction is discussed. RESULTS AND CONCLUSION: The combination of the starch-iodine technique and tumescent liposuction is safe and effective for therapy of axillary hyperhidrosis.

The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia.

BACKGROUND: Data suggest that androgenetic alopecia is a process dependent on dihydrotestosterone (DHT) and type 2 5alpha-reductase. Finasteride is a type 2 5alpha-reductase inhibitor that has been shown to slow further hair loss and improve hair growth in men with androgenetic alopecia. OBJECTIVE: We attempted to determine the effect of finasteride on scalp skin and serum androgens. METHODS: Men with androgenetic alopecia (N = 249) underwent scalp biopsies before and after receiving 0.01, 0.05, 0.2, 1, or 5 mg daily of finasteride or placebo for 42 days. RESULTS: Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56. 5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively. Serum DHT levels declined significantly (P <.001) by 49.5%, 68.6%, 71.4%, and 72.2% in the 0.05, 0.2, 1, and 5 mg finasteride treatment groups, respectively. CONCLUSION: In this study, doses of finasteride as low as 0.2 mg per day maximally decreased both scalp skin and serum DHT levels. These data support the rationale used to conduct clinical trials in men with male pattern hair loss at doses of finasteride between 0.2 and 5 mg.

Clinical dose ranging studies with finasteride, a type 2 5alpha-reductase inhibitor, in men with male pattern hair loss.

BACKGROUND: Androgenetic alopecia is a common condition of adult men. Finasteride, a type 2 5alpha-reductase inhibitor, decreases the formation of dihydrotestosterone from testosterone. OBJECTIVE: Two separate clinical studies were conducted to establish the optimal dose of finasteride in men with this condition. METHODS: Men from 18 to 36 years of age with moderate vertex male pattern hair loss received finasteride 5, 1, 0.2, or 0.01 mg/day or placebo based on random assignment. Efficacy was determined by scalp hair counts, patient self-assessment, investigator assessment, and assessment of clinical photographs. Safety was assessed by clinical and laboratory measurements and by analysis of adverse experiences. RESULTS: Efficacy was demonstrated for all end points for finasteride at doses of 0.2 mg/day or higher, with 1 and 5 mg demonstrating similar efficacy that was superior to lower doses. Efficacy of the 0.01 mg dose was similar to placebo. No significant safety issues were identified in the trials. CONCLUSION: Finasteride 1 mg/day is the optimal dose for the treatment of men with male pattern hair loss and was subsequently identified for further clinical development.

Hair repair surgery. Corrective measures for improvement of older large-graft procedures and scalp scars.

BACKGROUND: Implanted hair follicles generally take and grow well. This can be desirable or undesirable, depending on the skill and aesthetic eye of the surgeon. Older methods employing larger grafts often produced pluggy, bristle brush, or "Barbie doll" hairlines that were unsightly and conspicuous. OBJECTIVE: Since patients possessing these outcomes often seek corrective measures, a search was undertaken to find effective, corrective repair methods. Unfortunately, relatively little has been published on this subject. METHODS AND RESULTS: Discussion will center on recipient site repair, donor site repair, and scar repair. Recipient sites can be improved with a combination of laser ablation, electrolysis, punch removal, and fill-in micrografting. Donor sites can be improved by reexcision, undermining, tissue expansion, and layered closure. Anterior scalp scars may be improved by punch excision and micrografting. CONCLUSIONS: Satisfactory improvement for untoward hair transplantation outcomes may be obtained with one or more corrective procedures in many patients.

Intratumoral chemotherapy with fluorouracil/epinephrine injectable gel: a nonsurgical treatment of cutaneous squamous cell carcinoma.

BACKGROUND: We attempted to originate a nonsurgical treatment alternative for cutaneous squamous cell carcinoma (SCC), and we evaluated intratumoral modified-release chemotherapy with fluorouracil/epinephrine injectable gel (5-FU/epi gel). OBJECTIVE: To assess the safety and efficacy, we conducted an open-label pilot study of 5-FU/epi gel in 25 patients with biopsy-proven SCC lesions on the face, head, neck, trunk, arms, and hands. METHODS: Each tumor site was injected intradermally with up to 1.0 ml of 5-FU/epi gel. One SCC per patient was treated weekly for up to 6 weeks, then observed for 4 months at which time the tumor site and margins were excised for histologic examination. RESULTS: Overall, 96% (22 of 23) of evaluable treated tumors had histologically confirmed complete tumor clearing. No clinically significant systemic reactions or unexplained treatment-related adverse medical events occurred. The evaluations of the cosmetic appearance of the treated sites, judged subjectively by clinicians and patients, were mostly good to excellent and generally in close agreement. CONCLUSION: Treatment of superficial SCC with 5-FU/epi injectable gel results in a high rate of histologically confirmed complete tumor responses and may provide a nonsurgical treatment alternative in selected patients.

Treatment of acne with a combination clindamycin/benzoyl peroxide gel compared with clindamycin gel, benzoyl peroxide gel and vehicle gel: combined results of two double-blind investigations.

BACKGROUND: It has previously been shown that a combination of erythromycin and benzoyl peroxide is superior to either ingredient when used alone in the treatment of acne. A clindamycin/benzoyl peroxide combination gel might have an advantage over erythromycin/benzoyl peroxide gel because the former does not require refrigeration after it is dispensed. OBJECTIVE: Our purpose was to determine the efficacy and safety of a combination clindamycin/benzoyl peroxide gel when compared with benzoyl peroxide, clindamycin, or vehicle gels. METHODS: In two double-blind, randomized, parallel, vehicle-controlled trials, patients were treated for 11 weeks with once-nightly application of one of the above preparations. Evaluations were performed at 2, 5, 8, and 11 weeks and included lesion counts and assessment of global responses and irritant effects. RESULTS: A total of 334 patients completed the study. All three active preparations were significantly superior to the vehicle in global improvement and in reducing inflammatory lesions and noninflammatory lesions. The combination gel was significantly superior to the two individual agents in global improvement and reduction of inflammatory lesions and also to the clindamycin gel in reducing noninflammatory lesions. There was no significant difference in tolerance to the active gels versus the vehicle gel. CONCLUSION: In the treatment of acne, topical clindamycin/benzoyl peroxide combination gel is well tolerated and superior to either individual ingredient.

Relationship of genital wart burden to therapeutic response to fluorouracil/epinephrine injectable gel.

The efficacy of a single cycle of a new therapy for genital warts, intradermal fluorouracil/epinephrine (5-FU/epi) injectable gel, has been evaluated in 2 large pivotal trials; the objective of this study was to evaluate a second cycle of treatment. Twenty-two patients with total wart areas of 5-447 mm2 were treated with up to 2 cycles of < or =6 treatments of 5-FU/epi gel. After the first cycle of treatments, patients with warts showing a partial response or no response or new warts were continued into a second cycle. Seventy-three per cent (16/22) of patients had complete responses. Patients with total wart areas < or = 100 mm2 tended to respond completely in the first cycle of treatment (average 4.7 treatments). Patients with numerous warts or large total wart areas (>100 mm2) required an average of 7.5 treatments to achieve a complete response. Thus, a second treatment cycle may be appropriate for difficult-to-treat patients with numerous warts or large total wart areas.

A randomized trial to assess once-daily topical treatment of tinea corporis with butenafine, a new antifungal agent.

BACKGROUND: Tinea corporis treatment usually requires topical application of an antifungal agent for 2 to 3 weeks. OBJECTIVE: We evaluated short-term treatment of tinea corporis with butenafine hydrochloride, a new benzylamine with in vitro fungicidal activity. METHODS: Patients (n = 78) were randomly selected to apply butenafine or its cream vehicle alone once daily for 14 days and were periodically assessed until day 42. RESULTS: Butenafine recipients had significantly higher rates of mycologic cure beginning at day 7 (64% vs 9%) with continued improvements through day 42 (88% vs 17%). They also had higher rates of effective treatment (mycologic cure and 90% to 100% symptom improvement) at day 7 (33% vs 0%) with increasing rates through day 42 (81% vs 14%). CONCLUSION: Butenafine provides rapid and persistent antifungal activity and symptom relief in patients with tinea corporis. Significant effects were observed within 7 days of therapy initiation, and increasing effectiveness was observed 4 weeks after therapy.

Clinical efficacy and safety comparison of adapalene gel and tretinoin gel in the treatment of acne vulgaris: Europe and U.S. multicenter trials.

BACKGROUND: Adapalene is a new chemical entity that exhibits tretinoin-like activities in the terminal differentiation process. OBJECTIVE: We evaluated a dose range effect of two concentrations of adapalene gel as acne treatment and compared adapalene 0.1% gel with tretinoin 0.025% gel in the treatment of acne patients in two large multicenter studies. METHODS: Multicenter, investigator-masked, parallel group studies including 89 acne patients in the dose range study and 591 patients in the concurrent controlled studies were conducted. RESULTS: Adapalene gel 0.1% was significantly more effective in treating acne lesions than 0.03% adapalene gel. Adapalene gel 0.1% was significantly more effective than 0.025% or tretinoin gel in one study and of the same effectiveness in the other study. Adapalene gel was always better tolerated than tretinoin gel. CONCLUSION: Adapalene 0.1% gel is a safe and effective treatment of acne vulgaris.

Intralesional fluorouracil/epinephrine injectable gel for treatment of condylomata acuminata. A phase 3 clinical study.

BACKGROUND AND DESIGN: A new intralesional sustained-release chemotherapy is under development as a treatment for condylomata acuminata; it is administered as an injectable gel that consists of fluorouracil and epinephrine with a purified bovine collagen as the gellant (fluorouracil/epinephrine gel). In this randomized, double-blind study, we evaluated the safety and efficacy of this intralesional treatment in 401 patients, using 2 active drug formulations (fluorouracil/epinephrine gel and fluorouracil gel alone) and a placebo. Each lesion was injected once a week for up to 6 weeks, and patients were followed up for 3 months. RESULTS: A total of 359 patients with 1926 condylomata underwent evaluation. For all lesions treated with fluorouracil/epinephrine gel, the complete response (CR) rate was 77%. For all patients treated with fluorouracil/epinephrine gel, the CR rate was 61%. The fluorouracil/epinephrine gel was significantly more effective (P < .002) in treating condylomata than the fluorouracil gel without epinephrine (CR rate, 43%); both were superior to placebo (CR rate, 5%). At 3 months after completion of treatment, recurrence rates in patients with CRs were as follows: fluorouracil/epinephrine gel group, 50%; fluorouracil gel group, 58%. No clinically significant drug-related systemic reactions occurred. Finally, the type and severity of local tissue reactions of patients with a positive pretreatment collagen skin test result (6/401 [1.5%]) were similar to those of patients with a negative collagen skin test result. CONCLUSION: The fluorouracil/epinephrine injectable gel is a safe and effective treatment for condylomata acuminata.

Development of intralesional therapy with fluorouracil/adrenaline injectable gel for management of condylomata acuminata: two phase II clinical studies.

OBJECTIVES: To evaluate a sustained release chemotherapy for treating condylomata acuminata with an injectable gel containing fluorouracil and adrenaline (5-FU/adrenaline gel). Study 1-- To assess contributions of the components of 5-FU/adrenaline gel to efficacy. Study 2--To assess therapeutic contribution of adrenaline and safety and efficacy of the formulations. DESIGN: Randomised, double blind, placebo controlled studies. SETTING: Private practices and university clinics in the United States. PATIENTS: Men and women with new, recurrent, or refractory external condylomata acuminata. INTERVENTION: Six injections over 8 weeks; follow up visits at weeks 1, 4, 8, and 12. EFFICACY: patient/wart response, times to complete response, recurrence rates. SAFETY: injection reactions, tissue conditions, other adverse events, laboratory studies. RESULTS: Study 1: 132 evaluable patients. Complete response (CR) rate was highest for the 5-FU/adrenaline gel group, followed by the 5-FU/adrenaline solution group, then the 5-FU gel group. 5-FU, adrenaline, and the collagen gel vehicle (in the presence of 5-FU) significantly affected CR and strongly influenced time to CR. The effects of 5-FU and adrenaline were statistically significant. Cutaneous reactions were mild to moderate. Study 2: 187 evaluable patients. Patients treated with 5-FU/adrenaline gel had a significantly higher CR rate and lower cumulative 90 day recurrence rate than those treated with 5-FU gel without adrenaline. Treatments were generally well tolerated, with only three treatment related, serious adverse events. CONCLUSION: 5-FU/adrenaline gel is safe and efficacious for treatment of condylomata acuminata, and when compared with individual or various combinations of components, this formulation provided the greatest therapeutic advantage.

Vanadium in ascidians: changes in vanadium coordination and oxidation state upon cell lysis.

Changes in vanadium coordination during cell lysis have been followed by EPR spectroscopy of the blood cells of the phleborbranch ascidians Ascidia ceratodes and PHallusia julinea. The spectra obtained for A. ceratodes whole blood samples can be mainly ascribed to aquated oxovanadium(IV) in which the signals are broadened in freshly frozen blood relative to when the cells are lysed by thawing. The sources of this broadening are discussed and it is shown that the oxovanadium(IV) signal has its origin in a small percentage of damaged or lysed cells which release vanadium into a low sulfate, low acid environment in fresh samples. When thawed, the cells lyse releasing acid and sulfate into the environment of the oxovanadium(IV), with consequent narrowing of the EPR spectral linewidth. Freshly frozen P. julinea blood cell samples have EPR spectra with parameters intermediate between aquated oxovanadium(IV) and the "type I" parameters observed in a previous investigation of tissue samples of this species (S. G. Brand, C. J. Hawkins, A. T. Marshall, G. W. Nette, and D. L. Parry, Comp. Biochem. Physiol. 93B, 425 (1989)). A. ceratodes tissue samples also have EPR spectra that differ from that of the blood. It is suggested that EPR studies on tissue samples are more indicative of the resting state of vanadium in the cells as there is more physiological material to provide a pH buffering effect to stabilize the cells. Schemes are presented which incorporate all of the EPR observations in ascidian literature, where cellular lysis is proposed to be accompanied by vanadium undergoing oxidation and a series of chelate exchanges from a "type I" complex to aquated oxovanadium(IV). Protons released during these exchanges are suggested to provide the acidity characteristic of blood cell lysates. The biological implications of the concomitant release of vanadium and tunichrome (S. W. Taylor, D. L. Parry, C. J. Hawkins, and J. H. Swinehart, Comp. Biochem. Physiol. 106A, 531 (1993)) from the blood cells, to the process of wound repair are discussed.

Scalp lifting. Anatomic and technical considerations.

BACKGROUND: Extensive scalp lifting, though offering the potential for tremendous benefit to the patient with extensive male-pattern alopecia, has not been widely accepted or understood. OBJECTIVE: The anatomic and technical features of extensive scalp lifting are discussed. METHODS: The performance of extensive scalp lift surgery must be preceded by a thorough understanding of the specific goals, anatomic considerations, surgical techniques, and specific methods for successful completion of this operation. A knowledge of preoperative preparation, anesthesia, intraoperative methods, undermining, hemostasis, means of scalp advancement, and proper closure are essential for minimizing side effects and complications of this beneficial procedure. One must understand the dynamics of scalp stretching and lifting in order to achieve optimum removal of baldness and to successfully predict the outcome of the operation. CONCLUSION: Present and future advantages of scalp lifting over traditional scalp reduction have been enumerated and discussed.