Acromegaly caused by ectopic growth hormone-releasing hormone production from a bronchial carcinoid tumor.

Acromegaly is usually caused by a growth hormone (GH)-secreting pituitary adenoma. In rare cases, however, it is caused by the ectopic production of growth hormone-releasing hormone (GHRH). We report a case of acromegaly due to ectopic production of GHRH from a bronchial carcinoid in a 42-year-old female. The carcinoid tumor was successfully treated with bilobectomy.

Treatment with a barrier-strengthening moisturizing cream delays relapse of atopic dermatitis: a prospective and randomized controlled clinical trial.

BACKGROUND: Standard treatment of atopic dermatitis (AD) is based on topical glucocorticosteroids or calcineurin inhibitors to treat flares combined with moisturizer treatment to alleviate dry skin symptoms. Patients with AD have an abnormal skin barrier function, and strategies for reducing the risks for eczema would be to repair the barrier or prevent barrier dysfunction. OBJECTIVES: The objective of this study was to explore the time to relapse of eczema during a 26-week maintenance treatment with a urea containing moisturizer compared to no treatment (neither medical nor non-medicated preparations) after successful clearing of atopic lesions. The moisturizer has previously been shown to improve skin barrier function. METHODS: Patients applied betamethasone valerate (0.1%) on eczematous lesions during a 3-week period. Those with cleared eczema entered a 26-week maintenance phase, applying the moisturizer or left the previously affected area untreated. Upon eczema relapse, patients were instructed to contact the clinic and to have the relapse confirmed by the investigator. RESULTS: Fifty-five patients entered the study and 44 patients were included in the maintenance phase (22 using moisturizer twice daily and 22 using no treatment). Median time to relapse for patients treated with moisturizer was > 180 days (duration of the study) compared with 30 days for the no-treatment group. Sixty-eight per cent of the patients treated with the moisturizer and 32% of the untreated patients remained free from eczema during the observation period. CONCLUSIONS: Maintenance treatment with a barrier-improving urea moisturizer on previous eczematous areas reduced the risk of relapse to approximately one third of that of no treatment.

The rate of formation of corneocyte layers after stripping the noninvolved psoriatic skin and its relation to parakeratosis and epidermal enzyme levels.

Corneocyte layer formation rate using dansyl chloride as corneocyte marker was followed in noninvolved skin during a period of 2 weeks after that the skin had been subjected to cellophane stripping. The rate increased after stripping in 7 of 9 tested but it was not paralleled by any apparent parakeratosis. In 1 of 9 patients a Koebner reaction occurred. The corneocyte formation rate in the Koebner reaction was 6.1 times that of the noninvolved skin and with a degree of parakeratosis of 41%. In involved skin, a positive correlation, coefficient 0.81, was shown between corneocyte layer formation rate (range 3.9-15.2 layers/day) and degree of parakeratosis (range 24-100%). In the skin 5 to 14 days after stripping the rate of formation of the corneocyte layer varied from 1.6 to 8.2. In the noninvolved and involved skin the mean rate was 2.2 and 9.7, respectively. In the stripped skin epidermal glucose-6-phosphate dehydrogenase and pyruvate kinase activities generally were the same as those of the noninvolved skin. In the Koebner reacting epidermis the 2 enzymes were increased 2.2 and 1.1 times the noninvolved levels but were statistically not significantly increased from control values.

Subpopulations of mononuclear cells in microscopic lesions of psoriatic patients. Selective accumulation of suppressor/cytotoxic T cells in epidermis during the evolution of the lesion.

The age of microscopic lesions in psoriatic subjects was assessed from the stacking characteristics in the horny layer and related to type and density (cells/tissue volume) of mononuclear cells in the epidermis and the dermis determined by immunoperoxidase methods using monoclonal antibodies. Pan T cells (Lyt-2+, Lyt-3+, Leu-4+, OKT3+), T helper cells (Leu-3a+, OKT4+), T suppressor/cytotoxic cells (Leu-2a+, OKT8+), Ia+ cells and monocytes (OKM2+, BRL alpha mono+) were determined in epidermis and dermis. The psoriatic lesion was divided into regions underneath a parakeratotic and an orthohyperkeratotic/hypergranular portion of the horny layer and contrasted with perilesional and uninvolved psoriatic skin as well as with healthy skin. In the various regions and skin layers, the cell density was highest in parakeratosis and decreased toward normality with decreasing histologic abnormality. The relation between epidermal and dermal cell densities of the T-cell subsets was modified in the involved psoriatic skin with a selective preponderance of T suppressor/cytotoxic cells in the epidermis. The accumulation was present in the youngest lesion found (3 days) and cell densities were unchanged in older lesions. The findings suggests that the altered relationship in the subsets of T cells has an important role during the induction and progress of the psoriatic process in the skin.

Effects of low medium magnesium concentration on bone resorption in response to parathyroid hormone and 1,25-dihydroxyvitamin D in organ culture.

We have examined the effects of decreasing the magnesium concentration in the medium on bone resorption in organ culture. During a 5-day culture, low magnesium (0.25 vs. 0.8 mM) caused a decrease in unstimulated 45Ca release from live and killed fetal rat bones for the first 2 days but not thereafter, suggesting an early and transient alteration in physicochemical equilibrium for calcium between bone and extracellular fluid in magnesium deficiency. In addition, 45Ca release in response to low and intermediate doses of PTH and 1,25-dihydroxyvitamin D3 was significantly impaired throughout the 5-day culture period, such that the response to the lowest dose of both hormones that was effective at 0.8 mM magnesium was abolished at 0.25 mM. The DNA and magnesium content of bones was significantly decreased after 1 day of preculture in deficient medium. Subsequently, there was DNA loss from control bones, such that there was no significant difference in high and low magnesium concentrations at the end of the culture period. Our studies show that low magnesium concentration impairs the skeletal response to calcium-mobilizing hormones in vitro and that this is not likely to be due to nonspecific cell toxicity. Such an effect may play a role in the hypocalcemia associated with magnesium depletion in vivo.

Thionapthene-2-carboxylic acid: a new antihypercalcemic agent.

Thiophene-2-carboxylic acid (TCA) was previously shown to be hypocalcemic in the rat. We have compared TCA with thionapthene-2-carboxylic acid (TNCA), an analog which is a more potent inhibitor of bone resorption in vitro, for the ability to decrease serum calcium concentration in vivo. In normocalcemic rats on a low calcium diet, TNCA (2 mmol/kg) produced a larger and more prolonged decrease in calcium concentration than TCA. In rats bearing the Walker 256 carcinosarcoma, which became hypercalcemic, TNCA produced a dose-related decrease in serum calcium concentration at 0.3-1.2 mmol/kg. TNCA reduced serum calcium concentration in 4-6 h, and the effects were sustained for up to 72 h. TNCA was effective after oral as well as sc administration. Unlike calcitonin which produced only a transient reduction in serum calcium followed by escape, the effects of TNCA (0.6 mmol/kg) were sustained for 1 week and were accompanied by a decrease in mortality in tumor-bearing animals. We conclude that TNCA is a potent hypocalcemic action which has a rapid and prolonged effect without evidence of escape. This and related compounds should be tested further for use in treatment of hypercalcemia and other states characterized by excessive bone resorption.

From major amputation to prosthetic outcome: a prospective study of 190 patients in a defined population.

In this prospective study, the overall treatment and outcome of patients that underwent major lower limb amputation in a defined population is described. The study was performed over a five year period in the Health Care District of North-East Skåne, Sweden. Some 190 patients, permanent inhabitants of the Health Care District, underwent major lower limb amputation. Sixteen (16) of these patients had amputations before the study started and went through late second leg amputation during the period. One hundred and seventy four (174) patients had primary major amputation. Seventy nine (79) were men and 95 were women, with a median age of 81. The re-amputation rate was 17% although the primary knee preservation ratio was as high as 3.0:1. Rigid dressing was the standard method following trans-tibial amputation and was used for 5-7 days. ICEROSS silicone liner was used for compression therapy in 90% of all cases that resulted in delivery of a prosthesis. Prostheses were delivered to 43% of all patients with primary amputations. These patients spent a median of 13 days at the orthopaedic clinic. 55 days at the rehabilitation unit. Pressure casting was used as a standard method in the production of the prosthetic socket. ICEX carbon-fibre socket was used in 52%. New procedures, treatments and techniques were introduced, standardised and evaluated whilst the routines in the hospital were reorganised. In this way, a system has been implemented that better guarantees the outcome of the whole procedure and the service received by this category of patients.

Iodine status of adolescent girls in a population changing from high to lower fish consumption.

OBJECTIVES: During the last decades, fish and milk consumption has decreased considerably in Iceland, especially among adolescents. As these food items are important dietary iodine (I) sources, the aim of the study was to assess the iodine status and dietary pattern of adolescent girls in a population changing from a high to lower consumption of milk and fish. SUBJECTS/METHODS: Subjects were randomly selected adolescent girls (16-20 years old, n=112). A validated Food Frequency Questionnaire (FFQ) was used to evaluate food consumption and compare it with food-based dietary guidelines for milk and dairy products (2-3 portions/day) and fish (> or =2 times/week). Urine samples were collected for measuring urinary iodine (U-I) and creatinine (Cr) and blood samples for measuring serum thyroid-stimulating hormone (TSH). RESULTS: Milk and dairy products provided 43% and fish provided 24% of the total dietary I. More than 65% of the girls consumed fish less than twice a week, and 40% consumed less than two portions of milk and dairy products per day. The median U-I concentration was 200 microg/l and the U-I/Cr ratio 138 microg I/g Cr. High intake of milk was associated with higher urinary iodine concentration, but fish intake was not found to be directly associated with urinary iodine concentration. CONCLUSIONS: Iodine status of Icelandic adolescent girls is within the optimal range defined by the World Health Organization. It is important to monitor both iodine status and the iodine concentration of important sources of iodine, as both dietary habits and composition of food might change with time.

Razor blade surgery of large vessels on the nose.

Large vessels of the nose have been treated with razor blade shave technique in 5 patients. A good cosmetic result has been achieved.

A simplified method of focal salabrasion for removal of linear tattoos.

A simple method for the removal of linear tattoos is described, where tissue destruction is limited to tattooed skin and the resulting necrosis does not extend more than 1 mm into non-tattooed skin. The epidermis overlying tattooed skin can easily be scraped after heat separation. Table salt is rubbed into and left on the area where epidermis has been removed. The achieved necrosis appears only in the heat-treated skin and heals with an acceptable scar.

Razor blade surgery of keratoacanthoma.

This simple method is both a diagnostic and therapeutic procedure which combines the advantages of other methods that have been proposed in the literature. The cosmetic results have been very good in the presented cases.

Psoriasis of the scalp treated with Grenz rays or topical corticosteroid combined with Grenz rays. A comparative randomized trial.

To investigate the effect of Grenz ray therapy alone compared with Grenz rays combined with a topical corticosteroid (betamethasone dipropionate) in psoriasis of the scalp, 40 patients were randomized into two groups. One group received 4 Gy of Grenz rays administered on six occasions at intervals of 1 week and the other group was given the same Grenz ray treatment plus topical corticosteroid. The patients were assessed before and after Grenz ray therapy and were followed-up for 6 months. Of the 37 patients who completed the trial 16 out of 19 (84%) of the patients in the Grenz ray group, and 13 out of 18 (72%) of the patients in the combination group healed. The remission time did not differ significantly between the two groups. Of the patients who healed, 5 of 16 patients in the Grenz ray only group and 4 of 13 patients in the combination group remained healed at 6 months. We conclude that Grenz ray therapy is a useful treatment modality for scalp psoriasis, but that the addition of a topical corticosteroid has only a minor effect.

The effect of grenz rays on psoriasis lesions of the scalp: a double blind bilateral trial.

Sixteen patients with symmetrical psoriasis lesions of the scalp were treated with grenz rays. In a double blind fashion, one side of the scalp was irradiated with 4 Gy of grenz rays applied on 6 occasions at intervals of 1 week, and the other side of the scalp was given placebo treatment. The patients were seen before and after X-ray therapy. A significantly (P less than 0.0001) better therapeutic result was recorded on the side of the scalp which had received active grenz ray therapy. In 14 of the 16 patients there was complete healing on the grenz ray-treated side after 6 wk of treatment. Nine patients were still free of lesions of the scalp 3 months after the start of the grenz ray therapy.

Additional effect of grenz rays on psoriasis lesions of the scalp treated with topical corticosteroids.

In a double-blind study comprising 17 patients with symmetrical psoriasis lesions of the scalp, the combination of grenz ray treatment and topical steroid showed a faster clearing than with the topical steroid alone. The results also indicate a longer remission time with the combination therapy compared to grenz rays alone. Therefore both the faster clearing and the longer remission time with the combination therapy, as compared to our previous study of grenz ray treatment of scalp psoriasis, are probably due to the additional effect of steroid therapy, on grenz rays.

Measurement of the horny layer turnover after staining with dansyl chloride: description of a new method.

A simple non-radioactive technique is described. The corneal layers were stained with 5% dansyl chloride ointment during 24-48 h of occlusion. The number of newly formed corneal layers were counted on sections from punch biopsies obtained at various intervals after the staining. The rate of formation is given as layers formed per 24 hours. The technique makes it possible to detect an increase in the turnover rate when it is more than 15-32% above normal. The biological material can also be utilized for comparative studies utilizing biochemical and histological methods. The average rate of formation was 1.15+-0.09 (S.E.M.) layers per 24 hours in a group of 10 subjects.

Corneocyte morphology and formation rate in lichen planus and experimental parakeratosis in subjects with and without psoriasis.

In a recent paper changes in corneocyte morphology and formation rate in psoriasis have been established. In the present study the specificity of these alternations were analysed in two situations. Early lichen planus papules were chosen as a model of hyperproliferation with hypergranulosis and orthohyperkeratosis. Hyperproliferation with parakeratosis was induced by nonanoic acid (CH3(CH2)7COOH) as an experimental model in psoriatics and non-psoriatics. In lichen planus papules, the rate of corneocyte layer formation was 2.4 times that of the non-involved skin. In psoriasis, a similar rate was found in parts with hypergranulosis. A 13% decrease in corneocyte diameter took place in lichen planus lesions--similar to that found in psoriasis. The corneocytes in lichen planus were also thicker than normal cells, though their volumes were similar. Thickness decreased in more superficial locations of these corneocytes. Swelling was a finding during the histological procedure, Corneocytes in the lesion increased markedly in volume, due to swelling. The parakeratosis elicited by nonanoic acid showed cells with irregular membranes and nuclei with non-flattened and irregular borders. The rate of corneocyte layer formation was 2.6 times that of the normal skin. The epidermal reaction to the superficial damage by nonanoic acid did not differ between psoriatics and non-psoriatics. This type of parakeratosis was distinctly different from that present in psoriasis.