Increased risk of breast cancer in relatives of malignant melanoma patients from families with strong cancer familial aggregation.

The aim of this study was to evaluate the risk of occurrence of malignancies of different site of origin in patients with malignant melanoma (MM) of the skin and their first-degree relatives from families with cancer familial aggregations with unknown pathogenetic background (CFA). We analysed tumour spectrum and age at diagnosis of malignancies in 51 families with MM/CFA. In addition, we evaluated observed frequency (OF); expected frequency (EF); and relative risk (RR) of occurrence of malignancies in these families. In all cases peripheral blood examination of common Polish founder BRCA1 mutations was performed. In 25 families, we analysed loss of heterozygosity of BRCA1 and BRCA2 genes. We identified two subgroups of cases: 22 MM/CFA families with MM diagnosed before 55 years (< or =55 MM/CFA) and 29 MM/CFA families with MM diagnosed after 55 (>55 MM/CFA). In these families we observed increased proportion of breast cancers: 17.52% in the first subgroup (mean age of diagnosis 48.5) and 12.15% in the second subgroup. The odds ratio for breast tumours occurring before 50 in < or =55 MM/CFA families was 3.71. We also observed increased numbers of liver cancers, CSU and leukaemias. OF and EF analyses revealed increased risk of occurrence of cancers of breast (OF 10.4%, EF 4.5%) and liver (OF 1.9%, EF 0.8%) in women from MM/CFA families, RR for breast tumours was approximately 3.3 in < or =55 MM/CFA families. Molecular examination of MM/CFA families revealed no alterations within the BRCA2 gene and one germline mutation of the BRCA1 gene. In conclusion, it seems to be justified to consider systematic breast surveillance beginning at the age around 35-40 years as an option in women from < or =55 MM/CFA families.

[Bacterial flora of acne lesions in diagnostic material of the Microbiology and Immunology Department, Pomeranian Medical Academy (PAM) in Szczecin]. / Flora bakteryjna zmian tradzikowych w diagnostycznym materiale Zaklad Mikrobiologii i Immunologii PAM w Szczecinie.

A retrospective analysis of the bacterial flora of acne lesions was carried out in 320 patients. Atypical flora was isolated very rarely. The pathogenic flora was found most frequently in the Autovaccine Laboratory when the microbiological material was taken directly onto plates and the investigation was repeated several times. Atypical flora was isolated only from three cases. Propionibacterium and Staphylococcus epidermidis were found to be sensitive to the antibiotics routinely used in the treatment of acne. The highest antibacterial effect in vitro against both these species was demonstrated using rifampicin and tetracycline.

[Skin reactions to antigens of propionibacterium acnes in patients with acne vulgaris treated with autovaccine]. / Odczyny skórne na antygeny Propionibacterium acnes u pacjentów z tradzikiem pospolitym leczonych autoszczepionka.

One of the most common diseases of the skin is acne. The etiology and pathogenesis of acne, in spite of the advancement of medical knowledge, remain unknown and the effects of treatment unsatisfactory. The mechanism of the beneficial effects of immunotherapy in some cases of acne, including autovaccines prepared from the bacterial strains of the patient, also awaits explanation. The present work was aimed at elucidating the influence of autovaccine on some parameters of specific humoral and cellular response against the same strains of Propionibacterium acnes that were isolated from the patient to prepare the autovaccine. These parameters were evaluated in vivo on the basis of early and delayed skin reactions and in vitro using respective laboratory tests. By analysing the influence of autovaccine on the immunological status it was hoped to shed some light on the immunological aspects of acne. An improvement after autovaccine was noted in 47.6% of patients. At the same time it was observed that the results of the present treatment with autovaccine were much better in patients who were previously treated for acne with Acnevac or autovaccine than in other patients. One may therefore conclude that repeated immunotherapy in acne is advantageous in terms of results. The frequency of early skin reactions against the Propionibacterium acnes of the patient and against standard strains, the level of serum IgE antibodies in patients with acne of various intensity and the release of histamine in the presence of Propionibacterium acnes from basophils of patients with positive early skin reactions all stand against the role of early-type hypersensitivity and anaphilactoid phenomena linked with the structural antigens of the patient's strains of Propionibacterium acnes in the pathogenesis of acne (Tab. 1, Fig. 1). Reactions reflecting delayed-type hypersensitivity against the patient's strains of Propionibacterium acnes were observed more frequently than early-type reactions and more frequently than against standard strains (Tab. 2). Clinical improvement was particularly evident in patients in whom the intensity of the reactions decreased after treatment. This was accompanied by higher titres of specific antibodies against structural antigens of Propionibacterium acnes (Tab. 3) and a greater inhibition of migration of mononuclear cells in the presence of these bacteria or a nonspecific mitogen (PHA). It was concluded that specific antibodies generated by the autovaccine and directed against the strain of Propionibacterium acnes of the patient may reduce the intensity of delayed-type reactions in some cases of acne, as previously reported for tularemia and tuberculosis. Final unequivocal conclusions as to the pathogenesis of acne and mechanism of the effects of autovaccine could not be drawn. However, the present results form an encouraging basis for further research in this field.

Bullous systemic lupus erythematosus with antiphospholipid syndrome.

We report the case of a 44-year-old male with a 10-year history of manifestations of the rare form of bullous systemic lupus erythematosus (SLE) with coexisting antiphospholipid syndrome (APS) that remained undiagnosed until thrombotic-embolic episodes appeared and high titres of anticardiolipin (ACL) antibodies were detected. The patient fulfilled the criteria for SLE and the atypical cutaneous manifestations together with histopathological changes and a favourable response to sulphones were the grounds for the diagnosis of the bullous variety of SLE. Treatment with prednisolone, acenocoumarol and dapsone resulted in marked clinical improvement, reduction in antinuclear antibodies (ANAs) and normalization of ACL antibody titres.