Langerhans cell histiocytosis and Erdheim‐Chester disease,both with cutaneous presentations,and papillary thyroid carcinoma all harboring the BRAFV600E mutation

Langerhans cell histocytosis (LCH) and Erdheim‐Chester disease are two rare histiocytic disorders. Their occurrence in the same patient is more infrequent, but has been described. We report a case of a 38‐year‐old woman who presented with a diagnosis of single system cutaneous LCH. Subsequently, she developed multiple papules on her extremities consistent with a non‐LCH xanthogranuloma type lesion. BRAF^V600E mutation immunostain, VE1 was positive in the skin lesion, which was confirmed by molecular polymerase chain reaction (PCR) studies, initiating a complete systemic workup for Erdheim‐Chester disease. Systemic involvement was confirmed with bilateral sclerotic bone lesions and retroperitoneal and pelvic fibrosing disease. She was also found to have a BRAF^V600E mutation positive papillary thyroid carcinoma. New suspicious cutaneous lesions presenting in patients with a history of LCH need to be biopsied. A BRAF^V600E mutation in a non‐LCH histiocytic lesion with a xanthogranuloma phenotype (CD163/CD68/CD14/fascin/Factor 13a) should prompt an Erdheim‐Chester disease workup. This is a unique case of a woman with BRAF^V600E mutation positive Erdheim‐Chester disease and cutaneous LCH, while also being, to our knowledge, the first reported case in the English literature of it occurring in a patient with a BRAF^V600E mutation positive papillary thyroid carcinoma.     

Refractory Angina

The regimen for treating refractory angina is similar to that for impending infarction. Specific approaches to treatment include drugs and other medical methods. Operative intervention is reserved for those patients who do not respond to medical measures.     

Treatment of Neurogenic Voiding Dysfunction: An Update

The neurophysiology of volitional voiding is a poorly understood and constantly evolving field. Some of the most difficult clinical problems in urology arise from structural or neural deviations from this process. These may occur as a result of traumatic injury, congenital defect, or neurological disease. Neurogenic voiding dysfunction is a frequently encountered disorder with multiple etiologies and nonstandardized care. A pervasive complaint in neurogenic voiding dysfunction is detrusor overactivity and resultant urinary incontinence. However, the results of “ideal” initial therapy—catheterization with or without anticholinergics—have been far from satisfactory. This review attempts to go beyond perfunctory measures to explore recent data on anticholinergic therapies, long-term data on botulinum A toxin injections, and applications of neuromodulation.     

Introduction: aging education in a global context

Introduction to a collection of articles on aging education in a global context based on the proceedings of the annual conference of the Association for Gerontology in Higher Education (AGHE). The volume includes a dual focus on (1) issues related to gerontology and geriatric education around the world and (2) issues related to teaching about global and cross-cultural aging. Several of the chapters provide useful information and resources for educators seeking ways to incorporate cross-cultural aging into their courses. The remaining three chapters deal with issues related to aging education in Kenya, Japan and China.     

Cutaneous involvement in a rare case of adult visceral leishmaniasis acquired in Israel

Skin lesions are rare in visceral leishmaniasis, especially in Mediterranean countries. We describe an unusual case of visceral leishmaniasis in a 41-year-old man that began with a skin lesion. The parasites isolated from both the skin lesion and the bone marrow were typed as Leishmania donovani sensu stricto. This pathogen is not endemic in Israel or neighboring countries; its contribution to adult visceral leishmaniasis in Israel is summarized.     

Lymphokine-induced phagocytosis in angiocentric immunoproliferative lesions (AIL) and malignant lymphoma arising in AIL

A factor that augmented the phagocytosis of IgG-coated ox red blood cells by the human monocyte/macrophage line U937 was identified in cell culture supernatants from two of two patients with angiocentric peripheral T cell lymphomas, three of three patients with angiocentric immunoproliferative lesions that were not frankly malignant, and one of two patients with T lymphoblastic malignancies. The factor was not present in supernatants derived from 14 nonangiocentric peripheral T cell lymphomas of other histologic types nor in ten cases of B cell lymphoma and two cases of Hodgkin's disease. A similar factor was present in the supernatants of concanavalin A (Con A)-stimulated normal peripheral blood mononuclear cells and in the supernatants of IL-2- dependent T cell lines derived from normal peripheral blood. The factor had an apparent mol wt of greater than 50,000 daltons, was heat labile (100 degrees C for two minutes), and stable at pH 2.0. Its stimulation of phagocytosis was independent of any increase in number of Fc receptors. Thus, this factor is probably not gamma-interferon. This factor may play a pathogenetic role in the hemophagocytic syndromes associated with certain T cell malignancies and immunodeficient states.     

Inducing Low Tar/Nicotine Cigarette Smoking in Women

Sixteen female smokers participated in a study of ‘safer cigarettes’ and bought their cigarettes from the experimenters at less than prevailing prices. Half received an economic incentive for purchasing cigarettes delivering progressively less tar and nicotine: the other half paid the same price regardless of brand purchased. Subjects were not required to change brands. Twelve of the sixteen subjects completed the twelve-week study. Significant reductions in tar and nicotine intake, which persisted for more than six months beyond the twelve-week study period, occurred in both groups. The differences between the two groups in tar and nicotine intake were not significant. A control group of seven female smokers showed little change in tar and nicotine intake over the same twelve-week period, and only modest changes in the subsequent six months. Neither the number of cigarettes smoked nor exhaled carbon monoxide levels (measured in a subsample of participants) increased as the subjects switched to lower nicotine levels.