Incidence of cancer among patients with atopic dermatitis

OBJECTIVE: To assess the risk of skin cancer and other cancers among patients with atopic dermatitis. DESIGN: Register-based retrospective cohort study. SETTING: Sweden.Patients A total of 15 666 hospitalized patients identified in the national Inpatient Register as having discharge diagnoses of atopic dermatitis between January 1, 1965, and December 31, 1999.Interventions The National Swedish Cancer Register coded malignant neoplasms during the entire period of study. Follow-up time was calculated from the date of entry in the cohort until the occurrence of a first cancer diagnosis, emigration, death, or the end of the observation period, whichever occurred first. MAIN OUTCOME MEASURES: Follow-up by means of record linkages to several nationwide registers, among them the National Swedish Cancer Register. Standardized incidence ratios (SIRs) (the ratios of numbers of observed patients with cancer to expected numbers of incident cases of cancer) estimated the risk of developing cancer relative to the risks in the age-, sex-, and calendar year- matched general Swedish population. RESULTS: After excluding the first year of follow-up, the risk of developing any cancer was increased by 13% (95% confidence interval [CI] of SIR, 1.01-1.25, based on 311 observed patients with cancer). Excess risks were observed for cancers of the esophagus (SIR, 3.5; 95% CI, 1.3-7.7; 6 patients), pancreas (SIR, 1.9; 95% CI, 1.0-3.4; 11 patients), brain (SIR, 1.6; 95% CI, 1.1-2.4; 27 patients), and lung (SIR, 2.0; 95% CI, 1.3-2.8; 31 patients) and for lymphoma (SIR, 2.0; 95% CI, 1.4-2.9; 29 patients). There was a nonsignificant 50% excess risk for nonmelanoma skin cancer (SIR, 1.5; 95% CI, 0.8-2.6; 12 patients), seemingly confined to men and to the first 10 years of follow-up. Malignant melanoma did not occur more often than expected. CONCLUSIONS: The observed risk elevations, all of borderline statistical significance, should be interpreted cautiously. We could not control for possible confounding by cases of cancer caused by smoking, and the combination of multiple significance testing and few observed patients may have generated chance findings.     

Darier-White disease treated with oral isotretinoin

Darier-White Disease (DWD) is an autosomal dominant disorder, described by Darier and White in 1889, characterized by abnormal keratinization in the epidermis, nails and mucosae. We present the case of a 16-year-old, male patient, with clinically and histologically confirmed DWD treated with oral isotretinoin (0.7 mg/kg/day) for six months, with good response. We recommend an optional therapeutic treatment for chronic, itchy, recalcitrant lesions with oral retinoids.     

Parental support for newborn screening for cystic fibrosis

Aim: To describe the attitudes among parents towards including cystic fibrosis (CF) in the newborn screening programme and towards the potential knowledge of their own carrier status. Methods: A questionnaire with three to five response categories and an information leaflet was posted to 143 CF parents, 3 matched diabetes and 3 matched population parents, the response rate being 85%, 74% and 70%, respectively. Comparisons between groups were made with statistical tests for independent groups. Results: Eighty‐six percent of CF, 70% of diabetes and 77% of population parents were in favour of newborn screening for CF, 47%, 45% and 50%, respectively, wished to know their CF carrier status. The parental attitude was independent of the age of the child, as well as delay of diagnosis and well‐being of the CF child at the time of diagnosis. Sixty percent of the CF parents experienced the diagnosis as delayed. Conclusion: Parents in Sweden support CF newborn screening. Half of the parents wanted to know their CF carrier status.     

Human telomerase RNA component expression in Spitz nevi,common melanocytic nevi,and malignant melanomas

BACKGROUND: Telomerase is a ribonucleoprotein DNA polymerase that is capable of synthesizing telomeres onto the ends of chromosomes. The cumulative loss of telomerase activity is believed to be associated with cell senescence. Telomerase activity has been shown to be higher in malignant melanomas than in common melanocytic nevi. The aim of the present study was to elucidate the pattern of expression of the human telomerase RNA (hTER) component in routinely processed specimens of Spitz nevi, malignant melanomas, and ordinary melanocytic nevi. METHODS: Ten specimens of each type of tumor were studied, using an in situ hybridization technique. RESULTS: All three types of tumors demonstrated moderate to high intensities of hTER expression, usually in more than half of the tumor cells, and the majority of the studied lesions in each group did not show stratification of staining. The hTER component was also detected in the epidermis, sweat glands, and pilosebaceous units. CONCLUSIONS: hTER levels do not necessarily correlate with the level of telomerase activity, and the level and pattern of hTER expression are not useful as an adjunct to the histologic differential diagnosis of Spitz nevi from melanocytic nevi and malignant melanomas.     

Time-resolved assessment of collateral flow using 4D CT angiography in large-vessel occlusion stroke

Objectives

In acute stroke patients with large vessel occlusion, collateral blood flow affects tissue fate and patient outcome. The visibility of collaterals on computed tomography angiography (CTA) strongly depends on the acquisition phase, but the optimal time point for collateral imaging is unknown.

Methods

We analysed collaterals in a time-resolved fashion using four-dimensional (4D) CTA in 82 endovascularly treated stroke patients, aiming to determine which acquisition phase best depicts collaterals and predicts outcome. Early, peak and late phases as well as temporally fused maximum intensity projections (tMIP) were graded using a semiquantitative regional leptomeningeal collateral score, compared with conventional single-phase CTA and correlated with functional outcome.

Results

The total extent of collateral flow was best visualised on tMIP. Collateral scores were significantly lower on early and peak phase as well as on single-phase CTA. Collateral grade was associated with favourable functional outcome and the strength of this relationship increased from earlier to later phases, with collaterals on tMIP showing the strongest correlation with outcome.

Conclusions

Temporally fused tMIP images provide the best depiction of collateral flow. Our findings suggest that the total extent of collateral flow, rather than the velocity of collateral filling, best predicts clinical outcome.

Key Points

? Collateral flow visibility on CTA strongly depends on the acquisition phase ? tMIP offers the best visualisation of the extent of collaterals ? Outcome prediction may be better with tMIP than with earlier phases ? Total extent of collaterals seems more important than their filling speed ? If triggered too early, CTA may underestimate collateral flow     

Sensory processing in the auditory and olfactory domains is normal in laryngeal dystonia

Journal of Neurology - Abnormal sensory discriminatory processing has been implicated as an endophenotypic marker of isolated dystonia. However, the extent of alterations across the different...     

Vermessung der Cochlea mittels eines Tablet-basierten Softwarepakets: Einfluss der Bildgebungsmodalität und des Untersucherhintergrunds

HNO - Die Größe der Cochlea ist individuell unterschiedlich, was sich in der variablen Länge des Ductus cochlearis (CDL) ausdrücken lässt. In der Cochleaimplantatversorgung...