Basal cell carcinoma. An epidemiologic study in a defined population.

BACKGROUND. The incidence of basal cell carcinoma (BCC) in a defined population is unknown. METHODS. The incidence of histologically diagnosed cases of BCC in a defined population of a city in southern Sweden was studied. Four 2-year periods were examined from 1970 to 1986. Cases from 1970 and 1980 were reexamined microscopically. RESULTS. From 1970 to 1986, the age-standardized incidence of BCC was doubled. BCC was equally common in male and female patients. It was possible to trace another BCC in the medical history of 41% of the patients. The risk of development of BCC increased rapidly with age greater than 55 years. Approximately two-thirds of the tumors were found in the head and neck region. There was a possible increase in superficial multicentric tumors on the trunk but otherwise an essentially unchanged pattern in type and distribution. CONCLUSIONS. The age-standardized incidence of histologically diagnosed BCC was doubled from 1970 to 1986. The rapid increase should be taken into consideration when planning allocation of medical resources.     

Activation of inflammatory systems during cardiopulmonary bypass

"Whole body inflammation" induced by cardiopulmonary bypass may play a role in the pathogenesis of postoperative complications after open-heart surgery. The inflammatory response, in terms of complement activation and release of granular proteins from neutrophil granulocytes, was investigated in six patients undergoing aortocoronary bypass surgery. Complement activation was demonstrated as well as substantially increased plasma levels of lactoferrin and myeloperoxidase--two granulocyte factors. The activation of inflammatory systems probably takes place on the artificial surfaces of the extracorporeal device. The biocompatibility of these components therefore should be further studied.     

Invasive fungal sinusitis and meningitis due to Arthrographis kalrae in a patient with AIDS

We report the first described case of Arthrographis kalrae pansinusitis and meningitis in a patient with AIDS. The patient was initially diagnosed with Arthrographis kalrae pansinusitis by endoscopic biopsy and culture. The patient was treated with itraconazole for approximately 5 months and then died secondary to Pneumocytis carinii pneumonia. Postmortem examination revealed invasive fungal sinusitis that involved the sphenoid sinus and that extended through the cribiform plate into the inferior surfaces of the bilateral frontal lobes. There was also an associated fungal meningitis and vasculitis with fungal thrombosis and multiple recent infarcts that involved the frontal lobes, right caudate nucleus, and putamen. Post mortem cultures were positive for A. kalrae.     

Further studies on the musculo-fibrous anomaly of the Barrett's mucosa in esophageal carcinomas.

A total of 50 esophagi with carcinoma were reviewed for the presence of histological changes in the subepithelial tissues of the Barrett's mucosa. Those changes consisted in the thickening of the muscularis mucosae, the presence of muscle fibres in the lamina propria mucosae, fibrosis of the submucosa and sometimes total obliteration of the subepithelial tissues by collagen-rich sclerosis. Those changes have been connoted as "musculo-fibrous anomaly". Barrett's mucosa was present in all 18 specimens with adenocarcinoma and in 13 of the remaining 32 specimens with squamous cell carcinoma. Musculo-fibrous anomaly of the Barrett's mucosa occurred in all 18 specimens with adenocarcinoma and in 10 of the 13 specimens with a concomitantly growing squamous cell carcinoma. Esophageal and metaplastic glands were surrounded, compressed and deformed by the fibrotic tissue. The histological changes described explain the difficulties in the differential diagnosis--in biopsy specimens--between normal glands or glands with dysplastic changes "trapped" in the collagen-rich fibrotic tissue and true invasive adenocarcinoma of the Barrett's esophagus.     

High rate of transfer of Staphylococcus aureus from parental skin to infant gut flora

Many Swedish infants carry Staphylococcus aureus in their intestinal microflora. The source of this colonization was investigated in 50 families. Infantile S. aureus strains were isolated from rectal swabs and stool samples at 3 days and at 1, 2, 4, and 8 weeks of age. The strains were identified by using the random amplified polymorphic DNA method and compared to strains from swab cultures of the mothers' hands, nipples, and nares and from the fathers' hands and nares. Maternal stool samples were also obtained at a later stage to compare infant and adult intestinal S. aureus colonization. Although 60% of 1-month-old children had S. aureus in the stools, this was true of only 24% of the mothers. The median population numbers in colonized individuals also differed: 10(6.8) CFU/g of feces among infants at 2 weeks of age versus 10(3.2) CFU/g of feces in the mothers. Of S. aureus strains in the stools of 3-day-old infants, 90% were identical to a parental skin strain. A total of 96% of infants whose parents were S. aureus skin carriers had S. aureus in their feces and 91% had the same strain as at least one of the parents. In comparison, only 37% of infants to S. aureus-negative parents had S. aureus in the stool samples. Thus, infantile intestinal S. aureus colonization was strongly associated with parental skin S. aureus carriage (P = 0.0001). These results suggest that S. aureus on parental skin establish readily in the infantile gut, perhaps due to poor competition from other gut bacteria.     

A theoretical study of restricted convection-diffusion as applied to blood-tissue barrier exchange.

This paper handles a model of the capillary function in the exchange of uncharged molecules between the blood and the tissue. The capillary system is subdivided into a filtering and a reabsorbing part. The exchange is assumed to occur through channels which are described in operational terms as pores. Through these pores there is a transport of solutes by concomitantly acting convection and diffusion influenced by a steric hinderance (restricted convection-diffusion). The outflux of glucose and raffinose is enhanced in the filtering pores, raffinose relatively more than glucose. In the reabsorbing pores the outward diffusion is hindered to some extent, raffinose relatively more than glucose. It is shown that the net effect of filtration and reabsorption is to increase the outflux of raffinose as compared to that of glucose. This mechanism may explain why glucose and raffinose and other small molecules appear to pass across capillary walls in proportion to their free diffusion coefficients and not in proportion to their restricted diffusion coefficients.     

The effect of restricted convection-diffusion on bolus concentration along an exchange vessel.

If a sudden rise in solute concentration travels through a capillary system, a diffusible neutral solute passes the walls of the exchange vessels. If then the rate of passage depends on a chemical potential gradient (diffusion) and a hydrodynamical potential gradient (convection) and is sterically restricted (restricted convection-diffusion), water and low molecular weight solvents leave the filtering part of the capillary at a higher rate than the solute, causing a relative increase in its concentration. This phenomenon and the effect of an increasing pore size along the capillary is investigated in a model for an impermeable solute and two diffusible solutes, corresponding to glucose and raffinose. It is shown that in the model, the concentration fall along the capillary tends to become rectilinear.     

Development of nocturia in relation to health, age and the menopause

Objectives:To analyse the relationship between nocturia, age, the menopausal transition, parturition and hormone replacement treatment (HRT) in women.Material and methods:A questionnaire study was carried out in 3669 randomly selected women (out of 6000 invited) in the County of Jämtland, Sweden. Questions were asked about health, the occurrence of somatic diseases and symptoms, habits, health care and medication.Results:In univariate analyses age, menopausal state and HRT, but not parturition, were associated with increased nocturia. In a multiple logistic regression analysis, independent correlates for two or more nocturnal micturition episodes versus no more than one episode were: health, poor versus good 2.9 (2.1–3.8); <5 years after the menopause versus before 1.8 (1.3–2.5); 5–9 years after the menopause versus before 2.1 (1.5–3.0); ≥10 years after the menopause versus before 3.1 (2.3–4.2). Age and HRT were deleted by the logistic regression model.Conclusion:The present data indicate that menopausal state, but not age, parturition and HRT are independent correlates of nocturia in 40–64-year-old women.     

Nocturia and health in women aged 40-64 years

To analyse the relationship between nocturnal micturition and health in 40- to 64-year-old women. A questionnaire study was carried out in 3669 randomly selected women (out of 6000 invited) in the County of J?mtland, Sweden. Questions were asked about the general health status of health, health development during the last 5 years, nocturnal micturition, parity, menstrual status, menopausal symptoms, hormone replacement therapy, cardiac diseases, diabetes and snoring. Poor health was reported by 10.4%. In 24.1% of the women health development had been unfavourable in the last 5 years. Poor health was reported by 4.7% of women without nocturnal micturition, and by 11.2, 20.1 and 39.0% (P<0.0001) of women with one, two, and three or more nocturnal voiding episodes, respectively. In a multiple logistic regression analysis significant independent correlates of health were: one versus no nocturnal micturitions (odds ratio [OR] 2.2; confidence interval [CI] 1.5-3.3), two versus none (OR 3.2; 1.9-5.3), and three or more versus none (OR 6.5; 3.5-11.9), spasmodic chest pain (OR 6.6; CI 3.0-14.5), irregular heart beats (OR 3.0; CI 2.1-4.3), diabetes (OR 5.1; CI 2.8-9.4), leg oedema> or =6 days/month versus <6 days/month (OR 23; CI 1.6-3.3), snoring: < or =3 times/week versus never (OR 1.4; CI 1.0-2.0), snoring 4-7 times/week versus never (OR 1.6; CI 1.1-2.2), being<5 years after versus being before the menopause (OR 1.6; 95% CI 1.0-2.5), 5-9 years after versus before the menopause (OR 1.7; CI 1.0-2.9), > or =10 years after versus before the menopause (OR 2.2; CI 1.3-3.7), diuretic treatment (OR 2.8; CI 1.7-4.6). The perceived state of health in 40- to 64- year-old women is profoundly affected by nocturia, independently of heart diseases, diabetes, snoring, age and menopausal status.     

Myocardial energy metabolism during mitral valve replacement

To elucidate the metabolic changes during a relatively short ischemic period, papillary muscle excisions were investigated in 38 patients operated for mitral valve replacement. The overall mean age was 62 years, in 27 women and 11 men. Two excisions were made during ischemia, the first after 13 minutes and the second after 48 minutes of aortic occlusion. These excisions were analyzed for adenine nucleotide, creatine phosphate, lactate and pyruvate contents. The results indicated an ongoing metabolism with an accumulation of lactate, and also influences on the energy charge. For example, although the content of ATP was unchanged between the excisions, the relation to creatine phosphate, as a source for ATP level maintenance, was altered. This is of clinical importance since cardioplegia and hypothermia (myocardial temperature below 20 degrees C) were employed and the interval between the excisions was only 35 minutes on average. Although no significant decrease in myocardial ATP took place, 31 of 38 patients needed inotropic support to wean them off bypass. On the basis of the present results further efforts seem necessary to improve myocardial preservation techniques.