Biomedical subjects
Publications and source records attributed to P J August.
Presented in this paper are two cases of longstanding gross and disfiguring lupus pernio of the nose successfully treated by CO2 laser resurfacing Both patients were resistant to previous medical therapy and have had an excellent postoperative cosmetic result.
Dominant transmission of multiple uterine and cutaneous smooth-muscle tumors is seen in the disorder multiple leiomyomatosis (ML). We undertook a genomewide screen of 11 families segregating ML and found evidence for linkage to chromosome 1q42.3-q43 (maximum multipoint LOD score 5.40). Haplotype construction and analysis of recombinations permitted the minimal interval containing the locus, which we have designated "MCUL1," to be refined to an approximately 14-cM region flanked by markers D1S517 and D1S2842. Allelic-loss studies of tumors indicated that MCUL1 may act as a tumor suppressor. Identification of MCUL1 should have wide interest, since this gene may harbor low-penetrance variants predisposing to the common form of uterine fibroids and/or may undergo somatic mutation in sporadic leiomyomata.
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The Nd:YAG laser effectively removes or lightens amateur and professional tattoos. The biomechanics of the removal of tattoo particles at the cellular level are incompletely understood. We examined biopsies obtained from 35 amateur and professional tattoos (including coloured tattoos), treated on three or more occasions with the Nd:YAG laser. Biopsies taken immediately after laser treatment showed vacuolation with complete clearance of tattoo particles in the most superficial layers of the dermis, as assessed by light and electron microscopy. We propose that the 'disappearance' of the tattoo particle arises from the formation of atomic species and gaseous products, which are rapidly dissolved in the extracellular fluid. Residual fragmented particles that are commonly found in the mid- and lower dermis are rephagocytosed. The interaction between the Nd:YAG laser and black tattoo particles at 1064 nm, and red tattoo particles at 532 nm, appears to be specific, as there was little evidence of thermal damage to adjacent cells or stromal collagen.
Two hundred and twenty-one amateur tattoos and 27 professional tattoos were treated with a Nd/YAG laser (lambda 1064 nm and 532 nm). The response was expressed as the percentage area cleared of tattoo. Seventy-nine per cent of amateur black tattoos were > or = 75% clear after one to five treatments (mean 2) at 1064 nm. The response of professional tattoos was slower and less complete. Seventy-four per cent of black professional tattoos were > or = 75% clear after one to 11 treatments (mean 6.3) at 1064 nm. Red tattoos responded well to 532 nm and were > or = 75% clear after one to five treatments. Yellow, orange, blue and green tattoos were resistant to treatment. Side-effects included minor scarring in 1.2% of tattoos and transient pigmentary changes in 77% of patients.
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Aquagenic pruritus has been reported in association with a variety of underlying disorders including polycythaemia rubra vera, myelodysplastic syndrome, the hypereosinophilic syndrome and juvenile xanthogranuloma. However, in most cases the aetiology is unknown. The onset of intractable aquagenic pruritus is reported in a fit 71-year-old lady; however, 10 months later she was found to have hepatic metastases arising from a squamous cell carcinoma of the cervix treated 15 years previously. The occurrence of these two relatively rare conditions is likely to be coincidental. None the less, the close temporal relationship between the onset of aquagenic pruritus and the hepatic metastases raises the possibility of a true association. Aquagenic pruritus may be associated with a wider variety of underlying disorders than previously reported. Intractable symptoms of recent onset in a patient with a past history of cancer should be investigated.
A 47-year-old woman developed widespread psoriasis following insertion of a combined oestradiol-testosterone implant into her anterior abdominal wall for post-oophorectomy symptoms. The rash did not resolve until the effects of the implant had worn off and recurred following insertion of a second oestradiol-testosterone implant. Implants containing oestradiol alone were tolerated. We have found no previous reports suggesting a relationship between testosterone implants and psoriasis.
We report a case of severe incapacitating seasonal urticaria and angioedema in an 11-year-old boy due to grass pollen sensitivity, who responded well to desensitization therapy with Timothy grass pollen extract.
A patient with Crohn's disease and alopecia totalis is described. Despite relative inactivity of the Crohn's disease, treatment with azathioprine was commenced. This led to complete regrowth of hair which was lost when the drug was discontinued. Re-institution of azathioprine restored hair to normal again and the patient has since declined to try stopping the drug despite the knowledge of potential side effects.
Topical steroids are the most commonly prescribed drugs for use on the skin. Various factors affecting the choice of such a steroid in the UK are considered and explained.
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Twelve patients with lichen sclerosus et atrophicus of the vulva were treated by a nitrous oxide cryoprobe. All had had severe itching which was relieved in the post-operative period in 75% and for 3 years in 50%. Eight had histologically proven leukoplakia which cleared post-operatively in five (62.5%) and remained clear at three years in four (50%). In one patient pruritus, leukoplakia and ultimately squamous carcinoma appeared.
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