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Long-term carcinogenesis studies on 2,3,7,8-tetrachlorodibenzo-p-dioxin and hexachlorodibenzo-p-dioxins.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) and 1,2,3,6,7,8- and 1,2,3,7,8,9-hexachlorodibenzo-p-dioxins (HCDDs) are among the most toxic and carcinogenic of "man-made" chemicals. These "dioxins," as well as many of the other polychlorinated dibenzodioxins (PCDDs) and dibenzofuran (PCDFs) derivatives, are chlorinated aromatic compounds which are chemically stable, insoluble in water, and highly soluble in fats and oils. TCDD acts as a complete carcinogen in several species, causing both common and uncommon tumors at multiple sites. It is a highly potent chemical carcinogen in chronic animal studies, producing carcinogenic effects in laboratory animals with doses as low as 0.001 micrograms/kg/day. In rats, TCDD induces neoplasms in the lung, oral/nasal cavities, thyroid and adrenal glands, and liver. In mice, TCDD induces neoplasms in the liver and subcutaneous tissue, thyroid gland, and thymic lymphomas. In hamsters, it induces squamous cell carcinomas of the facial skin. Tumors of the integumentary system are reported after oral (mice and rats), intraperitoneal (hamsters), and dermal (mice) administration. A mixture of HCDDS (defined as the mixture of the 1,2,3,6,7,8- and 1,2,3,7,8,9 isomers used in the NTP experiments) are potent liver carcinogens in mice and rats. Pharmacokinetic studies in laboratory animals indicate that 50-90% of dietary TCDD is absorbed. It concentrates in adipose tissue and the liver. In mammals, the TCDD present in the liver is slowly redistributed and stored in fatty tissue. Elimination of TCDD occurs via excretion of metabolites in the bile and urine and passively through the gut wall. Metabolism is slow: the biological half-life of TCDD varies from weeks (rodents) to years (humans), and is strongly dependent upon the rate of TCDD metabolism. Many of the toxic effects of TCDD, including teratogenicity, may arise by receptor-mediated mechanisms. The induction of cytochrome P-448 and related enzymes by TCDD occurs by such a mechanism, and is related to the binding of TCDD to the Ah receptor. The specific mechanism(s) by which TCDD exerts its carcinogenic effects is unclear: receptor-binding may be part of the story. The role of the Ah receptor has been indicated in a skin promotion assay. The evidence for mutagenicity is inconclusive. TCDD did not induce lethal mutations, chromosomal aberrations, micronuclei or sister chromatid exchanges in rodents treated in vivo, nor was it mutagenic to bacteria, but it did enhance transformation of mouse C3H 10T1/2 cells by N-methyl-N'-nitro-N-nitrosoguanidine and was mutagenic to mouse lymphoma cells.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Maternal weight loss associated with hyperemesis gravidarum: a predictor of fetal outcome.

Over a 5-year period in our center 64 patients were hospitalized with a diagnosis of hyperemesis gravidarum. Patients were classified into two groups to determine whether weight loss was an objective predictor of pregnancy outcome. Patients whose weight loss was greater than 5% of their prepregnancy weight were classified as group A (n = 30). Patients with nausea and vomiting of pregnancy but with maintenance of at least 95% of prepregnancy body weight were in group B (n = 34). Infants in group A were significantly smaller with respect to average birth weight expressed as a percentile for gestational age: 38.11 percentile, versus 72.00 percentile for group B (p less than 0.025). Macrosomia (greater than or equal to 4000 gm) was significantly associated with group B (18% versus group A, 0%; p less than 0.025). Growth retardation (less than or equal to 10th percentile weight at birth) was significantly associated with group A (30% versus group B, 6%; p less than 0.01). Three integumentary system abnormalities (3 of 30 cases) occurred in group A compared with none in group B. Although hyperemesis gravidarum has been viewed as a positive predictor, those patients who also demonstrate weight loss and electrolyte disturbance may be a distinct entity and at greater risk for growth retardation and fetal anomalies.

Adult↗

Prenatal and postnatal findings in monochorionic, monoamniotic twins discordant for bilateral renal agenesis-dysgenesis (perinatal lethal renal disease).

We report on a male twin born with no functional renal tissue and without the extrarenal manifestations of Potter facies, skin changes, club feet and pulmonary hypoplasia. The monoamniotic co-twin had normal renal function, thereby maintaining sufficient amniotic fluid to avoid the classic presentation of Potter's syndrome. Prenatal diagnosis of this condition allowed prompt confirmation of these findings and support for the parents without unnecessary intervention. This experiment of nature demonstrates the necessity of normal renal function in the maintenance of amniotic fluid and its relationship to the proper development of the pulmonary and integumentary systems.

Adult↗

[Vogt-Koyanagi-Harada syndrome].

INTRODUCTION: Vogt-Koyanagi-Harada syndrome is a rare, inflammatory disease with manifestations affecting the ocular, central nervous, audito-vestibular, and integumentary systems. Vogt-Koyanagi-Harada syndrome is more frequent in Asia but is also described in Europe. We report three new non asiatic cases of this syndrome. OBSERVATIONS: The three patients had bilateral panuveitis and hypoacusia. Two of them had peripheral facial palsy, two of them had vestibular syndrome and one of them lymphocytic meningitis. In each case we found characteristic HLA II typing and in one case we discovered the simultaneous presence of three auto-antibodies: anti-retina (anti-Arrestin type), anti-choroid and anti-cochlea. These patients were treated by corticosteroids but required an additional treatment by cyclophosphamide (0.8g/m2). The clinical course was favorable with visual sequelae for two and auditory one for one. DISCUSSION: These biological and therapeutic elements and a review of the recent literature are in favor of an autoimmune origin of this syndrome.

Adult↗

Hair transplantation between identical twins.

Hair transplantation between monozygotic twins was used to repair a marked congenital, nonprogressive alopecia of the scalp. The alopecia was due to a follicular aplasia that, along with several other abnormalities of the integumentary system, affected only one of the twins. This case represents a unique application of isograft transplantation.

Adolescent↗

Fungal diseases of reptiles.

Fungal infections affecting the integumentary system, the upper and lower respiratory system and the gastro-intestinal tract have been reported in many species of captive reptiles. Systemic mycoses are diagnosed rarely in reptiles, and in most cases, they are a postmortem finding. Commonly, immunocompromised reptiles, kept in suboptimal environmental conditions are affected. In many cases, mixed bacterial and fungal infections of opportunistic organisms may be present. A diagnosis of a primary fungal infection is based on proper selection and collection of diagnostic specimens such as biopsies of infected tissues. Treatment of fungal infections in reptiles includes administration of effective antifungal agents and correction of inappropriate environmental conditions such as poor hygiene, too high or too low temperature and humidity, inadequate diet, and stress from overcrowding. Few studies have investigated effective dosages and dosage intervals of antifungal agents in reptiles.

Animals↗

Skin diseases of ferrets.

This article describes the most common diseases that affect the integumentary system of ferrets. Emphasis is placed on diagnosis and treatment of each disease.

Animals↗

Colocalization of glial fibrillary acidic protein, metallothionein, and MHC II in human, rat, NOD/SCID, and nude mouse skin keratinocytes and fibroblasts.

The expression of glial fibrillary acidic protein (GFAP) by perivascular cells of many mammalian organs suggests an as yet unknown function of this intermediate filament protein in the maintenance of homeostasis and vascular permeability at the blood-tissue interface. Although a similar situation may exist at the air-tissue interface, the cellular distribution of GFAP in skin tissue has never been demonstrated. To approach this issue, we have employed immunofluorescence and Western blotting techniques to detect GFAP in skin sections of young and adult humans, normal rodents, and two types of mutant mice, as well as in rat lung sections, and in cultured human keratinocytes and fibroblasts. Colocalization with antigens known to be associated with GFAP in other tissues was also tested. Epidermal and hair follicle keratinocytes and dermal fibroblasts showed distinct staining for GFAP as well as colocalization with alpha-actin, metallothionein, and antigens of the class-II major histocompatibility complex (MHC II). GFAP was also identified in rat alveolar fibroblasts which, in common with keratinocytes, form part of the air-tissue interface. GFAP was upregulated together with MHC II in nude mice but was barely detectable in the skin of non-obese diabetic severe combined immunodeficiency mice, suggesting a possible involvement in antigen-presenting functions. The intriguing distribution of a common set of antigens both in certain cells of the integumentary system and at the blood-tissue interfaces of internal organs suggests the involvement of these proteins in universal mechanisms controlling tissue homeostasis and protection.

Animals↗

Common surgical problems of the head and neck.

In most cases of epistaxis, bleeding can be controlled with anterior nasal packing or a Foley balloon catheter. If this fails, posterior packing and otolaryngologic consultation are indicated. In initial assessment of injuries of the head and neck, a classification that is useful divides the region into the following anatomic systems: integumentary, respiratory, vascular, neurologic, musculoskeletal, and digestive. The possible effects of injury on each of these must be considered. The early detection of asymptomatic cancers of the head and neck by primary care physicians depends in large part on a routine of systematic examination and a knowledge of the clinicopathologic course of the disease. A seemingly harmless lump in the neck may well be a cervical node metastasis from an occult primary tumor.

Craniocerebral Trauma↗

Web pages: an effective method of providing CAI resource material in histology.

Increased student numbers and the recognition that computer skills are essential for medical students led to the introduction of computer-aided instruction (CAI) resource material as an integral part of the second-year histology course at the University of Natal (South Africa) Medical School. Several copies of a commercial software package (compact disc-CD) covering the entire course were available. During the course of the year, using the physical and human resources available, the first in-house software package ('The Integumentary System') was generated in MS Word and saved as a series of linked html documents. The package could be accessed simultaneously by all students via the local area network (LAN). As part of an extensive evaluation of the introduction of CAI in histology, student comments and criticisms of the commercial and in-house package were canvassed. The response regarding the in-house software was encouraging, with students perceiving that it met their educational needs, preferring it to the commercial package. This report describes the ease with which this software can be developed, using limited resources and available skills, while providing students with valuable learning opportunities.

Journal Article↗

Musculoskeletal manifestations of physical abuse after intimate partner violence.

BACKGROUND: Domestic violence is the most common cause of nonfatal injury to women in the United States, with an estimated cost of $50 billion annually. Little is known about the spectrum of musculoskeletal injuries in victims of domestic violence. We examined the characteristics of abused women, the prevalence of musculoskeletal injuries, and the variables associated with increasing frequency of physical violence against women. METHODS: We identified all female survivors of intimate partner violence who were referred to the Minnesota Domestic Abuse Program from January 1, 2002, through December 31, 2003. Characteristics of each woman's background, abuse history, and injuries were obtained by a trained program therapist in an in-depth, 2-hour intake interview. Specific data forms were completed for each interview. Five forms of experienced abuse were explored (physical, emotional, psychological, sexual, and financial). Injuries were subcategorized as (1) head and neck, (2) musculoskeletal, (3) chest, (4) abdomen, and (5) skin (integumentary system). We conducted regression analyses to determine factors associated with the frequency of physical abuse. RESULTS: Of 270 potentially eligible women, 263 (97%) with complete records were included. Women were commonly Caucasian (62%) in their third decade of life with one or more children (87%). A history of abuse was recalled by over half of the women (54%). The most prevalent forms of abuse were emotional (84%), psychological (68%), physical (43%), sexual (41%), and financial (38%). Child protective services were concomitantly involved in half of the women living in abusive relationships. Among those women who reported physical abuse, 36% sought medical attention. We identified 144 injuries in 218 physically abused women. Head and neck injuries were the most prevalent after intimate partner violence (40%). Musculoskeletal injuries were the second most common manifestation of intimate partner violence (28%). The spectrum of injuries included sprains (n = 21 injuries), fracture/dislocations (n = 17 injuries), and foot injuries (n = 2 injuries). Our analysis identified seven variables associated with increasing physical abuse frequency. These included (1) younger age (p = 0.04); (2) shorter length of relationship (p = 0.049); (3) emotional abuse (p = 0.02); (4) psychological abuse (p = 0.003); (5) sexual abuse (p = 0.004); (6) drug dependency (p = 0.05); and (7) alcohol dependency (p = 0.045). CONCLUSIONS: Among women presenting to a domestic violence therapy program seeking counseling, head and neck and musculoskeletal injuries were most common. Frequency of physical abuse was most likely to be associated with younger women who are in short-term relationships, have chemical and alcohol dependency, and concomitant emotional, psychological, and sexual abuse. Recognizing musculoskeletal injuries in women as a potential result of intimate partner violence is warranted. Identifying children exposed to abusive situations may further alert treating surgeons to the potential for intimate partner violence in the mother.

Adolescent↗

Update on uveomeningoencephalitides.

PURPOSE OF REVIEW: Uveomeningoencephalitides, commonly known as Vogt-Koyanagi-Harada (VKH) disease, are characterized by chronic bilateral granulomatous panuveitis involving the central nervous, auditory and integumentary systems. Visual prognosis is generally favourable, but outcomes in patients with VKH disease may vary. Also, the treatment of choice differs in different parts of the world. This review addresses the literature on the possible pathogenesis, diagnosis and treatment of this disorder. RECENT FINDINGS: Atypical presentations of VKH disease, as well as those associated with interferon-alpha therapy, have been reported. Most reports suggest an association with autoimmunity. The diagnostic criteria were revised by the International Workshop on VKH in 1999, allowing for the presence of different ocular findings in the early and late stages of the disease. New techniques have also been developed to aid in the rapid diagnosis of VKH disease and evaluation of treatment. Different routes of administration of corticosteroid and adjuvant therapy were tried, with positive results. SUMMARY: Although the pathogenesis of VKH disease is uncertain and antigen-specific treatment strategies have not yet been developed, reports increasingly suggest an autoimmune nature for uveomeningoencephalitides. Currently, systemic corticosteroid therapy remains the standard initial treatment. Different routes of administration are used to reduce the frequency of side effects of systemic corticosteroids, and there are various adjuvant therapies. With the aid of modern equipment, early diagnosis and prompt and appropriate treatment, resulting in better visual outcomes, can be anticipated. A large-scale, multinational, prospective study is warranted to determine the optimal initial therapy.

Humans↗

Isotretinoin and tetracycline in the management of severe nodulocystic acne.

Thirty patients with treatment-resistant cystic and conglobulate acne entered a randomized double-blind protocol, testing the efficacy of isotretinoin versus tetracycline. After 16 weeks of isotretinoin treatment, the mean number of cysts decreased by 64% and the mean sum of the longest diameters was reduced by 68%. After 16 weeks of tetracycline therapy, the total number of cysts showed a mean decrease of 52%, and the mean sum of the longest diameters decreased by 60%. The reduction in the number of cysts and the sum of their longest diameters that occurred after 16 weeks of treatment was statistically significant for each of the treatment groups, but there was no statistically significant difference between the treatment groups at the end of therapy. Eight weeks after the discontinuation of treatment in the isotretinoin group, there was an overall reduction from baseline of 82% in the cyst count and 88% in the sum of the longest diameters. In the tetracycline treatment group, the overall reduction from baseline in the cyst count was 54% and in the sum of the longest diameters, 60%. This led to a statistically significant difference in the two treatment groups at 24 weeks. All patients on isotretinoin experienced side effects that were primarily related to the integumentary system but necessitated discontinuation of the drug for a short period of time in only one patient. Long-term follow-up, 8 months after discontinuation of the study, showed a prolonged significant remission of acne in the isotretinoin group but not in the tetracycline group.

Acne Vulgaris↗

Clouston syndrome: an ultrastructural study.

A previously undescribed French-Canadian family affected with Clouston Syndrome (Hypohidrotic Ectodermal Dysplasia) is described. Ultrastructural study of the hair shows disorganization of the hair fibrils with loss of the cuticular cortex. The SEM findings are consistent with the model, suggesting a biochemical defect in the keratin of the integumentary system.

Child↗

[A study on development site of pleomorphic adenoma--a rare case report in external nose].

A rare case of pleomorphic adenoma in the external nose is reported. As a result of studies on the correlation between the sites of occurrence of pleomorphic adenomas reported and the sites of secretory glands with myoepithelial cells, it is found that pleomorphic adenomas occur in all secretory glands with myoepithelial cells. There are distinctive differences in the incidence in each part of the body, and in the hollow organs in the digestive and respiratory tracts: it is high in the face and decreases as the sites become farther away from the face. In the integumentary system, it is also high in the face. However, pleomorphic adenomas occurring in secretory glands without myoepithelial cells, and in non-glandular tissue such as the middle ear, paranasal sinuses, mesangial sinuses, vagina and tests can be considered either as those where glandular tissue and myoepithelial cells mingled during development (and thus are ectopic) or as those when invasion into adjacent organs occurred as the pathologic lesion (pleomorphic adenoma) expanded.

Aged↗

Impact of onychomycosis on quality of life.

The author reviews the current knowledge of the impact of onychomycosis on quality of life. Like other visible disorders of the integumentary system, onychomycosis affects many aspects of life, including physical functioning, interpersonal interactions, and emotional state. After examining the nature of quality of life and the study instruments used to measure it, the author reviews several studies that have examined the relationship between onychomycosis and quality of life. The author concludes that onychomycosis is a significant medical problem that has a great impact on patients' lives and should therefore be treated as definitively as possible.

Adult↗

NTP Toxicology and Carcinogenesis Studies of Dichloromethane (Methylene Chloride) (CAS No. 75-09-2) in F344/N Rats and B6C3F1 Mice (Inhalation Studies).

Dichloromethane is widely used in industrial processes, food preparation, and agriculture. In industry, dichloromethane is used as a solvent in paint removers, degreasing agents, aerosol propellants, and triacetate solutions; as a blowing agent in flexible urethane foams; and as a process solvent in the manufacture of steroids, antibiotics, vitamins, and tablet coatings. The use of dichloromethane as an extraction solvent for spice oleoresins, hops, and caffeine from coffee has been approved by the U.S. Food and Drug Administration. Dichloromethane has been used as an inhalation anesthetic and as a fumigant for grain and strawberries. Toxicology and carcinogenesis studies of dichloromethane (99% pure) were conducted by inhalation exposure of groups of 50 male and 50 female F344/N rats and B6C3F1 mice 6 hours per day, 5 days per week, for 102 weeks. The exposure concentrations used (0, 1,000, 2,000, or 4,000 ppm for rats and 0, 2,000, or 4,000 ppm for mice) were selected on the basis of results from 13-week inhalation studies in which groups of 10 rats and 10 mice of each sex were exposed to dichloromethane at concentrations of 525-8,400 ppm 6 hours per day, 5 days per week. During the 2-year studies in rats, body weight gains for exposed males and females were comparable to those of the chamber controls. The survival of exposed male rats was comparable to that of the chamber controls; however, the survival of all groups of males at the termination of the study was low (control, 16/50; low dose, 16/50; mid dose, 17/50; high dose, 9/50). Most of the early deaths among male rats occurred during the final weeks of the study; the survival of male rats through week 86 of the study was 36/50, 39/50, 37/50, and 33/50. This decreased survival is believed to be related to the high incidence of leukemia (34/50; 26/50; 32/50; 35/50). Survival of female rats exposed at 4,000 ppm was reduced relative to that of the chamber controls (30/50; 22/50; 22/50; 15/50); leukemia occurred frequently in all female rat groups. Final mean body weights of high dose male mice and low and high dose female mice were 10%-17% lower than those of the chamber controls; these reductions occurred during the last 16 weeks of the study. The survival of dosed male mice and high dose female mice was reduced relative to that of the chamber controls (male: control, 39/50; low dose, 24/50; high dose, 11/50; female: 25/50; 25/50; 8/50). This reduced survival may have been due to the chemically induced development of liver and lung neoplasia in male and female mice. Increased incidences of benign mammary gland lesions (adenomas and fibroadenomas) occurred in male and female rats exposed to dichloromethane (male: 0/50; 0/50; 2/50; 5/50; female: 5/50; 11/50; 13/50; 23/50). The incidence of malignant mammary gland neoplasms was not increased in female rats (2/50; 2/50; 2/50; 0/50); none was observed in male rats. In addition, integumentary system tumors in the area of the mammary chain occurred with a positive trend in male rats (subcutaneous tissue fibroma or sarcoma: 1/50; 1/50; 2/50; 5/50); the combined incidence of all tumors in the mammary area in male rats was 1/50, 1/50, 4/50, and 9/50. Exposure to dichloromethane was associated with increased incidences of hepatic hemosiderosis, cytomegaly, cytoplasmic vacuolization, necrosis, granulomatous inflammation, and bile duct fibrosis in both male and female rats. There was a positive but marginal trend in the incidence of hepatocellular neoplastic nodules or hepatocellular carcinomas (combined) in female rats (2/50; 1/50; 4/50; 5/50). The incidence of squamous metaplasia of the nasal cavity was increased in female rats exposed at 4,000 ppm (1/50; 2/50; 3/50; 9/50) but not in males (4/50; 5/50; 3/50; 3/50). No nasal cavity tumors were observed in rats. The increased incidences of mononuclear cell leukemia in mid dose and high dose female rats (17/50; 17/50; 23/50; 23/50) were statistically significant by age-adjusted analyses. In male rats, mesotheliomas (arising primarily from the tunica vaginalis) occurred at increas) occurred at increased incidences (0/50; 2/50; 5/50; 4/50). Lung tumors occurred at increased incidences in male and female mice exposed to dichloromethane (alveolar/bronchiolar adenomas: male - 3/50; 19/50; 24/50; female - 2/50; 23/48; 28/48; alveolar/bronchiolar carcinomas: male - 2/50; 10/50; 28/50; female - 1/50; 13/48; 29/48). Cytologic degeneration of the liver was observed at increased incidences in high dose male and dosed female mice (male: 0/50; 0/49; 22/49; female: 0/50; 23/48; 21/48). Incidences of hepatocellular adenomas or hepatocellular carcinomas (combined) were increased in high dose male and dosed female mice (male: 22/50; 24/49; 33/49; female: 3/50; 16/48; 40/48). There were also dose-related increases in the numbers of mice bearing multiple lung or liver neoplasms. Dose-related increases were observed in the incidences of testicular atrophy in male mice and uterine and ovarian atrophy in female mice; these effects are considered to be secondary responses to neoplasia. An audit of the experimental data was conducted for the 2-year studies of dichloromethane. No data discrepancies were found that influenced the final interpretations. Under the conditions of these inhalation studies, there was some evidence of carcinogenicity of dichloromethane for male F344/N rats as shown by an increased incidence of benign neoplasms of the mammary gland. There was clear evidence of carcinogenicity of dichloromethane for female F344/N rats as shown by increased incidences of benign neoplasms of the mammary gland. There was clear evidence of carcinogenicity of dichloromethane for male and female B6C3F1 mice, as shown by increased incidences of alveolar/bronchiolar neoplasms and of hepatocellular neoplasms. Synonyms: DCM; methylene chloride

Journal Article↗

AIDS nursing: patient care issues in the hospital setting.

The types of settings in which the acute care of AIDS patients takes place range from AIDS-designated units to general medical-surgical wards. Though the settings may differ, many of the nursing interventions that these patients require remain relatively consistent. Alterations in respiratory, neurological, gastrointestinal, and integumentary systems are common in individuals with HIV infection, requiring nursing measures to address such problems as diarrhea, fever, poor nutrition, mucositis, impaired oxygenation, dyspnea, alterations in sensation and perception, impaired skin integrity, bleeding risk, pain, and altered thought processes. In addition, the bedside nurse is often in a position that enables him or her to coordinate a multidisciplinary approach to selected problems.

Acquired Immunodeficiency Syndrome↗