Hair Cortisol is Elevated in Erythropoietic Protoporphyria Patients and Correlates with Body Mass Index and Quality of Life

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Entartungsrisiko von gutartigen Knochenläsionen

Zusammenfassung

Ziel

Benigne Knochenläsionen wie einige Tumoren oder nichtneoplastische Läsionen besitzen in bestimmten Fällen ein nicht unerhebliches Risiko einer malignen Entartung. Das Wissen um dieses ist wesentlich, da die Patientenberatung und -führung entsprechend angepasst werden muss. Ziel dieser Arbeit ist es, die typischen Läsionen aufzuzeigen sowie das relative Risiko und den potenziellen Verlauf darzustellen.

Material und Methoden

Aus der vorhandenen Literatur und der klinischen Erfahrung wurden jene Knochenläsionen benannt, bei denen ein Potenzial zur sekundären Malignisierung besteht oder vermutet wird. Dieses wurde dann in einer dezidierten Literaturrecherche evaluiert.

Ergebnisse

Belege für die Dedifferenzierung oder sekundäre Malignität fanden sich für kartilaginäre Exostosen, Enchondromatose, Morbus Paget, fibröse Dysplasie, osteofibröse Dysplasie, Knocheninfarkt, Osteomyelitis und die synoviale Chondromatose. Für den notochordalen Tumor, das Osteoblastom und die aneurysmale Knochenzyste ist die Datenlage zu gering, um eine solche zu postulieren.

Schlussfolgerung

Es gibt benigne Läsionen, die in einer Inzidienz von bis zu 40 % in ein sekundäres Malignom übergehen können. Dieses muss in der Patientenberatung vermittelt werden. Geeignete Vorsorgeuntersuchungen, wie z. B. das Ganzkörper-MRT bei den multiplen chondroiden Läsionen, sind aufwendig, in diesen Fällen jedoch auch zu rechtfertigen.

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Hair Cortisol is Elevated in Erythropoietic Protoporphyria Patients and Correlates with Body Mass Index and Quality of Life

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Critical appraisal of the oxidative stress pathway in vitiligo: a systematic review and meta-analysis

Abstract

Background

The pathogenesis of vitiligo remains a topic of extensive debate. This is partly due to the moderate efficacy of current treatments. The role of oxidative stress pathway in vitiligo is a popular although controversial research topic.

Objective

To clarify the role of the oxidative stress pathway in vitiligo compared to other inflammatory skin disorders and to assess the therapeutic role of antioxidants.

Methods

We conducted a systematic search of the existing literature on the aberrancies of the oxidative stress pathway in vitiligo. Subsequently, the efficacy of both topical and oral antioxidants in clinical trials was investigated.

Results

A deregulated oxidative pathway is clearly evident with elevated superoxide dismutase (SOD), decreased catalase (CAT) and increased lipid peroxidation. However, similar results have been obtained in other inflammatory skin diseases such as psoriasis, atopic dermatitis, lichen planus and urticaria. This questions the unique role of oxidative stress in the development of vitiligo. Some isolated successes have been reported with oral ginkgo biloba, polypodium leucotomos and vitamin C and E preparations, while other clinical trials have failed to show reproducible results. The use of topical antioxidants delivers in general no beneficial results.

Conclusion

The oxidative pathway is affected in vitiligo but its unique initiating or contributory role in the pathogenesis is less evident. Interesting data support the added value of oral antioxidants in vitiligo although confirmatory studies are missing.

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Atypical presentation of eosinophilic annular erythema in a 5-year old girl

Abstract

A 5-year-old female presented with a 1-year history of slightly pruritic erythematous annular plaques covering her trunk and limbs (Figure 1). The remaining integument as wells as the mucous membranes were not affected. The lesions persisted for about one week slowly developing a more violaceous hue before disappearing.

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Dermoscopy versus reflectance confocal microscopy for the diagnosis of lentigo maligna

Abstract

Background

Several dermoscopic and in vivo reflectance confocal microscopy (RCM) diagnostic criteria of lentigo maligna (LM)/lentigo maligna melanoma (LMM) have been identified. However, no study compared the diagnostic accuracy of these techniques.

Objective

We evaluated the diagnostic accuracy of dermoscopy and RCM for LM/LMM using a holistic assessment of the images.

Methods

223 facial lesions were evaluated by 21 experts. Diagnostic accuracy of the clinical, dermoscopic and RCM examination were compared. Inter-investigator variability and confidence level in the diagnosis were also evaluated.

Results

Overall diagnostic accuracy of the two imaging techniques was good (area under the curve of the sROC function: 0.89). RCM was more sensitive (80%, versus 61%) and less specific (81% versus 92%) than dermoscopy for LM/LMM. In particular RCM showed a higher sensitivity for hypomelanotic and recurrent LM/LMM. RCM had a higher inter-investigator agreement and a higher confidence level in the diagnosis than dermoscopy.

Conclusion

RCM and dermoscopy are both useful techniques for the diagnosis of facial lesions and in particular LM/LMM. RCM is particularly suitable for the identification of hypomelanotic and recurrent LM/LMM.

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Socioeconomic Deprivation and the Burden of Head and Neck Cancer- Regional variations of Incidence and Mortality in Merseyside and Cheshire, North West, England

Abstract

Objectives

The aim of this longitudinal study is to examine the distribution of head and neck cancer (HANC) disease burden across the region comparing it to national trends.

Design

We undertook a retrospective study of routine data combining it with indicators of deprivation and lifestyle at small geographical areas within the nine Local Authorities (LAs) of Merseyside and Cheshire Network (MCCN)for head and neck cancers.

Data from the North West of England and England were used as comparator regions.

Setting

This research was undertaken by the Cheshire and Merseyside Public Health Collaborative, UK.

Participants

The Merseyside and Cheshire Region serves a population of 2.2 million. Routine data allowed us to identify HANC patients diagnosed with cancers coded ICD C00-C14 and C30-C32 within three cohorts 1998-2000, 2008-2010 and 2009-2011 for our analysis.

Main Outcome Measures

Directly age standardised incidence rates and directly age standardised mortality rates in the LAs and comparator regions were measured. Lifestyle and deprivation indicators were plotted against themand measured by Pearson's correlation coefficients.

Results

The incidence of head and neck cancer has increased across the region from 1998-2000 to 2008-2010 with a peak incidence for Liverpool males at 35/100,000 population.

Certain Middle Super Output Areas contribute disproportionately to the significant effect of incidence and mortality within LAs. Income deprivation had the strongest correlation with incidence (r =0.59) and mortality (r =0.53) of head and neck cancer.

Conclusion

Our study emphasizes notable geographical variations within the region which need to be addressed through public health measures

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