Biomedical subjects
Publications and source records attributed to A Nyfors.
This paper presents the case of a 35-year-old man who consulted the department of venereology because of healing problems with some wounds caused by burning his skin perianally with cigarettes as part of a sexual satisfaction ritual. Knowledge of such lesions may be useful to physicians and social workers. Sadomasochism and 'offers' in the intimate-massage clinics in Copenhagen are surveyed.
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To investigate, whether an assessment of the folate and methotrexate concentrations in erythrocytes could be used to indicate incipient histological liver changes, these 2 parameters were related to liver histology in series of liver biopsies (means 4.3 biopsies) from 31 long-term methotrexate-treated psoriasis patients. Logistic regression analysis showed that the probability of changes in liver histology during methotrexate therapy increased significantly with increasing erythrocyte methotrexate concentrations and with decreasing erythrocyte folate concentration. The application of these variables as a decisive criterion when to institute liver biopsy surveillance needs further studies, but can probably help reduce the number of liver biopsies to be taken during long-term methotrexate therapy considerably.
Skin biopsies from 10 patients with seborrheic keratoses were examined by electron microscopy for the presence of Langerhans' cells. Comparing seborrheic keratoses with normal skin of the same patient and with normal skin from controls, neither an increased number of Langerhans' cells nor an increased number of specific granules, Birbeck granules, nor abnormal Langerhans' cells, was found. Melanosomes in a Langerhans' cell were observed in 2 seborrheic keratoses, suggesting phagocytic activity of the Langerhans' cell.
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The plasma concentration and urinary excretion of methotrexate were followed in twelve psoriatic patients after intravenous and oral doses of methotrexate ranging from 7.5 to 30 mg. In six of the patients, a nonlinear relation was found between the fractional amount of methotrexate excreted in the urine and the corresponding area under the plasma concentration-time curve. The methotrexate clearance was found to be increased during the initial high plasma concentration, probably due to saturation of the tubular reabsorption of methotrexate. Considerable interindividual variation was found in the apparent saturation point of the active reabsorption, but up to 500-800 ng/ml first order kinetics still applied. At plasma concentrations below saturation, the renal clearance of methotrexate ranged from 52-102 ml/min (mean +/- SD, 83 +/- 19.4 ml/min).
The intraerythrocytic levels of folate and methotrexate were measured in 25 patients on long-term methotrexate therapy for recalcitrant psoriasis. The mean steady state concentration of methotrexate in erythrocytes was 85 nmol/l and the mean erythrocyte folate concentration was 729 nmol/l. A linear correlation was not observed between these parameters, but the greatest methotrexate accumulation was found in cells at the lower end of the erythrocyte folate concentration range. In 5 patients started on methotrexate therapy the erythrocyte concentrations of methotrexate and folate were followed over 6 months. 3-4 days after the first dose, methotrexate had been accumulated against a concentration gradient in the erythrocytes. The methotrexate concentration increased steadily until the steady state level was reached after 4-6 weeks. The steady state level was maintained during the 6 month observation period. The erythrocyte folate concentration did not change during this period. The data suggest that methotrexate polyglutamate synthesis within the circulating erythrocyte is a major cause of methotrexate accumulation in these cells.
Mast cells with endocytic and autophagic vacuoles were observed in a biopsy from a lesion of urticaria pigmentosa. In several areas of the specimen the mast cells revealed the typical morphology of mast cells which have released low molecular weight mediators, but this phenomenon did not seem to be correlated morphologically to the phagocytic activity of the mast cells. Some mast cells contained giant granules with a normal as well as an abnormal substructure.
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Allergic contact dermatitis is described in 2 patients treated with Synthaderm, a polyurethane covering for leg ulcers. One of the patients was patch tested with 3 extractions made from Synthaderm as well as with 5 isocyanate compounds. Her patch tests were negative to both extractions and isocyanates, but positive to Synthaderm samples with different batch numbers and years of production.
The frequency of malignant neoplasms was studied in 248 psoriatics treated with a single, weekly, oral dose of methotrexate ranging from 5 to 25 mg. The follow-up period ranged from 5 to 14 years with a median of 7 years. The following 10 malignant neoplasms were found: ovarian cancer 3, breast cancer 2, esophageal cancer in 1 male, pancreatic cancer in 1 female, malignant lymphoma in 1 female and 1 male and 1 squamous cell carcinoma of the scrotal skin. As the observed number of malignant neoplasms was considerably smaller than the expected number, it is concluded that methotrexate therapy as used in the treatment of psoriasis does not seem to contribute to the development of malignant neoplasms.
The paper presents the results of a cooperative, retrospective study of mycosis fungoides in Norway, in 112 patients diagnosed histologically between 1960-80. The study includes an analysis of incidence, clinicopathological findings, survival, mortality and autopsy findings. In addition, other factors, such as occupation, the incidence of cancer, associated illnesses and contact allergies are reviewed. The significant prognostic variables with regard to survival included, age at diagnosis, stage of the disease at diagnosis and occupation. Industrial workers showed the highest incidence of MF and the poorest prognosis in terms of survival after biopsy. In 59% of deceased MF patients, the cause of death was related to MF.
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Based on data from literature and a study of 245 psoriatic children psoriasis in children was found to be more sensitive to psychic trauma, more often triggered by infections, more often localized to face and scalp, more often itching, and earlier present in girls than boys. An unfavourable course has often been seen in children with an early onset of psoriasis or with psoriasis located to face and trunk. Before starting therapy precipitating causes of psoriasis such as infections and psychic trauma should be eliminated--if possible. Most scales should be removed before topical therapy is started. Mainly topical therapy should be given, favourably in combinations. UVB therapy is effective, also in children, and may be given in any home. PUVA should not be used as it accelerates the ageing of the skin and is possibly carcinogenic. Methotrexate is too hepatotoxic to be used in children.
Sections of liver tissue from 41 patients with psoriasis were examined histologically and by immunofluorescence microscopy to detect cells bearing the immunoglobulins IgG, IgA or IgM. Two patients with non-specific, reactive hepatitis and two with cirrhosis had more numerous immunoglobulin-bearing cells, while no correlation was found between the number of immunoglobulin-bearing cells and 1) other types of abnormal liver histology, 2) lymphocytic infiltrates in the liver, or 3) methotrexate therapy.
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