Breslow thickness and Clark level can be used to determine surgical procedures for cutaneous malignant melanoma and patient eligibility for experimental adjuvant therapy. Efforts to predict the thickness of melanomas using dermatoscopy have focused on differences between single dermatoscopic findings. The aim of this study was to develop a method for preoperative identification of melanomas of > or = 1 mm Breslow thickness using the entire range of dermatoscopic findings. Sixty-five melanomas were assessed for the presence of 22 dermatoscopic features. Ten dermatoscopic features showed differences in thick and thin melanomas and were selected for further analysis. A latent trait analysis construct implied that a progression in dermatoscopic features was associated with advancement of melanomas. Early melanomas are characterized by a light brown colour, a pigment network and irregularity or heterogeneity. Gray-blue areas, white scar-like areas and an atypical vascular pattern gradually displace these features. Likelihood ratios were determined for these 6 dermatoscopic findings and an algorithm for calculating the probability of thick malignant melanoma was established.

Denmark↗

PubMedDate not supplied

Treatment of chlamydial urethritis in men and Chlamydia trachomatis-positive female partners: comparison of erythromycin and tetracycline in treatment courses of one week.

Seventy-one consecutive men who had Chlamydia trachomatis-positive nongonococcal urethritis were assigned randomly to treatment for one week with either tetracycline or erythromycin (1g daily). Seventy men completed the study. At follow-up, there were two therapeutic failures among 36 patients treated with erythromycin, and two failures among 34 patients treated with tetracycline. Twenty-four C. trachomatis-positive female contacts were randomly assigned to treatment regimens similar to those of the men. There was one treatment failure among 12 women treated with erythromycin, and no failure among 12 treated with tetracycline. In this study the urethral smears contained fewer than five leukocytes per high-power field in 16% of the C. trachomatis-positive men with symptoms suggestive of urethritis.

Adolescent↗

PubMedDate not supplied

A comparison of an enzyme immunoassay and cell culture for detection of Chlamydia trachomatis in genito-urinary specimens.

Chlamydia trachomatis infection is easy to treat but laborious to diagnose by culture. An antigen-detecting enzyme immunoassay (EIA; Chlamydiazyme, Abbott Laboratories, North Chicago, IL), suitable for testing many samples, was compared with the conventional iodine-stained, one-passage culture. A total of 471 duplicate samples from 218 men (urethra) and 128 women (urethra and cervix) attending a sexually transmitted disease clinic were examined by both tests. The overall sensitivity, specificity, and predictive value of positive and negative results were 80.3%, 96.7%, 86.4%, and 95.0%, respectively. No difference between male and female patients was observed. A remarkable difference between sensitivities of female urethral (60.0%) and cervical (95.5%) samples was found. This difference is clearly important in cases of women with urethral infection only (19% in our study) and points to the need for further improvement of this EIA.

Bacteriological Techniques↗

PubMedDate not supplied

Neurosyphilis, or chronic heavy metal poisoning: Karen Blixen's lifelong disease.

BACKGROUND: Since the 1490s, the treatment of syphilis has consisted of heavy metals--first mercurial and later arsenic and bismuth preparations. Tabes dorsalis, as described by Duchenne in the 1850s, is made up of various characteristic neurologic symptoms. "Gastric crises," sudden stabbing pains followed by vomiting and diarrhea, was originally included by Duchenne, but later, syphilologists disputed its relevance to syphilis. Poisoning by heavy metals, including mercury, may produce similar pain reactions and tabes-like neurologic symptoms. METHODS: According to an earlier published pathography, the Danish author Karen Blixen (1885-1962), also known under the pseudonym Isak Dinesen, suffered from a lifelong disease described as tabes dorsalis. She got syphilis in 1914 and took mercury pills for a year, after which she experienced a severe mercurial intoxication. The Wassermann reaction (WR) in peripheral blood was positive only once, in 1915, before treatment with arsphenamine (Salvarsan), which she received during hospitalization in Copenhagen in 1915 to 1916. Her spinal fluid was examined several times from 1915 to 1956. Apart from an increased number of cells in 1915, the fluid remained unremarkable and the WR was always negative. RESULTS AND CONCLUSIONS: It was postulated that her illness, ending with a cachectic state, was the result of heavy metal poisoning from the various treatments and not a monosymptomatic tabes dorsalis with negative serology.

Arsenicals↗

PubMedDate not supplied

Comparison of dermatoscopic ABCD rule and risk stratification in the diagnosis of malignant melanoma.

For didactic and documentation purposes the dermatoscopic ABCD rule and the dermatoscopic risk stratification have been proposed. The aim of this investigation was to compare the ability of the 2 methods to separate patients with cutaneous malignant melanoma from individuals with other pigmented skin lesions. Three dermatologists, experienced users of dermatoscopy, assessed macroscopic clinical and dermatoscopic slides from 258 patients referred to the skin cancer outpatient clinic by the ABCD rule and risk stratification methods. Diagnostic performance of the 2 methods was compared by receiver operating characteristics curve analysis. When all pigmented skin lesions were compared, there was a trend for the observers to perform better using risk stratification. When only lesions with a well-defined pigment network were included, the diagnostic performance of the risk stratification method was superior to the dermatoscopic ABCD rule (areas under the receiver operating characteristics curve median 0.93 vs. 0.80, p<0.004) for all observers. The agreement between the 2 methods was moderate to substantial (kappa coefficient 0.53-0.62). More melanomas were identified when the rules were combined. The dermatoscopic ABCD rule has been accepted as a standard for identifying melanomas with the dermatoscope, but should be considered secondary to pigment network analysis.

Biopsy, Needle↗

PubMedDate not supplied

Incidence and prognostic significance of skin disease in patients with HIV/AIDS: a 5-year observational study.

Mucocutaneous diseases are common in HIV-infected patients. The aim of the present study was to determine the observed frequency of skin diseases and their prognostic significance for the progression of HIV infection. In a cohort of 150 HIV-infected patients diagnosed from 1986 to 1987 the number of mucocutaneous diseases, the CD4+ cell count, time to development of AIDS and survival time were registered for a period of 5 years. Eight patients were lost for follow-up. In the remaining 142 patients the number of mucocutaneous findings increased markedly during the observation period. The most frequent registered diseases and these with the highest increase were oral candidiasis, hairy leukoplakia, seborrhoeic dermatitis and herpes simplex. On average, 5.2 different diagnoses were registered per patient at the end of the follow-up period. The study showed that the total number of mucocutaneous diseases and the CD4+ cell count were significantly correlated to survival time and time to development of AIDS. The number of mucocutaneous diseases, like the CD4+ count, is an indicator of the immune system and the prognosis of HIV infection.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

An unusual severe case of subcorneal pustular dermatosis treated with cyclosporine and prednisolone.

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Adult↗