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Costello syndrome with decreased glucose tolerance.

We report a case of Costello syndrome, which is an uncommon multisystemic condition with cutaneous manifestations on the palms and soles. In the literature there are 29 cases described, all the studies are published in the genetic literature with a few exceptions. We add a further case associated with impaired glucose tolerance. The diagnostic clinical signs are impressive, and highly characteristic. Cutaneous manifestations are: loose skin of the hands and feet "washer woman's hand", hyperkeratosis palmoplantaris, curly or sparse hair, acanthosis nigricans, papillomata nasi. Coarse, progeroid facial features with a bulbous nose, feeding difficulties in infancy, cardiac involvement with cardiomyopathy or conduction defect, and in our case impaired glucose tolerance also presented. Postnatal growth retardation, mental retardation, and a distinctive friendly personality is characteristic. Hyperextensible fingers with broad distal phalanges and joint contractures were observed, and peroneal hypertonicity required treatment by Achilles tendon lengthening. The decreased glucose tolerance is interesting in the view of the acanthosis nigricans. No storage disease and no chromosomal abnormality were observed. Only in one case is a balanced translocation described in the literature.

Abnormalities, Multiple↗

Ringtail in suckling Munich Wistar Fromter rats: a histopathologic study.

Ringtail is a pathologic condition of the tail of rats and other rodents that is traditionally attributed to low environmental humidity, although dietary deficiencies, genetic susceptibility, environmental temperature, and degree of hydration of the animal also have been suggested as possible causes. To the authors' knowledge, a detailed histopathologic study that may serve to shed light on the etiopathogenesis of this disease has not yet been published. We describe the histologic findings of ringtail observed in 12 suckling Munich Wistar Fromter (MWF) rats from two litters. Epidermal hyperplasia characterized by orthokeratotic and parakeratotic hyperkeratosis and acanthosis was observed in all affected rats. Numerous often dilated vessels were present in the dermis of tails that appeared of red/brown color at gross examination. In severe cases, the dilated vascular structures were thrombotic and accompanied by dermal hemorrhages and focal coagulative necrosis of the overlying epidermis. These findings suggest that epidermal acanthosis and hyperkeratosis are the main and primary events in the development of ringtail. To clarify the cause of this disease, future studies should be focused on the numerous factors that can induce such epidermal changes.

Animals↗

Histopathology of skin lesions in chronic arsenic toxicity--grading of changes and study of proliferative markers.

Chronic arsenic toxicity (CAT) manifests predominantly as cutaneous lesions in the form of melanosis, keratosis and neoplastic changes. We have studied skin biopsies from 42 patients of CAT. Histological study of H/E stained sections showed--hyperkeratosis in 13, parakeratosis in 13, acanthosis in 12, papillomatosis in 24, elongation of reteridges in 21, increased basal pigmentation in 27 and dysplastic changes in 8 cases. Squamous cell carcinoma was present in 2, basisquamous in 1 and basal cell carcinoma in 1 case. Changes of skin lesions after drug DMSA and DMPS therapy compared to placebo were studied. The result was inconclusive. Proliferative activity of skin lesions in CAT were studied by AgNOR stain to assess the biological behaviour of the lesions. AgNOR score showed--normal control 1.08, benign changes (e.g. Hyperkeratosis, parakeratosis, acanthosis, papillomatosis etc.) without dysplasia--1.35, mild to moderate dysplasia--1.735, severe dysplasia--3.0 and carcinoma--3.56. Thus, AgNOR score gives some idea on the biological behaviour of CAT lesions. It is suggested that AgNOR staining should be done regularly along with H&E staining for proper assessment of the cases.

Adolescent↗

Confluent and reticulated papillomatosis of Gougerot and Carteaud.

Confluent and reticulated papillomatosis is a rarely reported dermatosis of unknown origin. It is similar to nummular and confluent papillomatosis; punctate, pigmented verrucose papillomatosis; acanthosis nigricans; pseudoacanthosis nigricans; benign acanthosis nigricans; pseudoatrophoderma colli; tinea versicolor; Darier's disease; epidermodysplasia verruciformis; and verruca plana. Treatment may be temporarily successful, but the lesions usually recur within a period of months.

Adult↗

NTP Toxicology and Carcinogenesis Studies of Diethylphthalate (CAS No. 84-66-2) in F344/N Rats and B6C3F1 Mice (Dermal Studies) with Dermal Initiation/ Promotion Study of Diethylphthalate and Dimethylphthalate (CAS No. 131-11-3) in Male Swiss (CD-1(R)) Mice.

Diethylphthalate and dimethylphthalate are used as phthalate plasticizers, in an extensive array of products. The chronic dermal toxicity of diethylphthalate was evaluated in male and female F344/N rats and B6C3F1 mice in 2-year studies. In a series of special studies, the tumor initiation or promotion potential of diethylphthalate or dimethylphthalate was evaluated in male Swiss (CD-1(R)) mice by an initiation/promotion model of skin carcinogenesis. The genetic toxicity of diethylphthalate and dimethylphthalate in Salmonella typhimurium and cultured Chinese hamster ovary cells was also evaluated. 4-WEEK STUDY IN F344/N RATS: Groups of 10 male and 10 female rats were dermally administered diethylphthalate at volumes of 0, 37.5, 75, 150, or 300 &mgr;L (0, 46, 92, 184, or 369 &mgr;g) applied neat, 5 days per week for 4 weeks. All male and female rats survived to the end of the study. No evidence of dermatotoxicity was observed, with no adverse clinical signs observed and no effects on weight gain or feed consumption. Relative liver weights of 300 &mgr;L males and females and 150 &mgr;L females were greater than those of controls. Relative kidney weights of 150 and 300 &mgr;L males and 150 &mgr;L females were greater than those of controls. No other adverse effects were observed in this study. 4-WEEK STUDY IN B6C3F1 MICE: Groups of 10 male and 10 female mice were dermally administered diethylphthalate at volumes of 0, 12.5, 25, 50, or 100 &mgr;L (0, 15, 31, 62, or 123 &mgr;) applied neat, five days per week for 4 weeks. One control female died before the end of the study; all other mice survived. No evidence of dermatotoxicity or other adverse clinical signs were observed, and no clear adverse effects on weight gain or feed consumption were seen. Absolute and relative liver weights of 25 and 100 &mgr;L females were greater than those of the controls. Based on these 4-week study results, doses of 0, 35, and 100 &mgr;L diethylphthalate were recommended for the 2-year mouse studies. A chronic study in male and female B6C3F1 mice at 0, 35, and 100 &mgr;L (applied neat, once per day, 5 days per week) was started and subsequently stopped after 32 weeks when significant body weight reductions were noted in treated animals (males and females, 100 &mgr;L groups: 19% lower; males, 35 &mgr;L group: 12% lower; females, 35 &mgr;L group: 10% lower than controls). Based on these body weight reductions, doses of 0, 7.5, 15, and 30 &mgr;L in 100 &mgr;L acetone were recommended for the restart of the 2-year mouse study. 2-YEAR STUDY IN F344/N RATS: Based upon the results of the 4-week study, doses of 0, 100, or 300 &mgr;L diethylphthalate (0, 123, or 369 &mgr;) were chosen for the 2-year rat study. Groups of 60 male and 60 female rats received the doses applied neat 5 days per week for 103 weeks and up to 10 animals per group were evaluated after 15 months. Survival, Body Weights, and Clinical Findings: Survival of dosed rats during the first 15 months was similar to that of controls. However, 2-year survival was significantly reduced in all groups of male rats (survival probabilities, males: 0 &mgr;L, 8%; 100 &mgr;L, 12%; and 300 &mgr;L, 12%). The mean body weights of 300 &mgr;L males were slightly less than those of the controls throughout the study. No adverse clinical signs were observed, including no evidence of dermatotoxicity. Pathology Findings: No morphological evidence of dermal or systemic toxicity was observed in male or female rats. Skin neoplasms were not observed in female rats and were only rarely observed in male rats. A high incidence of anterior pituitary adenoma occurred in all groups of male and female rats. The incidence of anterior pituitary adenomas in the 0, 100, and 300 &mgr;L groups were: males, 39/44, 41/49, 41/49; females, 38/50, 33/49, 33/48. The incidence of this benign tumor in control males (84%) exceeded the historical control mean incidence [feed controls, (28.7%)] and range (12% to 60%). Anterior pituitary adenomas were considered a primary contributing factor in the increased mortality observed in all grtor in the increased mortality observed in all groups, regardless of treatment. A dose-related decreasing trend in the incidence of mammary gland fibroadenomas was observed in female rats (21/50, 12/48, 7/50). The incidence of mononuclear cell leukemia in male rats in this study was lower than the historical incidence and may be attributable to the shortened life span of male rats. Similarly, the incidence of interstitial cell tumors of the testes was markedly decreased in all groups of males (4/50, 3/50, 8/50), relative to historical control rates (90.1%; range 74%-98%). The incidence of fatty liver degeneration was notably lower in dosed rats than in controls (males: 26/50, 8/50, 4/51; females: 23/50, 11/50, 3/50). 2-YEAR STUDY IN B6C3F1 MICE: Groups of 60 male and 60 female mice received doses of 0, 7.5, 15, or 30 μL diethylphthalate (0, 9, 18, or 37 μ) in 100 μL acetone 5 days per week for 103 weeks with a 1 week recovery period, and up to 10 animals per group were evaluated after 15 months. Survival, Body Weights, and Clinical Findings: Two-year survival of dosed mice was similar to that of controls: 43/50, 41/48, 46/50, and 43/50 (males), and 41/50, 38/51, 37/49, and 36/49 (females). Mean body weights of dosed male and female mice were similar to those of the controls throughout the study. No adverse clinical signs were observed in mice, including no gross evidence of dermatotoxicity. Feed consumption by male and female mice was similar to or up to 13% greater than that by controls. Pathology Findings: No morphological evidence of dermal toxicity was observed in male or female mice. No skin neoplasms were observed in dosed male mice. In female mice receiving 30 μL, one squamous cell carcinoma and one basal cell carcinoma were seen at the site of application. An increased incidence of liver neoplasms was observed in dosed male and female mice. The incidence of hepatocellular adenoma or carcinoma (combined) in B6C3F1 mice in the 0, 7.5, 15, and 30 μL groups were: (males) 9/50, 14/50, 14/50, and 18/50; (females) 7/50, 16/51, 19/50, and 12/50. The incidence of adenoma or carcinoma (combined) was increased in 30 μL male mice and the incidences of adenoma and of adenoma or carcinoma (combined) were increased in 7.5 and 15 μL females. A positive dose-related trend in the incidence of adenoma or carcinoma (combined) was also observed in male mice. The incidence of basophilic hepatic foci was increased in 15 μL male mice (0/50, 1/50, 9/50, 3/50). The increased incidence of liver neoplasms in this study was considered equivocal because the incidence of hepatocellular neoplasms in control and dosed males was within the historical range and because there was no clear dose-response relationship in females. No other treatment-related findings were observed in this study. 1-YEAR INITIATION/PROMOTION STUDY IN MALE SWISS (CD-1®) MICE: Groups of 50 male mice were dosed dermally with diethylphthalate or dimethylphthalate to study their effect as initiators and promoters. Diethylphthalate and dimethylphthalate were tested as initiators with and without the known skin tumor promoter 12-O-tetradecanoylphorbol-13-acetate (TPA). Diethyl phthalate and dimethylphthalate were tested as promoters with and without the known skin tumor initiator 7,12-dimethylbenzanthrancene (DMBA). Comparative control groups used during the study of diethylphthalate and dimethylphthalate included: vehicle control (acetone/acetone); initiation/promotion control (DMBA/TPA); initiator control (DMBA/acetone); and promoter control (acetone/TPA). Based on the incidence of skin neoplasms diagnosed histologically and the multiplicity of skin neoplasms, there was no suggestion that either diethylphthalate or dimethylphthalate was able to initiate skin carcinogenesis when chronically promoted by TPA. Further, there was no evidence that either diethylphthalate or dimethylphthalate was able to promote skin carcinogenesis in skin previously initiated with DMBA. High incidences of both squamous cell papillomas and squamous cell carcinomas occurred among the initiation/promotion control animals initiated with DMBA and promoted with TPA. All TPA-dosed groups had significantly greater incidences of dermal acanthosis, ulceration, exudation, and hyperkeratosis than controls. GENETIC TOXICOLOGY: Neither diethylphthalate (10-10,000 μ/plate) nor dimethylphthalate (33-6,666 μ/plate) induced gene mutations in Salmonella typhimurium strains TA98, TA100, TA1535, or TA1537, with or without rat and hamster liver S9. In cultured Chinese hamster ovary cells, both diethylphthalate and dimethylphthalate induced sister chromatid exchanges in the presence of S9. Neither induced sister chromatid exchanges in the absence of S9. Neither chemical induced chromosomal aberrations, with or without S9, in cultured Chinese hamster ovary cells. CONCLUSIONS: Under the conditions of these 2-year dermal studies, there was no evidence of carcinogenic activity of diethylphthalate in male or female F344/N rats receiving 100 or 300 μL. The sensitivity of the male rat study was reduced due to low survival in all groups. There was equivocal evidence of carcinogenic activity of diethylphthalate in male and female B6C3F1 mice based on increased incidences of hepatocellular neoplasms, primarily adenomas. In an initiation/promotion model of skin carcinogenesis, there was no evidence of initiating activity of diethylphthalate or dimethylphthalate in male Swiss (CD-1®) mice. Further, there was no evidence of promotion activity of diethylphthalate or dimethylphthalate in male Swiss (CD-1®) mice. The promoting activity of TPA following DMBA initiation was confirmed in these studies. Minor dermal acanthosis was observed following dermal application of diethylphthalate in male and female F344/N rats dosed for 2 years and in male Swiss (CD-1®) mice dosed for 1 year. Synonyms: Diethylphthalate (CAS No. 84-66-2): 1,2-benzenedicarboxylic acid, diethyl ester; DEP; diethyl 1,2-benzenedicarboxylate; diethyl o-phthalate; diethyl phthalate; ethyl phthalate; o-benzenedicarboxylic acid diethyl ester; phthalic acid, diethyl ester; RCRA U088 Dimethylphthalate (CAS No. 131-11-3): 1,2-benzenedicarboxylic acid, dimethyl ester; dimethyl 1,2-benzenedicarboxylate; dimethyl benzene-o-dicarboxylate; dimethyl benzeneorthodicarboxylate; dimethyl o-phthalate; dimethyl phthalate; DMP; FIFRA 028002; methyl phthalate; go-dimethyl phthalate; phthalic acid, dimethyl ester; phthalic acid methyl ester; RCRA U102

Journal Article↗

NTP Toxicology and Carcinogenesis Studies of Titanocene Dichloride (CAS No. 1271-19-8) in F344/N Rats (Gavage Studies).

Titanocene dichloride is an organometallic compound composed of two cyclopentadienyl rings, titanium, and chloride. It is used as a cocatalyst in polymerization reactions. Toxicology and carcinogenesis studies were conducted by administering titanocene dichloride (greater than 98% pure) in corn oil by gavage to groups of F344/N rats for 14 days, 13 weeks, and 2 years. Genetic toxicology studies were conducted in Salmonella typhimurium and in Chinese hamster ovary cells. 14-Day and 13-Week Studies: In the 14-day studies, titanocene dichloride was administered at doses of 0, 65, 125, 250, 500, or 1,000 mg/kg. All high-dose rats and four of the five male and two of the five female rats given 500 mg/kg died during the studies. A dose-related decrease in body weight gain was seen in rats given 125, 250, 500, and 1,000 mg/kg. Lesions related to chemical administration included hepatocellular necrosis, tubule necrosis in the kidney, erosions and ulcers of the glandular stomach, and hyperplasia of the forestomach epithelium. The 13-week studies were conducted by administering titanocene dichloride at doses of 0, 8, 16, 31, 62, or 125 mg/kg. One female rat in the 125 mg/kg dose group died from chemical toxicity during the fourth week of the studies. Body weight gain was lower in rats given 62 or 125 mg/kg than in control groups. Treatment-associated histopathologic lesions were seen in the stomachs of high-dose males and all groups of females given titanocene dichloride. These lesions included hyperplasia and metaplasia of the glandular stomach and hyperplasia and hyperkeratosis of the forestomach. Body Weight and Survival in the 2-Year Studies: The doses selected for the 2-year studies in rats (0, 25, and 50 mg/kg) were based on the potentially life-threatening nature of the glandular stomach lesions and the decreased body weight gain compared to controls seen in the 62 and 125 mg/kg dose groups in the 13-week studies. The final mean body weights of high-dose males and females were 91% and 89% of controls, respectively. The 2-year survival rates for males in the control, low-, and high-dose groups were 41/60, 30/60, and 24/60; survival rates for female rats were 37/60, 30/61, and 31/60. Nonneoplastic and Neoplastic Effects in the 2-Year Studies: The principal toxic effects associated with the administration of titanocene dichloride for 2 years occurred in the stomach. The lesions in the stomach were seen at the 15-month interim evaluations and were similar to, but less severe than, those observed at 2 years. The lesions included focal erosions of the glandular mucosa with an associated inflammatory response, hyperplasia and metaplasia of the epithelium of the fundic glands, and fibrosis of the lamina propria and submucosa. Forestomach lesions included focal acanthosis (hyperplasia) and hyperkeratosis of the stratified squamous epithelium. Squamous cell papillomas of the forestomach were seen in four low-dose males, one high-dose male, one low-dose female, and two high-dose females; none were observed in controls. A squamous cell carcinoma of the forestomach occurred in one low-dose male and a benign basosquamous tumor occurred in one high-dose male. Accumulations of macrophages with blue-gray pigment believed to contain titanium were present in many organs of dosed rats including the gastrointestinal tract, liver, lung, and lymph nodes. A dose-related increase in the incidence of inflammation of the nasal mucosa and lung also occurred and was attributed to reflux and/or regurgitation and aspiration of gavage solution due to the severe stomach lesions. Genetic Toxicology: Titanocene dichloride was mutagenic in Salmonella typhimurium strain TA100 in the absence of exogenous metabolic activation (S9); it was not mutagenic in TA100 with S9, nor was it mutagenic in TA1535, TA1537, or TA98 with or without S9. Titanocene dichloride did not induce sister chromatid exchanges or chromosomal aberrations in Chinese hamster ovary cells, with or without S9. Conclusions: Under the conditions of these 2-year gavage studies, there was equivocal, there was equivocal evidence of carcinogenic activity of titanocene dichloride in male F344/N rats based on a marginal increase in the incidence of forestomach squamous cell papillomas, squamous cell carcinoma, and basosquamous tumor benign. There was equivocal evidence of carcinogenic activity of titanocene dichloride in female F344/N rats based on a marginal increase in the incidence of forestomach squamous cell papillomas. Nonneoplastic lesions associated with the administration of titanocene dichloride for up to 2 years included erosions and inflammation of the gastric mucosa, hyperplasia and metaplasia of the fundic glands with fibrosis of the lamina propria in the glandular stomach, and acanthosis (hyperplasia) and hyperkeratosis of the forestomach epithelium. Synonyms: Titanium ferrocene; biscyclopentadienyltitanium dichloride; dichlorodi-p-cyclopentadienyltitanium; dichlorobis(h5-2,4-cyclopentadien-1-yl)titanium; dicyclopentadienyltitanium dichloride; dichlorodicyclopentadienyltitanium; dichlorotitanocene; dicyclopentadienyldichlorotitanium; dichlorobis(p-cyclopentadienyl)titanium; bis (h5-cyclopentadienyl) titanium dichloride; dichlorobis(h5-cyclopentadienyl)titanium; dichlorobiscyclopentadienyl titanium; dichlorobis(1,3-cyclopentadiene)titanium; bis(cyclopentadienyl)dichlorotitanium

Journal Article↗

NTP Toxicology and Carcinogenesis Studies of Ampicillin Trihydrate (CAS No. 7177-48-2) in F344/N Rats and B6C3F1 Mice (Gavage Studies).

Ampicillin trihydrate is a broad-spectrum semi-synthetic penicillin that is effective in the treatment of gram-positive and gram-negative bacterial infections produced by Streptococcus, Bacillus anthracis, Haemophilus influenzae, Neisseria gonorrhoeae, and Escherichia coli. This antibiotic is used in the treatment of upper respiratory tract infections, genital and urinary tract infections, and otitis media in children. Toxicology and carcinogenesis studies of ampicillin trihydrate (97%-99% pure) were conducted by administering the chemical in corn oil by gavage to groups of 50 F344/N rats and 50 B6C3F1 mice of each sex, 5 days per week for 103 weeks. Male and female rats received doses of 0, 750, or 1,500 mg/kg, and male and female mice received doses of 0, 1,500, or 3,000 mg/kg. Doses selected for the 2-year studies were based on the lack of body weight effects and histopathologic effects at 2,400 mg/kg in the 14-day studies and 3,000 mg/kg in the 13-week studies. Clinical signs in the 13-week studies included diarrhea at 3,000 mg/kg in male and female rats and male mice. Corn oil suspensions containing more than 300 mg ampicillin trihydrate/ml were too viscous to be administered by gavage; therefore, a high dose of 1,500 mg/kg was selected for rats and a high dose of 3,000 mg/kg was selected for mice. During the 2-year studies, mean body weights of male and female rats were similar to or slightly increased over those of the corresponding vehicle control groups. Mean body weights of low dose and high dose male mice were similar to those of the corresponding vehicle group during year 1 of the study but were slightly below those of the vehicle control group during the last half of the study. Mean body weights of low dose and high dose female mice were greater than those of the vehicle controls throughout most of the study. No significant differences in survival were observed in groups of rats or mice of either sex. Clinical signs observed in dosed rats included diarrhea, excessive urination, and chromodacryorrhea and in dosed mice included increased salivation and decreased activity. In male rats, administration of ampicillin trihydrate was associated with an increased incidence of mononuclear cell leukemia (vehicle control, 5/50; low dose, 14/50; high dose, 13/50). Malignant lymphomas were observed in one additional vehicle control male rat and two low dose male rats. Lymphocytic leukemia was seen in one high dose rat. High dose male rats showed increased incidences of pheochromocytomas of the adrenal gland medulla (13/50; 12/50; 23/49). Malignant pheochromocytomas were observed in 1/50 vehicle control, 5/50 low dose, and 1/49 high dose male rats. The incidence of adrenal gland medullary hyperplasia was not increased in male rats (14/50; 10/50; 8/49). There were increased incidences of C-cellhyperplasia of the thyroid gland in low dose male and high dose female rats. High dose male rats showed increased incidences of hyperkeratosis and acanthosis of the forestomach. In male and female mice, ampicillin trihydrate administration was associated with increased incidences of forestomach lesions, including ulcers, inflammation, hyperkeratosis, acanthosis, and evidence of fungal infection. Ampicillin trihydrate was not mutagenic in Salmonella typhimurium strains TA98, TA100, TA1535, or TA1537 in the presence or absence of Aroclor 1254-induced male Syrian hamster or male Sprague-Dawley rat liver S9 when tested according to preincubation protocol. Ampicillin trihydrate was not mutagenic in L5178Y mouse lymphoma cells with or without metabolic activation. Ampicillin trihydrate did not cause chromosomal aberrations or sister-chromatid exchanges in Chinese hamster ovary cells with or without metabolic activation. An audit was conducted for these 2-year studies. Animal/carcass identification discrepancies were observed in rats and mice. The most common findings were the failure to clip some toes in rats and opened ear holes in mice. A review of the inlife data (including body weights, clinical observations, and dosing records) indicrecords) indicated that animals had not been interchanged among groups. The data are considered adequate to support the conclusions. Under the conditions of these 2-year gavage studies, there was equivocal evidence of carcinogenicity of ampicillin trihydrate for male F344/N rats as shown by increased incidences of pheochromocytomas of the adrenal medulla and by marginally increased incidences of mononuclear cell leukemia. There was no evidence of carcinogenicity for female F344/N rats receiving 750 or 1,500 mg/kg or for male and female B6C3F1 mice receiving 1,500 or 3,000 mg/kg per day. Nonneoplastic lesions of the forestomach were seen in male rats and male and female mice. Synonyms and trade names: Acillin; Amcap; Amcill; Aminobenzylpencillin trihydrate; a-Aminobenzylpencillin trihydrate; Amperil; Ampichel; Ampikel; Ampinova; Amplin; Cymbi; Divercillin; Liffampil; Morepen; Pen A; Pensyn; Polycillin; Princillin; Principen; Ro-ampen; Trafarbiot

Journal Article↗

Histological study of necrolytic acral erythema.

Described in 1996, necrolytic acral erythema remains the sole diagnostic cutaneous marker for hepatitis C virus infection. To date only eight cases have been described in literature, a fact that makes full histological description and appreciation of the disease process inadequate. Thirty necrolytic acral erythema cases were biopsied and detailed histological description was performed by three separate dermatopathologists who were blinded as to clinical presentation. Clinicopathological correlation was used to evaluate the disease progress. In the early stage, there is moderate regular acanthosis with variable spongiosis and inflammation, progressing to a picture resembling nummular eczema. In its fully evolved form, necrolytic acral erythema shows psoriasiform epidermal hyperplasia with marked papillomatosis. Associated findings include parakeratosis, focal hypergranulosis, subcorneal pustule, epidermal pallor, necrotic keratinocytes, which sometimes become confluent in the upper epidermis and/or track along the acrosyringia, vascular ectasia and papillary dermal inflammation. Late stage samples display some remaining acanthosis with variable inflammation. Pigment incontinence is seen in all stages.

Acrodermatitis↗

Evaluation of carcinogenic effect of mineral oil used in the processing of jute fibres.

To evaluate the carcinogenic activity of jute-batching oil (JBO), this substance was painted on the skin of ITRC mice up to 300 days. Initially hyper- and parakeratosis of the stratum corneum, acanthosis and spongiosis of the stratum Malpighii, hyperactivity of fibroblasts, and laying down of collagen fibres in the dermis were encountered at 100 days. This was followed by poor hair growth, acne formation and ulceration. As time passed, these animals partially adapted themselves to the oil-painting so that by 200 days hyperkeratosis and parakeratosis of the stratum corneum, as well as acanthosis and spongiosis of the stratum Malpighii, had almost disappeared. The ulcers healed and no more acne was visible; however, the baldness and loss of hair appendages persisted to 300 days. No carcinogenic changes in the skin or in the viscera of these mice were observed. On UV and IR spectroscopy no traces of any polycyclic aromatic hydrocarbons were found in the JBO sample. Mice, on the other hand, when painted with the known carcinogen 3,4 benzpyrene (BP), developed skin tumours, showing that the mice used in this study were not cancer-resistant. Also, when JBO was applied with BP, the time taken for tumour development in mice was shortened by about 4 weeks as compared to another group painted with the same dose of BP alone. This suggests a cancer-promoting activity which needs to be investigated further.

Acne Vulgaris↗

[Clinical features, hormonal profile, and metabolic abnormalities of obese women with obese polycystic ovary syndrome].

OBJECTIVE: To investigate and analyze the clinical presentation, hormonal profile, and metabolic abnormalities of obese women with polycystic ovary syndrome (PCOS). METHODS: The data of the anthropometric measurements, clinical manifestations of hyperandrogenism, serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E(2)), testosterone (T), prolactin (PRL), dehydro-epiandrosterone sulfate (DHEAS), sex-hormone-binding globulin (SGBG), and 17-oxyhydroprogesterone (17-OHP), fasting plasma glucose (FPG) and fasting insulin (FINS) detected after oral glucose tolerance test (OGTT), serum lipid levels, including total cholesterol (Chol), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL), homeostasis model assessment (HOMA) and area under curve (AUC) so as to assess the insulin resistance (IR), free androgen index (FAI) to estimate the extent of hyperandrogenism, HOMA IS and DeltaI(30)/DeltaG(30) used to assess the function of islet beta cells, were collected from 192 women with PCOS, aged 24 +/- 6, that were divided into 2 groups according to the body mass index (BMI): Group A (n = 70) with the BMI > or = 25 kg.m(-2) and Group B (n = 122) with the BMI < 2 5 kg.m(-2), and 65 age-matched bilateral tubal block factor infertile women served as controls that were divided into 2 groups as well: Group C (n = 25) with the BMI > or = 25 kg.m(-2); and Group D (n = 79) with the BMI < 25 kg.m(-2), and underwent a cross-sectional study. RESULTS: (1) Clinical phenotype: The presence of obesity was 36.46% (70/192) of which 80.00% (56/70) was central obesity. The incidence of acanthosis nigricans was 17.18% (33/192), 35.71% in Group A and 6.56% in Group B. (P < 0.01). Groups A and C showed increased frequency of acanthosis nigricans compared with Group B. The value of FAI of Group A was 3.40 +/- 1.84, significantly higher than those of Group B (1.75 +/- 1.20) and Group C (1.65 +/- 0.90), (both P < 0.01). The LH/FSH ratio of Group B was 2.41 +/- 1.13, significantly higher than those of Groups A, C, and D (all P < 0.01). (2) Hormonal profile: The IR rate was 43.23% in the 192 patients, 82.86% in Group A and 20.49% in Group B. The LH and LH/FSH ratio were significantly higher in Group B than in Groups A, C, and D (all P < 0.01); T level was higher in Groups A and B than in Group C and D (all P < 0.05). SHBG was lower in Group A (108.70 +/- 81.35 nmol.L(-1)) and Group C (150.34 +/- 106.23 nmol.L(-1)) compared with Group B (192.49 +/- 98.30 nmol.L(-1)) and Group D (231.84 +/- 90.09 nmol.L(-1)) (P < 0.01 and P < 0.05). FAI level was 3.40 +/- 1.84 in Group A, significantly higher than those of Groups B (1.75 +/- 1.20), C (1.65 +/- 0.90), and D (0.84 +/- 0.45) (all P < 0.01). The FINS, TG, and HOMA IR of Groups A and C were all significantly higher than those of Groups B and D (all P < 0.01). The OGTT GAUC was significantly higher than those of Groups B, C, and D (P = 0.006, 0.028, and 0.031 respectively). (3) Metabolic profile: The prevalence of IR was 43.23% (83/192) with a higher prevalence rate in Group A (82.76%, 58/70) compared with Group B (20.49%, 25/122). The values of FINS, HOMA IR, GAUC, IAUC, and TG were all higher in Group A than in Group B (all P < 0.01). BMI and WHR were positively correlated with FAI and HOMA-IR (all P < 0.01), whereas negatively correlated with LH/FSH ratio (r = -0.345, -0.260, P < 0.01). There were no significant differences in HOMA-IS and DeltaI(30)/DeltaG(30) among these groups (all P > 0.05). CONCLUSION: Obese PCOS women have more severe hyperandrogenism, IR and hyperinsulinism than normal-weight PCOS women, which may have some health implications later in life.

Adolescent↗

[Exploration of the classification of polycystic ovarian syndrome].

OBJECTIVE: To investigate the clinical presentation, hormonal profile and metabolic abnormalities in subgroups of women with PCOS and explore a reasonable classification for PCOS. METHODS: A cross-sectional study of 192 women with PCOS (14 - 38 years of age) was performed. The patients were divided into 3 groups of A, B and C according to the revised 2003 consensus on diagnostic criteria and also divided into 2 groups according to body mass index (BMI): group A (n = 110), long term anovulation, clinical and biochemical evidence of high androgen level, ovary enlargement with its size larger than 10 ml or number of small follicles of 2 - 9 mm >or= 12 under ultrasound with exclusion of other diseases caused by high androgen; group B (n = 46), long term anovulation, clinical and biochemical evidence of high androgen level; group C (n = 36), long term anovulation, ovary enlargement with its size larger than 10 ml or number of small follicles of 2 - 9 mm >or= 12 under ultrasound with exclusion of other disease caused by high androgen; obesity PCOS group (OB-PCOS, n = 70), BMI >or= 25 (kg/m(2)); no obesity PCOS group (NOB-PCOS, n = 122), BMI < 25 (kg/m(2)). One hundred and four women with bilateral tubal block factor caused infertility served as control group. Anthropometric measurements, Ferriman Gallwey hirsutism scoring, presence of acne and acanthosis nigricans were noted. Hormonal profile was assessed by measuring follicle-stimulating hormone (FSH), luteinizing hormone (LH), free testosterone (FT), prolactin (PRL), sex hormone binding globulin (SHBG). The metabolic profile was investigated by measurements of oral glucose tolerance test (OGTT), serum lipid levels, including total cholesterol (Chol), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Hyperinsulinemia was estimated by measurement of fasting insulin (FINS) and insulin area under the curve (IAUC). The extent of insulin resistance (IR) and hyperandrogenism was estimated by homeostasis model assessment (HOMA) and free androgen index (FAI) respectively. RESULTS: (1) Clinical phenotypes: the presence of obesity was 36.4% (70/192), among which 80.0% (56/70) were central obesity. Higher rates of acanthosis nigricans were observed in OB-PCOS group (35.7%, 25/70) compared with NOB-PCOS group (7.4%, 9/122; P < 0.01). Waist to hip ratio (WHR) was lower in group C than those in groups A and B (P < 0.05). (2) Endocrinology: FAI level was higher in OB-PCOS group than in NOB-PCOS group (P < 0.01), whereas LH/FSH ratio was lower in OB-PCOS group compared with NOB-PCOS group (P < 0.01). FAI level was higher in groups A and B than in group C (P < 0.01). SHBG, LH/FSH ratio did not differ between groups A, B, and C. (3) Metabolism: the prevalence of IR was 43.2% (83/192). A higher prevalence was observed in group OB-PCOS (82.8%, 58/70) compared with group NOB-PCOS (20.5%, 25/122; P < 0.01). FINS, HOMA-IR, glucose area under the curve (GAUC), IAUC and TG were higher in group OB-PCOS than in group NOB-PCOS (P < 0.01), whereas HOMA-IR, lipid profile did not differ between groups A, B, and C. CONCLUSION: The classification according to the revised 2003 consensus on diagnosis reflects the basic characteristics of PCOS; while the classification based on obesity shows the severity of hyperandrogenism and degree of IR, and thus has substantial significance for evaluation of metabolic complications.

Adolescent↗

[Type 2 diabetes mellitus in children in black Africa: description of first five cases in Togo].

The purpose of this report is to describe epidemiological, clinical and therapeutic features of the first five cases of childhood type 2 diabetes mellitus (T2DM) documented in Togo. The five children were admitted to either the Barruet Clinic (n=4) or Tokoin de Lomé University Hospital Centre (n=1) between 1999 and 2004. All presented one or more of the following risk factors for T2DM: obesity, familial history of T2DM, acanthosis nigricans, polycystic ovary syndrome, dyslipidemia, and high blood pressure. Age at diagnosis was 15 years in two cases and 13, 11 and 12 years in the other three cases (mean, 13.2 + 1.79 years). There were three females and two males. All five patients were obese and had risk factors for obesity (high fat intake, sedentary lifestyle and lack of physical exercise). All had a familial history of T2DM and two had Acanthosis nigricans. All five patients were treated initially with insulin that was gradually discontinued in favor of exercise and diet in four. These are the first reported cases of childhood T2DM in Togo. An education campaign is necessary to inform the population on about the risk factors for T2DM.

Adolescent↗

Non-infective skin associations of diabetes mellitus.

A study of non-infective skin associations of diabetes mellitus was conducted on 100 consecutive outpatient diabetics over a 3-month period. 10 were insulin-dependent diabetics (IDDM), 24 insulin-requiring and 66 non-insulin dependent diabetics (NIDDM). A total skin evaluation was done for each patient with skin biopsy whenever appropriate. Twenty-three patients had diabetic dermopathy; the frequency of retinopathy in this group (39.1%) is significantly higher than that without diabetic dermopathy (6.9%) (p less than 0.001). There were 20 instances of cutaneous complications of therapy; 10 had insulin lipodystrophy (29.4% of 34 insulin users). Twelve patients, 8 of whom were overweight, had acanthosis nigricans. There were 6 Indians among them and all the patients had NIDDM. Eight had xanthelasma. Vitiligo occurred in 3.3% of those with NIDDM. Classical scleredema diabeticorum and cheiroarthropathy occurred in 2% of patients. One patient had atypical granuloma annulare. There was a higher incidence of xanthelasma in our study compared with studies done previously. Insulin lipodystrophy and acanthosis nigricans in the absence of classically described syndromes of insulin resistance seem to be fairly common phenomena and merit further investigation locally.

Adolescent↗

Topical effects of molten salt on rat integument: a histological and photometric assessment.

The topical effects of the molten salt 1-methyl-3-ethylimidazolium tetrachloroaluminate (melt) and its organic component, the organic salt 1-methyl-3-ethylimidazolium chloride were tested on rat integument. Evaluation was accomplished using standard histological techniques supplemented with digital analysis using the microscope photometer. Two groups of animals were treated with 1.5 ml of either the melt or the organic salt for 10 consecutive days. A third group treated with the melt had the treated area flushed with running water 5 min after each application (wash). Significant treatment effects were observed in rats treated with the melt and wash preparations while the effects of the organic salt were unremarkable. The melt induced an ulcerative dermatitis with acanthosis while the wash produced only mild acanthosis and dermatitis. This damage appears to result from the penetration of aluminum chloride in the melt through the skin and its toxic effects on the cells of the dermis and epidermis.

Aluminum↗

Treatment of Darier's disease with an oral aromatic retinoid (Ro 10-9359): a clinical and light and electron microscopic study.

An aromatic retinoid (Ro 10-9359) cleared 6 of 8 patients with Darier's disease in 4-6 weeks. After discontinuing the treatment, remission was maintained for up to 5 months. In 2 severe cases continuous treatment proved necessary in order to maintain the improved state. Acantholysis, various types of dyskeratosis and acanthosis with downward proliferation of rete ridges were seen by light microscopy before treatment. Electron microscopy revealed a decreased number of desmosomes and other cellular attachments and conspicuous microvillous changes of cell surface in separated basal cells. Keratinization in epidermal cells was premature and characterized by abnormal aggregations of keratinization products. Under the influence of retinoid there seemed to appear a new generation of basal cells better able to form intercellular attachments, after which the progress of keratinization in the entire epidermis shifted towards normal, and acanthosis decreased.

Administration, Oral↗

Laryngeal carcinoma--or is it laryngeal blastomycosis.

A patient is described who was evaluated for persistent hoarseness. Although an initial diagnosis of squamous cell carcinoma of the larynx was made, review of the pathology slides revealed pseudoepitheliomatous hyperplasia, acanthosis, and what appeared to be a fungal infection. After a detailed work-up was initiated the patient was treated successfully with ketoconazole for a blastomycosis infection of the larynx. The literature relative to blastomycosis infections of the respiratory larynx is reviewed. The authors emphasize that patients who show evidence of acanthosis and pseudoepitheliomatous hyperplasia along with the diagnosis of squamous cell carcinoma should be suspected as having a potential fungal infection.

Aged↗

Histological changes in the hamster cheek pouch epithelium induced by topical application of sodium lauryl sulphate.

Dentifrices, two containing sodium lauryl sulphate (SLS) and one containing stearylethoxylate as surfactant, were gently rubbed on the mucosal surface of the medial wall of cheek pouches in adult male Syrian golden hamsters. Four daily applications were performed. On the fifth day, the animals were sacrificed and cheek pouch mucosal tissue was routinely processed for light microscopy. After applications of SLS containing dentifrices, the epithelium showed consistently prominent structural changes, especially hyperkeratinization, including ortho and para-keratinization, acanthosis with widening of the intercellular spaces, and varying degrees of basal hyperplasia. Identical morphological changes were also observed after application of a paste containing only SLS as an agent. In contrast, after application of the stearylethoxylate containing dentifrice, as well as a paste containing only stearylethoxylate as an agent, the epithelium remained essentially identical to the epithelium of cheek pouches treated with sterile saline, and to the nontreated cheek pouches. From these results, we may conclude that SLS is the agent responsible for the striking changes in the epithelial structure. The specific cytological effects of SLS on the epithelial cells remain to be further studied. Interestingly, application of SLS provides a useful system for the rapid production of acanthosis and hyperkeratinization in the stratified squamous epithelium of the hamster cheek pouch.

Administration, Topical↗

Narrowband UV-B produces superior clinical and histopathological resolution of moderate-to-severe psoriasis in patients compared with broadband UV-B.

OBJECTIVE: To compare the therapeutic effectiveness of daily exposure to narrowband (NB) UV-B vs broadband (BB) UV-B with and without tar. DESIGN: Half-body exposures to NB UV-B or BB UV-B were given daily for 4 weeks in this comparative treatment study. Narrowband UV-B was delivered from TL-01 fluorescent bulbs and BB UV-B from conventional bulbs in the same phototherapy cabinet. Narrowband UV-B was compared using a paired treatment approach to BB UV-B above the waist and to BB UV-B with tar (Goeckerman treatment) below the waist. SETTING: General clinical research center of a university hospital inpatient unit. PATIENTS: Twenty-two patients with moderate-to-severe plaque-type psoriasis completed the study. MAIN OUTCOME MEASURES: Clinical efficacy was measured weekly using psoriasis severity scoring. Therapeutic outcomes after 4 weeks were compared in paired biopsy samples from treated lesions using objective histopathological measures (quantitative reduction in epidermal acanthosis and keratin 16 expression). RESULTS: Clinical resolution of psoriasis was achieved on 86% of paired sites treated with NB UV-B vs 73% treated with BB UV-B. Histopathological resolution of epidermal hyperplasia (marked by keratin 16 expression) was achieved in 88% of lesions treated with NB UV-B vs 59% treated with BB UV-B. Epidermal acanthosis was reduced more completely by NB UV-B treatment. Clinical resolution of psoriatic lesions occurred more rapidly following NB UV-B treatment, with some patients achieving complete resolution after 2 to 3 weeks of treatment. CONCLUSIONS: Narrowband UV-B offers a significant therapeutic advantage over BB UV-B in the treatment of psoriasis, with faster clearing and more complete disease resolution. The erythema response to NB UV-B treatment was significantly more intense and persistent compared with BB UV-B. Considerably more necrotic keratinocytes were observed in histopathological sections of skin treated with NB UV-B after a single 2.0-minimum erythema dose exposure. Treatment should be coupled with obligate minimum erythema dose testing to NB UV-B and close clinical observation during dose increases.

Adolescent↗