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Background Nonmelanoma skin cancer (NMSC) has been linked to cutaneous human papillomaviruses of the genus beta (betaPV). Objectives We sought to assess the presence of betaPV in NMSC biopsies from a group of Scottish skin cancer patients, both immunocompetent (IC) patients and immunosuppressed (IS) organ transplant recipients. Methods One hundred and twenty-one paraffin-embedded skin tumours (27 actinic keratosis, 41 intraepidermal carcinoma, 53 squamous cell carcinoma) and 11 normal skin samples were analysed for the presence of betaPV by a polymerase chain reaction–reverse hybridization assay designed to detect the presence of the 25 known betaPV genotypes. Results In IC patients, betaPV was detected in 30 of 59 (51%) tumours and two of 11 (18%) normal skin samples ( P = 0·046). In IS patients, betaPV was found in 27 of 62 (44%) tumours; no normal skin samples were available for comparison. The most frequently found genotypes were HPV-24, HPV-15 and HPV-38. Of those tumours infected with betaPV, 28 of 57 (49%) were infected with more than one genotype (range 2–8). Tumours from IS patients were from a younger age group (mean age 57·4 years) than IC patients (mean age 73·8 years). Multiple infections were more common in tumours from IC patients (21 of 30; 70%) compared with those from IS patients (seven of 27; 26%) ( P < 0·001). In the IC group, age did not appear to influence the distribution of single and multiple infections whereas in IS patients the proportion of multiple infections to single infections increased with age. There were no multiple infections in normal skin. Conclusions A wide spectrum of betaPV types was detected in our samples. Further characterization of betaPV in vivo is needed in order to determine the mechanisms by which the virus contributes to cutaneous carcinogenesis. [ABSTRACT FROM AUTHOR]

Examines on the influence of oral contraceptives on morality in England. Assessment on the risk of death in oral contraceptives; Linear trend in the death rates; Effect of oral contraceptives use on mortality.

Vessey M P (Department of Public Health and Primary Care, Radcliffe Infirmary. Oxford OX2 6HE, UK), Villard-Mackintosh Land Yeates D. Epidemiology of carpal tunnel syndrome in women of childbearing age. Findings in a large cohort study. 1990, : 655–659. There are few epidemiological data in the scientific literature about the carpal tunnel syndrome. This paper describes the characteristics of the 154 women referred to hospital for management of this condition among the 17 032 taking part in the Oxford-Family Planning Association contraceptive study. Standardized first referral rates for carpal tunnel syndrome doubled as age increased from 25–29 to 50 or more, tripled as smoking increased from zero to 25 or more cigarettes per day, doubled as total duration of oral contraceptive use increased from zero to ten years or more and doubled as Quetelet's obesity index (weight(g)/height(cm)) increased from up to 1.99 to 2.6 or more. All these trends were statistically significant. Carpal tunnel syndrome was also found to be positively associated with a history of menstrual disorders, gastrointestinal tract symptoms and various orthopaedic conditions. The findings on cigarette smoking are of particular interest but require confirmation or refutation in another study before firm conclusions can be drawn. [ABSTRACT FROM PUBLISHER]

The Oxford-Family Planning Association contraceptive study has now followed 17,000 women, predominantly of childbearing age, for a total of more than 200,000 woman-years. The incidence of myocardial infarction and angina in women aged less than 50 years has been low: 0.03/1,000 woman-years at ages 25-34 rising to 0.67/1,000 woman-years at ages 45-49. However, the overall incidence in women who were smokers at entry to the study is more than three times that in women who were non-smokers, the increase in individual risk being proportional to the number of cigarettes smoked. Observations on other risk factors must be treated with caution in view of the small numbers involved: in general, the differences and trends reported are not statistically significant. However, a consistent positive relation is observed between incidence rates and both relative weight and parity after adjustment for age and smoking, while no consistent trend is observed for social class. Ever use of oral contraceptives is associated with a twofold increased risk of myocardial infarction (not statistically significant), but there is no increased risk in current users as was suggested by earlier studies. This may reflect the adoption of lower dose preparations and the positive selection of healthy women for oral contraception. [ABSTRACT FROM PUBLISHER]

The clinical features and genetic background of 18 patients with rheumatoid arthritis were investigated following the development of penicillamine-induced myasthenia (PIM). The initial myasthenia symptoms in all patients consisted of variable diplopia and/or ptosis with progression to a more generalized involvement in 7 of them. No clinical, humoral, or genetic factor was determined which would allow identification of individuals developing generalized as opposed to ocular myasthenia. Withdrawal of penicillamine was associated over 4-60 weeks with a slow resolution of symptoms, facilitated in 12 patients by the use of anticholinesterase agents. In 2 patients a persistent partial unilateral ptosis remains after 15 and 25 months, while in a further patient diplopia is present 42 months after resolution of the other myasthenic symptoms. The patients with PIM when compared with a healthy 'control' population had a significant increase in HLA Dr1 (p corr less than 0.005) and an absence of HLA Dr 3. A genetic susceptibility to the development of PIM, distinct from that observed in myasthenia gravis of spontaneous onset, is suggested by this abnormal distribution of HLA Dr antigens. [ABSTRACT FROM PUBLISHER]

Cheiroarthropathy is a recently recognised complication of juvenile onset diabetes mellitus. It comprises inability to extend fully the fingers, contracted tendons, and waxy thickening of the skin overlying the fingers and to a lesser extent the hands. We report two families in which one parent and a number of siblings had the typical features of cheiroarthropathy without juvenile onset diabetes mellitus. The changes developed gradually during childhood and did not progress after adolesence. There were no other abnormal clinical findings, no persistently abnormal laboratory tests, and no association with a specific HLA phenotype. There are some similarities with scleroderma and its recognition is important to prevent unnecessary treatment and to reassure patients. [ABSTRACT FROM AUTHOR]

Examines the epidemiology of endometriosis in women attending family planning clinics in Great Britain. Suppression of endometriosis by oral contraceptives; Diagnosis of endometriosis in women using intrauterine devices (IUDs); Occurrence of pain and bleeding in using IUDs.

The article presents a case study of a 69-year-old woman suffering with severe lichen sclerosus (LS) affecting her scalp, trunk and legs. The patient develops a hyperkeratotic lesion on her left buttock, in an area of LS in 2005. The histological examination shows that a well-differentiated squamous cell carcinoma (SCC) develops from the overlying dyplastic epidermis. The article suggests that UVA-1 play a role in carcinogenesis for it reduce DNA damage in human cells.

Patients receiving high-dose psoralen plus ultraviolet (UV) A (PUVA) have an increased risk of nonmelanoma skin cancer (Lim JL, Stern RS. High levels of ultraviolet B exposure increase the risk of non-melanoma skin cancer in psoralen and ultraviolet A-treated patients. J Invest Dermatol 2005; 124: 505–13). The skin cancer risk associated with narrowband (NB) phototherapy is not yet known although mathematical models have been created to quantify the risk (Diffey BL. Factors affecting the choice of a ceiling on the number of exposures with TL01 ultraviolet B phototherapy. Br J Dermatol 2003; 149: 428–30). Until recently, > 150 lifetime PUVA treatments and > 300 NB-UVB treatments constituted a high dose of phototherapy. PHOTONET protocols suggest that an annual skin cancer check is carried out for patients in this category. The audit aims were to assess: (i) the number of patients receiving high-dose phototherapy; (ii) if annual checks are being carried out in these patients; (iii) the numbers of skin cancers diagnosed in the group; and (iv) the number of patients on third-line medication. Sixty-six patients receiving high-dose phototherapy were identified from the PHOTONET database; 60 case notes were available for review: 38 PUVA, 22 UVB. Sixteen of 60 are currently on third-line therapy; an additional 30 of 60 have previously been on third-line therapy. Six of 60 patients have developed skin cancer, all from the PUVA group. Four patients have developed nine squamous cell carcinomas, one of which has metastasized to regional lymph nodes. Two further patients have had one basal cell carcinoma each. Fourteen of 60 patients attend the photodermatology clinic for high-dose checks, 14 of 60 attend general dermatology outpatients, three of 60 attend both clinics and 29 of 60 have no dermatology follow up. We have found that nearly 50% of patients receiving high-dose phototherapy are not being reviewed at any dermatology clinic. Of the group being followed up 10% (16% of patients receiving PUVA) have had at least one skin cancer; this raises concerns about the group that has not been followed up. An annual high-dose check at a dedicated clinic has a number of potential benefits. The consultation has a skin cancer focus and a full body examination including the genitals is carried out. We can take the opportunity to educate patients on skin self-examination and early reporting of suspicious lesions. Finally, there should be a more focused approach to follow up of regular nonattendees, with correspondence to both patient and the general practitioner where necessary. In view of these findings, each patient receiving high-dose phototherapy has been invited to attend for screening. The photodermatology clinic has been restructured to allow a monthly, dedicated high-dose phototherapy clinic. We plan to repeat the audit cycle annually. This audit has demonstrated the use of the PHOTONET database in facilitating audit and highlighting clinical governance issues. [ABSTRACT FROM AUTHOR]