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Weight stigmatization and discrimination are pervasive issues that have numerous adverse consequences for those with excess weight. It has been proposed that some individuals may be addicted to hyperpalatable processed foods, resulting in weight promoting eating behaviours. The current study replicated and extended a study examining the effect of a food addiction explanation for eating behaviours on weight-based stigma and weight-controllability beliefs. Undergraduate students (N = 757) were randomly assigned to one of four conditions where they read a newspaper article accompanied by a photo of a woman 1) who was either of a higher body mass index (BMI) or a lower BMI, and 2) that attributed her eating behaviours to either food addiction or poor dietary and lifestyle choices. Stigma towards the woman and individuals with a higher BMI in general were assessed. Results indicated that the woman with a higher BMI elicited greater weight stigma. Attributing weight to food addiction increased perceptions of psychopathology towards the woman, whereas attributing weight to poor dietary and lifestyle choices elicited judgment towards the woman. Neither explanation about eating behaviours elicited stigma towards individuals with a higher BMI in general. Findings suggest that a food addiction explanation alone may not be sufficient to reduce weight stigma.

Objective Standard surgical treatment for CIN may impair fertility generating a need for alternative treatment options. We tested the efficacy and toxicity of oral DIM in the treatment of CIN 2 or 3 lesions. Methods Patients with biopsy-proven cervical intraepithelial neoplasia (CIN) 2 or 3 scheduled for loop electrosurgical excision procedure (LEEP) were randomized 2:1 to receive diindolylmethane (DIM) (BioResponse-DIM®, BioResponse, Boulder, CO) orally at approximately 2 mg/kg/day for 12 weeks or placebo (defatted rice bran, BioResponse). Subjects were evaluated every 3–4 months for 1 year. Analysis of data up to 1 year was assessed including Pap smear, HPV, colposcopy, biopsy and physical examination were performed at follow-up. Central pathology review confirmed all histology diagnoses. Results To date, 64 subjects (mean age 28 years, range 18–61) have been enrolled (45 in the DIM arm, 19 in the placebo arm), with 60 available for analysis. Average follow-up was 6 months. At enrollment, 58% were diagnosed with CIN 2 and 42% with CIN 3, 57% of subjects were Caucasian, 15% African American, 12% Hispanic and 17% Asian. During treatment 2 subjects (3%) complained of nausea (grade 2) at the 3- to 4-month visit. No systemic toxicities were observed (normal CBC, LFTs, comprehensive metabolic). Forty-six subjects had biopsies at first follow-up (77%). Twenty-one subjects (47%) in the DIM group had improved CIN with a decrease by 1–2 grades or a normal result. Median time to improvement was 5 months. Improved Pap smear was seen in 49% (22/45) with either a less severe abnormality or normal result. Colposcopy improved in twenty-five subjects in the DIM group (56%). Of these 25 subjects, 21 (84%) had improved colposcopic impression, 13 (52%) had a decrease in involved quadrants and 18 (72%) had a decrease in lesion number. Complete colposcopic response was observed in 4 subjects (9%). Stratifying by level of dysplasia, age, race, HPV status, tobacco use, contraceptive used did not alter the results. At median follow-up of 6 months, 85% of subjects have not required LEEP based on routine clinical triage of improving global assessment. There was no statistically significant difference in any outcome between the DIM and placebo group. Conclusion Oral DIM at 2 mg/kg/day is well tolerated with no significant toxicity. We observed a high rate of clinically significant improvement in confirmed CIN 2 or 3 lesions among both treatment groups in this randomized clinical trial.

Osteoporosis and atherosclerosis are leading causes of mortality and morbidity in the Western world. A link between osteoporosis and atherosclerosis was proposed by epidemiologic and laboratory data. In the present study, we investigated skeletal status in postmenopausal women with hypercholesterolemia using quantitative ultrasonometry (QUS). Six hundred healthy postmenopausal subjects were enrolled within a 2-mo period by primary care physicians. Information on lifestyle and calcium intake was collected for each enrolled subject. Subjects (n = 256) were divided into two groups according to lipid profile: normal (n = 180) with serum cholesterol

We hypothesized that exposure to high levels of hCG in women diagnosed with choriocarcinoma would decrease future breast cancer risk.We used the Surveillance, Epidemiology, and End Results (SEER) registry limited-use database (1973-2004) to search for placenta tumors (ICD-10 C58), i.e. choriocarcinoma (CC). Demographics were obtained including patient ID, primary site, year of diagnosis, sex, race, DOB, age group and survival months. Patients with initial choriocarcinoma were searched for subsequent breast cancers. The cohort diagnosis with CC and subsequent breast cancers were compared to general population-based rates of breast cancer.A query for CC yielded 646 women between the ages 15 and 54 years. Of the 646 women, 422 were white, 129 African-American, and 95 "other". Total women-years of observation were 7165.3 with two CC patients developing breast cancer yielding a breast cancer incidence rate of 27.9/100,000 women-years. The incidence rate ratio(IRR) of the CC cohort to the general population was 0.21 (95% CI(0.145-0.327); P0.01). In women with CC under the age of 35 years the breast cancer rate was 34.1/100,000, IRR 0.27 (95% CI(0.182-0.386); P0.01). Controlling for race, breast cancer rates in whites were 49.3/100,000 (IRR 0.37, P0.01); in African-American 1.3/100,000 (IRR 0.01, P0.001); and 2.6/100,000 (IRR 0.03, P0.001) in "others" compared to the general population.Women with prior CC had a 79% reduction in breast cancer risk compared to the general population regardless of age and race. Given the high level of hCG and decreased rate of breast cancer among women with CC, the hypothesis that hCG is protective against breast cancer seems plausible.

Sunscreen loses efficacy when used with the insect repellent N,N -diethyl-3-methylbenzamide (diethyltoluamide; deet). A previous study demonstrated a 33.3% decrease in sun protection factor when insect repellent and sunscreen were applied sequentially to the skin. The purpose of this study was to determine whether the efficacy of insect repellent is affected by two different formulations of sunscreen. The combination of sunscreen and insect repellent was tested in 8 groups: a control group (no sunscreen or insect repellent), sunscreen alone (two groups [gel and cream]), insect repellent alone, insect repellent applied before sunscreen (two groups), and insect repellent applied after sunscreen (two groups). The results of this study showed that insect repellent has the same efficacy even when sunscreen is applied with it. This indicates that in the formulations tested, sunscreen does not reduce the efficacy of insect repellent.

This open-label, uncontrolled, retrospective study assessed the long-term effects of late thrombolysis on left ventricular (LV) function. We studied 79 patients (52 men and 27 women; mean age, 51 ± 5 years) treated with alteplase (group 1) and 46 patients (33 men and 13 women; mean age, 52 ± 8 years) treated with heparin alone (group 2) at their first myocardial infarction (MI). Patients were eligible for the study if they were younger than 62 years, their duration of pain was longer than 6 hours, and they had no episodes of angina in the 48 hours preceding their MI. The peak of creatine kinase-muscle and brain subunits was significantly less in group 1 than group 2 (106 ± 67 vs 205 ± 102 IU/L). Both LV ejection fraction and wall-motion score were better in thrombolysed patients, and the cumulative frequency of radionuclide defects was higher in these patients during the 4-year follow-up. Our study supports the concept that thrombolysis reduces the incidence of long-term post-MI residual ischemia, improving global LV function even when given late after the onset of MI symptoms.

Superficial papillary adenomatosis of the nipple is a benign tumor of the ductal epithelium that clinically resembles Paget's disease. Histologically, the tumor is characterized by proliferating ductal structures lined by a double layer of columnar epithelium. Keratin cysts and apical intraluminal projections are commonly found. Since this entity's original description as "florid papillomatosis" in 1954, 174 cases have been reported in the English language literature. We review these cases and report a classic example.

The purse string suture technique has received little attention in the surgical literature. Its application in dermatologic surgery has been mainly to reduce the size of a surgical defect to allow placement of a smaller, full-thickness skin graft.1-4 We have found the purse string suture to be effective in the management of poorly demarcated melanoma. We have used the purse string technique in 10 patients with biopsy-confirmed melanoma. For most of them, the clinical margin of the neoplasm was poorly defined. All underwent excision of the clinically detectable lesion, using recommended guidelines of 5 mm for in situ melanoma, 1 cm for invasive melanoma with Breslow's depth less than 1 mm, and 2 cm for intermediate-thickness melanomas.5,6 The oval surgical defects were then managed with an intradermal circumferential purse string suture, with 3-0 or 4-0 nonabsorbable polypropylene.4 The purse string was tied, thereby either reducing the size of or in some cases completely closing the defect. The pathology reports were received in 48 to 72 hours. If a positive margin was present, the patient returned for additional surgery. The original oval defect was re-created after the removal of the purse string suture. This greatly facilitated a more precise measurement for additional margins and excision of the residual tumor. The newly created larger defect was often managed again with a purse string suture. If clear surgical margins were achieved, the purse string suture was removed after 21 days. The type of final reconstruction and its timing were primarily dependent on size and location of the lesion, as well as the degree of confidence in obtaining clear margins. We used fullthickness skin grafts, flaps, primary closure, and second-intention healing as final reconstructive options. No significant complications were observed. A biopsy-confirmed lentigo maligna on the right cheek (Fig. 1) with poorly definable clinical margins was outlined with the aid of a Wood's lamp and excised with a 5 mm margin. The oval From the Dermatology Service, Walter Reed Army Medical Center. The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or reflecting the views of the Department of Defense or the United States Army. Reprints not available from the authors. J Am Acad Dermatol 1998;38:99-101. 16/74/85559 Surgical Pearl: Purse string suture in the management of poorly delineated melanomas

Paclitaxel is the first of a new class of microtubule-stabilizing antitumor agents, with demonstrated activity against advanced and refractory ovarian, breast, lung, and head and neck cancers. It was first isolated from the bark of the endangered Pacific yew Taxus brevifolia. 1 Neutropenia is the dose-limiting toxicity of paclitaxel. A high incidence of major hypersensitivity reactions (HSRs) (including those with cutaneous manifestations) occurred in phase I studies, but they were minimized by premedication schemes and prolonged administration times. 2 We describe a previously unrecognized hypersensitivity to paclitaxel that we classified as a bullous fixed drug eruption.

Mössbauer experiments were performed on the oxy- derivatives of human hemoglobin and its products of digestion with carboxypeptidases. The hemoglobins were chemically enriched to 95% in 57Fe, and were free from hemochrome impurities. Spectra were taken at low temperatures in the presence and absence of a 5.0 T magnetic field. It was observed that the enzymatic digestions which remove residues at least 16 A from the iron of the nearest heme appear to modify the electronic environment of the metal.

This is the first report of dermal grafting to the oral cavity for vestibuloplasty and lingual reconstruction. A 3 1 2 - year follow-up of patients suggests that it is a useful, well-tolerated technique. The method of obtaining the dermal graft is simple and results in much less morbidity to the patient than does the split-thickness skin graft. It survives as a true tissue transplant and undergoes self-epithelization. Histologic sections show that metaplasia of the graft leads to tissue resembling normal mucosa.