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AIMS: To compare the health and economic outcomes of using acarbose, an intensive lifestyle modification programme, metformin or no intervention to prevent progression to diabetes in Canadian individuals with impaired glucose tolerance (IGT). METHODS: A model was developed to simulate the course of individuals with IGT under each treatment strategy. Patients remain in the IGT state or transition from IGT to diabetes, to normal glucose tolerance (NGT) or to death. Effectiveness and resource use data were derived from published intervention trials. A comprehensive health-care payer perspective incorporating all major direct costs, reported in 2000 Canadian dollars, was adopted. RESULTS: Over a decade, 70 of the 1000 untreated patients are expected to die and 542 develop diabetes. Intensive lifestyle modification is estimated to prevent 117 cases of diabetes, while metformin would prevent 52 and acarbose 74 cases. The proportion of those who return to NGT also increases with any treatment. While lifestyle modification is more effective, it can increase overall costs depending on how it is implemented, whereas acarbose and metformin reduce costs by nearly $1000 per patient. Lifestyle modification was cost effective, varying from CAD $10 000/LYG vs. acarbose. Acarbose costs somewhat more than metformin, but is more effective: CAD $1798/LYG. CONCLUSION: The results of this model suggest that the treatment of IGT in Canada is a cost-effective way to prevent diabetes and may generate savings. While pharmacological treatments tended to be less costly, intensive lifestyle modification, if maintained, led to the greatest health benefits at reasonable incremental costs. [ABSTRACT FROM AUTHOR]

Focuses on the diagnosis of lipoid proteinosis. Clinical manifestations of the disease; Histology and histochemistery of the disease; Prognosis and treatment of lipoid proteinosis.

A 51 year old male electrician was referred for patch testing. Approximately two months before he had developed an erythematous eruption on the face and dorsal aspects of the hands and forearms. This had developed the day after prolonged exposure to unfiltered fluorescent lighting. Patch testing to the NACDRG standard tray revealed a one plus reaction to the caine mix. All the others were negative. Patch tests and photo-patch tests were then performed. There was no positive reactions. This side was irradiated with a Hanovia Hot Quartz lamp through window glass for 15 minutes.

A 30 year old white male physician presented with a pruritic erythematous eruption which was well localized to the right side of the neck and to the right anterior axillary fold. There was no history of any topical agents applied exclusively to these areas. The patient slept on the left side of the marriage bed. The right side of his neck and the interior axillary fold on the right were thus in contact with the bedclothing, which could be contaminated by substances, 5 percent benzoyl peroxide applied to his wife as an anti-acne preparation on her back. Presumably enough benzoyl peroxide rubbed off on to the pillowcases and sheets to induce an eruption in the patient. Since his wife discontinued using the preparation, he has had no further trouble.

The article presents information about a case reported in 1972 in which a 3-year-old Negro child with features of xerodemia pigmentosum was seen with a nodular lesion on the left forehead. The tumor was totally excised and histological sections confirmed the diagnosis of keratoacanthoma. Solar elastosis was found on the surrounding skin. After a follow-up of the patient for over five years, no relapse of keratoacanthoma was found, although in 1974 she developed a squamous cell carcinoma of the tongue, followed by a squamous cell carcinoma of the Iower lip.