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Thimerosal is a mercurial preservative that was widely used in vaccines in the United States and Europe until 2001. By 1999, expanding recommendations for infant vaccinations indicated that United States children who received a complete series of vaccines that contained thimerosal received up to 187.5 μg of ethyl mercury during the first six months of life. This cumulative exposure could exceed the United States Environmental Protection Agency’s recommended safe intake level, estimated in 1997, to be no more than 0.1 μg of mercury per kilogram of body weight per day. This observation lead to a recommendation by the American Academy of Pediatrics that thimerosal is removed to all vaccines that are administered to infants in the United States. Realizing the potential dangers of thimerosal in vaccines, six states have enacted legislations that have limited the amount of thimerosal that can be used in vaccines in their States (Iowa, California, New York, Missouri, Delaware and Washington). In 1987, Congress established the Vaccine Injury Compensation Program to provide compensation to family of individuals who suffer injuries from vaccines. Until recently, these judgments have been paid only to families of non-autistic children who received complications due to the vaccines. In 2008, the Government conceded its first vaccine-autism case in Federal Court. Scientific studies of this autistic child suggested that the autism was related to a mitochondrial disorder. The Federal Government should enact legislation that prohibits the use of thimerosal in vaccines given to pregnant women and their infants.

This article reviews information on the hazards of cornstarch powder on medical gloves. Dusting powders were first applied to latex gloves to facilitate donning. After 1980, manufacturers devised innovative techniques without dusting powder. It has been well documented that these powders on gloves present a health hazard to patients and health care workers by 5 different mechanisms. First, the glove cornstarch has documented detrimental effects on wound closure techniques. Second, this powder potentiates wound infection. Third, cornstarch induces peritoneal adhesion formation and granulomatous peritonitis. Finally, these powders serve as carriers as latex allergen and they precipitate a life-threatening allergic reaction in sensitized patients. These well-documented hazards of glove powder have caused the United Kingdom and Germany to ban cornstarch powder on medical gloves over 10 years ago.

During the last 25 years, there have been revolutionary advances in the treatment of Familial Adenomatous Polyposis (FAP). The purpose of this article is to describe the pathophysiology, genetic testing, surveillance, surgical interventions, and psychosocial issues. The genetic defect in FAP is germline mutation in the adenomatous polyposis coli (APC) gene. Syndromes once thought to be distinct from FAP are now recognized to be part of the phenotypic spectrum of FAP. Syndromes with a germline mutation in the APC gene include FAP, Gardner syndrome, Turcot syndrome, and Attenuated Adenomatous Polyposis Coli (AAPC). FAP is a germline mutation in the APC gene with onset of florid polyposis in childhood and development of colorectal cancer by age 30. Colectomy is advised because of the high risk of developing colorectal cancer. AAPC is a variant of this condition with later age of onset and milder clinical phenotype. However, colectomy is advised once polyposis develops and polyps cannot be managed endoscopically. Despite the unique advances in genetic testing, psychosocial management of these syndromes remains to be a challenging problem.

This collective review focuses on three major factors that influence the incidences of multiple sclerosis (MS) to include ultraviolet radiation (UVR), vitamin D3 supplementation, and vitamin D receptor gene (VDRG) polymorphisms. In general, the rate of MS increases with latitude. Individuals tend to carry their original risk with them if they migrate to a different latitude after adolescence. It is important to emphasize that UVR increases the synthesis of vitamin D3, which has a known immune suppressant action via the VDRG. Clinical studies have pointed out that vitamin D deficiency may exacerbate the development of MS. Because vitamin D3 is an inhibitor of MS, providing supplemental D3 for individuals at risk for MS should be mandatory. There is unanimous agreement that exposure to UVR and vitamin D3 supplementation can reduce the incidence of MS. Although there is debate regarding the association of MS with the use of silver mercury fillings, there is general agreement throughout the world that there is a need for dental-patient informed-consent brochures for all dentists who use dental restoration materials. For the dentists who remove silver mercury amalgam from their patients, there is a uniform international agreement that all dental offices should use reliable debris collection devices that prevent pollution of our environment.

Psoriasis is a papulosquamous skin disease that is recognized as one of the most common immune-mediated disorders. At least nine chromosomal psoriasis susceptibility loci have been identified. It is important to emphasize that management of psoriasis begins with identification of the extent of the cutaneous disease. There are three clinical forms of psoriasis, to include psoriasis vulgaris, pustular psoriasis, and erythrodermic psoriasis. Treatments currently available are topical agents used predominantly for mild disease and for recalcitrant lesions in more severe disease, phototherapy for moderate disease, and systemic agents, including photochemotherapy, oral agents, and newer injectable biological agents, which have revolutionized the management of severe psoriasis.

It is well known that vitamin D plays a key role in calcium homeostasis and is important for optimal skeletal growth. The major function of vitamin D is to enhance the efficiency of calcium absorption from the small intestine. Most physicians relate vitamin D deficiency to disorders of skeletal muscle. Vitamin D deficiency in children can manifest itself as rickets. In adults, vitamin D deficiency results in osteomalacia. Because most physicians do not appreciate the role of vitamin D deficiency in predisposing the development of cancer, we have written this important report as a wake-up call to physicians and other healthcare workers in documenting the relationship of vitamin D deficiency and cancer. Epidemiological data show an inverse relationship between vitamin D levels and breast cancer incidence. In addition, there is a well-documented association between vitamin D intake and the risk of breast cancer. Low vitamin D intake has also been indicated in colorectal carcinogenesis. A vitamin D deficiency has also been documented in patients with prostate cancer, ovarian cancer, as well as multiple myeloma. Larger randomized clinical trials should be undertaken in humans to establish the role of vitamin D supplementation in the prevention of these cancers.

The purpose of this report on breast cancer and ovarian cancer genetics is to review the evidence for the efficacy of surveillance for early detection, bilateral prophylactic mastectomy, prophylactic oophorectomy, and chemoprevention in preventing breast cancer and improving survival of BRCA1 and BRCA2 carriers. This collective review highlights radiologic screening of patients with this genetic predisposition for cancer as well as discusses cancer risk reduction strategies and reproductive concerns in female BRCA1/2 mutation carriers. It has now been well documented that magnetic resonance imaging (MRI) of the breast has a higher sensitivity than mammography for the diagnosis of breast cancer in patients predisposed to breast cancer. We also emphasize that a new diagnostic device, molecular breast imaging (MBI), is now available and may be as sensitive as MRI. To date, this exciting technology, MBI, has not been used in studies of patients with BRCA1/2 genes. We also discuss in more detail the unique psychological ramifications of female BRCA1/2 mutation carriers. These women face unique choices regarding management of their high risk for breast and ovarian cancer that impact their reproductive options. Despite their high levels of concern, few female BRCA1/2 mutation carriers consider assisted reproduction technologies such as pregnancy surrogate, cryopreservation of oocytes or embryos, or implantation genetic diagnosis to select embryos without BCRA1/2 mutation. Further research must be undertaken to explore the risk management of patients with inherited cancer predisposition and to incorporate these preferences into clinical care.

Background During the last 25 years, scientific experimental and clinical studies have documented the dangers of cornstarch powder on examination and surgical gloves because the cornstarch promotes wound infection, causes serious peritoneal adhesions and granulomatous peritonitis, and is a well-documented vector of the latex allergy epidemic in the world. Realizing the dangers of cornstarch on examination and surgical gloves, Germany's regulations of personal protective equipment banned the use of surgical glove powder cornstarch in 1997. In 2000, the Purchasing and Supply agency for the United Kingdom ceased to purchase any gloves lubricated with cornstarch. Discussion Realizing the dangers of cornstarch-powdered gloves, many hospitals and clinics in the United States have banned the use of cornstarch-powdered examination and surgical gloves. Hospitals that have banned cornstarch in their examination and surgical gloves have noted a marked reduction in the latex allergy epidemic in their facilities. Realizing the dangers of cornstarch-powdered examination and surgical gloves, Dr Sheila A. Murphey, branch chief, Infection Control Devices Branch, Division of Anesthesiology, General Hospital, Infection Control, and Dental Devices Office of Device Evaluation, Center for Devices and Radiological Health of the Food and Drug Administration (FDA), recommended that a Citizen's Petition be filed to the FDA to ban cornstarch on surgical and examination gloves. Conclusion The 12 authors of this report have attached the enclosed petition to the FDA to ban the use of cornstarch on all synthetic and latex examination and surgical gloves used in the United States.

Background and Objectives: During the last four decades, our research team has devised advances in wound repair that are highlighted in Part II of this collective review. Discussion: There are several different methods to provide an accurate and secure approximation of the skin edges—sutures, tapes, staples, and tissue adhesives. Ideally, the selection of the wound closure technique will be based on the biologic interaction of the materials employed, tissue configuration, and biomechanical properties of the trauma wound. Selection of the appropriate wound dressing is another important consideration in the management of the trauma wound. Conclusion: On the basis of the comprehensive research and clinical studies, we have individualized the wound closure techniques for traumatic wounds so that healing can be achieved with more aesthetically pleasing scars.