David Gould

The green tea polyphenol (-)-epigallocatechin gallate and green tea can protect human cellular DNA from ultraviolet and visible radiation-induced damage.

Background: Antioxidant compounds in green tea may be able to protect against skin carcinogenesis and it is of interest to investigate the mechanisms involved. A study was therefore conducted to determine whether the isolated green tea polyphenol (−)‐epigallocatechin gallate (EGCG) could prevent ultraviolet radiation (UVR)‐induced DNA damage in cultured human cells. This work was then extended to investigate whether drinking green tea could afford any UVR protection to human peripheral blood cells collected after tea ingestion.

Making sense of clinical reasoning: judgement and the evidence of the senses

Background  Close noticing, as keen discrimination and judgement between qualities, is a key capability for work in visual domains in medicine. This generic capability is normally assumed, and its specifics are left to develop through experience, as traditional apprenticeship in a specialty. Discrimination is an outcome of learning in the affective domain, and introduces a vital aesthetic dimension to clinical work that aligns with the interests of the medical humanities. An aesthetic approach to clinical reasoning, however, remains largely unexplored as an explicit focus for medical education.

Photodynamic therapy using meta‐tetrahydroxyphenylchlorin (Foscan®) for the treatment of vulval intraepithelial neoplasia

Background  Photodynamic therapy (PDT) has unique properties which make it suitable for the local treatment of superficial epithelial disorders; it has been suggested as a useful treatment for carcinoma in situ of the vulva.

Learning how to see: doctors making judgements in the visual domain

Initial results are presented from an ongoing, work‐based collaborative inquiry between three medical consultants (a pathologist, a radiologist and a dermatologist) and three experienced visual artists into processes of clinical and aesthetic judgements in the visual domain. The doctors’ habitual conventions are challenged through the interventions of the artists, leading to a re‐education of the senses through a revitalised clinical imagination. Outcomes include self‐assessed improvement of clinical acumen through systematic review of the clinical reasoning process looking specifically at the aesthetic dimension. A central research interest is how forms and styles of judgement construct identities of the expert practitioner in work settings. The papers describes a change in practice from “looking” to “seeing” as the development of a “connoisseurship” of informational images informed by tolerance of ambiguity, creating a practice identity against the grain of the normative technical‐rational discourse of clinical reasoning.

A preliminary investigation of the effects of arsenate on irradiation-induced DNA damage in cultured human lung fibroblasts.

Single-cell gel electrophoresis (the comet assay) was used to assess single-strand breaks (SSBs) produced in cultured lung human fibroblasts by xenon lamp irradiation alone, various concentrations of arsenate [As(V)], alone or various combinations of the two. It was found that significantly higher levels of SSBs were observed in the irradiated cells than the nonirradiated cells and that elevating levels of arsenate enhanced the level of damage detected in both irradiated and nonirradiated cells in a concentration-dependent manner; that is, incubating cells with arsenate alone produced marked DNA damage without an irradiation insult being necessary. The results of this study indicate that arsenate is acting as a cogenotoxin with irradiation in this cell line. This additive effect may also be cocarcinogenic, and as a result it is possible that less solar irradiation may be required to induce skin cancer in arsenic-exposed populations.

Generalized pruritus as a presentation of idiopathic haemochromatosis

SIR, Idiopathic haemochromatosis in the older patient usually presents with the classical triad of liver disease, diabetes and skin pigmentation, although in the younger patient hypogonadism and cardiac dysfunction seem more common. (Cazzola, Ascari & Barosi, 1983). We wish to report its presentation with generalized pruritus. A 70-year-old woman gave a 4-month history of intractable generalized pruritus and a 5-year history of ataxia. In the past she had undergone bilateral cataract extraction, and, at the age of 60, she had a hysterectomy for the treatment of menorrhagia. On examination she was dysarthric and mildly ataxic but there were no skin changes. Investigations revealed haemoglobin 13-6 g/dl with normal white cell count and an erythrocyte sedimentation rate of 20 mm/hr. Liver function tests were normal apart from an elevated alanine transferase 59 IU/1 (normal up to 40); serum iron was 48 /<mol/l (she had not been receiving any iron therapy) and serum ferritin 1573 ng/ml (normal post-menopausal range 12-230). Fasting blood glucose was 52 mmol/1 with a 2 hour level, after 75 g glucose, of io-1 mmol/1. Her chest X-ray showed a cardiac size at the upper range of normal and her electrocardiogram was within normal limits. A liver biopsy revealed the presence of large amounts of iron-containing pigment mainly within hepatocytes but also seen within bile duct epithelium with minimal fibrosis. She was treated by regular venesection. A total of 7 2 1 blood was removed over a period of 3 months. During this time her serum iron fell to 22 3 mmol/1 and serum ferritin to 171 ng/ml. Her pruritus resolved and has not returned. Pruritus has been reported on one previous occasion in a patient with idiopathic haemochromatosis which resolved on treatment (Nestler, 1983). Pruritus, however, is more commonly seen in the presence of iron deficiency, although the exact aetiology is unknown. It has been postulated that pruritus in idiopathic haemochromatosis, in the absence of cholestasis, might be due either to direct stimulation of C class fibres by iron deposits in the skin, or such iron deposits might be responsible for the local release of histamine from tissue mast cells (Nestler, 1983). However, the skin biopsy in the present case showed only a slight increase in melanin but iron-containing pigment was absent. There are several reports of patients with idiopathic haemochromatosis in whom neurological features have dominated the clinical course. (Jones & Hedley-White 1983; Sinclair & Afrooz 1977; Singh, Rao & Bhuyan 1977). Neurological features have also been described with several other diseases involving heavy metals, e.g. copper in Wilsons disease, aluminium in dialysis encephalopathy, mercury in Minamata disease, and also poisoning with manganese, thallium and zinc with improvement in some cases upon removal of the metal. Idiopathic haemochromatosis should be considered in the diagnosis of elderly patients with mild liver dysfunction who present with ataxia and pruritus.

Topical lithium succinate—a safe and effective treatment for seborrhoeic dermatitis in adults

Large, tense, thick-roofed blisters were a prominent feature of hydralazine induced lupus erythematosus in three patients, aged from 65 to 74 years, who were receiving between 50 and 150 mg daily for hypertension. The initial clinical diagnosis included bullous pemphigoid (one case) and erythema multiforme (one case), but histology and the development of subsequent lesions showed that the blistering was due to an underlying vasculitis in each case. Two patients had deep lingual ulcers at the time of presentation and two patients had previously undergone extensive investigations for other symptoms and signs which were also due to hydralazine induced LE. These included anaemia, pleural effusions, neutropenia, thrombocytopenia and splenomegaly. All patients had a diffuse pattern of antinuclear antibodies and elevated DNA binding. The blistering was followed by significant areas of skin necrosis in all three patients. In two patients this was complicated by serious secondary bacterial infection and one eventually required mid-thigh amputation. Blistering is an uncommon feature of drug induced lupus erythematosus. Its recognition may aid the early diagnosis of this serious drug reaction.

Hg(II) Exposure Exacerbates UV-Induced DNA Damage in MRC5 Fibroblasts: A Comet Assay Study

When exposed to UVR, MRC5 fibroblasts incubated with mercuric chloride (0–15 μM) for 1 hour show increased DNA damage (as measured by the comet assay) compared to control cells (UVR irradiated but no mercuric chloride). This demonstrates that mercuric chloride and UVR in combination increase DNA damage in a synergistic manner. This may have implications to those exposed to mercury as it suggests that exposure to mercury in the environment may increase sensitivity to sunlight-induced carcinogenesis.

An Investigation of the Genotoxic Effects of Airborne Particulate Matter Using Single-Cell Gel Electrophoresis

Samples of the PM 10 fraction of airborne particulate mat ter were collected from a roadside location in Cornwall using a Partisol 2000 gravimetric air sampler. Cultured human lung fibroblasts were exposed to a sonicated extract of this matter for various periods of time (0-120 h) and the presence of DNA damage was then assessed using single-cell gel electrophoresis. Four times the level of DNA damage was detected in the PM10-exposed cells than that observed in similarly treated but non-PM10 exposed control cells. This indicates that the airborne PM10 from this site has significant genotoxic effects in this experimental system and that single-cell gel electro phoresis is a useful technique for the assessment of this form of particulate matter-induced biological damage.

Tin miners'granuloma

Seven miners from the South Crofty and Geevor tin mines in Cornwall presented with granulomas on the dorsum of the hand following rock fall abrasions. These tended to be smooth nodules, with local dissemination only. Histologically, tuberculoid granulomas were seen, but early lesions sometimes only showed inflammatory changes. Acid‐fast bacilli were demonstrable, and cultures grew Mycobacterium marinum.