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Inflammation, and the emerging tumors as infundibulocystic squamous cell carcinoma rather than keratoacanthomas. In contrast to previous cases of keratoacanthoma marginatum and keratoacanthoma en plaque, 3-7 our patients' initial lesions were dominated by changes that resembled hypertrophic lichen planus rather than discrete keratoacanthomas. The term infundibulocystic squamous cell carcinoma may be more appropriate for tumors that may not resemble keratoacanthoma clinically, have a prominent infundibulocystic component, and do not follow the biological course of keratoacanthoma. The frequency of detecting HPV in keratoacanthomas in previous studies25-28 has varied. We were unable to demonstrate the presence of HPV by polymerase chain reaction analysis using several consensus HPV primer sets on tissue extracts from 2 of our patients. There were no papilloma-related viral cytopathic changes in the biopsy material, but these findings do not exclude the possible presence of HPV as a cofactor. All 3 of our patients provided a therapeutic dilemma, as the tumors were difficult to treat surgically. The presence of infiltrative cords or lobules of atypical keratinocytes in the deep dermis under the infundibulocystic pseudoepitheliomatous hyperplasia was a feature that made us favor the diagnosis of squamous cell carcinoma. Even in the absence of proven squamous cell carcinoma, these marked hyperplastic reactions represent a therapeutic challenge. Retinoids have been used successfully to slow the development and reduce the number of solar keratoses and squamous cell carcinomas, particularly in transplant patients receiving immunosuppressive therapy.29 Retinoids have also been shown to accelerate the involution of keratoacanthomas and have been useful in the management of unusual variants of keratoacanthoma, including keratoacanthoma marginatum centrifugum and keratoacanthoma en plaque. We had previously used acitretin to successfully treat a patient who had hypertrophic lichen planuslike reaction in a burn scar and biopsy specimens that showed pseudoepitheliomatous hyperplasia and early squamous cell carcinoma.30 Because of the age of our patients, we chose a conservative dosage of 25 mg daily of acitretin to minimize adverse effects. We did not need to increase the dosage higher than 25 mg daily, as there was response to treatment in the first month. One of our patients only tolerated 10 mg of acitretin daily, but even this dosage resulted in a halt of the progression of her tumors and gradual involution of all lesions. We monitored all patients carefully, as we were concerned that these tumors may have progressed. Previous experience has indicated that skin malignancies and keratoses may rebound if retinoids are ceased, particularly in immunosuppressed patients. Lowering the dosage of acitretin in one of our patients resulted in the reappearance of nodules in the skin graft, but these resolved again by elevating the dosage. The main adverse effects observed in all 3 patients were those related to retinoids, namely, dry skin and hair loss. The 3 patients did not have a strong history of skin cancers and were not immunosuppressed, and the acitretin was discontinued after 15 to 24 months. Although we cannot exclude the possibility that the results of therapy were due to spontaneous involution, each patient had a pro REPRINTED ; ARCH DERMATOL VOL 140, OCT 2004 1266.
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Avocational archaeologist Edward F. Lehner died in Tucson, Arizona on January 3, 2003 after a brief illness. Born in New York City in 1914, Ed spent his first five years living in a sod hut in North Dakota. However, he must have been captivated by the West, because he spent most of his life in Arizona, except for duty during World War II. Ed's contributions to American archaeology were recognized by the National Park Service at the Pecos Archaeological Conference held at the Salinas Pueblo ruins in New Mexico in 1985. With degrees in economics and chemistry from Colgate University in 1936 and animal husbandry from Cornell in 1938, Ed went West to work with cattle above the Mogollon Rim. With World War II on the horizon, Ed joined the U.S. Cavalry and was stationed at Fort Robinson, Nebraska, an important outpost during the Indian Wars. Here, at the last horse cavalry post of the U.S. Army, Ed said he did more shoveling of meadow muffins than riding horses. He told me about being transferred during the war to military intelligence, which he considered an oxymoron. This was when the Army learned he was fluent in German. He also told of his experience in looking after notorious Nazis held prisoner at Wiesbaden for trial at Nuremberg, but he never told me of being wounded. This I learned from John Jennings's article about Ed in the Tucson Citizen of June 12, 1995. In the interview, Ed says it was a beautiful August night in the French countryside when a German machine gunner cut loose on his Jeep. As Ed told it, "One bullet came in the side of the Jeep and would have put a hole in the other side, too, but luckily my legs got in the way." That is quintessential Ed Lehner humor. Ed had an interest in just about all things scientific, including botany. In fact, I have a bumper sticker from Ed that says "I brake for verbascom." I don't know that Ed had a particular attraction for this plant. I think he just liked the name. Ed was also a good hunter and, early on, harvested waterfowl coming to his irrigation ponds, but eventually he became more interested in bird watching. In fact, his place became a favorite of bird watchers, some of whom Ed and Lyn allowed to use the guest house. In 1994, Sam Lowe of the Phoenix Gazette interviewed Ed and reported, in the July 16th issue, on the science conducted over the past 40 years at the Lerner site, the Clovis site that Ed eventually purchased. In the article, Lowe included Lehner humor that we had all come to appreciate. He quoted Ed saying "Not much to do around here, so we organized the Hereford Pre-Mortem Funeral Association. We figure a person ought to have the chance to go to his funeral before he dies so he can hear all the nice words people are going to say about him." And here I quote Lowe: The meetings start, Lehner says, with the designated guest knocking at the front door. Then he has to clear his throat loud enough so somebody inside the house will ask, "Is that you coffin?" The guest replies, "Of corpse it is." And the guy inside will answer, "Well, you cadaver tell." Aside from his quick wit and great sense of humor, Ed was a serious scholar with interesting thoughts about Paleoindian lifeways, peopling of the Americas, and the extinction question. Each year, when I took my classes on weekend fieldtrips to the Clovis sites of the San Pedro Valley, we would camp in Ed and Lyn's yard and barbecue hamburgers on their patio. We would bribe Ed with bourbon-on-the-rocks to recount tales, but, of course, the bribe was really not necessary. We were going to hear, like it or not, about how difficult it was to shoot fish in a barrel or fall off a log, or how hot cakes don't always sell that well. And we loved it. Seeing his Clovis site was only part of the reason for visiting Ed and Lyn. Social pleasure was the rest of the reason. My students always considered the visit the highlight of their academic year. It was mine too. Vance Haynes Vance Haynes is Regents Professor Emeritus at the University of Arizona.
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Nosocomial transmission of droplet-borne respiratory infections such as severe acute respiratory syndrome SARS ; may be influenced by the choice of oxygen face mask. A subject inhaled saline mist and exhaled through three oxygen masks to illustrate the pattern of dispersal of pulmonary gas. In two commonly used masks, exhaled gas formed a plume emanating from the side vents, while a third mask with a valved manifold, which was modified by adding a respiratory filter, retained the droplets. Maintaining respiratory isolation during the administration of oxygen may reduce the risk of the nosocomial transmission of respiratory infections such as SARS. CHEST 2004; 125: 11551157.
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1. Char D. Clinical Ocular Oncology. New York, NY: Churchill Livingstone Inc; 1989: 207-224. 2. Shields JS, Shields CL. Intraocular Tumors: A Text and Atlas. Philadelphia, Pa: WB Saunders Co; 1992: 377-392. 3. Zelter M, Damel A, Gonzalez G, Schwartz L. A prospective study on the treatment of retinoblastoma in 72 patients. Cancer. 1991; 68: 1685-1690 and actimmune!
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Satoh, S., Nussler, A. K., Liu, Z. Z., and Thomson, A. W. 1994 ; . Proinflammatory cytokines and endotoxin stimulate ICAM-1 gene expression and secretion by normal human hepatocytes. Immunology 82, 571-576. Setchell, K. D., Rodrigues, C. M., Clerici, C., Solinas, A., Morelli, A., Gartung, C., and Boyer, J. 1997 ; . Bile acid concentrations in human and rat liver tissue and in hepatocyte nuclei. Gastroenterology 112, 226-235. Svegliati-Baroni, G., Ridolfi, F., Hannivoort, R., Saccomanno, S., Homan, M., De Minicis, S., Jansen, P. L., Candelaresi, C., Benedetti, A., and Moshage, H. 2005 ; . Bile acids induce hepatic stellate cell proliferation via activation of the epidermal growth factor receptor. Gastroenterology 128, 1042-1055. Tsai, J. C., Liu, L., Zhang, J., Spokes, K. C., Topper, J. N., and Aird, W. C. 2001 ; . Epidermal growth factor induces Egr-1 promoter activity in hepatocytes in vitro and in vivo. Am.J.Physiol Gastrointest.Liver Physiol 281, G1271-G1278. Xu, J., Lee, G., Wang, H., Vierling, J. M., and Maher, J. J. 2004 ; . Limited role for CXC chemokines in the pathogenesis of liver injury. Am.J.Physiol Gastrointest.Liver Physiol 287, G734-G741. Yan, S. F., Fujita, T., Lu, J., Okada, K., Shan, Z. Y., Mackman, N., Pinsky, D. J., and Stern, D. M. 2000 ; . Egr-1, a master switch coordinating upregulation of divergent gene families underlying ischemic stress. Nat.Med. 6, 1355-1361 and adriamycin.
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