A total of 138 consecutive patients with bullous pemphigoid were included and were grouped ac-cording to the treatment they received: methotrexate, prednisone, a combination of both, or topical glucocorticoids (for mild disease).Result: Methotrexate was the most effective treatment, with only a few adverse effects and a tendency toward better survival rates in patients with moderate to severe disease. Conclusion:Methotrexate is an effective and safe drug and provides an excellent treatment option in patients with bullous pemphigoid.

MIB-1 is useful in evaluating proliferative activity and in predicting the aggressiveness in a variety of tumors. To investigate if MIB-1 immunoreactivity can add prognostic information to conventional prognostic variables in papillary thyroid carcinoma (PTC), 30 PTCs were evaluated using the MIB-1 antibody. For comparison, 10 follicular thyroid carcinomas (FTC), 8 anaplastic thyroid carcinomas (ATC), and 96 follicular thyroid adenomas (FTA) were similarly analyzed. The median MIB-1 index was 0.5% in FTA, 1.9% in PTC, 2.7% in FTC, and 16.2% in ATC. The 13 tumors from patients classified as having aggressive PTC (defined as dead from disease, persisting disease, or the occurrence of distant metastases) had significantly higher MIB-1 index (median, 5.4%) than the 17 patients with nonaggressive disease (median, 1.1%). MIB-1 index 1.85% or more was found to be an independently significant risk factor for a less favorable clinical course in PTC. Because of overlap of single values the utility of MIB-1 index as a clinical test is somewhat limited. Still, at levels where no overlap occurs (MIB-1 index 2 3.2% or ' 0.5%) the index seems to add information to the established prognostic parameters. MIB-1 index should therefore be considered in routine histopathology of PTC.

Determinants of increased risk of CMM death in stage I and II CMMs were increasing T-stage, presence of ulceration, presence of mitoses and VGP. This was not found for TILs or regression.

Almost half of the PTCs showed RET-TK expression; in only three was this explained by expression of a RET/PTC rearrangement. Instead, expression of WT-RET was detected in 45 per cent of the RET-TK-positive tumours and this expression was an independently significant risk factor for aggressive PTC. Presented in abstract form to the Millennium Meeting of Endocrine Surgeons held by the American Association of Endocrine Surgeons, British Association of Endocrine Surgeons and Swedish Association of Endocrine Surgeons, London, UK, May 2000

In order to approach the genetic mechanisms behind initiation and progression of papillary thyroid carcinoma (PTC) tumorigenesis, we characterized numerical chromosomal imbalances in a panel of 25 PTCs with varying histopathological and clinical features using comparative genomic hybridization (CGH). The most frequently detected imbalance was gain of 9q33-qter, which was seen in close to 30% of the cases. The commonly occurring regions of loss were assigned to 22q (12%) and 9q21.3-q32 (12%), while gains preferentially involved the entire X chromosome (20%), 1q (16%), 17q (16%), and 22q (12%). The distribution of CGH alterations supports the idea of a progression of genetic events in the development of PTC, where gain of 9q33-qter would represent a relatively early event that is followed by loss of 22q and gain of X, 1q, 17q, and 22q. When the detected CGH alterations were compared with the clinical outcome and the histopathological features of the 25 PTC cases, several statistically significant correlations were revealed. The total number of genetic alterations was higher in tumors from patients with aggressive disease as compared to those without signs of aggressiveness. Gain of 1q and loss of 9q21.3-q32 were exclusively seen in tumors from patients with aggressive disease, and the presence of distant metastases was associated with gain of 1q. A sex-dependent distribution was also evident for one of the common alterations, with gain of X exclusively seen in male cases. Taken together, the findings identify several candidate locations for tumor suppressor genes and oncogenes that are potentially involved in the establishment and progression of papillary thyroid carcinogenesis.

Abstract. Fine needle aspiration biopsy (FNAB) is the preferred technique for the initial diagnostic evaluation of thyroid lesions, which nevertheless poses a diagnostic challenge for all clinicians involved. The latter necessitates the use of molecular markers on thyroid cytology. MIB-1 is a molecular marker already used in the cytological evaluation of various tumors. In this study, we assessed whether MIB-1 proliferation index adds diagnostic information to the conventional cytological analysis of thyroid nodules and prognostic information in thyroid cancers. MIB-1 index for various thyroid lesions was retrospectively reviewed in a series of 504 patients. Furthermore, the prognostic value of MIB-1 index was investigated for 183 of the patients with papillary thyroid cancer (PTC). MIB-1 index was significantly higher in anaplastic thyroid cancer (ATC) compared to other tumor types (p<0.01). No significant difference in MIB-1 index was observed between thyroid adenomas and follicular carcinomas. In PTC, MIB-1 index equal to or >4% was found to be an independent factor significantly associated with higher risk of distant metastasis and disease-related mortality (p<0.05). Conclusively, this study shows that preoperative MIB-1 index assessment in FNAB of thyroid nodules offers little diagnostic information as far as follicular tumors are concerned. In cases of PTC, though, MIB-1 may serve as a prognostic indicator of disease spreading and poor survival and hence influence the planning of the overall treatment scheme.

IMPORTANCE Psoriasis is a heterogeneous disease. Improved understanding of prognosis and long-term outcomes in new-onset psoriasis may improve care.OBJECTIVE To describe the clinical course of psoriasis and identify possible indicators of long-term outcomes. DESIGN, SETTING, AND PARTICIPANTSThe Stockholm Psoriasis Cohort was a noninterventional inception cohort study enrolling patients between 2001 and 2005. The present study was conducted from January 15, 2019, to February 5, 2021. At enrollment and 10 years, patients were examined by dermatologists and rheumatologists. Data from examinations were complemented by questionnaires, medical records, and registers. A total of 721 patients with recent-onset psoriasis (<12 months duration), 15 years or older were recruited using advertising and referrals from a broad range of health care settings.MAIN OUTCOMES AND MEASURES Disease severity and psoriatic arthritis (PsA). Recursive partitioning and regression models were implemented to identify probable indicators of long-term outcomes.RESULTS A total of 721 patients (median [interquartile range] age, 39 [27-55] years; 405 [56%] women), including 542 (75%) with plaque-onset and 174 (24%) with guttate-onset psoriasis, were enrolled. The median follow-up was 9.6 years (interquartile range, 8.8-10.4 years). The cumulative incidence of severe psoriasis at 12 years from enrollment was 21%. Among 509 patients examined clinically after 10 years, 77 of 389 patients (20%) with plaque onset and 56 of 116 (48%) with guttate onset had minimal disease activity without treatment, and 120 of 509 (24%) had PsA. Recursive partitioning identified strata with distinct risks for severe skin disease and PsA: the cumulative incidence of severe disease in patients with plaque phenotype, above-median disease activity, and scalp lesions was 52% (95% CI, 41%-64%), compared with 11% (95% CI, 8%-14%) in patients with below-median disease activity at inclusion; and 48 of 82 patients (59%) with peripheral enthesitis had PsA after 10 years compared with 37 of 304 patients (12%) without initial joint pain (P < .001). Smoking (hazard ratio, 1.70; 95% CI, 1.10-2.63) and activating genes in the interleukin-23 (IL-23) pathway (odds ratio, 1.55; 95% CI, 1.14-2.11) were also significantly associated with a severe disease course. Systemic therapy at or before enrollment was associated with a lower risk for severe disease at 10 years compared with later initiation of systemic therapy (odds ratio, 0.24; 95% CI, 0.06-0.90). CONCLUSIONS AND RELEVANCEThe findings of this cohort study suggest that combinations of clinical characteristics at onset and activating genes in the IL-23 pathway are significantly associated with the clinical course of psoriasis, whereas joint pain and peripheral enthesitis may indicate the probability of PsA. Patients within those categories merit specialist referral and closer follow-up. The possibility of modifying the disease course with early systemic intervention should be tested.

Rosacea is a field within dermatology with new insight within immunological research and new treatment-algorithm. Patient education on rosacea and appropriate treatments is an important aspect in helping patients succeed with therapy. Treatment should be tailored to each individual patient, taking into account: symptoms, trigger factors, patients’ wishes, most bothersome symptoms, psychological aspect, individual needs. A combination of clinical therapies to treat different symptoms concomitantly may offer the best possible outcomes for the patient. In this review article we describe these aspects.