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Notes: Cross-border consolidation of financial institutions within Europe has been relatively limited, possibly reflecting efficiency barriers to operating across borders, including distance; differences in language, culture, currency, and regulatory/supervisory structures; and explicit or implicit rules against foreign competitors. EU policies such as the Single Market Programme and European Monetary Union attenuate some but not all of these barriers. The evidence is consistent with the hypothesis that these barriers offset most of any potential efficiency gains from cross-border consolidation. Banks headquartered in other EU nations have slightly lower average measured efficiency than domestic banks and non-EU-based foreign banks.

Notes: A 66-year-old man with a past medical history of hypertension and arthritis was hospitalized and treated for bacterial pneumonia. Chest X-ray revealed a left-sided chest mass. Computed tomography (CT) scan of the chest demonstrated a large heterogeneously enhancing mass occupying most of the left lower lobe and extending to the inferior aspect of the hilum. It measured 16.6 × 12 cm and caused a mild shift of the mediastinum to the right. The patient declined further work-up or surgical resection of the mass. Dermatologic examination was unremarkable at that time.Over the next 5 months, numerous skin lesions erupted on the patient's trunk. He then experienced several syncopal episodes, at which time he was found to be profoundly hypoglycemic. It was suspected that the chest tumor was producing high serum levels of insulin-like growth factor (IGF) resulting in hypoglycemia and syncope. Serum laboratory investigations were significant for glucose of 20 mg/dL (normal, 60–120 mg/dL), IGF-1 of 39 ng/mL (normal, 152–494 ng/mL), IGF-2 of 927 ng/mL (normal, 210–750 ng/mL), and insulin of 〈 5.0 microunits (MCU)/mL (normal, 0–30 MCU/mL). Surgical extirpation of the chest tumor was recommended.The dermatology service was consulted to evaluate whether the numerous skin lesions in the area of planned surgery would pose an increased risk of infection. Cutaneous examination revealed a dense aggregation of pigmented hyperkeratotic plaques with a “stuck-on” appearance, predominantly localized on the trunk. Many were unusually large or darkly pigmented. A particularly dense distribution was apparent on the left side of the chest (〈link href="#f1"〉Fig. 1a). Numerous large acrochordons were evident on the lower eyelids and in the axillary vaults. Acanthosis nigricans was not present. A biopsy specimen from a hyperkeratotic lesion on the left upper back revealed an acanthotic, hyperpigmented epidermis with a lamellar horn, anastomosing rete, and pseudohorn cysts (〈link href="#f1"〉Fig. 1b).〈figure xml:id="f1"〉1〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD1970:IJD_1970_f1"/〉(a) Dense aggregation of pigmented hyperkeratotic papules and plaques with a “stuck-on” appearance predominantly localized on the left side of the trunk. Many are unusually large or darkly pigmented. (b) Photomicrograph of a biopsy specimen from a hyperkeratotic lesion on the left upper back. An acanthotic, hyperpigmented epidermis with a lamellar horn, anastomosing rete, and pseudohorn cysts is demonstrated (hematoxylin and eosin stain; original magnification, × 4)Left thoracotomy and left lower lobectomy were performed, and surgeons extirpated an 18 × 17 × 10 cm cystic, multilobular, hard tumor (〈link href="#f2"〉Fig. 2a) adhering to the left diaphragm, left lower lobe, and left parietal pleura. Pathologic examination revealed a highly cellular spindle cell tumor (〈link href="#f2"〉Fig. 2b). The nuclei were relatively monotonous with few mitoses. No areas of necrosis were identified. These pathologic findings were diagnostic for solitary fibrous tumor of the pleura.〈figure xml:id="f2"〉2〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD1970:IJD_1970_f2"/〉(a) Gross specimen of solitary fibrous tumor of the pleura measuring 18 × 17 × 10 cm. The mass was a cystic, multilobular, hard tumor adhering to the left diaphragm, left lower lobe, and left parietal pleura. (b) Histopathology demonstrates a highly cellular spindle cell tumor. The nuclei are relatively monotonous with few mitoses. Necrosis is not present (hematoxylin and eosin stain; original magnification, × 20)After surgery, the patient experienced no further syncopal episodes. The truncal seborrheic keratoses decreased substantially in number, size, and density over the following 6 months. Post-operative laboratory data revealed normalization of the blood glucose, insulin, IGF-1 (191 ng/mL; normal, 71–290 ng/mL), and IGF-2 (515 ng/mL; normal, 358–854 ng/mL).

Notes: Abstract: Exposure of skin to solar irradiation generates reactive oxygen species that damage DNA, membranes, mitochondria and proteins. To protect against such damage, skin cells have evolved antioxidant enzymes including glutathione peroxidase (GSH-Px), copper and zinc-dependent superoxide dismutase (SOD1), the mitochondrial manganese-dependent superoxide dismutase (SOD2), and catalase. This report examines the effect of a single low or moderate dose exposure to solar-simulating combined UVB and UVA irradiation on the gene expression and activities of these antioxidant enzymes in cultured normal human fibroblasts. We find that both doses initially decrease GSH-Px, SOD2 and catalase activities, but within 5 days after irradiation the activities of the enzymes return to pre-irradiation level (catalase) or are induced slightly (SOD1, GSH-Px) or substantially (SOD2) above the basal level. For SOD1, SOD2 and catalase, the higher dose also detectably modulates the mRNA level of these enzymes. Our results indicate that the effects of a single physiologic solar simulated irradiation dose persist for at least several days and suggest that skin cells prepare for subsequent exposure to damaging irradiation by upregulating this antioxidant defense system, in particular the mitochondrial SOD2. Our findings are consistent with the existence of a broad-based SOS-like response in irradiated human skin.