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Fifty seven children with dermatitis herpetiformis, 18 from Finland and 39 from Hungary, were studied. Diagnostic criteria included the finding of granular IgA deposits in the skin of all patients. The mean age at onset of the rash was 7 X 2 years and favoured sites were the elbows, knees, and buttocks. Symptoms suggesting small intestinal disease were rare but in 35 (61%) of the children subtotal villous atrophy and in 16 (28%) partial villous atrophy were found on jejunal biopsy. Eighteen children underwent a second biopsy after a mean of 21 months on a gluten free diet; villous height was found to be increased and the intraepithelial lymphocyte count decreased in all these patients. Gluten challenge caused a reversal in the two children who underwent a third biopsy. The effect of the gluten free diet on the rash was examined in Finnish children by observing the daily requirements of dapsone, a drug used to control the rash at the beginning of the diet. Eight (67%) of the 12 children were able to stop taking dapsone after a mean of 11 months on the diet and all three patients treated with diet alone became asymptomatic after three to 6 months on the diet. These results confirm that most children with dermatitis herpetiformis have jejunal villous atrophy, though they rarely have gastrointestinal symptoms. The central role of gluten in childhood dermatitis herpetiformis is evidenced by the fact that a gluten free diet helps the damaged jejunal mucosa to recover and controls the rash even in those children who do not have an abnormal jejunal biopsy. [ABSTRACT FROM AUTHOR]

The incidence of side-effects on administration of chloranolol (Tobanum), a beta-adrenergic receptor blocking drug, to 2066 patients with hypertension, angina pectoris or arrhythmias was measured by three different methods. In 600 patients in an efficacy trial (Group 1) both spontaneously reported complaints and objective signs were tabulated. A side effect - directed method, utilising a questionnaire containing a list of possible side-effects was also used, with the questionnaire being completed by the physician. 35 questions referred to anticipated and other side-effects. The trial was performed in two groups: in 537 patients a placebo was also given (Group 2), and in another set of 929 patients (Group 3) the questionnaire inquiry was performed uncontrolled, without placebo. All three groups were comparable in their distribution of sexes, ages and diagnoses, the mean daily dose of chloranolol its use alone or in combination, and in a similar duration of treatment. 55% of all patients received chloranolol therapy for a period of more than 3 months. The ratio of in- and outpatients was 1:5. The side-effect incidence was independent of the age and sex of the patients and of the dose of chloranolol. The incidence was also unaffected whether chloranolol was used alone or in combination. The number of side-effects differed markedly between the three groups, their ratio was 1:10:24 in Groups 1, 2 and 3. Two-thirds of the side-effects subsided spontaneously within 1 month of their onset. The duration of the side-effects varied according to their character: cardiorespiratory side-effects were of the shortest duration and those affecting the central nervous system were the most enduring. The appreciable differences in incidence could be attributed to the methods of collection of the data. It has been stated that placebo controlled trials using a detailed questionnaire are the most suitable for estimating the incidence of side-effects; recording side-effects spontaneously reported by patients are insufficiently sensitive, and uncontrolled trials using a questionnaire have been shown to be too sensitive. The revealed incidence of side effects leading to interruption of treatment is less affected by the method chosen. In 100 patients (4.8%) therapy had to be suspended because of the side-effects of chloranolol (Group 1: 1%, Group 2: 6.20%, Group 3: 6.6%). Comparison of the incidence of cessation of therapy due to side-effects did not show an appreciable difference between the various beta-adrenergic receptor blocking agents, including chloranolol. [ABSTRACT FROM AUTHOR]

The effects of intravenous strophanthin K (0.125 and 0.25 mg) and lanatoside C (0.4, 0.8 and 1.6 mg) on systolic time intervals (STI) and impedance plethysmographic (IP) values were studied in ten patients with compensated coronary heart disease. The heart rate decreased significantly during a two-hour study in the lying position after both glycosides and placebo; the systemic blood pressure remained unchanged. Electromechanical systole (QS), left ventricular ejection time (LVET) and preejection period (PEP), corrected for heart rate (QSI, LVETI, PEPI), showed no change after placebo. The glycosides caused no change in LVETI. QSI was significantly shortened only after lanatoside C 1.6 mg. PEPI and ICT were significantly shortened by both doses of strophanthin K and lanatoside C; the effects were dose-related. Taking into consideration the effects of cardiac glycosides on STI, use of the index ICT/QS, the quotient of isovolumic contraction time and electromechanical delay, is proposed, because it showed quite sensitively the increase in myocardial contractility after digitalis. The effect of strophanthin K could be detected 10 minutes, and that of lanatoside C 30-40 minutes, after injection. The amplitude of the IP curve and the relative pulse volume showed positive and negative changes without any trend after administration of placebo or glycoside. The data suggests that the usual therapeutic doses of these cardiac glycosides do not cause significant changes in the peripheral circulation in patients with compensated coronary heart disease, but their action on STI is quite marked, showing a positive inotropic effect. [ABSTRACT FROM AUTHOR]

Twenty one children with dermatitis herpetiformis were studied in an attempt to evaluate the response in the skin, in jejunal morphology, and in jejunal immunoglobulin containing cell counts to gluten elimination and subsequent gluten challenge. In all of the 15 patients whose jejunal biopsy was studied after the eventual gluten challenge the jejunal lesion had returned in 2.4 to 28 months. The numbers of IgA- and IgM-containing cells were similarly raised in primary and postchallenge biopsies. In the 13 patients whose skin improved during a gluten free diet and who were challenged with gluten the rash worsened and the dapsone/sulphapyridine requirement increased. The jejunal deterioration was equally marked in the six patients whose gluten challenge was stopped because of an intractable rash as it was in those who completed the preplanned challenge. The specimens of the former, however, had significantly more IgA-containing cells than specimens of the latter. The number of intraepithelial lymphocytes clearly reflected the degree of intestinal damage. IgA-containing cells proved to be the most sensitive indicator of an immune reaction taking place in the gut of these patients. Even in the two children with initially normal or nearly normal jejunal mucosa, the IgA cell counts in the jejunal lamina propria were markedly raised. [ABSTRACT FROM PUBLISHER]

An analysis of the ultrastructural features of 35 canine kidneys after hypothermic preservation in Rheomacrodex, Collins and Sacks II solutions, and subsequent autologous reperfusion for 2 to 3 hours is presented. Signs of irreversibility (intramitochondrial crista fragmentation, cell membrane rupture, detachment of the brush borders in the area of the proximal tubular system) were confined to the rheomacrodex-preserved kidneys. Other abnormal features (cytoplasmic vacuolation, mitochondrial swelling in the proximal tubules, vacuolation of the visceral epithelial cells, heteromorphism in the glomerular system) found in the acute stage of revascularization may be regarded as reversible and account for the transitory functional disorders of renal transplants. [ABSTRACT FROM AUTHOR]

Comparative studies were performed for about fifteen months in 26 patients with chronic atrial fibrillation to evaluate the efficiency of Quinidine Durules or quinidine sulphate in maintaining sinus rhythm. There was no difference in the two groups as to underlying disease, type of rhythmic disturbance and its duration, nor in the frequency of occurrence of congestive heart failure prior to DC shock applied for restoration of sinus rhythm. On the basis of our observations made during a period of about 15 months adequate doses of quinidine sulphate and Quinidine Durules - monitored by the plasma quinidine levels - proved equally suited for the maintenance of sinus rhythm. Quinidine sulphate elicited side effects (toxic symptoms) more frequently than did the long-acting Quinidine Durules. With two daily dosages of Quinidine Durules - more convenient for the patient than four daily administrations of quinidine sulphate - a more stable plasma quinidine level was maintained. That in turn might explain the less frequent occurrence of side effects. [ABSTRACT FROM AUTHOR]

A second part of a cross-over study was performed for fifteen months in 16 patients to compare the efficiency of long-acting and conventional quinidine in maintaining sinus rhythm after electrical conversion of atrial fibrillation. Both quinidine preparations in adequate dosage were capable of maintaining sinus rhythm. The long-acting form of quinidine produced more stable blood levels with less fluctuation in concentration. The long-acting preparation caused fewer side effects than the conventional form of quinidine sulphate. [ABSTRACT FROM AUTHOR]

A monozygous female twin pair discordant for dermatitis herpetiformis and concordant for gluten-sensitive enteropathy is reported. The diagnosis of dermatitis herpetiformis was verified by demonstrating granular IgA deposits in the uninvolved skin. Gluten-sensitive enteropathy was confirmed according to the ESPGAN criteria. Monozygosity was proved by the standard genetic characteristics. [ABSTRACT FROM AUTHOR]