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10 of 16 (62.5%) patients with granuloma annulare presented microangiopathic changes in the skin. The incidence in control groups was 100% in diabetic patients, 40% in old-age patients not known as diabetics and 0 in young victims of road accidents. The frequency of the vascular findings does not seem to be shared equally by the two types of granuloma annulare, the generalized and the localized type. In the first, as in the diabetic group, microangiopathy was observed in all patients examined. Whereas, in the second it was detected in only 2 of the 8 patients. It is concluded, therefore, that from the point of view of their relation to a diabetic state, the two forms of the disorder differ from each other.

Our experience with pemphigus vulgaris consists of 35 cases. The majority are Jews of Eastern European origin, with an average age of 49.3 years. A daily 40–60 mg of prednisone was effective to initiate remission in most of the cases. Substitution of prednisone by an equivalent dose of triamcinolone avoided further increasing in the dose in 11 of 14 cases. Other regimens of treatment, such as alternate-day therapy, addition of estrogen and of methotrexate, were utilized in some of the patients. They were effective in only a part of the cases and after the disease has been held in remission by the conventional daily therapy. Our data shows that it is adviseable to make allowances for individual reactions on determining the level of initial dosages and when utilizing the other modalities of treatment.

SUMMARY The carbohydrate tolerance was routinely investigated in fifty-two patients with granuloma annulare. Thirteen of the fifty-two cases presented the generalized type and the remaining thirty-nine had the localized form of the disorder. The results obtained in these patients were compared with those revealed in two control groups of patients. The same number of patients of the same sex, age and ethnic group with skin diseases other than granuloma annulare were similarly investigated as were 386 patients with conjunctival micro-aneurysms. Some degree of carbohydrate intolerance was detected in 36.5% of patients with both types of granuloma annulare. However, the incidence of this disturbance in patients with the localized form was no greater than in those with other skin diseases. The important finding in this study was the 76.9% incidence of carbohydrate intolerance in generalized granuloma annulare. This finding was supported by the histopathological changes in the small cutaneous blood vessels of these patients.

Ten patients with active Behçet’s disease were studied to evaluate whether the cutaneous response to intracutaneous injection of autologous plasma differs from those known to occur in the disease following needle prick and injection of normal saline (pathergy). No specific response to plasma was noticed. 8 of the 10 patients tested reacted positively to all 3 stimuli, and the remaining 2 developed no reaction to any of them. The reaction to plasma in a given patient was clinically identical to those produced by normal saline and needle prick. The only histological difference noticed was the prevalence of acute inflammation and perivascular granulocytic infiltrate at the sites of plasma. None of the reactions revealed thrombosis or necrosis of the blood vessels, and those minor vascular affections noticed seem to be secondary to the inflammatory process.

Summary Clinical or chemical (latent) diabetes was discovered in 7 of 8 patients with generalized granuloma annulare; all were women. The average age of onset of their disease was 50 years. Treatment with chlorpropamide and low carbohydrate diet seemed to alleviate the skin manifestations in 6 of 7 patients so treated.

Alternate-day prednisone therapy was tried in 21 children, with rheumatic fever, 1 with nephrotic syndrome, and in 14 patients with pemphigus vulgaris. Ten of the latter were already treated by the conventional daily method and their lesions were well controlled by a carefully established daily maintenance dose. The additional 4 received the alternate-day treatment directly after their lesions were first controlled by the daily method. The follow-up of our cases revealed the following: (a) the adverse reactions to this regimen were comparatively mild and rare, and most of the already existing ones improved or disappeared totally, (b) the endogenous pituitary adrenal function was well preserved and in 3 it returned to normal following its depression by the daily method, (c) the treatment was apparently as effective as the daily devided doses regimen, (d) in 1 patient with pemphigus vulgaris the treatment failed to bring a primary remission, however, it was effective in maintaining the remission achieved by the daily method.

The infusion of 10% solutions of glucose, galactose and fructose into normal subjects caused significant increases in the excretion ratios of phosphate and alpha-amino nitrogen. The infusions of 10% xylose solutions at the same rate caused similar hemodynamic and osmotic alterations, but no changes in the excretion of these substances. Column chromatographic analysis revealed that glucose infusion impaired the reabsorption of numerous amino acids. The excretion ratios of phosphate and alpha-amino nitrogen could not be correlated with the plasma hexose concentrations or rate of hexose excretion, but other data are cited to support the thesis that the observed inhibition of phosphate and amino acid reabsorption is due to a toxic effect of the hexoses or their metabolites on the renal tubular transport system.

The Wide Range Achievement Spelling Test was administered to 64 aphasic subjects. Total errors on each of the 100 test words and errors made by subjects in each quartile were analyzed in relation to the logarithm of word frequency, and word length determined by number of letters. Both word length and word frequency were found to be significant variables in determining the spelling performance of aphasic subjects. Word frequency and word length were negatively correlated, and accounted almost completely for the errors on the test words in all segments of the population.