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Introduction: Promising clinical results support the positive effects of interdisciplinary multimodal pain treatment (IMPT) for patients with chronic musculoskeletal pain (CMP). Additional scientific evidence is warranted however, specifically on long-term effectiveness1. Inadequate descriptions of interventions often impede interpreting treatment effectiveness and comparing study results2. The objective therefore, is to provide a systematic and thorough description of a 10-week IMPT program for patients with CMP provided at the Centre for Integral Rehabilitation (CIR) in the Netherlands. Methods: We used the TIDieR-checklist3 as a guide, although we added subsections describing the eligibility criteria and evaluation procedures in order to provide a complete description of the intervention. We included a detailed overview of all sessions in each phase of the program, as well as their timing and duration. Results: The CIR program aims to increase patients' daily functioning by supporting them to adapt their behaviour so that they can better manage their complaints, and consists of three phases: a start phase, an education phase and a skill-learning phase. The treatment incorporates pain education, Acceptance and Commitment Therapy (ACT), cognitive behavioural therapy (CBT) like graded activity and exposure in vivo, and physical training (experiential learning). Discussion: All patients follow the same schedule with the same sessions, however tailoring takes place on a per-session basis to address a patient's specific needs and goals. Process evaluation: Due to the individual tailoring it is not possible to provide an exact description of the treatment which is identically replicable. Individualisation however does increase the effectiveness of IMPT programs. [ABSTRACT FROM AUTHOR]

We present two patients with generalized and three with localized skin eruptions due to various non-amiconvulsant drugs, with a histological picture of a pseudolymphoma of the skin. Cessation of the causative drugs resulted in disappearance of the lesions in all cases. [ABSTRACT FROM AUTHOR]

In lymphomatoid papulosis two histological types can be distinguished, i.e. type A and type B. In the present study various immunological, enzyme-histochemical and ultrastructural techniques were used to investigate the cellular infiltrate in both types of lymphomatoid papulosis. The type A lesions showed a predominance of large atypical cells, relatively few T cells and few or no Langerhans or related cells, as defined by a positive staining for OKT6 and NA 1/34 antisera. The immunological, cytochemical and ultrastructural characteristics of these large atypical cells resembled those of the Langerhans cell/interdigitating reticulum cell series. The morphology and marker profile of these large cells resembled those of Reed-Sternberg cells, which suggests a relationship between lymphomatoid papulosis type A and Hodgkin's disease. The type B lesions showed a predominance of small, medium-sized and large cerebriform mononuclear cells with the phenotype of activated T helper cells, and numerous Langerhans and/or related cells. Their cellular composition was similar to that observed in the early stages of mycosis fungoides. [ABSTRACT FROM AUTHOR]

Clinicopathological findings, methods of treatment and survival in ninety-two patients with cutaneous T-cell lymphoma (CTCL) (eighty-five mycosis fungoides and seven Sézary syndrome), seen in the Leiden University Hospital between 1974 and 1980, are reported. All patients were staged and treatment was given accordingly. Patients without signs of extracutaneous disease (74%) were treated with either total-skin electron-beam irradiation (E beam), topical mechlorethamine (HN2) or PUVA. Topical HN2 and E beam had an equal effect on survival. Electron-beam induced a higher number of initial complete remissions than HN2, but fewer patients relapsed while on maintenance treatment with HN2. In the patients with lymph node and/or visceral involvement, E beam followed by systemic Chemotherapy—cyclophosphamide, vincristin (Oncovin) and prednisone (COP)—gave better results than topical therapy or COP alone. Survival was influenced most by the type of skin lesion, the presence or absence of lymph node and/or visceral involvement, and the ability to induce a complete remission initially. [ABSTRACT FROM AUTHOR]

A review of sixty-four skin biopsies from sixteen patients with lymphomatoid papulosis revealed two characteristic histological types (type A and type B), which also had a different clinical behaviour. In lymphomatoid papulosis type A lesions, four histological patterns corresponding with the age of the lesion could be distinguished. Such a relationship was not found in type B lesions. The finding of transitional forms in some biopsy specimens, showing histological features of both type A and type B, and the presence of both types in different but concurrent lesions, suggests that these two types are not different entities but rather represent the ends of a spectrum. At least two different populations of atypical ceils can be distinguished in lymphomatoid papulosis. Apart from the atypical cerebriform mononuclcar cells, which are T-lymphocytic in origin and predominant in type B lesions, large atypical cells with vesicular nuclei, prominent nucleoli and abundant cytoplasm are found, particularly in type A lesions. Preliminary immunohistochemical and cytochemical investigations suggest that these cells are not lymphoid in origin, but are related to the Langerhans cell series. [ABSTRACT FROM AUTHOR]

A patient with diffuse cutaneous mastocytosis, present since birth, developed several cutaneous mastocytomas without any symptoms after puberty. Although the histological picture of the tumours, showing nuclear atypia, mitotic figures and varying metachromasia of the granules, raises suspicion of systemic involvement, this has not appeared so far. The absence of symptoms could be due to the synthesis of an abnormal secretory product by the mast cells, which is supported by the absence of oedema and dilated blood vessels in the presence of extensive degranulation and by the unusual ultrastructural picture of the mast cell granules, i.e. little electron density with the almost complete absence of lamellar and crystalline structures. [ABSTRACT FROM AUTHOR]

Localized scleroderma-like skin lesions which developed in two children, from 8 to 10 months after successful bone marrow transplantation for aplastic anaemia, showed histopathological features resembling those of scleroderma. This finding, like the animal models described in the literature, provides additional support for the auto-immune nature of scleroderma. [ABSTRACT FROM AUTHOR]

Mycosis fungoides (MF) and Sézary's syndrome are cutaneous T cell lymphomas, characterized by the presence of lymphoid cells with deeply indented nuclei (CMC) in the infiltrate. In order to find objective criteria for the diagnosis of early MF involvement of lymph nodes from patients with MF, we performed morphometric analysis of lymphoid cells in lymph node cell suspensions measuring the degree of nuclear indentation as expressed by the nuclear contour index (NCI). Statistical discriminant analysis was used to analyze the differences in the NCI histograms between lymph nodes without and with MF involvement and to select the most discriminating parameters for diagnostic classification. Using a training set of 6 lymph nodes from patients with unrelated diseases and 8 lymph nodes from patients involved by cutaneous T cell lymphomas, the mean and standard deviation of the NCI histograms were selected as the most discriminating parameters. All lymph nodes from the training set were assigned to the correct diagnostic classification group with a probability over 90%. The predictive value of the morphometric classification was tested on a set of 12 enlarged lymph nodes from patients with MF. The histological diagnosis was used as a reference. In 10 cases the morphometric classification was identical to the histological classification, whereas in two cases (1 classified as positive, 1 as negative) a disagreement was found. It is concluded that morphometry of lymphoid cells can contribute substantially to the diagnosis of early MF involvement in lymph nodes. [ABSTRACT FROM AUTHOR]

C-type virus-like particles were found in 7 skin biopsies and in 4 lymph nodes from 7 patients with mycosis fungoides (MF). In addition, such particles were also found in skin biopsies from 2 patients with Sézary's syndrome (SS). The particles were invariably found in cells derived from the mononuclear phagocytic series i.e. Langerhans cells and 'related cells', but never in cerebriform mononuclear cells (CMC) nor in any other cell-type. No virus-like particles were found in control specimens consisting of skin biopsies from 8 patients with chronic benign skin lesions and peripheral lymph nodes from 4 patients with unrelated diseases. In one patient with MF particles possessing some characteristics of retraviruses could be released from skin lesions. They band at a density of about 1.16 g/cm in a sucrose gradient and exhibit reverse transcriptase activity (RNA-dependent DNA-polymerase activity). Electron microscopy of the skin lesions and of the 1.16 g/cm sucrose gradient fraction confirmed the presence of C-type virus-like particles. The presence of C-type virus-like particles only in Langerhans cells and in related cells: i.e. indeterminate cells in the skin and IDC in lymph nodecells with a specific preference for T cell regions-from patients with MF and SS might be related to the aetiology of these cutaneous T cell lymphomas. [ABSTRACT FROM AUTHOR]

It is well known that in some cases of mycosis fungoides the lymph nodes contain atypical mononuclear cells with a characteristic electron-microscopic morphology, first described in skin lesions of mycosis fungoides. Because it has been shown, that these cells have T-cell membrane characteristics the question can be raised, if these cells have other properties of T cells. One of these is a preferential localization in the T-cell dependent regions (paracortical areas) of the lymph node. In this paper we present a study of dermatopathic lymph nodes from four patients with mycosis fungoides (plaque stage). The lymph nodes of these patients contained atypical mono nuclear cells in the paracortical areas only, and not in the follicles or medulla. In one of the patients we could demonstrate the migration of these cells through the epitheloid venules into the paracortical area. Our observations give further evidence of the T-cell nature of the atypical mononuclear cells in mycosis fungoides. [ABSTRACT FROM AUTHOR]

, , 125-131. Two cases of tracheal tumour are described, one a carcinoid and the other an adenoid cystic carcinoma (cylindroma). Both patients were treated by repeated partial bronchoscopic resections. The patients are in good health nine and three years respectively after treatment. [ABSTRACT FROM PUBLISHER]