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People receiving therapy with either 8-methoxypsoralen plus long wavelength ultraviolet radiation (PUVA) or medium wavelength ultraviolet radiation (UVB) have been studied to see whether their unresponsiveness to the contact sensitizer dinitrochlorobenzene (DNCB) is a form of immunological tolerance. It was confirmed that both PUVA and UVB therapy impair sensitization by DNCB: 4/13 PUVA-treated and 9/29 UVB-treated psoriatic subjects became sensitized by a dose of DNCB which sensitizes 100% of untreated patients. Subjects unsuccessfully sensitized during PUVA therapy could subsequently be sensitized perfectly normally. Subjects unsuccessfully sensitized during UVB therapy showed slight impairment of subsequent sensitization which was not statistically significant, and which was probably a persistent effect of UVB exposure. In conclusion, the temporary unresponsiveness seen in human subjects exposed to antigens during PUVA or UVB therapy is not due to immunological tolerance. [ABSTRACT FROM AUTHOR]

Twenty cutaneous warts from 18 renal transplant recipients (RTR) and a single wart sample from a patient suffering from Hodgkin's disease were screened for the presence of human papillomavirus (HPV) sequences by Southern blot analysis. Thirteen samples were shown to contain HPV DNA sequences, one was identified as HPV-3, two as HPV-4, six as HPV-2 and four were unidentifiable by restriction digest analysis. HPV-3 was identified in the wart sample from the patient suffering from Hodgkin's disease. In the six samples in which HPV-2 was found, the viral genome showed polymorphism for the PvuII and PstI sites. Two PvuII patterns and one PstI pattern are novel. [ABSTRACT FROM AUTHOR]

One hundred and six melanocytic lesions were studied to determine the value of the so called Ag NOR technique in differentiating dysplastic naevi, Spitz naevi and spindle cell naevi of Reed from malignant melanoma and from ‘banal’ compound or intradermal naevi. In 79 cases Ag NOR counts were possible. The banal naevi (36) had a mean count of 1.54, (SD 0.3), and the unequivocally malignant superficial spreading melanomas (13), lentigo maligna melanomas (4) and secondary melanomas (4) had a mean count overall of 3.9 (SD 1.59). For dysplastic naevi (16) the mean Ag NOR count was 1.63 (SD 0.36) and for Spitz and spindle cell naevi (in toto 6) the figure was 1.72 (SD 0.55). The difference in Ag NOR counts between all types of naevi and all types of melanoma was highly statistically significant, but there was no difference between banal naevi and dysplastic, Spitz, and spindle cell naevi. Correlation of Ag NOR counts between three independent observers was good. This technique may, therefore, be a useful adjunct in separating true melanoma from borderline melanocytic naevi. [ABSTRACT FROM AUTHOR]

We studied sensitization to dinitrochlorobenzene (DNCB) in psoriatic patients before, during and 2,4, and 6 weeks after a course of photochemotherapy (PUVA). The inhibition of sensitivity observed during PUVA was completely reversed after 6 weeks. Thus the PUVA-mediated inhibition of cutaneous immune responsiveness is of short duration. However, whether there are long-term sequelae remains to be established. [ABSTRACT FROM AUTHOR]

We have investigated the contributions of dose per unit area and area of application to the degree of sensitivity induced by dinitrochlorobenzene (DNCB). Subjects sensitized with 35.4 μg/cm2 showed equal sensitization whether the total dose was 250 μg applied to 7.1 cm2 or 62.5 μg applied to 1.8 cm2. Three groups of subjects were sensitized with 16.4 μg/cm2 applied as 56 μg on 3.5 cm2, 116 μg on 7.1 cm2 or 232 μg on 14.2 cm2. Although the total dose changed by a factor of four, the proportions of subjects sensitized were comparable (66, 50 and 55%, respectively), and their degrees of reactivity were similar. This contrasts with previous findings that when the area of sensitization was fixed and the concentration was increased over a similar range, highly significant increases in the proportion of sensitized subjects and degree of reactivity occurred. [ABSTRACT FROM AUTHOR]

Twenty patients with palmoplantar pustular psoriasis were treated initially for 4 weeks with 70 mg etretinate daily. This led to clinical improvement and a significant fall in pustule count. The patients were then allocated randomly to 30 mg etretinate daily or placebo for a further 12 weeks. There was a rapid deterioration in the clinical condition and a rise in pustule count in the placebo group. The etretinate-treated group still showed clinical improvement and a significantly lower pustule count after 12 weeks. Clinical side-effects were few and adverse effects on liver function and serum lipids were not found. [ABSTRACT FROM AUTHOR]

We Studied 67 patients with multiple contact allergies to determine whether there was an association of this state with any particular HLA antigen. HLA-A, -B and DR antigens were typed by standard serological methods. There was no significant HLA association, although there was an increased frequency of DR4 in those patients who included nickel as one of their sensitivities (64% compared with 33% in controls), and an increase in DR6 in those patients who included sensitivity to a rubber accelerator (45% compared with 16% in controls). However, when the probabilities were corrected for the number of HLA antigens tested and the number of substances in the patch test battery, these associations were no longer statistically significant. We also examined the morphology and numbers of Langerhans cells in epidermal sheets from six subjects with multiple allergies. There were no differences in appearance or numbers of Langerhans cells stained for ATPase, compared with 20 non-allergic controls. [ABSTRACT FROM AUTHOR]

In a double-blind controlled study of patients with pustular psoriasis of palms and soles who were allocated at random to etretinate or placebo, we found that etretinate improved the condition as assessed by pustule count and overall clinical response. Side-effects occurred but were accepted by the patients in the short-term. The clinical usefulness of etretinate in this condition will depend on time to relapse, and whether this can be prevented or postponed by continuous treatment. Toxicity in the long-term will also be important. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum may occur in patients with haematological disorders but has not frequently been reported in patients with polycythaemia rubra vera. To support the view that this is a significant association, we report a further two cases and discuss the implications of the development of pyoderma gangrenosum in patients with polycythaemia. [ABSTRACT FROM AUTHOR]

Two separate, double-blind, randomized, half-and-half body comparisons, each involving 20 inpatients with psoriasis, were conducted to compare the effect of different concentrations of crude coal tar in yellow soft paraffin. The therapeutic effect of 1% crude coal tar used twice daily for 10 days was significantly less than that achieved with an incremental regimen starting at 5% and increasing by 5% every second day to a maximum of 25%. No such difference was seen when a steady concentration of 5% was compared with the same incremental regimen. We conclude that there appears to be no benefit from exceeding a concentration of 5% crude coal tar in yellow soft paraffin in the treatment of patients with psoriasis and that the plateau in the dose-response curve for the action of crude coal tar in psoriasis begins at a point between 1 and 5%. [ABSTRACT FROM AUTHOR]

We examined the effects of a small initial sensitizing dose of antigen (dinitrochlorobenzene, DNCB) on the subsequent response to a second, defined sensitizing stimulus. The second stimulus was actually the regimen of four doses of DNCB (3.125,6.25,12.5, and 25 μg; total 46.9 μg) normally used as the elicitation challenge. In two separate experiments Hand 18 control subjects received an initial 'challenge' with the four doses to induce sensitivity, and 4 weeks later their responses were determined with a second, elicitation challenge. Two groups of 12 and 15 experimental subjects received an inital dose predicted to induce clinically detectable sensitivity in 50% or 25%, respectively. Four weeks later, their responsiveness was determined with quantitative challenge and the subjects who gave no response received a further challenge 4 weeks later. Their responses, compared with those from the control subjects, were augmented, indicating that sub-clinical priming of the immune system had indeed occurred. [ABSTRACT FROM AUTHOR]

The article presents a case report relating to ankyloblepharon filiforme adnatum. The section discussed two cases of ankyloblepharon filiforme adnatum, and novel aspects of treatment, associations and classifications. Ankyloblepharon filiforme adnatum is a rare but potentially ambylogenic congenital abnormality of the eyelids, in which single or multiple bands of tissue join the upper and lower eyelid.

This article presents an abstract for the paper "Isotretinoin, Creatine Kinase and Exercise," by D.M. Tillman, S.I. White and T.C. Aitchison. The CK level was not significantly related to myalgia, this symptom occurring in only 13% of occasions when the CK was raised. Myalgia was, however, related to isotretinoin therapy, being present in 28% of patient assessments during, and only 4% out with the treatment period. There was no significant myoglobinaemia or myoglobinuria at week 0 or at week 16. The mean 24-h urinary creatinine excretion at week 16, before and after correction for creatinine excretion, showed no significant change from week 0.

Presents an abstract of the article "Analysis of ras Gene Mutations in Non-Melanoma Skin Cancer by the Polymerase Chain Reaction (PCR) and Mutation-Specific Oligonucleotide Probing," by S. I. White and A. Balmain, presented at the British Society for Investigative Dermatology Annual Meeting held on September 1989 in Birmingham, England.

This article reports that the histopathological assessment of malignancy may be difficult in certain melanocytic lesions. It has been shown that the number of demonstrable nucleolar organizer regions (NORs) may refiect the degree of histological malignancy. NORs are portions of ribosomal DNA present in the nucleoli. NORs and NOR-associated proteins may be stained by an agyrophilic technique and visualized as nuclear black granules. Benign melanocytic naevi had the fewest nucleolar organizer regions.

This article presents information about the research paper entitled "Activated Harvey ras oncogene with a codon 12 mutation derived from a basal cell carcinoma," presented by S. I. White and A. Balmain at the British Society for Investigative Dermatology Annual Meeting, Cambridge, September 1987. The activated ras oncogene has been detected in human malignancies of many histological types. In all cases of activation a point mutation at either codon 12 or 61 has been found. Basal cell carcinoma is the commonest skin malignancy and with ultraviolet light as a major aetiological factor in its genesis an activated oncogene might be expected.

Background: The aim is to compare the outcomes of surgical management of large bowel emergencies. The traditional treatment of Hartmann's resection was compared to the new modalities of Colonic stenting for malignant obstruction and laparoscopic washout for perforated sigmoid diverticulitis. Methods: This paper is a retrospective review of 112 consecutive large bowel emergencies presenting to The Tweed Hospital and John Flynn Private Hospital warranting surgical intervention during the 8 year period 2000–2008. Patients with obstruction from cancer and perforation from diverticulitis were included. Patients with volvulus, pseudo-obstruction, bleeding, stercoral ulceration and prolapse were excluded. Patients with non urgent colonic stenting were also excluded. Results: The patient groups were comparable for age, ASA and pathology after exclusions. 57 patients underwent a Hartmann's (obstruction 23, perforation 34) vs. 55 patients undergoing stent for obstruction 21, or washout for perforation 34. Significant differences were observed in the mortality rates, Hartmann's 11/57 (19%) vs. stent and washout 2/55 (37%). Also length of stay: Hartmann's 15 days vs. stent and washout 6 days. Hartmann's was required to salvage 2 failed stents and 6 failed washouts. In 16 of 26 washouts and 11 of 17 stents patients underwent delayed elective resection. Conclusion: Patient selection, technical expertise and long learning curve were all aspects that influenced the early results of stenting and washout. Hartmann's is no longer the preferred treatment option for left sided colonic emergencies. [ABSTRACT FROM AUTHOR]

Background: Management of acute LBO remains challenging. An urgent surgical intervention is often associated with poorer clinical outcome compared to an elective procedure. SEMS as BTS or palliative measure remain controversial and not widely available. Methods: From 1995 to 2008, retrospective analysis of the patients presenting with an acute malignant LBO to the Tweed and John Flynn Private Hospitals was performed. Results: SEMS were inserted in 31 patients (median age 74 (46–95), 17 females and 14 males, ratio 1.2:1). 12 were elective and therefore excluded. The remaining 19 had emergency SEMS insertion – 12 as BTS and 7 palliative. LOS was 4.5 days (2–21). Tumour was located in the left colon and the rectum (15) and transverse colon (4). 15 patients experienced complete resolution of LBO. 10 patients from the BTS group had subsequently undergone one-stage curative resection with good outcome. There were 2 deaths and 2 unsuccessful SEMS placements. Urgent operation was performed in 23 patients (median age 74 (52–89), 10 males and 13 females, ratio 1.3:1): 18 Hartmann's procedures, 3 resections with primary anastomosis and 2 defunctioning colostomies. LOS was 17.7 days (2–59). There was 1 death, 1 ongoing pelvic sepsis, 5 significant wound complications, stoma prolapse, AMI, IHD exacerbation, 2 episodes of AF, 3 UTI, pneumonia and 3 cases of prolonged ileus. Conclusions: In expert hands SEMS are effective in treatment of LBO. They are associated with an overall better outcome and improved quality of life of patients. Surgery is indicated, where SEMS are unavailable or have failed. [ABSTRACT FROM AUTHOR]

Limited nursing knowledge exists to explain how culture influences men's health care decisions and practices. The purpose of this collaborative research was to explore the health care meanings, values, expressions, lived experiences, and practices of Anglo-American adult males residing in the rural Midwest. Using the ethnonursing research method, data were collected through interviews with 7 key and 12 general informants residing in Iowa. Four culture values and five themes were supported by the findings. Leininger's culture care modes were used to explicate culturally meaningful nursing care actions and decisions that are in harmony with the cultural values and practices of rural men.

A 47-year-old man presented with a several month history of non-specific acquired ichthyosis, an unknown period of generalized lymphadenopathy and a short history of erythematous papules and nodules affecting the cutaneous drainage area of his right axillary lymph nodes. Histology confirmed these lesions to be specific lesions of Hodgkin's lymphoma; that is, metastatic retrograde lymphatic spread from his axillary lymph nodes of CD30+, CD15+, Reed-Sternberg cells as well as mononuclear Hodgkin's cells. This is the most common site and mode of spread of Hodgkin's disease to the skin. As is typical of advanced Hodgkin's disease, as evidenced by specific cutaneous involvement, this patient died shortly after definitive diagnosis was made.

Biopsies of involved and uninvolved skin from five patients with plaque psoriasis and normal skin from four healthy volunteers were investigated for steady-state quantities of TGF-alpha RNA and protein by in situ hybridization and immunohistochemistry. Increased levels of TGF-alpha RNA were found only in the high-level keratinocytes of involved psoriatic skin (p less than 0.001). Elevated levels of TGF-alpha protein were seen in both the high-level and basal layers of involved psoriatic skin compared to uninvolved psoriatic and normal control skin. Elevated TGF-alpha gene expression is thus implicated in the hyperproliferation of keratinocytes and possibly the altered maturation pattern seen in psoriasis.

We report a case of the association of Coombs'-positive haemolytic anaemia with mycosis fungoides. The patient was found to have polyclonal elevation of B lymphocytes in the peripheral blood but infiltration by T helper cells in the skin.

An epidemic of nosocomial Legionella micdadei pneumonia occurred among renal transplant patients in the University of Virginia hospital between 1978 and 1982. Although no further cases were diagnosed after 1982, filters and ultraviolet light (UVL) fittings were installed in 1985 as an attempt to disinfect water piped to rooms of transplant patients, because of concern about persistence of L micdadei in hospital water. Water samples were obtained from eight UVL-treated rooms and eight control rooms. 26 of 95 control samples were culture positive for L micdadei compared with 0 of 71 samples of filtered, UVL-treated water (p less than 0.0001, Fisher's exact test). After the UVL fitting and filter had been bypassed because of a leak, 9 of 33 samples from the UVL rooms were positive (p less than 0.0001). These data suggest that UVL treatment may be useful in continuous disinfection of water in the hospital rooms of high-risk patients.

Environmental surface and personnel hand impression cultures were obtained during 13 sampling periods in the University of Virginia Pediatric Intensive Care Unit to document potential reservoirs of nosocomial pathogens. In 78 environmental cultures Staphylococcus aureus was found eight times and gram-negative bacilli ten times. The patient chart cover was the most commonly contaminated surface. Acinetobacter calcoaceticus was found in five of ten cultures positive for gram-negative bacilli. Thirty of 59 hand cultures were positive for S aureus and gram-negative bacilli; nurses and residents had both, respiratory therapists only gram-negative bacilli, and A calcoaceticus was the most commonly isolated bacterium of potentially nosocomial significance (14/30). Laboratory investigation of bacterial survival revealed that gram-negative bacilli survived on a dry formica surface from a few hours up to three days but Acinetobacter survived up to 13 days. Since A calcoaceticus has been implicated in many nosocomial infections, its long survival on a dry surface may be an additional factor in its transmission in hospitals and suggests that more attention be paid to environmental surfaces as a source of significant nosocomial pathogens.