Highly purified omega-3-polyunsaturated fatty acids for topical treatment of psoriasis. Results of a double-blind, placebo-controlled multicentre study

We report the results of a multicentre, double-blind, placebo-controlled study of topical therapy with omega-3-polyunsaturated fatty acids (omega-3-PUFA) in 52 patients suffering from moderate plaque-type psoriasis. In each patient, two similar stable psoriatic plaques served as indicator lesions for the study. One indicator lesion was randomly assigned to treatment with topical preparations of highly purified omega-3-PUFA in one of two concentrations (1 or 10%), and the other was treated with placebo. Efficacy assessment was based on changes in local psoriasis severity index, area involved, erythema, desquamation, induration and pruritus. After 8 weeks of treatment, all indicator lesions had improved significantly, compared with baseline. However, no statistically or clinically relevant differences between the omega-3-PUFA-treated and the placebo-treated lesions were found. Therapy was well tolerated and, apart from one patient who developed perilesional eczema, no clinically relevant adverse events occurred. In conclusion, topical omega-3-PUFA were not effective in a randomized, placebo-controlled, double-blind setting. Results of non-blind trials should be (re-)considered with caution.

Headache following carotid endarterectomy: a prospective study

The occurrence of headache in the 28 days following surgery was studied in 50 consecutive patients (14F and 36M, mean aged 70 years) who underwent carotid endarterectomy for atheromatous carotid stenosis. Thirty-one patients (62%) reported headache. Headache occurred in the first five days after surgery in 87% of cases. Its characteristics and temporal profile were highly variable but it was mostly bilateral (74%), mild or moderate (78%), requiring no treatment (77%). No correlation was found between the occurrence of headache and degree of stenosis, intraoperative characteristics and past history of headache. In none of our patients was severe ipsilateral headache, cerebral hyperperfusion syndrome, or cluster-like hemicrania encountered and only five patients met the IHS criteria for post-endarterectomy headache. Post-endarterectomy headache is frequent when specifically looked for and is therefore not a single entity. The present IHS criteria are unsatisfactory and should be modified accordingly.

The influence of temperature on muscle function in the fast swimming scup. I. Shortening velocity and muscle recruitment during swimming

In this study, electromyography showed that scup can swim to a maximum speed of 80 cm s-1 with their red muscle whereas previous results showed that carp can swim to only 45 cm s-1. Our aim was to evaluate the adaptations that enable scup to swim nearly twice as fast as carp. Although we anticipated that, at their respective maximum speeds, the red muscle of scup would be shortening at twice the velocity (V) of carp muscle, we found that the values of V were the same (2.04 muscle lengths s-1). At any given swimming speed, V was higher in carp than in scup because carp had a larger sarcomere length excursion and higher tail-beat frequency. The smaller sarcomere excursion in scup is primarily associated with using a less undulatory style of swimming (i.e. with a smaller backbone curvature). This less undulatory style of swimming may be an important adaptation that not only reduces V but may also reduce drag. At their respective maximum speeds, however, the 28% lower sarcomere length excursion in scup is balanced by a 26% higher tail-beat frequency, giving an equal V to that of carp. Although the scup in this study were somewhat longer than the carp in the previous one (19.7 vs 13.4 cm), we believe that many of the observed differences are species-related rather than size-related. We also found that scup swam in a kinematically similar fashion at 10 degrees C and 20 degrees C. However, at 10 degrees C, the scup could swim to only 54 cm s-1 before recruiting their white muscle whereas, at 20 degrees C, they could swim to 80 cm s-1. The difference in speed of initial white muscle recruitment, as well as information on muscle mechanics, suggests that the scup compress their recruitment order into a narrow speed range at low temperatures, thereby recruiting more muscle fibres. Quantitative analysis of red muscle electromyograms in this paper supports this hypothesis.

[Selective changes in lymphocytic differentiation antigens in the peripheral blood of patients with alopecia areata treated with oral zinc]

Recent research has shown that the regrowth of hair in alopecia areata (AA) is associated with the normalization of the CD4+/CD8+ ratio, which is usually in an unbalanced state. This dysbalance is represented by an increased level of CD4+ and a decrease of CD8+ cells and found not only in the bulbar region but also in the peripheral blood. Since zinc generally acts as a polyclonal T-cell activator and has been proved a useful oral therapeutic in AA, we additionally controlled the levels of CD4+ and CD8+ cells as well as other lymphocyte subpopulations in the peripheral blood of AA patients before and during oral treatment with zinc. Our data revealed a significant raise of CD3+, CD8+, CD19+, HLA-DQ+, HLA-DR+, and Leu 2a+8+ cells during oral therapy with zinc. We conclude that the successful treatment of AA with zinc may be due to immunomodulation, especially through the increase of CD8+ cells.

[The value of serologic inflammatory parameters in the diagnosis of alopecia areata]

Even recently, focal processes or inflammatory diseases have repeatedly been discussed as the possible causes of alopecia areata (AA) and corresponding diagnostic measures are still recommended. Therefore, we initially attempted to find definite indications of processes like these in AA patients by means of serologic parameters of inflammation and ESR as well as supplementary clinical focal diagnostics. The data obtained revealed increased titers of antistreptolysin in 2.9% and antistreptococcal DNase B in 25.7%, positive C-reactive protein in 8.6%, positive rheumatoid factor in 4.3%, and elevated ESR in 11.7% of the cases. After these data had carefully been compared to those in healthy persons, only the titer of antistreptococcal DNase B and the ESR were found to be increased. In the majority of the cases, these elevations correlated with concomitant bacterial infections detected by clinical focal diagnostics. Antistreptococcal DNase B titer and ESR seem to be the most appropriate of all our test parameters to provide some indications of a focal process or concomitant inflammatory diseases. The remaining parameters are not indicated in AA.

[Treatment of alopecia areata of the eyebrow with diphenylcyclopropenone and its possible risks]

The treatment of alopecia areata (AA) with diphencyprone is well established and acknowledged. Up to now, diphencyprone has only been applied in case of AA of the capillitium. Thus, for the first time, we used this substance in the treatment of AA of the eyebrows. In consideration of the possible risks, we discuss the necessary precautions regarding the patient, as well as possible side effects.

[Epidermal reticular CD1 pattern]

183 biopsies taken from various skin diseases as well as normal skin were studied in cryostat sections by means of the avidin-biotin complex immunoperoxidase technique, using monoclonal antibody anti-Leu 6, which is directed against the Langerhans cell antigen CD1. In 47 cases, we observed a reticular, pemphigus-like intercellular pattern. This pattern was neither correlated to individual skin diseases, nor to the quality or quantity of corial or epidermotropic infiltrates, nor to the HLA-DR expression of keratinocytes, nor to the count of Langerhans cells. There was, however, a correlation to the presence of Langerhans cells: This pattern was never observed in the aerosyringia or deep infundibula. We conclude, therefore, that the stained antigen has to be regarded as free CD1 derived from the Langerhans cell and diffusing into the keratinocytic intercellular spaces.

[The significance of lymphocytic differentiation antigens in the diagnosis and therapy of alopecia areata]

In an earlier study, a significant reduction of the CD8+, CD16+, CD19+, CD8+Leu8+ and HLA-DQ+ cells was found in the peripheral blood of patients with alopecia areata (AA). On the basis of these findings, typing was repeated after 6 months at the earliest in a total of 44 patients who had meanwhile received different therapies, to detect any shifts in these lymphocyte subgroups with cure or persistence of AA. Any external or internal treatment had been discontinued 4 weeks before typing, in order to preclude short-term influences of the therapy. An increase, i.e., normalization, in CD8+ cells together with a significant decrease in CD4+ cells was shown in the group with complete remission, in contrast to the patients in whom AA had not yielded to treatment. The remaining lymphocyte dysbalances persisted unchanged in both groups. This shows that healing of AA is associated with an increase in CD8+ and a decrease in CD4+ cells.

Two-color flow cytometry analysis in alopecia areata

Since previous studies have shown that circulating T cytotoxic/suppressor cells and natural killer cells are reduced in alopecia areata (AA), we attempted to find further imbalances in mononuclear cells by double labeling with these and additional monoclonal antibodies. In all, the blood of 35 patients and 44 controls was examined using the combinations anti-Leu 3a/8, Leu 2a/8, Leu 2a/15, Leu 7/15 and Leu 7/11a. We found a highly significant reduction of the subpopulation Leu 2a+8+ (p less than 0.008). The results show that patients with AA have additional abnormalities of the circulating mononuclear cells, whereby the reduced Leu 2a+8+ subpopulation represents a new additional marker.

Differential expression of major histocompatibility complex class II antigens on human keratinocytes

Skin biopsies from 136 patients with 30 different dermatoses and eight biopsies of normal skin were investigated with the avidin-biotin-peroxidase complex method with regard to the expression of major histocompatibility complex class II antigens human leukocyte antigen (HLA) HLA-DR, HLA-DQ, HLA-DP on keratinocytes. In normal skin the expression of these antigens was restricted to acrosyringia and Langerhans cells. In the dermatoses investigated HLA-DR was found in 51.5% (70 of 136), HLA-DQ in 24.3% (33 of 136), and HLA-DP in 20.5% (8 of 39). In 37 cases (27.2%) only HLA-DR could be detected, whereas in 33 cases (24.3%) HLA-DR was expressed jointly with HLA-DQ. Coexpression of HLA-DR and HLA-DQ was found especially often in cutaneous T cell lymphomas, skin tumors, and inflammatory dermatoses.

Why animals have different muscle fibre types

Animals have different muscle fibre types: slow fibres with a low maximum velocity of shortening (Vmax) and fast fibres with a high Vmax. An advantage conferred by the use of different fibre types during locomotion has been proposed solely on the basis of their in vitro properties. Isolated muscle experiments show that force generation, mechanical power production and efficiency are all functions of V/Vmax, where V is the velocity of muscle shortening. But it is not known whether animals actually use the different fibres at shortening velocities that are optimal for mechanical power production and efficiency. Here we compare the V of muscle fibres during locomotion with their Vmax. This comparison shows that during slow locomotion, the slow fibres shorten at a velocity that gives peak mechanical power and efficiency and the fast fibres shorten at their optimal velocity when powering maximal movements. Our results also show that maximal movements are impossible without fast fibres because the slow ones cannot shorten rapidly enough.

[Maculopapular exanthema during diltiazem therapy]

A maculopapular exanthema developed in a 60-year-old man with coronary heart disease while being treated for angina with the calcium antagonist diltiazem. Epicutaneous and scratch tests were positive, both for the immediate type (type I) and the delayed type (type IV), proving that the drug had caused the allergic reaction. The exanthema quickly disappeared once the drug had been discontinued. Anti-anginal treatment was continued without further complications with nifedipine.

[Type IV immunity in alopecia areata in a comparison of 2 test methods]

69 patients with alopecia areata of different degree and duration were tested for cell-mediated immunity (DCH) by means of the Multitest system and other recall antigens. Our findings revealed a normergic status in most of the patients. In comparison with healthy controls, however, these patients showed decreased cell-mediated immunity, which was proved by a diminished score and a reduced number of positive reactions. There was no correlation between an anergic or hypoergic status on the one hand, and the degree or duration of the disease on the other.

[Autoimmunity in alopecia areata. An assessment in 100 patients]

The sera of 100 patients with varying degrees of alopecia areata were examined for the presence of circulating autoantibodies against nuclear, mitochondrial, reticulin-fibril, smooth muscle, parietal cell, thyroglobulin, and microsomal components. Furthermore, in all cases we measured the percentage of total T-lymphocytes, T-helper, and T-suppressor cells. Other diseases were also considered that could cause such antibodies. In addition, the assumption was examined as to whether or not the loss of suppressor cells correlates with the presence of autoantibodies. The incidence of autoantibodies mentioned was not found to be statistically higher in our study; most of the autoantibodies could be explained by other accompanying diseases. Only in the T-suppressor cells was there a significant decrease. Patients with autoantibodies showed no more deficit in T-suppressor cells than patients without autoantibodies.

Cumulative trauma disorder controls: the ergonomics program at Ethicon, Inc

Over the past 10 years, Ethicon, Inc., has developed a successful program for the management of cumulative trauma disorders. The program is based on a multidisciplinary approach created through the existence of an ergonomics task force. Various functions of the task force and examples of its operations are described.

[Value of pathologic thyroid gland findings in alopecia areata]

As we had frequently found goiters in patients with alopecia areata, we performed specific thyroid diagnostics in 120 patients suffering from this kind of loss of hair. By means of palpatory, sonographic, and scintigraphic examination of the thyroid gland, we found in 18% no goiters, in 70% diffuse goiters, and in 12% nodular goiters. In 115 patients, the metabolic condition showed euthyroidism, 3 patients had subclinical hypothyroidism, and 2 patients subclinical hyperthyroidism. We did not detect any increased incidence of antibodies against thyroglobulin or thyroid microsomes; only one patient showed Hashimoto's thyroiditis. The resected goiter tissue of 3 patients with thyroid enlargement and alopecia areata predominantly revealed the typical regressive changes usually seen in colloid and common goiters. But, contrary to the scalp biopsies, the goiter tissue only showed slight antigen expression of HLA-DR. On account of the high incidence of non-toxic diffuse goiters, we discuss the possibility of a goitrogenic factor associated with alopecia areata.

[Class I alloantigens in alopecia areata]

HLA-ABC antigens in 51 patients suffering from alopecia areata have been analyzed by means of 47 different antigens using the microlymphocytotoxicity test. In comparison with various control populations, there could not be proved any significant association in the tested antigens. Thus we suggest that the reported associations may have been caused by geographical or racial variations.

Blood flow changes at the wrist in manual workers after preventive interventions

Radial and ulnar artery circulatory changes at the wrist were studied at the work site in manual workers performing repetitive tasks to compare the effects of two preventive interventions, exercise and rest. The Doppler method was used for assessment of blood flow velocity, and systolic blood pressure measurements were made on 16 right hand-dominant female workers in a suture manufacturing industry. Radial and ulnar blood flow velocity decreased while systolic blood pressure at these arteries remained stable after 1 1/2 hours of manual work. After 5-minute interventions of either exercise or rest, blood flow velocity increased, radial blood pressure remained stable, and ulnar blood pressure decreased. A 5-minute exercise program produced greater increases in radial blood flow velocity than did a 5-minute rest program. Brief exercise programs have been shown to improve circulation at the wrist after circulation was compromised by the performance of manual work. Such programs may offer one practical method of preventing soft tissue injuries related to the sustained compromise of blood flow at the wrist.

[Clinical and immunologic studies of the use of thymus polypeptide factor (thymostimulin) in chronic mucocutaneous candidiasis]

T-cell lymphocyte subpopulations were successfully converted by means of thymus polypeptide factor in a 17-year-old boy with chronic mucocutaneous candidiasis and combined immunodeficiency. It was demonstrated that the injections caused normalization of the peripheral T-lymphocytes subpopulations and a better state of general health. Normalization was due to a minimal increase in total peripheral T-lymphocytes and T-helper cells and a significant decrease in T-suppressor cells.

The Three Mile Island Population Registry

Shortly after the March 28, 1979, accident at the Three Mile Island (TMI) nuclear plant outside Harrisburg, Pa., the Pennsylvania Department of Health, in conjunction with the Centers for Disease Control and the U.S. Bureau of the Census, conducted a census of the 35,930 persons residing within 5 miles of the plant. With the help of 150 enumerators, demographic and health-related information was collected on each person to provide baseline data for future short- and long-term epidemiologic studies of the effects of the accident. Individual radiation doses were estimated on the basis of residential location and the amount of time each person spent in the 5-mile area during the 10 days after the accident. Health and behavioral resurveys of the population will be conducted approximately every 5 years. Population-mobility, morbidity, and mortality will be studied yearly by matching the TMI Population Registry with postal records, cancer registry records, and death certificate data. Because the radiation dose from TMI was extremely small, any increase in morbidity or mortality attributable to the accident would be so small as not to be measurable by present methods; however, adverse health effects as a result of psychological stress may occur. Also, a temporary increase in reporting of disease could occur because of increased surveillance and attention to health.

Hemofiltration during extracorporeal circulation (ECC)

In cardiac surgery hemofiltration can be used: 1. to balance fluids during ECC, especially in long-term perfusion; 2. to carry out open heart procedures in patients with terminal renal insufficiency; 3. to treat acute hyperkalemia. The model of the 12.5 by 4.5 cm DIAFILTER TM and the model of operation are described. The compounds of the ultrafiltrate (UF) are identical with that of plasma water. Particles with a molecular weight of less than 50,000 can pass freely across the filtration membrane. The filtration capacity is 100 cc/min UF (Q blood: 300 cc/min, pressure across the membrane 600 mm Hg and hematokrit (Hkt) 25%). The technical details of operation are explained. Its general use as well as its simplicity is demonstrated in 10 patients.