Long-term clearance of patch-stage mycosis fungoides with the 308-nm laser

In order to investigate the effectiveness of the 308-nm xenon chloride laser in the treatment of patch-stage mycosis fungoides that is refractory to topical steroids, we conducted a prospective, histologically controlled, open-label pilot study. Eight patients with stage 1A or 1B cutaneous T-cell lymphoma that was unresponsive to application of potent topical steroids received 20 treatments with the laser over 10 weeks and were then followed up for a minimum of 30 months. Three patients had a complete clinical and histological response and remained free of disease after 30 months A further three patients had complete clinical and histological clearance of disease, but experienced relapse within the 30 months follow-up period. One patient withdrew from the study and one had a partial response. Further research to establish the role of the 308-nm laser in the treatment of MF appears justified.

The stability of micro-organisms preserved in LENTICULE discs, demonstrated by repeat sample distributions of the EQUAL Scheme for Indicator Organisms (water microbiology)

AIMS

To demonstrate the stability of microorganisms preserved in LENTICULE discs, employed by the EQUAL Scheme for Indicator Organisms.

METHODS AND RESULTS

Five sample batches containing several indicator organism parameters were each despatched in two separate distributions at intervals of up to 24 months apart. A comparison of participants' median counts and bar charts of their cumulated results was then made.

CONCLUSIONS

The results demonstrated that LENTICULE discs provided a remarkably stable preparation format for the maintenance of viable organisms in reproducible numbers.

SIGNIFICANCE AND IMPACT OF THE STUDY

Complex mixtures of organisms can be maintained in stable numbers for extended periods of time at a freezer temperature of -20 degrees C and satisfactorily transported without the requirement for cold chain conditions.

The lack of significant changes in scalp hair follicle density with advancing age

BACKGROUND

Age-related reduction in hair is seen in the axillary and pubic regions as well as the scalp; however, it has not been investigated qualitatively on the scalp. Horizontally sectioned scalp biopsy is an ideal tool to investigate the impact of advancing age on scalp hair follicle density and morphology.

OBJECTIVES

To examine the effect of age and follicle miniaturization on total hair count in 1666 horizontally sectioned mid-scalp biopsies from 928 women aged between 13 and 84 years with hair loss.

METHODS

SETTING

Specialist hair loss referral clinic in a teaching hospital.

DESIGN

Analysis of data set. Methods: All scalp biopsies were 4 mm in diameter and taken from the crown. Miniaturization was assessed by calculating the ratio of terminal to vellus-like hairs (T/V) at the mid-isthmus level and considered significant if the ratio was < or = 4 : 1. Fibrosis was documented when present. Linear regression was used to examine the association between total hair count, age and miniaturization.

RESULTS

The average number of hair follicles per biopsy was 39.6 (SD +/- 10.8). A highly significant negative association (P < 0.0001) was found between age and total follicle number, although the predictive value of age in total hair count was found to be small [root error mean square (R2) < 2%]. Controlling for T/V < or = 4 : 1, the association was weakened, but remained significant. The relationship unconfounded by T/V < or = 4 : 1 shows that for every additional year of ageing, 0.077 total hair follicles (0.22%) are lost per biopsy.

CONCLUSIONS

Age and follicular miniaturization were found to be extremely weak predictors of total hair count in women with hair loss.

Single-nucleotide polymorphism-based differentiation and drug resistance detection in Mycobacterium tuberculosis from isolates or directly from sputum

The rapid technique of pyrosequencing was used to examine 123 samples (in the form of DNA extracts and inactivated sputum) of Mycobacterium spp. Of 99 Mycobacterium tuberculosis samples investigated for single-nucleotide polymorphisms (SNPs), 68% of isoniazid-resistant isolates analysed had an AGC --> ACC mutation in katG at codon 315, resulting in the Ser --> Thr substitution associated previously with isoniazid resistance. Of the rifampicin-resistant isolates, 92% showed SNPs in rpoB at codons 516, 531 or 526. Inactivated sputum samples and DNA extracts could both be analysed by pyrosequencing, and the method was able to differentiate rapidly between the closely related species of the M. tuberculosis complex (M. tuberculosis, Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti and Mycobacterium microti), except between M. tuberculosis, M. canetti and one of two M. africanum strains. This low-cost, high-throughput technique could be used as a rapid screen for drug resistance and as a replacement for some of the time-consuming tests used currently for species identification.

Audit of scope and culture techniques applied to samples for the diagnosis of Mycobacterium bovis by hospital laboratories in England and Wales

This audit examines the ability of English and Welsh laboratories to diagnose Mycobacterium bovis infection. All 164 clinical laboratories submitting samples to the PHLS Mycobacterium Reference Unit and Regional Centres for Mycobacteriology were surveyed. Twenty per cent of responding centres did not use a pyruvate-containing medium or incubate for the minimum recommended period of 8 weeks. This study demonstrates the potential for the underdiagnosis of M. bovis infection in England and Wales. Possible reasons for underdiagnosis are discussed together with strategies to optimize recovery of M. bovis.

Results of a phase I trial evaluating a liver support device utilizing albumin dialysis

BACKGROUND

We have previously reported the clearance of protein-bound and water-soluble hepatic toxins, in vitro and in an animal model, using albumin dialysis as an extracorporeal hepatic support (ECHS) device.

OBJECTIVE

The objective of this study was to evaluate albumin dialysis through a phase I clinical trial. We hypothesized that albumin dialysis would (1) decrease elevated levels of hepatic toxins, (2) increase the Fischer ratio, and (3) decrease hepatic encephalopathy (HES) and intracranial pressure (ICP), while (4) maintaining stable hemodynamics.

METHODS

Patients with acute liver failure were treated with an ECHS device utilizing continuous hemodiafiltration with continuous albumin dialysis. Mean arterial blood pressure (MAP), heart rate (HR), systemic venous oxygen saturation (Svo(2)), ICP, and HES were recorded. Blood samples were evaluated for hepatic toxins and factor VII levels.

RESULTS

Nine patients were enrolled (status I, n = 5; status IIA, n = 4). There was no significant change in MAP, HR, or Svo(2) (MAP: Pre = 81 +/- 5.6 mm Hg, Post = 79 +/- 5.9 mm Hg, P =.70; HR: Pre = 104 +/- 5.2 bpm, Post = 107 +/- 6.2 bpm, P =.62; Svo(2): Pre = 72 +/- 3.5, Post = 71 +/- 1.7, P =.77). There was a decrease in the ammonia and total bilirubin levels (NH(3): Pre = 129.8 +/- 23.8 mg/dL, Post = 63.9 +/- 16.1 mg/dL, P =.01; total bilirubin: Pre = 20.3 +/- 2.5 mg/dL, Post = 17.6 +/- 2.7 mg/dL, P =.4). There was a significant increase of the Fischer ratio and factor VII levels (Fischer ratio: Pre = 0.98 +/- 0.2, Post = 2.17 +/- 0.5, P =.038; factor VII: Pre = 13.9 +/- 4.9, Post = 23.2 +/- 4.8, P =.015). There was a significant decrease in the HES and ICP (HES: Pre = 3.8 +/- 0.1, Post = 2 +/- 0.7, P =.02; ICP: Pre = 37 +/- 3.9, Post = 13.3 +/- 2.8, P =.048). Of 5 status I patients, 1 recovered native hepatic function and 3 were bridged to transplantation.

CONCLUSIONS

This phase I study suggests that albumin dialysis as a liver support device is safe and effective in clearing hepatic toxins, with an associated decrease in the HES and ICP. This encouraging efficacy data warrant further investigation with a phase II/III trial.

Bringing the human genome and the revolution in bioinformatics to the medical school classroom: a case report from Washington University School of Medicine

The human genome project is revolutionizing medical research and the practice of clinical medicine. To understand and participate in this revolution, physicians must be fluent in human genomics and bioinformatics. At Washington University School of Medicine (WUSM), the authors designed a module for teaching these skills to first-year students. The module uses clinical cases as a platform for accessing information stored in GenBank, Online Mendelian Inheritance in Man (OMIM), and PubMed databases at the National Center for Biotechnology Information (NCBI). This module, which is also designed to reinforce problem-solving skills, has been integrated into WUSM's first-year medical genetics course.

Identifying sputum specimens of high priority for examination by enhanced mycobacterial detection, identification, and susceptibility systems (EMDISS) to promote the rapid diagnosis of infectious pulmonary tuberculosis

AIMS

To compare clinical information and sputum microscopy as methods for the selection of samples for enhanced mycobacterial detection, identification, and susceptibility systems (EMDISS) to promote the rapid diagnosis of patients with infectious pulmonary tuberculosis.

METHODS

Two thousand, two hundred and sixty four specimen request forms were examined for clinical details, which were then used to identify specimens likely to yield Mycobacterium tuberculosis on culture. These results were compared with the results of sputum microscopy for acid fast bacilli (AFB). Both methods were assessed against the results of culture using a combination of continuous automated mycobacterial liquid culture (CAMLiC) and conventional solid culture.

RESULTS

Classification based on clinical details was an inefficient method of identifying high priority specimens for EMDISS. Although, when given, clinical details were often consistent, a substantial proportion of specimens arrived with no details. This approach would result in the referral of at least 16% of the workload but lead to the detection by culture of only 46% of the M tuberculosis present within it. In contrast, microscopy for AFB defined a much smaller number of specimens (4.8% of the total), which contained 90% of the M tuberculosis isolates.

CONCLUSIONS

Microscopy for AFB is the most efficient method for defining sputum specimens suitable for referral for enhanced mycobacteriological techniques. However, it is essential that the methods used for smear preparation and microscopy are of the highest possible standard, otherwise some patients with infectious pulmonary tuberculosis will be denied, unnecessarily, the benefits of important advances in mycobacteriology.

Adolescents and smoking: evidence from France and Spain

Until recently detailed evidence on smoking and its reduction was found mainly in the U.S.A. and the U.K. Now there is active research in a much wider range of countries which increases the potential for international comparison and international learning. In this paper we focus on the recent evidence now available from France and Spain for the smoking behaviour of adolescents and young people.

The 1997 list. Proposed new bacterial taxa and proposed changes of bacterial names published during 1997 and considered to be of interest to medical or veterinary bacteriology (an informational note)

A list of names published or validated in 1997 is presented. We also comment on the tendency to base names of new taxa on a single bacterial strain, and the consequences for reliable descriptions that this tendency implies.

The 1998 list. Proposed new bacterial taxa and proposed changes of bacterial names published during 1998 and considered to be of interest to medical or veterinary bacteriology (an informational note)

A list of names published or validated in 1998 is presented.

The 1997 list. Proposed new bacterial taxa and proposed changes of bacterial names published during 1997 and considered to be of interest to medical or veterinary bacteriology. An informational note

A list of names published or validated in 1997 is presented. We also comment on the tendency to base names of new taxa on a single bacterial strain, and the consequences for reliable descriptions that this tendency implies.

The 1997 list. Proposed new bacterial taxa and proposed changes of bacterial names published during 1997 and considered to be of interest to medical or veterinary bacteriology. An informational note

A list of names published or validated in 1997 is presented. We also comment on the tendency to base names of new taxa on a single bacterial strain, and the consequences for reliable descriptions that this tendency implies.

Electrical and calcium signaling in dendrites of hippocampal pyramidal neurons

This review discusses recent data regarding the different types of voltage-gated Na+, Ca2+, and K+ channels in dendrites of CA1 pyramidal neurons and their function for synaptic integration and plasticity. Na+ and Ca2+ channels are uniformly distributed throughout the dendrites, although Na+ channels in the soma and proximal dendrites differ in their inactivation properties from Na+ channels in more distal regions. Also, different regions of the neuron express different subtypes of Ca2+ channels. K+ channels are unevenly distributed, with the distal dendrites expressing a more than fivefold greater density of a transient A-type K+ channel than proximal regions. These K+ channels exert profound control over the excitability of the pyramidal neurons and the spread of synaptic potentials throughout the dendrites. The ways in which the active properties of dendrites may contribute toward the induction and maintenance of long-term synaptic plasticity are discussed.

The effect of subcutaneous edema on transcutaneous oximetry

A rabbit animal model of tissue edema was created to determine its effect on transcutaneous oximetry (T-com). Measurements of T-coms were performed before and at 5-minute intervals after the injection of body temperature saline into the skin and subcutaneous tissues of 5 rabbits. Photomicrographs were obtained to document the morphological appearance of edema. The injection of saline had no effect on relative T-com values. This investigation suggests that edema alone does not influence T-com measurements.

Does storage of sputum specimens adversely affect culture results?

It has been recommended that samples submitted for microbiological examination should be retained for 48 hours after issue of the final report. In order to ascertain whether reproducible results could be achieved following storage of sputum specimens, two laboratories each re-cultured 100 samples 48 hours after their report had been issued and a further laboratory re-cultured 100 samples 48 hours after receipt. Discordant results were obtained in only 5-25% of specimens, indicating that potential respiratory pathogens could survive storage.

Integration of positional signals and regulation of wing formation and identity by Drosophila vestigial gene

Appendage formation is organized by signals from discrete sources that presumably act upon downstream genes to control growth and patterning. The Drosophila vestigial gene is selectively required for wing-cell proliferation, and is sufficient to induce outgrowths of wing tissue from eyes, legs and antennae. Different signals activate separate enhancers to control vestigial expression: first, in the dorsal/ventral organizer through the Notch pathway, and subsequently, in the developing wing blade by decapentaplegic and a signal from the dorsal/ventral organizer. Signal integration must be a general feature of genes like vestigial, that regulate growth or patterning along more than one axis.

Unsafe practices in the treatment of pediculosis capitis

The purpose of this descriptive study was to identify unsafe uses of prescription, over-the-counter and home remedies used in the treatment of pediculosis. Twenty-seven families with 119 children were visited at home and interviewed about their use of remedies for head lice. In addition to prescription and over-the-counter products home remedies were commonly used. Kerosene, alcohol, insecticides, and head shaving were some of the home remedies reported.

Effect of diflubenzuron on the maturation and reproductive success of the copepod Eurytemora affinis

: The insect growth regulator diflubenzuron (DFB) may have substantial effects on non-target organisms, especially crustaceans. By targeting the moulting process, DFB would be expected to elicit the most obvious effects on subadult crustaceans which moult frequently. Previous studies in this laboratory have demonstrated acute and chronic effects of DFB on survival and development of nauplii of the estuarine copepod Eurytemora affinis at water concentrations of less than 1 p.p.b. The present study examines the effects on maturation to adulthood and brood production. Effects on brood production were observed at 0.8 p.p.b. DFB in individuals exposed only during the copepodite stages. Significant effects on production of nauplii were documented only in the early exposure to 0.93 p.p.b. DFB. Inability of post-moult copepodites to completely cast exuviae also was documented in the exposed treatments. At salinities of 2, 10 and 15 p.p.t., survival from naupliar to adult stages was significantly reduced at 0.84 p.p.b. and none survived to adulthood at 1.7 p.p.b. These results suggest that DFB has substantial effects on survival and development of E. affinis at a water concentration of less than 1 p.p.b. DFB concentrations exceeding this concentration have been reported from Chesapeake Bay surface waters although there is no current evidence of potentially toxic concentrations overlapping with the known distribution of E. affinis in the bay.