Endothelin-1 is significantly elevated in plasma of patients with vitiligo treated with psoralen plus ultraviolet A

BACKGROUND

Recent evidence suggests that systemic psoralen plus ultraviolet A (PUVA) therapy may have a stimulatory effect on melanocytes, not only locally but also systemically. Aim. We aimed to assess endothelin-1 (ET-1), a potent melanocyte mitogen, in plasma of PUVA-treated paients with vitiligo.

METHODS

ET-1 was sequentially assessed (using ELISA) in patients with nonsegmental vitiligo treated with PUVA (n = 20), at 8, 16 and 24 h following the PUVA session. Evaluations took place at 0, 1 and 3 months of therapy. Patients with psoriasis (n = 15) treated identically and healthy subjects not receiving any therapy (n = 15) served as controls. Vitiligo Area Scoring Index (VASI) and Psoriasis Area Severity Index (PASI) scores were simultaneously evaluated.

RESULTS

ET-1 was significantly lower in vitiligo than in psoriasis at month 0 (8.2 +/- 3.6 vs. 13.7 +/- 5.4 pg/mL; P = 0.03) and it was significantly higher in both than in healthy controls at all time points of the PUVA sessions (P < 0.001). In vitiligo, it significantly increased at month 3 at 8 (8.2 +/- 3.6 vs. 10.8 +/- 2.7 pg/mL; P = 0.02) and 16 h (8.2 +/- 3.6 vs. 11.5 +/- 3.9 pg/mL; P < 0.01), whereas in psoriasis, it significantly decreased at month 3 at 8 (13.7 +/- 5.4 vs. 3.5 +/- 0.4 pg/mL; P < 0.01) and 16 h (13.7 +/- 5.4 vs. 6.3 +/- 4 pg/mL; P = 0.01). In contrast to psoriasis, sequential values of vitiligo revealed insignificant variance (P > 0.05). VASI score significantly decreased at month 3 (19 +/- 9.6 vs. 11.9 +/- 7.3; P < 0.01), whereas PASI score significantly decreased at months 1 (38.2 +/- 16.1 vs. 13.8 +/- 3; P < 0.05) and 3 (38.2 +/- 16.1 vs. 7 +/- 2.6; P = 0.03). There was a significant indirect correlation of ET-1 with VASI score (P < 0.01) and a significant direct correlation with PASI score (P < 0.01).

CONCLUSION

Systemic PUVA therapy in vitiligo may have a generalized mitogenic effect on melanocytes through the release of ET-1 into the circulation.

Prevalence of HCV/HIV co-infection among haemophilia patients in Baghdad

To estimate the seroprevalence of HCV infection among HIV-infected haemophiliacs and to demonstrate the most prevalent HCV genotype, 47 HIV-infected haemophilia patients were screened for anti-HCV antibodies. By performing polymerase chain reaction and DNA enzyme immunoassay, HCV-RNA was detected with subsequent genotyping. Seroprevalence of anti-HCV antibodies was 66.0%. Of 31 HCV/HIV co-infected patients, 21 (67.7%) had no history of blood transfusion. We detected 4 HCV genotypes: 1a, 1b, 4 and 4 mixed with 3a, HCV-1b being the most frequent. Contaminated factor VIII (clotting factor) could be responsible for disease acquisition.

Non-sarcoidal, non-tuberculoid granuloma in common variable immunodeficiency

Sarcoidal (non-caseating) or tuberculoid granulomas are cutaneous manifestations of common variable immunodeficiency (CVID). In this case report, we describe a patient with CVID but with non-sarcoidal, non-tuberculoid granuloma. The 29-year-old Egyptian male patient presented with a vitiliginous patch on the chin of 1 year duration and multiple recurrent warts on the hands and feet of 8 years duration. He is a known case of CVID with chronic diarrhea, recurrent otitis media, pneumonia, purulent conjunctivitis, septic arthritis, hepato-splenomegaly, and generalized lymphadenopathy. In addition, he had evidence of multiple non-tender subcutaneous nodules predominantly juxta-articular and recurrent rheumatoid-like arthritis. The skin overlying the nodules was either normal or slightly erythematous. Laboratory findings revealed markedly reduced serum immunoglobulins (IgG 3.4, n = 7.2-16.9 g/l; IgA 0.1, n = 0.69-3.82 g/l and IgM 0.1, n = 0.63-2.77 g/l) and deficient T cell function. Histopathologic examination of a skin nodule showed well demarcated areas of fibrinoid degeneration of collagen that stain homogeneously and are surrounded by histiocytes in a palisading arrangement, suggestive of granuloma annulare. No microorganisms could be detected. Serology for rheumatoid factor and HIV infection has been persistently negative. Although most infections, including common warts responded well to intravenous immunoglobulin replacement therapy (12 g/i.v., every 2 weeks) and oral broad spectrum antibiotic therapy, the subcutaneous nodules persisted. The vitiliginous patch responded favorably and disappeared within 24 local PUVA sessions. Since skin nodules are asymptomatic, no further treatment was given.

Detection of T lymphocytes and T lymphocyte subsets in lichen planus: in situ and in peripheral blood

BACKGROUND

Abnormal immune mechanisms are thought to be important in the pathogenesis of lichen planus (LP). This is a study to clarify the changes that occur in T lymphocytes and T lymphocyte subsets, both in situ and in peripheral blood.

METHODS

A group of 100 patients with LP were included in this study. T lymphocytes and T lymphocyte subsets were detected in lesional skin by immunoperoxidase cell surface staining using monoclonal antibodies. Peripheral T lymphocytes and T lymphocyte subsets were also detected by indirect immunofluorescence using monoclonal antibodies. A group of 10 normal healthy subjects were used as controls.

RESULTS

The study of the lesional T lymphocytes and T lymphocyte subsets demonstrated that helper T cells was the predominant subset in LP lesions in most of the patients. This predominance was evident irrespective of the duration of the disease and was more evident in late than in early lesions. The percentage of both total T lymphocytes and helper T cells in peripheral blood was decreased significantly in patients compared with controls. A significant decrease in helper T cells and the helper/cytotoxic T cell ratio was detected in patients with a longer duration of the disease.

CONCLUSION

Activation of helper T lymphocytes that were found to be the predominant subsets in LP lesions may be responsible for epidermotropic cellular infiltrates leading to damage and destruction of epidermal cells.

Branchial cleft anomalies--a study of 20 cases

Preauricular sinus, branchial cyst, branchial sinus and branchial fistula are the result of incomplete obliteration of branchial clefts. Classically these lesions have particular sites and nature. The aim of this three years retrospective study was to see the prevalence of these conditions as well as the outcome of the conventional surgery. Twenty cases of branchial cleft anomalies were reported, of which 60% had with preauricular sinus. One case with preauricular sinus had recurrence during postoperative follow-up.

Recent trends in the prevalence and distribution of schistosomiasis in the Nile delta region

In 1983, a survey of 71 villages in the Nile delta demonstrated that the overall prevalence of Schistosoma mansoni and S. haematobium infections was 39% and 5%, respectively. Recent increased availability of praziquantel, combined with Egyptian Ministry of Health-sponsored media efforts to educate the public about schistosomiasis, prompted us to determine the current status of S. mansoni and S. haematobium infections in the delta and evaluate any changes that may have occurred since the previous survey. The same villages that participated in the 1983 survey were resampled in 1990. Stool and urine samples were requested from all occupants over the age of two years in a 5% sample of houses within each village. Stool (Kato) thick smears and urine sediments were read qualitatively at the rural health station. Field-prepared Kato smears and a 20% sample of urine specimens were forwarded to the Ministry of Health Laboratory, where quantitative readings were also performed. Analysis of samples obtained from 17,310 persons revealed that S. mansoni prevalence had decreased to 23% and that S. haematobium prevalence had decreased to 3% (P < 0.001). The highest levels of schistosome infection were found in governates located in the eastern section of the delta. The observed changes in the prevalence of S. mansoni and S. haematobium suggest that control measures are having a favorable impact on schistosomiasis transmission in this region.

Incrimination of Anopheles aconitus Donitz as a vector of epidemic malaria in Bangladesh

In 1989-91, post-monsoon epidemics of vivax malaria occurred in the central flood plain near Dhaka. Anopheles philippinensis, the usual vector in the paddy field habitat, was not present, but 1.4% of parous An. aconitus were infective. This is only the second time An. aconitus has been incriminated as a vector in Bangladesh. We speculate that the surprising increase in lowland malaria may have been caused by environmental change that favored the survival of An. aconitus.

Changes in antischistosomal drug usage patterns in rural Qalyubia, Egypt

To investigate the usage of antischistosomal drugs in the Nile Delta, an antischistosomal drug history was obtained by interview from a sample of inhabitants of the villages of Halaba (1,024, or every 4th household) and Kharkania (505, or every 20th household), south-central Nile Delta. Only 3% and 0.4% of participants, respectively, in the 2 villages reported receiving antischistosomal drugs during the previous 4 years. Most villagers received oral compounds (praziquantel and niridazole), and the treatment regimen was completed by 95%. This study reveals changes in antischistosomal drug usage since a study 8 years earlier in the village of Halaba, when most of the drugs were injectable compounds.

Serological assessment of acyclovir treatment of herpes genitalis

Oral acyclovir was given to 60 patients with herpes genitalis--20 experiencing a first attack and 40 with recurrent attacks. All patients were followed up for 1 year. Serial serum samples from the patients as well as from 20 controls were studied to determine the effect of therapy on the immune response to herpes simplex virus (HSV). No toxicity was observed, and very few patients had rather insignificant side effects (e.g., diarrhea). The frequency of recurrence (number of recurrences per year) of genital herpes in acyclovir-treated patients was found significantly lower than in controls. More frequent recurrences were observed in those who had high antibody titer in their early convalescent phase sera than in those without or with a low titer of such antibodies. The antibody titers were reduced in those who received acyclovir as compared with controls. The mean time to seroconversion was longer in the acyclovir-treated group than in controls. Oral acyclovir is thus effective and well tolerated in patients with herpes genitalis. Treatment with acyclovir also diminishes the humoral antibody response to HSV, but it does not prevent recurrence. The effects of acyclovir on the immune response to HSV are discussed.

Prevalence of trachoma in school children and ophthalmological outpatients in rural Egypt

The prevalence of trachoma in school children and ophthalmological patients in rural villages of the Qalyub Governorate of Egypt was determined by clinical and laboratory diagnostic procedures and reported as mild, moderate, or severe according to the WHO classification scheme. Of 777 primary school students examined in 3 villages, 204 (26%) had clinically active trachoma. The overall prevalence of the disease in this population ranged from 16% to 35%. The prevalence of infection was higher in younger groups and decreased throughout primary school. Of 312 patients with ocular complaints examined at the village outpatient clinics, 100 (32%) had trachoma infections. Monoclonal FA staining showed higher sensitivity in detecting positive cases of trachoma than did Giemsa staining. This study has shown that trachoma is still prevalent in rural Egypt and that the monoclonal FA staining is a relatively sensitive and practical test for the laboratory diagnosis of trachoma in a field study, where reasonable facilities for culture diagnosis are not available.

Acute bacterial sinusitis. Minocycline vs amoxicillin

The efficacy and safety of minocycline were compared with that of amoxicillin in the treatment of 58 patients with acute bacterial sinusitis. The most frequently isolated pathogens were streptococci, staphylococci, and Haemophilus influenzae. After therapy for a mean time of 11 days, clinical cure or improvement and bacterial eradication were evident in 100% of the patients treated with minocycline and in 95% of the patients treated with amoxicillin. Roentgenographic results indicated clearing or improvement in 91% of the minocycline recipients and in 70% of those who received amoxicillin. These differences between treatments were not statistically significant. A low incidence of generally mild adverse clinical experiences occurred in both treatment groups. Thus, minocycline and amoxicillin were equally safe and effective in the treatment of these patients with acute bacterial sinusitis.

Immunoglobulin deposits in leprosy skin

An immunofluorescent study was carried out on skin biopsies from 12 leprosy patients who had been suffering from the disease for periods of one to 30 years; all were treated with dapsone and clofazimine at one stage. Skin biopsies made from reactive nodular lesions showed that all 12 had IgG deposits and seven had IgM deposits in the dermal-epidermal junction. No IgA, IgE, C3 and fibrinogen were found deposited in any biopsy. All patients had significantly raised levels of serum immunoglobulins and rheumatoid factor. Anti-epithelial (eight patients) and anti-nuclear (three patients) antibodies were also found. The possible role of autoantibodies in the present findings is discussed.

Patterns of antischistosomal drug usage in Qalyubia Governorate of the Nile Delta

To further investigate factors responsible for the recently documented changes in schistosomiasis patterns in the Nile Delta, questionnaire-derived information on antischistosomal drug usage was obtained from a 25% systematic sample of 609 residents of a stable village in the south-central Delta. Ten percent of the population had received antischistosomal drugs during the previous 4 years. Most of the drugs administered were injectable compounds, and 92% of individuals receiving them failed to complete the treatment regimen. Additional sources of information from a village physician, a pharmacist and a major pharmaceutical corporation confirmed and expanded the survey findings, indicating that antischistosomal drug usage cannot explain the recently observed changing patterns of human schistosome infections in the Nile Delta region.

Ceruminoma in association with other sweat gland tumours

Tumours arising from ceruminous glands of the ear are rare. Two cases of ceruminoma seen in the ENT Department, Ipswich Hospital, during the past three years were both associated with other sweat gland tumours, the first with eccrine spiradenoma in the neck, and the second with multiple cylindromata on the scalp (turban tumour).

The behaviour of lead dioxide electrodes in acidic sulfate electrolytes

The variation of discharge capacity during charge-discharge cycling of a PbO2 electrode, prepared by pressing PbO2 powder onto a smooth lead disc, in sulfuric acid and acidic ammonium sulfate solutions of various concentrations was investigated by the potentiodynamic technique. The discharge capacity was found to increase with cycle number in 0.05-4.3 H2SO4; this was explained in terms of the increase in porosity of the electrode with cycling. The rate of increase was highest in a 1 mol dm-3 solution. The presence of ammonium sulfate decreased the discharge capacity at all concentrations of sulfuric acid except for the 1 mol dm-3 solution where it caused a small increase in capacity. The morphology of the electrode was studied by scanning electron microscopy and the results are correlated with the discharge capacity. These results indicated that a solution of composition 0.5 mol dm-3 ammonium sulfate and 1.0 mol dm-3 sulfuric acid will produce a greater utilization of positive plate active material (PbO2) during discharge. This result, taken together with the results of earlier studies on lead in acidic sulfate electrolytes, points to the possibility of a Pb/H2SO4,/PbO2 battery for electric-vehicle propulsion.

Non-suppurative otitis media in children. (A retrospective study of 100 cases)

This is a retrospective study of 100 cases of non-suppurative otitis media among children who presented to the E.N.T. Department at Poole General Hospital between 1975 and 1978. Their histories, investigations and management are reported, with special emphasis on the significance of surgical treatment, and its value in the prognosis of such cases.

Intra-articular steroid injection in acute rheumatoid arthritis of the larynx

A case of stridor due to rheumatoid arthritis of the cricoarytenoid joints is presented, with special emphasis on a new line of treatment by local intra-articular steroid injection.

Fatal haemorrhage due to ruptured inferior thyroid artery aneurysm

A rare case is reported of an aneurysm of one of the branches of the inferior thyroid artery presenting as a thyroid swelling compressing the trachea, oesophagus and left recurrent laryngeal nerve, and complicated by erosion of the tracheal wall through which a sudden attack of bleeding into the trachea suffocated the patient immediately.