Autoimmune disease and HTLV-1 infection

We describe two patients who presented with mixed connective tissue disease. Both had antinuclear antibodies and antibodies to the extractable nuclear antigen U1RNP, and both were found to be seropositive for HTLV-1 infection. We found no evidence of HTLV-1 infection in 20 other patients known to have antibodies to U1RNP or in 36 British and West German patients with idiopathic adult polymyositis. In addition the serum from 20 anti-HTLV-1 positive patients did not contain antinuclear antibodies or antibodies to U1RNP. We conclude that rheumatological disease is associated with HTLV-1 through geographical rather than aetiological means.

Complete heart block and severe aortic incompetence in relapsing polychondritis: clinicopathologic findings

We describe a patient with relapsing polychondritis who developed fatal cardiac involvement comprising complete heart block, acute aortic incompetence, and cardiovascular collapse. Pathologic studies showed fibrosis of the cardiac conducting system and necrotizing inflammation of the aortic valve, features not previously described in relapsing polychondritis, as well as evidence of coronary artery vasculitis.

Operation drawings of Dame Barbara Hepworth

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The bacteriology of skin sores in Goroka children

The bacteriology of infected skin lesions was studied in paediatric outpatients. Thirty-nine untreated lesions were studied: 37 (95%) grew beta haemolytic streptococci (46% group A, 3% group B, 23% group C, 26% group G), 21 (54%) grew Staphylococcus aureus and 13 (33%) grew Corynebacterium haemolyticum. No attempt was made to selectively isolate Corynebacterium diphtheriae in this study. Vincent's organisms were seen in 13 (37%) of 35 gram stains from untreated lesions, including eight (73%) of 11 tropical ulcers. Twenty-three (92%) of the 25 strains of S. aureus isolated from untreated sores were resistant to penicillin.

Penicillin in the treatment of skin sores in children

Skin infections are a common cause of morbidity in children, particularly in tropical areas. Cultures from such lesions often grow both penicillin-resistant staphylococci and penicillin-sensitive streptococci. In a controlled trial of the treatment of septic skin lesions in 227 paediatric outpatients at Goroka Hospital, sequential analysis of the response to treatment showed that washing plus the intramuscular administration of procaine penicillin was more effective than washing plus placebo (P less than 0.05) after the 25th preference had been decided. When the amount of healing in the two groups was compared, washing plus penicillin was again more effective than washing plus placebo (P less than 0.001; Wilcoxon's rank-sum test). Because it eradicates beta-haemolytic streptococci, penicillin is a safe and effective agent for the treatment of large, multiple, or badly infected skin sores, even in countries such as Australia and Papua New Guinea in which most staphylococci are resistant to penicillin.