Peripheral large nerve fibre function in patients with chronic plaque psoriasis

Accumulating evidence suggests the involvement of neurogenic inflammation in the pathogenesis of psoriasis. Moreover, the concomitant occurrence of peripheral neuropathy has been reported in several psoriatic patients. Thus, the aim of the present study was to answer the question whether an impairment of peripheral large nerve fibre function may exist in psoriasis. Thirty-two patients with severe and generalized chronic plaque psoriasis and 32 sex- and age-matched healthy controls were evaluated by detailed clinical neurological and standard neurophysiological examination. The latter included motor nerve conduction study of one nerve in the upper and one in the lower extremities and sensory nerve conduction study of one nerve in the upper and two in the lower extremities. Neurological examination failed to demonstrate any clinical evidence of large fibre neuropathy. Furthermore, all values of the examined neurophysiological parameters were within normal limits; comparisons of the corresponding mean values in the patient and the control group showed no statistically significant differences. These findings demonstrate no measurable abnormalities of the peripheral large nerve fibres in psoriatic patients and therefore an association of psoriasis with peripheral large fibre neuropathy cannot be suggested.

Comparing contingent valuation and contingent ranking: a case study considering the benefits of urban river water quality improvements

This paper contrasts applications of both the contingent valuation (CV) and contingent ranking (CR) methods as applied to a common issue, the valuation of improvements to the water quality of an urban river (the River Tame, running through the city of Birmingham, UK). Building upon earlier experimental work, the CV design used ensures that respondents are fully aware of all impending valuation tasks prior to undertaking any one of those tasks. Such an approach is directly comparable to the CR design for which full awareness of all options is a pre-requisite. Findings indicate that the CV responses exhibit strong internal consistency with expected relationships observed between values and theoretically expected parameters. External comparisons show that CR valuations are substantially larger than those elicited through CV (with protest votes excluded), and that the response rate for the CR survey is significantly higher than that for the CV survey.

Age-related alterations in the carbohydrate residue composition of the cell surface in the unexposed normal human epidermis

BACKGROUND

The results of the very few histochemical studies that have been performed so far on the lectin-binding profile of normal human epidermis are mostly controversial; thus, the carbohydrate residue composition of the cell surface in the latter still remains in dispute and the possible alterations in the epidermal lectin-binding profile are unknown.

OBJECTIVE

To investigate the influence of age on the carbohydrate residue composition of the cell surface in unexposed normal human epidermis by means of lectin histochemistry.

METHODS

Biopsy specimens obtained from the sun-protected (unexposed) buttock skin, divided into 5 age groups of 18 subjects each, were fixed in buffered formalin (10%) and embedded in paraffin. 4-mum sections were processed for histochemistry using a panel of six biotinylated lectins.

RESULTS

In the unexposed normal human epidermis the concentration and distribution of cell surface beta-D-galactose, D-galactose-beta-(1,3 N-acetylo-D-galactosamine), beta(1,4 D-N-acetylo-D-glucosamine) and alpha-D-N-acetylo-D-galactosamine were almost identical in all age groups, whereas those of alpha-D-mannose, alpha-D-glucose and alpha-L-fucose revealed significant age-related differences.

CONCLUSION

These findings may be due to an age-related decline in synthesis and/or transport of monosaccharides from the cytoplasm to the surface of epidermal cells. Thus, the corresponding lectins concanavalin A and Ulex europaeus agglutinin-I can only be used in comparative histochemical studies of the carbohydrate residue composition of the cell surface in the normal and pathological epidermis of individuals of the same age, whereas Ricinus communis agglutinin-I, peanut agglutinin, wheat germ agglutinin and Dolichos biflorus agglutinin, whose binding to carbohydrates is not affected by aging can be used in histochemical studies of carbohydrate residue composition of the cell surface in the normal and pathological epidermis in human subjects of any age.

Qualitative and quantitative alterations of cell surface carbohydrate residues during epidermal morphogenesis

The purpose of this study was to investigate the carbohydrate residue composition of cell surface in the developing epidermis and to define the chronological sequence of its alterations in human fetuses from the 10th to the 20th weeks of gestation and at the 23rd week of gestation, using a panel of six biotinylated lectins: Concanavalin A, Ulex europaeus agglutinin-I, Ricinus communis agglutinin-I, Peanut agglutinin, Wheat germ agglutinin, and Dolichos biflorus agglutinin. Distinct qualitative and quantitative alterations in the expression of cell surface carbohydrate residues were found during epidermal morphogenesis prior to keratinization (10th to 20th weeks). At the 23rd week of gestation, the already keratinized fetal human epidermis revealed a pattern of cell surface glycosylation very similar to that of the adult human epidermis. Further studies are now warranted to answer the question regarding whether the glycosylation pattern in the developing human epidermis is disturbed in fetuses with genodermatoses and whether these disturbances might be important for prenatally diagnosing the latter.

In vivo fluorescence kinetics and photodynamic therapy in condylomata acuminata

BACKGROUND

Topical application of 5-aminolaevulinic acid (ALA) to condylomata acuminata leads to accumulation of protoporphyrin IX (PpIX); therefore ALA-induced photodynamic therapy (ALA-PDT) appears to be a potential treatment.

OBJECTIVES

To investigate in vivo the PpIX fluorescence time course after topical application of ALA in order to determine the optimal time for irradiation, and to assess the efficacy of subsequently performed ALA-PDT.

METHODS

Fluorescence kinetics was studied in 12 male patients with condylomata acuminata. Confirmation of diagnosis was established with conventional histology and polymerase chain reaction. Lesions were treated with 20% ALA and irradiated at the optimal time with a dose of 70 J cm-2 or 100 J cm-2 light. An additional session with 100 J cm-2 was administered 1 week later to lesions that persisted.

RESULTS

The in vivo study of fluorescence kinetics indicated that the optimal time for irradiation varied among patients from 6 to 11 h. The overall cure rate was 72.9%, 12 months after treatment.

CONCLUSIONS

Topical ALA-PDT is a potentially effective treatment for condylomata acuminata.

Sensorimotor polyneuropathy after a three-month oral acitretin therapy

We report a patient with chronic plaque psoriasis who developed clinical and electrophysiologic features of polyneuropathy affecting motor and sensory fibers in upper and lower extremities after three months of treatment with oral acitretin. Drug withdrawal resulted in a complete clinical recovery and normalization of all electrophysiologic abnormalities within two months.

Stiff-person syndrome associated with oral isotretinoin treatment

We describe a patient with severe nodulocystic acne who developed disabling muscle stiffness and painful superimposed spasms of the neck, back and upper limbs 10 days after the onset of oral isotretinoin treatment. The muscle hyperactivity condition, which revealed the clinical and electromyographic features of the stiff-person syndrome, gradually resolved 2 weeks after drug withdrawal.

Calcipotriol plus short-contact dithranol: a novel topical combination therapy for chronic plaque psoriasis

The purpose of this double-blind randomised parallel-group study was to compare the efficacy and safety of short-contact treatment with dithranol ointment (2%) with its combination with calcipotriol ointment (50 microg/g) in 2 groups of in-patients with chronic plaque psoriasis. The patients of the first group (n = 23) topically applied dithranol once daily for 30 min and the vehicle of calcipotriol twice daily. The patients of the second group (n = 23) used a single topical application of dithranol for 30 min daily and additionally applied calcipotriol twice daily. The extent and the severity of psoriasis were assessed by means of psoriasis area and severity index score (PASI score) before the onset of the 6-week therapy and weekly thereafter. The difference between the two groups with regard to the mean PASI score became statistically significant already after the first week of treatment and remained so until the end of the trial. No significant differences were observed between the two groups with respect to the cutaneous adverse events. These findings indicate that the addition of calcipotriol ointment to short-contact dithranol markedly augments the therapeutic efficacy of the latter in chronic plaque psoriasis and impressively accelerates the response of psoriatic plaques to this well-tolerated regimen.

Effects of oral acitretin on contrast sensitivity and tear film function: a prospective study

The purpose of this prospective study was to investigate the ocular side effects of short-term therapy with oral acitretin (1 mg/kg/day) in 24 patients with severe and recalcitrant dermatoses. Apart from the routine ophthalmological examination, the following tests were performed: break-up time of tear film for the determination of its stability, Schirmer test for the assessment of lacrimal gland function, rose bengal staining for the detection of possible ocular surface damage and contrast sensitivity test for the evaluation of visual function. No statistically significant differences could be found between the pretreatment values of the assessed parameters and those obtained after 1 and 2 months of therapy. It seems reasonable, therefore, to suggest that ocular surface integrity and tear film and visual function are not affected by short-term oral acitretin administration.

Effects of short-term oral acitretin therapy on peripheral nerve function: a prospective neurological and neurophysiological study

The aim of the present prospective study was to substantiate possible side effects of short-term oral acitretin therapy (1 mg/kg/day) on peripheral nerve function of 13 patients with severe keratinization disorders. Clinical neurological examination before and 1 and 3 months after onset of treatment was unremarkable in all patients; however, a significant alteration of one or more neurophysiological, predominantly sensory, parameters was demonstrated in 3 out of 13 patients (23%) after 1 month and in 9 out of 13 (69%) after 3 months of oral acitretin therapy. These findings indicate that oral acitretin might be capable of causing a dysfunction of predominantly sensory nerve fibres in some individuals. Although in the investigated patients this dysfunction remained subclinical, it seems reasonable to suggest that neurological and neurophysiological evaluation of peripheral nerves should be added to the list of investigations that are routinely performed in patients receiving oral acitretin.

Public perceptions of health risks from polluted coastal bathing waters: a mixed methodological analysis using cultural theory

This article explores public perceptions of, and attitudes toward, possible health risks from polluted coastal bathing waters in the United Kingdom. Cultural theory is applied in the present analysis, using a mixed methodology of quantitative analysis from interviews and qualitative interpretation of focus group discussions to provide insights into how different cultural solidarities view a number of issues. These include risks to health; attitudes toward regulation; public consultation and information provision; and trust, blame, and accountability applied to different stakeholders in the bathing-water-quality debate. The results show that individuals' standpoints can be represented on a number of dimensions, consistent with cultural theory, including perceptions of power and authority, beliefs in the efficacy of collective action, and acceptance or rejection of incremental change as opposed to radical solutions. The discussion focuses both on methodological and substantive issues related to the use of cultural theory as a research tool, and on policy recommendations arising from this research.