Anthralin cream as short contact therapy for psoriasis

Anthralin is effective in the management of psoriasis. Because of frequent skin irritation, staining of skin and clothing, and patients' difficulty in using stiff paste and ointment preparations in traditional regimens, newer treatment protocols are being evaluated. We report a four-week study of twenty patients using an anthralin cream for thirty-minute short-contact therapy. Both 0.5 percent and 1.0 percent anthralin concentrations were evaluated. We found that short contact therapy with the anthralin cream preparations was effective. In four weeks it resulted in the clearing of treated areas in more than one-third of the patients, and significant improvement in an additional 35 percent. Little difference in efficacy was noted between the 0.5 percent and 1.0 percent concentrations. Most patients found the treatment regimen cosmetically acceptable and experienced minimal problems with staining and skin irritation.

Evolution of recurrent herpes simplex lesions. An immunohistologic study

We performed immunoperoxidase stains on skin biopsies taken from nine patients with recurrent peripheral herpes simplex lesions at 12 h to 6 d after onset of signs of symptoms to phenotype the inflammatory infiltrate, to detect cells producing interferons alpha and gamma, and to locate herpes simplex virus antigen-containing cells. Viral glycoprotein antigen was located in the nuclei and cytoplasm of necrotic epidermal cells, often within vesicles, in biopsies taken between the first and third day. Histologically, biopsies of all stages showed intradermal focal perivascular and diffuse mononuclear inflammatory infiltrates. The cells constituting the infiltrates were predominantly T lymphocytes with lesser numbers of histiocytes; Leu 7+ (most natural killer/killer) cells and B cells were rare in the biopsy specimens. Leu 3a+ ("helper") T lymphocytes predominated in both subepidermal and perivascular regions of early lesions (12-24 h). Tissue helper/suppressor ratios ranged from 6.3 to 3.4 compared with 1.9-1.0 in blood. In later lesions (after 2 d), monocytes/macrophages were more prominent in tissue sections and the helper/suppressor ratios (2.3-2.5) more nearly approximated those of blood (1.6-2.7). The negative correlation of tissue ratios with time was significant (P less than or equal to 0.02). A large proportion of the infiltrated T lymphocytes expressed DR antigens. There was also diffuse strong DR expression on epidermal cells in five cases (all of two or more days). In six biopsies, scattered macrophages and small cells, presumably lymphocytes, demonstrated cytoplasmic or membrane staining for a substance which copurifies with interferon gamma. We identified such stained cells within vessels, suggesting that these cells circulate. Gamma interferon might have an important role within the herpetic lesions, possibly inducing macrophage activation and cytotoxic T lymphocytes and increasing DR expression on monocyte and epidermal cells.

Comparative radiographic features of community acquired Legionnaires' disease, pneumococcal pneumonia, mycoplasma pneumonia, and psittacosis

The features of the chest radiographs of 49 adults with legionnaires' disease were compared with those of 91 adults with pneumococcal pneumonia (31 of whom had bacteraemia or antigenaemia), 46 with mycoplasma pneumonia, and 10 with psittacosis pneumonia. No distinctive pattern was seen for any group. Homogeneous shadowing was more frequent in legionnaires' disease (40/49 cases) (p less than 0.005), bacteraemic pneumococcal pneumonia (25/31) (p less than 0.01) and non-bacteraemic pneumococcal pneumonia (42/60) (p less than 0.05) than in mycoplasma pneumonia (23/46). Multilobe disease at presentation was commoner in bacteraemic pneumococcal pneumonia (20/31) than in non-bacteraemic pneumococcal pneumonia (15/60) (p less than 0.001) or legionnaires' disease (19/49) (p less than 0.025). In bacteraemic pneumococcal pneumonia multilobe disease at presentation was associated with increased mortality. Pleural effusions and some degree of lung collapse were seen in all groups, although effusions were commoner in bacteraemic pneumococcal pneumonia. Cavitation was unusual. Lymphadenopathy occurred only in mycoplasma pneumonia (10/46). Radiographic deterioration was particularly a feature of legionnaires' disease (30/46) and bacteraemic pneumococcal pneumonia (14/27), and these groups also showed slow radiographic resolution in survivors. Radiographic resolution was fastest with mycoplasma pneumonia; psittacosis and non-bacteraemic pneumococcal pneumonia cleared at an intermediate rate. Residual intrapulmonary streaky opacities remained in over a quarter of survivors from legionnaires' disease (12/42) and bacteraemic pneumococcal pneumonia (5/19).

An institution for change: developing a family day unit

This paper describes the theory and structure of a day unit designed to intervene in the systems of families who present with severe or multiple problems to agencies attempting to help them, but who are difficult to engage in a therapeutic pact and unresponsive to attempts at outpatient therapy. An analysis of these families is offered in terms of the relations between internal and external boundaries and difficulties in making transitions in the daily contexts of life. The principles of the unit are described in terms of the creation of an artificial extended family, the intensification of sequence and patterns of interaction, and the making and traversing of boundaries. Particular attention is paid to the function of agency interventions in family patterns and to redefining the relationship between family and agencies.

Hyponatraemia in Legionnaires' disease

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Biosynthesis of immunoglobulin in human immunoproliferative diseases. II. Comparison of tumour cell mass in multiple myeloma measured by synthetic rate studies with that calculated from clinical staging systems

Tumour cell mass (TCM) in patients with multiple myeloma has been measured by synthetic rate studies of bone-marrow tumor cells in culture. From the measurements of Salmon and co-workers, a simple clinical staging system in which TCM is calculated by a programmable pocket calculator has been developed. We have compared the measurement and calculation of TCM in patients with IgG and IgA multiple myeloma by these methods in our own laboratory. There was correlation between synthetic rate and serum IgG paraprotein concentration but not the serum IgA paraprotein concentration. In patients with IgG myeloma there was correlation between measured and calculated TCM as well as measured TCM and serum IgG paraprotein concentration, urine Bence-Jones protein excretion, and serum albumin concentration. Measured TCM also inversely correlated with haemoglobin concentration. In patients with IgA myeloma, however, there was no correlation between measured TCM and calculated TCM or any other individual clinical laboratory parameter. A number of problems have contributed to the overall failure of this method to measure and calculate TCM including methodological differences, definition of myeloma cells, proteolysis of newly synthesized paraprotein in culture, changes in synthetic rates with time and assessment of the degree of bone lesions by skeletal roentgenograms. We cannot recommend these methods as they stand to measure and calculate TCM in patients with multiple myeloma.

The Fish Connection: A Trophic Link Between Planktonic and Rocky Reef Communities?

The blacksmith (Chromis punctipinnis), an abundant pomacentrid fish off southern California, regularly forages on zooplankton during the day and shelters in rocky reefs at night. This behavioral pattern results in the importation of 8 grams of carbon per square meter per year, deposited as feces in the nocturnal shelter. Since blacksmiths regularly return to the same shelters, this represents a transport of extrinsic organic carbon to the reef which is predictable in time and space.

Early clinical differentiation between Legionnaires' disease and other sporadic pneumonias

Early diagnosis of Legionnaires' disease is difficult because other pathogens cause a similar clinical picture and microbiologic tests are usually only of retrospective value. Since May 1977, 17 patients with sporadic cases of Legionnaires' disease have been admitted, all previously well, the diagnosis being made with standard serologic or bacteriologic criteria. From the clinical, laboratory, and radiologic findings, we propose criteria that may enable the clinician to make a diagnosis earlier in many cases, differentiating them from other pneumonias. Within 24 hours of admission, any three of the following four features are strongly suggestive of Legionnaires' disease: [1] prodromal "viral" illness, [2] dry cough or confusion or diarrhoea, [3] lymphopenia without marked neutrophilia, [4] hyponatremia. Two thirds of cases had at least three of these features, and no false-positive diagnoses would have been made in other pneumonias that were serologically negative for Legionnaires' disease if these proposed criteria had been applied diagnostically. In the next few days the diagnosis is very likely if microbiologic tests are negative and if there is radiologic extension, abnormal liver function test results, or hypoalbuminemia.

Writing man-machine dialogues for a MUMPS system using the Application Controller Language (ACL)

The Application Controller Language (ACL) was designed to facilitate the development of man-machine dialogues. An exact specification of such a dialogue before programming begins is unlikely to be implemented without many changes. Immediately a dialogue is used, the 'hands-on' experience suggests many improvements. ACL was designed to serve as a flexible tool to enable easy re-shaping of this dialogue. For this reason, ACL is structured, allows documentary comments, and may be easily edited. ACL complements MUMPS and encourages the writing of small modular MUMPS programs to carry out well-defined tasks. For this purpose, ACL serves as the 'top' of a top-down written structure, with calls to MUMPS programs being made from ACL statements. A smooth dialogue is made easier to achieve by having all ACL statements use a single I/O processor giving a uniform terminal behaviour and appearance to the display. The programmer is encouraged to call this same I/O processor from his MUMPS application programs. ACL was used extensively for the development of a data management systems for hospital critical care.

Legionnaires' disease: a clinical description of thirteen cases

We describe 13 patients with legionnaires' disease in Nottingham, all presenting with lobar pneumonia. Six patients required artificial ventilation and 2 died. No common source of infection has yet been identified, but the disease appears to be prevalent and possibly endemic in this city.

Chromosome polymorphism and banding patterns in the owl monkey (Aotus)

Diploid numbers, chromosome morphology, G- and C-banding characterisitics and pelage phenotypes were studied in 330 owl monkeys (Aotus) captured and exported from several parts of South America. Among these animals, seven distinctive karyotypes were recognized by the number of chromosomes and their individual identification by G- and C-banding methods. These seven karyotypes were distributed among four distinctive phenotypes differentiated by color patterns in the pelage. These specific phenotypes were designated in this study with capital letters (A through D) and the karyotypes by Roman numerals (I-VII), followed in parentheses by their diploid number. Specimens with phenotype A originated from Brazil and their karyotypes all conformed to a type designated karyotype I (2n=54). Animals classified as having phenotype B were exported from Colombia and their karyotypes were designated as karyotypes II (2n=54), III (2n=53), IV (2n=52), and V (2n=46). Monkeys received from Peru were designated as phenotype C and karyotype VII (2n=52). A group of owl monkeys received from Bolivia were designated as having karyotype VI (2n=50 male; 2n=49 female). Their distinctive phenotype was labeled D. All males in this sample had a diploid number of 49 and the Y-chromosome was translocated to an autosome.

A comparative trial of hyposensitization in 1973 in the treatment of hay fever using Pollinex and Alavac-P

A direct comparison was made in 112 hay fever patients of hyposensitization treatment with glutaraldehyde-pollen-tyrosine adsorbate (Pollinex) and with alum-precipitated pyridine extract (Alavac-P) which is an accepted form of treatment, its efficacy having been shown by a comparative trial against a placebo preparation. No significant difference could be detected between the results of the two forms of treatment. Seventy-seven per cent of patients responded with improvement following treatment with the tyrosine adsorbed vaccine, and 81% of those receiving the alum-precipitated vaccine. Side effects from treatment, both local and general, were generally of an infrequent or mild nature for both vaccines.

A trial of hyposensitization in 1974/5 in the treatment of hay fever using glutaraldehyde-pollen-tyrosine adsorbate

One hundred patients with hay fever were treated in 1974/5 with a glutaraldehyde-pollen-tyrosine adsorbate, the response to treatment being assessed at the end of the hay fever season by direct questioning of the patient and examination of a daily record card. Successful results of treatment were recorded in 73% of all patients, results for both years being similar both for patients who had been previously hyposensitized and for those who had not previously received this form of treatment. Side reactions to treatment were generally infrequent or mild, and in only one patient was it necessary to discontinue treatment due to side reactions.

D. pteronyssinus-tyrosine adsorbate: biological and clinical properties

Adsorption of D. pteronyssinus on tyrosine gives a depot formulation with retained immunogenicity. Preliminary clinical evaluation of this material showed improvement in the majority of allergic subjects after receipt of the initial six doses, improvement being continued during subsequent maintenance therapy.