New BAR tools for mining expression data and exploring Cis-elements in Arabidopsis thaliana

Identifying sets of genes that are specifically expressed in certain tissues or in response to an environmental stimulus is useful for designing reporter constructs, generating gene expression markers, or for understanding gene regulatory networks. We have developed an easy-to-use online tool for defining a desired expression profile (a modification of our Expression Angler program), which can then be used to identify genes exhibiting patterns of expression that match this profile as closely as possible. Further, we have developed another online tool, Cistome, for predicting or exploring cis-elements in the promoters of sets of co-expressed genes identified by such a method, or by other methods. We present two use cases for these tools, which are freely available on the Bio-Analytic Resource at http://BAR.utoronto.ca.

BAR expressolog identification: expression profile similarity ranking of homologous genes in plant species

Large numbers of sequences are now readily available for many plant species, allowing easy identification of homologous genes. However, orthologous gene identification across multiple species is made difficult by evolutionary events such as whole-genome or segmental duplications. Several developmental atlases of gene expression have been produced in the past couple of years, and it may be possible to use these transcript abundance data to refine ortholog predictions. In this study, clusters of homologous genes between seven plant species - Arabidopsis, soybean, Medicago truncatula, poplar, barley, maize and rice - were identified. Following this, a pipeline to rank homologs within gene clusters by both sequence and expression profile similarity was devised by determining equivalent tissues between species, with the best expression profile match being termed the 'expressolog'. Five electronic fluorescent pictograph (eFP) browsers were produced as part of this effort, to aid in visualization of gene expression data and to complement existing eFP browsers at the Bio-Array Resource (BAR). Within the eFP browser framework, these expression profile similarity rankings were incorporated into an Expressolog Tree Viewer to allow cross-species homolog browsing by both sequence and expression pattern similarity. Global analyses showed that orthologs with the highest sequence similarity do not necessarily exhibit the highest expression pattern similarity. Other orthologs may show different expression patterns, indicating that such genes may require re-annotation or more specific annotation. Ultimately, it is envisaged that this pipeline will aid in improvement of the functional annotation of genes and translational plant research.

Next-generation mapping of Arabidopsis genes

Next-generation genomic sequencing technologies have made it possible to directly map mutations responsible for phenotypes of interest via direct sequencing. However, most mapping strategies proposed to date require some prior genetic analysis, which can be very time-consuming even in genetically tractable organisms. Here we present a de novo method for rapidly and robustly mapping the physical location of EMS mutations by sequencing a small pooled F₂ population. This method, called Next Generation Mapping (NGM), uses a chastity statistic to quantify the relative contribution of the parental mutant and mapping lines to each SNP in the pooled F₂ population. It then uses this information to objectively localize the candidate mutation based on its exclusive segregation with the mutant parental line. A user-friendly, web-based tool for performing NGM analysis is available at http://bar.utoronto.ca/NGM. We used NGM to identify three genes involved in cell-wall biology in Arabidopsis thaliana, and, in a power analysis, demonstrate success in test mappings using as few as ten F₂ lines and a single channel of Illumina Genome Analyzer data. This strategy can easily be applied to other model organisms, and we expect that it will also have utility in crops and any other eukaryote with a completed genome sequence.

Transcutaneous electrical nerve stimulation for postoperative pain relief after total knee arthroplasty

Transcutaneous electrical nerve stimulation (TENS) has been used to treat chronic pain syndromes and has been reported to be of some utility in the treatment of postsurgical pain. A randomized, blinded, placebo-controlled trial was designed to evaluate the utility of TENS after total knee arthroplasty. Patients were randomly enrolled into patient-controlled anesthesia (PCA) alone, PCA plus TENS, or PCA plus sham TENS. The cumulative dose of morphine by PCA for each group was used as the end-point of the study. There was no significant reduction in the requirement for patient-controlled analgesia with or without TENS. We conclude that there is no utility for TENS in the postoperative management of pain after knee arthroplasty.

[Congenital pachyonychia type II (Jackson-Lawler syndrome)]

Pachyonychia congenita (PC) is a rare ectodermal dysplasia with variable expression. The condition is usually inherited as an autosomal dominant trait. Several classifications of PC have been proposed. Feinstein and colleagues suggested four clinical types of PC. Type II, the Jackson-Lawler-Syndrome, is characterized by multiple epidermal cysts, palmoplantar bullae and hyperhidrosis as well as natal teeth in addition to the main findings of pachyonychia, palmoplantar hyperkeratosis and follicular keratosis. We report two patients (father and son) with Jackson-Lawler-Syndrome and describe in detail pathogenesis, diagnostic criteria and treatment approaches as well as the different classifications of pachyonychia congenita.

Photopatch testing: the 12-year experience of the German, Austrian, and Swiss photopatch test group

BACKGROUND

In 1984, the German, Austrian, and Swiss Photopatch Test Group was founded to standardize the photopatch test procedure and to investigate photoallergic reactions, as well as the epidemiology of photoallergy, in central Europe. Therefore in a first test period from 1985-1990, 32 test substances were applied on the backs of patients suspected to be photosensitive. After evaluation of these data, some substances were dismissed, and others were additionally integrated into the test tray. Thus a modified test tray comprising 26 test substances was used for the second test period (1991-1997).

OBJECTIVE

According to the standard photopatch test procedure defined in the first test period, the aim of this multicenter study was to apply compounds from the modified second test tray to a large group of photosensitive patients. After evaluation of the second test period (1991-1997), the outcome was compared with the results of the first period. On the basis of these results and influenced by concurrently published case reports, a third modified photopatch test tray has been established.

METHODS

After the application of a duplicate test tray for 24 hours, one test site was irradiated with 10 J/cm(2) UVA, and the other test site served as the control area. Readings were performed immediately and 24, 48, and 72 hours after irradiation. Test reactions were qualitatively graded according to a 4-point scale and classified by the investigators of the participating centers. In 49 participating clinics 1261 photopatch tests were performed. All data were subjected to computer-assisted analysis by using a specially developed software to classify all positive test reactions as plain contact or photoinduced reactions (nonspecific, toxic, or allergic photoreactions) and to define substance-specific reaction patterns.

RESULTS

In test period 1 data of 1129 patients were evaluated. From 2859 positive test reactions, 28.6% were excluded as plain contact reactions, 71.4% were found to be photoinduced reactions, and 3.8% were classified as photoallergic. In test period 2 data of 1261 patients were evaluated. One thousand four hundred fifteen positive test reactions were observed, and of these, 28.7% were excluded as plain contact reactions, 71.3% were classified as photoinduced reactions, and 8.1% were classified as photoallergic reactions. In both test periods nonsteroidal anti-inflammatory drugs, disinfectants, and phenothiazines represented the leading photoallergens in the evaluated central European region. By using computer-assisted reaction pattern analysis, substance-specific reaction patterns could be distinguished. These substance-specific reaction patterns comprised 4 main categories: the well-known decrescendo (phototoxic) and crescendo (photoallergic) reaction patterns, as well as a combined and a plateau pattern.

CONCLUSION

The test modification after the first test period led to a notably reduced number of positive (mainly nonphotoallergic and thus nonrelevant) test reactions per patient in the second test period (from 2.6 to 1.1). In contrast, the percentage of photoallergic reactions increased significantly from 3.8% to 8.1% of all positive test reactions. Test modifications after the first test period led to a remarkably improved specificity of the photopatch test. Furthermore, substance-specific reaction patterns observed in test period 1 were confirmed in test period 2.

[UV-therapy in HIV-infected patients]

We examined the prevalence of HIV-associated cutaneous disorders as well as the frequency and efficiency of UV-radiation in HIV-infected patients by evaluating the clinical records of 1310 patients seen between and 1994 and 1996. 41 patients were treated with UVB-radiation and 4 patients with UVA1-radiation, while three patients received PUVA-therapy. UV-radiation proved to be efficient and safe in the treatment of pruritic papular eruption, atopic dermatitis and psoriasis. Although some in vitro studies and studies with transgenic mice have suggested a negative impact of UV radiation on the immunosystem of HIV-positive patients, no progression of the HIV infection due to phototherapy has been proven.

[Palpable migratory acriform erythema and lymphocytic infiltration of the skin--different presentations of the same entity?]

Palpable arciform migratory erythema of Clark (PAME) has been described as a rare member in the group of T-cell pseudolymphoma. The clinical picture of infiltrated annular erythema developing into large migrating lesions with the trunk as predilection site is distinctive from other pseudolymphomas. Because of the very similar histology and immunohistochemistry in comparison to the more frequent lymphocytic infiltration of the skin of Jessner and Kanof (LIS) doubts have been raised about the existence of PAME as an unique entity. A 46-year old patient presented with the typical picture of PAME on his trunk while showing typical lesions of LIS on his neck and face. Both diseases showed synchronous intermittent remissions in response to different therapeutic modalities. Multiple biopsies were subsequently performed and histological, immunohistochemical and molecular biological examinations did not reveal relevant differences between PAME and LIS in this patient. We conclude that the findings in this key case suggest that the T-cell pseudolymphoma PAME is not an unique entity, but a special clinical presentation of LIS.

[Acral papular lichen myxedematosus]

In 1986 Rongioletti introduced the term acral persistent papular mucinosis for persistent papules on the dorsum of the hands and distal forearms. Skin specimens reveal mucin deposits which resemble those in lichen myxedematosus (LM). Laboratory results are usually unremarkable. Our 54-year-old female patient showed a 2 1/2 year history of skin lesions in the typical acral distribution pattern. This entity appears to be an acral papular subtype of LM. In the classification of LM, acral papular lichen myxedematosus should replace the discrete papular form. This latter form has been well known for many years, but is not sufficiently definable and is of secondary clinical importance.

Allergic contact dermatitis from pyoctanin

Although pyoctanin is widely used in medicine, there are hardly any reports of contact allergy to it. Most reports of side-effects refer to irritant reactions after topical application. We describe 2 patients who developed pyoctanin contact dermatitis after long-term application on damaged skin. Positive patch test results down to concentrations of 0.0025% and 0.05% aqueous pyoctanin solution, respectively, were found.

[Erysipelas after leg vein harvesting for aortocoronary bypass operation]

We have seen 4 patients in 1995 who showed erysipelas in the leg used for vein graft harvesting for coronary bypass surgery. None of the patients had experienced erysipelas prior to surgery. One patient had his first attack erysipelas while the others experienced recurrent disease. Venectomy puts these patients at risk for later erysipelas. Therefore careful foot hygiene, eradication for mycotic infections and adequate therapy for initial erysipelas are mandatory in cardiac high risk patients after coronary bypass surgery.

Localized cicatricial pemphigoid of the Brunsting-Perry type with transition into disseminated cicatricial pemphigoid. Report of a case proved by preembedding immunogold electron microscopy

BACKGROUND

In 1979, Provost described two patients with the clinical features of disseminated cicatricial pemphigoid for the first time. Until now, only four additional cases of disseminated cicatricial pemphigoid have been described. Existence of diagnosis of disseminated cicatricial pemphigoid has been discussed controversially because in four cases investigated by electron microscopy the blister formation was found below the lamina densa, which is indicative of an epidermolysis bullosa acquisita.

OBSERVATION

A 78-year-old woman is presented with a generalized eruption of blisters leaving behind scars that developed after a 7-year-long history of mild circumscribed recurrent blisters and scarring eruptions that had been diagnosed previously as Brunsting-Perry type of cicatricial pemphigoid. Immunofluorescence antigen mapping disclosed the blister formation above the lamina densa. Electron and immunoelectron microscopy using a preembedding immunogold technique revealed blister formation and antibody binding within the lamina lucida, predominantly below the subbasal dense plate.

CONCLUSIONS

The clinical features of disseminated blistering followed by scarring, the immunofluorescence antigen mapping, and the electron and immunoelectron microscopic findings in our case for the first time clearly prove the existence of a disseminated cicatricial pemphigoid.

[Acute primary stage of HIV infection with documented seroconversion]

We report a 34-year-old homosexual man who developed a maculopapular, non-itchy exanthema mainly on the trunk in addition to fever up to 39.8 degrees C, general malaise, arthralgias, generalized enlargement of the lymph nodes, watery diarrhoea and weight loss. The patient was in an acute phase of the HIV infection according to standards of WHO and CDC (i.e. acute infection with duration from 3 days to 3 weeks with occasional mononucleosis-like symptoms and positive antibody tests). We documented the seroconversion from HIV-negativity to HIV-positivity 15 days after the onset of the acute illness, concomitant with the resolution of the clinical symptoms. Haematological changes were monitored during the conversion. The infection with HIV-1 was shown by the reduction of T4 helper cells (262/microliters) and the inversion of the CD4:CD8 ratio (< 0.5 during seroconversion). The patient also developed generalized candidiasis owing to the acute immunodeficiency.

[Localized cicatricial bullous pemphigoid of the Brunsting-Perry type]

Localized cicatricial pemphigoid of the Brunsting-Perry type is a very rare bullous condition, which has so far been reported in 51 cases. It is characterized by scarring blisters confined to the head, scalp and neck. Diagnosis can be difficult because of the discrete skin lesions, often repeatedly false-negative direct immunofluorescence, and the absence of circulating antibodies. We report on a 87-year-old male patient with the typical clinical feature of a cicatricial pemphigoid of the Brunsting-Perry type and give a review of the 51 cases published in the world literature.

Progressive multifocal leukoencephalopathy in patients with HIV infection: lack of impact of early diagnosis by stereotactic brain biopsy

Thirteen patients with HIV-related progressive multifocal leukoencephalopathy (PML), representing an institutional incidence of 4.2%, are reported. All cases were diagnosed by image guided stereotactic brain biopsy shortly after their presentation for neurologic complaints. All patients were males; risk factors included homosexual or bisexual activity or intravenous drug use. At the time of presentation with PML, the mean T4 count was 85 (range 9-240 cells/mm3). The most common neurologic symptoms were cognitive dysfunction and aphasia, whereas gait abnormalities and disordered cognition were the most common neurologic signs. Cerebrospinal fluid analysis was helpful only to rule out other causes of CNS disease. Magnetic resonance imaging, more sensitive than computed tomography (CT) scanning, typically revealed multiple areas of increased intensity on T2 weighted images although unifocal disease was seen in 23% of patients. Despite early stereotactic biopsy and aggressive symptomatic therapy, survival of these patients was poor with a mean of 2.6 months after the onset of neurological symptoms and 2.0 months after biopsy.

[Quality control in epicutaneous testing--reproducibility in the right-left comparison]

In 121 patients, 26 substances of a standard test battery were applied symmetrically on both sides of the upper back. The Finn chamber on Scanpor was the test system used, the final reading being taken on day 3 or 4. Of 166 tests, 131 were positive on both sides. Test substances and patients age had no influence. In comparison with the results in the literature, ours show a good reproducibility of 78.9%. Doubtful reactions (?+) were difficult to evaluate. These reactions deserve future research.

[The incidence of atopic symptoms in patients with psoriasis]

Retrospective studies have repeatedly shown that patients with psoriasis rarely suffer from concomitant atopic dermatitis. Recently conflicting results have been published. To see whether the predisposition to psoriasis and that to atopic disease influence each other, we performed a prospective study to investigate the prevalence of atopy in patients suffering from psoriasis. Atopy was diagnosed in 8 of 68 psoriasis patients (11.8%), indicating that its frequency is the same in patients with psoriasis as in the general population. The dynamic aspects of atopic dermatitis, which is mainly a disease of children, and of psoriasis, which is mainly a disease of adults, mean that concomitant manifestation of both entities should be observed in less than 0.01% of the population.

[A classical form of eosinophilic pustular folliculitis--successful therapy with PUVA]

Eosinophilic pustular folliculitis was first defined by Ofuji et al. in 1970 [13]. It is reported most frequently in Japanese patients. It is characterized by the repetitive appearance of sterile papulopustular lesions that heal without scarring. Case reports from outside Japan frequently refer to ulcerating inflammation. We describe a classic form of eosinophilic pustular folliculitis in an European, and we show for the first time that the eosinophilic pustular folliculitis responds well to PUVA treatment.

MR imaging of the normal and abnormal clivus

We retrospectively reviewed 330 T1-weighted sagittal images, 80 T2-weighted sagittal images, and 83 gadopentetate-dimeglumine-enhanced scans of normal adults to determine the MR appearance of the normal adult clivus. MR images of 21 patients with an abnormal clivus (19 with tumor invasion and two with marrow reconversion) were also evaluated retrospectively and compared with those of the control group to assess MR features distinguishing the two groups. Our study revealed that a normal adult clivus consisted of low- and high-intensity portions mixed in various proportions on T1-weighted images. The low-intensity portion was isointense or hyperintense relative to the pons and always contained foci of bright signal intensity. The low-intensity tumor of a pathologic clivus tended to be hypointense relative to the pons (17/19), and was completely devoid of foci of bright signal intensity. The normal adult clivus was approximately isointense relative to the pons on T2-weighted images. Clival tumors were grossly hyperintense relative to the pons on T2-weighted images in 11 of 17 patients. In the remaining six patients, either a portion of or the entire lesion was isointense relative to the pons and, therefore, was not detectable on T2-weighted images. A normal adult clivus can enhance to some degree (19/83). Clival tumors were found to enhance intensely. A clivus of very low signal intensity (signal void) on T1- or T2-weighted images was always abnormal. The clivus with marrow reconversion was uniformly hypointense relative to the pons on T1-weighted images and isointense relative to normal marrow on T2-weighted images. The intensity patterns of the normal clivus on T1- and T2-weighted MR images change predictably with advancing age. Intensity patterns of abnormal clivi differ from those of normal clivi. When contrast material is used, normal and abnormal clivi generally show different patterns of enhancement.

Calvarial and skull base metastases: comparison of nonenhanced and Gd-DTPA-enhanced MR images

Fourteen patients with calvarial metastases were studied with magnetic resonance (MR) imaging before and after intravenous administration of gadolinium diethylenetriamine-pentaacetic acid (DTPA) to evaluate the utility of contrast material enhancement for the detection of calvarial metastatic tumor. MR imaging was also performed before and after enhancement in 60 patients for reasons other than evaluation of metastases or calvarial tumor, to determine the apperance of the normal calvaria with enhancement. The normal pattern of fat distribution in the diploic space was typically symmetric. Except for enhancement of diploic veins and meninges near pacchionian granulations, the normal diploic space did not enhance. Calvarial metastases typically enhanced with Gd-DTPA. Enhanced MR images were superior to nonenhanced studies for detecting subtle intradiploic metastases but were inferior to nonenhanced studies for detecting tumor extension into fat-containing areas. Careful comparison of nonenhanced and enhanced MR images is required for complete evaluation of lesions affecting the calvaria and skull base.

Osteocartilaginous tumors in the parapharyngeal space arising from bone exostoses

Three osteocartilaginous tumors that arose from bone stalks were diagnosed by the demonstration, on multiplanar cross-sectional CT and MR images, of the site of stalk attachment to the adjacent mandible (one), skull base (one), and cervical vertebra (one). All three patients presented with signs and symptoms related to mass effect in the parapharyngeal region. Mass effect was more pronounced in the two cases of malignant degeneration (osteosarcoma, chondrosarcoma) than in the single case of benign osteocartilaginous exostosis. Differentiation of benign from malignant osteocartilaginous tumor may be accomplished by appreciating characteristic CT and MR features of the cartilage cap. The differential diagnosis of mass lesions of the parapharyngeal space should include tumors of osteocartilaginous origin.

MR imaging of the normal and abnormal clivus

We retrospectively reviewed 330 T1-weighted sagittal images, 80 T2-weighted sagittal images, and 83 gadopentetate-dimeglumine-enhanced scans of normal adults to determine the MR appearance of the normal adult clivus. MR images of 21 patients with an abnormal clivus (19 with tumor invasion and two with marrow reconversion) were also evaluated restrospectively and compared with those of the control group to assess MR features distinguishing the two groups. Our study revealed that a normal adult clivus consisted of low- and high-intensity portions mixed in various proportions on T1-weighted images. The low-intensity portion was isointense or hyperintense relative to the pons and always contained foci of bright signal intensity. The low-intensity tumor of a pathologic clivus tended to be hypointense relative to the pons (17/19), and was completely devoid of foci of bright signal intensity. The normal adult clivus was approximately isointense relative to the pons on T2-weighted images. Clival tumors were grossly hyperintense relative to the pons on T2-weighted images in 11 of 17 patients. In the remaining six patients, either a portion of or the entire lesion was isointense relative to the pons and, therefore, was not detectable on T2-weighted images. A normal adult clivus can enhance to some degree (19/83). Clival tumors were found to enhance intensely. A clivus of very low signal intensity (signal void) on T1- or T2-weighted images was always abnormal. The clivus with marrow reconversion was uniformly hypointense relative to the pons on T1-weighted images and isointense relative to normal marrow on T2-weighted images.(ABSTRACT TRUNCATED AT 250 WORDS)

[Unusual manifestations of Lyme borreliosis. A contribution to the clinical spectrum of this disease group]

Since the discovery that EM (erythema migrans), ACA (acrodermatitis chronica atrophicans) and BL (borrelial lymphocytoma) have an infectious etiology, these syndromes have been receiving particular attention. This report describes four patients whose dermatological symptoms did not at first indicate borreliosis. In all four cases serological antibody tests proved that they were caused by Borrelia burgdorferi. In two of these cases these findings were confirmed by bacterial cultures. The unusual skin symptoms, i.e. multiple disseminated erythema, erysipelas-like manifestations, swelling and discoloration of the eyelids and lichenoid papules, extend the known clinical spectrum of cutaneous borreliosis in Europe.

Pseudomonas osteomyelitis of the spine. Report of a case not associated with drug abuse

Pseudomonas aeruginosa, as a cause of vertebral osteomyelitis, has previously been described as occurring in drug abusers. Various empirical methods of treatment have been employed without good follow-up studies. This case report provides a radiological and clinical evolution of pseudomonas vertebral osteomyelitis together with a successful treatment regimen in a 73 year old man who had spontaneous onset of the disease.

Volar approach and screw fixation technique for fractures and non-unions of the carpal scaphoid

Delayed or non-union of the carpal scaphoid may be treated in a variety of ways. This article describes the operative technique and clinical results of a volar approach and screw fixation technique, which offers distinct advantages over other approaches. The volar approach to the scaphoid is simple, safe and rapid. It allows access to the fracture for fixation, the radioscaphoid joint for assessment and the distal radius for the procurement of a bone graft where necessary. Access to the volar aspect of the scaphoid is also biomechanically sound as it allows insertion of a wedge-shaped bone graft into the 'collapsed' area of the scaphoid in established non-unions. Compression screwing of the fracture site has the same advantages of stability and early mobilization that applies in other sites. Our clinical experience in 32 fractures has involved a low complication rate with early return of mobility and activity.

[Ultraviolet in dermatology: spectra--instruments--possibilities]

Following an historical review on the development of UV therapy, the clinical, histological and molecular changes in human skin by treatment with UV-B, UV-A and PUVA are discussed. Low- and high-pressure mercury arc lamps, with and without filtering, are produced by several manufacturers and are available for UV therapy. Practical hints and rules for treatment are given.

Candy flavoring as a source of salicylate poisoning

Methyl salicylate (oil of wintergreen) in the form of candy flavoring was ingested by a 21-month-old male infant who subsequently developed vomiting, lethargy, and hyperpnea. A "swallow" of the solution resulted in a serum salicylate concentration of 81 mg/dL six hours after ingestion. The infant was treated with parenteral fluids and sodium bicarbonate and he recovered rapidly. Hazards associated with salicylate use in this form include lack of parental awareness of the substance's toxic potential, the attractiveness of the candy-like odor, and the availability of the liquid in non-child-resistant packaging containing potentially lethal quantities.

[The Dermatology department of the Munich-Schabing Municipal Hospital in changing times]

In July 1914 the Department of Dermatology of the newly built municipal hospital of Munich started to work. The department head, Professor Wilhelm Heuck, established social organizations that were ahead of his time. Nevertheless, in 1931 he had to fight the threatened closure of this department that came about as a result of the increasing amount of outpatient treatment in private practice. Two dermatologists of his school became famous: Vonkennel and Kimmig. His successor, Professor August Poehlmann, managed the difficult circumstances during World War II. The hospital had been confiscated by the occupying forces and the dermatological patients were spread over the city in different hospitals. In 1950 Poehlmann was successful in transferring all patients into the Biederstein hospital. In 1955 Curt Böhm moved the dermatological department back to the hospital of Schwabing. The present head, Professor Hans-Jürgen Bandmann, has nicely refined the triad of patient treatment, teaching and research.

Post-traumatic radioulnar synostosis

There is a paucity of data about post-traumatic radioulnar synostosis, an unusual but serious complication of forearm fractures. Treatment methods have included excision of the synostosis with interposition of soft tissue or synthetic material, excision of the proximal radius, insertion of a screw to distract the radius from the ulna, and a rotational osteotomy of the radius to improve function. In the case of a 28-year-old woman, the treatment was excision of the synostosis, obliteration of the dead space with muscle, prevention of hematoma formation, and early mobilization. The result was an active range of motion of 80 degrees pronation and 60 degrees supination.

Non-pulmonary tuberculosis in Australia

In 1980, out of 1457 new cases of tuberculosis diagnosed in Australia, 816 occurred in migrants, 343 of whom were Vietnamese refugees. Non-pulmonary tuberculosis comprised about 20% of cases. About 14% of the patients presented first to their local medical practitioner.

The Langerhans cell: the master key to contact dermatitis: a hypothesis

A tentative model is presented which is based on existing published data. The model suggests that the epidermal Langerhans cell plays a central role in contact dermatitis by proliferation control of keratinocytes and as the most peripheral outpost of the immune system. Contact dermatitis to chemicals is the injurious expression of a defense mechanism designed phylogenetically against arthropods and insects.

Measurement of erythemal response to ultraviolet radiation by "monochromatic" photography

The main early color change induced by ultraviolet light consists of a decreased oxyhemoglobin reflectance. A method is presented in which the skin together with a calibrated gray scale is photographed using an interference filter with a peak transmission at 540 nm, the region of the specific absorption bands of hemoglobin. On the processed photographs the irradiated skin can then be compared with the calibrated scale and thus the degree of ultraviolet erythema calculated.

[Epidermolysis bullosa dystrophica inversa, a review and case report]

An additional case of epidermolysis bullosa dystrophica inversa is reported. A review of the literature shows that until now reports about probably 15 patients from seven families were published, although the first 13 patients were not investigated by electron microscope [3]. By blistering beneath the basal lamina similar to the Hallopeau-Siemens type these patients develop bullae predominantly at the trunk and the inverse sites of the axillar and genitoanal regions continuously or at close intervals starting shortly after birth. The mucous membranes of the mouth, the esophagus, and the cornea and conjunctiva of the eye are very often involved. By bacterial infection of the skin lesions the patients develop hpochrome anemia. The web-like structures in the esophagus following blistering can be successfully treated by careful dilatation because of the low tendency to scar formation. An autosomal recessive mode of inheritance seems to be most likely.

[Phototoxic and photoallergic reactions of the skin (author's transl)]

Phototoxic and photoallergic reactions of the skin are certainly not very common, but, on the other hand, the complete list of medicinal substances which are accused of causing them is extremely extensive. For this reason, dispensing with many details, an attempt is made to present the basis of such reactions. After irradiation with longwave ultra-violet light, which alone would not have produced inflammation, a reaction occurred through the agency of many drugs which can proceed according to a toxic or allergic mechanism.