Showing papers by "St Thomas' Hospital published in 1982"

Systemic Lupus Erythematosus

Abstract: This review covers major advances in clinical issues related to systemic lupus erythematosus (SLE) published between 1995 and 2000. The classification criteria for both SLE and antiphospholipid syndrome (APS) have been updated, and up to 19 different subsets of neuropsychiatric lupus have been defined. New epidemiological data show that the incidence of new cases and the survival of patients with SLE are both increasing. Several randomised controlled trials have defined the role of cyclophosphamide, methotrexate, antimalarials, and hormonal treatment in the management of SLE. New data are available for drugs such as ciclosporin and thalidomide. Finally, several new treatments for severe refractory cases, such as mycophenolate mofetil and stem-cell transplantation, are being increasingly used. New data also refer to management of thrombosis in APS and high-risk pregnancies in women with SLE or APS.

Intra-prostatic urinary reflux: an aetiological factor in abacterial prostatitis.

Abstract: Summary— That urine might reflux into the prostatic ducts during micturition has never before been proved. Using a suspension of carbon particles it has been demonstrated that this can occur. It is suggested that this may be important both as a route of infection in bacterial prostatitis and as a cause of the inflammatory process in abacterial prostatitis.

Relationships between the metabolism of high-density and very-low-density lipoproteins in man: studies of apolipoprotein kinetics and adipose tissue lipoprotein lipase activity.

Abstract: . In order to gain further insight into the relationship between high-density lipoprotein (HDL) metabolism and plasma triglyceride transport, measurements were made of HDL cholesterol concentration, apoprotein (apo) AI and AII metabolism, very-low-density lipoprotein (VLDL) apo B metabolism, and heparin-elutable adipose tissue lipoprotein lipase (LPL) activity in seventeen subjects with a wide range of plasma triglyceride concentrations (0.8–25 mmol/l). The fractional catabolic rate (FCR) of VLDL apo B was directly related to LPL activity (r=+ 0.80), providing evidence that the activity of the enzyme in adipose tissue is a determinant of the rate of lipolysis of VLDL in man. HDL cholesterol concentration was a positive function of both VLDL apo B FCR (r=+ 0.74) and LPL activity, a finding consistent with previous evidence for the origin of a proportion of HDL cholesterol from ‘surface remnants’ liberated during VLDL catabolism. The FCRs of both apo AI and apo AII were inversely related to VLDL apo B FCR (AI, r= - 0.52; AII, r= - 0.69) and to LPL activity. The synthetic rate of apo AII, but not that of apo AI, was positively correlated with VLDL apo B synthesis (r=+ 0.71). Thus, the metabolism of the major proteins of HDL in man appears to be closely associated with VLDL metabolism.

A comparative study of toxic erythema of pregnancy and herpes gestationis

Abstract: SUMMARY We compared the clinical features, histopathology, immunopathology and immunogenetics of 30 patients with toxic erythema of pregnancy and 24 patients with herpes gestationis. Although we found some clinical and histopathological overlap we highlighted several important differences. In toxic erythema of pregnancy prominent striae were frequently present. Herpes gestationis was suggested by the occurrence of periumbilical lesions, acute exacerbations immediately after delivery, and persistence of the eruption for more than 3 weeks post-partum. In herpes gestationis, immunofluorescence studies were consistently positive, there was a high frequency of HLA-B8 and an association with autoimmune thyrotoxicosis. Toxic erythema of pregnancy did not share these immunological features. Therefore we feel that toxic erythema of pregnancy and herpes gestationis should continue to be classified as separate disorders.

The specific dermatoses of pregnancy: a reappraisal with special emphasis on a proposed simplified clinical classification.

Abstract: Summary There is little insight into the pathogeneses of most of the specific dermatoses of pregnancy, and therefore they have remained poorly classified. The terminology has become increasingly confusing with several names in use for similar clinical conditions. In an attempt to rationalise the nomenclature we have critically reviewed the clinical descriptions of the dermatoses specifically related to pregnancy and we have proposed a simplified clinical classification into three broad categories: (1) pemphigoid gestationis, (2) polymorphic eruption of pregnancy and (3) pregnancy prurigo.

Childhood respiratory illness and the home environment. II. Association between respiratory illness and nitrogen dioxide, temperature and relative humidity.

Abstract: The relation of respiratory illness to nitrogen dioxide (NO2), temperature and relative humidity in homes with a gas cooker was investigated in five and six year old children living in an urban area of the northern England. NO2 was measured for one week in the child's bedroom and living room of each home, and temperature and relative humidity were measured in the bedroom only. Information on respiratory conditions experienced by the child and characteristics of the home was collected in a self-administered questionnaire completed by the child's mother. Access was gained to 183 homes (54.3% of 337) where only gas was used for cooking. Complete information was obtained for 179 (93.7%) of 191 children who lived in the 183 homes. After allowing for the effects of age, sex, social class, and number of cigarette smokers in the home and temperature or relative humidity, no statistically significant relation was found between the prevalence of having one or more respiratory conditions and weekly average levels of NO2 in the bedroom (range 4.7 to 160.8 ppb) or living room (range 9.0 to 292.2 ppb). However, the prevalence of having one or more respiratory conditions tended to be highest in homes with high levels of NO2 and lowest in homes with low levels, consistent with earlier findings. A significant positive association was found between the prevalence of respiratory conditions and relative humidity (p less than .05). A harmful effect on health from NO2 cannot be totally dismissed but if it exists it is weak and difficult to detect in small samples of children.

Hypopigmented mycosis fungoides: report of five cases with ultrastructural observations

Abstract: Five dark-skinned individuals presented with widespread well-demarcated hypopigmented lesions, biopsy of which revealed the histopathological features of mycosis fungoides. Ultrastructural studies showed focal invasion of the epidermis by mycosis cells with degenerative changes in adjacent melanocytes and keratinocytes. The majority of melanocytes exhibited swelling of cytoplasmic organelles and disordered melanogenesis with production of spherical incompletely melanized melanosomes. In addition disintegrating melanocytes were occasionally seen. Perifollicular repigmentation within hypopigmented areas occurred in two patients following clearing of the epidermal infiltrate with PUVA therapy. Mycosis fungoides may present with areas of cutaneous hypopigmentation.

Carbamazepine (‘Tegretol’) and toxic epidermal necrolysis: report of three cases with histopathological observations

Abstract: Summary Three patients who developed toxic epidermal necrolysis whilst receiving carbamazepine are described. Two patients experienced severe oropharyngeal ulceration and extensive cutaneous necrolysis with subsequent transient alopecia, nail shedding and persistent ulceration of the tongue. Histology of the skin revealed changes resembling those found in not only erythema multiforme and toxic epidermal necrolysis but also homograft rejection and the acute graft-versus-host reaction, suggesting that cutaneous damage was mediated by ‘aggressor lymphocytes’ sensitized to epidermal cells.

Demyelination induced in mice by avirulent Semliki Forest virus. II. An ultrastructural study of focal demyelination in the brain.

Abstract: Kelly W.R., Blakemore W.F., Jagelman S. & Webb H.E. (1982) Neuropathology and Applied Neurobiology 8, 43–53 Demyelination induced in mice by avirulent Semliki Forest virus. II. An ultrastructural study of the focal demyelination in the brain Four-week-old mice were infected intraperitoneally with an avirulent strain A7(74) of Semliki Forest virus (SFV) and killed at 4, 10, 15, 21 and 29 days after inoculation. Focal demyelinating lesions were present by 10 days. These were usually accompanied by a mononuclear infiltrate which included lymphocytes possessing characteristic cytoplasmic projections. These latter extended deep into the cytoplasm of adjacent cells, which were usually astrocytes and macrophages. Other features of the focal lesions were expansion of the extracellular space and demyelination which appeared to be fragmentation or lysis rather than stripping of myelin by macrophages. Although healing occurred in some mice after 4 weeks, acute lesions were still found in others of the same age. It was concluded that the demyelination probably had an immunological basis, and interaction between elements of the immune system and glial cells was a factor which inhibited orderly remyelination of the relatively mild lesions resulting from this infection.

Lymphomatoid papulosis and pityriasis lichenoides: are they related?

Abstract: Ever since Macaulay (1968) first introduced the term lymphomatoid papulosis there has been continued speculation as to its nosological identity. Even today there is still no absolute consensus—this in itself suggests that possibly a number of different diseases may simulate both the clinical and histological changes seen in lymphomatoid papulosis. The purpose of this article is to look at the spectrum of lymphomatoid papulosis and suggest a definition and subdivision which may help clinicians dealing with these rarer problem cases. In doing this the author cannot consider himself to be an 'innocent bystander' since, as will be seen shortly, he is firmly committed to the view that, at least in part, lymphomatoid papulosis is closely related to pityriasis lichenoides. Broadly there have been three opinions concerning the nosology of lymphomatoid papulosis: (1) Lymphomatoid papulosis as a variant of pityriasis lichenoides (Verallo & Haserick, 1966; Pinol Aguade, Rubio & Grimalt, 1967; Couperus, 1967; Muller & Schulze, 1971; MacMillan & Vickers, 1971; Black & Wilson Jones, 1972; Valentino & Helwig, 1973). (2) Lymphomatoid papulosis as a lymphoreticular neoplasm: lymphomatoid papulosis eventuating as a malignant lymphoma (Samman, 1964); histiomonocytic reticulosis (Dupont, 1965); skin reticulosis (Takada, 1968)5 malignant reticulosis (Kawada et al., 1969); mycosis fungoides (Fine, Meltzer & Rudner, 1974; Lutzner et ah, 1975; Brehmer-Anderson, 1976; Thomsen & Schmidt, 1977); Hodgkin's disease (one case), lymphocytic lymphoma (one case) (Sheen, Doyle & Winkelmann, 1981); Hodgkin's disease (Dowd, Munro & Stansfeld, 1981); systemic lymphoma (Messenger, Marshall & Summerly, 1981). (3) Lymphomatoid papulosis as a distinctive disease by clinical, histological and biological criteria which may be differentiated histologically from pityriasis lichenoides and mycosis fungoides in nearly every instance (Weinman & Ackerman, 1981; Haserick, 1981).

Subtrigonal phenol injection for urge incontinence secondary to detrusor instability in females

Abstract: Thirty female patients with urge incontinence or bypassing an indwelling urethral catheter have been treated by subtrigonal phenol injection. All were proven to have detrusor instability. The injection method is described. Seventy-six per cent of patients were rendered dry. The urodynamic changes are recorded.

National study of health and growth: social and family factors and obesity in primary schoolchildren.

Abstract: The association of social and family factors with triceps skinfold and weight for height and age was assessed using multiple regression analyses for 5-11 year-old-children in England and Scotland. Parents' body build was the factor most consistently associated with the two proxy measures of obesity. Number of siblings in the family was inversely related to triceps skinfold thickness. Parents' body-build and number of siblings were more strongly related to our measures of obesity in the older age groups and in girls, whereas child's birth-weight was more associated with weight for height and triceps skinfold in the younger age groups. Father's social class and mother's education made almost no contribution to the variation of triceps skinfold and weight for height in children. The relative risk of obesity associated with any individual independent variables was less than or around two. We conclude that there is little scope for identifying the majority of children at risk of obesity in a characteristic social environment. However, the increase in the association between our measures of obesity in parents and older children provides a possible tool for the early detection of children who may become obese.

Wegener's granulomatosis presenting as pyoderma gangrenosum.

Abstract: Summary This case report illustrates that pyoderma gangrenosum may be the only presenting feature of Wegener's granulomatosis The pyoderma gangrenosum lesions were in this case effectively treated by minocycline hydrochloride but this did not prevent the later manifestations of Wegener's granulomatosis from developing

Follicular mucinosis associated with mycosis fungoides presenting with gross cystic changes on the face.

Abstract: Mrs M.W., a 68-year-old widow, had suffered from recurretit boils atid cysts on her face for 10 years. Over the last 3-4 years her skin had become generally thickened and she had developed numerous nodules, cysts and plaques over most of her face. Smaller plaques also appeared on the trunk and limbs with plugged follicles and smaller cyst formation. There was complete loss of hair from the right eyebrow.