摘要:

SUMMARYIntermediate thickness (0.76–1.69 mm) clinical stage I melanomas at BANS locations (upper Back, posterior Arm, posterior Neck, posterior Scalp) were initially reported to have worse prognosis than similar thickness lesions at other subsites. Subsequent investigation did not support this observation. We re‐examined the hypothesis in 156 consecutive patients with clinical stage 1 melanomas in this thickness range, who were seen at the Massachusetts General Hospital from 1977 to 1985. Patients with BANS lesions suffered recurrences at twice the rate of those with non‐BANS lesions (28% compared with 13% at 5 years after excision of the primary melanoma), but this difference was not statistically significant.A meta‐analysis of the effect of BANS subsite on death risk was performed using data from our investigation and five comparable published studies. The original data set which led to the BANS hypothesis was excluded from the meta‐analysis in order to avoid bias. BANS location was associated with a 60% increased risk of death (P = 0.002). The difference remained statistically significant after elimination of any two of the six studies from the analysis. This confirms the influence of anatomical subsite on the prognosis of intermediate thickness

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1988.tb03465.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYExperiments were performed to examine the hypothesis that the surface expression of HLA‐DR by keratinocytes in certain disease states is conferred by the activity of gamma‐interferon, derived from dermal activated T lymphocytes.In vivostudies revealed a spatial relationship between keratinocyte HLA‐DR expression and activated T lymphocytes within the dermal inflammatory infiltrate.In vitrostudies confirmed that gamma‐interferon can induce keratinocyte synthesis of HLA‐DR. These results suggest that,in vivo, gamma‐interferon produced by activated T lymphocytes induces keratinocyte HLA‐DR synthesis a

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1988.tb03466.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYEndoscopic gastrointestinal mucosal biopsy specimens from one patient with systemic mastocytosis and five with urticaria pigmentosa (UP) were fixed with Carney's reagent and then stained for chloracetate esterase. The mast cell population densities were enumerated in the mucosa using cursor planimetry. Compared with controls, mast cell counts were increased in gastric and duodenal but not sigmoid mucosae. On a histological basis, systemic involvement would appear commoner in urticaria pigmentosa than is generally expected. Gastrointestinal symptoms did not relate to elevated mucosal mast cell counts.

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1988.tb03467.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYDuodenal biopsies from 29 adult atopic dermatitis (AD) patients with multiple positive skin prick test reactions were examined and the results compared with biopsies from 13 non‐atopic controls. The duodenal mucosa showed mild inflammatory changes in six out of the 29 patients, but was normal in all the controls. Numerous anti‐IgE positive cells, increasing with the severity of AD, were found in the duodenal mucosa in 25 of the 29 AD patients compared with few sporadic positive cells seen in only two out of 13 controls (P<0. 001). The total serum IgE level showed a significant positive correlation with the number of anti‐IgE stained cells in the mucosa (P<0.05). No significant differences were found in the total number of toluidine blue stained cells or cells immunoreactive for histamine between patients and controls. However, AD patients who had high numbers of anti‐IgE positive cells often had decreased numbers of histamine immunoreactive cells in the mucosa suggesting mast cell degranulation. These findings provide further evidence that also in adult AD patients the gastrointestinal tract may serve as a portal of entry for allergens which may lead to exacerbatio

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1988.tb03468.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYWe have studied biopsies of lesional skin with monoclonal and polyclonal antibodies to determine the nature of the infiltrate in different forms of psoriasis. In guttate psoriasis the number of Langerhans cells (LC) was not increased and CD8 + cells predominated, however, most CD4+ cells were activated. In erythrodermal psoriasis some CD1 + cells were found in the dermis although CD8 + cells predominated and were activated. In palmo‐plantar psoriasis LC were found in the epidermis and superficial dermis and CD4+ cells were more numerous than CD8 + cells, some in turn expressing HLA‐DR. In flexural psoriasis the LC formed clusters in the epidermis, and activated CD4+ cells predominated. In psoriasis vulgaris CD4+ cells predominated over CDS + although the latter were activated. Our observations tend to support Valdimarsson's hypothesis on the immune basis of psoriasis, but we believe that two cycles coexist in psoriasis—one inflammatory and the other immunological—and that interaction between these leads to epidermal hyperprolif

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1988.tb03469.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYIn an ongoing study of patients on long‐term etretinate (Tigason) therapy, 13 patients with a congenital or inherited disorder of keratinization and 10 patients with psoriasis were examined to investigate the incidence of, and the factors associated with, skeletal hyperostosis. Skeletal scintigraphy, plain radiographs, haematological and biochemical analyses were performed. Using all criteria, 7 of 13 patients with a congenital or inherited disorder of keratinization showed evidence of hyperostosis. No single investigation was able to detect all these cases; in particular, skeletal scintigraphy was positive in only nine of the 13 patients who showed hyperostosis. Eleven of the 13 patients with hyperostosis gave a history of musculoskeletal symptoms compared with three of the 10 patients without hyperostosis. There was no clear association with total dose or duration of treatment. Serum chemistry and haematological studies were normal. In two patients the 24‐h urinary calcium excretion was significantly elevated, an abnormality which has not been described previously. Annual lateral thoracic spine radiographs with additional views of symptomatic areas are recommended for patients on long‐term etretinate th

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1988.tb03470.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYSkeletal toxicity is known to occur with high doses of isotretinoin (>2 mg/kg/day). We have attempted to evaluate the clinical significance and document the extent of musculoskeletal toxicity associated with a relatively low dose of isotretinoin (0.5 mg/kg/day) used in the treatment of severe acne. Radiographs of 120 patients were examined. Twelve per cent showed minor changes (four patients had spinal hyperostoses and 10 had calcaneal hyperostoses). None of the musculoskeletal changes we observed was clinically significant. Comparison with matched control X‐rays showed 8% of the controls to have similar non‐significant changes. Follow‐up of 11 of the patients with abnormal X‐rays showed minor deterioration in one patient, no change in four and improvement in six. Thus, doses of 0.5 mg/kg/day isotretinoin in such patients did not produce any significant long‐term musculoskeletal changes. With increasing use of this beneficial drug in acne, radiologists and dermatologists should be aware of its skeletal

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1988.tb03471.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYA water based 5% benzoyl peroxide gel (Benzac® W5) was compared with topical 1% clindamycin phosphate solution (Cleocin T®) in the treatment of acne vulgaris using a randomized, investigator blind study design. Lesion counts were significantly reduced in both treatment groups over the 12‐week study period; however, the reduction of total lesions produced by benzoyl peroxide gel was significantly greater than that produced by clindamycin phosphate (P<0.05). Clindamycin phosphate had a milder effect on the skin surface in terms of peeling and drying than the benzoyl peroxide

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1988.tb03472.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYTwenty four of 30 patients with chronic plaque psoriasis completed a double‐blind randomized paired comparison of dithranol in Lassar's paste versus dithranol and fluocinonide in Lassar's paste. There was a more rapid reduction in severity of the psoriasis on the side treated with the dithranol and fluocinonide mixture, but no difference in the final time to clearance between the two sides. There were fewer burning episodes on the side treated with dithranol and fluocinonide and greater staining of the skin. Of the 20 patients who were subsequently followed up for up to 3 months, 11 had relapsed more on the side treated with dithranol and fluocinonide, two on the side treated with dithranol alone and in seven there was no appreciable difference. It was concluded that the addition of a topical steroid to a conventional dithranol regimen produced more rapid initial clearance and less burning, but more rapid relapse of the psoriasi

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1988.tb03473.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYThe effects of zinc sulphate and azelaic acid on 5α‐reductase activity in human skin were studied using anin vitroassay with 1,2[3H]‐testosterone as substrate. When added at concentrations of 3 or 9 mmol/1, zinc was a potent inhibitor of 5α‐reductase activity. At high concentrations, zinc could completely inhibit the enzyme activity. Azelaic acid was also a potent inhibitor of 5α‐reductase; inhibition was detectable at concentrations as low as 0.2 mmol/l and was complete at 3 mmol/l. An additive effect of the two inhibitors was observed. Vitamin B6 potentiated the inhibitory effect of zinc, but not of azelaic acid, suggesting that two different mechanisms are involved. When the three substances were added together at very low concentrations which had been shown to be ineffective alone, 90% inhibition of 5α‐reductase activity was obtained. If this inhibition is confirmedin vivo, zinc sulphate combined with azelaic acid could be an effective agent in the treatment of androgen related pathology

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1988.tb03474.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY