Canadian/U.S. health systems: asking the right questions.
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Biomedical subjects
Publications and source records attributed to J Ring.
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In cultures of peripheral blood mononuclear cells (PBMC) from 23 atopic patients and 14 controls the influence of mitogens, allergens and CD8 suppressor T lymphocytes on the in vitro IgE response was studied. The in vitro IgE levels in lymphocyte culture supernatants reached a plateau after 6 days of culture, whereby low levels of IgE could be reproducibly measured down to 0.5 ng/ml. The spontaneous in vitro IgE secretion from PBMC of atopic eczema patients was elevated in comparison to the control group and showed a direct correlation (r = 0.72) to the serum IgE levels. Pokeweed mitogen rather suppressed the in vitro IgE production. After removal of the CD8 subpopulation of T lymphocytes by using an indirect erythrocytes rosetting technique we found increased in vitro levels pointing to a role of IgE regulating T suppressor subpopulations.
Apart from increased production of immunoglobulin E antibodies and disturbed T-cell regulation, altered patterns of releasability of vasoactive mediators have been described in patients with atopic eczema. The best studied substance is histamine which is a classical inducer of pruritus in man. Elevated concentrations of histamine have been found in vivo in the skin and in the plasma of patients with atopic eczema especially during exacerbation of the disease. Similar findings have been described for other atopic diseases as extrinsic bronchial asthma. Histamine acts via characteristic receptors; symptoms as itch, wheal formation, mucus production, contraction of smooth muscle, tachycardia H2-effects include acid secretion in the stomach as well as the development of flush and itch reactions, blood pressure changes and cardiac arrhythmia. Of special interest is an inhibitory effect of histamine on lymphocyte reactions mediated via a H2-receptor. The existence of a new H3-receptor in the brain serving as autocrine feed-back inhibitor of histaminergic neurones has been established in the rat but not yet in man. In vitro an increased histamine releasability of peripheral leukocytes has been found after stimulation with a variety of different substances. The difference between patients with atopic eczema and normals is generally most pronounced after stimulation with anti-IgE. There is, however, a tendency towards an increased spontaneous histamine release compared to normals. The release reaction of histamine seems to occur more rapidly in atopics compared to normals.(ABSTRACT TRUNCATED AT 250 WORDS)
A 66-year-old female patient developed within 2 years clinical symptoms of hyalinosis cutis et mucosae due to a plasmocytoma with monoclonal IgG-light-chain gammopathy. The clinical diagnosis was supported by light- and electron-microscope studies. The form of hyalinosis cutis et mucosae described by Urbach and Wiethe is a genetic disease with its onset in early childhood. For this reason, we propose the designation "acquired hyalinosis cutis et mucosae" for the case reported here.
Between 1831 and 1929, the department of dermatology and venereology in Munich achieved an outstanding reputation for excellence, which was recognized both in Germany and elsewhere. Such eminent personalities as Joseph von Lindwurm and Leo Ritter von Zumbusch were especially influential in this development.
Keratoacanthoma centrifugum marginatum (KCM) is a rare distinct variant of keratoacanthoma. Based on three personal observations and a review of the literature, the authors describe the clinical and histological features of this neoplasm. Clinically KCM is characterized by the lack of a tendency for spontaneous remission and by continuous centrifugal spread. Histologically there is a subclinical, iceberg-like growth pattern. Like keratoacanthoma, KCM is a highly differentiated, biologically benign, non-metastasizing tumour. The treatment of choice is early excision of the tumour.
Five alk(en)ylsulfinothioic acid alk(en)yl-esters isolated from onions and four synthetic thiosulfinates inhibited 5-lipoxygenase of porcine leucocytes, histamine release and leukotriene B4 and C4 biosynthesis of human polymorphonuclear leucocytes, thromboxane B2 biosynthesis by human platelets and allergen- and PAF-induced bronchial obstruction of guinea-pigs. The anti-asthmatic and anti-inflammatory effects of onions depend in part on the thiosulfinate moiety: (Formula: see text).
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We have quantified Langerhans cells (LC) in cryosections of normal human skin and lesional skin from patients with atopic eczema and psoriasis vulgaris using six different methods. The results from the different methods varied considerably and were sometimes contradictory, for example when LC numbers in psoriatic skin were compared with those in normal skin. Thus, in addition to the staining technique used and the selection of the dendritic cell type to be counted, the enumeration method used can also influence the quantitation of LC in normal and pathological skin.
Thirty-seven men (36 homosexual or bisexual and one heterosexual) with epidemic Kaposi's sarcoma and underlying HIV infection were followed up over a period of up to 32 months. Fourteen patients (38%) died, with a median survival time of 7.2 months after the diagnosis of AIDS. Seventeen patients (46%) presented with one or more opportunistic infections, mostly Pneumocystis carinii pneumonia. Eighteen patients (49%) had lymphadenopathy syndrome according to the definition of the CDC. Using the Laubenstein-classification of Kaposi's sarcoma, all patients either remained stable or deteriorated, improvement was never observed. Absolute T4 lymphocyte counts and the T4/T8 ratio were not related to the disease stage. With the onset of B symptoms (systemic symptoms), however, the absolute T4 numbers and the T4/T8 ratio markedly decreased. Delayed type hypersensitivity also showed no relationship to the clinical stages of Kaposi's sarcoma. Thus, the clinical progression of Kaposi's sarcoma lesions seems to be largely independent of the immunological parameters investigated. However, the onset of B symptoms was observed to be related to changes in immune status.
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A standard patch test series was tested for 7 years (1977-1983) in a total of 11,962 patients. The annual frequency of positive reactions to the compounds tested was assessed for the total and for males and females separately. During the observation period, there were significant increases in positive reactions in the total group from 6.2% to 12.7% for nickel sulphate, from 5.3% to 7.0% for balsam of Peru and from 3.8% to 6.5% for potassium dichromate, reflecting significant changes in both sexes. The frequency of positive reactions to wool alcohols, formaldehyde, neomycin sulphate, paraben mix and gentamycin sulphate significantly increased, while that of positive reactions to clioquinol, mercuric chloride and turpentine peroxide significantly decreased in either males or females, sometimes leading to significant changes in the total group.
A new, standardized, ready-to-apply patch test, the TRUE Test, has been evaluated on 698 consecutive patients with suspected contact dermatitis. The patients were tested with 12 different allergens. Simultaneously, the same 12 allergens in pet. (Trolab) were applied symmetrically to the opposite side of the upper back using the conventional Finn Chamber technique. There were positive test reactions to all 12 allergens tested in the patient group. The concordance of positive reactions between the TRUE Test and the Finn Chamber test was 67%; 13% of all positive reactions were recorded only for the TRUE Test and 20% only for the Finn Chamber method. The frequency of questionable and irritant reactions was of the same low order of magnitude for both test methods; such reactions were recorded in around 2% of all test patches.
The design of a prospective phase-II study on the treatment of Kaposi's sarcoma (KS) in patients with HIV infection is described. In this study the toxicity and antineoplastic activity of high-dose alpha-interferon (20 x 10(6) U/m2 s.c. daily) will be investigated in patients with advanced and progressive KS. Patients with progressing KS during IFN treatment or with relapsing KS after IFN will be treated with vinblastine (4 mg/m2 i.v., days 1, 8, and 15) and bleomycin (15 mg i.v., days 1 + 8). The study was only recently activated; results are so far not available.
In 38 patients with polymorphous light eruption (PLE) photoprovocation tests were performed by applying 100 J/cm2 of UV-A to the extensor side of the upper arm on three consecutive days. Test sites were divided into four areas by covering the patients' skin with Schott glass filters WG 320, WG 335, WG 360, and GG 385 (or GG 395). In 17 patients typical skin lesions could be provoked in at least one test field. 10 patients reacted either at all test sites or at shorter wavelengths (simultaneously higher doses) only. In the remaining 7 patients test reactions did not occur underneath filters with lower cut-off points, whereas skin lesions were induced by radiation deprived of the shorter wavelengths passing through these filters. This observation suggests an inhibitory effect of shorter wavelengths in these cases.
In 181 patients with systemic reactions to hymenoptera stings as a result of immediate-type allergy to bee or wasp venom confirmed by history, skin testing and demonstration of hymenoptera venom-specific IgE antibodies on radioallergosorbent testing (RAST), in vitro histamine release from peripheral basophilic granulocytes following stimulation with bee or wasp venom was evaluated. Suspensions of washed peripheral leukocytes at a density of 2 x 10(6)/ml were incubated with four different concentrations of hymenoptera venoms. Histamine was measured by spectrofluorometry, and histamine release was calculated as a percentage of the total histamine content. Tests performed with peripheral leukocytes obtained from 18 non-allergic individuals served as controls. In both bee venom allergy and wasp venom allergy the corresponding allergen induced concentration-dependent histamine release. Upper normal limits of histamine release were defined for the venom concentrations used. When these were used as reference values the basophil histamine release test exhibited a specificity of 94% and a sensitivity of 82% in the diagnosis of bee venom allergy, and a specificity of 83% and a sensitivity of 68% in the diagnosis of wasp venom allergy. Since there was no relevant significant correlation between the results of the basophil histamine release test on one hand and the severity of sting reactions and the prick test and RAST results on the other, it seems that the histamine release test determined additional parameters of sensitization. Thus, the method is a valuable adjunct to the in vitro methods available for the diagnosis of hymenoptera venom allergy.
Single oral doses (5, 10 and 15 mg) of the new H1-receptor antagonist 3,7-dihydro-7-[2-hydroxy-3-[4-[3-phenylthio) propyl]-1-piperazinyl]propyl-1,3-dimethyl-1H-purine-2,6-dione dihydrochloride (tazifylline, RS-49014) were administered at 7-day intervals to 12 atopic and 12 non-atopic volunteers in a double-blind randomised cross-over study. Antiallergic activity was evaluated from pre to 60 min post dose inhibitions of wheal and flare areas provoked by various cutaneous challenges. Atopic subjects showed greater skin reactivity than non-atopics to some challenges. Tazifylline was associated (in atopics and non-atopics) with statistically significant dose related inhibitions, of flare over 5-15 mg and of wheal (10-15 mg) induced by the more potent and reproducible challenges of codeine, 1% histamine and anti-IgE. Antiallergic activity of tazifylline in the 10-15 mg dose range was superior to 5 mg without the intervention of clinically significant sedative effects at any of the 3 dose levels tested.