Biomedical subjects
Publications and source records attributed to M L Price.
Autopsy findings in a patient who had an adrenal-to-brain transplant for Parkinson's disease 4 months before his death showed adrenal tissue in the basal ganglia, but it was necrotic. Symptomatic improvement lasted for only 2 weeks.
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A total intravenous anaesthetic technique with a propofol infusion for maintenance of anaesthesia was compared with an inhalational technique that used oxygen, nitrous oxide and enflurane in 98 unpremedicated patients who presented for day case surgery. Overall quality of anaesthesia during induction and maintenance was comparable in both groups. Quality of maintenance of anaesthesia in the propofol group was improved by an increase of the initial infusion rate from 12 to 15 mg/kg/hour. There was a larger decrease in arterial blood pressure after induction in the propofol group but no difference in blood pressure between the groups during maintenance. Recovery times and scores using the Steward scoring system were not significantly different. Nausea and vomiting were slightly less frequent in the propofol group.
The histopathological appearance of proliferative squamous lesions removed from the skin of iatrogenically immunosuppressed patients differs subtly from that of classical malignant and premalignant epidermal lesions. The majority of cases show 'Bowenoid' changes with a marked degree of cellular atypia including characteristic multinucleate cells.
The clinical and histopathological features of 12 female patients with Flegel's disease were studied. The onset of this dermatosis was delayed until adulthood. The eruption consisted of scaly papules 1-5 mm in diameter which developed principally on the lower legs, upper arms and pinnae. Histopathologically there were discrete foci of hyperkeratosis with some parakeratosis over an attenuated and partially spongiotic epidermis. A genetic influence in this disorder was suggested by its occurrence in sisters in two families and in a mother and daughter. Immunohistochemical and biochemical studies suggested that there is a disorder of keratinocyte proliferation in the disease.
An ultrastructural study of lesional skin from 4 subjects with hyperkeratosis lenticularis perstans (Flegel's disease) demonstrated variable numbers of lamellar bodies of normal size and architecture within cells of the stratum granulosum and the upper stratum spinosum. Their characteristic lamellate inclusions were frequently observed within the intercellular spaces. These observations suggest that the lamellar bodies are qualitatively normal in Flegel's disease.
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Localized persistent pigmented macules and plaques due to a chronic form of pigmented purpuric dermatitis are described in forty-two patients. The designation 'lichen aureus' for this eruption can be justified because of the striking yellowish or bronze-like colour assumed by many of the lesions. The lower legs were the commonest sites but other body regions can be affected also. Histologically lichen aureus differs from other pigmented purpuric dermatoses in the density of the lichenoid tissue reaction and the marked accumulation of pigment-containing macrophages. Recently developed endothelial cell markers have been studied in selected cases.
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Twenty-nine atopic children aged 3-12 years were given elimination diets for 3 weeks, individual groups of foods being then reintroduced over 6 weeks. Most children improved whilst dieting and relapsed on return to normal food intake. In all but 4 cases some food group which caused exacerbation of symptoms was identified, fruits and colourings proving more of a problem than milk and eggs. Taking into account these suspected food allergens, tailored diets were designed for each child. Using these diets the group participated in a double-blind crossover trial of oral sodium cromoglycate (SCG) versus placebo. Twenty-two patients completed the trial. The results indicated that tailored diets were of value in the management of eczema but SCG did not produce a significant additional effect. At follow-up 1 year later most children were adhering to their diet; thirteen were better and only three worse. Children who had initially continued using SCG had stopped it; no accompanying change in their eczema was noticed. A considerable reduction in the use of topical steroids was observed, in marked contrast to previous requirements. Sequential measurements of total serum IgE (PRIST) showed variable changes apparently unrelated to recent SCG therapy. There was little agreement between skin prick tests and specific IgE (RAST) to corresponding foods. Correlation between RAST and food challenge was poor for positive results (r = 0.39) but good for negative results (r = 0.99).
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A study of dermatopathological specimens exhibiting parakeratosis has been made and the parakeratosis classified on morphological and topographical criteria. Twelve patterns of parakeratosis have been identified and their association with particular pathological conditions described.
The underlying cause of atopic eczema remains unknown but both food intolerance and dietary deficiency--notably of essential fatty acids--may well be exacerbating factors. Studies investigating the involvement of food intolerance have shown that only some children obtain benefit from avoiding milk and eggs. In other cases, the use of an elimination or of a chemically-defined diet followed by challenge with specific foods may allow an effective personalized diet to be devised. Skin-prick tests and measurement of IgE levels have proved to be unreliable predictors of reactions to food. The development of a reliable test to assess food intolerance would represent a significant advance in the treatment of atopic eczema.