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Biomedical subjects

P Klemp

Publications and source records attributed to P Klemp.

At least 55 records · Page 3Linked to original sources

The effects of antipsoriatic treatment on cutaneous blood flow in psoriasis measured by 133Xe washout method and laser Doppler velocimetry.

In 8 patients with psoriasis vulgaris, the cutaneous blood flow (CBF) was measured simultaneously in both involved and uninvolved psoriatic skin before (i.e., on the first day of hospitalization) and on the 3rd, 7th, 14th, and 28th days of treatment with tar. The 133Xe washout method was used after epicutaneous labeling and compared to the laser Doppler velocimetry (LDV) technique. Control experiments were performed in 10 normal individuals. Before treatment the mean CBF in involved psoriatic skin was 62.6 +/- 18.7 SD ml X (100 g X min)-1, which is significantly higher than CBF of uninvolved skin in psoriatic patients, 9.5 +/- 4.0 SD ml X (100 g X min)-1, (p less than 0.01) and is 13.6 times higher than CBF in the normal individuals (p less than 0.01). Fifty hours following onset of treatment (i.e., after only 2 applications of tar), mean CBF of the involved psoriatic skin had decreased significantly to 35.0 +/- 13.9 SD ml X (100 g X min)-1, (p less than 0.01), which was not statistically different from the CBF on the 7th day. During the following weeks, the CBF in involved psoriatic skin decreased at a more moderate rate than that observed during the first week and was 15.0 +/- 6.1 SD ml X (100 g X min)-1 on the 28th day. This value is not significantly different from the CBF of uninvolved skin in these patients. At the end of treatment, the CBF of the uninvolved skin had decreased significantly (p less than 0.05) in all the patients to values similar to those observed in the skin of normal individuals. A parallel decline was observed in a clinical psoriatic score index; however, it is not known whether the observed decrease in CBF was preceded or succeeded by the clinical improvement. A comparison of the 133Xe measurements and LDV measurements in the normal individuals by linear regression analysis yielded a correlation coefficient of -0.24 (N = 20, p greater than 0.05). In the skin of psoriatic patients the correlation coefficient was 0.01, (N = 47, p greater than 0.05) for unaffected skin, and 0.61 (N = 47, p less than 0.001) in the involved psoriatic skin sites. The LDV measurements did not reflect changes in the uninvolved skin in psoriatic patients during treatment and resulted in a remarkably high C.V. in the bilateral measurements of skin in normal individuals (43.8%) compared to the C.V. of 133Xe flow measurements (14.8%). It is concluded that while the LDV method gives a rough estimate of blood flow in cutaneous tissue with a high capillary perfusion rate, inaccurate measurements are made in skin areas with normal to twice the normal CBF range.

Adolescent↗

The Klippel-Trenaunay syndrome with acro-angiodermatitis (pseudo-Kaposi's sarcoma).

A patient with the Klippel-Trenaunay syndrome and pseudo-Kaposi elements is reported. This combination of symptoms has only been published very occasionally. Selective quantitative measurements of the peripheral tissue blood flow revealed a significantly increased cutaneous blood flow in the hypertrophied leg. This finding supports the assumption that a high perfusion rate and a high oxygen saturation are involved in the etiopathogenesis of the pseudo-Kaposi elements.

Acrodermatitis↗

Systemic lupus erythematosus in 3 black South African men. Case reports.

Only 1 case of systemic lupus erythematosus (SLE) has been documented in a South African Black man. We report 3 further patients, 1 each from Cape Town, Durban and East London, diagnosed between 1978 and 1982. All 3 patients fulfilled the revised American Rheumatism Association criteria for the classification of SLE.

Adult↗

Local regulation of cutaneous blood flow in psoriasis.

Local regulation of cutaneous blood flow (CBF), i.e., the venoarteriolar reflex mechanism and the autoregulation response, was studied in 27 patients with psoriasis using atraumatic epicutaneous 133Xe-labeling tracer washout technique. Venous stasis of 40 mm Hg induced a significant reduction in CBF--as in normal subjects (i.e., a vasoconstrictor response)-in both involved psoriatic skin (0.47 +/- SEM 0.04, p less than 0.0001) and uninvolved psoriatic skin (0.38 +/- SEM 0.03, p less than 0.0001). The vasoconstrictor response to neural blockade with lidocaine was investigated in two control experiments in psoriatic skin. It was found to be normal: neural blockade with lidocaine 2 cm outside the measured field did not affect the vasoconstrictor response, whereas local infiltration with lidocaine did block the vasoconstrictor reflex. Limb elevation of 40 cm above heart level induced a 2-fold significant increase in the CBF of involved psoriatic skin in 10 patients. This response is a paradoxical deviation from normal local autoregulation of the CBF (p less than 0.002). Limb elevation had no significant influence on CBF of uninvolved psoriatic skin, indicating a normal autoregulation of the CBF. The paradoxical increase in CBF during limb elevation in involved psoriatic skin was not influenced by local neural blockade with lidocaine, or by local neural and vascular, smooth muscle blockade obtained by injection of lidocaine and papaverine. The results indicate that the reason for this paradoxical phenomenon might be due to the special morphology of the capillaries of involved psoriatic skin.

Adult↗

Quantification of cutaneous oedema in patch test reactions by measurement of skin thickness with high-frequency pulsed ultrasound.

69 doubtful and positive patch test readings (?+21, +23, ++18, 7) in 15 contact dermatitis patients were studied by measurement of skin thickness as an expression of allergic oedema. Exposed skin was compared with a regional control. Skin thickness was measured by 15 MHz pulsed ultrasound (A-scan) to 0.1 mm accuracy. The ?+, +, ++, and reactions could be separated by measurements of absolute difference in thickness (p less than 0.001, p less than 0.001, p less than 0.02) between exposed and non-exposed skin; the mean increases were 0.14, 0.49, 0.93, and 1.37 mm. The ?+, +, and ++ reactions, but not the reactions, could also be separated by measurements of relative increase in skin thickness (p less than 0.001, p less than 0.001, n.s.); the mean increases were 7%, 25%, 50% and 55%. The normal thickness of the skin of the back was shown to have increased (p less than 0.02) in patients with reactions only. It is concluded that the high-frequency ultrasound method is suitable for quantification of doubtful and positive patch test reactions. The reactions are probably explained by the normal thick skin of the back, and they need no separate recording in patch testing. Standards of increase in skin thickness in doubtful and positive patch tests are defined: absolute increase (mm) was ?+ less than or equal to 0.2; +0.3-0.7; ++0.8-1.3 ( greater than or equal to 1.4); relative increases were ?+ less than 15%; +15-45%, ++ ( included) greater than 45%.

Adult↗

Hypermobility and injuries in a professional ballet company.

A study was conducted on members of the Cape Performing Arts Board (CAPAB) professional ballet company to determine the prevalence of hypermobility and to document the injuries sustained over a ten year period. If forward flexion, which is acquired through training, is excluded as a parameter the difference in hypermobility between dancers and controls is not statistically significant. Considering the stresses imposed on the musculoskeletal system, the number of injuries was surprisingly low. Ligamentous injuries about the ankle and knee were both common and accounted for the major morbidity. There were minor differences in the nature and severity of injuries in the male and female dancers. Back injuries, fractures and osteoarthrosis were uncommon and shin splints was not recorded in any of the dancers.

Adult↗

Skin blood flow in psoriasis during Goeckerman or beech tar therapy.

Skin blood flow (SBF) was measured by the laser Doppler technique in lesional and clinically normal skin of 8 patients with psoriasis vulgaris during Goeckerman or beech tar therapy. The SBF measurements were performed before therapy and 1, 2, and 3-4 weeks after treatment was initiated. The results were compared to a clinical psoriasis index based on the objective assessment of infiltration, erythema, and scaling of the psoriatic plaques. The pre-treatment value of SBF in lesional skin was about 9 times higher than that of clinically normal skin. During therapy SBF of involved skin decreased rapidly approaching that of uninvolved skin after 3-4 weeks. Furthermore, there was a significant linear correlation between the SBF values and the clinical psoriasis index. It is concluded that SBF in psoriatic lesions decreases significantly during Goeckerman or beech tar therapy, and that this variable might be used to obtain a quantitative measure of the disease activity.

Adult↗

Patch test responses evaluated by cutaneous blood flow measurements.

We measured the cutaneous blood flow in positive standard patch test reactions by use of the laser-Doppler technique. The results were compared with conventional visual readings to develop a quantitative method. Compared with the basal blood flow in negative or nontested sites, the blood flow was significantly increased about fivefold in the doubtful reactions (?+), and about tenfold in both weak (1+) and strong (2+) positive reactions. The blood flows in the 1+ and 2+ reactions did not differ significantly from each other. No 3+ positive reactions were measured. We conclude that this method might be used to separate negative, doubtful, and positive reactions, whereas weak and strong positive reactions have to be differentiated by other means.

Adult↗

A hypermobility study in ballet dancers.

Hypermobility, using Beighton's mobility score, was present in 9.5% of 377 ballet dancers. Females were more mobile than males. A direct relationship was found between forward flexion and both the duration of dance training and age. This suggests that forward flexion is acquired, and unlike generalized hypermobility, which was found among family members of the hypermobile group. None of the hypermobile dancers studied had evidence of mitral valve prolapse but injuries were significantly more common compared to controls (p less than 0.05). We regard hypermobility as a liability to the ballet dancer.

Adolescent↗

Paroxysmal dysarthria and Raynaud's phenomenon in the tongue.

Three patients suffering from systemic scleroderma and Raynaud's phenomenon in the digits as well as the tongue are reported. Following exposure to cold, a vasospasm was observed in the digits and the tongue accompanied by severe dysarthria. These striking oral symptoms had been overlooked for years in the medical ward. It is recommended to question all patients with Raynaud's phenomenon about visceral manifestations during the digital attacks.

Aged↗

[Rheumatism--a disease of civilization? Incidence of inflammatory rheumatic diseases in South Africa].

The population of Southern Africa is currently estimated at least 40 million and comprises people of 3 major--groups Negroid, Khoisan and Caucasoid. In addition to these, there are also smaller groups whose origin is Asiatic or Oriental, and a mixed group (coloured) which has resulted from the miscegenation between the Negroid-Caucasoid and other groups [1]. This great diversity of peoples and cultures permits unique opportunities for studies in comparative medicine which may provide valuable information about the pathogenesis and natural history of disease. The rheumatic diseases have not been looked at in this comparative way until recently. This is, in part, because the demands of infective and nutritional diseases on medical services have tended to overshadow the rheumatic diseases. This paper reviews the investigation of inflammatory rheumatic disease in Southern Africa.

Adult↗

[Scurvy].

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Alcohol Drinking↗

Lymphatic albumin clearance from psoriatic skin.

In nine patients with untreated psoriasis vulgaris, human serum albumin labelled with 125I or 131I was injected intradermally in symmetrically located involved and uninvolved skin. The activity of the depots was followed by external detection, and the arrival of labelled albumin in plasma was monitored. In involved psoriatic skin the local mean half-time (T1/2) for tracer disappearance was 20.8 +/- 8.2 (S.D.) hr and in clinically normal skin, 29.1 +/- 9.6 (S.D.) hr. The difference was significant (p less than 0.002). Accordingly, the tracer from involved skin reached higher plasma levels than the tracer from uninvolved skin. However, under slight lymphatic stasis the appearance rate of radiolabelled albumin in plasma from both tissues was minimal during 1 to 2 hours after the injection, indicating that a local direct transvascular drainage of plasma albumin from the interstitium of diseased and normal skin was negligible. We conclude that the previously demonstrated increased extravasation of plasma proteins in involved psoriatic skin is compensated by an increased lymphatic drainage of plasma proteins, and not by an increased local transvascular return.

Adult↗