Biomedical subjects
Publications and source records attributed to R H Cormane.
Immunopathological studies in a case of Sweet's syndrome revealed IgM- and IgE-bearing polymorphonuclear leucocytes in involved skin when the direct immunofluorescence technique was used. Circulating polymorphonuclear neutrophils showed defective chemotaxis with normal random migration, phagocytosis, killing, and hexose monophosphate shunt activity.
To assess the role of epidermal melanin in a patient with porphyria variegata and vitiligo, the MED was determined in pigmented and vitiliginous skin for wavelengths of 310, 405 and 500 nm. The energy required to elicit erythema by irradiating vitiliginous skin at 310 nm was half that for pigmented skin. For 405 nm the differences was 4-fold and at 500 nm 2-fold. A possible explanation for the different protection by melanin against light of 310, 405 and 500 nm is given. UV-B irradiation, as a potent stimulus for melanization of the skin, is proposed as an additive measure in the protection against photosensitivity reactions in porphyria patients.
A case of acute diffuse scleroderma without contemporaneous visceral involvement is described. Antibodies to endothelial cells have been found in the skin.
Anti-endothelial cell antibodies could be removed from circulating lymphocytes by means of acid elution techniques in eight patients with different degrees of alopecia areata. These antibodies were specifically directed against the endothelial cells in the capillary network of the hair bulb, indicating the existence of an antigen, which is unique to these particular endothelial cells. These antibodies do not bind complement "in vitro" and are species-specific. Circulating ANA (speckled type) were only noticed in case with alopecia areata in spots. A significant decrease in circulating T cells was noticed in six of eight patients with a certain degree of alopecia.
Seven patients with papulo-pustular rosacea were investigated with immunofluorescence (IF) techniques. Indirect IF has been performed also with antibodies eluted from circulating lymphoid cells. Besides confirming the data in the literature on the positivity of the basal zone, anticollagen antibodies were found, and eluted antinuclear antibodies were detected against nuclei of cells in the epidermis and dermis, namely, scattered dermal, endothelial and eccrine duct cells.
Serum levels of 8-methoxypsoralen were determined in six human volunteers after two different methods of oral administration. 8-Methoxypsoralen was given as an aqueous solution and as powder in gelatin capsules. The area under the curve (AUC) values were higher (P < 0.05) for the solution than for the capsules, indicating a higher bioavailability. Also, the peak serum levels were higher and were reached earlier when given as a solution. Considerable individual variation of the maximum serum levels and the area under the curve values was observed for both methods of administration, but the time required to reach the maximum serum level was more predictable after administration of the solution.
Using a solid-phase radioimmunoassay technique, mean serum IgE concentrations were found to be raised in patients with early syphilis. Antitreponemal specificity of the IgE response was investigated by the fluorescent treponemal antibody absorption test using a fluorescein-isothiocyanate-labelled antiserum against the Fc-fragment of human IgE. Validity of this test procedure was assessed by blocking experiments. The results provide evidence of the antitreponemal specificity of the IgE response in syphilis and indicate a possible role for antitreponemal IgE in the pathogenesis of the Jarisch-Herxheimer reaction and in the immune-complex origin of some of the lesions of secondary syphilis.
The delay in antibody production in response to infection with Treponema pallidum may be caused by a block in the differentiation of antigen-stimulated B (Bursa-dependent) lymphoid cells towards plasma cells. This hypothesis was tested by a study to detect clonal expansion of immunoglobulin-bearing B lymphoid cells by in-vitro immunofluorescence tests in patients with primary syphilis. In addition, antibodies eluted from circulating lymphoid cells were investigated for treponemal binding by the enzyme-linked immunosorbent assay, the T pallidum immobilisation test, and the immunoglobulin class-specific FTA-ABS test. Results indicated that the number of IgG-bearing lymphoid cells were increased in patients with primary syphilis. However, in only a few cases could antitreponemal antibodies be eluted from isolated lymphoid cells. For this reason, the original hypothesis was rejected.
In previous studies to assess the role of cell-mediated immunity in Treponema pallidum infection investigations of delayed type skin hypersensitivity tests, lymphocyte transformation test, leucocyte migration inhibition tests, and histological studies of the reticuloendothelial system have been performed. In this study, the numbers of T (thymus-dependent ) lymphoid cells in 10 patients with primary syphilis (eight untreated) were estimated by the rosette technique. Results indicate a significant decrease in the number of T lymphoid cells in patients with primary syphilis.
Non-specific defence mechanisms are thought to be ineffective in eliminating Treponema pallidum after infection in the early stages, but studies aimed at the elucidation of this phenomenon are few. In this study, the number of IgG-bearing polymorphonuclear leucocytes in patients with primary syphilis was increased; this is most probably a normal phenomenon of infection.
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The chemotaxis of inflammatory cells induced by the skin-window technique using IgD as cytotaxigen or cytotaxinogen was studied in 16 patients with allergic contact dermatitis. Six patients with leg ulcer served as controls. By means of this method the recruitment of inflammatory cells with receptors for IgD could be shown.
Immunofluorescence techniques were used to find out whether immunoglobulins (Ig) and complement (C3) determinants are present on the membrane of eosinophilic granulocytes in atopic patients and in patients with an allergic contact dermatitis. Normal healthy individuals served as controls. The studies were performed with eosinophilic granulocytes in suspension and in thin cell layers. The demonstration of the presence of cytoplasmic Ig and C3 in eosinophilic granulocytes was carried out in skin specimens taken 20-30 min after injection of the antigen and in specimens taken from positive patch tests 48 h after application of the antigen. No immunoglobulins or C3 determinants could be demonstrated on the membrane of eosinophilic granulocytes in the patients or the healthy controls, when the suspension methods were used. However, in thin cell layers and in skin sections the eosinophilic granulocytes showed a positive fluorescence of the cytoplasm after having been exposed to various conjugates and a FITC solution. It is concluded that the commonly used immunofluorescence techniques tend to give non-specific staining results, most likely due to reactivity of the FITC marker of the conjugates with basic proteins present in the cytoplasm of the eosinophilic granulocyte.
One hundred and seven patients with psoriasis underwent initial PUVA therapy. Complete clearance was obtained in 52.3% of the patients, incomplete in 40.2% while 7.5% of the patients did not respond at all. The non-responders to the regular PUVA treatment regime (0.5 mg 8-MOP/kg body-weight) were given an increased 8-MOP (8-methoxypsoralen) dose schedule (0.6 mg 8-MOP/kg body weight) and in 90.9% of these patients their lesions cleared after 35 PUVA exposures. However, a small percentage (9.1%) of the non-responders to the normal dose schedule did not want to continue the increased 8-MOP dose schedule because of persistent nausea. For this reason they were given regular PUVA therapy and they reacted well, but only after fifty-five exposures. Irrespective of the complete or incomplete clearance of psoriasis the patients remained in remission for a mean period of about 5 1/2 months. During the remission period the patients were advised to use a tar preparation or topical corticosteroids in the event of minor exacerbations.
Chronic ulcers on legs resulting from venous hypertension can be successfully managed by split-thickness skin grafts. Special attention must be paid to preliminary preparation of ulcers and to the period after grafting. Technical details of grafting are described and the results in 12 patients are recounted.
By means of acid elution two antibodies could be removed successfully from the circulating lymphocytes of 11 patients with certain varieties of scleroderma. One was specifically directed against nuclear antigen(s) of endothelial cells (NEC) of the dermal blood vessels, and another against nuclear antigen(s) of epidermal basal cells (NBC) of the involved and uninvolved skin of the patients. In two cases of acroscleroderma, the eluates failed to react with either endothelial or basal cells of involved or uninvolved skin. In none of 20 healthy controls involved in this study could an antibody be eluted from the circulating lymphocytes. The aforementioned antibodies do not bind complement in vitro and do occur in the serum of four patients. Circulating antinuclear antibody (speckled type) was detectable in two cases of scleroderma.