Biomedical subjects
Publications and source records attributed to R Holst.
Genital ulceration is today often thought to be caused by herpes simplex. In this case report, a rare differential diagnosis, ulcus vulvae acutum is described, probably caused by Epstein-Barr virus (EB-virus).
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We describe two patients with severe oral cicatricial pemphigoid, one of whom also had severe pharyngeal involvement. Both patients were resistant to treatment with corticosteroids and other standard immunosuppressive therapies. Plasma exchange alone proved to be only temporarily effective, but the combination of plasma exchange with subsequent cyclophosphamide resulted in a remission in both patients. Both patients experienced mild side-effects during the plasma exchange treatment (urticaria and mild hypotension). At present, at follow-up of 6 and 9 years, respectively, the patients have no symptoms of active disease and have not required any further immunosuppressive treatment.
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Small intestine is often unnecessarily irradiated during radiotherapy because it lies near tumor volumes and thus may be dose limiting. Repositioning of normal tissues can sometimes be accomplished by mechanical rather than invasive surgical techniques. At our institution, physical displacement of small bowel tissues was carried out on a population of patients with good result. Patients suffering from prostatic, cervical, and rectal carcinoma were treated using a custom built and padded block composed of rigid Styrofoam. The block, in most cases, successfully displaced significant amounts of healthy tissues from treatment fields. Maximum displacement of bowel was accomplished at the time of simulation using fluoroscopy and manual positioning of the device. The optimum displacement position and location of the Small Bowel Displacement Device (SBDD) were recorded by means of orthogonal radiographs. The device was affixed to a piece of mylar that had been previously scribed with an X and Y coordinate system, which could be used to permanently anchor the SBDD to its position of maximum displacement. Displacements of as much as 4.0 to 5.0 cm were noted on most patients. Patients generally tolerated the device well as long as they were able to lie prone. Patients with recent abdominal surgery were less likely to tolerate the SBDD, and omental slings or meshes generally precluded movement of the small bowel.
A 15-year-old girl is presented with symmetric, hyperpigmented streaks and whorls on trunk and extremities. The pigmentation is located in the basal layer of the epidermis. The clinical and histopathological picture seems to be identical to the reticulate hyperpigmentation of Iijima, Naito and Uyeno, hitherto only described from Japan.
The proliferation of hospital libraries since World War II has created a generation of librarians who take for granted the existence of libraries in hospitals. A literature review for the first half of the twentieth century presents a picture of uncertainty and struggle for identity for the hospital library. Then as now, hospital libraries reflect the institutions within which they operate. A brief history of the development of the American hospital provides a context for describing the various roles that the hospital library has played within its parent institution during the twentieth century. Some personal reflections on working in a hospital library are also presented.
Two occlusive dressings--one zinc oxide medicated (Mezinc) and one hydrocolloid (Duoderm)--were compared in a prospective, randomized trial over a period of 8 weeks to determine their healing ability and effect on pain for venous and arterial leg ulcers. All patients were patch-tested before the study and colophony allergy was an exclusion criterion. Of the 43 outpatients included, 31 completed the trial and 6 patients randomized to each treatment group were withdrawn. The initial ulcer areas decreased after 8 weeks of treatment with Mezinc by 64% and by 48% after treatment with Duoderm. Ulcer pain was relieved in 50% of the patients--with a similar analgesic effect for the two dressings. Mezinc treatment was discontinued in 2 cases due to sensitization to colophony (one ingredient of Mezinc) which indicated a risk of contact allergy to colophony due to Mezinc treatment. 1103 consecutive eczema patients were patch-tested on the back with Mezinc and colophony 20% in petrolatum simultaneously. It was found that 42 (4%) of the patients showed allergic skin reactions to colophony and 19 (2%) to Mezinc. Both dressings were well tolerated by leg ulcer patients and there appeared to be no major differences in the efficacy of the two occlusive dressings.
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Two cases with recurrent annular lesions of similar clinical appearance and course are described. The histopathological investigations showed in both cases dense and diffuse infiltrates mainly of polymorphonuclear neutrophilic leucocytes in the mid dermis. No fever, leucocytosis or elevated ESR were observed. Systemic corticosteroid treatment controlled symptoms but recurrence after treatment was withdrawn occurred in both cases. It is discussed if we are dealing with a variant of Sweet's syndrome or a new entity.
A new dithranol formulation (Dithranol-Biogram), in which the dithranol is microencapsulated by crystalline monoglycerides, has been developed. This stable formulation has pharmaceutical and cosmetic properties which overcome several draw-backs associated with conventional dithranol preparations. The clinical efficacy and side-effects of Dithranol-Biogram were compared to a conventional ex-tempore formulation in the treatment of 33 patients at a day-care centre. The study was designed as a randomized, single-blind, within-patient comparison. Patients were treated 4 times weekly for up to 6 weeks. Each session started with suberythematous UV-B doses followed by application of 1% dithranol for 20 min. There was no difference in clinical efficacy between treatments. Within 2-6 weeks the lesions in 21 of the 33 patients were classified as healed. The average reduction in severity score was 39%, 62% and 79% after 2, 4 and 6 weeks, respectively. The incidence of perilesional irritation was, however, several times higher for the ex-tempore treated sides. At the end of the study 21 patients preferred the Dithranol-Biogram formulation, 6 the ex-tempore formulation and 6 had no preference. The results of this study suggest that this novel formulation may become an important contribution to the management of psoriasis.
Combination chemotherapy with cyclophosphamide, vincristine, VP-16, adriamycin and prednisolone was given in 9 cases of mycosis fungoides in the tumor stage; 3 of these patients received COP, one received CHOP, and 5 CAVOP. Complete remission was obtained in one case and partial remission in 5, the response rate thus being 6/9. It was impossible, however, to maintain remission. The treatment was reduced or withdrawn owing to toxic effects in 4 cases. These forms of combination chemotherapy are beneficial in non-Hodgkin lymphomas but do not seem to be of value in the tumour stage of mycosis fungoides.
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A case of eosinophilic pustular folliculitis (Ofuji) is presented. This long-lasting disease of unknown aetiology has hitherto been reported only from Japan. It is characterized by tinea-like slowly growing rings and by blood eosinophilia, The histological changes are epidermal infiltrations and abscesses of predominantly eosinophilic leukocytes, often localized to the follicles.
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The cutaneous sensitivity to benzalkonium chloride, sodium lauryl sulphate and potash soap was determined in 54 monozygotic and 46 dizygotic twin pairs. Comparing the intra-pair reaction strength a higher degree of concordance was found among monozygotic than among dizygotic twins, and even more so when monozygotic twins were compared with matched controls.
Positive and negative patch tests to merthiolate occur with the same frequency in monozygotic and dizygotic twin pairs. There is no correlation to strong or weak reactions to primary irritants. Consequently, the positive merthiolate reactions should be considered allergic rather than irritant.