TPHA test. Experience at the Clinic of Dermatology, University of Milan.

The results of serological investigations with the treponemal haemagglutination (TPHA) test are reported in a large number of luetic and non-luetic patients. From these the following conclusions can be drawn: (1) The sensitivity of the TPHA test is decreased if the test is carried out with micromethods; however, in our opinion, the same degree of sensitivity can be obtained either with the macromethod at dilution 1/80-1/60 or with micromethods at 1/20-1/40. (2) The sensitivity of this test is high, being similar to that of the fluorescent treponemal antibody absorption (FTA-ABS) test in primary and secondary syphilis and even higher than that of the FTA-ABS test in treated subjects. (3) The specificity of the reaction is high, as demonstrated by examining sera in patients with a negative history and clinical examination together with negative results to Treponema pallidum immobilisation (TPI) and FTA-ABS tests, and by studying biological false positive sera. (4) For the serological screening, it may be sufficient to perform the TPHA test with the 1/20-1/40 micromethod together with the Venereal Disease Research Laboratory (VDRL) test. In patients with suspected syphilis, it is advisable to perform the TPHA test by the macromethod, in combination with the FTA-ABS test.     

Pediatric Hospital Dermatology: Experience with Inpatient and Consult Services at the Mayo Clinic

Data describing the management of pediatric patients admitted to a hospital under the care of a dermatologist and dermatology hospital consults for pediatric inpatients are limited. We aim to describe the role of an inpatient hospital service jointly run by dermatology and pediatrics and the activities of a pediatric dermatology hospital consult service. We retrospectively identified pediatric (age < 18 yrs) dermatology inpatients and hospital consult patients from January 1, 2009, through December 31, 2010. We examined patient demographics, indications for admission, length of stay, treatment provided, consult‐requesting service, and consult diagnosis. One hundred eight admissions were by a dermatologist. The mean age was 5.8 years; the median length of stay was 3 days. Indications for admission included atopic dermatitis (86.1%), psoriasis (3.7%), and eczema herpeticum (2.8%). The main treatment provided was wet dressings (97.2%). Eighty‐three dermatology hospital consults were requested. The mean age was 7.4 years. The main indications for dermatology consultation included drug rash (12.1%), cutaneous infections (12.1%), contact dermatitis (9.6%), psoriasis (8.4%), atopic dermatitis (6.0%), and hemangiomas (6.0%). This study describes the utility of the hospital pediatric dermatology inpatient and consult services in treating patients with severe skin disease.     

52d Cologne Dermatology Meeting of the Cologne University Dermatology Clinic 24 January 1990

Patients with the following diagnoses were presented: pyoderma gangraenosum in a patient with myelodysplastic syndrome passing into an acute myelomonocytic leukemia and specific cutaneous infiltration, primary genital infection with herpes simplex virus, type 1 (HSV-1) in an adult patient, pellagroid, Sweet's syndrome with follicular involvement, Sweet's syndrome in a patient with cancer of the breast, lichen amyloidosus, angiolymphoid hyperplasia with eosinophilia, Darier's disease 1. associated with basal cell carcinoma 2. with specific cutaneous infiltrations in a patient with acute myeloid leukemia, body building, anabolic steroids and fertility, multiple trichodiscomas and perifollicular fibromas, Buschke's scleroedema adultorum, extensive necrobiosis lipoidica without diabetes mellitus, extramammary, multifocal type of Paget's disease.     

Patch test results of the Dermatology Clinic Zurich in 1989: personal computer-aided statistical evaluation.

The patch test results of 921 consecutively tested patients were registered on an IBM personal computer. A computer program based on the dBase III plus database software, especially designed for this purpose, was used. The statistical evaluation was performed with dBase III plus. 59% of the probands were females and 41% males. The average age was 42.8 years. 26% of the probands were inpatients and 74% outpatients. A majority of the patients presented with eczema of the hands, face or the lower legs. The largest occupational groups were houseworkers and cleaning personnel, office workers and pensioners. To 450 of the 921 patients, at least 4 test series were applied simultaneously. These included European standard, vehicles and emulgators, topical medications, and preservatives and biocides. The other 20 test series available were employed only by 2-81 patients each. The highest sensitization rates were found with: nickel, 18.7%; cobalt, 10.2%; balsam of Peru, 8.8%; framycetin, 8.0%; neomycin, 6.8%; potassium dichromate, 6.1%; p-phenylene diamine, 5.4%; paramix, 4.9%; formaldehyde, 4.8%, and (chlor)methylisothiazolinone, 4.7%. The critical evaluation of the data showed two kinds of problems: first, test-specific aspects led to optimization of the patch test procedures; second, the crucial importance of an adequate statistical analysis for epidemiological investigation was revealed.     

Non‐attendance rate in a Danish University Clinic of Dermatology

Aim To clarify the rate of non‐attendance (NA) in an out‐patient clinic. Methods Attendance lists of 3592 patients were collected daily from 21 July–21 August and 21 October–21 November, 2009. NA patients were contacted to determine extenuations. To study NA in relation to diagnosis and age, a control group of patients who attended before or after a NA was established. Furthermore, two time periods from 8:00–11:30 am and 11:30 am –3:00 pm were compared. Results In total, 13% NA gave no cancellation (54.2% females and 45.8% males). Divided into age groups, 496 patients 0–25 years old had appointments, but 87 (18.6%) showed NA. In the 26–65 years old, 2188 patients were planned, but 313 (14.1%) showed NA. Over 65 years old, 878 patients were planned, but 69 patients (7.9%) showed NA. NA was higher (P < 0.05) in patients 0–25 years old in comparison with the other age groups. Diagnoses had no influence on the rate of NA (P > 0.05), neither had seasons nor time of the day. The main explanations reported by the NA were: forgetfulness (34.3%), erroneous scheduling (27.7%) and various reasons (38.0%). However, 18.5% had shown NA before while 17.1% were NA first timers. Conclusion The NA rate 13% of 3592 patients was mostly patient‐related. Erroneous scheduling was estimated to be 3.6%. NA was more frequent among young patients. NA rate is small in comparison with non‐adherence to medicines, however, of major practical and economic consequence for the health system. SMS or e‐mail notification and improved scheduling are potential actions to improve NA in the routine.     

Changing trends in skin diseases at the University Clinic Hamburg.

The author reports about statistical analyses of the outpatients from the dermatological department of the University hospital Hamburg 1935-1966. It can be demonstrated in general a change of the frequency of some skin diseases e.g. a regression of bacterial diseases and scabies, a increase of mycoses and of neurodermatitis and of eczema.     

Serological diagnosis of untreated early syphilis. Importance of the differences in THA, TPHA, and VDRL test titres.

The treponemal haemagglutination (THA) test has been used for 11 years as a routine test for syphilis at a central serology laboratory. Among patients with untreated early syphilis the antibodies detected by the THA test usually appeared later or were of relatively lower titre than those detected by the reagin tests. This finding was confirmed by follow up of patients and by replies to questionnaires and has been incorporated in a computer program. During 1981, using the results obtained on unpaired specimens and minimal other data, 74 of 123 patients who were finally diagnosed as having untreated early syphilis were correctly identified by the computer. Most of those not selected by the computer were patients with early primary syphilis with little or no circulating antibody or with late secondary syphilis with very high titres.