A second report on multidrug therapy for leprosy in Trinidad and Tobago

Multidrug therapy consisting of rifampicin, clofazimine and dapsone, was introduced to Trinidad and Tobago in January 1982. This was with slight modification of the WHO regimens. Since then 717 patients have completed multidrug therapy up to the end of December 1987. Of these, 272 patients have completed surveillance and have been discharged from clinic attendance. Thirty-four patients died before completing surveillance and three are known to have migrated. Of the remaining 408 cases still under surveillance, the majority are multibacillary. This paper reviews the outcome of multidrug therapy in Trinidad and Tobago between January 1982 and December 1987--a period of 6 years, and presents some of the statistics related to the newly diagnosed patients within the same period.     

DEVELOPMENT OF ANTHRALIN SHORT-CONTACT THERAPY IN PSORIASIS: SURVEY OF PUBLISHED CLINICAL TRIALS

In a survey of clinical trials concerning the efficacy of short-contact therapy with anthralin in psoriasis vulgaris, focusing principally on methodologic issues, twenty-four papers published between January 1982 and December 1989, in English, French, and Italian, were selected. Nine of 24 papers reported on more than one trial, giving a total of 37 clinical trials to be evaluated. A great heterogeneity was evident in many aspects of the design and conduct of these trials, making pooling of results impossible. Most trials suffered from flaws in general methodologic aspects such as randomization and blinding. Limitations in general applicability of results were discussed with reference to the popular use of self-control design and selection of composite indexes (e.g., PASI) as an outcome variable. Published trials are not a reliable guide to clinical decisions concerning short-contact therapy, and some methodologic observations we made could be of general interest in designing clinical trials of psoriasis.     

Use of psoralen plus UV-A therapy in the autonomous community of Valencia, Spain

BackgroundPhotochemotherapy with 8-methoxypsoralen and long-wavelength UV-A (PUVA) has been extensively used for the treatment of various skin diseases since its approval in 1982 by the US Food and Drug Administration.MethodsA retrospective study was performed of patients treated with PUVA, including topical and systemic treatment, over a period of 14 years. All patients were treated using a standard PUVA therapy regimen.ResultsA total of 877 patients were analyzed for the period 1982 to 1996. Forty-one skin diseases were treated, including 341 cases of psoriasis and 71 cutaneous T-cell lymphomas. The aim of the study was to describe the characteristics of the patients treated with PUVA therapy during that period and compare the results with those observed in other regions.ConclusionsAlthough PUVA therapy is widely used in a large number of countries for the treatment of various skin diseases, few studies have described the characteristics of the patients and the differences in the parameters of PUVA according to the disease.     

An accounting of governmental liaison activities of the American Academy of Dermatology, 1977-1982

The major governmental liaison activities for the period 1977–1982 are briefly summarized.     

Combination chemotherapy with bleomycin, cyclophosphamide, prednisone and etretinate (BCPE) in advanced mycosis fungoides: a six-year experience

A six-year experience in 20 patients with advanced mycosis fungoides treated with combination chemotherapy with bleomycin, cyclophosphamide, prednisone and etretinate (BCPE) in advanced mycosis fungoides showed initial complete remissions in 16 patients (85%). The initial complete remissions lasted in average 8 months. A second complete remission was obtained in seven patients. The overall survival after 2 years was 50% and 30% after 4 years. At the time of the investigation six patients are alive, three in complete remission and three in partial remission. Two patients are in partial remission after 6 years, one of these had additional therapy with alfa-interferon. Patients entering the study until 1982 also received transfer factor, an immune stimulating agent. Since in 1982 a double-blind study revealed no differences between patients given the active--and patients given the inactive medication, no new patients since then had transfer factor. BCPE compares favourable with other chemotherapeutic regimes. The data presented seem to justify the use of retinoids as a part of combination chemotherapy in mycosis fungoides.     

Home phototherapy: report on a workshop of the British Photodermatology Group, December 1996

Phototherapy is a popular and effective treatment for many patients with skin diseases. However, repeated journeys to hospital for phototherapy can be inconvenient and expensive. If it were available, many patients might prefer home-based phototherapy as long as it was safe and effective. Indeed, many psoriasis patients already self-treat with ultraviolet A sunbeds at home. This report represents a consensus view from a British Photodermatology Group workshop held in December 1996, the purpose of which was to examine the potential role of home-based phototherapy in dermatological practice. We conclude that home-based therapy represents a suboptimal treatment with greater attendant risks than phototherapy in a hospital environment. The level of medical supervision of the home treatment is crucial to its safety and effectiveness. Until further studies are forthcoming, home phototherapy should be largely restricted to those with overwhelming difficulties in attending hospital.     

Depression,isotretinoin, and folic acid: A practical review

Isotretinoin (ISO) is a first‐generation retinoid discovered in 1952 and approved by the FDA for the treatment of nodulocystic acne in 1982. The anti‐inflammatory properties of ISO have found its use in disorders other than acne. ISO can create psychiatric problems, including depression and suicidal ideation. These neuropsychiatric problems are very similar to disorders secondary to hyperhomocysteinemia (HHcy), vitamin B12, and folic acid (vitamin B9) deficiencies. Given that previous literature suggested folate supplementation improved the efficacy of traditional antidepressant medications, clinicians may wish to consider folate supplementation for patients with depression or possible depressive symptoms, such as acne patients with genetic susceptibility. Brain‐derived neurotrophic factor may be a cytokine‐specific screening biomarker in immune‐based antidepressive therapy.     

Germinative testicular tumors. On the current status of diagnosis, therapy and prognosis

On the basis of results obtained in a multicentric study on testicular tumors (Bonn 1982) including our own group of patients, we give an outline of the present state of modern diagnosis, therapy, and prognosis concerning germinative tumors of the testes: Etiologically essential is an unknown dysontogenetic disturbance of both gonads. The only clinical predilection factor is cryptorchism. Among the new diagnostic methods, specific tumor markers and high-resolution ultra-sonography have been proved especially useful. In non-seminomas, orchidectomy and lymphadenectomy is followed by chemotherapy instead of radiation therapy, today. Polychemotherapy has greatly improved the prognosis. Andrologically most interesting questions concerning sperm conservation, limited retroperitoneal lymphadenectomy, as well as late sequelae of chemotherapy cannot be definitely answered. Our findings rise new questions, which are fully discussed in concluding remarks.     

Increased incidence in leprosy of hypersensitivity reactions to dapsone after introduction of multidrug therapy

In order to address the question whether hypersensitivity reactions to dapsone are becoming more frequent, the clinical data of 7300 leprosy patients treated between 1949 and September 1988 at the McKean Rehabilitation Centre in Thailand were reviewed. Information from the period 1949 to 1969 was too incomplete to allow conclusions. The incidence of hypersensitivity reactions to dapsone between 1970 and 1982 was 0.3%. From 1982 (with the introduction of multidrug therapy) to September 1988, the incidence was 3.6%; a tenfold increase compared with the previous period. Of the 19 cases seen since 1982, 12 were diagnosed as Dapsone syndrome. Of a total of 13 patients seen since 1980 with Dapsone syndrome, 3 ended fatally, indicating the severity of the complication. The question is raised whether an unexplained drug interaction with rifampicin is responsible for the increase of hypersensitivity reactions to dapsone in patients treated for leprosy.     

Experience with multidrug therapy in paucibacillary leprosy

Eighty paucibacillary leprosy cases were randomly put on two different multidrug regimens for 6 months followed by dapsone monotherapy. Regimen I was according to WHO (1982) recommendations consisting of Dapsone and six once a month rifampicin. In regimen II in addition to above two constituents, clofazimine was added 100 mg on alternate days. Dapsone thereafter was continued in both the regimens upto one year. The efficacy, acceptability and side effects of multidrug regimens were observed for a period of one year. Histopathological assessment was done on completion of multidrug therapy in all cases. A comparative evaluation of effect of two multidrug regimens in paucibacillary leprosy patients is reported. Addition of clofazimine over WHO (1982) recommended regimen appears to have no added benefit. The duration of WHO (1982) recommended regimens was found to be inadequate in many cases.     

Ultrastructural localization of in vitro binding sites of circulating anti-basement membrane zone antibodies in bullous pemphigoid

Ultrastructural localization of the in vitro binding sites of circulating anti-basement membrane zone antibodies was investigated using two immunoperoxidase methods: the ordinary IgG indirect immunoperoxidase method and the complement immunoperoxidase method. The results indicate that the binding sites of the circulating autoantibodies were diverse. It is postulated that those antibodies demonstrable by the ordinary IgG indirect method and those antibodies possessing capacity to fix complement should bind to different sites of the basement membrane zone. Conventional electron microscopic observation of one lesional skin from bullous pemphigoid confirmed this possibility. (Received December 23, 1982.)     

Dermatologic therapy: December 1985 to December 1986

I have reviewed the significant therapeutic changes reported in the English literature between December 1985 and December 1986. Readers should review the original articles in toto before attempting any new experimental or controversial therapy summarized.     

Diffuse (presenile) hyperplasia of the sebaceous glands, a new entity? Successful treatment with 13-cis-retinoic acid

We report the case of a young man with extreme sebaceous gland hyperplasia that occurred in a diffuse pattern of aggregated papular lesions involving the entire face, neck and upper chest, together with marked seborrhoea oleosa. Oral therapy with 13-cis-retinoic acid (isotretinoin) resulted in remarkable improvement within a few weeks. Parallels from our case are drawn to familial sebaceous hyperplasia, reported by Dypre et al. in 1980 [6], and to a case of a young man with severe sebaceous gland hyperplasia and facial seborrhoea, reported by de Villez et al. in 1982. We suggest that these types of seboglandular proliferative disorders be classified as diffuse (presenile) sebaceous gland hyperplasia in contrast to the well-defined senile circumscribed variant, and that they be regarded as a separate entity.     

Epidemiology

Syphilis cases (primary and secondary) reported in the United States in 1982 numbered 32,553, an increase of some 5% over the previous year.¹ It was more common during this period than any single form of hepatitis and was exceeded in frequency among the sexually transmitted diseases classified as notifiable only by gonorrhea.     

Long-term radiographic follow-up after isotretinoin therapy

We evaluated the effects of long- and short-term isotretinoin therapy on the skeletons of patients. Eight patients who were treated with isotretinoin for disorders of keratinization received frequent radiographic evaluations for 4 to 9 years. Seven patients developed multiple hyperostoses at the spine and extremities. Hyperostoses increased in size and number over the course of therapy, although relatively few sites were symptomatic. Hyperostoses typically developed first in the spine and later in the extremities, where both bilaterally symmetric and asymmetric involvement was observed. After 5 years of therapy one patient did not develop hyperostosis. In a group of nine patients who received a relatively high dose of isotretinoin in 1982 for the treatment of acne, two patients developed tiny, asymptomatic hyperostoses. One patient had hyperostoses 1 year after isotretinoin therapy, which remained unchanged 3 years later, whereas the other patient had one hyperostosis 4 years after therapy had been stopped. Although we suspect that these hyperostoses were retinoid induced, they should not be of concern for the patient needing routine isotretinoin therapy for the treatment of cystic acne.     

Factors influencing the risk of infection with human immunodeficiency virus in homosexual men, Denver 1982-1985

The factors associated with infection with the human immunodeficiency virus (HIV) in 216 homosexual men enrolled from November 1982 through December 1985, including 40 asymptomatic HIV seronegative, 20 asymptomatic seropositive, 66 with generalized lymphadenopathy (GLS), 37 with AIDS-related complex (ARC), and 53 with AIDS were studied. Because univariate analysis did not show significant differences between asymptomatic seropositive men and men with GLS or between men with ARC and AIDS, these groups were combined for analysis. In multivariate analysis the number of episodes of receptive and intercourse, the age at which regular sexual intercourse with a male partner was started, the use of enemas, sexual contact with someone with ARC or AIDS, and a history of hepatitis B were all independently associated with HIV infection. In univariate analysis the men with ARC or AIDS did not differ significantly from asymptomatic seronegative men as to number of episodes of receptive or insertive anal intercourse and number of sexual partners, but this most likely represents confounding that occurs when current risk factor behavior in fatally ill men is used in place of risk factor behavior at the time of HIV transmission. It indicates, however, that this group has become less sexually active and that HIV infection is largely spread by relatively healthy infected men.     

Serovars, auxotypes, and plasmid profiles of PPNG strains with Asian type plasmid isolated in Amsterdam.

In 1982 an increase of penicillinase producing strains of Neisseria gonorrhoeae (PPNG), carrying the 4.5 megadalton Asian type plasmid and the 24 megadalton transfer plasmid (Asia+), was observed in Amsterdam. The main auxotypes were proline requiring (Pro-) and proline and hypoxanthine requiring (Pro-Hyx-). Using two monoclonal antibody systems, it was shown that the serovars of strains with these auxotypes isolated in 1981 were different from those isolated in 1982, which indicated the start and end of microepidemics. Different serovars were also observed in Pro- and non-requiring (NR) Asia- PPNG strains isolated in 1981-2 and 1985 respectively. Only one serovar (Aedih/Arst) was common in strains isolated in 1981-2 as well as in 1985.     

Short term chemotherapy of paucibacillary leprosy

Twenty freshly diagnosed, previously untreated, adult male patients with paucibacillary leprosy were treated with Multi drug therapy (MDT) according to WHO regimen (1982). The patients remained in the hospital throughout the course of the study. At the end of six months treatment, they were evaluated clinicobacteriologically and histologically for evidence of the disease activity. Active disease was present in 55% of the patients at the end of six months treatment. DDS had to be discontinued in one patient who developed hepatitis.     

Treatment of acne with isotretinoin: recommendations based on Australian experience

Oral isotretinoin revolutionized acne treatment when it was introduced in 1982 in the USA. However, its use was restricted to patients with severe nodulocystic acne. Today its use worldwide has expanded to treat also patients with less severe but scarring acne who are responding unsatisfactorily to conventional therapies. These recommendations assess the potential for use of oral isotretinoin as a safe and effective treatment for severe nodulocystic acne unresponsive to conventional therapy, and acne of any severity that causes scarring or is associated with psychological distress.     

贵州省64例艾滋病病人抗病毒治疗随访情况分析

目的：了解贵州省部分艾滋病病人抗病毒治疗随访情况并分析有关的影响因素,为建立更有效的随访模式提供依据. 方法：将2007年11月～2008年4月在我省各抗病毒治疗点参加抗病毒治疗且到2009年4月30日仍在治疗的艾滋病病人的随访数据用SPSS12.0进行分析. 结果：随着治疗时间的延长,随访及按时随访的病人数均呈现下降趋势,CD4＋淋巴细胞检测、病毒载量检测的完成情况分别为48.4%和37.5%. 结论：治疗病人的管理随访存在不规范的问题和困难,有必要建立更加有效和实用的管理随访模式.