T cells reactive with the NC16A domain of BP180 are present in vulval lichen sclerosus and lichen planus

Background Lichen sclerosus (LS) is a chronic inflammatory skin condition. The recent demonstration of circulating autoantibodies to extracellular matrix protein 1 and to basement membrane zone (BMZ) components, chiefly BP180, suggests that autoimmunity to these components might contribute to pathogenesis. However, there is no binding of autoantibodies in vivo and as LS is characterized by a lymphocytic infiltrate, it seems likely that LS is mediated, in part, by antigen‐specific lymphocytes. Similar mechanisms may apply to vulval lichen planus (LP), an interface dermatitis, with clinical and immunological overlap with LS. Objectives This study aims to test the hypothesis that T cells reactive with the NC16A domain of BP180 are present in the peripheral blood of patients with vulval LS and LP. Methods Isolated peripheral blood mononuclear cells from 14 patients with vulval LS, 5 with vulval LP and 4 healthy controls were grown in vitro. We examined for immunogenicity of overlapping peptides spanning the NC16A domain of BP180 using interferon‐γ enzyme‐linked immunospot assay (ELIspot) on the cultured T‐cell lines. BMZ antibodies were assayed, HLA type determined and clinical parameters noted. Results Significant interferon‐γ production was observed in response to the NC16A peptides in 6 of the 14 vulval LS and 2 of the 5 LP patients, but not in the control subjects. There was an associated autoantibody response to BP180 in 3 LS and 1 LP patient with T‐cell responses. These data suggest that in some vulval LS and LP patients, NC16A domain‐specific T cells circulate at sufficiently high frequency to be detectable in vitro and show rapid effector function. There was no association with HLA type or clinical parameters. Conclusion We have demonstrated that in > 40% of our vulval LS and LP patients, the NC16A domain of BP180 is a target for circulating T cells, and in vulval LS and LP there are associated autoantibodies to BP180.     

The treatment of macular holes by pars plana vitrectomy and internal air/SF6 exchange

The results of a series of patients with full-thickness macular holes treated by pars plana vitrectomy are described. A air/gas mixture is used to tamponade the retinal hole and no adhesion is applied. Eleven eyes, including six high myopes, were treated using this method and sustained reattachment was achieved in eight eyes (73%). Three cases failed due to the presence of preretinal membrane formation and retinal shortening. This method is technically easy, allows good tamponade of the retinal hole with controlled internal drainage of subretinal fluid, and appears much safer than previously described techniques.Presented at the 1984 meeting of the Club Jules Gonin in Lausanne, Switzerland     

Vena caval filter to prevent pulmonary embolism: experimental study. Work in progress

A new inferior vena caval filter was tested in an experimental series of 23 dogs and in an in vitro study. The filter consists of a pliable basket and anchoring legs made of stainless steel. It can be inserted percutaneously in an antegrade or retrograde fashion through a 10-F Teflon catheter and can be retrieved with a snare or forceps. The filter is self-orienting in the inferior vena cava, becomes securely the inferior vena cava, becomes securely fixed to the wall, and has exhibited no tendency to migrate. It is highly effective in capturing small and large emboli. There was no significant elevation in upstream hydrostatic pressure following entrapment of emboli. Spontaneous thrombus formation within the basket was observed in two of six dogs who had short-term follow-up. In dogs who had long-term follow-up, the filter remained patent. Microscopically, the filter caused sclerosis of the intima where the wire was in contact with the vessel wall. Breakage of an anchor leg and separation at the fusion between anchor and basket were seen in the study. They were eliminated by improvement of the prototype, which is now ready for clinical application.     

MR imaging in patients with metallic implants

A total of 305 magnetic resonance (MR) examinations were performed in 236 patients with metallic implants. Most examinations were performed at 0.3 T. The metallic implants included central nervous system shunting devices, tantalum mesh, surgical wire, skin staples, surgical clips, metallic orthopedic devices, and a few miscellaneous metallic objects. Patients with cardiac pacemakers, electrical implants, prosthetic cardiac valves, and aneurysm clips were excluded from MR examinations. The images were reviewed for evidence of metallic artifact. The conspicuity of artifact was related to the composition, mass, orientation, and position of the metallic object in the body. In most instances, the metallic artifact did not interfere with the interpretation of the image. The patients' records were also reviewed for adverse effects noted by each patient during the MR examination. Only two patients reported discomfort that could possibly have been related to their metallic implants, but in both cases it seemed unlikely that the symptoms were actually related to the imaging process. There were no apparent short-term adverse effects demonstrated in these patients.     

Lipids and lipoproteins in patients undergoing coronary-artery surgery

Fasting blood samples were obtained from 290 patients who were undergoing elective coronary-artery graft procedures, and cholesterol, triglyceride and high-density lipoprotein cholesterol levels were measured. The 1983 National Heart Foundation of Australia's Risk Factor Prevalence Study was used as a source of age- and sex-matched "control" data. Of these patients, 80% had cholesterol levels of greater than 5.5 mmol/L; in 55% of patients, the level exceeded 6.5 mmol/L. Only 4% of patients who received a graft showed hypertriglyceridaemia alone (triglyceride level, greater than 2 mmol/L). Combined hyperlipidaemia (cholesterol level, greater than 5.5 mmol/L and triglyceride level, greater than 2.0 mmol/L) was present in 52% of subjects. Low-density lipoprotein cholesterol levels exceeded 3.5 mmol/L in 69% of men and in 71% of women. In terms of five 10-year age intervals, mean plasma triglyceride and cholesterol levels were elevated significantly in patients who had undergone a coronary-artery grafting procedure compared with those of subjects in the National Heart Foundation study. The mean high-density lipoprotein cholesterol levels were markedly-lower compared with those of the subjects in the National Heart Foundation study. Of those patients whose plasma cholesterol levels were less than 5.5 mmol/L, 97% of patients had high-density lipoprotein cholesterol levels that were less than the mean level for subjects in the National Heart Foundation study. Thus, a very-high proportion of patients who underwent coronary-artery bypass surgery had lipid abnormalities which required intervention postoperatively.     

V-shaped pillows and unsafe infant sleeping

To investigate the possibility that adult size V-shaped pillows may be associated with accidental asphyxial deaths in infants.

Methodology:

Review was undertaken of all cases of sudden infant death presenting to the Women's and Children's Hospital in Adelaide involving infants who had been found on adult size V-shaped pillows.

Results:

Four cases of sudden infant death were found in which infants were found sleeping on V-shaped pillows. All of the deaths had occurred in 1995. In two of the cases the pillows were considered to be implicated in the cause of death as the potential for obstruction of the infants' airways could be demonstrated on death scene reconstruction.

Conclusion:

Adult size V-shaped pillows may be unsafe for use in small infants who may accidentally suffocate if trapped between the two arms, or under, the pillow. The use of such pillows to maintain the body position of sleeping infants should be discouraged.