Pityriasis rosea – a virus-induced skin disease? An update

Summary.  Pityriasis rosea (PR) is an acute, inflammatory skin disease of unknown cause. Clinical and experimental findings indicate an infectious etiology of PR. Various infectious agents including viruses have been proposed as causative agents and their presence in PR samples has been extensively investigated. Recently, human herpesvirus 7 was linked to PR, but contradictory findings have been reported by various investigators. Here, we describe the features of PR that suggest an infectious cause and review the data from viral studies in PR reported in the literature. In addition, we present a pathogenetic model of PR which may be helpful in planning and evaluating studies for the search of a putative PR-associated virus. Based on the current state of knowledge, none of the known viruses could, so far, be conclusively associated with PR. Received February 22, 2000 Accepted March 17, 2000     

Cardiac biopsy in childhood

Endomyocardial biopsy was attempted in 18 children aged 5 months to 15 years with 82% success. Biopsies obtained from 15 children were examined by light and electron microscope making positive morphological diagnoses in 3 cases. The biopsy findings were actively helpful in 7 other cases, which contrasts with experience in adult biopsy series. This is a low risk procedure which does not add to the hazards of cardiac catheterization in children.     

Vascular damage after photodynamic therapy of solid tumors: a view and comparison of effect in pre-clinical and clinical models at the University of Louisville

Microvascular damage that results in blood flow stasis is a frequent consequence of photodynamic therapy. The magnitude of this response is dependent on the type of photosensitizer employed for treatment, the amount of drug and light used in therapy and the time period between drug injection and treatment. This review highlights the mechanisms that lead to blood flow stasis in tumor and normal tissues and discusses methods to increase the selectivity of vascular response.     

Phase I study of recombinant beta-interferon given by four-hour infusion

Twelve patients with advanced malignant disease were entered onto a Phase I study of escalating doses of beta-interferon serine given by 4-h i.v. infusion twice a wk. Three patients each were entered at starting doses of 0.01, 1, 10, and 30 million units (MU)/m2. Doses escalation within individual patients was allowed to a maximum dose of 400 MU/m2. Fever, chills, fatigue, and acral cyanosis were commonly seen and increased in frequency at higher doses. Myalgia, nausea, diarrhea, headache, and confusion were seen at lesser frequencies. Mild leukopenia, paresthesia, infusion site erythema, and hypotension were each seen in one patient. No conventional maximal tolerated dose could be defined, since several patients underwent escalation to the highest allowable dose and seemed to develop tolerance to acute toxicities. However, a maximal starting dose of 10 MU/m2 was identified, such that those begun at this level or below tolerated semiweekly dose escalation, while those begun at 30 MU/m2 could not tolerate continued therapy. Detectable serum interferon levels were noted during treatment at 10 and 30 MU/m2, the levels at which significant toxicity also first appeared. A maximal starting dose of 10 MU/m2, with gradual escalation as tolerance to side effects develops, is suggested if therapy with high-dose beta-interferon serine is given by 4-h infusion.     

Comparison of meclofenamate sodium with buffered aspirin and placebo for the relief of postoperative dental pain

The analgesic effect of meclofenamate sodium at two dose levels (100 mg and 200 mg) was compared with the effects of buffered aspirin (600 mg) and placebo in a double-blind, randomized study of 105 dental outpatients with acute pain following third-molar extraction. Meclofenamate sodium at either dose level was significantly superior to both buffered aspirin and placebo, resulting in significantly greater relief of pain. All four treatments were well tolerated, and side effects were minimal. Meclofenamate sodium is a safe, highly effective analgesic for the relief of acute pain.     

A study of primary mooring and deformation of the peri-acetabular area under static load]

We propose a method to study the primary stability and the periacetabular deformation under static load, with and without cemented and cement-free acetabular implants, using a biomechanical model that stimulates the balance mechanism described by Pauwels. The biomechanical model uses whole pelvises of recently frozen corpses. We have imitated the gluteus medius and minimus muscles on the pelvis with cables and pulleys. The loading device comprises a metallic frame, on which a hydraulic press is set up for static testing, and a prototype femoral prosthesis made of two main parts: one on which the gluteal muscles are inserted, and another one on which the femoral head is attached. The pelvis is fixed to the metallic frame by a plate attached to the sacrum and allowing movements in all planes of space. The measurement method utilizes: for primary stability, four transducers, including three three-directional ones, in the three planes of space outside the pelvis, only one being located inside the pelvis with a 16 degrees orientation relative to the vertical; for deformation, a transducer located in three different places in the periacetabular region. We have used ten freshly frozen pelvises with six different implants (two with and four without cement) and eighteen implantations.     

Human monoclonal antibodies directed against melanoma tumor-associated antigens

To analyze the humoral immune response to melanoma, human-mouse hybridomas were generated by the fusions of regional lymph node lymphocytes of patients with the mouse myeloma cell line M5. Six stable hybridomas were cloned from six separate lymphocyte parents obtained from three patients. Ascites were obtained from nude mice after i.p. injection with cultured hybridoma cells. The monoclonal antibodies, four immunoglobulin Gs and two pentameric immunoglobulin Ms, were partially purified to remove mouse immunoglobulin and then conjugated to biotin for immunocytochemical and immunohistochemical studies. With the avidin:biotin:peroxidase complex method to detect and amplify binding by the biotin-conjugated human monoclonal antibodies, we found the six antibodies to be reactive against cytoplasmic determinants in five short-term melanoma cultures and formalin-fixed paraffin-embedded melanoma tumors from four patients. The antigenic target of the antibodies identified was not carcinoembryonic antigen. Two antibodies, 2-139-1 and 6-26-3, were studied in more detail. Each stained 25 of 25 specimens of melanomas. Little or no reactivity was detected against fixed sections of normal skin, which included tissues such as epidermis, dermis, monocytes, lymphocytes, and vascular endothelium. More striking was the absence of binding to melanocytes in the basal layer of the skin or to pigmented nevus cells. Both antibodies showed cross-reactivity against other tumors, in particular colonic and prostatic carcinomas. In the normal colon, reactivity was restricted to the surface of the columnar epithelium; no reactivity was detected against normal prostatic epithelium. Reactivity was also not observed against liver and lung. However, the epithelia of the renal tubules, pancreatic ducts, and salivary ducts were all reactive. These human monoclonal antibodies identify cytoplasmic melanoma-associated tumor antigens that appear different from the membrane antigens defined by serological approaches and by most mouse monoclonal antibodies.     

Alpha-2-interferon/melphalan/prednisone in previously untreated patients with multiple myeloma: a phase I-II trial

Alpha-2-interferon (IFN) has demonstrable activity in advanced, relapsing, or refractory multiple myeloma. Because of the in vitro synergism between the IFNs and cytotoxic agents, we conducted a trial of 30 previously untreated patients with multiple myeloma utilizing various doses of alpha-2-IFN in combination with standard oral doses of melphalan and prednisone. The combination was well-tolerated without unusual or unexpected toxic effects. The limiting toxicity included dose-related myelosuppression, and alpha-2-IFN induced flu-like symptoms and fatigue. Response was seen in at least as many patients as would be expected with melphalan and prednisone alone. The maximal tolerated dose for a phase II-III trial was 5.0 X 10(6) IU/m2 of alpha-2-IFN in combination with standard doses of melphalan and prednisone. Future trials should utilize this dose of alpha-2-IFN with dose de-escalation according to tolerance.     

Hearing ability after cholesteatoma surgery

Five years after cholesteatoma surgery (primary operation in 1981 and 1982) we examined 112 patients to determine the hearing and clinical results in follow-up. In 12 (10.7%) patients Cholesteatoma recurred. During the period of follow-up 28 (25%) ears underwent second surgery. Comparing the open (50.9%) with the closed (49.1%) technique a better air bone gap was gained for the closed technique procedures. This was confirmed when the different types of tympanoplasty were compared between the two groups. In 69.5% of the closed procedures the air bone gap was less than 20 dB, whereas the value for the open technique was 51.1%. In 30 patients a second-look operation was recommended, which was performed in 15 persons; 8 recurrent cholesteatoma were detected. Reducing the application of the closed procedures from a rate of 78.1% in the years 1971/1972 to 49.1% in 1981/1982, we saw a distinct reduction of cholesteatoma recurrence from 25% in 1971/1972 to 10.7% in the present study. The data show that the advice for a second-look operation should be seriously considered. Furthermore, the study indicates that due to modern tympanoplastic techniques also in longterm follow-up good hearing results can be obtained.