Localized crusted scabies in the acquired immunodeficiency syndrome

Crusted scabies (CrS) is an uncommon occurrence among patients with AIDS. Indeed to date only five cases have been described, all with widespread lesions. A case of localized CrS appearing as a yellowish and crusted plaque on the second right toe is reported in a woman with AIDS. Scraping off the verrucous surface, as well as punch-biopsy revealed many mites within the horny layer. The infestation is related to the cutaneous immune response and thus CrS should be considered an opportunistic infestation in AIDS. The importance of the early diagnosis of CrS in order to prevent disseminated lesions and involvement of other health-care workers is underlined.     

Fracture of the carpal scaphoid: frequency and distribution in a well-defined population.

The incidence, location, and type of scaphoid fractures found in a well-defined population is described. Fractures of the carpal scaphoid (n = 442) were identified during an eight-year period, of which 19 (5%) were nonunions. At the initial radiographic examination the fractures were visible on PA views in 70% of the cases (true lateral 10%, scaphoid view neutral 77%, scaphoid view ulnar deviated 73%, and scaphoid view with the X-ray tube tilted 30 degrees distally 71%). Among inhabitants living in the Odense Municipality (population at risk 170648 in 1983 to 174948 in 1989) 222 males and 51 females (age range 9-87 year) sustaining scaphoid fractures during a seven-year were period used for computation of incidences. During the survey, there was an average annual incidence of scaphoid fracture of 8 per 100000 females, and 38 per 100000 males. All patients (except a 9-year-old male) were aged 10 years or over. In the age-group 10-14 years there was an average annual incidence of 3 per 100000 females, and 39 per 100000 males. Average annual incidence per 100000 inhabitants of carpal scaphoid fractures according to the location was proximal 6, middle 15, and distal (fractures of the tuberosity included) 2. Average annual incidence per 100000 inhabitants of carpal scaphoid fractures according to type was transverse 7, horizontal oblique 9, vertical oblique 1, avulsion/fracture of the tuberosity 5, and not stated 1.     

Computer-assisted alignment of standard serial sections without use of artificial landmarks. A practical approach to the utilization of incomplete information in 3-D reconstruction of the hippocampal region.

An algorithm for the alignment of stained serial sections without the support of artificial landmarks is described. Four-hundred-thirty serial sections of the rabbit hippocampal region were digitized, and computer-based alignment was performed without use of artificial markers, resulting in a consistent matrix. Following proper filtration, artificial sections were cut through the matrix. In a second experiment every second image was deleted and reconstructed by interpolation with a minor loss of biological information. In a third experiment every second image was deleted and the rest of the images were 'disordered', realigned and the missing planes reconstructed by interpolation. Under these circumstances the matrix was reconstructed with some loss of information. These results may widen the limits of 3-dimensional (3-D) reconstruction, as routine histological preparations normally include only every second or every third section without artificial landmarks.     

The ELAM-1 ligand sialosyl-Lex is present on Langerhans cells isolated from stratified epithelium

In this study we show the expression of the newly identified carbohydrate ligand, sialosyl-Le(X) on Langerhans cells. The receptor for sialosyl-Le(X) is the endothelial leukocyte adhesion molecule-1 (ELAM-1) present on activated endothelial cells. Using flow cytometry, Langerhans cells were selected due to positivity for an antibody against CD1a and low orthogonal light scatter. The CD1a antigen stained by the OKT6 antibody is considered a maturational marker of Langerhans cells in agreement with the specific labeling of dendritic cells in the epithelium only. Double immunostaining (OKT6/anti-sialosyl-Le(X)) using flow cytometry and immunohistochemistry demonstrated that almost all OKT6-positive cells in normal stratified epithelium expressed sialosyl-Le(X). Conversely, by immunohistochemistry of oral epithelium with acute inflammation, additional dendritic cells negative for OKT6 were found to express sialosyl-Le(X). In addition, sialosyl-Le(X)-positive but not OKT6-positive dendritic cells were found in the submucosa. These findings indicate that the carbohydrate antigen sialosyl-Le(X) is expressed earlier than the CD1a antigen in the maturation of the Langerhans cell lineage. Future studies should aim at investigating the importance of adhesion between sialosyl Le(X) and ELAM-1 in epithelial recruitment of Langerhans cells.     

Treatment of head and neck dermatitis comparing itraconazole 200 mg and 400 mg daily for 1 week with placebo

BACKGROUND: Head and neck dermatitis (HND) is a variant of atopic dermatitis often seen in young adults. A hypersensitivity to Malassezi antigens is considered to be of pathogenic importance. Previous mostly uncontrolled studies have shown that oral antimycotics might be of use in this condition. OBJECTIVE: To evaluate the efficacy of itraconazole in the treatment of HND in a randomized, double-blind, placebo-controlled trial. PATIENTS: Adult patients with HND were included. Systemic steroids and oral/topical antimycotics were avoided 1 and 2 months prior to the trial. Topical steroids were not allowed in the head and neck area within 2 weeks. Patients in generally good health were included and female patients had to have had a negative urine pregnancy test. The patients signed an informed consent. STUDY DESIGN: The study included a 7-day treatment period and a follow-up period of 105 days. Control visits were carried out on days 3, 7 and 14 and after 15 weeks. METHODS: The SCORAD index (one for the head and neck area and one for the remaining surface area) and global evaluations by patient and investigator were used for clinical evaluation at each visit. Prick tests with Malassezia antigens and Candida albicans antigen were carried out at the start of the trial and included positive and negative controls. The patients were randomized into three groups, which were treated with 400 mg itraconazole daily, 200 mg itraconazole daily or placebo, respectively, for 7 days. RESULTS: The number of patients included was 53: 18 had 200 mg itraconazole daily, 17 had 400 mg itraconazole daily and 18 placebo. At days 7 and 14, significant improvement was seen in the SCORAD of the head and neck area for the groups given 400 mg itraconazole daily (P = 0.0385 and P = 0.0134), and 200 mg daily (P = 0.0104 and P = 0.0006). Patients in the placebo group improved slightly (P = 0.0785). At day 14, comparison of improvement of SCORAD of the head and neck area between all three groups showed a significant difference in favour of the 200 mg itraconazole group compared to the placebo group (P = 0.0318). The prick test was positive for Pityrosporum ovale in 37% and negative for C. albicans in all patients. CONCLUSIONS: One week of treatment with 200 or 400 mg itraconazole as a single treatment has a significant effect on the head and neck area. Compared to placebo there was a significant improvement in SCORAD of the head and neck area in favour of the 200 mg itraconazole group after 14 days. The important observation seems to be that antifungal systemic treatment has a significant SCORAD reduction of atopic dermatitis, irrespective of the presence of allergy.     

Predictive value of parathyroid scintigraphy in the preoperative evaluation of patients with primary hyperparathyroidism.

BACKGROUND AND AIMS: The surgical gold standard in primary hyperparathyroidism was until recently exploration of all four parathyroid glands. Today more patients undergo minimal invasive procedures demanding more accurate preoperative localization studies. The aim of the study was to determine the positive predictive value (PPV) of parathyroid scintigraphy (PS) and to some extent ultrasonography (US), defined as the probability of finding one single adenoma on the affected side at surgery when the scans had shown one single focus. MATERIAL AND METHODS: Eighty-eight surgically treated patients (76 women and 12 men, 8 with multiglandular disease) were included. The PS consisted of 99mTc-sestamibi scan with dual-phase technique, both planar and SPECT imaging, followed by 99mTc-pertechnetate scan. A positive scan was defined as a single focus accumulating sestamibi. Focal lesions on US were defined as hypoechoic nodules. RESULTS: PS was positive in 80 patients. Seventy-nine had only one focus, of which 64 were correctly localized adenomas (PPV 81%). Forty-seven of 77 US examinations were positive. In 44 there was only one focus of which 38 were correctly localized (PPV 86%). PPV was 97% when both examinations were positive. CONCLUSIONS: Both PS and US have acceptably high PPVs defined as the ability to predict whether or not one single focus represents a parathyroid adenoma. Concordant positive results were accompanied by a PPV close to 100%.     

A Toxicological Basis to Derive a Generic Interspecies Uncertainty Factor.

A new method is proposed to derive the size of the interspecies uncertainty factor (UF) that is toxicologically and statistically based. The method involves quantifying interspecies variation in susceptibility to numerous toxic substances via the use of binary interspecies comparisons that are converted to a 95% UF. This interspecies UF represents an estimate of the upper 95% of the population of 95% prediction intervals (PI) for binary interspecies comparisons within four categories of phylogenetic relatedness (species within genus, genera within family, families within order, orders within class). The 95% interspecies UFs range from a low of 10 for species within genus up to 65 for orders within class. Most mammalian toxicology studies involving mice, rats, cats, dogs, gerbils, and rabbits are orders-within- class categories for human risk assessment and would be provided a 65-fold UF. Larger or smaller interspecies UF values could be selected on the level of protection desired.