A COMPARISON OF GLUTATHIONE REDUCTASE AND GLUTATHIONE PEROXIDASE ACTIVITES IN PATIENTS WITH RHEUMATOID ARTHRITIS AND HEALTHY ADULTS

A 30% increase in erythrocyte glutathione peroxidase (GP) activitywas found in patients with rheumatoid arthritis when comparedwith healthy controls (p = 0.001) whereas the increase in glutathionereductase (GR) was statistically insignificant. No correlationwas found between the activities of the enzymes and the erythrocytesedimentation rate (ESR). The enzyme activities were independentof age, sex, or type of drug treatment of the patients. A possibleinterpretation of the results is presented. KEY WORDS: Glutathione peroxidase, Glutathione reductase, Rheumatoid arthritis, Disease activity, Thiol, Peroxides     

HTLV-1-associated cutaneous disease: a clinicopathoiogical and molecular study of patients from the U. K.

The clinieopathological features of eightpatients with cutaneous disease associated with HTLV-1 infection are reviewed. All were U. K. residents of West Indian extraction, and two are currently alive. Disease remained confined to the skin in two patients. Five patients with a cutaneous prodromal phase developed leukaemia after a medianduration of 124 months (3months-21years), and in one of these combination chemotherapy produced a sustained clinical remission for 20 months. Two patients developed cutaneous disease after remission of their leukaemia. Cutaneous lesions were heterogeneous and included localized papules, a generalized papulonodular eruption, diffuse and localized erythematous plaques, pompholy x-like lesions on the palms and soles, and tumours. The histology of the skin lesions was also variable, and consisted of aheavy dermal infiltrate with lymphocytes, histiocytes, plasmacells, eosinophils and cytologically atypical mono-nuclear cells. Epidermotropism was present in biopsies from five patients. Tumour cells with large, densely staining, pleomorphic nuclei, arranged in rows between collagen bundles, were present in the majority of cases. In one patient the infiltrate also consisted of epithelioid cells and muitinucleated giant cells. Six cases were classified histologically as pleomorphic T-cell lymphoma, and two as cerebriform or mycosis fungoides type. Molecular studies revealed a clonal T-cell population associated withmonoclonal integration of HTLV-1 provirus in tissue DNA from six patients. In two patients HTLV-1 integration was established retrospectively using enzymatic in vitro amplification of a specific HTLV-1 pol genesequence in DNA extracted from paraffin-embedded sections. This study indicates that the clinical and pathological features of HTLV-1-associated cutaneous disease are diverse. Patients may have disease confined to the skin for prolonged periods, either at presentation or following clinical relapse—cutaneous adult T-celll ymphoma. Molecular techniques allow distinction from other types of cutaneous T-cell lymphoma, and provide an opportunity for retrospective studies of archival material.     

Pulmonary veno-occlusive disease. A report of four cases

Four cases of pulmonary veno-occlusive disease are described. Two patients, who were brothers, had respiratory tract infections. The third patient had chronic active hepatitis and coeliac disease suggesting an abnormality of the immune system; the fourth patient had no obvious cause but presented initially with systemic hypertension. Three of the cases had been diagnosed initially as primary pulmonary hypertension either on open lung biopsy or clinically. In all cases the pulmonary arteries were abnormal with medial hypertrophy, intimal fibrosis and, in some cases, thrombosis in elastic pulmonary arteries. These findings suggest that pulmonary veno-occlusive disease is not confined to veins and should be considered as a widespread pulmonary vascular disease. The range of aetiological factors indicate that it should not be considered as a single disease entity.     

Clinical and pathological heterogeneity in cutaneous gamma-delta T-cell lymphoma: a report of three cases and a review of the literature

Cutaneous gamma-delta (γδ) T-cell lympboma is rare. Eleven cases have been reported to date including four cases of mycosis fungoides (MF). two of pagetoid reticulosis and five of pleomorphic cutaneous T-cell lymphoma (CTCL). We report three further cases of cutaneous γδ T-cell lymphoma: one of ME. one of a pleomorpbic CTCL and one of a subcutaneous T-cell iymphoma. Combined data suggest that although cutaneous γδ T-cell iymphomas do not appear to comprise a single clinicopathoiogical entity, they may be associated with aggressive clinical behaviour and a poor prognosis.     

Tooth loss, attrition and temporomandibular joint changes in a Romano-British population

Mandibular condyles and temporal fossae were studied in a large Romano-British collection of skulls. The size and shape of the condyles differed from those in previous populations studied. Changes in form or shape of the condyles were age-related and could be correlated to the number of teeth lost on the same side and on the contralateral side. No statistically significant correlations were seen between attrition and condylar form and surface change.     

Acquired immunobullous disease: a cutaneous manifestation of IgM macroglobulinaemia

Summary Waldenstrom's macroglobulinaemia has been associated with a variety of cutaneous manifestations. We report a patient with an acquired bullous disorder associated with skin fragility and IgM kappa paraprotein. Immunofluorescence studies demonstrated bright linear deposition of IgM along the basement membrane zone (BMZ), around dermal blood vessels and on arrector pili muscles. Weak keratinocyte cell surface staining with IgM was also noted. There was no deposition of complement or other immunogiobulins. Indirect immunotluorescent studies revealed a circulating IgM anti-BMZ antibody (titre 1/200), which bound to both the roof and the floor of a 1 mol/l NaCI split skin substrate. Immunoblotting analysis ofthe patient's serum, with both epidermal and dermal extracts, was negative. Treatment with a combination of prednisolone and azathioprine was successful. We suggest that this IgM kappa paraprotein has a low affinity for an undefined epitope within the lamina lucida, which has produced a subepidermal bullous disorder associated with skin fragility.     

Plasma exchange in refractory cutaneous vasculitis

Eight patients with intractable cutaneous leucocytoclastic vasculitis were given a trial of plasma-exchange therapy. All but one improved, five substantially. Four have been successfully treated by intermittent plasma exchange for periods of 5-12 years. Apart from one episode of hepatitis B, possibly related to administration of fresh frozen plasma, no major adverse effects have occurred. Plasma exchange can be a valuable therapeutic option in patients with severe refractory cutaneous vasculitis.     

PHENOTYPING OF INDIVIDUALS SENSITIVE TO SUXAMETHONIUM: The Cholinesterase Research Unit at the Royal Postgraduate Medical School

Four hundred and thirty blood samples from suxamethonium-sensitiveindividuals have been phenotyped by the Cholinesterase ResearchUnit following its transfer from Exeter to the Hammersmith Hospital.The distribution of genotypes has been shown to be similar tothat found in Exeter. Screening for the and genes has not yielded any major differences in the gene frequencies ofsensitive individuals, even during pregnancy. The uneven sexdistribution of the patients, as well as other unusual pointsthat have arisen, are discussed. A new gene for the biosynthesisof cholinesterase has probably been identified.