Photoprovocation in the Patients with an EBV Associated Hydroa Vacciniforme‐Like Eruption

Skin conditions in individuals with undifferentiated connective tissue disease (UCTD) are poorly classified and characterised. We reviewed 892 consecutive cases of individuals who had a workup for UCTD. ATAbs were positive in 526(59%). The ATAb(+) and ATAb(−) groups had similar antinuclear antibody (ANA) positivity (32% versus 28% respectively), average age (59 versus 58), and female‐male ratio (8:1 versus 6:1). ATAb positivity was significantly associated with a dermatitis, manifested as erythematous macules/patches or papules on legs, shoulders or upper backs, in 9%(47/526) individuals versus 2%(7/366) in ATAb(−) individuals (Pearson's chi‐square = 18.7, p < 0.0001). Sixteen individuals with dermatitis had biopsies, 14 ATAb(+) and 2 ATAb(−). Routine hematoxylin‐eosin and colloidal iron‐stained sections were examined. Eleven biopsies (79%) from ATAb(+) individuals (5 ANA‐negative, 5 with thyroid disease) and one from ATAb(−) ANA(−) individuals showed interface/lichenoid dermatitis with mild basal keratinocyte vaculopathy, variable dermal mucin deposition, and perivascular mononuclear inflammatory cell infiltrates in the upper dermis. The interface dermatitis was not significantly associated with ANA positivity or thyroid disease. In summary, we report an ATAb‐associated interface dermatitis in UCTD patients which may represent a new subset of autoimmune disease, and suggest that ATAb tests may be a useful marker for UCTD.     

Emergencies in Dermatology : Acute Skin Failure

Rational understanding of etiopathogenesis of the systemic complications arising out of sudden, severe alterations in structure and function of the skin consequent to the syndrome of acute skin failure clearly establishes the necessity of a dedicated ICU in a skin department.Immune suppression due to increased age, organ transplantation, malignancy, prolonged intake of steroids as also the indiscriminate use of drugs have lead to a spurt in the incidence of widespread, recalcitrant dermatoses with significant potential to eventuate into reaction patterns terminating into acute skin failure, viz. universal erythema and scaling of erythroderma and widespread denudations of bullous dermatoses. Prompt intensive management of all such cases in the ICU on the lines of 100% burns is mandatory.Key Words: Acute skin failure, Erythroderma, Bullous dermatoses, Recalcitrant dermatoses     

Analgesia in labour: non-regional techniques

For many women, labour may be the most painful experience theyencounter. A European multicentre study of 611 nulliparous womenconcluded that the most satisfied were those who not only receivedeffective pain relief, but had expected more pain before theiranalgesia. The experience of labour, including pain severity,is different for each woman and the measures taken to relievepain remains the choice of the individual. The provision ofclear information about the types of pain relief available hasbeen found to increase feelings of being in control. Local servicesvary and the advent of midwife-led units for low risk labourmay limit the type of analgesia available.¹     

Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India

Background

Control of sexually transmitted infections (STIs) is an important part of the effort to reduce the risk of HIV/AIDS. STI clinics in the government hospitals in India provide services predominantly to the poor. Data on the cost and efficiency of providing STI services in India are not available to help guide efficient use of public resources for these services.

Methods

Standardised methods were used to obtain detailed cost and output data for the 2003–2004 fiscal year from written records and interviews in 14 government STI clinics in the Indian state of Andhra Pradesh. The economic cost per patient receiving STI treatment was calculated, and the variations of total and unit costs across the STI clinics analysed. Multivariate regression technique was used to estimate incremental unit costs. The optimal number of STIs that could be handled by the clinics was estimated.

Results

18807 STIs were diagnosed and treated at the 14 STI clinics in fiscal year 2003–2004 (range 323–2784, median 1199). The economic cost of treating each STI varied 5-fold from Indian Rupees (INR) 225.5 (US$ 4.91) to INR 1201.5 (US$ 26.15) between 13 clinics, with one other clinic having a very high cost of INR 2478.5 (US$ 53.94). The average cost per STI treated for all 14 clinics combined was INR 729.5 (US$ 15.88). Personnel salaries made up 76.2% of the total cost. The number of STIs treated per doctor full-time equivalent and cost-efficiency for each STI treated had a significant direct non-linear relation (p < 0.001, R² = 0.81; power function). With a multiple regression model, apart from the fixed costs, the incremental cost for each STI detected and cost of treatment was INR 55.57 (US$ 1.21) and for each follow-up visit was INR 3.75 (US$ 0.08). Based on estimates of optimal STI cases that could be handled without compromising quality by each doctor full-time equivalent available, it was projected that at 8 of the 14 clinics substantially more STI cases could be handled, which could increase the total STI cases treated at the 14 clinics combined by 38% at an additional cost of only 3.5% for service provision.

Conclusion

There is un-utilised capacity in the public sector STI clinics in this Indian state. Efforts to facilitate utilisation of this capacity would be useful, as this would enable more poor patients with STIs to be served at minimal additional cost, and would also reduce the cost per STI treated leading to more efficient use of public resources.     

Evaluation of gall bladder carcinoma with dynamic magnetic resonance imaging and magnetic resonance cholangiopancreatography

The objective of this study is to evaluate the efficacy of dynamic MRI with magnetic resonance cholangiopancreatography (MRCP) in the preoperative assessment of gall bladder carcinoma. Magnetic resonance imaging and MRCP were carried out in 15 patients with gall bladder carcinoma before surgery and the imaging findings correlated with surgical and pathological findings. Gall bladder carcinoma manifested as focal or diffuse wall thickening in 73% (11/15) and as a mass replacing the gall bladder in 27% (4/15). All tumours showed enhancement in the early phase, which persisted into the delayed phase. The sensitivity and specificity of MRI with MRCP in detecting hepatic invasion, lymph node metastasis and bile duct invasion was 87.5 and 86%, 60 and 90%, and 80 and 100%, respectively. Magnetic resonance imaging correctly diagnosed duodenal invasion in only 50% and in none of the two patients with peritoneal metastasis. In conclusion, dynamic MRI with MRCP is an accurate and a reliable method of showing gall bladder carcinoma and in assessing its local and regional extent as part of preoperative assessment.     

毛细管气相色谱-电子捕获法测定人血清中5-单硝酸异山梨醇酯的浓度和药代动力学参数

A simple, sensitive and precise capillary GC-ECD method was developed for thedetermination of isosorbide-5-mononitrate in human serum,Pharmacokinetic parameters of the drugwas obtained from the human serum level-time curve measured. Serum samples were extracted with a mixture of ethyl ether-ethyl acetate(4:1), the upperphase was collected and evaporated to about 100μl under a gentle nitrogen stream,Isosorbide dinitratewas used as internal standard.With a human serum sample size of 200μl ,the detection limit of IS-5-MN was found to be about 5 ng/ml,and the athelute recovery from 74%to 85%. The within-dayand between-day relative standard deviation were less than 7%and 9%,respectively. This method was applied to the pharmacokinetic studies of IS-5-MN tablets froth two differentsouroes.Two sets of t_1/2(Ke),T_max and AUC values obtained from 8 volunteers were tested statisti-cally and no significant difference was found.     

钩藤碱对血小板聚集和血栓形成的影响

钩藤碱(Rhy)明显抑制AA,胶原及ADP诱导的大鼠血小板聚集。Rhy不影响血小利用外源性AA合成TXA₂,但抑制胶原诱导的TXA₂生成;在抗血小板聚集有效剂量时,对PGI₂的生成无影响。Rhy有显著降低血栓形成诱导剂ADP及胶原加肾上腺素静脉注射所致小鼠死亡率。     

毛细管气相色谱－电子捕获法测定人血清中5－单硝酸异山梨醇酯的浓度和药代动力学参数

毛细管气相色谱－电子捕获法测定人血清中５－单硝酸异山梨醇酯的浓度和药代动力学参数夏桂珠，傅贻柯，董善年，李然（北京医科大学分析化学教研室，北京医科大学应用药物研究所１０００８３）５－单硝酸异山梨醇酯（ｉｓｏｓｏｒｂｉｄｅ－５－ｍｏｎｏｎｉｔｒａｔｅ，...     

大豆甙元(S86019)与乳香有效成分Bc-4或阿糖胞苷对HL-60细胞分化的联合诱导

大豆甙元($86019)单独处理HL-60细胞,对细胞生长诱导分化作用较弱,NBT阳性细胞数低于10%。当S86019与乳香有效成分Bc-4联合应用时,对HL-60细胞的生长有明显抑制,并有明显的分化诱导;S86019与Bc-4或Ara-c联合应用,对细胞的增殖有较强的抑制和分化诱导作用。S86019与Bc-4联合应用4d,NBT阳性细胞达80%,75%细胞获得吞噬乳胶颗粒能力,90%细胞向成熟粒细胞方向分化;S86019与Ara-c联合应用4d,NBT阳性反应细胞达70%,82%细胞获得吞噬能力,90%细胞形态发生分化。S86019与Bc-4或Ara-c联合用药4d,可明显阻断细胞由G1期向s期移行,G1期细胞数明显增加。