ERYTHRODERMA DUE TO PERITRATE AND GLYCERYL TRINITRATE

Cutaneous sensitivity to peritrate (pentaerythritol tetranitrate) and glyceryl trinitrate is described, having developed simultaneously, despite the fact that the patient had previously taken drugs without mishap for 10 years.     

Preponderance of lysosomal bodies in cultured fibroblasts from patients with recessive epidermolysis bullosa dystrophica

Fibroblasts of skin explants from three normal men and six patients with recessive epidermolysis bullosa dystrophica (EBD-R) were cultured in Dulbecco's medium, grown to confluence, sectioned and studied with the electron microscope. The normal control fibroblasts from the 6th to 13th passage (secretory phase) showed irregular or lobed nuclei with centrally scattered chromatin. They also had prominent RER, Golgi complexes, variously shaped mitochondria and cytoskeletal microfibrils. Their peripheral cytoplasm exhibited many vacuoles and a small number of these were autophagic lysosomes. In addition to the ultrastructural features described in the control fibroblasts, the EBD-R cells from the 6th passage contained remarkable numbers of strongly electron dense lysosomal bodies through their entire cytoplasm with very few empty vacuoles. It is speculated that the accumulation of these lysosomes may be connected with a primary metabolic cellular defect in the dermal fibroblasts of patients with EBD-R akin to that described in mucopolysaccharide storage diseases.     

Pityriasis rubra pilaris: epidermal cell kinetics

Epidermal proliferative kinetics were studied in a patient with pityriasis rubra pilaris. Elevated proliferative indices (flash labelling and mitotic indices) were apparent compared with normal epidermis and measurements of the birth rate indicate that the rate of epidermal cell production was similar to that found in psoriasis, and equalled 11.8 cells/1000 germinative cells/h; this suggests a cell cycle time of 60 h. Contemporaneous measurements of the rate of entry into DNA synthesis showed values similar to the rate of entry into mitosis; hence there is no G₂ cell loss as appears to occur in the hyperproliferative psoriatic epidermis.     

Tattoo removal using infra-red coagulation

Using a radiation source from which the output is maximal in the near infra-red range, we have successfully treated thirty-six tattoos in twenty-one patients. This technique is described and its place in practice is discussed.     

Tattoo removal using infra-red coagulation: a dose comparison

Using an infra-red coagulator, 42 tattoos were treated using pulses of 1.125 s (27 tattoos) or 1.25 s (15 tattoos). Treatment failures occurred only in three professional tattoos. Amateur tattoos were satisfactorily treated in over 80% of cases regardless of dose. Deeper collagen necrosis occurred with 1.25 s, but scarring was clinically similar. Pre-treatment biopsy to assess pigment depth was of no value in selection of the optimum pulse duration and increased the complication rate. The possible mechanism of pigment removal is discussed.     

Minitracheotomy Seldinger—assessment of a new technique

A multicentre, prospective study of 26 patients was undertaken for the assessment of insertion of minitracheotomy tubes by the Seldinger technique. The technique of insertion is described. There were two misplacements, three blockages of the inserting Tuohy needle with fat, and six cases of difficulty in passing the minitracheotomy tube.     

The in vitro erosive potential of a range of baby drinks

Objective.  The aim of this study was to assess the erosive potential of a range of commercially available baby drinks in the laboratory.
Methods.  The erosive potential of each product was assessed by measuring its initial pH, neutralizable acidity, and ability to erode primary and permanent enamel. These parameters were compared to those of an orange juice positive control.
Results.  The initial pH of the baby drinks ranged from 3.5 to 4.0 with their neutralizable acidity ranging from 5.76 to 16.02 mL of 0.1  m NaOH. The amount of primary enamel removed following 1-h immersion in the drinks ranged from 3.77 to 8.10 microns, while the amount of permanent enamel removed ranged from 1.09 to 4.86 microns. In comparison, the orange juice control (Tropicana smooth) had an initial pH of 3.86, a neutralizable acidity of 37.0 mL of 0.1  m NaOH, and removed 6.39 microns of primary enamel and 5.32 microns of permanent enamel.
Conclusion.  All the baby drinks tested were found to be erosive; some of the products were as erosive as orange juice.     

Case Studies with the Experts: Management Decisions in Atrial Fibrillation

Atrial fibrillation (AF) is the most common outpatient arrhythmia. The recent ACC/AHA/ESC guidelines outline a variety of approaches to the management of AF, but their implementation into clinical practice requires multi-faceted patient evaluations and assessments for optimizing patient care. Using a case-based approach, issues such as rate versus rhythm control, anticoagulation, cardioversion, pharmacological and catheter ablation for maintenance of sinus rhythm, and the pathophysiology of AF are discussed. These data were originally presented at a satellite symposium titled Case Studies with the Experts: Management Decisions in AF , held on May 10, 2007, during the annual Heart Rhythm Society meeting.     

Elastic fibre damage induced by low-dose D-penicillamine

We have studied 23 patients receiving penicillamine for the treatment of rheumatoid arthritis to determine the prevalence of penicillamine-induced elastosis. One female patient had pseudoxanthoma elasticum-like skin changes and bramble-bush elastosis without calcification in the involved skin. Penicillamine elastosis was present in the joint capsule in 62% of eight patients or 64% of II joints examined and was detected in joint capsules after as little as I year of treatment.