Preliminary evaluation of vitiligo using in vivo reflectance confocal microscopy

BACKGROUND: Vitiligo is the most common pigmentary disorder with a global incidence from 0.1% to 2% in different geographical areas. Histopathology and histochemistry have shown the reduction of melanocytes in achromic patches, but microscopic changes of lesional and non-lesional skin are still not completely understood. Reflectance confocal microscopy (RCM), based on the different light reflectance index of cutaneous structures, allowed in vivo, en face microscopic evaluation of superficial skin layers with a resolution similar to skin histology. AIM: The purpose of this study was to evaluate RCM features of lesional and non-lesional skin of vitiligo patients. Moreover, re-pigmented areas were taken into consideration in order to evaluate melanocyte response to ultraviolet B (UVB) radiation. SUBJECTS AND METHODS: Sixteen patients of different phototypes affected by active non-segmental vitiligo and 10 controls were enrolled in the study. In vivo skin imaging was done using a commercially available RCM (Lucid, Vivascope 1500. Re-pigmented areas from 6 to 16 patients (after UVB narrow-band therapy) were also examined. RESULTS: Vitiligo lesions showed the disappearance of the bright rings normally seen at the dermo-epidermal junction. Moreover, non-lesional skin of vitiligo patients showed unexpected changes as the presence of half-rings or scalloped border-like features of the bright papillary rings. In re-pigmented areas after UVB narrow band therapy, the presence of activated, dendritic melanocytes was seen. CONCLUSIONS: Considering our results, and following further studies, RCM clinical applications could be used in the therapeutic monitoring and evaluation of the evolution of vitiligo.     

Brain morphology in first-episode schizophrenic-like psychotic patients: a quantitative magnetic resonance imaging study

Brain morphology was examined using magnetic resonance imaging in 30 first-episode patients with a schizophreniclike psychosis, 15 chronic schizophrenics, and 20 neurological controls. Statistical analyses of computer-generated measurements of regions of interest were controlled for gender, age, social class, and total brain volume. Lateral ventricular size was increased in both first-episode and chronic schizophrenic patients, with greater significance on the left than on the right side. Only the chronic patients, however, had reduced temporal lobe size, which also was greater on the left side. No major correlations of regional brain morphological measurements with cognitive functioning were found, although some measurements of verbal memory were correlated with parahippocampal size. This is a report of a preliminary study that suggests that some morphological brain changes may be present at the time of first treatment for a psychotic illness, whereas others may occur later in the course of illness. Future prospective studies may determine the clinical significance of these changes and whether they progress with the development of illness chronicity.     

Role of burst activity in attribute detection by visual neurons of the cat cortex

The temporal structure of neuronal responses has been investigated in the Clare-Bishop area of the cat cortex. Stationary and moving slit and moving spot have been used for stimulation. It was found that orientational and directional selectivity was determined mainly by the number of clustered impulses and the number of clusters. A closed-loop model for features detection which is able to interpret clustered activity is presented.     

Agoraphobics 5 years after imipramine and exposure. Outcome and predictors

Five years after treatment in a controlled trial, in which all had received self-exposure homework, a group of 40 agoraphobic outpatients retained marked improvement in agoraphobia, mood, and free-floating anxiety. Frequency of spontaneous panics decreased as much in those who had placebo and self-exposure as in those who received imipramine and self-exposure. Few patients, however, were completely well at 5 years and over half had received further treatment for agoraphobia during the follow-up. Patients who were still highly phobic at the end of the clinical trial were more often prescribed psychotropic medication during follow-up and remained phobic at 5 years. Phobic improvement had generalized more in those patients with very low than in those with moderate pretreatment Hamilton depression scores. Frequency of initial spontaneous panics did not predict outcome. Improvement in agoraphobia was associated with improved marital adjustment. Those who began with the best marital, work, and social adjustment were more improved in their phobias 5 years later.     

Bacteriology of sickle-cell leg ulcers in the equatorial forest belt of South-Western Nigeria

Forty-one sickle-cell leg ulcer patients attending the haematology out-patient clinic of the University of Benin Teaching Hospital, Benin City, Nigeria were included in this study and had swabs taken for bacterial studies. Single bacterial isolates were more frequent (68%) than mixed isolates (22%). No growth was obtained in 10% of patients. The relative frequency of Staphylococcus aureus was 57%; and the next most frequent organism was Escherichia coli (17%). Coliforms were relatively less frequent. Salmonella species and anaerobes were not isolated. The high incidence of skin pathogens (90%) raises the possibility of a bacterial role in the prevention of healing of these ulcers. A case is made for the use of appropriate antibiotics in promoting early healing.     

Vagotomy in the surgery of perforated pyloroduodenal ulcer

Under analysis are results of the surgical treatment of 300 patients with perforating pyloroduodenal ulcers. The correct selection of patients for the operation gives best nearest and especially long-term results of vagotomy with antrum resection. The amount of recurrences after a simple suturing of the ulcer in 164 patients was 50%, while after vagotomy with/without various draining operations it was 3.7%. Postoperative lethality after vagotomy was not great, long-term results being considerably better than after the operations of simple suturing the ulcer.