Immunofluorescent studies in ocular cicatricial pemphigoid

Twenty nine patients with cicatrizing conjunctivitis were studied; 17 with a clinical diagnosis of cicatricial pemphigoid, five with a clinical diagnosis of pseudopemphigoid caused by long-term application of topical medication and seven who had a cicatrizing conjunctivitis from other causes. Biopsies from clinically uninvolved bulbar conjunctiva were taken for direct immunofluorescence and blood was taken for indirect immunofluorescence using normal human conjunctiva, oral mucosa and skin as substrates. On direct immunofluorescence, in vivo bound immunoglobulins were found along the basement membrane in 10 of the 17 patients with cicatricial pemphigoid, one of the five with pseudopemphigoid and two of the seven with a cicatrizing conjunctivitis associated with other diseases. Circulating anti-basement membrane zone antibodies were found only when conjunctiva was used as a substrate. These were present in seven of the patients with cicatricial pemphigoid, three of those with pseudopemphigoid and two of those with a cicatrizing conjunctivitis caused by other diseases. These results indicate that direct immunofluorescence is a useful, but not absolute diagnostic marker for ocular cicatricial pemphigoid. The results in the pseudopemphigoid group argue that this is an immunologically mediated disorder indistinguishable from spontaneous cicatricial pemphigoid and probably triggered by the drugs. The presence of circulating antibodies should allow for precise identification of the antigen involved in cicatricial pemphigoid using SDS electrophoresis and Western blot analysis.     

Renal function after long-term low-dose cyclosporin for psoriasis

Two groups of patients receiving cyclosporin A (CyA) for psoriasis had their renal function assessed by measurement of glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). The first group comprised 13 patients who had taken low dose (average 3 mg/kg per day) CyA for an average period of 2.5 years. Seven of the 13 had a normal GFR of 108 (77-121) ml/min (median; range). In the other six patients the GFR was low at 63 (50-77) ml/min and CyA was discontinued for periods ranging from 3 to 17 weeks. The GFR rose in all six patients, to 79 (60-91) ml/min; this change was significant (P less than 0.05). The six patients restarted CyA because their psoriasis recurred and after a mean interval of 15 weeks the GFR had fallen in all six to 63 (46-80) ml/min (P less than 0.05) and the ERPF decreased from 339 (231-414) ml/min to 244 (177-321) ml/min (P less than 0.05). In the second group of 11 patients measurements were made prior to starting CyA and after taking CyA for a mean of 9 weeks. The GFR fell in eight out of 11 subjects, the GFR for the 11 patients being 117 (72-128) ml/min before taking CyA and 97 (51-122) ml/min after CyA (P less than 0.02). The ERPF was measured in nine of the 11 patients and fell in seven of the nine. The ERPF for the nine patients before CyA was 490 (296-642) ml/min and for the 11 patients after CyA was 410 (195-543) ml/min (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

ARTIFICIAL REGENERATION OF MOUNTAIN ASH (EUCALYPTUS REGNANS)

(a) Chuting as a means of extraction of plantation thinnings from steep slopes (over 25°) has been investigated since 1965. Eight chute designs of five basic types have been tested but only the two closed types can be considered successful.

(b) As it did not prove practical to reduce the weight of chutes to enable them to 'be readily handled by manpower, a single-drum 3 h.p. winch was developened to locate chutes and haul logs to the chute line.

(c) The method is the only practical one so far evolved for the extraction of thinnings from steep slopes, but it is still costlier than other methods in use on gentle slopes.     

Sulphamethoxypyridazine for dermatitis herpetiformis, linear IgA disease and cicatricial pemphigoid

One-hundred and sixty-eight cases of dermatitis herpetiformis were reviewed to compare the clinical response to and incidence of side-effects from dapsone and sulphamethoxypyridazine. Thirty-seven received sulphamethoxypyridazine (0.25-1.5 g/day) as a single agent therapy at some stage during their care and 161 had dapsone only (50-450 mg/day). Thirty of these patients received both drugs, but at different times. Both were highly effective in controlling the skin disease in 97% of patients on dapsone and 89% on sulphamethoxypyridazine. While 36 (22%) of dapsone-treated subjects had intolerable side effects warranting a change in therapy, this occurred in only five (13.5%) of those treated with sulphamethoxypyridazine. Sulphamethoxypyridazine was also effective as a single agent in three patients with linear IgA disease who had suffered adverse effects from dapsone, and in 10 out of 15 patients with oral and cutaneous lesions of cicatricial pemphigoid.     

Factors underlying performance on written tests of knowledge

The study compares two popular forms of written tests; the multiple choice test (MCQ) and the Modified Essay Question (MEQ). Two factors were varied in the experiment: the format of the questions (multiple choice, directed free response, or open-ended free response) and the context of the questions (in a patient problem or in random sequence). Six problems were developed in each version, and administered to a total of 36 medical students at three educational levels using a Latin-square design. The results showed a significant effect of each factor in the design, amounting to a difference of 8.7% between MCQ and directed free response, 4.2% between directed and open-ended free response and 4.3% between problem and random context. However, the correlation of scores based on content across the formats approached unity after correction for attenuation. A process score, based on the style and presentation in the undirected format, correlated more strongly with the free-response questions. The results suggest that, although the MCQ and MEQ may assess different skills, there is a very strong relationship between content scores derived from the two formats. The free response formats may present the opportunity for assessment of other factors related to presentation if scoring procedures are modified. Finally, the effect of randomizing questions is a deterioration of performance when compared to placing questions in the problem context.