The inter-relation between inflammation and epidermal proliferation in normal skin following epicutaneous application of leukotriene-B4—an immunohistochemical study

Topical application of leukotriene-B4 (LTB4) on normal skin has been used as an in-vivo model to investigate cutaneous inflammation and epidermal proliferation, which are important phenomena in the pathogenesis of psoriasis. The aim of the present investigation is to further elucidate the interrelation between inflammation and epidermal proliferation, using specific monoclonal antibodies as markers for the different cell types involved. Aliquots of LTB4 were applied on the upperarms of eight healthy volunteers. After LTB4-application, biopsies were taken at consecutive time intervals. On frozen sections, epidermal proliferation was assessed by Ks8.12-(keratin 16) and Ki-67-binding (cycling cells), inflammation was characterized using anti-elastase (PMN), T11 (T-lymphocytes), pan-B (B-lymphocytes), WT 14 (CD14-positive cells) and OKT 6 (Langerhans cells). New observations were that the density of CD14-positive cells was increased even at 8 h and decreased slightly at 72 h. A striking rearrangement of Langerhans cells was seen in close vicinity to intra-epidermal accumulations of PMN. Remarkably an increased density of these cells in the dermis at 72 h was seen and a decrease in the epidermis. In line with previous studies, the accumulation of PMN reached a maximum 24 h after LTB4-challenge. The identity of the mononuclear infiltrate cells which have been reported 48-72 h after LTB4 proved to be T-lymphocytes. No B-lymphocytes were observed. Ki-67-positive nuclei were maximally increased 72 h after LTB4-application, which implies that recruitment of cycling cells is of relevance for the LTB4-induced proliferation in vivo. The hyperproliferation-related keratin 16 was expressed inconsistently in the suprabasal compartment.(ABSTRACT TRUNCATED AT 250 WORDS)     

DISPOSITION OF PROPOFOL AT CAESAREAN SECTION AND IN THE POSTPARTUM PERIOD

We have compared the pharmacokinetics of a bolus dose of propofol2 mg kg^–1 in eight patients undergoing Caesarean sectionwith those in eight postpartum patients undergoing sterilizationby mini-laparotomy. The Caesarean section group had a totalbody clearance of (median) 31.5 (range 24.4–53.3) ml min^–1kg^–1, apparent volume of distribution at steady state5.10 (2.46–6.61) litre kg^–1 and mean residence time161 (52.3–251) min; values for the postpartum group were33.8 (21.5–47.2) ml min^–1 kg^–1, 5.17 (3.47–8.09)litre kg^–1 and 163 (92.3–238) min, respectively.The 95% confidence interval for the umbilical venous to maternalvenous ratio of propofol at delivery was 0.62–0.86. Plasmaprotein binding studies showed there was less unbound propofolin maternal plasma (1.28–2.29%) compared with umbilicalplasma (2.08–3.88%) (P<0.01). Neonatal concentrationsof propofol were greater than maternal concentrations at 2 hand were in the range 0.05–0.11 µg ml^–1 at4h.     

Development of the Conduction System of the Heart

The muscle cells forming the myocardium and the muscle cells forming the intestinal smooth muscle layers, are both derived from the visceral mesoderm. All cardiomyocytes display autorhythmicity, intercellular conduction via gap junctions, and contraction, irrespective whether they are derived from atrium, ventricle, node, or bundies. It is the anatomical arrangement of the distinct components that is responsible for the coordinate contraction wave over the heart. These very basic principles have been insufficiently appreciated in most studies on the development of the conduction sytem, by which it got unnoticed that the proper anatomical arrangement is, in essence, layed down very early in development in the cardiac tube. In this review we will summarize recent immunohistochemical studies that have permitted this appreciation. *     

Responses of an AV Universal (DDD) Pulse Generator (Cordis 233D) to Programmed Single Ventricular Extrastimuli

To evaluate factors playing a role in initiation and perpetuation of pacemaker-mediated tachycardias (PMTs), 22 consecutive patients with symptomatic conduction disorders were studied after implantation of an AV universal (DDD) pulse generator (Cordis 233D). Patients were divided into two groups, depending upon the presence or absence of ventriculo-atrial (VA) conduction during electrophysiological study (EPS) performed before pacemaker implantation. PMTs could be initiated in six of eight patients of Group I and in none of 14 patients of Group II. Initiation and perpetuation of PMTs during DDD pacing were dependent upon the capacity of the patient to conduct ventricular premature beats (VPBs) and subsequent paced ventricular beats retrogradely to the atria, and upon three programmable parameters of the pulse generator (AV delay period, upper rate limit, tachycardia response). Programmed single ventricular extrastimulation demonstrated that: (1) merely the presence of VA conduction during EPS, although necessary, was not sufficient to induce PMTs after DDD pacemaker implantation; (2) VPBs introduced late rather than early in the cardiac cycle initiated PMTs in a different way; (3) the initiation of PMTs could be prevented during study by adjusting the programmable parameters (AV delay period, upper rate limit, tachycardia response); (4) one of the two available tachycardia responses of the pulse generator (gradual fall-back response) was able to terminate and initiate PMTs consistently. These observations helped in understanding the responses of the Cordis 233D pulse generator to ventricular premature beats. They indicate that additional refinement of the pulse generator is necessary to solve the problem of PMT.     

COSMETIC TATTOOING AS A TREATMENT OF PORT-WINE STAINS

Background. Medical treatment for port-wine stains frequently is cosmetically unsatisfactory. An alternative possibility is cosmetic medical tattooing. Methods. By means of a traditional Japanese tattooing technique, five patients were treated in multiple sessions until the color of the lesion matched that of the surrounding skin. Results. The results were excellent, the skin texture remained normal, and the patients could discontinue cosmetic camouflage. Discussions. Cosmetic medical tattooing when carefully done is a valuable addition to the medical armamentarium and may replace more aggressive techniques.     

Importance of Tachycardia Cycle Length for Differentiating Typical Atrial Flutter from Scar‐Related in Adult Congenital Heart Disease

Background: Radiofrequency catheter ablation (RFCA) for intraatrial reentrant tachycardia (IART) in congenital heart disease (CHD) remains difficult. Methods: Thirty‐four consecutive adult patients (age, 37.6 ± 12.8 years; male, 21) with previously repaired CHD and IART underwent an electrophysiological study and RFCA. CHD included atrial septal defect (ASD, n = 14), tetralogy of Fallot (n = 11), ventricular septal defect (n = 4), pulmonary atresia (n = 2), atrioventricular septal defect (n = 1), transposition of the great arteries (n = 1), and double‐outlet right ventricle (n = 1). Results: Duration of CHD repair to IART onset was 19.1 ± 8.5 years. Thirty and four patients had single‐ and double‐loop reentrant tachycardia, respectively. Among the total of 38 IARTs, which were mapped, 22 (57.9%) and 13 (34.2%) IARTs were cavotricuspid isthmus (CTI)‐dependent atrial flutter (AFL) and scar‐related AFL, respectively. Typical AFL electrocardiography findings including definite sawtooth appearance in inferior leads and positive F wave in lead V1 were observed in only 12 of 21 patients (57.1%) with CTI‐dependent AFL. CTI‐dependent AFL had a significantly longer tachycardia cycle length (TCL) than scar‐related AFL (267.6 ± 34.4 ms and 235.9 ± 37.0 ms, respectively; P = 0.031). TCL > 250 ms had 79% sensitivity as the cutoff value for differentiating CTI‐dependent from scar‐related AFL. The acute success rates of RFCA in CTI‐dependent and scar‐related AFLs were 85.7% and 90.0%, respectively. The recurrence rates in CTI‐dependent and scar‐related AFLs were 11.1% and 11.1%, respectively, during a follow‐up of 21.2 ± 28.3 months. Conclusions: CTI‐dependent AFL was the most common IART in adult patients with repaired CHD and was easily manageable by RFCA. TCL might help to differentiate CTI‐dependent AFL from other IARTs. (PACE 2012;35:1338–1347)     

Bullous pemphigoid successfully controlled by tetracycline and nicotinamide

In 1986, Berk and Lorincz reported the efficacy of tetracycline and nicotinamide in the treatment of bullous pemphigoid (BP). In the present study of seven patients with BP, we found that a regimen of 2 g tetracycline combined with 2 g nicotinamide daily was effective in clearing the skin lesions. Total remission was achieved within 6-8 weeks, after which the dose was gradually tapered. The mean duration of therapy was 7 months. No effect on the titre of antibasement membrane antibodies was observed. The mode of action of this therapy is unknown.     

Solid-phase synthesis of peptide haptens containing a cysteine—sulfur mustard adduct

Solid-phase synthesis of peptide haptens containing 2-[2-(S-cysteinyl)ethylthio]ethanol has been achieved by solution-phase synthesis of a properly protected S-alkylated cysteine derivative and subsequent solid-phase incorporation. © Munksgaard 1995.