ABNORMAL FIBRINOLYSIS IN RETINAL VEIN OCCLUSION

Some cases of central and branch retinal vein occlusion are associated with and may be caused by abnormal fibrinolytic mechanisms.
The abnormality we described is that of plasminogen activator enzyme deficiency, which is a treatable condition.
That seven cases were seen by one practitioner in a two year period may indicate that this particular condition is under-recognised.     

Relief of pain after surgery

Sublingual buprenorphine (0.4 mg) and intramuscular papaveretum (20 mg) were compared in sixty patients after abdominal hysterectomy. Though slower in onset of effect the sublingual tablets proved effective for pain relief and appeared to have a longer duration of action. The only side-effects of note were nausea and vomiting which occurred after both treatments. Haloperidol was tried as a long acting antiemetic and appeared successful.     

The potassium iodide patch test in dermatitis herpetiformis in relation to treatment with a gluten-free diet and dapsone

The potassium iodide patch test was studied in twenty-six patients with dermatitis herpetiformis. Histological assessment was found more sensitive than clinical. All of five patients with active disease and not on treatment had a positive test, whereas only two of six patients taking a gluten-free diet (GFD) and one of eight taking dapsone were positive. In another two patients taking a GFD, but in whom the diet had not been strict, the test was positive. All three patients in remission and both patients with the linear pattern of IgA (but with active disease) were negative. Immunofluorescence studies showed no difference in the presence, quantity, or distribution of immunoglobulin, complement or fibrinogen between the patch test site and uninvolved skin, or in the uninvolved skin between patients with and without active lesions.     

Update on Management of In-stent Restenosis

In-stent restenosis (ISR) is a common and frequently resistant problem. The pathophysiology of in-stent and nonstent restenosis is different, the former resulting primarily from intimal hyperplasia, while the latter is predominantly a consequence of negative late remodeling. Predictors of ISR are patient and lesion related. When approaching a patient with stent restenosis, false or pseudo-restenosis must be considered. Angiography frequently fails to reveal pseudo-restenosis, and, consequently, intravascular ultrasound can be essential in guiding the most effective strategy. Because of spontaneous neointimal regression, patients with asymptomatic stent restenosis often can be followed and treated medically. The mechanical approaches to ISR include balloon angioplasty alone, debulking plus PTCA, and restenting. For focal lesions (< 10 mm in length) balloon angioplasty at moderately high pressures is often effective. Following balloon dilatation, stent expansion and plaque extrusion equally account for the gain in lumen area. For more diffuse disease, debulking plus balloon angioplasty is preferred, although no randomized data are available. Only restenting is associated with a gain in MID that is comparable to the original stent implant and is not associated with reintrusion of neointima — INSTANT restenosis. Despite aggressive debulking with or without further stenting, diffuse stent restenosis often is resistant to purely mechanical treatment. Nonmechanical approaches, such as localized radiation therapy, will be required to effectively treat this difficult subset of patients.     

Altered cell-mediated immunity to group A haemolytic streptococcal antigens in chronic plaque psoriasis

The proliferative lymphocyte response to sonicated group A, beta-haemolytic streptococci (Strep-A) was measured by thymidine incorporation in 78 patients with psoriasis (guttate, chronic plaque or both). Lymphocytes from 72 of these patients were also cultured with streptokinase/streptodornase (SK/SD), and 20 of the patients with chronic plaque psoriasis were further tested with PPD, Candida albicans and sonicated Streptococcus mutans, a bacterial type not associated clinically with psoriasis. The median stimulation index (SI) of the psoriasis group to the Strep-A preparation was significantly higher than that of a group of 27 non-psoriatic individuals (P less than 0.05). Within this group, only the patients with chronic plaque psoriasis (n = 42) showed a significantly increased proliferative response compared to the non-psoriatic controls (median SI = 123.8 and 31.9, respectively, P less than 0.01). Although the lymphocyte response of the chronic plaque group to SK/SD was also markedly higher than that of the control group, this difference did not reach statistical significance. In addition, these patients did not show significantly increased responses to any of the other antigens tested, including S. mutans. No correlation was observed between the degree of proliferation to Strep-A and disease extent or activity. Similarly, ASO titres, which were raised in 11 out of 23 guttate and three out of nine chronic plaque psoriasis patients tested, did not correlate with the proliferative responses observed.     

A comparative serological and molecular study of linear IgA disease and dermatitis herpetiformis

The class I and class II HLA serologically defined antigens and DQ alpha and DX alpha restriction fragment length polymorphism (RFLP) in 23 patients with linear IgA disease (LAD) were determined and their frequencies compared with those in a group of patients with dermatitis herpetiformis (DH) and healthy controls. In LAD there was a significant increase in HLA-B8 and DR3 and a larger increase in the DQw1-DR2/DRw6 related DQ alpha 6.2 kb and 6.8 kb RFLP. In DH there was a significantly increased frequency of HLA-A1, B8, DR3, and DQw2 with a concomitant increase in the DR3-DQw2 related DQ alpha 4.6 kb RFLP. The difference in DR3 frequencies and the increased frequency of DQw1 rather than DQw2 in LAD indicates that different susceptibility genes operate in the two diseases.