Personality, disability and acne in college students

The relationship between acne, personality and disability was examined in a sample of 101 junior college students in Singapore. The clinical severity of their acne was assessed using a Acne Severity Grading Scale. The disability as perceived by the individual, was evaluated using the Acne Disability Index. Our data showed that there was no difference in personality, assessed by Eysenck Personality Questionnaire, between students with mild acne (Grades 0 and 2) and those with severe acne (Grades 4, 6 and 8). Personality influences the individual's perception of disability. Students with acne who were concerned about their facial appearance were more emotional and less tough-minded than those who were not. Otherwise, there was little disability resulting from the disease.     

Iloprost: Intracellular Ca2+-dependent Contractile Effect on Isolated Smooth Muscle Cells from Guinea-pig Ileum

Prostaglandin E₂ (PGE₂) and iloprost induced a concentration-dependent contraction of smooth muscle cells isolated from the circular layer of guinea-pig ileum. PGE₂- and iloprost-induced contractions were inhibited by the selective EP₁-receptor antagonist, SCI9220 (1-acetyl-2-(8-chloro-10, 11-dihydrodibenz (b,f) (1,4) oxazepine-10-carbonyl)-hydrazine), indicating the involvement of the EP₁ subtype of the PGE₂ receptor. When cells were incubated for 10 min in the presence of strontium (4 mm L^?1), an inhibitor of the release of Ca²⁺ from intracellular store, the contractile effect of PGE₂ and iloprost was inhibited. In contrast, incubation of cells in Ca²⁺-free medium, Ca²⁺-free medium plus EGTA, or in the presence of nifedipine, an organic Ca²⁺-channel blocker, did not alter the PGE₂- and iloprost-induced contraction. These observations suggest that the myogenic effect of PGE₂ and iloprost on intestinal smooth muscle is dependent on the release of intracellular calcium.     

The ultrastructural changes in the skin in dermatitis herpetiformis after withdrawal of dapsone

The development of skin lesions in patients with dermatitis herpetiformis after the withdrawal of their dapsone therapy was studied with the electron microscope. In control biopsies from patients prior to cessation of treatment, membrane-bound vacuoles were found beneath the basal lamina of the epidermis as previously described. After dapsone withdrawal, there was an apparent increase in the number of vacuoles and occasionally several vacuoles appeared to have coalesced forming an early blister. At this stage, the basal lamina and associated hemidesmosomes were normal although in places there were small discontinuities in the basal lamina. Where the reaction was more intense, vacuoles and cells, mainly eosinophils, were embedded in fibrin de posits. Above this, the basal lamina was usually disrupted with involvement of the basal epidermal cells. These results suggest that the vacuoles do play a part in the formation of the pathological lesion in dermatitis herpetiformis. In addition, the basal lamina is shown to be only secondarily involved. The nature of the vacuoles has still to be elucidated.     

THE ACTION OF CHEMOTHERAPEUTIC AGENTS ON PSORIATIC EPIDERMIS

SUMMARY. —Mitotic counts and histological features have been studied in 35 psoriatic patients prior to treatment, and during treatment with topically applied fluocinolone acetonide, methotrexate, dithranol and coal tar.
Prior to treatment there was considerable variation in the mitotic counts in the 35 biopsies. The granular layer was absent in 10 biopsy specimens, partially formed in small areas in 21, well formed in most areas in 2, and normal in 2. There was no correlation between the mitotic counts and state of the granular layer.
With methotrexate and dithranol treatment the granular layer showed improvement prior to a significant fall in the mitotic counts. With fluocinolone acetonide the improvement in the granular layer appeared at the same time as a significant fall in the mean mitotic count, but the granular layer had completely reformed in 7 of the 9 patients while the mitotic count was still considerably raised compared to uninvolved psoriatic skin. With coal tar the results were not uniform; some patients showed a significant fall in mitotic counts prior to improvement in the granular layer and others first showed improvement in the granular layer.
It is suggested that in clearing psoriasis these drugs have an action other than, or in addition to, inhibiting mitosis.     

Calcium Antagonists. Mechanisms, Therapeutic Indications and Reservations: A Review

The chief site of action of the calcium antagonist drugs isthe slow calcium channel in two tissues: the atrioventricularnode and vascular smooth muscle. The exact mode whereby theseagents work is still unknown, but recently studies withradioligandssuggest that the binding site for the dihydropyridines suchas nifedipine is different from the site for theverapamil group(including diltiazem). In some way these agents ‘close’or ‘block’ the calcium channels. Verapamil and diltiazemare active against the calcium channel of the atrioventricularnode which nifedipine in clinical doses is not; in contrast,nifedipine is more active on peripheral vascular arterial muscle,presumably inhibiting the calcium channel more strongly. Anintracellular site of action of these agents on calmodulin invascular smooth muscle cannot be excluded. Clinically, the chiefcalcium antagonists (verapamil, nifedipine, diltiazem) constitutea powerful group of cardioactive agents with a spectrum of therapeuticactions rather similar to beta-adrenoceptor blockade, beingeffectivein angina of effort and rest, and hypertension. Critical differencesare dependent on the individual propertiesof the calcium antagonists.Thus only verapamil and diltiazem are effective in inhibitingthe AV node while the dihydropyridines such as nifedipine areonly vasodilators in clinical doses. As a group, calcium antagonistscause vascular dilation and do not cause bronchial constriction,in contrast to the beta-adrenoceptor blocking agents. In manypatients these diverse properties allow safe combination ofcalcium antagonists and beta-adrenoceptor blockers if due careis observed.     

Gastrointestinal Effects of Diazepam-withdrawal are Linked to Activation of Central Cholecystokinin-ergic Pathways in Rats

Abstract— The influence of flumazenil-precipitated diazepam withdrawal on intestinal myoelectric activity and colonic transit was evaluated, in diazepam-dependent rats. Administered intraperitoneally, flumazenil (15 mg kg^?1) induced a strong stimulation of the duodenal spiking activity lasting 197 ± 20 min, and accelerated colonic transit corresponding to a significantly (P < 0·05) increased value of the geometric centre (3.52 ± 0.23 vs 2·44 ± 0·1 for the control). Both devazepide and L365260 administered intracerebroventricularly at a dose of 10 μg kg^?1 abolished the flumazenil-induced withdrawal effect on the duodenum, whereas at a lower dose (1 μg kg^?1) only L365260 was able to antagonize this effect. In the same way, devazepide, loxiglumide and L365260 suppressed the effect of precipitated withdrawal on colonic transit when administered intracerebroventricularly at a dose of 10 μg kg^?1, whereas similar blockade was obtained at a dose of 5 μg kg^?I with L365260, and 10 ng kg^?1 with PD135–158. It is concluded that in rats precipitated diazepam-withdrawal altered intestinal motility and colonic transit and that these effects are mediated by central release of cholecystokinin (CCK) or activation of CCK-ergic neurons.     

Is the Potential of Teenage Consultations Being Missed?: a Study of Consultation Times in Primary Care

There is a paucity of knowlege regarding teenage health eventhough it features as one of the priority areas in the government'shealth plans. There have been few reports of adolescent contactswith primary care teams, although there are impressions of asuboptimal service. As a prelude to understanding more aboutcommunication between general practitioners and teenage patients,this study aimed to look at the time spent on teenage consultations,which can be used as one method of describing the quality ofcare provided to teenage patients. Nine-hundred consultationsinvolving six doctors in one surgery were timed over a 3 monthperiod by one observer using a validated method. One-hundredand nineteen consultations with patients aged 11–19 werecompared with the 781 consultations for other age groups andshowed a statistically significant mean shortfall of nearly2 minutes (23%). This trend was confirmed for all six doctors,despite a broad range of average consulting times. The studyalso demonstrated some other characteristics of teenage consultations.Several implications of these results are discussed as wellas possible reasons for these findings. The study emphasizesthe need for further research in this area.     

"Double Steal" Syndrome

A case is presented of a patient who had undergone internal mammary artery bypass grafting and subsequently developed angina pectoris and cere-brovascular insufficiency as the result of a single proximal subclavian artery stenosis. The patient's ischemic symptoms resolved following successful angioplasty of the subclavian lesion. The status of the brachiocephalic circulation should be considered in patients presenting with angina following internal mammary artery bypass grafting and preoperatively in patients who are being considered for this procedure. (J Interven Cardiol 1989:2:1)     

A Case of Cardiomyopathy Induced by Inappropriate Sinus Tachycardia and Cured by Ivabradine

We present the case of a 67-year-old woman with cardiomyopathy induced by inappropriate sinus tachycardia (IST) and a particularly high average heart rate. The patient was resistant and/or intolerant to treatment with conventional rate-slowing medications. We used ivabradine—a specific sinus node I_f current inhibitor—and successfully lowered the heart rate (33 beats per minute mean heart rate decrease). Symptoms, systolic function, and heart rate variability parameters recovered dramatically. No side effect was noted. We suggest that ivabradine—evaluated in trials to treat stable angina—should be considered as a second-line treatment in patients with very symptomatic and refractory IST.