Thoracic Duct Drainage in Sle with Cutaneous Vasculitis

A 25-year-old woman had systemic lupus erythematosus manifested primarily by severe cutaneous vasculitis that was unresponsive to oral prednisone and azathioprine. She was treated with thoracic duct drainage (TDD). Her course was followed by serial photographs, skin biopsies, and serum immunoglobulin, antinuclear antibody, and complement levels. After I week of drainage there was obvious clinical improvement. During the remainder of her drainage, the vasculitis continued to improve. It was possible to taper oral corticosteroids and to discontinue azathioprine during TDD without any clinical or laboratory evidence of exacerbation. The patient had no recurrence of vasculitis 22 weeks after the termination of TDD.     

Pulmonary Function in Scleroderma

Pulmonary function tests were performed in 45 patients with scleroderma. Thirteen patients (29%) were found to have restrictive disease, 12 patients (27%) were found to have obstructive disease, and 19 patients (42%) had small airway disease (SAD). Smoking did not seem to be a factor underlying either obstructive or small airway disease in these patients. A low diffusing capacity was most common in patients with restrictive disease and rarely the only abnormality in pulmonary function. SAD was usually found in patients who had normal chest radiographs and no pulmonary symptoms and was often the only abnormality. SAD is therefore an early and sensitive indicator of pulmonary involvement in scleroderma.     

Thiemann' disease a brief reminder

Two brothers with Thiemann' disease are described and the accumulated world literature is briefly reviewed. Thiemann' disease is considered to be a form of idiopathic avascular necrosis of the PIP joints of the hands, with occasional involvement of other joints. The characteristic deformity and x-ray findings are reviewed. Thiemann' disease is a genetic disorder and, in families in which detail is available, is inherited as an autosomal dominant with virtual complete penetrance.     

Ultrasensitive profiling of UV-induced mutations identifies thousands of subclinical facial tumors in tuberous sclerosis complex

BackgroundTuberous sclerosis complex (TSC) is a neurogenetic syndrome due to loss-of-function mutations in TSC2 or TSC1, characterized by tumors at multiple body sites, including facial angiofibroma (FAF). Here, an ultrasensitive assessment of the extent and range of UV-induced mutations in TSC facial skin was performed.MethodsA multiplex high-sensitivity PCR assay (MHPA) was developed, enabling mutation detection at extremely low (<0.1%) variant allele frequencies (VAFs).ResultsMHPA assays were developed for both TSC2 and TP53, and applied to 81 samples, including 66 skin biopsies. UV-induced second-hit mutation causing inactivation of TSC2 was pervasive in TSC facial skin with an average of 4.8 mutations per 2-mm biopsy at median VAF 0.08%, generating more than 150,000 incipient facial tumors (subclinical “micro-FAFs”) in the average TSC subject. The MHPA analysis also led to the identification of a refined UV-related indel signature and a recurrent complex mutation pattern, consisting of both a single-nucleotide or dinucleotide variant and a 1- to 9-nucleotide deletion, in cis.ConclusionTSC facial skin can be viewed as harboring a patchwork of clonal fibroblast proliferations (micro-FAFs) with indolent growth, a small proportion of which develop into clinically observable FAF. Our observations also expand the spectrum of UV-related mutation signatures.FundingThis work was supported by the TSC Alliance; the Engles Family Fund for Research in TSC and LAM; and the NIH, National Heart, Lung, and Blood Institute (U01HL131022-04 and Intramural Research Program).     

Sex guilt and preferences for illegal drugs among drug abusers

This study investigated the relationship between sex guilt and drug preferences. Seventy polydrug users completed a drug preferences inventory and the Mosher Forced-Choice Sex Guilt Subscale. Results indicated that individuals who prefer sedatives are higher in sex guilt than either individuals who prefer stimulants or individuals with no definite preferences.     

Effects of selenium supplementation on hepatocarcinogenesis in rats

Four groups of weanling male Wistar rats (Groups A—D) received diethylnitrosamine (DEN, 40 ppm) in their drinking water for four weeks; after a recovery period of two weeks, they received (for the rest of the experiment) phenobarbital (PB, 500 ppm) added to a Torula yeast‐based diet containing 0.17 ppm of selenium. Dietary selenium (2 ppm), as sodium selenite, was given to Group B one week before and during DEN treatment, to Group C one week before and during PB treatment, and to Group D during the entire experiment. Groups A and E received the unsupplemented diet, whereas Group E was not treated with DEN or PB. Pair‐feeding conditions were used to minimize possible influences of differences in food intake and growth. Rats were killed at the 19th and 24th weeks after the experiment began. No significant differences were found in food and fluid intakes or in growth rates among the groups. Livers in Group E were histologically normal, whereas preneoplastic and neoplastic lesions were found in all other groups. In rats killed at the 19th and 24th weeks, the numerical and the volumetric densities of preneoplastic lesions did not differ significantly between all the groups. Similarly, the incidence of hepatocellular carcinomas only detected at 24 weeks was not significantly different between the groups. These results indicated that in this particular model of hepatocarcinogenesis, the dietary supplementation of 2 ppm of selenium did not modify the development of preneoplasia and carcinomas.