Hodgkin's disease and pemphigus

The second case of pemphigus associated with Hodgkin's disease is reported. Circulating pemphigus auto-antibodies were detected in this patient and cell-mediated (T cell) immunity was markedly depressed. It is postulated that this T-cell immunodepression predisposed the patient to the development of pemphigus.     

PUSTULAR BLASTOMYCOSIS

A 53-year-old Negro man had North American blastomycosis with acute onset of widespread pustular eruptions. Several tests suggested that the patient might have had a deficiency of delayed hypersensitivity.     

Erythromycin resistant propionibacteria in antibiotic treated acne patients: association with therapeutic failure

Erythromycin resistant (EmR) propionibacteria were isolated from the skin surface of 51% of patients treated with oral erythromycin and 42% of patients treated with topical clindamycin compared with 3% of untreated control subjects (P less than 0.001). Amongst the topical clindamycin-treated patients, there was a higher incidence of EmR propionibacterial carriage in those patients who had previously been treated with oral erythromycin (64%) than in patients with no known previous exposure to erythromycin (20%; 0.01 greater than P greater than 0.001). Patients responding to oral erythromycin treatment carried EmR propionibacteria less frequently (24%) than patients who were not responding or who had relapsed (70%; P less than 0.001). These observations suggest that the use of oral erythromycin and/or topical clindamycin encourages the development of resistant propionibacteria and that the emergence of resistant strains is associated with therapeutic failure in erythromycin-treated patients. In total 63 resistant isolates were obtained from 52 subjects. There were 42 strains of Propionibacterium acnes, 16 strains of Propionibacterium granulosum and five strains of Propionibacterium avidum. The majority of isolates were inducibly or constitutively resistant to macrolide (e.g. erythromycin), lincosamide (e.g. clindamycin) and streptogramin B type antibiotics. Therefore, the isolates are phenotypically indistinguishable from the majority of EmR bacteria in which resistance is due to methylation of 23S ribosomal RNA.     

The effects of cisapride on gastric and oesophageal emptying in dystrophia myotonica

The effects of cisapride on gastric emptying, oesophageal emptying, and gastrointestinal symptoms were evaluated in 10 patients with dystrophia myotonica who had delayed gastric emptying of the solid and/or liquid component of a meal. A double isotope technique was used to measure gastric emptying and oesophageal emptying was measured as the time taken for a bolus of the solid meal to enter the stomach. Gastrointestinal symptoms were assessed by a questionnaire. Gastric and oesophageal emptying and gastrointestinal symptoms were measured before and when each subject had taken cisapride (10 mg, q.i.d., p.o.) for 4 weeks. Cisapride improved solid gastric emptying, and there was a non-significant trend for improved liquid emptying. Cisapride had no effect on oesophageal emptying. Upper gastrointestinal symptoms were less after cisapride and there was an increased frequency of bowel actions. No side effects were reported. These results indicate that gastroparesis is a treatable cause of morbidity in dystrophia myotonica.     

Remembering and repeating childhood dental treatment experiences: parents, their children, and barriers to dental care

Background.  Despite improvements over the past two decades, caries and its treatment remain a problem for Scottish children.
Aim.  To investigate how the reported childhood dental care experiences of a group of Scottish parents impacted upon the dental treatment they accessed for their children.
Study design.  In-depth, semi-structured interviews were conducted with 19 parents of varied age and social background whose children were referred to Dundee Dental Hospital for the assessment of dental extractions. Parents were encouraged to discuss their own and their child's experiences of dental care. The interview data were systematically coded using key theme headings, and summary charts constructed to facilitate the analysis.
Results.  A sense of 'uneasiness' pervaded the parents' comments and perceptions of the dental care provided for their children. This was conceptualized as parents 'remembering in words' and 'repeating through actions' their own childhood dental experiences. They remembered and repeated their childhood experiences by delaying dental treatment for themselves and their children.
Conclusions.  Acknowledging the influence of parental dental experience would help ensure that parents of young children access routine care for their children and themselves.     

INFORMATION PROCESSING AND THE MENTALLY HANDICAPPED: an approach for considering work skills

The usefulness of information concepts in an assessment situation was commented on as early as 1957 by Annett and, more recently, by Olsen (1971) who suggested that channel capacity could act as a sensitive index of mental retardation. Renewed interest has been shown by Whelan (1974). The present study raises three major considerations. Firstly, it suggests that the ability of the mentally handicapped to process information is influenced by the nature of the cues used. Colour cues appear to be processed significantly faster than shape cues. Secondly, there are significant differences in the speed of information processing depending on the amount of information conveyed by the stimulus card. Thirdly, it suggests that measures of central processing over information levels where the subject has to utilise one or two bits of information are comparable with non-handicapped populations, and that handicapped individuals suffer in comparison in terms of their movement time.     

THE USE OF SPECULAR MICROSCOPY TO INVESTIGATE UNUSUAL FINDINGS IN THE CORNEAL ENDOTHELIUM AND ITS ADJACENT STRUCTURES

The use of specular microscopy is not confined to the corneal endothelial mosaic, but may be used at any level through the corneal stroma to the posterior endothelial surface. In the stroma the not very dense, irregularly rounded deposits of corneal dystrophies may be differentiated from the dense, geometric shapes of crystalline deposits. At the level of Descemet's membrane the fine parallel lines of tears in Descemet's are distinct from the multiple fine vertical deep stromal lines seen in advanced keratoconus. At the level of the endothelial mosaic the cells may be counted and their morphology examined, while blebs may also be seen in a wide variety of pathological conditions including superficial keratopathies, contact lens wearers, deep keratopathies, anterior uveitis and contusion injury. These blebs vary in size in different conditions and are often transient. They must be distinguished from guttae which are permanent and although an occasional finding in normal corneas are a constant feature of cornea gutatta and Fuchs' dystrophy. On the posterior endothelial surface the relief mode enables the examination of numerous deposits including red blood cells, white blood cells, keratitic precipitates, pigment granules and pseudoexfoliative KP. The morphology of these various findings is discussed.     

RISK and the Pregnant Body

Reasoning well about risk is most challenging when a woman is pregnant, for patient and doctor alike. During pregnancy, we tend to note the risks of medical interventions without adequately noting those of failing to intervene, yet when it's time to give birth, interventions are seldom questioned, even when they don't work. Meanwhile, outside the clinic, advice given to pregnant women on how to stay healthy in everyday life can seem capricious and overly cautious. This kind of reasoning reflects fear, not evidence.