Langerhans cells in human warts

Seventy-six warts (15 plantar, 38 hand, 16 miscellaneous and seven anogenital lesions) taken from 55 patients, were studied by indirect immunofluorescence with monoclonal antibodies specific for T-cell subsets, Langerhans cells (LC) and HLA-DR antigen. The results were related to the presence of viral antigen. Approximately 80% of the lesions showed an infiltrate. Only 19 lesions contained helper/inducer or suppressor/cytotoxic T cells. The distribution of LC was abnormal in 65% of biopsies which contained LC in the dermis, and 29% were devoid of LC in the epidermis. Many lesions had reduced numbers of LC in the epidermis. The disappearance of LC from the epidermis was related to the presence of viral antigen, but not to the presence of particular T-cell subsets. Infiltrating cells were sometimes HLA-DR-positive, whereas basal cells did not express HLA-DR antigen, irrespective of the density of the infiltrate.     

Attitudes of Physicians and Nurses Towards the Role of Social Workers in Primary Health Care: What Promotes Collaboration?

Many writers have indicated that the future of social work inprimary health care is dependent on the attitudes of physiciansand nurses. This article reviews the literature in the fieldand describes the results of a study of 95 physicians and 78nurses in Israel which found that physicians have a more positiveattitude towards social work intervention than nurses and exploresthe differences in these attitudes in relation to particularpersonal characteristics. Physicians who were young, had recently received their MD degreeand had been educated in Israel had by far the most positiveattitudes towards social workers. Those aged over 60 years old,who had received their MD degree in Western countries more than25 years ago were more positively inclined towards social workin the clinics than middle-aged physicians educated in EasternEuropean countries. The personal characteristics of the nursesmade little difference to their generally poor attitude towardssocial work in the clinics. Those who received their nursingeducation more recently were more positive than other nurses.     

Prevalence of motor‐skill impairment in preterm children who do not develop cerebral palsy: a systematic review

Aim Motor skill impairment is a common negative outcome in children born preterm who do not develop cerebral palsy (CP). This study aimed to conduct a systematic review of current data to provide an accurate estimate of the prevalence of non‐CP motor impairment in preterm children at school age. Method We searched the Medline, PubMed, and PsycInfo databases and relevant journals to identify all studies published post‐1990 that reported the prevalence of motor impairment in school‐aged children born preterm (<37wks’ gestation) using standardised motor assessment batteries. We applied a range of exclusionary criteria, with 11 studies included in the final analyses. We identified two levels of motor impairment commonly reported – mild–moderate and moderate – and conducted a random effects meta‐analysis to produce a prevalence estimate for each. Results The pooled estimate for mild–moderate impairment in preterm children was 40.5/100. and for moderate motor impairment the estimate was 19.0/100. There was also a trend for lower motor impairment levels in samples born before 1990 compared with those born after 1990. Interpretation Children born preterm are at increased risk of motor impairment, with prevalence three to four times greater than in the general population. This highlights the need for improved surveillance and intervention strategies in this group of children.     

Phase II study of megestrol acetate in the treatment of hepatocellular carcinoma

This is a report of a phase II study of megestrol acetate (160mg/day, orally) in the treatment of hepatocellular carcinoma (HCC). Forty-six patients with advanced HCC were studied and tumour response, changes in appetite, bodyweight, a feeling of well-being, survival and toxicity were evaluated. Thirty-two patients were able to be evaluated for response; there were no complete responders or partial responders. Twelve patients (38%) had stable disease and seven of these patients had a minor response with a median size reduction in the tumour of 18%. Twenty patients (62%) had progressive disease. Five of 24 (21%) patients had a median reduction in α-fetoprotein levels of 59ng/mL. The overall median survival was 4 months (range 1 week to 27 months). Twenty of 32 (62%) patients had an increased appetite and feeling of well-being. Fourteen of 22 (64%) patients had a median lean bodyweight gain of 5 kg (range 1–14 kg). Toxicities were minimal. Tests for glucocorticoid receptors were performed in 10 patients. Four of five patients who were positive for glucocorticoid receptors in the tumour had a stable disease and all five patients who were negative for glucocorticoid receptors had progressive disease. Megestrol acetate had no significant effect on the tumour in HCC patients. However, megestrol acetate is useful in the palliative management of HCC patients, with improvements in appetite, bodyweight and a feeling of well-being with minimal side effects. Some patients had stable disease, a minor reduction of tumour size and a prolonged survival after megestrol acetate treatment and this response may be related to the presence of glucocorticoid receptors in the HCC tumour.     

Mothers'' Perceptions of Their Neonates'' In-hospital Transfers from a Neonatal Intensive-Care Unit

This study explored mothers' perceptions of their neonates' in-hospital transfers from a neonatal intensive-care unit. A convenience sample of 15 mothers was selected, and the researchers interviewed each mother once within a week after her neonate's transfer. Three themes emerged from the data: (1) the mothers expressed feelings of relief accompanied by concern, fear of the unknown, and feelings of alienation; (2) the mothers depended on familiar things and people; and (3) the mothers experienced feelings of helplessness. The mothers' perceptions of their preparation for transfer and continuity of care were mainly negative.     

Comparison between the MHC-restricted antibody repertoire to Ascaris antigens in adjuvant-assisted immunization or infection

Genetic restrictions to the immune repertoire will be an important consideration in the development of anti-nematode vaccines. It has already been established that the major histocompatibility complex (MHC) limits responsiveness to nematode antigens in infection, but little is known of whether this also applies under other routes of sensitization, such as with adjuvants. The specificity of the antibody response was, therefore, compared in infection and adjuvant-assisted immunization using secreted and somatic antigens of Ascaris suum as a model system in mice and rats. The findings were, first, that the lack of responsiveness to certain antigens in infection was not circumvented by Freund's adjuvant-based immunization, despite the fact that the latter generally elicited higher levels of response. Secondly, that adjuvant-assisted immunization could elicit responses to parasite products which were not detectable in the context of infection. Conversely, some specificities were detectable in infection but absent under adjuvant immunization. Finally, immunization with a defined parasite allergen (ABA-1) in Freund's adjuvant did not provoke an IgE response which would be anticipated if the molecule were to have an intrinsic allergenic property. These results are likely to be of general importance to the application of subunit or recombinant vaccines against nematodiases and to the hypersensitivity reactions which vaccination might engender or recall.     

Cutaneous vasculitis associated with long-term thiouracil therapy

Many rashes have been attributed to thiouracil therapy, but severe vasculitis is rare. A distinct pattern of cutaneous vasculitis affecting limbs, face and ears has been described with propylthiouracil, and is particularly associated with treatment of more than 18 months duration. A positive Antinuclear Antibody (ANA) in the absence of LE cells is often demonstrated. We describe the first such case due to methylthiouracil therapy, the bullous haemorrhagic rash having the histology of pyoderma gangrenosum, and we review the available literature regarding this pattern of vasculitis.