Clinical and histopathological findings of ''psoriatic neurodermatitis'' and of typical lichen simplex chronicus

BACKGROUND: We have seen several patients with itchy lichenified plaques located bilaterally on the elbows and/or knees and have named this condition 'psoriatic neurodermatitis' (PN). OBJECTIVE: The purpose of this study was to compare clinical and histopathological characteristics of these patients to those of patients with typical lichen simplex chronicus (LSC). METHODS: Nineteen patients with PN and 34 patients with typical LSC were included. Besides clinical dermatological evaluation, the prick test was carried out on 49 patients; the Phadiatop test on 40 patients; the patch test with European standard series on 47 patients; histopathological evaluation on 39 patients; and clinical psychiatric examination on 38 patients. RESULTS: Almost exclusively, PN was seen in females and was located on the extremities. It caused more plaques than typical LSC did. In PN, the plaques were smaller, sharper, more keratotic and less excoriated, and had fewer lichenoid papules around them. Itching was usually more severe in the evening, while resting and in a hot environment in typical LSC, but not in PN. In plaques of PN, microabscesses in the horny layer, hypogranulosis, regular acanthosis and thinning of the suprapapillary plates were more frequent, and hyperpigmentation in the basal layer was less. In patients with PN, depressive disorder was found more frequently; and generalized anxiety disorder or psychosomatic characteristics, less. There were no significant differences in the results of prick, Phadiatop and patch tests between patients with PN and those with typical LSC. CONCLUSION: In our opinion, it is most likely that the so-called PN is itchy psoriasis superimposed by LSC.     

Treatment of refractoriness to platelet transfusion by protein A column therapy

Ten thrombocytopenic patients (platelets < 10–24 × 10(9)/L) who were refractory to platelet transfusion were investigated for their responsiveness to staphylococcal protein A column therapy. Nine patients had previously been treated with steroids, intravenous immune globulin, and/or other forms of immunosuppressive therapy without improvement in their transfusion response. All patients were receiving multiple platelet transfusions without achieving 1-hour corrected count increments (CCIs) > or = 7500. Eight patients had antibodies that reacted with platelets and were directed against HLA class I antigens, ABO antigens, and/or platelet-specific alloantigens. Plasma (500-2000 mL) from each patient was passed over a protein A silica gel column and then returned to the patient. Patients received from 1 to 14 treatments. A positive response to protein A therapy was defined as at least a doubling of the pretreatment platelet count and/or two successive 10- to 120-minute posttransfusion CCIs > or = 7500. Following plasma treatments, 6 of 10 patients responded with daily platelet counts that averaged 48 +/− 11 × 10(9) per L as compared with counts of 16 +/− 7 × 10(9) per L (p < 0.0005) before treatment. Posttransfusion CCI values determined in four of these patients averaged 2480 +/− 810 and 10,010 +/− 3540 (p < 0.005) before and after treatment, respectively. In contrast, among the four unresponsive patients, platelet counts averaged 10 +/− 9 and 13 +/− 10 × 10(9) per L (p = NS), respectively, while posttransfusion CCIs were 700 +/− 1410 and 1520 +/− 2460 (p = NS), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Natural killer cell activity and CSF monoamine metabolites in suicide attempters

The aim of this study was to investigate markers of serotonin and immune function in suicidal patients. Cytotoxic activity of natural killer cells (NK) and CD16 lymphocytes were studied in 28 suicide attempters and 26 healthy controls, and related in patients to 5-hydroxyindoleacetic acid (5-HIAA) in cerebrospinal fluid (CSF). Patients with CSF 5-HIAA below the median had significantly lower NK cell activity than other patients. CD16 cell frequency was significantly lower in patients than in controls, and patients also tended to have lower NK cell cytotoxicity than healthy controls. There were no statistically significant correlations between 4-hydroxy-3methoxyphenyl glycol (HMPG), homovanillic acid (HVA), CSF cortisol and NK cell activity. The results support the hypothesis of compromised immune function in suicidal patients with evidence of disordered serotonin function.     

Associations of peptic ulcer and gastric cancer with other diseases in US veterans.

OBJECTIVES: The purpose of this study was to examine, through the database of the Department of Veterans Affairs, the joint occurrence of different diseases in individual patients. METHODS: Patients with a diagnosis of gastric cancer, gastric ulcer, or duodenal ulcer were extracted from the 1987 through 1990 computer files. A random sample of patients from each annual file served as a control population. All previous discharges of each case or control patient between 1970 and 1990 were searched for the occurrence of hypertensive diseases or chronic diseases of the joints, lungs, pancreas, and liver. The relative frequencies of such diagnoses in case and control patients were compared by multivariate logistic regression. RESULTS: Gastric ulcer and duodenal ulcer, but not gastric cancer, were significantly associated with chronic diseases of the joints, lungs, pancreas, and liver. None of the three diagnoses showed any significant association with hypertensive diseases. CONCLUSIONS: These relationships may reflect the influence of nonsteroidal anti-inflammatory drugs, smoking, and alcohol. They stress the importance of environmental risk factors other than Helicobacter pylori in terms of damage to the upper gastrointestinal mucosa.     

Early separation and suicidal behaviour in the parental homes of 40 consecutive suicide attempters

Forty suicide-attempt patients who were consecutively admitted to an intensive-care unit, their significant others and treatment personnel were investigated by semistructured interviews. The patients were divided into neurosis (n = 14), abuse (n = 19) and psychosis (n = 7) groups. Twenty-one of the patients (52%) had lost contact with one or both parents before the age of 18, in 25% of cases owing to death and in 27% because of the parents' divorce or separation. Parents and/or siblings of 19 patients (47%) had shown suicidal behaviour in the form of attempted suicide and/or suicide. Differences between the groups were not significant. Alcohol abuse in the parental home was overrepresented in the abuse group compared with the other groups. The role of identification with the dead and suicidal parent in prompting suicidal actions in adulthood is discussed, as well as that of the impeded evolution of stable external object relations owing to parental losses.     

Passive euthanasia in response to attempted suicide: one form of aggressiveness by relatives

A total of 88 interviews were conducted with 40 people attempting suicide who were receiving care in an intensive-care unit, and 129 interviews were carried out with their relatives and friends. The subjects were divided into 3 diagnostic groups: neurosis (n = 14), abuse (n = 19) and psychosis (n = 7). The incidence of relatives' failure to provide care after the suicide attempt--turning-away reactions as well as do not resuscitate orders, a form of passive euthanasia--was investigated. In 8 cases, partners of patients in the abuse and neurosis groups showed turning-away reactions. In 2 cases, relatives of elderly patients in the neurosis group said to the doctor that life-preserving measures should not be taken. Relatives explained their behaviour by saying that they had the best interests of the suicidal individual at heart. In-depth interviews, however, revealed that these reactions were a manifestation of the relatives own psychic conflicts, brought forth by the confrontation with the depressed and suicidal patient. Turning-away reactions and do not resuscitate orders might be interpreted as expressing the relatives' aggressiveness towards the suicidal individual and attempts to escape from a difficult situation. It is important that doctors stand up for the interests of suicidal people, which at times may conflict with relatives' interests, and help the relatives to sort out their problems and wishes with respect to the problem areas of passive euthanasia.     

Lead exposure and intelligence in 7-year-old children: the Yugoslavia Prospective Study.

For a prospective study of lead exposure and early development, we recruited pregnant women from a lead smelter town and from an unexposed town in Yugoslavia and followed their children through 7 years of age. In this paper we consider associations between lifetime lead exposure, estimated by the area under the blood lead (BPb) versus time curve (AUC7), and intelligence, with particular concern for identifying lead's behavioral signature. The Wechsler Intelligence Scales for Children-Version III (WISC-III) was administered to 309 7-year-old children, 261 of whom had complete data on intelligence, blood lead, and relevant sociodemographic covariates (i.e., Home Observation for the Measurement of the Environment (HOME), birth weight, gender, sibship size, and maternal age, ethnicity, intelligence, and education). These showed anticipated associations with 7-year intelligence, explaining 41-4% of the variance in Full Scale, Performance, and Verbal IQ. Before covariate adjustment, AUC7 was unrelated to intelligence; after adjustment, AUC7 explained a significant 2.8%-4.2% of the variance in IQ. After adjustment, a change in lifetime BPb from 10 to 30 micro/dl related to an estimated decrease of 4.3 Full Scale IQ points; estimated decreases for Verbal and Performance IQ were 3.4 and 4.5 points, respectively. AUC7 was significantly and negatively related to three WISC-III factor scores: Freedom from Distractibility, Perceptual Organization, and Verbal Comprehension; the association with Perceptual Organization was the strongest. Consistent with previous studies, the IQ/lead association is small relative to more powerful social factors. Findings offer support for lead's behavioral signature; perceptual-motor skills are significantly more sensitive to lead exposure than are the language-related aspects of intelligence.     

Ureteral pseudodiverticulosis associated with carcinoma of renal pelvis

We describe a patient with bilateral ureteral pseudodiverticulosis of 10 years’ duration before developing transitional carcinoma of the pelvis.