Humanized anti-CD4 monoclonal antibody therapy of autoimmune and inflammatory disease

We have investigated the biological and therapeutic properties of a humanized anti-CD4 MoAb, hlgGl-CD4, in patients with refractory psoriasis and rheumatoid arthritis (RA). hIgGl-CD4 is a modulating, non-depleting MoAb, which induced a first-dose reaction in most patients treated. It provided brief symptomatic relief in both conditions, and psoriasis appeared easier to control with conventional agents after MoAb therapy. At the doses used, hIgGl-CD4 did not synergize therapeutically with the pan-lymphocyte MoAb CAMPATH-1H (C1H) in patients with RA treated sequentially with both agents. There were no serious adverse effects definitely attributable to therapy. Our results are compared with those of other CD4 MoAb studies, and factors influencing the outcome of therapy are discussed.     

CLINICAL EVALUATION OF THE AUGMENTED DELTA QUOTIENT MONITOR FOR INTRAOPERATIVE ELECTROENCEPHALOGRAPHIC MONITORING OF CHILDREN DURING SURGERY AND CARDIOPULMONARY BYPASS FOR REPAIR OF CONGENITAL CARDIAC DEFECTS

To assess the augmented delta quotient (ADQ) monitor as a monitorof cerebral function during cardiac surgery, we monitored duringoperation the electroencephalograms of 48 young subjects (aged2 weeks to 19 yr). We found ADQ patterns produced by cardiopulmonarybypass, hypothermia and general anaesthetic agents correlatedwith those obtained from a compressed spectral array (CSA) monitorand could be differentiated from changes caused by cerebralischaemia, except in the youngest group of patients ( 18 months)undergoing deep hypothermia (19.4 (SD 0.8) °C nasopharyngeal).In all other age groups the ADQ proved to be a simple monitorof the adequacy of cerebral perfusion. Neurological deficitoccurred only if the ADQ was abnormal during hypotension fora period exceeding 7 min. ADQ evaluation of cerebral functionwas limited by events which produced artificially normal ADQreadings such as low amplitude EEG activity and the describedisoflurane effect that was demonstrated to occur in some cardiacpatients. The results obtained by the ADQ were comparable tothose obtained by compressed spectral array and the ADQ waseasier to use and interpret. ^*Present address: Department of Anaesthesia and Intensive Care,Basingstoke District Hospital, Basingstoke, Hants.     

A model for research-based practice

• ? Nursing practice is based on experience, tradition, intuition, common sense, untested theory and sometimes research.
• ? There are a number of reasons why nurses may see research as irrelevant to their practice.
• ? This paper provides a model identifying possible strategies to help nurses develop research-based practice.

     

Nickel-containing alloys and platings and their ability to cause dermatitis

Summary A broad range of nickel-containing alloys and coatings used in jewellery, watches and clothes, were patch tested in 100 nickel-sensitive subjects and in 20 nickel-negative controls. Three non-plated stainless-steel alloys tested caused no patch-test reaction. Nickel interliners under gold, silver or chromium plating, as well as nickel-silver and some white-gold alloys, caused positive patch-test reactions. Ear ornaments, wristwatches and buttons were the objects most frequently causing dermatitis. Half the nickel-sensitive participants suspected that they had been sensitized before the age of 20. The results of the study have been used as the basis for developing clinically relevant analytical methods for nickel release. The methods are proposed as European Standards and will be used in the Nickel Directive, an EC regulation aiming at the prevention of nickel allergy.     

Erythrodermic psoriasis. Report of a case associated with symptomatic hypophosphataemia

We describe a patient with a long history of psoriasis who developed severe erythrodermic psoriasis associated with lethargy, muscular weakness and collapse. Serum biochemical screening at the time revealed severe hypophosphataemia, and when this was corrected by intravenous phosphate replacement her symptoms resolved and her psoriasis improved. Hypophosphataemia may therefore be another metabolic complication of erythrodermic psoriasis.     

Treatment of extramammary Paget's disease by radiotherapy

Summary Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy, which usually occurs in the elderly. Wide local excision is the recommended treatment, although this may not always be feasible. We report our experience of EMPD treated by radiotherapy In five patients. The radiotherapy was well tolerated in each case, and there were no signs of recurrence during follow-up (6 months-8 years). This study shows that radiotherapy is a useful alternative therapy for EMPD. and should be considered particularly in elderly patients who may not tolerate surgery.