Delayed, transient, postsolar truncal pruritus: a report of two cases.

We present two cases of a rare clinical condition presenting as a delayed and transient pruritus of the trunk following sun exposure. These cases differ from previously reported conditions such as brachioradial pruritus because of the transient nature and anatomical location of the itching. These two cases extend the clinical spectrum of sun-induced pruritus. The patients' initial response to rigorous sun protection is good, but the specific treatment and natural history of the condition have yet to be determined.

Dermatology outpatient case-mix survey for all Welsh Trusts, 2007.

Background In 2006 a U.K. government White Paper recommended making NHS care in England more accessible by shifting services from secondary care into community settings. There is a shortage of contemporary activity data for U.K. dermatology units to allow benchmarking for service development. This study will not only provide useful comparative data for the future in Wales, but will also serve to highlight the impact of changes made in England. Objective To provide an overview of 1 week's dermatology outpatient activity for the whole of Wales. Methods All dermatology units in Wales collected data for 1 week in early 2007. The case mix, appropriateness of referral, requirement for surgery or second-line therapies and follow-up requirements were all determined. Results A total of 2142 patients were seen. Of new patients, 21% had skin cancer. Seventeen per cent of skin cancers had no diagnosis suggested by the general practitioner (GP) and 10% of basal cell carcinomas, 33% of squamous cell carcinomas and 17% of malignant melanomas were inappropriately diagnosed. In all, 26% of new patients had benign lesions, and this group caused the greatest diagnostic difficulty for GPs. Seventy-one per cent of these patients were diagnosed, reassured and discharged at their first visit without the need for biopsy or surgery. Thirty-seven per cent of new patients required surgery, of which 21% required complex intervention. Twenty-six per cent of follow-up patients were receiving second-line therapies. The new to follow-up ratio varied considerably according to diagnosis, the mean ratio being 1 : 0.21 for benign lesions through to 1 : 5.53 for psoriasis. This highlights the inappropriate nature of a 'one fits all' ratio. The majority of follow-up patients in secondary care required this level of input for monitoring of cancer, complex second-line therapies or surgery. Conclusions This study provides evidence to support logical planning of dermatological services and to assess the impact of proposed changes on different healthcare systems in the U.K.

Development of a chitin assay for the quantification of fungus.

Chitin, a unique structural polysaccharide found in fungi and arthropods, is not produced by vertebrates. Thus, the potential applications of a specific and sensitive assay for chitin are numerous, including the evaluation of the extent of fungal keratitis. Chitin is a homopolymer of beta (1, 4) linked D-N-acetylglucosamine. We have developed a simple and reproducible assay for chitin and applied it to Candida albicans cultures. The assay involves homogenization of the culture and treatment with 21.1 M KOH to remove soluble materials, including proteins. This base treatment also deacetylates the chitin to the glucosamine polymer, chitosan. Chitosan is hydrolyzed by 0.5 M H2SO4 to glucosamine monomers which are then deaminated by the addition of NaNO2 to the acid solution. The resulting 2,5-anhydromannose is reduced by NaB[3H]4 to 1-[3H] 2,5-anhydromannitol. This radiolabelled sugar is isolated by paper chromatography and quantified via liquid scintillation. The sensitivity of this assay is assessed by comparison of colony forming units (CFU's) with a glucosamine standard. A typical run of the assay detects 53.1 CFU/c.p.m., and 356,000 c.p.m. per nanomole of N-acetylglucosamine. The specificity of the assay is very high because of the unique nature of chitin. This method of chitin determination may be a useful alternative method for future investigations involving the study of fungal infections in mammalian tissues.

A comparison of sub-bandage pressures produced by experienced and inexperienced bandagers.

An investigation of the relative importance of bandage design, experience of bandager and size of limb on sub-bandage pressures.

Rethinking anti-smoking media campaigns: two generations of research and issues for the next.

This article provides a variety of alternative theoretical issues and new research directions for smoking media campaign research. The first two generations of smoking media campaign research are reviewed and new ideas about public resistance and resolving complex issues are explored. The authors critique the limits of current campaign theory and their premise that how the public resolves issues such as smoking cessation needs to be seen in a broader context. The consciousness raising, working through, and resolution stages each present a series of different research challenges and issues for investigators. These are: (1) an assessment of the perceived credibility by the target audience toward mass media, news media, health care providers, tobacco firms, area health care agencies, the health care delivery system, and different classes of providers, (2) how smokers and nonsmokers differ on the linkage among biomedical, epidemiological, and toxicological controversies, (3) how smoking issues are managed within arenas, (4) how arenas potentially undermine popular participation in public policy formation, and (5) how in the creation of dialogue there should be dual emphases on the viability of the concept and tactics.

Relationships between scores on Wechsler Preschool and Primary Scale of Intelligence--Revised and Stanford-Binet IV.

The Wechsler Preschool and Primary Scale of Intelligence--Revised and the Stanford Binet-Intelligence Scale: Fourth Edition were given to 51 preschool, kindergarten, first, and second grade students. Twelve of 15 Pearson correlations between Wechsler IQs and composite and area scores of the Stanford-Binet IV were statistically significant. It is apparent that the two tests measure similar, but not identical, concepts.

Spontaneous photo-onycholysis.

Three cases of onycholysis following, and apparently caused by, sun exposure are reported. No case was associated with drug ingestion or demonstrable metabolic abnormality. Cutaneous phototesting of all patients with an irradiation monochromator was within normal limits, although the action spectrum for the defect may lie in the ultraviolet-A (UV-A) region. This appears to be the first report of spontaneous photo-onycholysis.

Cutaneous presentation of prolymphocytic leukaemia.

We report a case of prolymphocytic leukaemia which presented with annular, purpuric, erythematous plaques in the skin. Histology of the lesions showed cutaneous invasion with leukaemic cells. The lesions cleared with chlorambucil and prednisolone, and the leukaemic state responded to deoxycoformycin, an experimental anti T cell agent.

Outcome of carbon dioxide laser therapy for persistent cutaneous viral warts.

Twenty-two adults with persistent, symptomatic viral warts on the hands or feet which had failed to respond to conventional therapy were treated by carbon dioxide (CO2) laser ablation under local anaesthesia. Four patients did not return for follow-up treatment. Of the remaining 18 patients, 12 had plantar warts, the other six had warts on the hands that were mainly periungual. The median duration of the warts prior to laser treatment was 5 years. The areas treated were solitary in eight and multiple in 10 cases. After an average follow-up period of 10 months (minimum 6 months), all of the treated areas were clear of warts in 10 patients (56%), some had cleared in three, and all the treated warts had relapsed in the other five patients. Side-effects were commonly observed, especially post-operative pain, temporary loss of function of the treated part and scarring. The use of the CO2 laser may clear otherwise resistant viral warts but a significant morbidity may occur with this method of treatment.

Single-mode GaAs-Al(x)Ga(1-x)As rib waveguide switches.

Metal-oxide-semiconductor rib waveguides are low loss for any polarization and are efficiently electrooptically modulated. We show COBRA switching of 90% with 15 V and a 2 x 4 switch matrix. These suggest versatile applications in integrated optical circuits.

Rib waveguide switches with MOS electrooptic control for monolithic integrated optics in GaAs-Al(x)Ga(1-x)As.

Low-loss (1.4-cm(-1)) single-mode rib waveguides in Al(x)Ga(1-x)As heterostructures are fabricated by liquid phase epitaxy, double anodization, and photolithographic techniques. Switching of optical channels between adjacent waveguides is accomplished with directional coupler switches controlled with electrodes laid over an isolating dielectric, making a metal-oxide-semiconductor (MOS) configuration. Complete switching is achieved with <20 V applied to a stepped Deltabetareversal electrode configuration. A 2 x 4 switching matrix with low-loss lateral offsets of the waveguides is demonstrated. By laying out several optical switching and guiding experiments within a 128-mum stripe, we show that independent optical circuits can be packed with adequate optical isolation using centerline separations approximately 10 microm.

A comparative study of terbinafine versus griseofulvin in 'dry-type' dermatophyte infections.

We conducted a double-blind comparative study of terbinafine, 250 mg twice daily, versus griseofulvin, 500 mg twice daily, for 6 weeks in chronic dermatophyte infections of the feet or hands. All but three patients (total 31) had Trichophyton rubrum infection. At 12-week follow-up, 100% of the terbinafine-treated group were free from infection compared with 45% of those treated with griseofulvin. Therapy in 75% of the terbinafine-treated group and in 35% of those given griseofulvin was rated as effective overall at long-term follow-up, although these differences were not statistically significant. Six months after treatment all nine patients whose skin had cleared with terbinafine therapy remained in remission versus only one of seven patients treated with griseofulvin. None of the patients in either group experienced serious adverse effects.

Localization of bullous pemphigoid antibody--an indirect immunofluorescence study of 228 cases using a split-skin technique.

We have re-examined the site of deposition of IgG anti-basement membrane zone antibodies in 228 sera from suspected cases of bullous pemphigoid (BP), using 1.0 M sodium chloride split-skin as substrate for indirect immunofluorescence. Nine sera (4%) produced fluorescence on the floor of the split suggesting sub-basal lamina antibody deposition compatible with a diagnosis of epidermolysis bullosa acquisita (EBA). This ultrastructural localization was confirmed in only three of these nine by immuno-electron microscopy. Clinical details were available on six of these nine cases, and none had clinical features suggesting EBA. We have found the split-skin immunofluorescence technique unhelpful in identifying 'missed' cases of EBA. The prevalence of EBA presenting as BP would appear to be very low indeed in the U.K.

The effect of psoralen photochemotherapy (PUVA) on symptomatic dermographism.

A controlled trial of 4-weeks oral photochemotherapy (PUVA) on 14 patients with severe symptomatic dermatographism produced a clinically useful reduction in itching in five patients. In four of these patients itching had relapsed to pre-treatment levels within 3 months of finishing the PUVA course. A comparison of the weal and flare responses on exposed and covered (control) skin using a calibrated dermographometer showed no significant change in skin reactivity, even in the patients who experienced symptomatic relief. While PUVA may temporarily reduce itching in some patients with symptomatic dermographism, its use cannot generally be justified for treating this type of physical urticaria.

Fiber-dispersion and propagation-delay measurements with frequency- and amplitude-modulated cleaved-coupled-cavity semiconductor lasers.

By using combined frequency and amplitude modulation of a cleaved-coupled-cavity semiconductor laser together with a phase-sensitive detection scheme, we have measured the chromatic dispersion in a single-mode silica fiber. The method presented can measure dispersion down to 0.03 psec/nm km and, with a slight modification to the measurement routine, also measure the total propagation time with a 10(-7) accuracy.