Treatment of acne vulgaris comparing two similar lotion formulations, one with ('Actinac') and one without chloramphenicol.

A double-blind, randomized study was carried out in 37 patients with acne vulgaris to compare the efficacy of two similar lotion formulations, one with ('Actinac') and the other without chloramphenicol (4%). Patients used one or other of the two formulations twice daily for the first 4 days and then at night only for the remainder of the 3-month trial period. At the end of the first month's treatment, the group treated with the full formulation showed a statistically significant greater reduction in lesion count score than in the group receiving the formulation without chloramphenicol. Both treatments produced statistically significant reductions in lesion counts at all monthly follow-up visits. After 3-months' treatment, the mean lesion count score was reduced from 28.8 to 9.3 in the full formulation-treated group and from 39.5 to 14.3 in the formulation minus chloramphenicol group, but this difference did not reach statistical significance.

A comparison of nystatin cream with nystatin/triamcinolone acetonide combination cream in the treatment of candidal inflammation of the flexures.

In a multi-centre double-blind trial, 31 patients with proven bilateral candidal lesions of the flexures were treated for 14 days with nystatin cream on one side and with a combination of nystatin and triamcinolone acetonide cream on the other. Both treatments proved equally effective in terms of mycological cure and clinical improvement. There was a trend in favour of the combination preparation being preferred by both patients and physicians because of more rapid relief of symptoms.

Vasomotor rhinitis: neglected cause of nasal congestion.

Vasomotor rhinitis is a condition of chronic nasal congestion which is noninfectious and nonallergic. Its cause is thought to be an imbalance of autonomic control to the nasal mucosa. This disorder is a diagnosis of exclusion, and other causes of chronic nasal obstruction must be considered first. Treatment measures include avoidance of nonspecific stimuli which exacerbate symptoms and, for symptomatic relief, use of oral sympathomimetics. Antihistamine-decongestant combinations may be effective in some patients. Topical vasoconstrictors should not be used.

Common otolaryngologic problems of flying.

Pressure-volume changes associated with changing atmospheric pressure precipitate acute inflammation of the sinus and middle ear cavities, known collectively as barotrauma. Barotitis occurs during descent from high altitudes. A partial vacuum develops, manifested by a retracted tympanic membrane. Hemorrhage may occur as a consequence of the vacuum. Similar pathophysiology causes barosinusitis. While the cause of aerodontalgia is not known, pain in the teeth does occur during ascent rather than descent.

Interpreting serologic tests for syphilis.

Since syphilis is most often diagnosed by serologic studies, the correct interpretation of these tests is critical. Serologic tests are classified as nontreponemal of treponemal, according to the antigen employed. Flocculation tests are generally used for routine screening because of their simplicity. The treponemal procedures are more specific, but false-positive results may still occur. Results vary with the procedure, stage of disease and treatment. Significant difficulties remain with the serologic diagnosis of neurosyphilis and congenital syphilis.

Adenomyoma of the stomach.

We have described three cases of adenomyoma of the stomach. These benign lesions are found almost exclusively in the antrum or pylorus and are composed of combinations of ducts, glands, pancreatic tissue, and smooth muscle. Malignancy arising in adenomyomas is rare.

Idiopathic retroperitoneal fibrosis with diffuse involvement: further evidence of systemic idiopathic fibrosis.

We have presented a fatal case of idiopathic retroperitoneal fibrosis with an unusual diversity of systemic involvement, providing further evidence for the concept of systemic idiopathic fibrosis. Although the definitive cause of this disorder remains unknown, laboratory findings in this patient suggest an autoimmune process.

A histopathological study of 643 cutaneous horns.

A retrospective study of 643 cutaneous horns examined in our department between 1970 and 1989 revealed that 38.9% were derived from malignant or premalignant epidermal lesions, and 61.1% from benign lesions. Four main features were associated with premalignant or malignant histopathological change at the base of a cutaneous horn (base pathology). These were: (i) age--the mean age of the patients whose cutaneous horns showed premalignant or malignant base pathology was 8.9 years greater than the mean age of the patients where base pathology was benign (P less than 0.0005); (ii) sex--males were more likely to develop a cutaneous horn with (pre)malignant base pathology (P less than 0.001); (iii) site--over 70% of all (pre)malignant lesions were found on the nose, pinnae, backs of hands, scalp, forearms and the face; a cutaneous horn found at these sites was 2.1 times more likely to have derived from a (pre)malignant base than from any other part of the body (P less than 0.0001); (iv) geometry of the lesion--lesions with a wide base or a low height-to-base ratio were significantly more likely to show (pre)malignant base pathology. Of those solar keratoses giving rise to cutaneous horns, 8.9% also showed histological evidence of change to squamous cell carcinoma (SCC); this figure was not significantly different from the 6.2% of solar keratoses without horns that showed SCC change during the same period (1970-89).