The complex experience of psoriasis related skin pain: a qualitative study.

Background and aims Psoriasis is a common chronic skin condition, causing skin lesions with thickened and scaling skin, as well as erythema and inflammation that may involve painful sores, cracks, and pustules. Previously psoriasis was regarded as a painless skin condition. However, over the past decade studies show that skin pain is a frequently reported and bothersome symptom in patients with psoriasis. There is however a lack of rich narratives describing the experience of skin pain in these patients. The aims of this qualitative study were therefore to explore in depth how patients experience psoriasis-related skin pain, and how they deal with it. Methods Thirteen patients with psoriasis were recruited from a dermatology ward and outpatient clinic. One of the investigators (TML) performed individual, semi-structured interviews at an undisturbed room in the hospital. Interviews were thematically analyzed using the method of Systematic Text Condensation as described by Malterud (2012). Results Three main themes were identified from the interviews. First, the skin pain experience was complex. Patients used a variety of adjectives and metaphors to describe their pain, and their skin was sensitive to stimuli of every-day activities. Itch was a common cosymptom, and could both mask pain but also cause severe pain due to excessive scratching and damage to the skin. Second, skin pain had a negative impact on patients' life. Skin pain reduced their physical activity level, impaired their sleep, and made them irritable, depressed, unconcentrated on tasks, as well as withdrawn from other people and social activities. Third, patients dealt with their skin pain in various ways. Although some took action to relieve the pain and distract themselves from pain, most of the patients applied maladaptive and passive coping strategies such as put up with it, avoid painful activities, become fearful or trivialize their pain. Conclusions The experience of psoriasis related skin pain is complex. The pain has a major negative impact on patients' life in terms of physical, emotional, cognitive, and social functions. Patients use a variety of adaptive but most frequently maladaptive coping strategies in order to deal with their skin pain. Implications This study provides new and in-depth knowledge on psoriasis related skin pain. This information is valuable for further work on pain assessment tools and pain management recommendations customized for skin pain experienced by patients with psoriasis.

Extracorporeal surgery and autotransplantation for complicated renal calculous disease in 108 kidneys.

One hundred and eight kidneys in 97 patients with staghorn (72%) or multiple pyelocalyceal (28%) calculi were treated by extracorporeal surgery and autotransplantation, and followed up for 1-12 (mean 3) years. Twenty-seven patients had a solitary kidney, and 11 were operated on bilaterally. Sixty-nine % had a history of previous stone surgery, 74% had urinary tract infection and 30% renal dysfunction. Postoperative and late mortality rates were 3.1 and 2.1%, respectively. In addition, three kidneys were lost postoperatively and two later. Only one case of renal calculus recurrence was observed. Sixty-nine per cent of preoperatively infected patients were cured of infection, and 18% improved. Ninety-two per cent of patients with functioning autograft had preserved or improved renal function at follow-up. We find extracorporeal calculus removal a highly effective procedure with an acceptable risk.

Renal autotransplantation.

In the period, 1973-1985, a total of 305 renal autotransplantations (often with extracorporeal repair) were performed in 274 patients for fibromuscular (56) or atherosclerotic (98) renovascular disease, nephrolithiasis (97), renal tumor (15), or ureteral injury (8). One-third of the patients had reduced renal function, and approximately half of the patients with renovascular lesions presented with severe or malignant hypertension. The postoperative mortality rate of 4% was related to age over 60 years and reduced renal function. Postoperatively, 3.6% of the autografted kidneys were lost due to vascular thrombosis (7) or other causes (4). Twenty-five percent (69) of the patients had a solitary kidney. Two patients died postoperatively with functioning autografts. Long-term renal function remained stable in 60 patients, and deteriorated in 7. We conclude that autotransplantation and extracorporeal repair provide safe and efficient treatment for selected difficult renal lesions.

Donor-specific cellular and humoral immunity after clinical kidney transplantation.

The cellular and humoral immune response against donor lymphocytes was studied in 10 patients transplanted with kidneys from living related donors. Nine of the grafts were functioning well at the time of the study. No direct (T) cell-mediated cytotoxicity against donor cells was demonstrated. Specific anti-donor antibodies were found in two recipients with well accepted grafts. Their antisera were active in antibody-induced cell-mediated cytotoxicity (AICC) and inhibited the mixed lymphocyte culture (MLC), but were negative in complement-dependent cytoxicity (CDC). Thus, no single immunological factor responsible for a favorable clinical course could be demonstrated. Neither complete T nor complete B cell tolerance against donor cells had developed, and a well tolerated graft could co-exist with antibodies directed against donor cells.

Antibody response after single dose human alloimmunization.

Six individuals were immunized once, intradermally, with buffy coat cells from 100 ml of whole blood. The donor differed from the recipient for four HL-A antigens, two from the first and two from the second series. Two of the six recipients developed complement dependent cytotoxic antibodies, one of them against the immunizing donor only. Four of the six developed antibodies which were able to induce cell-mediated cytotoxicity, and which also inhibited the mixed lymphocyte culture interaction. Manily the responding cell in mixed lymphocyte culture was found to be inhibited. Antibodies with HL-A specificity seemed, at least partly, to be responsible for the observed effects.

Cellular and humoral immunity after clinical renal transplantation.

Cellular and humoral responses against donor lymphocytes were studied in ten kidney-transplant patients, nine of whom had well functioning grafts. No(T)cell-mediated cytotoxicity against donor cells was demonstrated. Specific anti-donor antibodies were found in two recipients with well-accepted grafts. A single immunological factor responsible for a favourable clinical course was not demonstrated. Neither complete T nor B cell tolerance against donor cells had developed, and a well-tolerated graft could coexist with antibodies directed against donor cells.