Anetoderma in cutaneous marginal-zone B-cell lymphoma.

Anetoderma is a rare condition, consisting of well-circumscribed areas of slack skin, in which dermal elastic fibres are destroyed or deficient. We present the case of a 45-year-old man with a 25-year history of deep nodules and plaques gradually progressing to areas of anetoderma. Histological examination found an infiltrate composed of neoplastic cells with lymphoplasmocytoid morphology. The cells were positive for CD20, CD38 and CD138, and there was a monoclonal kappa light chain gene rearrangement of plasma cells. A diagnosis of cutaneous marginal-zone B-cell lymphoma was made. The pathogenesis of anetoderma remains unknown, but it is possible that cytokines or other soluble factors produced by the infiltrating lymphocytes have a role in this process.

A new computerized method for the assessment of skin lesions in localized scleroderma.

OBJECTIVE: Up to now, no validated tools are in use for the assessment of the skin lesions in localized scleroderma (LS). The aim of this study is to evaluate the performance of a new computerized skin score (CSS) method for the measurement of circumscribed lesions in LS. METHODS: The study consisted of three phases: set up of the CSS technique, measurement of target lesions of LS patients, assessment of intra- and inter-rater reliability. The CSS technique consists in delimitating the indurate lesion on an adhesive transparent film, transferring it over a cardboard and then calculating the affected area with a specifically created software. The technique was explained to a panel of 10 physicians with different expertise in LS (three paediatric rheumatologists, two dermatologists, five paediatric residents). All participants, singularly and blindly to the others, examined 10 consecutive patients twice after a time interval of at least 6 h. The intra-observer variability was evaluated by the repeatability coefficient and the inter-rater reliability by the intra-class correlation coefficient (ICC). RESULTS: The repeatability coefficients were good, ranging between 1.90 and 7.03. The mean values of skin scores were not significantly different among the examiners. The ICC for indurate area calculation were high in both the experts (0.97) and the residents (0.91-0.94). CONCLUSIONS: CSS has shown to be a reliable method to assess the skin lesions in patients with LS. It is reproducible, easy to use and, with the support of the CSS software, applicable worldwide.

IL-16 serum level in children with atopic dermatitis.

IL-16 is a natural ligand of CD4 molecules and induces chemotaxis in CD4-expressing cells. It amplifies the inflammatory reaction by stimulating cytokine production in monocytes and activating T-cells. There is evidence that IL-16 plays a role in the pathogenesis of atopic dermatitis, and increased serum levels of IL-16 have been detected in allergic diseases. However, few data are available on IL-16 serum levels in atopic dermatitis. The aim of our study is to measure IL-16 serum levels in childhood atopic dermatitis before and after treatment and to evaluate a possible correlation between IL-16 serum levels and disease severity. IL-16 serum levels were measured by an ELISA approach in 34 children (19 males and 15 females; mean age 6.8 years) with moderate to severe atopic dermatitis, at their first visit and after 3 months of treatment, and in 10 non-atopic healthy controls of the same age group. The severity of atopic dermatitis was measured by SCORAD index. IL-16 serum levels were significantly higher in patients affected by atopic dermatitis than in controls before and after treatment with tacrolimus ointment. No clear correlation was found between IL-16 serum levels and atopic dermatitis severity. IL-16 serum levels are increased in atopic dermatitis but do not seem to correlate with disease severity.

Role of cellular immunity in the pathogenesis of autoimmune skin diseases.

The pathomechanism of most autoimmune skin diseases is still elusive; however, recent clinical and basic research is leading novel insights into the cellular and molecular biological underlying pathways. Several types of infectious skin diseases are infiltrated by significant number of gamma/delta T cells and similar observations have been made in selected immune-mediated skin conditions. In particular, a role for gamma/delta T cells has been suggested in discoid lupus erythematosus, contact dermatitis, herpetiformis dermatitis, necrotizing cutaneous vasculitis, and cutaneous lesions of systemic sclerosis. The pathogenesis of these diseases is different and this may suggest multiple potential functions of this subset of T cells in the immune system of the skin. Furthermore, most T cells infiltrating tissue and organs undergoing fibrosis have the potential to produce high levels of interleukin 4. This is particularly true for the CD8+ or CD4+ CD8+ double positive T-cell subsets. Furthermore, leukocyte recruitment is a key event in immunity and a better understanding of the signals involved in autoimmune diseases constitutes a valuable basis for the development of new strategies, which control leukocyte migration and function under pathological conditions.

Immunoglobulin heavy chain variable region family expression in primary cutaneous follicle centre cell lymphomas.

BACKGROUND: Primary cutaneous follicle centre cell lymphomas (PCFCCL) are the most common type of primary cutaneous B-cell lymphomas. Patients with this disorder develop one or a few clinically indolent tumour nodules, plaques, or papules confined to a circumscribed area. Only limited data have so far been published on the use of immunoglobulin heavy chain variable region (VH) families by these tumours. OBJECTIVES: Because the definition of the repertoire of VH genes could have significant biological and diagnostic implications, we evaluated a group of patients with PCFCCL for VH family use. METHODS: DNA obtained from 15 cases of PCFCCL was amplified by polymerase chain reaction (PCR) using a panel of VH family-specific amplimers. RESULTS: The pattern of VH family usage was similar to that reported in both normal peripheral blood B cells and the most common low grade non-Hodgkin's lymphomas, where VH region utilization is essentially random with frequent usage of the VH3 family. CONCLUSIONS: These findings support the hypothesis that PCFCCL may derive from the mature peripheral lymphoid compartment. Our results may also have implications for the routine analysis of B-lymphoid clonality in PCFCCL.

Spatial design for basic needs in eastern Upper Volta.

PIP: The methdological problems of basic needs showing what the response can be to an actual request by planners in the Eastern Region of Upper Volta. The planner's objective is to provide a system of basic needs those services (and goods) universally demanded by people to insure their individual survival and those services deemed necessary, by indigenous standards, for the individual or the individual family unit to reach the rural population within a given threshold of distance. This discussion provides an example of how a quantitative format may aid local development agencies, helping them to formulate their development objectives and thus present tangible and precise projects for international financing while specifically addressing concerns of the rural population. 4 steps are identified in this planning effort: 1)dividing Upper Volta's Eastern Region into programming units (PUs) for efficient field operations and for regional equity questions, 2)estimating the number of health centers, 3)determining which villages will receive service centers status, 4)establishing a funding priority sequence for the centers, step 4 is only introduced. To consider the settlement pattern within the PU, the 1st estimate of need was adjusted by using a nearest neighbor scale as a weighting factor. This procedure yielded a 2nd estimate that was found (via multiple p-median solutions) to be a more accurate assessment of the need. Of the 94 programming units, 71 were nontrivial, i.e., they had more than 2 villages. In only 4 of these is mB, this 2nd estimate, less than the actual number of clinics needed to satisfy the p-median constraints. 2 of these programming units had existing health centers, which reduced the flexibility of the assignment algorithm. 34 of the nontrivial solutions required fewer (usually 1 fewer) than mB centers. In balance, the need estimation procedure was successful. The model used ensures the equitable distribution of service centers with restrictions on the maximum distance traveled while minimizing aggregate distance traveled. This process offers an example of planning from below in a quantified format, considering existing disparities and assuring that future investments will be made to encourage equity in the distribution of new investment for development^ieng