Serum angiotensin converting enzyme activity in patients with psoriasis.

Serum angiotensin converting enzyme activity is frequently increased in patients with active sarcoidosis. In spite of a reported association between sarcoidosis and psoriasis, serum angiotensin converting enzyme activities have not been reported for patients with psoriasis. We found the mean (SD) angiotensin-converting enzyme activity for 51 healthy subjects was 18.6 (5.8) kU/l, but for 52 patients with psoriasis without coexisting sarcoidosis, it was 28.3 (6.7) kU/l. There is a significant difference between these means (p less than 0.01). Forty-two percent (22/52) of the psoriasis patients had an increased serum angiotensin converting activity. Other diseases sometimes associated with an increased serum angiotensin converting enzyme activity were excluded as possible causes of a elevated activity in our patients with psoriasis. We conclude that almost half of the patients with psoriasis will have an elevated serum angiotensin converting enzyme activity, even when coexisting sarcoidosis is absent.

An experimental endoscopic technique for reversing gastroesophageal reflux in dogs by injecting inert material in the distal esophagus.

After the lower esophageal sphincters of large mongrel dogs had been made surgically incompetent, the degree of sphincter incompetency was determined by the grade of esophagitis present and the reflux volume. Five dogs were endoscopically injected in the distal esophagus with 5 to 30 ml of Teflon paste during four to six injection sessions, and all five dogs developed transient increases in the reflux volumes. Each of the five dogs sloughed a portion of injected Teflon during the 4-month study. Four additional dogs received between 5 and 105 ml of bovine dermal collagen injected in the distal esophagus. All have reversed their esophagitis and have retained a reflux volume at least 5 times the preinjection value without evidence of slough.

Delayed hypersensitivity to mumps antigen in humans.

Sixty-one subjects, preselected for mumps sensitivity, were entered into a double-blind protocol to standardize Mumps Skin Test Antigen. Four lots of mumps antigen selected on the basis of in vitro potency tests were used. Four other antigens, Histoplasmin, Dermatophytin-O, Dermatophytin, and fluid tetanus toxoid were also tested; positive reactions for these four antigens occurred in 48, 68, 25, and 43% of individuals, respectively. The mumps lots exhibited delayed hypersensitivity with positivity ranging from 63 to 67% at 20 CFU/ml and 77 to 84% at 80 CFU/ml in the acceptable lots. Side effects were primarily local and minor in nature. Mumps Skin Test Antigen is a useful measure of the integrity of the immune system, but lacks complete specificity because of local dermal factors.

Bowenoid dysplasia of the vulva.

The histologic findings of five patients with clinically typical Bowenoid dysplasia (BD) allowed the authors to classify the vulvar and perineal biopsies of 18 patients under 40 years as BD and the vulvar biopsies of six patients under 40 years as squamous cell carcinoma in situ (CIS). The two best criteria for BD are cellular uniformity and absence of pilosebaceous involvement. Vesicular chromatin is a less constant feature of BD. Clinically, patients with BD were younger than those with CIS, more frequently had elevated and multiple lesions and other developed BD with pregnancy. Histologic features therefore discriminate between clinical BD and CIS, but the authors emphasize that both clinical and pathologic features are necessary for proper diagnosis. Follow-up of BD has been benign, with one exception. Spontaneous regression occasionally occurred. One patient with CIS developed microinvasive carcinoma. Patients with BD were regarded at lesser risk for invasive carcinoma than patients with CIS; they are therefore amenable to conservative therapy.

Scintigraphic evaluation of diabetic osteomyelitis: concise communication.

We have reviewed the three-phase bone scans, radiographs, and histologic findings of 39 diabetic patients with serious foot problems. The sensitivity and specificity of bone scans were 83% and 75%, respectively, for osteomyelitis of the small bones of the foot. The positive and negative predictive values were 87% and 69%, respectively. The radiographs were less sensitive (62%) and less specific (69%), with predictive values of 80% (positive) and 47% (negative).

Glycogen-rich clear cell carcinoma of the breast: a light and electron microscopic study.

A glycogen-rich clear cell carcinoma arose in the breast of a 49-year-old woman. Light microscopic examination of the neoplasm revealed both intraductal papillary growth and stromal invasion. Electron microscopic examination demonstrated neoplastic cells that contained massive quantities of nonmembrane-bound particulate glycogen and that formed numerous acini. Apically, these cells formed microvilli; laterally they formed tight junctions and desmosomes. Morphologic features of this neoplasm are similar to those of the fetal breast and to some other clear cell carcinomas arising elsewhere in the body.

Primary intracranial endodermal sinus tumor. Case report.

Endodermal sinus tumor (yolk sac carcinoma), a germinal neoplasm, is rarely primary in the cranial cavity. The authors add a third case with the tumor located in the anterior third ventricular (suprasellar) region to the literature. Seventeen previously reported intracranial cases, mostly in the pineal region, are briefly reviewed.