American Academy of Dermatology Patch Testing Survey: use and effectiveness of this procedure.

The results of an American Academy of Dermatology (AAD)-sponsored survey on the use and effectiveness of patch testing are presented. Academy members' responses indicate that 27% do not patch test at all. Reasons given for not testing included (1) the patient history was adequate for diagnosis, (2) patch testing was too time-consuming, and (3) reimbursement was not sufficient. Dermatologists in residency training programs who responded to a similar survey are testing frequently and report a high degree of positivity and relevancy among tests applied. Recommendations are presented with a focus toward increasing interest in patch testing among the membership.

Information networks and their impact upon medicine.

There is an information explosion and geometric growth of knowledge in medicine. The individual physician finds himself having great difficulty coping with this ever increasing knowledge base. The recognition of a gap in such knowledge; while frustrating, may also have a direct impact upon patient care. Computer technology, information retrieval modalities, and teleprocessing between remote locations has been viewed as a partial solution to this issue. Microcomputers and their associated elements are able to be used as information retrieval devices tapping into vast reservoirs of data and information on all aspects of medicine. Physicians faced with this new technology generally have little or no training, experience or understanding of how best to harness the power of computers to meet their individual practice requirements. This article provides a basic overview of those computer concepts that relate specifically to information retrieval from large data bases to individual physician's offices, regardless of their location. The article explores the specific hardware and software components that are required for effective linkage into a computer based information network for medicine. The article concludes with an overview of the work done by the American Academy of Dermatology in this area to satisfy informational needs of its members in coping with the ever increasing knowledge base of medicine.

Development of a human stomach explant organ culture system to study the pathogenesis of Helicobacter pylori.

These studies were undertaken to define conditions under which Helicobacter (formerly Campylobacter) pylori and viable human gastric mucosa could coexist in tissue culture with the ultimate goal of developing an in vitro experimental model which could be used to study interactions between H. pylori and gastric epithelium. Antral gastric biopsies obtained at upper endoscopy were placed in culture in either CMRL-1066 or keratinocyte growth media and incubated at 37 degrees C in either an oxygen-enriched environment (45% O2, 50% N2, 5% CO2) or a standard oxygen environment (95% air, 5% CO2). Without selective antibiotics to suppress growth of non-H.-pylori organisms, H. pylori could not be isolated from most initially positive tissue even after only 2 h in tissue culture; however, when selective antibiotics were utilized in the tissue culture media, H. pylori was isolated from 9 of 14 initially positive cases after 24-72 h in tissue culture. There was little difference in the morphology of either surface or glandular epithelium in H.-pylori-negative explants between time zero and 48-hour cultures. However, H.-pylori-positive explants after 48 h in tissue culture showed a significant increase in injury to both surface and glandular epithelium when compared to time zero specimens. These data demonstrate that viable H. pylori and human gastric epithelium can be maintained in explant organ culture and suggest that this gastric mucosal explant culture system may be useful in studying the significance of H. pylori infection of human gastric epithelia.

Prevalence and relevance of allergic reactions in patients patch tested in North America--1984 to 1985.

Between Jan. 1, 1984, and May 1, 1985, 1199 patients with suspected allergic contact dermatitis were patch tested with 32 "standard" allergens, 707 patients with 19 "vehicle and preservative" allergens, and 613 patients with 10 "special study" allergens. Ten dermatologists representing nine geographic centers collected and analyzed data with the use of the American Academy of Dermatology's mainframe computer in Evanston, Illinois. The most common sensitizers identified were nickel, p-phenylenediamine, quaternium-15, neomycin, thimerosal, formaldehyde, cinnamic aldehyde, ethylenediamine, potassium dichromate, and thiuram mix. Each positive reaction was assessed for its clinical relevance.

Characterization of urease from Campylobacter pylori.

Campylobacter pylori, a suspected agent of gastritis and peptic ulceration, rapidly hydrolyzes urea. Because urease serves as the basis of detection of the organism in gastric biopsies and may represent an important virulence factor, biochemical characteristics of the enzyme were determined. C. pylori was isolated from antral biopsies from 10 patients with complaints of abdominal pain or history of peptic ulcer disease. All isolates were urease positive, with an average rate of hydrolysis by cell lysates being 36 +/- 28 mumol of NH3 per min per mg of protein, more than twice that of Proteus mirabilis and 10 times that of other urinary tract isolates. The enzyme had an apparent molecular weight of 625,000 +/- 15,000 by column chromatography, an isoelectric point of 5.9, a Km of 0.8 +/- 0.1 mM urea, an optimal temperature of 45 degrees C, and an optimal pH of 8.2. Ten isolates tested produced ureases with identical electrophoretic mobilities on nondenaturing 5% polyacrylamide activity gels. Acetohydroxamic acid (100 micrograms/ml), hydroxyurea (85 micrograms/ml), flurofamide (0.05 micrograms/ml), and EDTA (8 mM) inhibited enzyme activity by 50%. Cell lysates retained 50% of initial urease activity after 6 days and 40% activity after 18 days when stored at 4 degrees C in 20 mM sodium phosphate, pH 6.8. At -70 degrees C for 18 days, 1 mM EDTA or 15% glycerol preserved 40 or 34%, respectively, of initial activity. The urease of C. pylori appears to be biochemically unique from the enzymes of other common urease-producing species.

The case for patch test readings beyond day 2. Notes from the lost and found department.

Additional patch test readings taken after 2 days (48 hours) are valuable in distinguishing false-positive reactions, which may occur up to 22% of the time. Second readings taken on days 3 through 7 may detect an additional 34% positive reactivity. Those reactions, both lost (initially positive, later negative) and found (initially negative, later positive) by delayed readings, require clinical correlation for relevance as do the readings that persist at and beyond day 2 (positive at both readings).

Stress-related mucosal damage: critical evaluation of potential new therapeutic agents.

Cell injury produced by hydrochloric acid is the final common denominator for stress-related mucosal damage. Actions of therapeutic agents designed to prevent such damage are directed toward either inhibiting acid secretion or stimulating protective mechanisms. Newer agents that fall into the former category include omeprazole, an inhibitor of the H+-K+-ATPase pump, prostaglandins, and somatostatin. In addition to inhibiting acid, prostaglandins stimulate mucus and bicarbonate secretion and therefore provide a two-pronged protective action. Tranexamic acid is an antifibrinolytic agent that is postulated to promote clotting at bleeding sites in upper gastrointestinal lesions. Analyses of composite data suggest that (1) prostaglandin E preparations appear to be as effective as currently recognized forms of therapy, such as antacid and H2-receptor antagonist administration; (2) little enthusiasm can currently be generated for use of somatostatin or tranexamic acid; and (3) omeprazole is a theoretically attractive agent that remains to be tested in the prophylactic treatment of gastrointestinal ulceration due to severe stress.

Computer software.

Software is the component in a computer system that permits the hardware to perform the various functions that a computer system is capable of doing. The history of software and its development can be traced to the early nineteenth century. All computer systems are designed to utilize the "stored program concept" as first developed by Charles Babbage in the 1850s. The concept was lost until the mid-1940s, when modern computers made their appearance. Today, because of the complex and myriad tasks that a computer system can perform, there has been a differentiation of types of software. There is software designed to perform specific business applications. There is software that controls the overall operation of a computer system. And there is software that is designed to carry out specialized tasks. Regardless of types, software is the most critical component of any computer system. Without it, all one has is a collection of circuits, transistors, and silicone chips.

Medical office computer systems. The selection process.

This article highlights the process that a physician should undertake in selecting and implementing a business computer system for the office. Included are suggested approaches to identifying needs, establishing priorities, and communicating requirements to prospective vendors. Methods for reviewing various systems to evaluate whether they meet the practice's defined requirements are suggested.

Ketoconazole-resistant Candida esophagitis in patients with acquired immunodeficiency syndrome.

Although ketoconazole has been shown to be effective in treating esophageal candidiasis in other immunodeficiency states, similar studies have not been reported in patients with acquired immunodeficiency syndrome. Six patients with acquired immunodeficiency syndrome and oral and esophageal candidiasis who had been treated with ketoconazole for more than 2 mo were evaluated with barium esophagram and endoscopy with biopsy and brush cytology. All of the patients had persistent Candida esophagitis. In 2 patients, fungal cultures and sensitivity testing indicated Candida albicans resistant to ketoconazole in vitro. In patients with acquired immunodeficiency syndrome, esophageal candidiasis may not resolve with up to 6 mo of ketoconazole therapy and may require more vigorous antifungal therapy than in patients with other immunodeficiency states.

Focal esophageal candidiasis in acquired immunodeficiency syndrome (AIDS).

When candidiasis involves the esophagus, it usually does so as an extensive and diffuse infection. In our experience, however, esophageal candidiasis in patients with the acquired immunodeficiency syndrome (AIDS) is clinically distinct from the same infection in patients with other immunodeficiency states. Of 25 patients with AIDS and esophageal candidiasis studied radiographically, 4 patients with localized involvement of the esophagus are presented. The clinical and radiologic manifestations of focal esophageal candidiasis in these patients are reviewed and compared to previously described cases of esophageal candidiasis.

Gastric carcinoma presenting as double-channel pylorus on upper gastrointestinal series.

A double-channel pylorus or gastroduodenal fistula is a rare entity frequently acquired in association with penetrating peptic ulcer disease. The diagnosis is made by upper gastrointestinal series or by endoscopy. We report a 59-year-old man who presented with gastric outlet obstruction whose upper gastrointestinal series was typical of benign peptic ulcer disease demonstrating antral ulcers and a double-channel pylorus. At operation, gastric carcinoma infiltrating the pyloric channel and dividing it into two lumens was found. No gastroduodenal fistula was found. The "gastroduodenal fistula" on upper gastrointestinal series had been created by gastric carcinoma protruding into the pyloric channel and dividing the barium flow into two streams. One can no longer assume that a double-channel pylorus is due to benign ulcer disease.

Dermatology manpower projections.

Since an oversupply of physician specialists leads to a waste of professional resources, planning of the number of physicians may be desirable. A model projecting the future supply of dermatologists was formulated on the basis of current residency capacity, which produces about 270 dermatologists per year, and on experience regarding the average length of active clinical practice. How changes in the training capacity affect the future supply of dermatologists was also examined. The model projects an equilibrium supply of about 9,500 dermatologists, or 3.2 per 100,000 population early in the 21st century, provided the number of new graduates remains at its present level. Assuming no economic barriers to access, 2.8 to three dermatologists per 100,000 population should be adequate to meet demand. Because of many unpredictable factors, periodic reassessment of dermatology training capacity is necessary.

DERM/MIS update. The Dermatology Management and Information System of the American Academy of Dermatology.

The Dermatology Management and Information System (DERM/MIS) was created by the Task Force on Biomedical Communications of the American Academy of Dermatology. The concept of such a System was conceived as part of the National Program for Dermatology and has been actively pursued since. The purpose of this report is to review the current status of DERM/OMS (Dermatology Office Management System); DERM/LIT (Dermatology Literature); DERM/RX (Dermatology treatment); DERM/DDX (Dermatology Differential Diagnosis); DERM/PATH (Dermatopathology). Other components of the DERM/MIS system are currently being planned. Predictions indicate that by the end of this decade a substantial percent of dermatologic offices will have access to some form of computerized programs. The DERM/MIS system has been designed specifically to meet the needs of the practicing dermatologist in the office setting.

Structure-activity relationships of somatostatin analogs in the rabbit ileum and the rat colon.

UNLABELLED: Somatostatin increases absorption of electrolytes and inhibits diarrhea in patients with endocrine tumors and short bowel syndrome. In an attempt to develop a gut-specific somatostatin analog, each amino acid in the somatostatin molecule was replaced with L-alanine, deleted, or substituted with its D-isomer. The potency of each analog to stimulate ion transport in the rabbit ileum was then determined using the modified Ussing chamber technique. The results were compared to the ability of each analog to inhibit the stimulated release of growth hormone from cultured rat anterior pituitary cells and to inhibit the arginine-stimulated release of insulin and glucagon in the rat in vivo. Analogs that showed gut selectivity were then tested for their ion transport properties in the rat colon. RESULTS: (a) Substitution with L-alanine or deletion of the amino acid at position 6, 7, 8, or 9 and deletion of Threonine(10)-produced analogs with significantly reduced ion transport properties to <4% of somatostatin's action. The substitution also markedly reduced the ability of the compounds to inhibit the release of growth hormone, insulin, and glucagon. (b) Selectivity of intestinal ion transport was achieved by any one of the following alterations: L-alanine substitution at Phenylalanine(11), deletion of Phenylalanine(11), substitution with D-lysine at Lysine(4), or substitution with L-alanine at Lysine(4). These compounds had intestinal ion transport properties of 52, 34, 139, and 94%, respectively, while demonstrating little or no inhibition of growth hormone, insulin or glucagon release. CONCLUSIONS: (a) Phenylalanine(6), Phenylalanine(7), Tryptophan(8), and Lysine(9) are required for the ion transport and other biologic actions of somatostatin, whereas Threonine(10) serves as an essential spacer. (b) Alteration at Phenylalanine(11) or Lysine(4) yields analogs that are selective for ion transport in the rabbit ileum and rat colon. These findings should be taken into consideration when developing a gut-specific somatostatin analog that can be useful in the treatment of diarrhea.