Evaluation of smoking-induced effects on sympathetic, hemodynamic and metabolic variables with respect to plasma nicotine and COHb levels.

The effect of smoking cigarettes containing 1.5 mg and 0.08 mg nicotine per cigarette and of sham-smoking was studied in six healthy habitual smokers. Levels of carboxyhemoglobin (COHb) and plasma nicotine were measured simultaneously with hemodynamic variables, such as heart rate and blood pressure, and with the metabolic parameters, plasma DBH, cortisol, blood glucose, lactate and free fatty acids. All variables, with the exception of COHb are dose related to plasma nicotine levels. Blood pressure, heart rate and lactate show simultaneous peaks together with maximal nicotine levels, while DBH and cortisol, blood glucose and free fatty acids show a delayed reaction compared to nicotine concentrations. No effects of COHb, even with levels up to 5.6 +/- 0.5% have been observed on the variables investigated. These results demonstrate, that it is nicotine which induces considerable hemodynamic and metabolic alterations after smoking.

Acute cardiovascular reactions after cigarette smoking.

The effect of cigarette smoking on the cardiovascular system was determined in the following way: Two cigarettes of relatively high (1.54 mg) and very low (0.08 mg) nicotine content were smoked and compared to sham smoking. After inhalation under standardized conditions there was a relatively high increase of the plasma nicotine levels and a subsequent exponential decrease. Two hours after smoking the levels were still elevated. After 2 low nicotine cigarettes there was a significant small short-term increase. The changes of the pulse rate were directly related to the nicotine levels and the pulse pressure transit time from the heart to the calf and the digital blood flow was indirectly related to them. The regulation of these parameters is exactly related with the nicotine levels probably through the release of catecholamines. The cardiovascular reactions after smoking may indicate the additional myocardial work load after cigarettes of different nicotine content.

Antinuclear antibodies and PUVA photochemotherapy.

Sequential testing for antinuclear antibody (ANA) in a group of 99 patients receiving long-term methoxsalen (PUVA [methoxsalen plus ultraviolet light]) therapy showed positive tests for ANA in the serum samples of 42 patients. In 22 patients, the ANA was persistent; in seven patients, it was transient; and in the other 13 patients, it developed near the end of the observation period. A causal association between the occurrence of ANA and PUVA therapy is suggested by the incidence of ANA, its conversion from a negative to positive ANA test in 31 of 42 patients, and its statistically significant correlation with the duration of PUVA therapy. The ANA titers were 1:80 or greater in only 12 patients. The staining pattern was homogeneous in 39 patients, speckled in two patients, and nucleolar in one patient. In patients with a positive ANA test, the serologic tests for antibodies to DNA and extractable nuclear antigens were negative. Patients with positive ANA tests were significantly older than patients with negative ANA tests. Symptomatic systemic disease has not developed in any patient with a positive ANA test in this group.

Combination therapy for psoriasis. Psoralens plus long-wave ultraviolet radiation with betamethasone valerate.

In the treatment of psoriatic patients with psoralens plus long-wave ultraviolet radiation (PUVA), clearing of psoriatic lesions was obtained more quickly and with smaller doses of ultraviolet light when topically applied corticosteroid therapy was added. Twelve patients with symmetrical plaque-type psoriasis were given PUVA on one side of the body and PUVA plus betamethasone valerate on the other side in a paired comparison study. Ten of the patients had faster clearing of lesions on the side that was treated with PUVA and betamethasone than on the side treated with PUVA alone. The other two patients had equal clearing on both sides. All patients remained clear of lesions during maintenance with PUVA alone for at least five months after steroid therapy was discontinued. Combination therapy may save the patient time, expense, and unnecessary exposure to radiant energy.

Localized scleroderma.

Familial scleroderma is rare; only seven documented instances of the disease have been reported, to our knowledge. This report adds two more families to the literature. Three children in one family and two in the other had clinically and histiologically established localized scleroderma.

Cutaneous macroglobulinosis.

A patient with Waldenström's macroglobulinemia had firm, translucent papules and nodules on the extremities. Clinically, the skin lesions were suggestive of amyloidosis cutis. Histologically, a homogeneous eosinophilic material was observed in the upper dermis and encasing the hair follicles. Special histochemical stains, electron microscopy, and immunofluorescence microscopy identified the material as IgM.

Blastomycosis.

Blastomycosis is an uncommon, sometimes self-healing, sometimes fatal, infectious disease caused by the fungus Blastomyces dermatitidis. Although amphotericin B is still considered the drug of choice, ketoconazole and several other imidazole drugs--miconazole, itraconazole, econazole--have shown promise in the treatment of blastomycosis.

A modified HET-CAM assay approach to the assessment of anti-irritant properties of plant extracts.

Hen's egg--chorioallantoic membranes were used to screen for and assess anti-irritant properties among aqueous extracts of plants (HET-CAM tests), in connection with searches for plant-derived substances with topical anti-irritant action. The main question to be answered was whether CAM-assay screening of plant extracts could provide a useful route to identifying promising anti-irritant extracts for follow-up clinical testing. To be useful, the method would have to flag materials with strong anti-irritant properties, and would have to avoid registering false negatives. The tests conducted provided positive indications. We measured the delays in onset of three manifestations of membrane irritation-vascular hemorrhaging, membrane lysis and membrane coagulation-observed with test substances relative to positive controls. Aqueous 15% lactic acid, a commonly used irritant in direct tests on human skin, was employed as the test irritant in this study. The ratio [irritation onset times after test substance pre-treatment]:[onset times without test substance pretreatment] was used to measure the anti-irritant power of test substances. A scoring notation was devised for this which treats the delay parameters as independent effects. Most tested plant extracts showed no significant irritant or anti-irritant effects. Among the apparently anti-irritant plant extracts (approx. 10% of all those tested), most showed their greatest effect against hemorrhaging. Lesser but still readily measurable effects against membrane lysis and coagulation were also observed in nearly all the apparently anti-irritant extracts. Two of the tested extracts proved to be membrane irritants. Some key CAM assay results were compared with results obtained in direct tests on human skin using the same test irritant (15% lactic acid). In these comparative tests on skin, an essentially similar pattern of efficacy was obtained, with the plant extract deemed best in the CAM screenings, outperforming the benchmark anti-irritant hydrocortisone. From these initial results it appears that physiological CAM assays may prove useful in screening natural materials for anti-irritant properties, as alternatives to mechanism-dependent biochemical assays, or expensive direct screening tests on human subjects. Further work remains to extend the CAM screening approach to irritants other than lactic acid, and to assess its quantitative powers of prediction of topical anti-irritancy.

Sarcoidosis of the female genital tract: a case presentation and survey of the world literature.

Sarcoidosis of the female genital tract is a rare clinical entity with only 20 cases reported in the world literature to date. An additional case is presented with a review of the previously reported cases. The diagnostic and histologic aspects of the disease are also discussed. The presence of granulomatous diseases in the female genital tract should initiate a thorough investigation for potential etiologies by both the pathologist and clinician. Etiologies of granuloma fraction must include coccidiomycosis, foreign body reactions, lymphogranuloma inguinale, and tuberculosis. Bacteriologic proof is essential to differentiate these from sarcoidosis.

Parenteral nitrogen mustard for inflammatory arthritis.

A patient with progressive psoriatic arthritis refractory to methotrexate therapy was treated empirically with intravenous nitrogen mustard, or HN2. His response to therapy was compared with the responses of five rheumatoid arthritis patients treated with the same regimen. At 14 days after therapy was begun the patient with psoriatic arthritis showed significant improvement, at least comparable to that observed in the rheumatoid arthritis group. Intravenous HN2 therapy may be an alternative to methotrexate for progressive psoriatic arthritis.

Extensive alopecia areata. Results of treatment with 3% topical minoxidil.

A 3% topical minoxidil solution was used to treat 31 normotensive persons (13 male, 18 female) with extensive alopecia areata. After 15 months, three patients (14%) had 75%-100% regrowth, 13 (59%) had some form of regrowth, and nine (41%) had no regrowth. In the initial three-month double-blind portion of the study, minoxidil was not shown to be more effective than placebo. Biopsy specimens from eight patients who underwent biopsy prior to treatment, after three months, and posttreatment showed no significant change in peribulbar or perivascular inflammation. Prominent, new anagen follicles were observed. The 3% topical minoxidil was generally well tolerated and skin irritation was minimal. Blood pressure monitoring revealed no significant changes in diastolic or systolic pressures. Minoxidil is a relatively safe treatment for extensive alopecia areata and may be effective in the treatment of some cases of recalcitrant disease.

Telogen effluvium: a clinically useful concept, with traction alopecia as an example.

Telogen effluvium is the excessive loss of normal club hairs. It can be diagnosed simply by microscopic examination of the hairs that are being shed. These hairs have uniform shaft diameter and normally shaped bulbs that contain no pigment. The causes of telogen effluvium are well known and easily distinguishable. They include parturition, febrile illness, surgical operations and anesthesia, anticoagulant drugs, psychi stress, crash diets, and traction. Traction alopecia often produces recognizable patterns of hair loss and can be diagnosed in many cases with reasonable certainty. It is usually not accompanied by inflammatory changes and the prognosis is excellent provided the causative styling practices-braids, rollers, ponytails, etc-are discontinued. Telogen conversion may be caused by interference with papillary blood flow. Since traction alopecia would seem to be reproducible, it may serve as a model for the study of telogen conversion.

Familial leiomyomata.

The autosomal dominant inheritance of multiple piloleiomyomas has been previously described. This is a report of two such cases, along with a brief review of the diagnosis, classification, and treatment of the cutaneous leiomyomas.

Pen push purpura: iatrogenic nail bed hemorrhages in the intensive care unit.

Peculiar fingernail hemorrhages appeared in a febrile, comatose patient several weeks after she was admitted to the hospital. Bedside questioning of the nursing staff uncovered a frequently used neurologic examination maneuver as the cause. We suggest the term "pen push purpura" to describe this phenomenon. The clinical significance and various causes of nail bed hemorrhages are reviewed.

Lymphatic complications of manual herpes simplex infection.

In seven patients with typical recurrent herpes simplex of the hand, lymphatic complications, developed in the arm during periods of herpetic activity. Six of the patients presented with lymphangitis and lymphadenitis. In one patient, persistent lymphedema developed in the involved hand and forearm.

Quinidine-induced pigmentation.

Antimalarial agents have long been known to cause a variety of pigmentary disturbances. Quinidine, a cincha alkaloid and D-isomer of quinine, is widely used for the treatment of ventricular arrhythmias. A paucity of literature, however, exists concerning quinidine-associated hyperpigmentation. We describe a case of focal ceruloderma we believe to be secondary to quinidine therapy.