Linoleic acid inhibition of naturally occurring lymphocytotoxicity to breast cancer-derived cells measured by a chromium-51 release assay.

Long-chain unsaturated free fatty acids have been shown to inhibit the immune responses of lymphocytes in vivo and in transformation and macrophage inhibition factor assays in vitro. The purpose of this study was to test the effect of linoleic acid on naturally occurring lymphocytotoxicity in a 51Cr release microcytotoxicity assay with the use of a human breast carcinoma cell line (AlAb) as source of the target cells. In the presence of increasing concentrations of linoleic acid, a linear decrease in lymphocytotoxicity was observed with complete inhibition at concentrations of 0.05-0.07 mg/ml. Concentrations of linoleic acid greater than 0.07 mg/ml resulted in nonspecific toxicity to target cells but not to lymphocytes as determined by trypan blue exclusion tests. When lymphocytes were pretreated with linoleic acid, washed, and then tested for cytotoxicity in the absence of linoleic acid, suppression of lymphocytotoxicity was still demonstrated. When leukocytes were depleted of macrophages, cytotoxicity in the absence of linoleic acid was enhanced 50-100%; complete inhibition of cytotoxicity was still observed at 0.05 mg linoleic acid/ml. When B- and T-cell populations were separated, each population showed typical decreases in lymphocytotoxicity in the presence of linoleic acid; however, the B-cell fraction (containing "null" cells) was two to three times more efficient at cell killing than was the T-cell fraction.

The ridgeback anomaly. A new follicular pattern of the scalp.

A patient with an anomaly of hair pattern development is described. Scalp hair follicles generally grow at a downward inclination to the scalp surface. Normal whorled patterns appear in the posteroparietal area. The patient described was noted to have a whorled hair pattern located over the right temporoparietal region, growing in a clockwise direction. The remainder of the scalp adopted the upward follicular growth pattern of the posterior portion of the whorl, directed toward the apical anatomic axis. A ridge of hair over the nape of the neck reversed direction, similar to hair growth on the Rhodesian Ridgeback dog, growing in a downward manner. The relationship of this new hair pattern to current theories of scalp hair pattern development is reviewed.

Disseminated Mycobacterium chelonae subspecies chelonae infection with cutaneous and osseous manifestations.

A 75-year-old man who had been receiving corticosteroids for treatment of chronic obstructive pulmonary disease presented with nodulopustular skin lesions, bone pain, and constitutional symptoms. Evaluation revealed a disseminated infection with Mycobacterium chelonae subspecies chelonae, with cutaneous and osseous involvement documented by histopathologic studies and cultures. The bone involvement is a novel observation for this subspecies. The patient was successfully treated with a three-drug regimen of tobramycin sulfate, erythromycin stearate, and ciprofloxacin hydrochloride. We present a discussion of the case in the context of the literature.

Rheumatoid neutrophilic dermatitis.

We recently examined a patient with severe rheumatoid arthritis who presented clinically with fixed urticaria-like plaques. Histologic examination revealed a dense neutrophilic dermal infiltrate without associated vasculitis. On clinical and histologic grounds, this case differs from other noninfectious neutrophilic inflammatory disorders. We present a case of rheumatoid neutrophilic dermatitis and review the salient features of this unique disorder.

Proteus syndrome.

The term Proteus syndrome was coined in 1983 to describe a disorder of skeletal, hamartomatous, and other mesodermal malformations. The syndrome was named after the Greek god Proteus, whose name means "the Polymorphous." Clinical features of this new syndrome are currently being defined. Including the case reported herein, we have found 34 patients with Proteus syndrome described in the English literature. Major clinical findings, defined as those findings seen in more than half of the cases, include hemihypertrophy, macrodactyly, exostoses, epidermal nevi, characteristic cerebriform masses involving the plantar or palmar surfaces, a variety of subcutaneous masses, and scoliosis. Histologic examination of subcutaneous masses has identified a variety of lipomatous, hamartomatous, and angiomatous tumors.

Cutaneous myiasis caused by the African tumbu fly (Cordylobia anthropophaga).

We describe a patient with cutaneous myiasis caused by the African tumbu fly (Cordylobia anthropophaga). This case demonstrates the need for a detailed travel history and an understanding of the fly life cycle to prevent erroneous diagnosis and to expedite prompt treatment. The nature of the lesions, larval morphological features, histological characteristics, and immune response directed toward fly maggots are described.

Subcutaneous emphysema.

A medical emergency, the detection of subcutaneous emphysema requires thorough evaluation to exclude the multitude of disease processes that may demonstrate this clinical finding. Gas gangrene must be considered in the differential diagnosis of all forms of subcutaneous emphysema and infections with some species, such as C. novyi, may not produce gas at all. Isolation of C. septicum from the blood is almost always associated with colon cancer or hematologic malignancies. Nonclostridial gas gangrene in diabetic patients is indistinguishable clinically from clostridial gas gangrene. A unique and true dermatologic emergency is the detection of nontraumatic subcutaneous emphysema of the thigh with or without associated erythema, tenderness, or bullous lesions. This finding is associated with perforated viscus in a retroperitoneal location. Infections with gas-producing organisms continue to be a source of significant morbidity in modern times.

Septic embolization arising from infected pseudoaneurysms following percutaneous transluminal coronary angioplasty: a report of 2 cases and review of the literature.

Septic embolization arising from infected pseudoaneurysms following percutaneous transluminal coronary angioplasty (PTCA) constitutes a distinct clinical and histopathologic entity. Pseudoaneurysms are a potential complication of both cardiac catheterization and PTCA. Repeated or prolonged catheterization increases the risk of bacterial seeding of these sites, resulting in septic embolization. Characteristic clinical features include fever within 2 to 5 days, unilateral embolic disease, and Staphylococcus aureus septicemia. Culture and examination of biopsy specimens of the embolic lesions typically demonstrate gram-positive microorganisms. We describe 2 patients presenting with ipsilateral palpable purpura, petechiae, and livedo reticularis caused by septic emboli from infected pseudoaneurysms. The recommended treatment includes administration of appropriate systemic antibiotics and surgical resection of the infected pseudoaneurysm. Both cholesterol and septic emboli should be considered in the differential diagnosis of ipsilateral embolic disease induced by invasive vascular procedures.

Diffuse venous malformation with intraosseous involvement.

A young boy with a large venous malformation of his left arm and hand was evaluated for Maffucci's syndrome. Initial hand films were remarkable for cystic bony lesions suggestive of enchondromas. Additional roentgenograms and magnetic resonance imaging studies showed the bony abnormalities were the result of a venous malformation infiltrating bone. Magnetic resonance imaging is a useful diagnostic tool in differentiating enchondromas from vascular anomalies. Venous malformations infiltrating bone should be included in the differential diagnosis of Maffucci's syndrome.

Pentoxifylline.

Pentoxifylline (oxpentifylline) is a methylxanthine derivative with potent hemorrheologic properties. In the United States it is marketed for the treatment of intermittent claudication. Human and animal studies have shown that pentoxifylline therapy results in a variety of physiological changes at the cellular level, which may be important in treating a diverse group of human afflictions. Immune modulation includes increased leukocyte deformability and chemotaxis, decreased endothelial leukocyte adhesion, decreased neutrophil degranulation and release of superoxides, decreased production of monocyte-derived tumor necrosis factor, decreased leukocyte responsiveness to interleukin 1 and tumor necrosis factor, inhibition of T and B lymphocyte activation, and decreased natural killer cell activity. Hypercoagulable states improve through decreased platelet aggregation and adhesion, increased plasminogen activator, increased plasmin, increased antithrombin III, decreased fibrinogen, decreased alpha 2-antiplasmin, decreased alpha 1-antitrypsin, and decreased alpha 2-macroglobulin. Wound healing and connective tissue disorders may respond to an increase in fibroblast collagenases and decreased collagen, fibronectin, and glycosaminoglycan production. Fibroblast responsiveness to tumor necrosis factor is also diminished. Potential medical uses of pentoxifylline are reviewed.

Superficial thrombophlebitis. I. Primary hypercoagulable states.

This review concentrates on those disorders in which superficial thrombophlebitis can be a significant or presenting clinical sign. Primary hypercoagulable states are those conditions associated with an increased risk of thrombosis caused by a specific measurable defect in the proteins of coagulation and/or fibrinolytic systems. These disorders are frequently inherited and include deficiencies of antithrombin III, heparin cofactor 2, protein C, protein S, abnormal fibrinolytic activity, dysfibrinogenemia, and Hageman trait. Patients with a lupus anticoagulant and anticardiolipin antibody syndrome with thrombotic episodes are also considered to have a primary hypercoagulable state. The physiology, pathophysiology, clinical characteristics, and treatment of primary hypercoagulable states are reviewed.

Superficial thrombophlebitis. II. Secondary hypercoagulable states.

Secondary hypercoagulable states are complex clinical conditions associated with an increased risk of thrombosis in which the exact pathophysiology is poorly understood. Secondary causes of superficial thrombophlebitis include malignancy, pregnancy, use of oral contraceptives, infusion of prothrombin complex concentrates, Behçet's disease, Buerger's disease, Mondor's disease, infectious agents, conditions that promote venous stasis, intravenous catheters and intravenous drug use. Conditions that may stimulate superficial thrombophlebitis include dermatophyte cellulitis at saphenous phlebectomy sites, sarcoidal granulomas, cutaneous polyarteritis nodosa, and hyperalgesic pseudothrombophlebitis in patients who test positive for human immunodeficiency virus. The distinguishing features, clinical evaluation, treatment, and histologic characteristics of the various disorders are reviewed.

Failure of prostaglandin induction in an obstructive müllerian abnormality.

Failure of prostaglandins E2 and F2 alpha to induce labor for intrauterine fetal death is infrequent. The factors contributing to these failures remain unclear. We describe a case of failed induction with the use of a combination of vaginal prostaglandin E2 and systemic prostaglandin F2 alpha in a 24-week intrauterine fetal death in association with a noncommunicating rudimentary uterine horn. The implications of this müllerian abnormality for theories of parturition are discussed.