Biomedical subjects
Publications and source records attributed to D D Munro.
We measured plasma sex-hormone binding globulin (SHBG) and testosterone levels in a pilot study of eight women aged 21-41 years who complained of diffuse hair loss; and subsequently in a larger group of fifteen patients of a similar age range. There was a significant reduction in SHBG levels in both groups of patients when compared ot controls, but testosterone values were normal.
Serum testosterone, sex hormone binding globulin (SHBG) and prolactin were measured in thirty-eight women with acne which persisted or started after the age of 18 years. One or more of these levels were abnormal in 76% of patients. Increased testosterone or low SHBG were present alone or in combination in 60% of patients. This group was presumed to have a raised level of non-protein bound, metabolically-available testosterone. Hyperprolactinaemia, which was present in 45% of patients, may be important in view of the reported association with increased adrenal androgens. The hormonal abnormalities may be causally related to the acne and a greater understanding of them may lead to better treatment.
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The development of topical corticosteroids has enabled many dermatoses to be more effectively treated than previously, but there is also no doubt that misuse of these preparations can lead to troublesome local effects and potentially serious systemic problems. The most effective assay for comparing different compounds has been their vasoconstrictive activity, and this on the whole correlates well with clinical effect. To be effective, corticosteroid must be absorbed and the importance of concentration, occlusion, the type of vehicle, added penetrants such as urea and the anatomical site, on the amount of absorption and therefore on clinical activity has been demonstrated. Ointments have been shown to be more effective than creams but because of the considerable choice of potencies now available most dermatologists tend to prescribe the different formulations according to the wishes of the patient. For the same reason, dilution of the commercially marketed preparations is now not generally recommended. The main therapeutic activity of topical corticosteroids is their nonspecific anti-inflammatory effect, thought to be primarily a result of their action on the chemical mediators of inflammation. They have also been shown to be antimitotic which may well be relevant not only to the treatment of scaling dermatoses but also to their dermal thinning effect resulting from inhibition of fibroblasts. Combinations of corticosteroids with antibacterial and antifungal agents have been shown to be very effective in flexural eruptions and secondarily infected dermatoses. As a general rule, the use of topical corticosteroids in outpatients, unless badly misused, is not associated with any significant risk of adrenal axis suppression, but care must be exercised as to the amount prescribed, especially if large areas of the body are to be treated with highly potent preparations. Certain groups such as young children and patients with liver failure, and certain anatomical sites such as the flexures and face appear much more prone to side effects, and in these cases mild or moderate compounds should be used in preference to the stronger preparations.
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Twelve patients had curative resection of primary bronchogenic carcinoma. Eleven to 84 months later, a second primary bronchogenic carcinoma was discovered and was operated on. Six patients underwent wedge resection, while the others had a lobectomy or pneumonectomy. There was no operative mortality. Two patients survived longer than 5 years. In addition to these patients, 26 patients who also had successive surgical resections for primary lung cancers were collected from the literature. Two operative deaths were related to respiratory insufficiency. Life-table analysis of this accumulated series of 38 patients revealed the survival rate 1 year after the resection of a second tumor to be 70%, and 2 and 3 years later, 55% and 27%, respectively. Thus, in patients in whom a second primary carcinoma of the lung develops, successive resections tailored to preserve respiratory reserve are compatible with low operative mortality and, in some instances, long-term survival.
Twenty-three patients with carcinoma of the lung and a brain metastasis had both the primary and secondary tumors surgically removed (combined operation). Results revealed that 52% of the patients were unimproved and died during the first 6 months. Operation improved short-term survival in 26%. Five patients (22%) lived longer than 2 years, and 3 of them (13%) are alive and well 10 or more years following operation.
In a study of 24 patients with alopecia areata, scalp biopsies were examined for immunofluorescence; all were negative. A number of other tests also failed to confirm an auto-immune aetiology for this disease. A possible explanation lies in the heterogeneity of alopecia areata, only a small proportion of cases being of the auto-immune type.
Twenty-three patients with bronchogenic carcinoma and a brain metastasis had their primary and secondary tumors treated surgically. The 10 men and 13 women had an average age of 52 years. Fifteen patients presented with a lesion of the lung and eight patients presented initially with neurological findings of an intracranial mass lesion. The most common histological type of tumor was adenocarcinoma (48%), followed by squamous cell carcinoma, undifferentiated small cell carcinoma, and bronchoalveolar carcinoma. Twelve patients (52%) had a poor result and died during the first six months. Surgery appeared to improve short-term survival in six patients (26%). Five patients (22%) had a good result and lived longer than 2 years without significant neurological deficit. Three patients (13%) are alive 10 or more years following surgery.
Mediastinoscopy is an efficient method of assessing lymphatic spread in carcinoma of the lung. It is also valuable in providing a definitive diagnosis of other lung diseases. At the Montreal Chest Hospital Centre diagnostic mediastinoscopy was performed in 60 patients with diseases of the lung other than primary carcinoma. All had preoperative radiologic evidence of hilar adenopathy. A definitive diagnosis was obtained in 91.7% of cases. Nonspecific adenitis was diagnosed in four patients and in none was there evidence of serious intrathoracic disease subsequently. Morbidity was minimal and there were no deaths. Mediastinoscopy is a safe, accurate and efficient aid in the evaluation of primary or secondary disease of the anterior intrathoracic lymphatic system.
Betamethasone 0.1% as valerate in an ointment base and fluocinonide 0.05% in a fatty alcohol propylene glycol (FAPG) base have been compared in a double-blind trial of 76 patients with either eczema or psoriasis. The results show betamethasone valerate ointment to be significantly (P less than.05) superior to fluocinonide FAPG in the treatment of both these skin conditions. In the light of publications from other studies on betamethasone valerate cream this trial indicates that the ointment base considerably increases the efficacy of betamethasone valerate.
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This report concerns the use of transaxillary thoracotomy for a variety of pulmonary, pleural, and mediastinal conditions in 50 patients. Primary and metastatic carcinomas, pneumothoraces, and benign lesions such as bronchogenic cysts and neurogenic tumors can be identified, evaluated, and treated with confidence. Reduced postoperative pain and morbidity, rapid return of arm and shoulder movements, reduced hospital stay, and excellent cosmetic result are among the advantages of this approach when compared with the usual posterolateral thoracotomy.
Hypothalamic-pituitary-adrenal (HPA) axis function has been monitored in adults and children who required intensive treatment of their skin disease with topical corticosteroid preparations while in hospital. Evidence of mild suppression of the HPA axis was seen in adults when the more potent topical steroids were used, but recovery of function was rapid when the intensive treatment ceased. In children suppression was still present in twelve of sixteen cases on the 2nd day after treatment with 0-1% betamethasone 17-valerate ointment had stopped, yet in nine cases treated in a comparable manner with 1% hydrocortisone acetate ointment, there was no evidence of impaired HPA axis function.
The initial results on ten patients in a trial of clobetasol propionate (Dermovate) ointment compared with dithranol in Lassar's paste are described. The rates of clearing for each preparation in each patient were not noticeably different. Relapse was slower with clobetasol propionate in all but one patient for whom there was no preference. The results are highly significant (P less than 0-005).
A ratchet-controlled micrometer screw gauge has been used to measure the changes in skin thickness produced by topical corticosteroids. Measurable thinning of the mouse ear followed repeated daily application of corticosteroids. This response in the animal was used to assess the atrophic potential in a variety of standard formulations. The same compounds were applied to human skin and the changes in thickness measured. Patterns of response and the rank order of thinning obtained from the animal model were found to parallel closely the human results.
The prolonged use of self-administered corticotrophin in the form of 'CMC ACTH' (Crookes) or 'Synacthen Depot' (Ciba) has been considered in twenty-seven patients with severe subactute of chronic eczema. Complications were not troublesome and the therapeutic response was good. Many of the patients were able to control their disease fully without the effort and discomfort of additional local treatment and patients' acceptance of the treatment was high.