Biomedical subjects
Publications and source records attributed to J A Hunter.
Forty-eight patients (23 male, 25 female) with severe alopecia areata were sensitized and treated with topical diphencyprone. Thirty-eight per cent of the subjects had good regrowth of hair at a mean follow-up period of 30.8 months. The presence of nail changes, a personal history of atopy and a long duration of alopecia had an adverse prognostic effect.
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An epidemiological study of atopic eczema (AE), based on a semirural community in Scotland, using sound diagnostic criteria, has yielded prevalence data for all age groups including infants and adults. The overall 1-year period prevalence, age-standardized to the Scottish population, was 2.3%. The 1-year period prevalence was highest in the under 2s (9.8%), and showed a continuous reduction with increasing age. Over the age of 40, AE was found to be relatively rare, with a 1-year period prevalence of 0.2%. Adults over 16 years made up 38% of all patients with AE.
Atopic eczema affects 2.3% of the U.K. population. We have carried out a community study in a semi-rural area to assess its economic impact. One hundred and fifty-five patients with atopic eczema were identified and expenditure was assessed over a 2-month period. The mean personal cost to the patient was pounds 25.90, while the mean cost to the health service was pounds 16.20. There were 58 lost working days and 17 lost school days. A cohort of 10 severely affected patients attending the Royal Infirmary of Edinburgh were studied; each patient spent, on average, pounds 325 in 2 months, and lead to a mean health service expenditure per patient of pounds 415, in 2 months. If these results were extrapolated to the U.K. population, the annual personal cost to patients with atopic eczema would be pounds 297m, the cost to the health service would be pounds 125m, and the annual cost to society of lost working days would be pounds 43m, making the total expenditure on atopic eczema pounds 465m.
Test-retest reliability and concurrent validity studies on the Adolescent Sexual Interest Card Sort (ASIC) were conducted in two samples of 38 juvenile sexual offenders, each. Of the 64 items of the ASIC, 60 were found to be significantly correlated across test administrations. Cronbach's coefficient alpha was employed to determine the internal consistency of ASIC items. Coefficients ranged from .62 to .96 across categories, with an overall alpha of .97. Client ratings of sexual interests via the Card Sort were correlated with phallometric response to similar categories of stimuli. Significant correlations were found for only 4 of the 14 categories examined, suggesting little correspondence between client report of sexual interest on the ASIC and phallometric assessment of the same. Findings are consistent with the adult sex offender literature suggesting that self-report measures are particularly vulnerable to dissimulation and often at variance with more objective measurement. Clinical and research issues pertinent to the measurement of sexual arousal and interest in juvenile sexual offenders are discussed.
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The aim of this study was to compare the efficacy and safety of once-daily with twice-daily application of a 0.05% cream formulation of fluticasone propionate in the treatment of atopic eczema in adults and children. Two hundred and seventy patients with moderate to severe atopic eczema were enrolled in the study, and randomized to receive either once-daily or twice-daily fluticasone propionate 0.05% cream for 4 weeks. Patients randomized to the once-daily group also received the vehicle cream to ensure that the study remained blinded. The clinical response of a preselected target area of affected skin was assessed by investigators at weekly intervals and compared with the baseline. Analysis of the investigators' overall assessment of the response of the target area for both the 'intent-to-treat' population and the per protocol population showed that 79-85% of patients were judged a clinical success. For both populations, there was no statistically significant difference between the response to once-daily and twice-daily active treatment (intent-to-treat; P = 0.35; 95% confidence interval for difference -14.2 to +5.0 percentage points: per protocol; P = 0.42; 95% confidence interval for difference -14.7 to +6.2 percentage points.) The improvement in the signs and symptoms was judged a success in 95-97% of patients. There was an equal reduction in severity scores for disease activity in both groups, and the speed of symptom relief was similar.(ABSTRACT TRUNCATED AT 250 WORDS)
The incidence of cutaneous malignant melanoma has increased considerably in south-east Scotland over recent years. In 1987 the Cancer Research Campaign launched a project to aid the early detection, diagnosis and treatment of malignant melanoma. Edinburgh, chosen as one of seven centres in the U.K. to participate in the study, was provided with funding for a direct access pigmented lesion clinic from 1987 to 1989. The changes in the pattern of cutaneous malignant melanoma before, during and after the publicity campaign have been examined; between 1982 and 1990. The incidence of malignant melanoma doubled from 5.7 to 11.4/100,000 per annum. The percentage of thin tumours (Breslow thickness < or = 1.5 mm) increased steadily and significantly (from 43% in 1982 to 68% in 1990), but the number of thick tumours (Breslow thickness > 3.0 mm) remained constant over the same period (22 +/- 3.8). The influence of publicity was assessed using a questionnaire. Those who were influenced by publicity were significantly younger and had more thin tumours (Breslow < or = 1.5 mm) than those who were uninfluenced by publicity. Five-year survival has significantly increased from 70% in the 1982-84 cohort to 84% in the 1987-89 cohort. The effect of the publicity campaign has been beneficial, but the impact on mortality cannot yet be assessed.
Chronic bullous dermatosis of childhood (CBDC) is a distinctive subepidermal blistering disorder that characteristically involves the perioral area, lower trunk, inner thighs and genitalia. Direct immunofluorescence shows a linear band of IgA at the dermoepidermal junction (DEJ). The eruption usually begins before the age of 6 years and is typically described as self-limiting, clearing with a few months or years. Chronic bullous dermatosis of childhood has many clinical and immunopathological similarities with adult linear IgA disease (LAD) and it has been suggested that they represent different manifestations of the same disease. We report a case of CBDC which started at 2 years of age and which has relapsed twice, first at age 6 years and then again, after puberty, at age 17 years.
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The current study examined the relationship between clinical characteristics and a phallometrically derived deviance quotient index in two samples of 44 and 54 juvenile sex offenders. Results support an association between higher measured deviant arousal and having a male victim only, consistent with the literature on adult child molesters. However, results reflected greater fluidity in the offense patterns of the juvenile offenders, and generally less correspondence between measured arousal and offense histories than what has been cited for adults. The authors review whether there is empirical support for a conditioning model of deviant arousal onset in juveniles, and suggest caution in the interpretation of phallometric data with this population.
Renal allograft recipients suffer from a markedly increased susceptibility to premalignant and malignant cutaneous lesions. Although various aetiological factors have been implicated, little is known of the associated genetic events. In this study we initially employed immunocytochemical techniques to investigate the prevalence and localisation of accumulated p53 in over 200 cutaneous biopsies (including 56 squamous cell carcinomas) from renal allograft recipients and immunocompetent controls. In renal allograft recipients accumulated p53 was present in 24% of uninvolved skin samples, 14% of viral warts, 41% of premalignant keratoses, 65% of intraepidermal carcinomas and 56% of squamous cell carcinomas [squamous cell carcinoma and intraepidermal carcinoma differed significantly from uninvolved skin (P < 0.005) and viral warts (P < 0.01)]. A similar trend was revealed in immunocompetent patients (an older, chronically sun-exposed population) but with lower prevalence of p53 immunoreactivity: 25% of uninvolved skin samples, 0% of viral warts, 25% of keratoses, 53% of intraepidermal carcinomas and 53% of squamous cell carcinomas. These differences were not statistically significant. Morphologically, p53 immunoreactivity strongly associated with areas of epidermal dysplasia and the abundance of staining correlated positively with the severity of dysplasia. These data suggest that p53 plays a role in skin carcinogenesis and is associated with progression towards the invasive state. No correlation was observed between accumulated p53 and the presence of human papillomavirus (HPV) DNA in any of the lesions. Single-strand conformational polymorphism analysis (exons 5-8) was used to determine the frequency of mutated p53 in 28 malignancies with varying degrees of immunopositivity. p53 mutations were found in 5/9 (56%) malignancies with p53 staining in > 50% of cells, reducing to 1/6 (17%) where 10-50% of cells were positively stained and none where < 10% of cells were stained. These data imply that factors other than p53 gene mutation play a part in accumulation of p53 in skin cancers.
It is well established that renal allograft recipients (RARs) have an increased incidence of viral warts and premalignant and malignant cutaneous lesions, and the risk of their development increases in proportion to duration of graft survival. It has been postulated that, in addition to the effects of prolonged immunosuppression and previous sun exposure, human papillomaviruses (HPV) may also contribute to the carcinogenic process. In this study, the prevalence of HPV DNA was examined in a range of premalignant and malignant cutaneous tumours from 50 immunosuppressed patients (47 renal allograft recipients plus three cardiac allograft recipients) and 56 immunocompetent patients using Southern hybridisation as a low-stringency screening method and type-specific polymerase chain reaction (PCR) assays for eight HPV types. The combined results for renal allograft recipients show that HPV DNA was detectable in 79% of viral warts, 42% of premalignant keratoses, 33% of intraepidermal carcinomas, 43% of invasive squamous cell carcinomas and 16% of uninvolved skin specimens (squamous cell carcinomas/renal allograft recipients significantly different at P < 0.05 from uninvolved skin specimens/renal allograft recipients). In immunocompetent patients the pattern of HPV DNA prevalence was 100% for viral warts; 25% for keratoses, 23% for intraepidermal carcinomas, 22% for squamous cell carcinomas and 8% for uninvolved skin. No single HPV type predominated in tumour specimens from either group. More tumours were found to contain HPV DNA by Southern hybridisation analysis than PCR, indicating the presence of HPV types other than HPV 1, 2, 5, 6, 8, 11, 16 and 18 in some tumours. However, 'low cancer risk' HPV types 1, 2 and 6 as well as 'high cancer risk' HPV types 5 and 16 were specifically detected by PCR in a small number of neoplasms. These data suggest that multiple HPV types may contribute to cutaneous neoplasia in RARs and that they appear to act early in the process of carcinogenesis, perhaps by functioning as tumour promoters via stimulation of cell proliferation.
Since the introduction of intra-articular steroid therapy 40 yr ago there have been many changes in the treatment of rheumatoid patients. Previous studies suggest differing times of response for the same agents. This study reports the response, measured by a five-point pain chart, of 300 patients with painful rheumatoid knees. Sixty received hydrocortisone succinate (HC), 150 received triamcinolone acetonide (TA), and 120 triamcinolone hexacetonide (TH). Results demonstrated little effect with HC, but good responses with TA and TH. More patients were rendered painfree for a longer time with TH; 18% at 12 weeks, as against 9% with TA (chi 2 test P < 0.005). At 12 weeks 59% showed continued improvement with TH as against 44% with TA (chi 2 test P < 0.05). TH is the preferred preparation for injection of the rheumatoid knee.
Three hundred and one clinical medical students in four universities took the same 50 question MCQ dermatology examination after their dermatology teaching. In one centre, half the students had had additional teaching; these students performed better (mean score 47.5%, n = 29) than those who had no extra teaching (mean score 40.9%, n = 29). In another centre, the students' mean score improved from 24.1 (SD = 6.7) before to 41.6 (SD = 7) (n = 46, P < 0.001) after their dermatology teaching. The different subject areas covered by the examination were analysed separately. In the lowest scoring centre (mean score 34.0, SD = 9.4) the students scored lowest in 9 of the 14 subject areas. In the highest scoring centre (mean score 47.5, SD = 9.9) students scored highest in 7 of these 14 subject areas. This study enabled questions of high discriminatory value to be identified for future use. The use of the same examination in different centres provides feedback for the centres concerning strengths and weaknesses of their teaching.
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Werner syndrome is a rare, autosomal, recessive condition that is frequently studied as a model of some aspects of human aging, although the behavioral changes that are usually associated with old age are only seen very infrequently. A most striking aspect of the phenotype of Werner syndrome, presumably arising from the same gene defect, is a dramatic shortening of the replicative life-span of dermal fibroblasts in vitro. The finite replicative life-span of human cells in vitro is due to the stochastic loss of replicative ability in a continuously increasing fraction of newborn cells at every generation. Normal human fibroblasts achieve approximately 60 population doublings in culture, while Werner syndrome cells usually only achieve approximately 20 population doublings. We describe an analysis of the replicative ability of fibroblasts from Werner syndrome patients and demonstrate that the cells in these cultures usually exit, apparently irreversibly, from the cell cycle at a faster rate than do normal cells, although they mostly start off with a good replicative ability. We propose that the Werner syndrome gene is a "counting" gene controlling the number of times that human cells are able to divide before terminal differentiation.
We assessed the use of endoscopic retrograde cholangiopancreatography (ERCP) after laparoscopic cholecystectomy (LC) at our hepatobiliary referral center. This assessment included patients from outside institutions with post-LC problems. Between May 1990 and September 1992, we performed 522 LCs and 1,723 ERCP examinations. There were 78 patients who underwent 143 ERCP examinations after LC, 65% of whom were referred. ERCP findings were categorized as follows: normal results (8%), problems inherent to stone disease (65%), and iatrogenic injury (27%). The types of inherent problems were common bile duct (CBD) stones, pancreatitis, and papillary stenosis/microlithiasis. Within the CBD stone group, 5 of 26 patients also had papillary stenosis, and, within the pancreatitis group, 9 of 11 patients also had papillary stenosis, making papillary stenosis the most frequent observation (55%). Almost all of these patients (96%) required endoscopic papillotomy for successful treatment. The iatrogenic injury group was comprised of 21 patients, 16% of whom had cystic duct leak and 84% of whom had CBD injury. These patients required a variety of endoscopic procedures including endoscopic papillotomy (67%), CBD endoscopic stenting (76%), percutaneous drainage of biloma (29%), and percutaneous transhepatic biliary drainage (24%). Open surgical procedures after endoscopic assessment or treatment were required in only three patients in the iatrogenic group and in none in the inherent group. At this time, long-term follow-up is not possible with regard to biliary stricture. We conclude that the majority of problems after LC are either due to papillary stenosis/microlithiasis with or without CBD stones or to biliary injury. Both can be successfully diagnosed and treated with endoscopic techniques.