Incidence of penile lichen sclerosus.
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Biomedical subjects
Publications and source records attributed to M A Fung.
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This randomized double blind study investigates the relative efficacies of controlled analgesia (PCA) regimens in three different patient groups: epidural diamorphine 2.5 mg followed by PCA bolus 1 mg with a 20-min lockout (Gp1), subcutaneous diamorphine 2.5 mg followed by PCA bolus with a 10-min lockout period (Gp2) and epidural diamorphine 2.5 mg in 4 mL of 0.125% (w/v) bupivacaine followed by a PCA bolus of 1 mg diamorphine in 4 mL 0.125% (w/v) bupivacaine with a 20-min lockout (Gp3). Patients were evaluated at 0, 1, 2, 3, 4, 8, 12, 16, 20, 24 and 48 h. Patients in Gp2 consumed significantly more diamorphine than those in Gp1 or Gp3 (P < 0.05), but their pain scores were higher only at 1, 2 and 3 h (P < 0.05) with respect to Gp3 and at 1 h with respect to Gp1. Fewer side effects (sedation, pruritus and nausea as assessed by anti-emetic requirements) occurred in Gp2 compared to Gp1 (P < 0.05). Fewer patients in Gp2 required catheterization than in Gp3 (P < 0.05). This study indicates that the use of PCA epidural diamorphine, either alone or in combination with bupivacaine, reduces the dose requirement for analgesia but offers little clinical advantage over subcutaneous PCA diamorphine.
Steroid acne (SA) may occur after the administration of topical or systemic corticosteroids. Because of several consultations of spinal injury patients with a very abrupt onset of a uniform papular eruption (i.e. days) initially misdiagnosed as a drug reaction or sepsis, we followed hospitalized patients who received intravenous corticosteroids (IVC) for the development of acute-onset SA in order to determine its incidence. Fifty-one consecutive subjects receiving IVC were followed for the duration of their hospital stay and examined for the development of acneiform lesions. Acute-onset SA occurred in 1 subject (2%). Acute spinal cord injury may represent a high-risk clinical setting for acute-onset SA.
Lichen sclerosus (LS) and lichen planus (LP) are two conditions frequently affecting genital skin whose clinical and histologic distinction can be difficult. Both diseases can feature solitary genital lesions with bandlike lymphocytic infiltrates. We reviewed 68 cases of vulvar LS to find sections that contained a transition from a lichenoid interface reaction to pathognomonic LS (i.e., marked papillary dermal sclerosis or edema), and in these nine cases we studied routinely and specially stained sections, as well as sections stained with a panel of antisera to lymphoid antigens, and compared the findings with those in six cases of genital LP. We assumed that changes at the periphery of a lesion of LS mirror findings seen in early lesions. The features that we found more commonly in the inflammatory phase of LS included a psoriasiform lichenoid pattern (100% LS, 0% LP), basilar epidermotropism (78% LS, 0% LP), loss of papillary dermal elastic fibers (100% LS, 33% LP), basement membrane thickening (44% LS, 0% LP), and epidermal atrophy (33% LS, 0% LP). Features found more commonly in LP included many cytoid bodies (0% LS, 100% LP), wedge-shaped hypergranulosis (11% LS, 100% LP), basal squamatization (22% LS, 100% LP), and pointed rete ridges (11% LS, 83% LP). We did not detect any significant differences in the immunohistochemical features of the infiltrates. Taken together, these histologic features comprise light microscopic criteria for the diagnosis of early vulvar LS and its differentiation from LP.
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A soluble component that transfers granulomatous tissue reaction was fractionated from Schistosoma mansoni egg-induced hepatic granulomas (SMHG) by Sephacryl S-300 column chromatography. The fractions separately bound to inert, Affi-Gel agarose beads were inoculated subcutaneously in naive mice. The low molecular weight fraction, consisting of proteins 23 kd, 20 kd, and 16 kd, produced organized granulomas 6 to 7 weeks after inoculation. This fraction was further purified by high-pressure liquid chromatography (HPLC) gel filtration and gave three fractions eluting at retention times of 44, 46, and 48 minutes. Each fraction contained all low-molecular-weight proteins in varying amounts and induced skin granulomas when inoculated subcutaneously. Amino acid sequence of the major 20-kd protein showed 11 N-terminal residues identical to those of cyclophilin. Antisera raised to the protein with retention time of 46 minutes, reacted with cells in the granulomas but not surrounding liver tissue as detected by immunofluorescence microscopy. The findings indicate a low molecular weight soluble fraction of SMHG can induce new granuloma formation when injected in an immobilized form into skin of naive mice. The results suggest granuloma initiation factor is a homolog of the cyclophilin gene family.
The conformational changes of the protein alpha-chymotrypsinogen which may take place on reversed-phase chromatographic material of differing hydrocarbon chain lengths e.g. C4, C6, C8, C10 and phenyl, have been studied by circular dichroism as a function of 1-propanol concentration and pH of the solvent before and after binding to the reversed-phase material.