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[The role of Helicobacter pyroli in the development of skin diseases].

The paper presents the current state-of-the-art concerning the effect of Helicobacter pyroli infection on the progress of some skin diseases (Raynaud's disease, purpura hyperergica, rosacea, prurigo nodularis, atopic dermatitis, chronic urticaria). The attention was turned to the lack of unanimity among authors respective to the effect of Helicobacter pylori on the progress of some skin diseases, especially those of allergic etiology. The methods of bacteria identification were discussed. The methods are as follows: invasive tests involving endoscopy of the upper segment of the alimentary tract--a traumatic test, histologic examination and bacteria culture as well as noninvasive tests: respiratory test and serological tests able to detect the humoral response to infection or examination of the bacteria genetic material by means of PCR. The therapeutic methods used to eradicate effectively the infection, recommended by the Working Group of the Polish Association of Gastroenterology (a three-component treatment for seven days--a drug able to diminish gastric secretion and two antibiotics) are also discussed.

Dermatitis, Atopic↗

Differences in red cell behaviour between patients with Raynaud's phenomenon and systemic sclerosis and patients with Raynaud's disease.

The 'filterability' and electrophoretic mobility of erythrocytes from 42 patients with systemic sclerosis and Raynaud's phenomenon were studied and compared with the findings from 24 patients with Raynaud's disease and 26 normal controls. Red blood cells from patients with systemic sclerosis and Raynaud's phenomenon were less filterable (P less than 0.0001) and had decreased electrophoretic mobility (P less than 0.001) compared with erythrocytes from patients with Raynaud's disease and the controls. There was no significant difference between the values from the patients with Raynaud's disease and the controls. These results indicate that measurement of erythrocyte filterability and electrophoretic mobility may be useful in the differentiation of patients with Raynaud's disease who have no underlying collagen disease from those who have Raynaud's phenomenon in association with systemic sclerosis.

Adolescent↗

Increased alpha-adrenergic responsiveness in idiopathic Raynaud's disease.

In our study of 28 patients with idiopathic Raynaud's disease, the patients had significantly greater digital blood flow responses to intraarterial phenylephrine and clonidine than did normal control subjects. There were no group differences in finger blood flow responses to body heating, reflex cooling, digital ischemia, or to intraarterial tyramine or isoproterenol. There were also no group differences in blood pressure or heart rate during any procedure. These results suggest that patients with idiopathic Raynaud's disease have increased peripheral vascular alpha-adrenergic receptor sensitivity and/or density compared with normal persons.

Adult↗

Prognostic significance of anticentromere antibodies and anti-topoisomerase I antibodies in Raynaud's disease. A prospective study.

Seventy-seven patients with Raynaud's disease were studied for a mean of 4 years (range 1-11 years) to determine the relationship between autoantibodies and long-term clinical outcome. Anticentromere antibodies (ACA) were assayed by indirect immunofluorescence and by immunoblotting of HeLa cell chromosome extracts. Antibodies to topoisomerase I (anti-topo I) were assayed by immunodiffusion and immunoblotting. Antibodies to the major centromeric protein, CENP-B, and anti-topo I were studied by enzyme-linked immunosorbent assay (ELISA). Eight patients developed telangiectasias, 4 developed skin tightening, and 4 developed a connective tissue disease other than scleroderma. The presence of ACA at the start of the study was associated with the development of telangiectasias (P less than 0.003). An initial 100-kd band on immunoblot in conjunction with a positive anti-topo I ELISA result was associated with the development of tight skin (P less than 0.0025), while a 100-kd band with a negative anti-topo I ELISA result was associated with the subsequent development of a connective tissue disease other than scleroderma (P less than 0.0073). Patients who were initially ACA positive, had the 100-kd band on immunoblot, or had positive ELISA results for anti-topo I or for anti-CENP-B were 63-fold more likely to develop signs of connective tissue disease by the end of the study (P less than 0.000009). The presence of any of these autoantibodies was more sensitive (100%), although less specific (75%), than were findings from nailfold capillaroscopy (sensitivity 67% and specificity 95%) in predicting subsequent clinical progression. We conclude that findings of assays for anti-topo I and ACA complement the findings from nailfold capillaroscopy in providing useful prognostic information in Raynaud's disease.

Antibodies↗

Exposure to vinyl chloride monomer: results of a cohort study after a seven year follow up. The French VCM Group.

In 1980 a prospective cohort study of exposed and non-exposed subjects was initiated in France by the Institut National de la Santé et de la Recherche Médicale (INSERM U287) in collaboration with occupational physicians from the companies involved. The aim was to evaluate the association between mortality and cancer morbidity and occupational exposure to vinyl chloride monomer (VCM). A total of 1100 subjects exposed to VCM and 1100 non-exposed controls matched for age (to two years), plant, and physician were followed up for seven years (8299 and 8202 person years for exposed subjects and controls respectively) for vital status and health and occupational state. Forty deaths occurred among exposed and 43 among non-exposed subjects (relative risk (RR) = 1.0; 95% confidence interval (95% CI) 0.6-1.5). Forty eight and 32 cases of cancer were reported among exposed and non-exposed subjects, respectively (RR = 1.3; 95% CI 0.8-2.1). Three cases of angiosarcoma of the liver occurred in the exposed group. Eight cases of lung cancer occurred among exposed subjects and six among non-exposed subjects. Fourteen cases of Raynaud's disease were found among exposed and one among non-exposed subjects and the difference was significant. One hundred and twenty three and 93 cases of cardiovascular disease (Raynaud's disease excluded) occurred in the exposed and non-exposed groups respectively (RR = 1.4; 95% CI 1.0-1.8); this difference was mainly due to hypertension. The test for an increasing risk with increased exposure was significant. The percentages of diseases of the respiratory system did not differ between the two groups (RR = 1.1; 95% CI 0.7-1.8).

Cardiovascular Diseases↗

Adrenoceptors in Raynaud's disease.

Experiments were designed to study adrenoceptor function in subjects with Raynaud's disease. Sympathetic agonists and antagonists were administered into the finger skin by iontophoresis, and the resulting change in local skin blood flow was evaluated by laser Doppler technique. The effects of norepinephrine (NE, stimulating alpha 1- and alpha 2-adrenoceptors), phenylephrine (stimulating alpha 1-adrenoceptors) were studied in 12 women with Raynaud's disease and in 12 healthy controls. Controls and cases showed a similar consistent vasoconstriction to NE and B-HT 933. All control subjects showed a vasoconstriction to phenylephrine. In contrast, the Raynaud subjects demonstrated a weaker vasoconstriction or even a vasodilation, especially to low concentrations of the drug. After blockade of the alpha 1-adrenoceptors by doxazosin in the controls, phenylephrine mimicked the reaction in Raynaud subjects. beta-Adrenoceptor agonists (isoprenaline and terbutaline) had no effect on finger blood flow in the examined finger skin area in either control or Raynaud subjects. We suggest that Raynaud's disease is characterized by a defect in alpha 1-adrenoceptor function.

Adult↗

Plasmapheresis in Raynaud's disease.

Understanding of the pathogenesis, clinical course, and treatment of Raynaud's disease is confused and unsatisfactory, and no success in treatment can be promised. Five patients with severe Raynaud's disease, who had not responded to other forms of treatment, were treated by plasmapheresis, which produced a striking improvement. Ultrasonic velocimetry showed that segments of digital arteries which had been thought to be permanently occluded became patent and remained patent after plasmapheresis.

Adult↗

[A case of primary pulmonary hypertension in a patient with Raynaud's disease].

A case of a 50-year female patient with Raynaud's disease is presented. The primary pulmonary hypertension accompanying the underlying condition suggests that the excessive contractibility of the vessels, typical for the Raynaud's disease, may play a role in the etiology of the primary pulmonary hypertension.

Female↗

[Esophageal motor abnormalities, gastroesophageal reflux and duodenogastric reflux in patients with Raynaud's disease].

Twenty-four patients with Raynaud's phenomenon, without ARA criteria for classification, were examined, after clinical history, by means of esophageal manometry, combined gastric and esophageal pH-monitoring, endoscopy. The results showed in these patients a high incidence of esophageal motor abnormalities (66.6%), of gastroesophageal reflux (50%), and of duodenogastric reflux (45.8%).

Cohort Studies↗