Stress as an influencing factor in psoriasis

Emotional stress may influence the development and exacerbation of psoriasis. The proportion of psoriasis patients who believe stress affects their skin condition (i.e., "stress responders") is considerably high, ranging from 37% to 78%. Stress may worsen psoriasis severity and may even lengthen the time to disease clearance. Although a pathogenic association appears likely, additional well-controlled studies are necessary to confirm such a causal relationship. Dysregulation of the hypothalamus-pituitary-adrenal and sympathetic adrenomedullary systems has been proposed as one possible underlying cause of stress-induced flares of psoriasis. While stress may be an exacerbating factor, psoriasis itself may contribute to significant adverse psychological sequelae. Breaking this stress cycle may be an important part of any therapeutic approach. Thus, stress reduction through psychotherapy and pharmacotherapy may be useful in treating psoriatic patients who are stress responders.

How Long Does the Benefit of Biologics Last? An Update on Time To Relapse and Potential for Rebound of Biologic Agents for Psoriasis

The biologic agents vary considerably in terms of their long-term duration of effect. Using the definitions provided by the National Psoriasis Foundation Medical Board, the objective of this review was to compare all biologic agents with respect to time to relapse and potential for rebound. Overall, alefacept had the longest off-treatment benefit (29.9 weeks in Psoriasis Area and Severity Index [PASI] 75 responders), followed by ustekinumab (22 weeks), infliximab (19.5 weeks), adalimumab (18 weeks), etanercept (12.1 weeks in PASI 50 responders), and, lastly, efalizumab (9.6 weeks). Rebound was reported commonly for efalizumab (14%) and, extremely rarely, for etanercept (0.002%).

Improved health-related quality of life following a randomized controlled trial of alefacept treatment in patients with chronic plaque psoriasis

BACKGROUND

Psoriasis has a negative impact on patients' quality of life. Treatment strategies should address both the cutaneous manifestations of the disease and their impact on quality of life.

OBJECTIVES

To evaluate the effect of alefacept on quality of life in 553 patients with chronic plaque psoriasis.

METHODS

In this multicentre, double-blind, parallel-groups study, patients were randomized to receive alefacept for two courses, alefacept in course 1 and placebo in course 2, or placebo in course 1 and alefacept in course 2. In each course, alefacept 7.5 mg or placebo was administered once weekly by 30-s intravenous injection for 12 weeks followed by 12 weeks of observation. The Dermatology Life Quality Index (DLQI), Dermatology Quality of Life Scales (DQOLS) and Short Form-36 Health Survey (SF-36) were administered at baseline, 2 weeks after the last dose in both courses, at the beginning of course 2, and at the end of the observation period in both courses.

RESULTS

In course 1, alefacept significantly reduced (improved) mean DLQI scores compared with placebo: 4.4 vs. 1.8 at 2 weeks after the last dose (P<0.0001) and 3.4 vs. 1.4 at 12 weeks after the last dose (P<0.001). Patients who received two courses of alefacept experienced additional enhancement of quality of life measures during the second course. Similar results were observed for the DQOLS. The SF-36 survey confirmed that alefacept had no negative impact on general quality of life.

CONCLUSIONS

Alefacept improved quality of life in patients with chronic plaque psoriasis and maintained this benefit for at least 12 weeks following cessation of treatment. A second course of alefacept provided additional quality of life benefit.

KNT-artificial neural network model for flux prediction of ultrafiltration membrane producing drinking water

This paper describes the prediction of flux behavior in an ultrafiltration (UF) membrane system using a Kalman neuro training (KNT) network model. The experimental data was obtained from operating a pilot plant of hollow fiber UF membrane with groundwater for 7 months. The network was trained using operating conditions such as inlet pressure, filtration duration, and feed water quality parameters including turbidity, temperature and UV254. Pre-processing of raw data allowed the normalized input data to be used in sigmoid activation functions. A neural network architecture was structured by modifying the number of hidden layers, neurons and learning iterations. The structure of KNT-neural network with 3 layers and 5 neurons allowed a good prediction of permeate flux by 0.997 of correlation coefficient during the learning phase. Also the validity of the designed model was evaluated with other experimental data not used during the training phase and nonlinear flux behavior was accurately estimated with 0.999 of correlation coefficient and a lower error of prediction in the testing phase. This good flux prediction can provide preliminary criteria in membrane design and set up the proper cleaning cycle in membrane operation. The KNT-artificial neural network is also expected to predict the variation of transmembrane pressure during filtration cycles and can be applied to automation and control of full scale treatment plants.

Application of short-term water demand prediction model to Seoul

To predict daily water demand for Seoul, Korea, the artificial neural network (ANN) was used. For the cross correlation, the factors affecting water demand such as maximum temperature, humidity, and wind speed as natural factors, holidays as a social factor and daily demand 1 day before were used. From the results of learning using various hidden layers and units in order to establish the structure of optimal ANN, the case of 3 hidden layers and numbers of unit with the same number of input factors showed the best result and, therefore, it was applied to seasonal water demand prediction. The performance of ANN was compared with a multiple regression method. We discuss the representation ability of the model building process and the applicability of the ANN approach for the daily water demand prediction. ANN provided reasonable results for time series prediction.

Image reconstruction using the wavelet transform for positron emission tomography

We conducted positron emission tomography (PET) image reconstruction experiments using the wavelet transform. The Wavelet-Vaguelette decomposition was used as a framework from which expressions for the necessary wavelet coefficients might be derived, and then the wavelet shrinkage was applied to the wavelet coefficients for the reconstruction (WVS). The performances of WVS were evaluated and compared with those of the filtered back-projection (FBP) using software phantoms, physical phantoms, and human PET studies. The results demonstrated that WVS gave stable reconstruction over the range of shrinkage parameters and provided better noise and spatial resolution characteristics than FBP.

Structure of the Ba-induced Si(111)- (3 x 2) reconstruction

The Ba/Si(111) surface, previously known as a 3 x 1 phase, is found to have a 3 x 2 periodicity and a semiconducting band gap. The substrate reconstructs into the honeycomb chain-channel (HCC) structure with Ba atoms in the channel, as in the alkali-metal-induced Si(111)-(3 x 1). However, the metal coverage is determined to be 1/6 monolayers, half the alkali-metal coverage. We propose that the structure and the metal coverage determined for the Ba adsorbate is universal for other alkaline-earth-metal adsorbates. With the alkali-metal-induced 3 x 1 case, our results lead to a rule that one donated electron per 3 x 1 surface unit is necessary to stabilize the HCC reconstruction of Si.

Study on the Expression of Insulin-like Growth Factor II (IGF- II) in Hepatocellular Carcinoma Cells and Developing Rat Embryos

PURPOSE

The insulin-like growth factor II (IGF-II) gene expresses a family of transcripts in embryonic/fetal tissue, and also highly was expressed during hepatocellular carcinogenesis. In this study, we showed that IGF-II mRNA and protein levels are detected in rat embryo, HepG2 human hepatoma cells and Chang liver cells.

MATERIALS AND METHODS

This study included sections of rat embryos 7~17 days post coitum (d.p.c), HepG2 cells and Chang liver cells. Using immunohistochemistry, Northern blotting and Western blotting, we observed the expression of IGF-II in the rat embryo, HepG2 cells and Chang liver cells.

RESULTS

We localized IGF-II gene products in sections of rat embryo 7~17 d.p.c by performing immunohistochemistry. The IGF-II was mainly expressed in the proximal endoderm and ectoplacental cone between 7 and 9 d.p.c. At 10 d.p.c. the expression was localized at the heart primodium as well as the proximal endoderm, and at 11 d.p.c. the IGF-II was expressed in the liver and heart. After 12 d.p.c. and 14 d.p.c., the expression was also detected in the brain, muscle and bone, and head mesenchyme, respectively. While the expression of IGF-II protein was not detected in the normal adult liver, intense staining was detected in the heart, liver and choroids plexus at 17 d.p.c.

CONCLUSION

These results suggest that IGF-II may act as an oncofetal protein during hepatocellular carcinogenesis and embryogenesis.

Tazarotene plus UVB phototherapy in the treatment of psoriasis

BACKGROUND

The addition of oral retinoids to phototherapy may accelerate and enhance antipsoriatic efficacy, but can result in systemic adverse events and additional laboratory monitoring costs.

OBJECTIVE

Our purpose was to determine whether the topical addition of tazarotene to UVB phototherapy improves efficacy without problems related to photosensitivity.

METHODS

Bilateral target plaques were randomized to receive two of the following, one on each plaque once daily for 14 days: tazarotene 0.1% gel, vehicle gel, or no treatment. Thereafter, the same treatments were continued 3 times per week, plus UVB phototherapy 3 times per week, for an additional 67 days.

RESULTS

Tazarotene plus UVB phototherapy achieved faster and significantly greater reductions in plaque elevation and scaling throughout treatment and achieved at least 50% improvement from the pretreatment baseline with a significantly lower median cumulative UVB exposure than vehicle gel plus UVB light or UVB phototherapy alone. No case of unusual photosensitivity was noted in the tazarotene plus UVB treatment group.

CONCLUSION

The addition of tazarotene to UVB phototherapy improves and accelerates efficacy and maintains acceptable safety and tolerability.

Concomitant administration of vitamin E does not change the side effects of isotretinoin as used in acne vulgaris: a randomized trial

BACKGROUND

Isotretinoin treatment is frequently associated with reversible, dose-related side effects. Recent studies claimed that combining vitamin E with high-dose isotretinoin ameliorated isotretinoin-induced side effects.

OBJECTIVE

The purpose of this double-blind, randomized study was to determine the effects of a fixed dose of vitamin E on the side effects of isotretinoin for treatment-resistant acne vulgaris.

METHODS

One hundred forty subjects were randomly assigned to one of two treatment programs with isotretinoin (1 mg/kg) together with either vitamin E (800 IU/day) or a vitamin E placebo for 20 weeks. The incidence, severity, and duration of the side effects (eg, dry eyes, dry lips) were assessed.

RESULTS

A fixed 800 IU/day dose of vitamin E did not improve the incidence, severity, or duration of side effects associated with isotretinoin (1 mg/kg per day).

CONCLUSION

Vitamin E did not significantly ameliorate retinoid side effects when combined with 1 mg/kg of isotretinoin in the treatment of acne.

Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent-initial experience

PURPOSE

To investigate the technical feasibility and clinical effectiveness of a polyurethane-covered expandable nitinol stent in the treatment of malignant gastroduodenal obstructions.

MATERIALS AND METHODS

The stent was constructed in-house by weaving a single thread of 0.2-mm nitinol wire in a tubular configuration and was covered with polyurethane solution by means of a dipping method. With fluoroscopic guidance, the stent was placed in 19 consecutive patients with malignant gastric outlet obstruction (n = 15) or duodenal obstruction (n = 4). All patients had severe nausea and recurrent vomiting, and their obstructions were inoperable.

RESULTS

Stent placement was technically successful in all but one patient. After stent placement, symptoms improved in all but one patient, who had another stenosis at the proximal jejunum. One patient with stent placement in the second portion of the duodenum became jaundiced. During the mean follow-up of 11 weeks, stent migration occurred in five patients 1-4 days after the procedure. All patients with stent migration were treated by means of placing a second, uncovered nitinol stent. Two of these five patients showed recurrence of stricture because of tumor ingrowth; they underwent coaxial placement of a third, covered nitinol stent with good results.

CONCLUSION

Placement of a polyurethane-covered expandable nitinol stent seems to be technically feasible and effective for palliative treatment of inoperable malignant gastroduodenal obstructions. Stent migration, however, is problematic and requires further investigation.

Current consensus and update on psoriasis therapy: a perspective from the U.S

Psoriasis is one of the more common forms of chronic dermatitis in the world. The latest U.S.-wide epidemiological study conducted by the author revealed a prevalence rate of 2.6% of the population, which translates to over 6 million Americans (1). Psoriasis comes in many different degrees of severity and responsiveness to treatment modalities. Some cases are very mild and quite responsive to treatment, while others are so severe, chronic and recalcitrant that they test the skill and ingenuity of the best clinicians. Fortunately, there are also many different treatment options. Topical therapies include crude coal tar, anthralin, corticosteroids, calcipotriol, and tazarotene. Phototherapy may be a better choice in patients with more extensive psoriasis; UVB or psoralen plus subsequest UVA (PUVA) can be used. There are also a host of systemic therapies (cyclosporine, methotrexate, acitretin), which can be chosen in recalcitrant cases, or when topical or phototherapy is impractical. Importantly, significant increases in efficacy can be obtained by combining multiple therapies (Re-PUVA, topical calcipotriol plus topical halobetasol) and significant decreases in side effects can be obtained by transitioning through or rotating between therapies (cyclosporine transitioning into acitretin).

Early rehabilitation program in postmastectomy patients: a prospective clinical trial

The purpose of this study was to determine whether 20 patients who received an early postmastectomy rehabilitation treatment program showed more improvement in range of shoulder motion and functional activities than 13 patients who received instruction for exercise only. Data were obtained at preoperatively, three days after operation, at discharge and at postdischarge one month for each patient on parameters such as range of motion of the ipsilateral shoulder joint, upper extremity circumferential measurements, as well as 10 elements of shoulder function. Postoperatively, both groups showed an increased range of motion of the shoulder joint and improved functional activities, but the group that received postoperative rehabilitation management had a better range of shoulder motion and less difficulty in five items for functional assessment. This study also showed that an early rehabilitation program did not increase postoperative complications. We concluded that an early rehabilitation program or intensive instruction program only by a well-trained physical therapist or physiatrist was beneficial to postmastectomy patients in regaining the function and range of shoulder motion, and significantly better in a rehabilitation group.

Tazarotene in combination with phototherapy

Despite the vast array of available therapies for treating psoriasis, there remains a need for safer, more effective treatments. Topical tazarotene has been shown to be effective in treating mild-to-moderate psoriasis without causing the adverse effects, such as mucocutaneous toxicity, hyperostosis, and elevation in serum lipids, often associated with orally administered retinoids. A 2-week pretreatment with tazarotene 0.1% gel once daily, followed by tazarotene plus UVB therapy (tazarotene-UVB) 3 times per week for 10 weeks, was more effective than UVB therapy alone or in combination with vehicle gel in reducing plaque elevation, scaling, and erythema. The tazarotene-UVB treatment was well tolerated, and no phototoxicity was observed. Treatment success, defined as a moderate response or better in psoriatic lesions (ie, > or = 50% improvement in psoriatic lesions compared with baseline), was achieved within 32 days with the tazarotene-UVB treatment, compared with 67 days with UVB alone or UVB plus vehicle gel.

How and where tazarotene might fit into the current therapeutic armamentarium: an expert opinion

When a new class of topical medication becomes available to treat psoriasis, its optimal usage may not be fully defined for years. This is because even the "experts" who tested the medication in clinical research and reviewed the scientific literature may have limited experience with its use in actual clinical practice. Eventually, the optimal usage will probably be defined by the sum total of the practitioner's experience with it, rather than by the researchers who investigated the agent initially. However, with that limitation in mind, and based on available information, one can start to define where this agent is likely to show its greatest advantage. Three areas of possible strength, and one situation where tazarotene might not show its best advantage, will be discussed in detail.

Correlations of bcl-2 expression with clinicopathological features in breast cancer

To evaluate the prognostic significance of bcl-2, we investigated the correlation of bcl-2 expression with the established indicators of prognosis and tumor behavior in breast cancer. This study included a patient group of 91 histologically diagnosed female breast carcinomas. To determine the bcl-2 immunoreactivity, we used a monoclonal antibody directed against the bcl-2 protein by immunohistochemistry from paraffin-embedded tissue in a series of 91 women with breast cancer. Interpretable DNA histograms were obtained from 84 patients. The median age at diagnosis was 45.5 years and the median follow-up time was 30.5 months. Forty-eight (52.7%) cancers showed the bcl-2 immunoreactivity in the cytoplasm. The nonneoplastic portion of ductal epithelial cells and normal lymphocytes were usually stained with bcl-2 antibody. Estrogen receptors (ER)(p < 0.001) and progesterone receptors (PR)(p < 0.001) showed strong positive correlation with bcl-2 immunoreactivity. The histologic grade (p < 0.05) and nuclear grade (p < 0.01) also showed positive relationships with bcl-2 positivity but tumor size (p > 0.05) and DNA ploidy (p > 0.05) were not related with it. The bcl-2 positive patients showed longer survival (p < 0.05) compared to bcl-2 negative tumors in univariate analysis (Kaplan-Meier life table analysis). Using multivariate analysis with Cox regression, bcl-2 (p > 0.05), nuclear grade (p > 0.05), ER status (p > 0.1) and PR status(p > 0.1) were not reliable indicators for overall survival except histologic grade (p < 0.05). Our results suggest that bcl-2 expression may be related to hormonal regulation and tumor differentiation in breast carcinoma. Larger patient study groups with a longer follow-up period will be helpful to clarify the prognostic significance of bcl-2.

Breast conserving therapy in stage I & II breast cancer in Korea

A randomized clinical study of 187 patients with T1, T2 breast cancer was performed, in order to compare the effects of modified radical mastectomy (MRM) and breast conserving therapy (BCT) on breast recurrence, overall survival, and disease-free survival. One hundred eighty seven patients with T1, T2 breast cancer, admitted at Yongdong Severance Hospital from April 1991 to August 1994, were randomized into two different treatment groups. Of the 187 patients, 111 patients had received MRM and 76 had received BCT. In any of the variables considered with the exceptions of age and menopausal status, patient characteristics such as tumor size, incidence of axillary lymph node metastasis, histologic grading, and estrogen and progesterone receptor positive rate were not significantly different between the two groups (p < 0.05). Using the Kaplan-Meier Product-limit method and log-rank test, the difference of locoregional recurrence, and overall and disease-free survival, between these comparable groups was analyzed. Average follow-up period was 37.6 months. Two out of 111 MRM patients and two out of 76 BCT patients had locoregional recurrence. Only one patient who had MRM was found to have a recurrence in her opposite breast. The overall survival rates in MRM and BCT patients were, respectively 93.7% and 94.1%. Furthermore, the disease-free survival rates were, respectively, 89.2% and 93.9%. This result indicates that there were no significant differences between two groups in locoregional recurrence, and overall and disease-free survival. Having gained a better cosmetic appearance, the conservative treatment group was satisfied with the BCT. In this study, we conclude that BCT is a good alternative surgical treatment modality for T1, T2 Korean breast cancer patients, which could substitute for the more traditional MRM. However, further follow-up will be needed for long-term results.

Alopecia areata and increased prevalence of psychiatric disorders

BACKGROUND

The relationship between psychiatric disorders and alopecia areata has not been well studied. Although previous reports have been unable to correlate psychiatric illness with hair loss, a recent study determined that 74% of patients with alopecia areata (AA) under evaluation had one or more lifetime psychiatric diagnoses.

METHODS

Two hundred and ninety-four community-based patients with alopecia areata responded to a detailed questionnaire distributed by Help Alopecia International Research, Inc. The prevalence of psychiatric disorders was determined using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IIIR).

RESULTS

Major depression, generalized anxiety disorder, social phobia, and paranoid disorder were all present in patients with alopecia areata at rates significantly higher than in the general population.

CONCLUSIONS

Alopecia areata patients are at a higher risk of developing psychiatric comorbidity during their clinical course.

Bombesin inhibits growth of pancreatic ductal adenocarcinoma (H2T) in nude mice

Bombesin (BBS), a tetradecapeptide, stimulates growth of various types of cells, including fibroblasts and human small cell lung cancer, and has been termed the universal "on-switch" due to its ability to stimulate the release of numerous hormones. In addition, BBS receptors have been identified in normal and neoplastic pancreatic tissue. A pancreatic ductal adenocarcinoma cell line (H2T), established in our laboratory, possesses specific binding sites for BBS. The purpose of this study was to examine the effect of BBS on the growth of H2T tumors transplanted into athymic nude mice. H2T cells (5 x 10(6) cells/mouse) were injected s.c. into the interscapular region of the nude mice and then the mice were randomized into two groups (n = 10/group). Mice received either 0.1 ml of saline with 0.1% bovine serum albumin (BSA) (control) or 0.1 ml BBS (5 micrograms/kg) intraperitoneally, three times/day. Tumor area was measured twice weekly until the mice were killed (day 32), when tumor and normal pancreas were removed, weighted, and assayed for DNA and protein content. Administration of BBS significantly inhibited H2T tumor area, weight, and DNA and protein content. Conversely, growth of normal pancreas, removed as an in vivo bioassay so as to ensure the efficacy of BBS, was stimulated. We conclude that BBS is a growth inhibitory factor for H2T tumors and that different mechanisms may be responsible for the differential growth effects elicited by normal and neoplastic pancreas in response to BBS.

Angiodysplastic syndrome with capillary and venous malformation associated with soft tissue hypotrophy

Angiodysplastic syndromes include a vascular malformation which may often be associated with secondary changes such as further vascular abnormalities, soft tissue and bone hypertrophy. One of the best known is the syndrome triad originally described by Klippel and Trenaunay, which includes a unilateral capillary malformation, ectatic veins and osseous and soft tissue hypertrophy. A female patient is reported who had an extensive capillary malformation, discrete ectatic veins overlying an extensive venous malformation and soft tissue hypotrophy without bone involvement. Our patient and cases from the literature illustrate the occurrence of 'atypical', hypotrophic variants of angiodysplastic syndromes. Discrete superficial angiodysplasias may overlie deep, extensive malformations, and identification of such cases is important with regard to management and prognosis. The current classification of angiodysplasias is based on the primary vascular malformation. The use of eponyms should be avoided, because they do not contribute to the diagnosis and management of such cases.

Plasma levels of 8-methoxypsoralen after topical paint PUVA

BACKGROUND

Topical PUVA therapy has become a useful alternative for patients who cannot tolerate the systemic side effects of nausea and headache or are concerned about the ophthalmologic risk associated with oral PUVA therapy. However, there is no study to date on the systemic absorption of psoralen after the localized application of topical paint PUVA.

OBJECTIVE

This study was designed to assess the plasma level of 8-methoxypsoralen (8-MOP) after paint PUVA therapy for patients with palmoplantar psoriasis or eczema.

METHODS

Reverse-phase high-pressure liquid chromatography was used to determine 8-MOP plasma levels in eight patients with palmoplantar psoriasis and two with eczema. Three patients receiving oral PUVA therapy served as the control group.

RESULTS

Plasma levels of 8-MOP taken 1, 6, and 24 hours after topical PUVA treatments of patients with palmoplantar psoriasis were undetectable. One patient with hand eczema consistently had detectable 8-MOP levels 1 hour after topical PUVA treatments.

CONCLUSION

This report indicates that there is minimal, if any, systemic absorption of 8-MOP after topical PUVA treatment of patients with palmoplantar psoriasis.

Psychotropic agents in dermatology

In this article, relatively detailed explanation of the use of selected psychopharmacologic agents is given along with their dermatologic and psychodermatologic indications. For a more complete description of the use of these medications, the reader is advised to consult standard textbooks on psychopharmacology and the Physician's Desk Reference. It should be emphasized that psychiatric consultation should be obtained whenever feasible. Yet for a significant proportion of psychodermatologic patients who refuse psychiatric input, the judicious use of these medications may provide much-needed assistance in their recovery from psychodermatologic disorders.

Bombesin stimulates growth of colon cancer in mice and decreases their survival

Bombesin (BBS) stimulates cellular proliferation of both normal and transformed cells. The mouse colon cancer cells (MC-26) possess specific binding sites for BBS. The purpose of this study, therefore, was to examine the effect of chronic administration of BBS on in vivo growth of MC-26 tumours in Balb/c mice and on survival of tumour-bearing mice. Three groups of mice (n = 10 each) inoculated with MC-26 cells received either saline containing 0.1% bovine serum albumin (BSA), or BBS (5 micrograms kg-1 or 20 micrograms kg-1) dissolved with 0.1% BSA saline by intraperitoneal route three times a day for 15 days. BBS increased weight, DNA and RNA contents of MC-26 tumours. To examine the effect of BBS on survival rates of mice with MC-26 tumours, three groups of mice (n = 20 each) were treated for 31 days, as above. One group of mice inoculated with MC-26 cells received 0.1% BSA saline; the other group of MC-26-inoculated mice and the control group without tumour received BBS (5 micrograms kg-1) dissolved with 0.1% BSA saline. BBS significantly decreased the survival rate of mice bearing MC-26 tumours (median survival; saline group: 42.5 days, BBS group: 32.0 days, P = 0.037). None of the mice in the control group died during the experiment. BBS may stimulate in vivo growth of MC-26 cells through specific receptors.

Amiloride inhibits the growth of human colon cancer cells in vitro

Cytoplasmic alkalinization induced by activation of the Na+/H+ antiport plays an essential role in the initiation of cell proliferation. In the present study we examined the effects of amiloride, a specific and reversible inhibitor of Na+/H+ antiporter, on the growth of human colon cancer cells (HT-29). Amiloride (50-800 microM) inhibited the growth of HT-29 cells in a dose-dependent fashion. Forty-three percent inhibition of growth was found at an amiloride concentration of 400 microM after 4 days of treatment. The inhibitory effect of amiloride on growth of HT-29 cells was reversible since removal of amiloride by a media change after 48 h treatment lead to rapid regrowth to control levels. The reversibility of growth inhibition suggests that amiloride is not a non-specific cytotoxin for HT-29 cells. We examined the possible mechanisms for the inhibitory effects of amiloride. Amiloride (400 microM) completely abolished serum-stimulated ODC activity and inhibited difluoromethylornithine (DMFO)-stimulated putrescine uptake by 56%. We conclude that amiloride inhibits the in vitro growth of human colon cancer cells; since ODC-activity and polyamine transport were both inhibited, the inhibitory effects may be mediated in part by polyamine-dependent processes. Amiloride may be a useful agent in the treatment of colon cancer.

The use of psychotropic medications in clinical dermatology

In this article, the use of selected psychopharmacologic medications was explained in detail. If a patient who is obviously suffering from a psychiatric component of his or her disorder that can be responsive to psychopharmacotherapy refuses to accept a referral to a psychiatrist or other mental health professional, the dermatologist must decide whether to use these medications. If he or she decides to use these medications, it should always be remembered that the choice of psychopharmacologic treatment depends on the nature of the underlying psychopathology-anxiety, psychosis, depression, or compulsion-rather than on the dermatologic label such as neurotic excoriations. It is the hope of the author that more patients who fall into this interface between psychiatry and dermatology will be helped if dermatologists become more familiar with the availability and use of these medications.

The development of B-cell lymphoma in a patient with psoriasis treated with cyclosporine

A 67-year-old Nicaraguan man with a history of chronic, severe, recalcitrant psoriasis participated in a multicenter study investigating oral cyclosporine in the treatment of psoriasis. He received cyclosporine for approximately 8 months at doses of 5 mg/kg/day or less. Treatment with cyclosporine was eventually discontinued because of progressive nephrotoxicity. Approximately 7 months after the discontinuation of cyclosporine, the patient developed a mass in the left maxillary sinus extending to the orbit, the palate, and the infratemporal fossa. Pathologic and histochemical analysis of the mass revealed a B-cell lymphoma. The development of a benign lymphocytic infiltrate has been reported in a patient who received cyclosporine therapy for psoriasis; however, to the best of our knowledge, this is the first case in the United States of lymphoma developing in a patient who was treated with cyclosporine for a condition other than organ transplantation.

Psychodermatology. Practical guidelines on pharmacotherapy

BACKGROUND

The importance of emotional factors in dermatologic disorders has been recognized for several decades. However, there have been few reports on the management of psychodermatologic disorders. Meanwhile, there has been tremendous progress in the pharmacologic treatment of these conditions. This article describes major categories of psychodermatologic disorders and provides practical management guidelines, emphasizing the use of selected psychopharmacologic agents.

OBSERVATIONS

Psychodermatologic conditions can be divided into three broad subgroups: psychophysiologic disorders in which the severity of primary cutaneous disease is influenced by the patients' emotions; primary psychiatric disorders in which the skin conditions are self-induced and reflect underlying psychopathologic conditions; and secondary psychiatric disorders in which the patients experience psychologic problems as a result of disfigurement associated with the skin conditions. There are many ways to manage these psychodermatologic conditions, including psychotherapy, behavioral therapy, and psychopharmacotherapy. To determine which pharmacologic agent is most appropriate, the nature of the underlying psychopathologic condition such as anxiety, depression, psychosis, and obsession/compulsion should be identified. Furthermore, there are nonpsychiatric disorders encountered by dermatologists in which psychopharmacologic agents may be more efficacious than conventional therapeutics.

CONCLUSION

We conclude that psychopharmacologic agents provide a useful option to the management of psychodermatologic disorders.

Profile of alopecia areata: a questionnaire analysis of patient and family

Eight hundred patients with alopecia areata (AA) responded to a detailed questionnaire that was compiled, distributed, and analyzed by Help Alopecia International Research, Inc. (HAIR). Among those responding, 28% were men and 72% were women. Fifty percent had localized alopecia, 30% had alopecia totalis, and 20% had alopecia universalis. Forty-eight percent developed their initial onset before the age of 20. A very strong family history of 42% was found. There were 333 additional family members with AA. Many patients and relatives had concurrent atopic diseases (seasonal rhinitis, bronchial asthma, and atopic dermatitis). Associated autoimmune diseases including vitiligo, thyroid disease, and collagen vascular disease in patients and relatives appeared consistent with previous reports. Insulin dependent diabetes mellitus (IDDM) was not increased in patients but greatly increased in relatives. Additional analysis suggests a genetic association between the two diseases where expression of AA may prevent the development of IDDM.

Psychologic aspects of acne

Psychologic factors may play a significant role in acne in at least three ways. First, as many patients readily report, emotional stress can exacerbate acne. Second, it is common for patients to develop psychiatric problems as a consequence of the conditions, such as those related to low self-esteem, social phobias, or depression. Finally, primary psychiatric illnesses such as obsessive-compulsive disorder and psychosis may be based on a complaint that is focused on acne. In this review we hope to facilitate an understanding of how emotional factors and acne connect, and aid the dermatologist in identifying the possible presence of psychiatric problems stemming from or contributing to the disorder.

Obsessive-compulsive disorders in the pediatric dermatology practice

Childhood and adolescent obsessive-compulsive disorders are sometimes seen in dermatology practice. When present, OCD is most frequently manifested in younger patients as trichotillomania, onychotillomania, onychophagia, and acne excoriée. In addition to these disorders, obsessive hand washing, AIDS phobia, and other psychosomatic dermatoses characterized by obsessive-compulsive tendencies are seen in all age groups. It is important to define the nature of any underlying psychiatric disorder before beginning drug treatment of these patients. With the availability of new medications, most notably, clomipramine and fluoxetine, there is reason for optimism regarding the treatment of OCD. Whenever feasible, the dermatologist should not hesitate to involve a psychiatrist to help with diagnosis and treatment when the diagnosis of OCD is being considered.

Relationship between T-lymphocyte subsets and suppressor cell activity in patients with chronic active hepatitis B

Thirty-nine patients with chronic HBV infection and 38 normal persons were investigated by simultaneous assay of T suppressor cell function and enumeration of T-lymphocyte subsets by monoclonal antibodies. In patients with chronic active hepatitis B (CAH-B), T suppressor cell activity (17.8 +/- 8.8%) was significantly lower than in healthy HBsAg carriers (35.4 +/- 12.3%) and normal control persons (38.3 +/- 16.3%). The proportions of T-lymphocyte subsets in patients with CAH-B were not different from those of healthy HBsAg carriers and control persons. No correlation was observed in between percentage suppression and proportions of T-lymphocyte subsets. These findings suggest that in the absence of a simultaneous assay of function, enumeration of T-lymphocyte subsets by using monoclonal antibodies is an inadequate assessment of immune regulation.

Immunological studies in patients with HBsAg-positive chronic active hepatitis--spontaneous lymphocyte transformation and natural killer cell activity

The present study was to address the nature of cells which are responsible for enhanced spontaneous lymphocyte transformation (SLT) observed in patients with HBsAg-positive chronic active hepatitis (CAH). The subjects consisted of 34 cases with HBsAg-positive CAH (group I), 31 HBsAg carrier (group II), and 27 normal persons (group III) who had no serological evidence of hepatitis B virus (HBV) infection. SLT values and the number of cells bearing HLA-DR antigens in group I (1021.45±276.40 cpm, 36.94±4.90%) were significantly (p<0.01) elevated as compared to group II (103.74±30.44 cpm, 13.26± 4.72%) and III (118.92 ± 30.84 cpm, 14.93±5.10%), but there was no difference of the number of the IL-2 receptor-bearing cells among each groups. Though natural killer (NK) cell activity in both group I (65.42±15.77%) and II (59.14±14.89%) were significantly enhanced as compared to group III (46.25±20.20%), there was no difference in between group I and II. These findings indicate that the cells bearing HLA-DR antigen, but not NK cells, are responsible for the enhanced SLT in patients with CAH.

Deconvolution algorithm for a Fabry-Perot interferometer

Fabry-Perot spectral output is a convolution between the input spectrum and the response function of the Fabry-Perot spectroscopic instrument. We have developed a deconvolution algorithm, where we do not specify the functional forms to the output spectrum and the instrumental response function but use only numerical data as observed. Merits of our algorithm include: the divergence problem is avoided by iterative methods treating data components in the order of their magnitudes; background and delta function type elastic components are treated automatically as part of the built-in signal; and very low level signals can be retrieved from the strong background.

Coma following ECT and intravenous droperidol: case report

A 60-year-old man with psychotic depression became comatose following the administration of intravenous droperidol given for post-ECT delirious agitation. The differential diagnosis, which included neuroleptic malignant syndrome and the possibility that droperidol may have uniquely detrimental effects in the context of post-ECT delirium, are discussed. In light of recent publications advocating droperidol as the pharmacologic treatment of choice for severe agitation, this case illustrates a need for greater caution in its use for the treatment of post-ECT delirium.