The three-dimensional scintillation dosimetry method: test for a106Ru eye plaque applicator

The need for fast, accurate and high resolution dosimetric quality assurance in radiation therapy has been outpacing the development of new and improved 2D and 3D dosimetry techniques. This paper summarizes the efforts to create a novel and potentially very fast, 3D dosimetry method based on the observation of scintillation light from an irradiated liquid scintillator volume serving simultaneously as a phantom material and as a dose detector medium. The method, named three-dimensional scintillation dosimetry (3DSD), uses visible light images of the liquid scintillator volume at multiple angles and applies a tomographic algorithm to a series of these images to reconstruct the scintillation light emission density in each voxel of the volume. It is based on the hypothesis that with careful design and data processing, one can achieve acceptable proportionality between the local light emission density and the locally absorbed dose. The method is applied to a Ru-106 eye plaque immersed in a 16.4 cm3 liquid scintillator volume and the reconstructed 3D dose map is compared along selected profiles and planes with radiochromic film and diode measurements. The comparison indicates that the 3DSD method agrees, within 25% for most points or within approximately 2 mm distance to agreement, with the relative radiochromic film and diode dose distributions in a small (approximately 4.5 mm high and approximately 12 mm diameter) volume in the unobstructed, high gradient dose region outside the edge of the plaque. For a comparison, the reproducibility of the radiochromic film results for our measurements ranges from 10 to 15% within this volume. At present, the 3DSD method is not accurate close to the edge of the plaque, and further than approximately 10 mm (<10% central axis depth dose) from the plaque surface. Improvement strategies, considered important to provide a more accurate quick check of the dose profiles in 3D for brachytherapy applicators, are discussed.

Isolated pemphigus vegetans of the tongue

Pemphigus vegetans affecting only the tongue is reported in a 35-year-old woman.

Silicone gel sheet dressings for prevention of post-minigraft cobblestoning in vitiligo

Punch grafting was performed in 15 patients using punches varying in size from 2 to 3 mm in diameter. Silicone gel sheets were used as a post-operative dressing. Removal of the dressings after 7 days revealed no lifting of grafts in 13 patients. A minimally raised surface seen in two patients flattened after 6 to 8 weeks of continuous use of the dressing. At two months of follow-up, no cobblestoning or any other untoward effect was evident. Firm pressure provided by silicone gel sheets probably prevents cobblestoning by counteracting forces which tend to lift the grafts. Additionally, the sheets act as a brace preventing graft dislocation, provide a sterile atmosphere underneath the grafts, facilitate periodic observation due to their transparency, and are easily removed at the time of follow-up.

Congenital bilateral sensory neural deafness, postaxial polydactyly, scrotal tongue and recurrent pyogenic infections

A case report of a 40-year-old male with congenital bilateral sensory neural deafness, postaxial polydactyly involving hands and feet, scrotal tongue and recurrent pyogenic infections is described.

Livedo reticularis with acute rheumatic fever

A 10-year-old boy, a diagnosed case of acute rheumatic fever, presented with livedo reticularis involving whole of body except face. Livedo reticularis has been very rarely reported in rheumatic fever.

Chloroquine-induced toxic epidermal necrolysis

Two female patients aged 25 and 12 years suffering from malaria presented with picture of Stevens Johnson syndrome. Each of them had received daily doses of chloroquine phosphate by intramuscular injection for 3 days. They progressed to toxic epidermal necrolysis and could not be saved despite best of efforts.

Trichotillomania in a 2-year-old child

A case report of a 2-year-old child with trichotillomania is described.

Herpes associated erythema multiforme annularis concentricum

A young man had large, concentric plaques over the back and extensors of forearms for eight weeks. Past history suggested recurrent herpes labialis. Serum anti HSV-1 IgG titre was raised to 32 micrograms/l and histopathology of an active lesion suggested erythema multiforme. Symptomatic treatment and oral zinc therapy subsided EM lesions but concentric depigmentation developed after healing.

Annular lesions in congenital syphilis

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Hypopigmented lesions in early leprosy--a clinical and histological study

26 Patients of leprosy presenting with hypopigmented lesions were divided on morphological grounds into 3 Sub groups, Group I (9 patients) with well-defined single patch with moderate to complete sensory loss; Group II (8 patients) with single ill-defined lesion having partial sensory loss; and Group III (9 patients) having multiple hypo-pigmented patches with mild to moderate sensory loss. Epidermal atrophy was a conspicuous histological finding in all groups. Only patients in Group I showed epitheloid cells in dermal infiltrate with erosion of epidermis in one case. This group may be labelled as maculoanesthetic leprosy. Patients in Group II and III showed mononuclear cell infiltrate in dermis, around neurovascular bundles and appendages. They were histologically consistent with indeterminate leprosy. Follow-up biopsy after six to eight months of treatment showed healing of the lesion of reduction in the infiltrate in most cases.

Effect of multiple interferon gamma injections on the disposal of Mycobacterium leprae

The effect of multiple intradermal injections (four to six) of 10 micrograms of interferon gamma on the number of Mycobacterium leprae in the skin of patients with polar lepromatous leprosy and borderline lepromatous leprosy was evaluated. To achieve a maximum zone of induration and cell emigration a preparatory dose of the lymphokine was required. A second group of three injections, given 3-4 days after the initial series, resulted in lesser degrees of induration and was more in keeping with a partial local hyporesponsive state. A marked emigration of T cells and monocytes into the dermis resulted from injections of interferon gamma and persisted for greater than 21 days. A preponderance of CD4+ cells in the infiltrate was seen within a few days and CD4/CD8 ratios remained elevated for greater than 5 weeks. The bacillary load of injected sites evaluated 21 days after lymphokine administration was reduced in 14/17 patients by factors ranging from 5- to 1000-fold. This occurred predominantly within diffuse lesions and occurred rarely in nodular sites. Biopsy samples of injected sites taken 6 months later demonstrated progressive 10-fold reductions in bacilli and the continued presence of a granulomatous response.

Selective cleavage of N-terminal amino acid in a peptide by polymeric cobalt (III) triene complex

Cellulose was functionalized to incorporate triethylenetetramine group. This was in turn converted into the polymeric analogue of cobalt(III)triene complex. The polymeric complex reacts with peptides resulting in the cleavage of amino end amino acid, thus suggesting the applicability of the polymeric reagent as a solid phase reagent for N-terminal determination.

The nature and kinetics of a delayed immune response to purified protein derivative of tuberculin in the skin of lepromatous leprosy patients

We have analyzed the nature and kinetics of a delayed, cell-mediated immune response to a purified protein derivative of tuberculin (PPD) in the skin of 154 naturally sensitized patients with lepromatous leprosy. After the intradermal injection of 5 U of PPD, biopsies were taken at 1-21 d and studied for the composition, extent, persistence, and organization of the emigratory cell response by light and electron microscopy. Induration of positive sites occurred promptly, reached a maximum diameter at 4 d, displayed a major extravasatory element, and was evident for as long as 21 d. The cellularity of the site exhibited a biphasic course, reached a maximum at 7 d, involved as much as 70% of the dermis and millions of new cells, and was elevated threefold above preinjection levels at 21 d. The emigratory cells were limited to T cells and circulating monocytes. T cells were more evident as they entered a preexisting lepromatous lesion containing parasitized macrophages and only occasional T cells many of the CD8+ phenotype. The predominant emigratory T cell was CD4+ although CD8+ cells were in evidence. The CD4/CD8 ratio of the lesions started at less than unity and in two distinct steps reached levels as high as 5:1. In most sites CD4+ cells were in the majority at 21 d. A well-defined granulomatous response with epithelioid and giant cells was apparent at 4 d, reached a maximum at 7 d, and involved all PPD sites at this time point. The generation of these differentiated mononuclear phagocytes from newly emigrated monocytes was never observed in the underlying lepromatous lesion but is a constant feature of the tuberculoid leprosy response. Epidermal thickening and keratinocyte proliferation, sequellae of the dermal reaction, reached a maximum at 7 d and gradually resolved by 3 wk. A constant feature of the PPD response was the extensive destruction of preexisting macrophages containing Mycobacterium leprae bacilli or their products. This was associated with the presence of and intimate contact with highly polarized lymphoid cells of unknown phenotype. Cell destruction did not involve other elements of the dermis and spared parasitized Schwann cells. Newly emigrated T cells and monocytes were never seen within the perineural sheath in contact with neural elements. It appears that a single antigenic stimulus leads to a very long-term, defined series of events with distinct temporal patterns. It includes waves of emigratory T cells, the maturation and organization of monocytes, the generation of killer cells, and the extensive destruction of parasitized macrophages.(ABSTRACT TRUNCATED AT 400 WORDS)

Summer Variant of Autosmal Dominant Ichthyosis Vulgaris

Eleven cases of mild autosomal dominant ichthyosis vulgaris (ADIV) were seen who presented with asymptomatic, brownish-black hyper keratotic lesions' over the flexure surfaces of wrists, dorsum of hands, knees and ankles for 1-2 months during peak summer months. The lesions disappeared with the onset of monsoon. All these cases had typical lesions of ADIV during winter months. This paradoxical phenomenon of ichthyosis alternating with hyperkeratotic pigmented lesions in the same individual during different seasons remains unexplained. Treatment with 20% urea cream and oral vitamin A had no effect on the course of the disease.

Increased macrophage activity in protein A treated tumor regressed animals

Male swiss albino mice transplanted with 1 x 10(6) viable fibrosarcoma tumor cells were treated with Protein A (60 micrograms/kg) right from the day of transplantation for 4 weeks, twice weekly. The therapy resulted in lesser tumor incidence, significant inhibition of tumor growth and enhanced percent survival in treated animals as compared to untreated controls. Treated animals also showed gains in body weight, an increase in peripheral blood leucocyte count, significant increase in macrophage function and number. Stimulation of macrophage number and macrophage function by Protein A may be related to its antitumor.

Effect of zinc administration on seminal zinc and fertility of oligospermic males

Fourteen infertile males (age 24-45 years; married over 2 years) with idiopathic oligospermia (sperm count less than 40 millions/ml) were investigated for the effect of oral zinc sulphate (220 mg) for 4 months on their serum and seminal zinc levels, and seminal parameters. With zinc administration serum zinc levels remained essentially unaffected, however, seminal zinc levels increased significantly. There was significant improvement in sperm count, number of progressively motile and normal spermatozoa, and acid phosphates activity. Wives of 3 patients conceived. Observations suggest that zinc has potential to be used in male infertility. However, further studies are warranted.

Coexistance of Subcorneal Pustular Dermatosis and Lepromatous Leprosy

A case of lepromatous leprosy having lesions of subcorneal pustular dermatosis is reported. This association supports the gypothesis that immunological factors are involved in the pathogenesis of SCPD.

Contact dermatitis in tie and dye industry workers

A survey of the 'Tie and Dye' industry of Jodhpur City in India was made to investigate occupational dermatoses. 49 (16.6%) of 250 workers had incapacitating dermatitis. Skin lesions were seen mostly over the dorsa of the hands and fingers. 26 patients were patch tested with various dyes and chemicals; 14 were positive. Fast Red RC salt was the most potent sensitizer. Other dyes showing positive reactions were Orange GC salt, Bordeaux GP salt, Blue B salt, Red B base and naphthol.

Ultrastructural study of epidermal Langherhans cells in leprosy

ATPase staining and ultrastructural study of skin biopsies from six patients of leprosy (2TT, 4LL) and three normal subjects was carried out to study Langherhans Cells (LC). ATPase staining showed normal counts of LCs in tuberculoid patients, while significant reduction was observed in lepromatous cases. Electron microscopy revealed morphological changes in LL cases in the form of dense matrix and indistinct cristae of mitochondria; decreased number of lysosomes and rough endoplasmic reticulum; and numerous vacuoles in cytoplasm. TT cases showed normal morphology. Possible role of Langerhans Cells in pathogenesis of leprosy is discussed.

Oral zinc as an adjunct to dapsone in lepromatous leprosy

Oral zinc was tried in 15 cases of multibacillary leprosy as an immunostimulant in addition to conventional antileprosy drugs. Results were compared with those in ten similar cases treated with dapsone alone. Cases treated with zinc showed faster clinical improvement, regrowth of eyebrows, rapid fall in the bacterial index (BI) and in the bacterial index in the granuloma (BIG), early and greater influx in lymphocytes in the granuloma, and neovascularization. Upgrading occurred in 6 out of 15 patients taking zinc, but in only 1 out of 10 patients in the control group. Five out of six patients who showed upgrading in the treated group became lepromin positive. Only one patient (BL) showed lepromin conversion in the control group.

Serum zinc levels in subtypes of leprosy

Serum zinc levels were estimated in 146 patients with different types of leprosy and 40 control subjects. Tuberculoid patients were found to have normal serum zinc levels. A gradual reduction in serum zinc levels was observed from TT to LL. Serum zinc levels were not significantly higher in patients treated with dapsone for approximately 18 months. The cause of hypozincemia is not clear, but the findings suggest that there are correlations among bacillary load, immune status, and serum zinc. Zinc deficiency could be one of the factors involved in the nonspecific suppression of cell-mediated immunity in lepromatous leprosy.