Atopic dermatitis

Atopic dermatitis is an important manifestation of the atopic diathesis with increasing incidence. The average lifetime prevalence in Switzerland is about 13%. The skin disease is characterised by severe itching, eczematous skin lesions with often distinctive distribution, dryness of the skin and a personal of family history of atopic diseases. The following article summarises some clinical, epidemiological, therapeutical and pathogenetical aspects of atopic dermatitis. Studies from the allergy unit of Zurich contributed to a better understanding of the disease. Thus, Storck was contributing various studies about neurovegetative and circulatory dysregulations in patients with atopic dermatitis. Furthermore, he already realised in 1955 a relation between exacerbations of eczema and the sensitisation to inhalatory allergens. Schnyder demonstrated that asthma, rhinitis and atopic dermatitis have the same genetic background and Wüthrich contributed important data about the natural history of the disease and the occurrence and relevance of total and specific IgE antibodies.     

Raised cerebrovascular resistance in idiopathic orthostatic intolerance: evidence for sympathetic vasoconstriction

We examined the gelatinolytic activity in human oral squamous-cell carcinoma tissues in order to evaluate the capability of intravasation and extravasation of cancer cells. By a microdissection-zymography, we demonstrated separately the gelatinolytic activities in cancer cell nests and stroma adjacent to the cancer cells. The gelatinolytic activities, such as pro-matrix metalloproteinase (MMP)9 and active-MMP2 in most of cancer cell nests were much higher than those of normal gingival epithelium. Moreover, the activities of active-MMP2 in cancer cell nests of metastatic cancers were significantly higher than those of non-metastatic cancers (p<0.05). These results suggest that active-MMP2 in cancer cells can be a predictive marker for metastasis formation in oral squamous-cell carcinoma patients.     

Ageing in reptiles

Like in fishes, the reptiles appear to show three types of senescence. The African skink, Mabuya buettneri, shows rapid senescence similar to death at mating observed in Salmon and marsupial mouse. Most of the lizards and snakes undergo gradual senescence comparable to the pattern exhibited by a majority of vertebrates. On the other hand, turtles, tortoises and crocodiles continue to grow throughout life and are thus credited with slow or negligible senescence. Evidences and mechanisms of rapid or negligible senescence in reptiles are still fragmentary and unclear. Findings in a few species of lizards (Calotes versicolor) and snakes (Natrix natrix) showing gradual senescence support the concept of commonalities in ageing phenomena in vertebrates. An age-related increase in the stability of collagen and accumulation of altered enzyme molecules, a decrease in metabolism and response to stress-enhanced anti-oxidative defence mechanisms and the nature of responses to hormones, restricted diet and lower environmental temperature corroborate the concept. On the other hand neither the increase in mortality rate and accumulation of lipofuscin nor the reproductive senility have been shown conclusively in ageing reptile populations. It is likely that there are multiple mechanisms of senescence in reptiles. Further studies on selected species from among the 6,000 living species are necessary to unravel the phenomena.     

Adjuvant chemotherapy for patients with resected Dukes' C and high-risk B2 colon cancer with fluorouracil and levamisole

Carcinoma of the large bowel is the second leading cause of cancer mortality in Singapore. Although the great majority of patients are discovered at a stage where resection with curative intent is possible, almost half of the patients afflicted will die of it. The combination of 5-fluorouracil + levamisole used in patients with curatively resected high risk Dukes B2 and all Dukes' C colon cancers has been shown to reduce cancer recurrence rate and improve overall survival. Since 1990 adjuvant chemotherapy has been recommended for this group of patients. This report describes patients treated in Singapore, their toxicities and their outcome. A total of 341 patients were treated between 1990 and 1996. Treatment compliance was 71.8%. Toxicity was moderate with mainly grade 1-2 nausea and vomiting, diarrhoea, stomatitis, alopecia, and neutropenia. There was 1 treatment-related death. Median recurrence-free interval was 81 months and median survival was not reached at 90 months. This regimen is tolerable. Until further randomised reports comparing 5-fluorouracil + levamisole to other combinations are available, this combination chemotherapy is recommended to patients after surgical resection of the high risk Dukes' B2 and Dukes' C colon cancer to reduce cancer recurrence and improve overall survival.     

Clinical evaluation of aminocaproic acid for managing traumatic hyphema in children

PURPOSE: The purpose of this study is to determine the incidence of secondary hemorrhage after traumatic hyphema in children and to evaluate the efficacy of epsilon aminocaproic acid in reducing this incidence. METHODS: In a prospective, randomized, double-blind study performed between November 1987 and February 1994, 94 children admitted for traumatic hyphema were assigned to receive either aminocaproic acid (n = 48) (100 mg/kg every 4 hours; maximum, 30 g daily) or placebo (n = 46) for 5 days. Patients who had ingested aspirin in the week preceding admission were excluded from the study. RESULTS: Mean age of the patients was 9.4 years. Black patients comprised 4% of the study population. Secondary hemorrhage occurred in only three patients (3.2%), two from the placebo group and one from the aminocaproic acid group, none of whom had any complications. The duration of hospital stay and the clot resorption times were increased significantly in the aminocaproic acid group (P < 0.001). CONCLUSIONS: The authors report a very low incidence of secondary hemorrhage compared with most previous studies. This difference is likely related to the small proportion of black patients in our study and to the exclusion of patients having ingested aspirin, two factors that seem to be associated with higher rates of rebleeding. The efficacy of aminocaproic acid could not be determined due to the low incidence of hemorrhage. The results of this study, however, suggest that the incidence of secondary hemorrhage in white patients without prior ingestion of aspirin is insufficient to justify routine use of aminocaproic acid in managing traumatic hyphema. Rather, an individualized decision based on the risk factors of each patient would seem more appropriate to avoid a slower clot resorption time and possible side effects of this medication.     

Plaque-type blue nevus

Blue nevus may rarely appear in plaque form. It seems to be a benign and asymptomatic lesion, but because of its rarity, no definite prognosis can be given. Only through reporting of additional cases and their follow-up will the prognosis become clear.     

Geotrichum septicemia

Although disseminated geotrichosis is an unusual disease (to our knowledge, only six cases have been reported), Geotrichum candidum is not a very virulent fungus. In our case, there was neutrophillic phagocytosis of the arthrosphores of G candidum, with rapid clearance of the fungus from the plasma of a chronically ill patient whose immune defenses were still intact.